Publications

December 2020

1. Bishop, K., Momah, T., Ricks, J. Nephrolithiasis. Primary Care Clinics: Clinics in Office Practice. Vol 47, Issue 4, December 2020, Pages 661-671
   
   Review article demonstrating Nephrolithiasis or kidney stones as the second most common CKD, affecting 12% of all people. Early recognition and treatment of this condition are important to prevent complications that can occur with delayed treatment. Furthermore, increasing prevalence of this disease underlines the importance of correctly diagnosing the causative factors, thereby affecting prevention of recurrence.
   
   
2. Cho, R.J., Senitko, M., Wong, J., Dincer, E.H., Khosravi, H., Abraham III, G.E. Feasibility of using the O-Arm imaging system during ENB-rEBUS-guided peripheral lung biopsy: A dual-center experience. European Respiratory Journal, 2020 56: 1204; DOI: 10.1183/13993003.congress-2020.1204.
   
   Malignant central airway obstruction is a debilitating complication of primary lung cancer and pulmonary metastases occurring in approximately 30% of patients. The goal of therapeutic bronchoscopy is to recanalize an airway to palliate the symptoms and/or to bridge to further cancer therapy. Microwave ablation (MWA) is a field-based technology that heats a tissue by creating an electromagnetic field around an ablation device. We present a case series utilizing MWA via flexible bronchoscopy as a novel, not previously described modality for the management of malignant central airway obstruction. Therapeutic bronchoscopy with a flexible small MWA antenna (MedWaves Inc.) was performed in five cases. We recorded tumor size, number of microwave energy applications, ablation time, amount of energy delivered, rate of successful ablation, use of other ablative techniques, complications, and 30-day follow up. Successful airway recanalization was achieved in all cases. No immediate complications were noted. In one case, tumor in-growth within a silicone stent was ablated with no damage to the stent.
   
   
3. Dhannawat, S.S., Sherwood, C., Bahadur, R. Eyelid Metastasis from Lung Adenocarcinoma, American Journal of Ophthalmology Case Reports, vol. 20, 2020, doi:10.1016/j.ajoc.2020.100991.
   
   This paper provides a report of an unusual case of lung metastasis presenting as an eyelid lesion. An 82-year-old man presented with a right upper lid lesion of 2 weeks’ duration proven to be adenocarcinoma of the lung. Metastasis to the eyelid is a rare occurrence. We present a review of the literature emphasizing factors contributing to its low incidence.
   
   
4. Lucar, J., Navalkele, B., Becker, B.P., Reed, C.D., Parham, J. Health care personnel exposure to a patient with asymptomatic SARS-CoV2 infection during a prolonged surgical intervention. American Journal of Infection Control. 2020 Aug; 48(8):955-957. doi: 10.1016/j.ajic.2020.05.036. Epub 2020 Jun 5. PMID: 32505792; PMCID: PMC7273138.
   
   There is ongoing debate regarding the role of aerosols in the transmission of SARS-CoV2 in the health care environment. Here, we report a case in which multiple operating room health care providers were exposed to a patient with asymptomatic SARS-CoV2 infection during a prolonged orthopedic surgical intervention and had no evidence of COVID-19 during the 14-day post-exposure period.
   
   
5. Kidnie R., Momah, T. Invasive adenocarcinoma of the ileum presenting as a small bowel obstruction: Case report. West African Journal of Medicine, vol. 37, No. 7, December, 2020
   
   A case report on Invasive adenocarcinoma of the ileum highlighting it as a rare tumor with an incidence of 0.59 per 1 million. Given its location in the distal portion of the small bowel, it is difficult to diagnose early and is often only discovered during surgery. This challenge leads to late diagnoses and poor prognoses. Surgical resection is the gold standard for treatment, with adjuvant therapy occasionally playing a supporting role. We present the case of a 62-year-old male with a complex past medical history, including non-small cell lung cancer with metastases to brain and treated with irradiation and left parietal craniotomy 13 years prior to presentation. Our patient presented to a community hospital complaining of abdominal pain. Findings on abdominal computerized tomography (CT) with intravenous (IV) contrast was consistent with a mechanical obstruction of the small bowel. The patient was admitted to the general medical floor for non-operative management. However, after three days of unsuccessful non-operative management, he was taken to the operating room for diagnostic laparoscopy. Surgery revealed an obstructing mass in the distal third of the ileum, which was excised and found to be invasive adenocarcinoma on histology. Adenocarcinoma of the ileum is very difficult to diagnose preoperatively. As a result, it often leads to delays in treatment and a poor prognosis in many patients, including ours. Because of its very low prevalence, a high index of suspicion is required to make an early diagnosis and obtain definitive treatment.
   
   
6. Secco, A.A., Akselrod, H., Czeresnia, J., Levy, M., Byrne, M., Monroe, A., Lucar, J., Horberg, M., Castel, A.D., Doshi, R., Rivasplata, H., Squires, L., Parenti, D., Benator, D.; DC Cohort Executive Committee. Sexually transmitted infections in persons living with HIV infection and estimated HIV transmission risk: trends over time from the DC Cohort. Sexually Transmitted Infections. 2020 Mar; 96(2):89-95. doi: 10.1136/sextrans-2019-054216. Epub 2020 Jan 6. PMID: 31907326; PMCID: PMC7031010.
   
   A rise in incidence of STIs has been noted in the USA and in the District of Columbia (DC). We aim to describe changes in incident STIs among persons in care for HIV in Washington, DC as well as trends in HIV viral load among those with incident STIs. We conducted a retrospective DC Cohort analysis (n=7810) measuring STI incidence (syphilis, gonorrhoea and chlamydia) as well as in-care viral load (ICVL) and percentage with all viral loads less than the limit of detection (%<LLOD) by year (2012-2016) among those with incident STIs. From 2012 to 2016, the incidence of STIs increased: chlamydia from 2.1 to 3.4 cases/100 person-years (p=0.0006), gonorrhoea from 2.1 to 4.0 (p<0.0001), syphilis from 1.7 to 2.6 (p=0.0042) and any STI episode from 5.3 to 8.8 (p<0.0001). STI incidence rates increased for those aged 18-34 (from 13.2 to 23.2 cases/100 person-years, p<0.0001), cisgender men (from 6.5 to 11.5, p<0.0001), non-Hispanic whites (from 8.6 to 16.1, p=0.0003) and men who have sex with men (from 9.3 to 15.7, p<0.0001). During 2012-2016, the ICVL among those with incident STIs improved from 108 to 19 copies/mL and %<LLOD from 23.6% to 55.1%. However, even in 2016, younger participants, cisgender and transgender women, non-Hispanic blacks and Hispanics had higher ICVLs and lower %<LLOD. Rates of incident STIs rose among persons in care for HIV in Washington, DC, with improved but not optimal measures of HIV viral suppression. These findings inform focused interventions towards preventing STI transmission and ending the HIV epidemic.
   
   
7. Sherman, J., Kemp, A., Momah, T., Cloy, A. Prescribing Patterns and Identification of Risks with Metoclopramide in a Family Medicine Clinic. Journal MSMA. vol. 11:4 2020.
   
   The purpose of this study was to analyze risk factors for developing tardive dyskinesia (TD) for patients in a family medicine clinic who were prescribed metoclopramide.  Patients receiving metoclopramide for greater than 12 weeks (GT12) were compared versus those receiving metoclopramide for 12 weeks or less (LT12). Further comparisons were made versus baseline after a brief educational intervention. Charts were reviewed retrospectively for all patients receiving at least one prescription for metoclopramide for a two-year period. Demographic data and patients at risk for TD were identified. Physician analyses of adverse effects were compared for the two groups, including use of the Abnormal Involuntary Movement Scale or any assessment of involuntary movements. Both groups were compared again eight months after a brief educational intervention. Patients in the GT12 group were more likely to have another risk factor for TD (p < 0.05). Physician assessment for involuntary movements significantly increased (p < 0.05) eight months after a brief educational intervention. Also, the number of patients continued on metoclopramide significantly decreased. Patients in the GT12 group were more likely to have a risk factor for TD. A brief educational intervention decreased the number of patients on metoclopramide and increased physician assessment of involuntary movements.
   
   
8. Walker, C.S., Walker, B.H., Brown, D., Buttross, S., & Sarver, D.E. (In press). Defining the role of exposure to ACEs in ADHD diagnosis: Examination in a nationally-representative sample of children. Child Abuse and Neglect.
   
   Clinical presentations of ADHD vary according to biological and environmental developmental influences. An emerging field of research has demonstrated relationships between exposure to adverse childhood experiences (ACEs) and ADHD prevalence, particularly in high-risk samples. However, research examining the combined role of traditional risk factors of ADHD and ACEs is limited, and reliance on high-risk samples introduces sampling bias. We examined the influence of ACEs on ADHD diagnosis using nationally representative samples (2017 and 2018) of 40,075 parents from the National Survey of Children’s Health (NSCH). We conducted logistic regression models to examine the association of ACEs and ADHD diagnosis, controlling for child and parent demographic variables and other risk factors. Results indicated exposure to ACEs was significantly associated with parent-reported ADHD diagnosis, controlling for known parental and child-risk factors of ADHD. The association followed a gradient pattern of increased ADHD prevalence with additional exposures. Compared to children with no ACEs, the odds of an ADHD diagnosis were 1.39, 1.92, and 2.72 times higher among children with one, two and three or more ACEs. The ACE most strongly associated with the odds of ADHD was having lived with someone with mental illness closely followed by parent/guardian incarceration. Results further strengthen the evidence that ACEs exposure is associated with increased ADHD prevalence. Clinicians should assess ACEs in the diagnosis of ADHD. Furthermore, results of the study lend support to the efforts of agencies (both institutional and state-level) promoting routine screening of ACEs in children.
   
   
9. Winthrop, K.L., Brunton, A.E., Beekmann, S., Polgreen, P., Baddley, J., Saag, K.G., Calabrese, C., Calabrese, L., Robinson, P.C., Wallace, Z.S., Curtis, J.R. COVID-19 Study Team*. SARS CoV-2 infection among patients using immunomodulatory therapies. Annuals of the Rheumatic Diseases. 2020 Aug 5:annrheumdis-2020-218580. doi: 10.1136/annrheumdis-2020-218580. Epub ahead of print. PMID: 32759259.
   
   The risk of coronavirus disease 2019 (COVID-19) and disease progression among patients using immunomodulatory therapy is unclear. Accordingly, we implemented an active surveillance project with USA/Canada Infectious Disease specialists via the Emerging Infections Network (EIN) to identify COVID-19 cases occurring in patients who use immunomodulatory therapy and to describe their clinical outcomes.

November 2020

1. Bressler, J., Marioni, R.E., Walker, R.M., Xia, R., Gottesman, R.F., Windham, B.G., Grove, M.L., Guan, W., Pankow. J.S., Evans, K.L., Mcintosh, A.M., Deary, I.J., Mosley, T.H., Boerwinkle, E., Fornage, M. Epigenetic age acceleration and cognitive function in African American adults in midlife: The Atherosclerosis Risk in Communities Study. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2020 Feb 14;75(3):473-480. doi: 10.1093/gerona/glz245. PMID: 31630168; PMCID: PMC7328191.
   
   Age acceleration, or the difference between age estimated from DNA methylation status and chronological age, has been proposed as a novel biomarker of aging. In this study, the cross-sectional association between two different measures of age acceleration and cognitive function was investigated using whole blood samples from 2,157 African American participants 47-70 years of age in the population-based Atherosclerosis Risk in Communities (ARIC) Study.  A significant inverse association between a 1-year increase in age acceleration calculated using a blood-based age predictor and scores on the Word Fluency Test was found using a general linear m del adjusted for chronological age, gender, and years of education (β = -0.140 words; p = .001) and after adding other potential confounding variables (β = -0.104 words, p = .023). The results were replicated in 1,670 European participants in the Generation Scotland: Scottish Family Health Study (fully adjusted model: β = -0.199 words; p = .034). A significant association was also identified in a trans-ethnic meta-analysis across cohorts that included an additional 708 European American ARIC study participants (fully adjusted model: β = -0.110 words, p = .003). These findings provide evidence that age acceleration is a correlate of performance on a test of verbal fluency in middle-aged adults.
   
   
2. Carron, J.D., Buck, L.S., Harbarger, C.F., Eby, T.L. A simple technique for droplet control during mastoid surgery. JAMA Otolaryngology – Head & Neck Surgery. 2020 Jul 1;146 (7):671-672.
   
   In the COVID-19 era, aerosol generating procedures including mastoidectomy have the potential to spread the SARS-Cov2 virus. We described a simple technique to control the aerosols generated during mastoidectomy using existing operating room materials.
   
   
3. Coile, C.E., Harvey, J.G., Senitko, M. Recent developments in the management of malignant pleural effusions: A narrative review. Current Pulmonology Reports (2020). https://doi.org/10.1007/s13665-020-00261-z
   
   The goal of this paper is to evaluate the literature published over past 3 years and emphasize the most recent updates in the diagnosis and management of malignant pleural effusions (MPE). The management of MPE is focused on palliation of symptoms and should take into account patient preferences and anticipated survival. Chemical pleurodesis and indwelling pleural catheters (IPC) are both definitive options for recurrent symptomatic MPE. IPC placement reduces hospitalization and can result in spontaneous pleurodesis, but these advantages must be weighed against the cost of materials and ongoing care. IPC is preferred over attempted pleurodesis in the presence of nonexpandable lung. The use of vacuum bottles during therapeutic thoracentesis is associated with increased pain and complications, and drainage via manual aspiration or to gravity is preferred. The routine use of manometry does not appear to reduce procedure-related discomfort. Several new advances have been made and discovered in relation to procedural aspects of thoracentesis, diagnosis, and management of MPE. We summarized the most relevant trials and studies and discuss their application in the clinical practice.
   
   
4. Gellert, K.S., Keil, A.P., Zeng, D., Lesko, C.R., Aubert, R.E., Avery, C.L., Lutsey, P.L., Siega- Riz, A.M., Windham, B.G., Heiss, G. Reducing the population burden of coronary heart disease by modifying adiposity: Estimates from the ARIC study. Journal of the American Heart Association. 2020 Feb 18;9(4):e012214. doi: 10.1161/JAHA.119.012214. Epub 2020 Feb 6. PMID: 32067578; PMCID: PMC7070207.
   
   We estimated the effect of hypothetical reductions in both body mass index (BMI) and waist circumference (WC) on CHD incidence. Methods and Results The study population included 13,610 ARIC (Atherosclerosis Risk in Communities) participants. Cumulative 12-year CHD incidence with no intervention was 6.3% (95% CI, 5.9-6.8%). Risk differences following the hypothetical BMI and WC reductions were -0.6% (95% CI, -1.0% to -0.1%) and -1.0% (95% CI, -1.4% to -0.5%), respectively. Consequently, we estimated that this hypothetical reduction of 5% in BMI and WC, respectively, could have prevented 9% and 16%, respectively, of the CHD events occurring in this study population over 12 years, after adjustment for established CHD risk factors. Conclusions Meaningful CHD risk reductions could derive from modest reductions in adiposity attainable through lifestyle modification.
   
   
5. Herrington, A. and Tacy, J. Crossing the power line: Using virtual simulation to prepare the first responders of utility linemen. Informatics 2020, 7, 26. https://doi.org/10.3390/informatics7030026
   
   The purpose of this pilot project was to evaluate virtual reality (VR) simulation applying the simulation standards of best practice with power line workers from the energy industry. This project was to help guide and inspire further adoption of VR and best standards in simulation in unconventional settings.
   
   
6. Herrington, A. and Gupta V. (April 2020). Roles and responsibilities of a medical simulation center manager. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK557670/
   
   This article takes an in-depth look into the many different roles and responsibilities of a simulation center manager. These leaders provide leadership to carry out the overall institution’s strategic mission, and goals focused on improving the knowledge, skills, and abilities of healthcare professional learners and, ultimately, patient care.
   
   
7. Hicks, C.W., Wang, D., Daya, N.R., Windham, B.G., Ballantyne, C.M., Matsushita, K., Selvin, E. Associations of cardiac, kidney, and diabetes biomarkers with peripheral neuropathy among older adults in the Atherosclerosis Risk in Communities (ARIC) Study. Clinical Chemistry. 2020 May 1;66(5):686-696. doi: 10.1093/clinchem/hvaa051. PMID: 32268368; PMCID: PMC7192523.
   
   We conducted a cross-sectional analysis of 3056 black and white participants in the Atherosclerosis Risk in Communities (ARIC) study who underwent standardized monofilament PN testing and had measures of cardiac function (hs-cTnT, N-terminal pro-B-type natriuretic peptide [NT-proBNP], and growth differentiation factor 15 [GDF15]), kidney function (serum creatinine, cystatin C, β-2 microglobulin, urine albumin-to-creatinine ratio), hyperglycemia (fasting glucose, hemoglobin A1c [Hb A1c], fructosamine, glycated albumin, 1,5-anhydroglucitol), and inflammation (C-reactive protein) assessed at visit 6 (2016-2017; age 71-94 years). Overall, hs-cTnT appears to be a global marker of end organ damage, including PN. Laboratory biomarkers may be able to help us identify those individuals with PN.
   
   
8. S., Schneider, A.L.C., Windham, B.G., Mosley, T.H., Gottesman, R.F., Coresh. J. Microvascular brain disease progression and risk of stroke: The ARIC study. Stroke. 2020 Nov; 51(11):3264-3270. doi: 10.1161/STROKEAHA.120.030063. Epub 2020 Oct 1. PMID: 32998653.
   
   Prospective analysis of 907 stroke-free ARIC participants who underwent a brain magnetic resonance imaging (MRI) in 1993 to 1995, a second brain MRI in 2004 to 2006, and were subsequently followed for stroke incidence through December 31, 2017 (median [25%-75%] follow-up 12.6 [8.9-13.4] years). At the second brain MRI (mean age 72), the distribution of the combined measure was 37% WMH grade <2 and no lacune; 57% WMH grade ≥2 or lacune; and 6% WMH grade ≥2 and lacune.  Compared with no change in the combined measure, moderate progression of microvascular brain disease was significantly associated with higher risk of stroke (adjusted hazard ratio, 3.00 [95% CI, 1.30-6.94]). Progression of microvascular brain disease, manifesting as both new lacunes and increase in WMHs grade, is related to substantial increase in long-term risk of stroke.
   
   
9. Lee, A.K., Juraschek, S.P., Windham, B.G., Lee, C.J., Sharrett, A.R., Coresh, J., Selvin, E. Severe hypoglycemia and risk of falls in type 2 diabetes: The Atherosclerosis Risk in Communities (ARIC) Study. Diabetes Care. 2020 Sep; 43(9):2060-2065. doi: 10.2337/dc20-0316. Epub 2020 Jul 1. PMID: 32611607; PMCID: PMC7440903.
   
   We conducted a prospective cohort analysis of participants from the Atherosclerosis Risk in Communities (ARIC) study with diagnosed diabetes at visit 4 (1996-1998). Episodes of severe hypoglycemia requiring medical treatment were identified using ICD-9 codes from hospitalizations, emergency department visits, and ambulance calls; total falls were identified from medical claims using E-codes from 1996 to 2013. Among 1,162 participants with diabetes, 149 ever had a severe hypoglycemic event before baseline or during the median of 13.1 years of follow-up. Severe hypoglycemia was associated with a doubling in risk of falls in this community-based population of adults with diabetes. Fall risk should be considered when individualizing glycemic treatment in older adults. Assessing hypoglycemia history and future hypoglycemia risk could also improve multifactorial fall prevention interventions for older adults with diabetes.
   
   
10. Lin, A., Roman, R., Regan, K., Bolch, C., Chen, C., Iyer, S., Eicosanoid profiles in the vitreous humor of patients with proliferative diabetic retinopathy. International Journal of Molecular Sciences. 2020, 21, 7451; doi:10.3390/ijms21207451.  (PMID:  PMID:  33050335)
    
    Proliferative diabetic retinopathy is a potentially blinding sequela of uncontrolled diabetes that involves a complex interaction of pro-angiogenic and inflammatory pathways. In this study, we compared the levels of pro-angiogenic arachidonic acid-derived mediators in human vitreous humor obtained from eyes with high-risk proliferative diabetic retinopathy versus controls. The results indicated that lipoxygenase and cytochrome P450-derived eicosanoids were elevated (5-HETE, 12-HETE, 20-HETE, and 20-COOH-AA), and there appeared to be no differences in levels measured in eyes with tractional retinal detachments versus those without. These results provide further insight into the pathogenesis of this disease and for the development of future potential therapeutic agents that target arachidonic acid metabolites to treat diabetic retinopathy.
    
    Funding: This study was funded/supported by: P20GM104357, DK104184 (R.J.R.), and HL138685 (R.J.R.)—National Institutes of Health Intramural Research Program Grant from the University of Mississippi (S.S.R.I.) Unrestricted grant for Research to Prevent Blindness, University of Florida (S.S.R.I.).
    
    
11. Lin, A. L. and Stanfield, K. Cystoid macular edema and retinitis pigmentosa: A pedicatric case study of presentation and treatment. New Retinal Physician. November/December 2020, pp. 7-9.
    
    A 10-year-old boy presented as a second opinion from another retina specialist for bilateral iridocyclitis and evaluation to start immunomodulating therapy.  He initially presented to his local retina specialist with bilateral decreased vision.  Per his initial exam, he was found to have trace flare but no cell on exam, and no other abnormalities on posterior segment exam.
    
    Optical coherence tomography (OCT) revealed bilateral cystoid macular edema (CME).  He was initially treated with topical steroids, and later with bilateral dexamethasone intravitreal implants, neither which showed efficacy.  His initial uveitis work-up revealed negative results for rheumatoid factor, antinuclear antibody, Quantiferon-TB Gold, human leukocyte antigen (HLA) B27, serum angiotensin converting enzyme, and rapid plasma regain (RPR).
    
    
12. Lutsey, P.L., Windham, B.G., Misialek, J.R., Cushman, M., Kucharska-Newton, A., Basu, S., Folsom, A.R. Long-term association of venous thromboembolism with frailty, physical functioning, and quality of life: The Atherosclerosis Risk in Communities Study. Journal of American Heart Association. 2020 Jun 16;9(12):e015656. doi: 10.1161/JAHA.119.015656. Epub 2020 Jun 1. PMID: 32476561; PMCID: PMC7429054.
    
    We compared long-term frailty status, physical function, and quality of life among survivors of VTE with survivors of coronary heart disease (CHD) and stroke, and with those without these diseases. Cases of VTE, CHD, and stroke were continuously identified since ARIC (Atherosclerosis Risk in Communities Study) recruitment during 1987 to 1989. Functional measures were objectively captured at ARIC clinic visits 5 (2011-2013, n=6161) and 6 (2016-2017); quality of life was self-reported. Compared with those without any of these conditions, VTE survivors were more likely to be frail (odds ratio [OR], 3.11; 95% CI, 1.80-5.36) and have low (<10) versus good scores on the Short Physical Performance Battery (OR, 3.59; 95% CI, 2.36-5.47). They also had slower gait speed, less endurance, and lower physical quality of life. When score on the Short Physical Performance Battery instrument was modeled continuously, VTE survivors performed better than stroke survivors but worse than CHD survivors. Conclusions: VTE survivors had triple the odds of frailty and poorer physical function than those without the vascular diseases considered. These findings suggest that VTE patients may benefit from additional efforts to improve postevent physical functioning.
    
    
13. Senitko, M., Abraham, G. Feasibility and safety of endoscopic microwave ablation for malignant central airway obstruction; a case series. European Respiratory Journal. 2020 56: 1204; DOI: 10.1183/13993003.congress-2020.1204
    
    Malignant central airway obstruction is a debilitating complication of primary lung cancer and pulmonary metastases occurring in approximately 30% of patients. The goal of therapeutic bronchoscopy is to recanalize an airway to palliate the symptoms and/or to bridge to further cancer therapy. Microwave ablation (MWA) is a field-based technology that heats a tissue by creating an electromagnetic field around an ablation device. We present a case series utilizing MWA via flexible bronchoscopy as a novel, not previously described modality for the management of malignant central airway obstruction. Therapeutic bronchoscopy with a flexible small MWA antenna (MedWaves Inc.) was performed in five cases. We recorded tumor size, number of microwave energy applications, ablation time, amount of energy delivered, rate of successful ablation, use of other ablative techniques, complications, and 30-day follow up. Successful airway recanalization was achieved in all cases. No immediate complications were noted. In one case, tumor in-growth within a silicone stent was ablated with no damage to the stent. MWA is a novel technique for a tumor destruction while maintaining an airway axis. The oven effect and air gap around a tumor allow to achieve safe and effective tissue devitalization and hemostasis without a thermal effect on surrounding structures of an airway lumen.
    
    
14. Sonsin-Diaz, N., Gottesman, R.F., Fracica, E., Walston, J., Windham, B.G., Knopman, D.S., Walker, K.A. Chronic systemic inflammation is associated with symptoms of late-life depression: The ARIC Study. The American Journal of Geriatric Psychiatry. 2020 Jan; 28(1):87-98. doi: 10.1016/j.jagp.2019.05.011. Epub 2019 May 21. PMID: 31182350; PMCID: PMC6868307.
    
    A total of 4,614 participants with measures of CRP as an indicator of inflammation, beginning in midlife and followed for 20 years, were included (age at late life depression symptom assessment: 75.5 [SD: 5.1]; 59% female; follow-up time: 20.7 years [SD: 1.0]). Chronic or repeated inflammation in the decades leading up to older adulthood was associated with late-life depression, even in the context of normal cognition.
    
    
15. Tang, O., Daya, N., Matsushita, K., Coresh, J., Sharrett, A.R., Hoogeveen, R., Jia, X., Windham, B.G., Ballantyne, C., Selvin, E. Performance of high-sensitivity cardiac troponin assays to reflect comorbidity burden and improve mortality risk stratification in older adults with diabetes. Diabetes Care. 2020 Jun; 43(6):1200-1208. doi: 10.2337/dc19-2043. Epub 2020 Mar 11. PMID: 32161049; PMCID: PMC7245347.
    
    We assessed the associations of elevations in high-sensitivity cardiac troponin I (hs-cTnI) and T (hs-cTnT) with comorbidities and improvements in mortality risk stratification among 1,835 participants in the Atherosclerosis Risk in Communities (ARIC) Study with diabetes (ages 67-89 years, 43% male, 31% black) at visit 5 (2011-2013). We used logistic regression to examine associations of comorbidities with elevations in either troponin (≥85th percentile). E levations in either troponin (≥9.4 ng/L for hs-cTnI, ≥25 ng/L for hs-cTnT) were associated with prevalent coronary heart disease, heart failure, chronic kidney disease, pulmonary disease, hypoglycemia, hypertension, dementia, and frailty. Over a median follow-up of 6.2 years (418 deaths), both high hs-cTnI and high hs-cTnT further stratified mortality risk beyond comorbidity levels; those with a high hs-cTnI or hs-cTnT and high comorbidity were at highest mortality risk. Even among those with low comorbidity, a high hs-cTnI (hazard ratio 3.0 [95% CI 1.7, 5.4]) or hs-cTnT (hazard ratio 3.3 [95% CI 1.8, 6.2]) was associated with elevated mortality. Many comorbidities were reflected by both hs-cTnI and hs-cTnT; elevations in either of the troponins were associated with higher mortality risk beyond comorbidity burden. High-sensitivity cardiac troponins may identify older adults at high mortality risk and be useful in guiding clinical care of older adults with diabetes.

October 2020

1. Bishop, J. A., Campbell, S.T., Graves, M.L., Gardner, M.J. Contouring plates in fracture surgery: Indications and pitfalls, Journal of the American Academy of Orthopaedic Surgeons: July 15, 2020 - Volume 28 - Issue 14 - p 585-595 doi: 10.5435/JAAOS-D-19-00462
   
   Effective fracture surgery requires contouring orthopaedic implants in multiple planes. The amount of force required for contouring is dependent on the amount and type of material contained within the plane to be altered. The type of contouring used depends on the desired plate function; for example, buttress mode often requires some degree of undercontouring, whereas compression plating may require prebending. Other reasons to contour a plate include matching patient anatomy either to maximize fixation options or to reduce implant prominence. Precontoured plates can be convenient and help to facilitate soft-tissue friendly techniques but have the potential to introduce malreduction if the plate position and fit are not carefully monitored.
   
   
2. Brooks, J.T., Bomar, J.D., Jeffords, M.E., Farnsworth, C.L., Pennock, A.T., Upasani, V.V. Defining a new three-dimensional method for determining femoral torsional pathology in children, Journal of Pediatric OrthopaedicsB: May 21, 2020 - Volume Publish Ahead of Print - Issue - doi: 10.1097/BPB.0000000000000743
   
   Femoral torsion was measured in 2D and 3D and compared using interclass correlation and Bland–Altman plots. The 2D and 3D measurements had excellent correlation (r > 0.79, P < 0.001). However, we found a fixed bias of −5.1 ± 11.3°, with 3D being consistently lower than 2D. This bias persisted when looking at only subjects with normal neck shaft angles. A proportional bias of 1.2 ± 7.8° was found when comparing 2D and 3D MRI measurements indicating that as the magnitude of the torsion changed, the difference between the two measurement techniques also changed.
   
   
3. Brown, J.T., Bergin, P.F., Prather, J.W., DiPaolo, D., Spitler, C.A. Acute femoral nailing and ipsilateral knee spanning external fixation: Improved early stability for floating knee injuries involving the tibial plateau. Journal of Orthopaedic Trauma. 2020 Sep. DOI: 10.1097/bot.0000000000001944.
   
   Ipsilateral femoral shaft and tibial plateau fractures, termed a "floating knee" are rare and challenging injuries. There is limited literature guiding the operative technique and the outcomes associated with these injuries. The author's preferred technique is early intramedullary of the femoral shaft fracture with knee spanning external fixation of any length unstable plateau fractures in the same operative setting. Early fixation of the femur fracture allows for improved hemodynamic and inflammatory stability. External fixation of the tibial plateau restores length and alignment and allows for soft tissue rest until definitive fixation. The purpose of this study is to describe this operative technique and determine the infection rate and complications requiring return to the operating room in patients with femoral shaft fractures and length unstable plateau fractures
   
   
4. Crudup, B.F., Natteru, P.A.,Auchus, A.P. Hypesthetic ataxic hemiparesis: Thinking beyond the conventional paradigm. Annals of Neurology, 88(Suppl 25):S168, 2020.
   
   Ataxic hemiparesis (AH) is one of the traditional lacunar syndromes, and was described by Fisher and Cole in 1965 as “homolateral ataxia and crural paresis.” It classically presents with ipsilateral weakness (leg>arm) and ataxia without sensory loss and is due to damage to the corticospinal and the cerebellar pathways. Typically, AH results from an infarct of ventral pons or posterior limb of the internal capsule, most commonly secondary to small-vessel disease. More recently, the ataxia in AH is thought to specifically localize to the ipsilateral red nucleus dysfunction due to disruption of cortico-rubral pathway at the internal capsule. We describe a patient with hemiparesis, hemiataxia and hemihypesthesia due to lenticulocapsular/corona radiata infarct. Hypesthesia should be recognized as part of the clinical spectrum in AH and when present may indicate a more lenticulocapsular/corona radiata localization.
   
   
5. Krenn, M.J., Vargas, L.J.L., Mayr, W., Stokic, D.S. Bipolar transcutaneous spinal stimulation evokes short-latency reflex responses in human lower limbs alike standard unipolar electrode configuration. Journal of Neurophysiology, 2020. doi:10.1152/jn.00433.2020.
   
   Transcutaneous spinal stimulation with the identified bipolar electrode configuration may offer several advantages for neuromodulation interventions over commonly used unipolar configurations: there are no associated abdominal contractions, which improves the participant’s comfort; additional dermatomes are not stimulated as when the anode is over the abdominal wall or iliac crest, which may have unwanted effects; and, due to a more localized electrical field, the bipolar configuration offers the possibility of targeting cord segments more selectively.
   
   
6. Sudduth, J.D., Moss, J.A., Spitler, C.A., Pham, V.H., Jones, L.C., Brown, J.T.,Bergin, P.F. Surgical infections. (ahead of print) http://doi.org/10.1089/sur.2019.140
   
   Based on this analysis, the rate of MRSA, gram-negative, and polymicrobial infections in open fractures is high and increasing compared with historical cohorts. With the sensitivity of early generation cephalosporins being relatively poor against gram-positive organisms, the present antibiotic regimen for open, long-bone fractures may need to be reconsidered with these emerging trends.
   
   
7. Johnson, A.O., Stevens, B.P.,Lam, J.T., Schweinfurth, J.M., Two cases of rare subglottic MALT lymphoma of the larynx. American Journal of Otolaryngology, 2020 Nov-Dec:41(6).
   
   Primary MALT lymphoma of the larynx is a rare condition first described in 1990.  The disease is classically indolent in nature and usually responds well to radiation therapy.  Symptoms are non-specific and may include hoarseness, sore throat, shortness of breath, and cough.  We describe below two cases of subglottic laryngeal MALT lymphoma identified from one academic medical center within five years of each other.  Surgical biopsy and histopathological exam are crucial to determine the etiology of unknown subglottic masses.
   
   
8. McDonald, T.C., Drake, L.C., Replogle, W.H., Graves, M.L., Brooks, J.T. Barriers to increasing diversity in orthopaedics, JB JS Open Access: April-June 2020 - Volume 5 - Issue 2 - p e0007 doi: 10.2106/JBJS.OA.20.00007
   
   From the orthopaedic residency program perspective, the greatest perceived barrier to increasing the racial/ethnic diversity of residents in their program is their lack of URM faculty. Surveyed programs with more URM faculty had more URM residents, and programs participating in Nth Dimensions and/or Perry Initiative programs had a higher percentage of URM faculty.
   
   
9. Morellato, J., O’Hara, N.N., Baker, M., O’Toole, R.V., Andrew, N. What is the long-term impact of an implant stewardship program on orthopaedic trauma implant pricing?, Journal of Orthopaedic Trauma: September 17, 2020 - Volume Publish Ahead of Print - Issue - doi: 10.1097/BOT.0000000000001967
   
   The study consisted of 2468 procedures. A mean construct price decrease of $66 per year (95% confidence interval [CI], $-170 to $-151), with distal femoral plates demonstrating the largest mean annual price decline ($486; 95% CI, $-540 to $-432). The minimum construct price decreased by $131 per year (95% CI, $-155 to $-111), with the largest reductions observed for distal femoral plates (-$436 per year; 95% CI, $-516 to $-354) and external fixators (-$122 per year; 95% CI, $-258 to $-136). The median price decrease was $407 (range: $6 to $2491), or 12.5% of the previous price. Positive changes in RYG levels increased surgeon usage of tibial nails by 115%, femoral nails by 106%, and external fixators by 104%. Surgeon implant selection was insensitive to RYG changes for distal femoral plates (RYG elasticity [ERYG]: -0.74) and proximal tibia plates (ERYG: -0.21).
   
   
10. Quince, E.M., Atkins, M.A., Brooks, J.T. A self-mutilation of the fingers after a supracondylar humerus fracture: The deleterious effects of a median nerve palsy, JB JS Case Connector: July-September 2020 - Volume 10 - Issue 3 - p e19.00460 doi: 10.2106/JBJS.CC.19.00460
    
    In very young children, it may be difficult to cope with the sensation of paresthesias after a MN palsy after a SHF. Self-mutilation of the fingers may be an unfortunate complication from these paresthesias.
    
    
11. Rose, W.S., Natteru, P.A., Auchus, A.P. Stumped by recurrent stroke? Think of “stump” syndrome! Annals of Neurology, 88(Suppl 25):S79, 2020.
    
    Following an arterial occlusion, further ischemic events are not expected as the occluded vessel is without flow. Vertebral artery stump syndrome (VASS) is an exception to this reasoning. When a thrombus occludes the proximal vertebral artery, embolization of the distal portion of the clot can result in new thromboembolic events. We describe a case of vertebral artery stump syndrome with recurrent strokes in the posterior circulation despite a persistent vertebral artery occlusion. Clinicians need to be aware of this dangerous phenomenon when caring for patients with vertebral artery disease.
    
    
12. Spitler, C.A., Hulick, R.M., Weldy, J., Howell, K.,Bergin, P.F., Graves, M.L. What are the risk factors for deep infection in OTA/AO 43C pilon fractures?, Journal of Orthopaedic Trauma: June 2020 - Volume 34 - Issue 6 - p e189-e194 doi: 10.1097/BOT.0000000000001726
    
    The overall rate of deep infection was 16.7%. Body mass index, tobacco use, and diabetes were not associated with deep infection. The rate of Gustilo–Anderson type 3A and 3B fractures was significantly higher in those with infection, but the overall open fracture rate was not significantly different between the groups. Medial and anterior open fracture wound location was significantly associated with deep infection, whereas lateral open fracture wound location was not. In closed fractures, anteromedial and anterolateral approaches were not significantly associated with infection, but posterolateral approach was associated with deep infection. Segmental bone loss and the need for soft tissue coverage were the only independent risk factors for deep infection.
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13. Stronach, B.M., Bergin, P.F., Perez, J.L., et al. The rising use of total hip arthroplasty for femoral neck fractures in the United States. HIP International. 2020; 30(1):107-113. doi:10.1177/112070001983298
    
    Our study identified 1,059,414 patients who underwent arthroplasty for the treatment of femoral neck fracture. We found a 42% increase in the use of THA during the study period from 8.4% in 2004 to 12.9% in 2013. While the large majority of patients received HA (87.1%), there was an overall decline in the use of HA (89,132 in 2004 to 85,635 in 2013) and increase in the use of THA (8,177 in 2004 to 11,375 in 2013). Patients receiving THA were younger (mean age 74.7 THA vs. 80.4 HA, p < 0.001) with fewer comorbidities, higher likelihood of discharge to home (24% THA vs. 10% HA, p < 0.001) and lower inpatient mortality rates (1.5 % THA vs. 2.4 % HA, p < 0.001) in comparison to HA.

September 2020

1. Garrigos, Z.E., Almeida, N.E.C., Gurram, P., Vijayvargiya, P., Campioli, C.G.C., Stulak, J.M., Rizza, S.A., Baddour, L.M., and Sohail, M. R. (2020). Management and outcome of left ventricular assist device infections in patients undergoing cardiac transplantation. Open Forum Infectious Diseases, 7(8), 1-8. https://doi.org/10.1093/ofid/ofaa303

Patients with left ventricular assist device (LVAD)-specific infection were managed with median of 14 days of antibiotics after heart transplantation with no relapses. For cases of uncomplicated LVAD-related blood-stream infection (BSI), who completed therapy pre-transplant, antibiotics were discontinued after standard peri-operative prophylaxis and none experienced recurrence.

2. Shane, A.L., Sato, A. I., Kao, C., Adler-Shohet, F.C., Vora, S.B., Auletta, J.A., Nachman, S., Raabe, V.N., Inagaki, K., Akinboyo, I.C., Woods, C., Alsulami, A.O., Kainth, M.K., Santos, R.P., Espinosa, C.M., Burns, J.E., Cunningham, C.K., Dominguez, S.R., Martinez, B.L., Zhu, F., Crews, J., Kitano, T., Saiman, L., Kotloff, K., A Pediatric Infectious Disease Perspective of SARS-CoV-2 and COVID-19 in Children. Journal of the Pediatric Infectious Diseases Society, piaa099, https://doi.org/10.1093/jpids/piaa099

Understanding the role that children play in the clinical burden and propagation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) responsible for novel coronavirus (COVID-19) infections is emerging. While the severe manifestations and acute clinical burden of COVID-19 has largely spared children compared to adults, understanding the epidemiology, clinical presentation, diagnostics, management, and prevention opportunities as well as the social and behavioral impacts on child health is vital. Foremost is clarifying the contribution of asymptomatic and mild infections to transmission within the household and community and the clinical and epidemiologic significance of uncommon severe post-infectious complications. Herein we summarize the current knowledge, identify useful resources, and outline research opportunities. Pediatric infectious disease clinicians have a unique opportunity to advocate for the inclusion of children in epidemiological, clinical, treatment and prevention studies to optimize their care, as well as to represent children in the development of guidance and policy during pandemic response.

3. Shipley, S.R., Clarks, M.S., and Norris, D.R. (2020). The suicidal patient. In: Paulman, P., Taylor, R., Paulman, A., Nasir L. (eds). Family Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-0779-3_34-2

Suicide is the intentional ending of one’s own life that is oftentimes the end result of another pathologic process such as substance abuse, mood disorders, or psychosis. Suicidality itself may be divided into a continuum of seriousness ranging from thoughts of death to passive and then active suicidal ideations which include a plan to suicide attempts and finally to completed suicide (Krug et al., World report on violence and health, vol 1.World Health Organization, Geneva, 2002). A related though somewhat separate entity is chronic suicidality often seen in the context of personality disorders (Wortzel et al., J Psychiatr Pract 20:63–67, 2014).

4. Simock, R., Thomas, T.V.,Estes, C., Fillippi, A.R., Katz, M.A., Pereira, I.J., Saeed, H. COVID-19: Global radiation oncology's targeted response for pandemic preparedness. Clinical and Translational Radiation Oncology. 2020 Mar 24;22:55-68. doi: https://doi:10.1016/j.ctro.2020.03.009.  PMID: 32274425. 

As the global COVID-19 pandemic escalates there is a need within radiation oncology to work to support our patients in the best way possible. Measures are required to reduce infection spread between patients and within the workforce. Departments need contingency planning to create capacity and continue essential treatments despite a reduced workforce. The radiation oncology community held an urgent online journal club in March 2020 to discuss these issues and create some consensus on urgent next steps. There were 121 global contributors. This document summarizes these discussions around themes of infection prevention, rationalization of workload and working practice in the presence of infection

5. Thomas, T.V.,Packianathan, S., Ahmed, H.Z., Joseph, S., Bhanat, E., Mundra, E.K., Kuruvilla, T.P., Vijayakumar, S. The Role of Concurrent Chemoradiotherapy and SBRT for Palliation of Previously Untreated Head and Neck Cancers. Precision Radiation Oncology. 2020 Mar 5. https://doi.org/10.1002/pro6.1086

Palliative concurrent chemoradiotherapy has not been evaluated well for patients who are not a candidate for definitive treatment. Even though stereotactic radiotherapy had established a role in the reirradiation of recurrent head and neck tumors, its role is not established as a possible primary treatment modality in patients who are not eligible for curative treatment. This article reviews the available literature on the role of chemoradiotherapy and stereotactic radiation for palliation of previously untreated head and neck cancers.

6. Thomas, T.V.,Packianathan, S., Bhanat, E., Albert, A., Abraham, A., Gordy, X.Z., Kanakamedala, M.R., Mehta, D., Vijayakumar, S. Oligometastatic Head and Neck Cancer: A Comprehensive Review. Journal of the Sciences and Specialties of the Head and Neck.  2020 Mar 27. PMID: 32220043 https://doi.org/10.1002/hed.26144

There are limited data available regarding the management of oligometastatic squamous cell carcinoma of the head and neck (SCCHN) patients, and no consensus guidelines are available. The objective is to review the available literature for the management of oligometastatic SCCHN. Articles were selected from English Medline literature between 1995 and 2018, searched by using the keywords: oligometastatic SCCHN/metastasectomy/ stereotactic body radiation treatment. With the available data, oligometastatic SCCHN patients appear to behave differently and tend to have a better prognosis than those with widespread metastases. Retrospective evidence suggests that the aggressive treatment of the primary disease and local treatment of the metastatic sites improves survival in oligometastatic SCCHN at diagnosis. The definitive treatment of the distant metastatic sites using metastasectomy or SBRT correlates with better survival in oligorecurrent patients. we concluded that Oligometastatic SCCHN patients may have a better prognosis if treated aggressively.

7. Thomas, T.V,Kuruvilla, T.P., Kahn, J., Bhanat, E., Parr, A.Q., Albert, A.A., Chowdhary, M/, Beriwal, S., Vijayakumar, S. Variations in Resources among Radiation Oncology Residency Programs in the United States. Advances in Radiation Oncology, 2020, ISSN 2452-1094, https://doi.org/10.1016/j.adro.2020.08.001.

The purpose of this research was to assess the existing variations in the residency training resources among radiation oncology (RO) residency programs in the United States. A total of 94 radiation oncology residency programs were identified during the academic year 2018-2019 and data were collected. The median number of attending physicians was 13 (Range: 4 -71). The median number of physicists and biologists were 9 and 3, respectively. The conventional techniques, including 3DCRT, IMRT, Electron Therapy, and SBRT/SRS, are available in all residency programs. In terms of specialized EBRT machines, Gamma knife, CyberKnife, and MRI LINAC were available in 49 (52%), 21(22%), and 7 (8%) programs, respectively. Only 19 programs (20%) had in house proton therapy availability; however, 37 programs (39%) offered proton therapy training via resident rotation at an affiliated institution. Prostate, gynecologic, and breast brachytherapy were available in 81 (86%), 82 (87%), and 58 (62%) of programs, respectively. Eighty-one (86%) programs reported to have High Dose Rate (HDR), and only 20 (21%) programs have Low Dose Rate (LDR) brachytherapy. Our study found that marked variations exist among RO residency programs in the United States with regards to the number of faculty and treatment machines or modalities. This study reports the status of these variations during the academic year 2018-2019 and will serve as a baseline for future intervention.

8. Thomas, T.V, Kuruvilla, T.P., Holliday, E.B., Bhanat, E., Parr, A.Q., Albert, A.A., Page, B., Schuster, J., Chapman, C., Vijayakumar, S. Cross-sectional Gender Analysis of US Radiation Oncology Residency Programs in 2019: More Than a Pipeline Issue? Advances in Radiation Oncology, 2020, ISSN 2452-1094, https://doi.org/10.1016/j.adro.2020.07.008.

The purpose of this study is to assess the current status of gender disparities in academic radiation oncology departments in the United States and the associated factors. Women constituted 30.8% of radiation oncology residents in the United States in 2019. Eight programs (12.5%) did not have any female residents in their programs, whereas six programs (9%) had women constituting more than half of their resident class. The fraction of female medical students applying to radiation oncology over the last seven years varied between 27% and 33%. Female attending physicians accounted for 30.5% of all the attending physicians in the academic programs. In the leadership positions of the department, the gender gap was wider where only 19 (20%), and 11 (12%) of programs had female program director or chair, respectively. There was a positive correlation between the number of attending physicians and the number of female residents in programs (p=0.01). A significant gender disparity continues to exist among the residents and physicians in the academic Radiation Oncology departments in the U.S. This disparity is pronounced in the leadership positions. The results of this study could be used as a benchmark to evaluate the progress that had been made by the efforts to improve gender disparities in radiation oncology.

9. Thomas, T.V., Kuruvilla, T.P., Bhanat, E., Parr, A.Q., Albert, A.A., Vijayakumar, S. An analysis of the resident’s research, education, and wellness resources in radiation oncology residency programs in the United States. Advances in Radiation Oncology, 2020, ISSN 2452-1094, https://doi.org/10.1016/j.adro.2020.08.005.

The purpose of this research is to evaluate the variations in research, education, and wellness resources for residents among Radiation Oncology (RO) residency programs across the United States. Information from the 94 ACGME accredited RO residency programs during the academic year 2018-2019 was collected. Seventy-five (80%) programs have reported the duration of dedicated research time on their websites. At least six months were allowed in 48 (51%) programs, whereas 27 (29%) programs have reported the dedicated research time is negotiable. Outstandingly, 20 (21%) programs allow one year of dedicated research time, and the median dedicated research time was nine months. From our study, only 13 (14%) residency programs reported to allow residents to rotate in other departments of the same institution. Fifty-nine (63%) programs allow away rotations at other institutions (external electives). An international rotation was permitted only in 19 (20%) programs. Regarding the wellness resources, fatigue management training, resident retreat, and resident mentoring programs were reported to be available in 53%, 26%, and 42% of programs, respectively. The salary information was obtainable for 63 institutions, and the yearly compensation ranged between $51,000 to $78,000. Moonlighting was allowed only in 28 (30%) of programs.Our study found that major variations exist among RO residency programs in the United States regarding research, education, and wellness resources for residents.

10. Thompson, D.J, Yom, S.S., Saeed, H., Naqa, I.E., Ballas, L., Bentzen, S., Chao, S.T., Choudhury, A., Coles, C.E., Dover, L., Guadagnolo, A., Guckenberger, M., Hoskin, P., Jabbour, S., Katz, M., Mukherjee, S., Rembielak, A., Sebag-Montefiore, D., Sher, D.J., Terezakis, S., Thomas, V., Vogel J, Estes C. Radiation fractionation schedules published during the COVID-19 Pandemic: A systematic review of the quality of evidence and recommendations for future development. International Journal of Radiation Oncology Biology Physics. 2020; 108(2):379-389. doi: 10.1016/j.ijrobp.2020.06.054. PMID: 32798063 

Numerous publications during the COVID-19 pandemic recommended the use of hypofractionated radiation therapy. This project assessed aggregate changes in the quality of the evidence supporting these schedules to establish a comprehensive evidence base for future reference and highlight aspects for future study. Based on a systematic review of published recommendations related to dose fractionation during the COVID-19 pandemic, 20 expert panelists assigned to 14 disease groups named and graded the highest quality of evidence schedule(s) used routinely for each condition and also graded all COVID-era recommended schedules. From January to May 2020 there were 54 relevant publications, including 233 recommended COVID-19eadapted dose fractionations. For site-specific curative and site-specific palliative schedules, there was a significant shift from estab- lished higher-quality evidence to lower-quality evidence and expert opinions for the recommended schedules (P Z .022 and P < .001, respectively). For curative-intent schedules, the distribution of quality scores was essentially reversed (highest levels of evidence "pre-COVID" vs "in-COVID": high quality, 51.4% vs 4.8%; expert opinion, 5.6% vs 49.3%), although there was variation in the magnitude of shifts between disease sites and among specific indications. A large number of publications recommended hypofractionated radiation therapy schedules across numerous major disease sites during the COVID-19 pandemic, which were supported by a lower quality of evidence than the highest-quality routinely used dose fractionation schedules. This work provides an evidence-based assessment of these poten- tially practice-changing recommendations and informs individualized decision-making and counseling of patients. These data could also be used to support radiation therapy practices in the event of second waves or surges of the pandemic in new regions of the world.

August 2020

1. Busche, K., Elks, M. L., Hanson, J. T., Jackson-Williams, L., Manuel, R. S., Parsons, W. L., Wofsy, D., Yuan, K. The Validity of Scores from the New MCAT Exam in Predicting Student Perforamnce: Results from a Multisite Study. Academic Medicine. 95(3): 387-395, March 2020.
   
   
2. Garg, T., Desai, A., Gala, K., Warawdekar, G., Tavri, S., (2020) Interventional Radiology Preparedness During Coronavirus Disease (COVID-19) Pandemic. Indian Journal of Radiology and Imaging.

This is a review article about state of affairs of the COVID-19 pandemic in India, and guidelines for IR departments across of the country to prepare adequately for a surge.

3. Jackson-Williams, L., The University of Mississippi School of Medicine, Academic Medicine, Volume 95, No. 9, September Supplement 2020.

This article provides an overview of the University of Mississippi’s medical education program. It includes key features of the curriculum such as a description of the curriculum, curriculum changes since 2010, pedagogies, and clinical experiences. A snapshot of facts for the School of Medicine is also provided.

4. Le H., Shue A., Freedman S., The Shrinking Eye: Dimensional Changes in the Young Child’s Eye after Glaucoma Drainage Device Implantation for Refractory Childhood Glaucoma. Journal of AAPOS. 2020 Apr;24(2):84.e1-84.e4. doi: 10.1016/j.jaapos.2019.12.011.  PMID: 32092365.

This study was designed to investigate the magnitude of reduction in the axial length (AL) and corneal diameter following glaucoma drainage device (GDD) placement and intraocular pressure (IOP) reduction in glaucoma patients <3 years of age at surgery. In this study cohort, reduction in AL, corneal diameter, and cup:disk ratio was found to be correlated with reduced IOP after GDD placement. This result merits consideration during surgical planning for glaucoma patients <3 years of age.

5. Liu, Y., Feng K., Jiang H., Hu F., Gao J., Zhang W., Zhang W., Huang B., Brant R., Zhang C., Yan H., Characteristics and Treatments of Ocular Blast Injury in Tianjin Explosion in China. BMC Ophthalmology. 2020 May 6; 20(1):185. doi: 10.1186/s12886-020-01448-3. PMID: 32375694.  PMCID: PMC7203803.
   
   Grant Support: (81830026/National Natural Science Foundation of China; 18ZXDBSY00030/Natural Science Foundation of Tianjin)

The study was to investigate the healing process and functional recovery of neuroretina after idiopathic macular hole surgery, as well as analyzing the influencing factors.  Various ocular injuries were commonly in the casualties of blast, in which open-globe injuries have worst visual prognosis. OTS is a valid approach for evaluation of prognosis and optimizing the therapeutic strategies subsequently in the massive casualty. Intense rescue and careful examination, proper surgery should be performed correctly to rescue patients.

6. McDonald, Tyler C., Drake, Luke C., Replogle, William H., Graves, Matthew L., Brooks, Jaysson T., Barriers to Increasing Diversity in Orthopaedics, JBJS Open Access: April-June 2020 - Volume 5 - Issue 2.

7. Penman, Alan D., Crowder, Kimberly, Watkins, William, 50 Studies Every Ophthalmologist Should Know. Oxford University press, 2020.

The book, 50 Studies Every Ophthalmologist Should Know, presents key studies that have shaped the practice of ophthalmology. Selected using a rigorous methodology, emphasis has been placed on landmark studies, which have influenced current ophthalmology practice guidelines. For each study, a concise summary is presented with an emphasis on the results and limitations of the study, and its implications for practice. An illustrative clinical case concludes each review, followed by brief information on other relevant studies. This book is a must-read for ophthalmologists, especially those in training or preparing for board review, as well as anyone who wants to learn more about the data behind clinical practice.

This article provides the residency program perspective in an effort to determine what orthopaedic residency program directors and coordinators believe are the barriers to improving diversity at their own programs. The top three barriers to increasing racial/ethnic diversity included: (1) not having enough minority faculty, which may deter minority applicants, (2) consistently high ranking of minority applicants but not matching them, and (3) not enough minority applicants.

8. Wang T., Li J., Xie R., Want J., Zhang W., Jiang F., Du M., Want X., Huang B., Brant R., Zhang C., Yan H., Intraocular Tumour Necrosis Factor Ligand Related Molecule 1 A Links Disease Progression of Proliferative Diabetic Retinopathy after Primary Vitrectomy. Clinical and Experimental Pharmacology & Physiology. 2020 Jun; 47(6):966-976.  doi: 10.1111/1440-1681.13284.  PMID: 32064668.
   
   Grant Support: (18ZXDBSY00030/Natural Science Foundation of Tianjin City; 31871184/National Natural Science Foundation of China; 81830026/National Natural Science Foundation of China)

This study aims to examine levels of TL1A in serum and intraocular fluid in patients with proliferative diabetic retinopathy (PDR), and to explore the correlation of intraocular TL1A with the prognosis of PDR progression after primary vitrectomy. Tumour necrosis factor ligand related molecule 1 A (TL1A), a member of tumour necrosis factor superfamily, has been identified as a crucial regulator for vascular homeostasis and inflammation. However, the function of TL1A in diabetic retinopathy (DR) is largely unknown. TL1A and multiple inflammatory cytokines were highly enriched in the intraocular fluid of PDR patients compared with the controls. Lower levels of intraocular TL1A were associated with development of PDR complications after primary PPV and might be used as prognostic factor in predicting the vitrectomy outcome in PDR patients.

9. Zhang W., Han H., Feng K., Wang X., Du M., Meng X., Liu Y., Huang B., Brant R., Yan H., Is it Necessary to Use Tobramycin-dexamethasone Eye Ointment Prophylactically in Eyes at the End of Intraocular Surgery?. BMC Ophthalmology. 2020 May 27;20(1):208. doi: 10.1186/s12886-020-01476-z. PMID: 32460732. PMCID: PMC7254748.
   
   Grant Support: (81830026/National Natural Science Foundation of China; 31871184/National Natural Science Foundation of China; 81800815/National Natural Science Foundation of China)

This study aimed to explore the necessity of using ocular tobramycin-dexamethasone prophylactically at the end of intraocular surgery.  We did not observe a statistically significant difference in the incidence of endophthalmitis in patients with or without prophylactic tobramycin-dexamethasone eye ointment. A tobramycin-dexamethasone eye ointment seemed to increase some side effects such as eye secretions increasing and foreign body feeling.

10. Zhu X., Wang J., Li J., Chen H., Huang B., Yan H., The Healing Process and Functional Recovery of Neuroretina after Idiopathic Macular Hole Surgery without Internal Limiting Membrane Reversal Tamponade. Journal of Ophthalmology. 4 May 2020:2478943. doi: 10.1155/2020/2478943. PMID: 32454986.  PMCID: PMC7222536.

The study was to investigate the healing process and functional recovery of neuroretina after idiopathic macular hole surgery, as well as analyzing the influencing factors. Full-thickness IMHs could achieve anatomic closure 3 to 5 days after surgery with first-step inner retina tissue bridging. Otherwise, they were not able to achieve hole closure and opened to larger holes about two weeks postoperatively. Macular hole diameter was an important factor affecting the healing of the holes. The delayed restoration of fovea detachment and ellipsoid area deficiency were responsible for poor vision outcomes after surgery.