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  1. Article ; Online: Opportunity for Reduction of Intensive Care Unit Resource Utilization in Pediatric Blunt Liver and Spleen Injuries: A National Trauma Data Bank Analysis.

    Wang, Theodore / Truche, Paul / Sachs, Rachel / Thenappan, Arunachalam / Lee, Yi-Horng / Burjonrappa, Sathyaprasad C

    Journal of pediatric surgery

    2024  

    Abstract: Introduction: Guidelines for blunt liver and spleen injury (BLSI) by the Arizona-Texas-Oklahoma-Memphis-Arkansas Consortium (ATOMAC) emphasize hemodynamic stability over injury grade when considering non-operative management (NOM). In this study, we ... ...

    Abstract Introduction: Guidelines for blunt liver and spleen injury (BLSI) by the Arizona-Texas-Oklahoma-Memphis-Arkansas Consortium (ATOMAC) emphasize hemodynamic stability over injury grade when considering non-operative management (NOM). In this study, we examined rates of intensive care unit (ICU) admission for children with isolated low-risk BLSI among US hospitals.
    Methods: The National Trauma Data Bank (NTDB) was queried for patients ages 1-15 admitted between 2017 and 2019 with BLSI. Patients with penetrating injuries and/or concomitant non-abdominal injuries with AIS score ≥3 were excluded. Isolated BLSI was considered low-risk if the patient had normal admission vitals and did not require operative intervention. Primary outcomes measured were ICU admission, ICU length of stay (LOS), and overall LOS.
    Results: 5777 patients ages 15 and under presented with isolated BLSI during the study period. 2031/5777 (35.2%) were considered low-risk. Low-risk patients had lower rates of ICU admission compared to high-risk patients (30.9% vs. 41.6%, p < 0.001) and had shorter ICU LOS (median 2 days vs. 2, p < 0.001) and shorter overall LOS (median 41 h vs. 54, p < 0.001). Pediatric verified and non-pediatric verified trauma centers had similar rates of ICU admission (36.8% vs. 38.9%, p = 0.11).
    Conclusion: Further work is needed to capture opportunities for reduction in ICU utilization in isolated BLSI.
    Level of evidence: III.
    Language English
    Publishing date 2024-03-16
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80165-3
    ISSN 1531-5037 ; 0022-3468
    ISSN (online) 1531-5037
    ISSN 0022-3468
    DOI 10.1016/j.jpedsurg.2024.03.017
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  2. Article: Overview of Corneal Transplantation for the Nonophthalmologist.

    Zhou, Yujia / Wang, Theodore / Tuli, Sonal S / Steigleman, Walter A / Shah, Ankit A

    Transplantation direct

    2023  Volume 9, Issue 2, Page(s) e1434

    Abstract: Corneal transplant is a procedure that aims to replace dysfunctional corneal tissue with a transparent graft and is one of the most widely performed transplant surgeries, but its public and professional awareness is low outside of ophthalmology. Corneal ... ...

    Abstract Corneal transplant is a procedure that aims to replace dysfunctional corneal tissue with a transparent graft and is one of the most widely performed transplant surgeries, but its public and professional awareness is low outside of ophthalmology. Corneal tissue consists of 5 major layers that serve to maintain its structural integrity and refractive shape: the epithelium, Bowman's layer, the stroma, Descemet's membrane, and the endothelium. Failure or irreversible damage to any layer of the cornea may be an indication for corneal transplant, and variants of this procedure may be full thickness or selectively lamellar. Complications related to corneal transplantation may occur anywhere from during surgery to years afterward, including rejection, dehiscence, cataract, and glaucoma. Complications should be managed by an ophthalmologist, but other physicians should be aware of prophylactic medications. Topical immunosuppressants and steroids are effective for preventing and treating rejection episodes, whereas there is little evidence to support the use of systemic immunosuppression. Eye protection is recommended for any corneal transplant recipient. Physicians should counsel patients on corneal donation, especially if outside the United States, where donor tissue is in short supply.
    Language English
    Publishing date 2023-01-12
    Publishing country United States
    Document type Journal Article ; Review
    ISSN 2373-8731
    ISSN 2373-8731
    DOI 10.1097/TXD.0000000000001434
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  3. Article: Hypercalcemia-Induced ST-Segment Elevation Mimicking Acute Myocardial Injury: A Case Report and Review of the Literature.

    Abugroun, Ashraf / Tyle, Aneesh / Faizan, Farah / Accavitti, Michael / Ahmed, Chaudhary / Wang, Theodore

    Case reports in emergency medicine

    2020  Volume 2020, Page(s) 4159526

    Abstract: ST-segment elevation in absence of acute coronary syndrome can be seen in multiple conditions, including acute pericarditis and coronary vasospasm, but it is rarely seen with severe hypercalcemia. The authors present a case of an 81-year-old female with ... ...

    Abstract ST-segment elevation in absence of acute coronary syndrome can be seen in multiple conditions, including acute pericarditis and coronary vasospasm, but it is rarely seen with severe hypercalcemia. The authors present a case of an 81-year-old female with a history of stage 4 squamous cell cancer of the lung, who presented to the emergency room with profound fatigue, weakness, anorexia, and drowsiness two weeks after her first chemotherapy cycle. Additionally, she had complaints of right-sided chest pain associated with worsening shortness of breath, as well as right arm numbness. An EKG obtained on arrival to the hospital showed diffuse ST-segment elevation (leads V3-V6, I, II, III, and aVF). Basic lab work found a calcium level of 20.4 mg/dl with elevated parathyroid hormone-related protein (PTHrP) of 135 pg/ml. Troponin I remained within normal limits. Serial EKS obtained during the patient's hospitalization demonstrated resolution of the ST elevation as calcium level normalized. This case emphasizes the importance of hypercalcemia as a differential diagnosis for ST-segment elevation and QT shortening when acute coronary syndrome is not present. Awareness of these EKG changes is critical for early diagnosis, recognition, and appropriate treatment.
    Language English
    Publishing date 2020-03-16
    Publishing country United States
    Document type Case Reports
    ZDB-ID 2684646-9
    ISSN 2090-6498 ; 2090-648X
    ISSN (online) 2090-6498
    ISSN 2090-648X
    DOI 10.1155/2020/4159526
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  4. Article ; Online: Identifying Disparities in Care in Treating Glioblastoma: A Retrospective Cohort Study of Patients Treated at a Safety-net Versus Private Hospital Setting.

    Wang, Theodore / Pham, Anthony / Yoo, Stella / Attenello, Frank J / Jennelle, Richard / Wagle, Naveed / Chang, Eric L / Zada, Gabriel

    World neurosurgery

    2020  Volume 137, Page(s) e213–e220

    Abstract: Background: Patients of lower socioeconomic status (SES) may experience barriers to their oncologic care, but current data conflict over whether SES affects the prognosis of patients with glioblastoma (GB).: Objective: We sought to determine whether ... ...

    Abstract Background: Patients of lower socioeconomic status (SES) may experience barriers to their oncologic care, but current data conflict over whether SES affects the prognosis of patients with glioblastoma (GB).
    Objective: We sought to determine whether SES disparities impaired delivery of neuro-oncologic care and affected the prognosis of GB patients.
    Methods: The records of GB patients treated from 2010 to 2014 at a safety-net hospital (SNH) or private hospital (PH), both served by 1 academic medical institution, were retrospectively reviewed and compared. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method.
    Results: A total of 55 SNH and 39 PH GB patients were analyzed with median 11-month follow-up. SNH patients were predominantly Hispanic, low income, enrolled in Medicaid, were less likely to receive radiation (89% vs. 100%), took longer to start radiation (41 vs. 29 days), and were less likely to complete radiation treatment (80% vs. 95%). Concurrent and adjuvant temozolomide use were also lower (85% vs. 94% and 60% vs. 71%, respectively). OS and PFS were not significantly different (15 vs. 16 months and 8 vs. 11 months, respectively). On multivariate analysis, adjuvant chemotherapy and RT completion predicted for better OS, whereas hospital type, income, and insurance did not.
    Conclusion: Although GB patients at our SNH received less adjuvant treatment compared with PH, outcomes were similar. Access to multidisciplinary care staffed by academic physicians may play an important role in overcoming socioeconomic barriers to treatment availability and quality at SNHs.
    MeSH term(s) Aged ; Antineoplastic Agents, Alkylating/therapeutic use ; Brain Neoplasms/genetics ; Brain Neoplasms/pathology ; Brain Neoplasms/therapy ; Chemoradiotherapy, Adjuvant/statistics & numerical data ; Chemotherapy, Adjuvant/statistics & numerical data ; Cohort Studies ; DNA Modification Methylases/genetics ; DNA Repair Enzymes/genetics ; Ethnicity/statistics & numerical data ; Female ; Glioblastoma/genetics ; Glioblastoma/pathology ; Glioblastoma/therapy ; Healthcare Disparities/statistics & numerical data ; Hospitals, Private ; Humans ; Isocitrate Dehydrogenase/genetics ; Kaplan-Meier Estimate ; Male ; Medicaid ; Middle Aged ; Neurosurgical Procedures ; Poverty/statistics & numerical data ; Progression-Free Survival ; Radiotherapy, Adjuvant/statistics & numerical data ; Retrospective Studies ; Safety-net Providers ; Social Class ; Standard of Care ; Survival Rate ; Temozolomide/therapeutic use ; Time-to-Treatment/statistics & numerical data ; Tumor Burden ; Tumor Suppressor Proteins/genetics ; United States
    Chemical Substances Antineoplastic Agents, Alkylating ; Tumor Suppressor Proteins ; Isocitrate Dehydrogenase (EC 1.1.1.41) ; DNA Modification Methylases (EC 2.1.1.-) ; MGMT protein, human (EC 2.1.1.63) ; DNA Repair Enzymes (EC 6.5.1.-) ; Temozolomide (YF1K15M17Y)
    Language English
    Publishing date 2020-01-27
    Publishing country United States
    Document type Comparative Study ; Journal Article
    ZDB-ID 2534351-8
    ISSN 1878-8769 ; 1878-8750
    ISSN (online) 1878-8769
    ISSN 1878-8750
    DOI 10.1016/j.wneu.2020.01.133
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    Zs.A 1159: Show issues Location:
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  5. Article ; Online: Quantitative Characterization of Tumor Proximity to Stem Cell Niches: Implications on Recurrence and Survival in GBM Patients.

    Lao, Yi / Yu, Victoria / Pham, Anthony / Wang, Theodore / Cui, Jing / Gallogly, Audrey / Chang, Eric / Fan, Zhaoyang / Kaprealian, Tania / Yang, Wensha / Sheng, Ke

    International journal of radiation oncology, biology, physics

    2021  Volume 110, Issue 4, Page(s) 1180–1188

    Abstract: Purpose: Emerging evidence has linked glioblastoma multiforme (GBM) recurrence and survival to stem cell niches (SCNs). However, the traditional tumor-ventricle distance is insufficiently powered for an accurate prediction. We aimed to use a novel ... ...

    Abstract Purpose: Emerging evidence has linked glioblastoma multiforme (GBM) recurrence and survival to stem cell niches (SCNs). However, the traditional tumor-ventricle distance is insufficiently powered for an accurate prediction. We aimed to use a novel inverse distance map for improved prediction.
    Methods and materials: Two T1-magnetic resonance imaging data sets were included for a total of 237 preoperative scans for prognostic stratification and 55 follow-up scans for recurrent pattern identification. SCN, including the subventricular zone (SVZ) and subgranular zone (SGZ), were manually defined on a standard template. A proximity map was generated using the summed inverse distances to all SCN voxels. The mean and maximum proximity scores (PS
    Results: Among all SCN-derived features, PS
    Conclusions: We introduced a novel inverse distance-based metric to comprehensively capture the anatomic relationship between GBM tumors and SCN zones. The derived metrics outperformed traditional edge or center distance-based measurements in overall survival prediction, risk stratification, and recurrent pattern differentiation. Our results reveal the potential role of SGZ in recurrence aside from SVZ.
    MeSH term(s) Glioblastoma/pathology ; Humans ; Prognosis ; Recurrence ; Stem Cell Niche ; Survival Analysis
    Language English
    Publishing date 2021-02-16
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 197614-x
    ISSN 1879-355X ; 0360-3016
    ISSN (online) 1879-355X
    ISSN 0360-3016
    DOI 10.1016/j.ijrobp.2021.02.020
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  6. Article ; Online: CAR T Cell Locomotion in Solid Tumor Microenvironment.

    Nguyen, Duy T / Ogando-Rivas, Elizabeth / Liu, Ruixuan / Wang, Theodore / Rubin, Jacob / Jin, Linchun / Tao, Haipeng / Sawyer, William W / Mendez-Gomez, Hector R / Cascio, Matthew / Mitchell, Duane A / Huang, Jianping / Sawyer, W Gregory / Sayour, Elias J / Castillo, Paul

    Cells

    2022  Volume 11, Issue 12

    Abstract: The promising outcomes of chimeric antigen receptor (CAR) T cell therapy in hematologic malignancies potentiates its capability in the fight against many cancers. Nevertheless, this immunotherapy modality needs significant improvements for the treatment ... ...

    Abstract The promising outcomes of chimeric antigen receptor (CAR) T cell therapy in hematologic malignancies potentiates its capability in the fight against many cancers. Nevertheless, this immunotherapy modality needs significant improvements for the treatment of solid tumors. Researchers have incrementally identified limitations and constantly pursued better CAR designs. However, even if CAR T cells are armed with optimal killer functions, they must overcome and survive suppressive barriers imposed by the tumor microenvironment (TME). In this review, we will discuss in detail the important role of TME in CAR T cell trafficking and how the intrinsic barriers contribute to an immunosuppressive phenotype and cancer progression. It is of critical importance that preclinical models can closely recapitulate the in vivo TME to better predict CAR T activity. Animal models have contributed immensely to our understanding of human diseases, but the intensive care for the animals and unreliable representation of human biology suggest in vivo models cannot be the sole approach to CAR T cell therapy. On the other hand, in vitro models for CAR T cytotoxic assessment offer valuable insights to mechanistic studies at the single cell level, but they often lack in vivo complexities, inter-individual heterogeneity, or physiologically relevant spatial dimension. Understanding the advantages and limitations of preclinical models and their applications would enable more reliable prediction of better clinical outcomes.
    MeSH term(s) Animals ; Cell Movement ; Immunotherapy, Adoptive/methods ; Neoplasms/pathology ; Receptors, Chimeric Antigen ; T-Lymphocytes ; Tumor Microenvironment
    Chemical Substances Receptors, Chimeric Antigen
    Language English
    Publishing date 2022-06-20
    Publishing country Switzerland
    Document type Journal Article ; Review ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 2661518-6
    ISSN 2073-4409 ; 2073-4409
    ISSN (online) 2073-4409
    ISSN 2073-4409
    DOI 10.3390/cells11121974
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  7. Article ; Online: Targeting microRNA-mediated gene repression limits adipogenic conversion of skeletal muscle mesenchymal stromal cells.

    Wosczyna, Michael N / Perez Carbajal, Edgar E / Wagner, Mark W / Paredes, Silvana / Konishi, Colin T / Liu, Ling / Wang, Theodore T / Walsh, Rachel A / Gan, Qiang / Morrissey, Christapher S / Rando, Thomas A

    Cell stem cell

    2021  Volume 28, Issue 7, Page(s) 1323–1334.e8

    Abstract: Intramuscular fatty deposits, which are seen in muscular dystrophies and with aging, negatively affect muscle function. The cells of origin of adipocytes constituting these fatty deposits are mesenchymal stromal cells, fibroadipogenic progenitors (FAPs). ...

    Abstract Intramuscular fatty deposits, which are seen in muscular dystrophies and with aging, negatively affect muscle function. The cells of origin of adipocytes constituting these fatty deposits are mesenchymal stromal cells, fibroadipogenic progenitors (FAPs). We uncover a molecular fate switch, involving miR-206 and the transcription factor Runx1, that controls FAP differentiation to adipocytes. Mice deficient in miR-206 exhibit increased adipogenesis following muscle injury. Adipogenic differentiation of FAPs is abrogated by miR-206 mimics. Using a labeled microRNA (miRNA) pull-down and sequencing (LAMP-seq), we identified Runx1 as a miR-206 target, with miR-206 repressing Runx1 translation. In the absence of miR-206 in FAPs, Runx1 occupancy near transcriptional start sites of adipogenic genes and expression of these genes increase. We demonstrate that miR-206 mimicry in vivo limits intramuscular fatty infiltration. Our results provide insight into the underlying molecular mechanisms of FAP fate determination and formation of harmful fatty deposits in skeletal muscle.
    MeSH term(s) Adipocytes ; Adipogenesis/genetics ; Animals ; Cell Differentiation ; Mesenchymal Stem Cells ; Mice ; MicroRNAs/genetics ; Muscle, Skeletal
    Chemical Substances MicroRNAs
    Language English
    Publishing date 2021-05-03
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
    ZDB-ID 2375354-7
    ISSN 1875-9777 ; 1934-5909
    ISSN (online) 1875-9777
    ISSN 1934-5909
    DOI 10.1016/j.stem.2021.04.008
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    Zs.A 6589: Show issues Location:
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  8. Article: Quality of Acute Stroke Care at Primary Stroke Centers Before and After Certification in Comparison to Never-Certified Hospitals.

    Shkirkova, Kristina / Wang, Theodore T / Vartanyan, Lily / Liebeskind, David S / Eckstein, Marc / Starkman, Sidney / Stratton, Samuel / Pratt, Franklin D / Hamilton, Scott / Kim-Tenser, May / Conwit, Robin / Saver, Jeffrey L / Sanossian, Nerses

    Frontiers in neurology

    2020  Volume 10, Page(s) 1396

    Abstract: Background and Purpose: ...

    Abstract Background and Purpose:
    Language English
    Publishing date 2020-01-22
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2564214-5
    ISSN 1664-2295
    ISSN 1664-2295
    DOI 10.3389/fneur.2019.01396
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  9. Article ; Online: Transient peaked T waves during exercise stress testing: an unusual manifestation of reversible cardiac ischemia.

    Manankil, Marian F / Wang, Theodore / Bhat, Pachalla K

    Journal of electrocardiology

    2011  Volume 44, Issue 1, Page(s) 23–26

    Abstract: A 57-year-old man presented with atypical upper body pain, initially attributed to musculoskeletal etiology. After analgesic failure, an exercise myocardial perfusion imaging was performed. During stress testing, patient's pain was reproduced, ... ...

    Abstract A 57-year-old man presented with atypical upper body pain, initially attributed to musculoskeletal etiology. After analgesic failure, an exercise myocardial perfusion imaging was performed. During stress testing, patient's pain was reproduced, accompanied by prominent T-wave peaking with minor J-point elevation. T-wave amplitude decreased at the end of the recovery phase when his chest pain completely resolved. The myocardial perfusion imaging revealed extensive reversible ischemia of the septum and apical walls. Subsequent coronary arteriography demonstrated a 99% stenosis of the left anterior descending artery that was stented. Patient has remained asymptomatic since. We conclude that transient peaked T waves with minor J-point elevation during exercise may be an unusual electrocardiographic manifestation of reversible cardiac ischemia.
    MeSH term(s) Coronary Stenosis/complications ; Coronary Stenosis/diagnosis ; Electrocardiography/methods ; Exercise Test ; Humans ; Male ; Middle Aged ; Myocardial Ischemia/diagnosis ; Myocardial Ischemia/etiology
    Language English
    Publishing date 2011-01
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 410286-1
    ISSN 1532-8430 ; 0022-0736
    ISSN (online) 1532-8430
    ISSN 0022-0736
    DOI 10.1016/j.jelectrocard.2010.07.002
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  10. Article ; Online: Mesenchymal Stromal Cells Are Required for Regeneration and Homeostatic Maintenance of Skeletal Muscle.

    Wosczyna, Michael N / Konishi, Colin T / Perez Carbajal, Edgar E / Wang, Theodore T / Walsh, Rachel A / Gan, Qiang / Wagner, Mark W / Rando, Thomas A

    Cell reports

    2019  Volume 27, Issue 7, Page(s) 2029–2035.e5

    Abstract: The necessity of mesenchymal stromal cells, called fibroadipogenic progenitors (FAPs), in skeletal muscle regeneration and maintenance remains unestablished. We report the generation of a ... ...

    Abstract The necessity of mesenchymal stromal cells, called fibroadipogenic progenitors (FAPs), in skeletal muscle regeneration and maintenance remains unestablished. We report the generation of a PDGFRα
    MeSH term(s) 3T3 Cells ; Animals ; Homeostasis ; Mesenchymal Stem Cells/metabolism ; Mice ; Mice, Transgenic ; Muscle Development ; Muscle, Skeletal ; Regeneration
    Language English
    Publishing date 2019-05-15
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
    ZDB-ID 2649101-1
    ISSN 2211-1247 ; 2211-1247
    ISSN (online) 2211-1247
    ISSN 2211-1247
    DOI 10.1016/j.celrep.2019.04.074
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