Nima Khoshab | Boston University (original) (raw)

Papers by Nima Khoshab

Research paper thumbnail of Supplemental Table 1

Research paper thumbnail of Necrotizing fasciitis: a cumulative review and new techniques in emergency room diagnosis

Necrotizing fasciitis (NF) is a rare and life threating soft-tissue infection specific to the ski... more Necrotizing fasciitis (NF) is a rare and life threating soft-tissue infection specific to the skin's fascia layer. It is most often encountered in the peripheries, abdominal wall, and perineum and has numerous etiologies and associated pathogens. Early diagnosis and rapid surgical debridement are essential in treating NF as the infection progresses rapidly and mortality rate increases significantly with time. The current difficulty in initial diagnosis is due to the lack of obvious skin findings early on in the infection. Laboratory tests, including the laboratory risk indicator for necrotizing fasciitis (LRINEC) score, gas on imaging tests, and physical exam findings are the current clues to an early diagnosis but official diagnosis can only be confirmed by surgical exploration and discovery of a lack of resistance to dissection in the fascia layer. The LRINEC score analyzes one variable, specifically C-reactive protein (CRP), which is often not included in routine laboratory tests skin infections at the emergency department (ED). Furthermore, no specific set of physical exam findings has been distinctly associated with diagnosis of NF over other soft-tissue infections and the most specific imaging tests are too expensive for routine use. A new and modified LRINEC score based only on routine ED laboratory tests as well as an additional objective scoring system for physical exam findings are the next steps toward rapid diagnosis. This approach requires large-scale retrospective vii statistical analyses of NF cases across the country for identification of the most prevalent physical exam findings and abnormal laboratory values. viii

Research paper thumbnail of Facial Fractures Have Similar Outcomes When Managed by Either Otolaryngology or Plastic Surgery: Encounters From a Single Level I Trauma Center

Craniomaxillofacial Trauma and Reconstruction, 2021

Retrospective cohort. Traumatic facial fractures (FFs) often require specialty consultation with ... more Retrospective cohort. Traumatic facial fractures (FFs) often require specialty consultation with Plastic Surgery (PS) or Otolaryngology (ENT); however, referral patterns are often non-standardized and institution specific. Therefore, we sought to compare management patterns and outcomes between PS and ENT, hypothesizing no difference in operative rates, complications, or mortality. We performed a retrospective analysis of patients with FFs at a single Level I trauma center from 2014 to 2017. Patients were compared by consulting service: PS vs. ENT. Chi-square and Mann-Whitney-U tests were performed. Of the 755 patients with FFs, 378 were consulted by PS and 377 by ENT. There was no difference in demographic data ( P > 0.05). Patients managed by ENT received a longer mean course of antibiotics (9.4 vs 7.0 days, P = 0.008) and had a lower rate of open reduction internal fixation (ORIF) (9.8% vs. 15.3%, P = 0.017), compared to PS patients. No difference was observed in overall opera...

Research paper thumbnail of Traction Osteogenesis: A Novel Approach to Growing the Pruzansky 3 Mandible

Plastic and Reconstructive Surgery - Global Open, 2021

Research paper thumbnail of Newly Identified Developmental Delays in a Large Population of Children with Nonsyndromic Cleft Lip and/or Palate

Plastic and Reconstructive Surgery - Global Open, 2021

Research paper thumbnail of Historical Tools of Anthropometric Facial Assessment: A Systematic Raw Data Analysis on the Applicability of the Neoclassical Canons and Golden Ratio

Aesthetic Surgery Journal, 2021

Background The fundamental tenets of facial aesthetic surgery education have not changed in centu... more Background The fundamental tenets of facial aesthetic surgery education have not changed in centuries. Research is beginning to demonstrate that the Neoclassical Canons and the Golden Ratio, Phi, have limited utilization in populations other than those of White European extraction. Objectives The purpose of this study was to analyze comparable raw data in the literature to determine (1) if there is interethnic variability in Neoclassical Canon and Phi measurements, and (2) if the measurements in these representative samples differ from the “ideal.” Methods A PubMed/Scopus search was performed. Manuscripts with raw data and individuals aged ≥16 were included. Measurements were extracted and employed to calculate the Neoclassical Canons and Phi. One-way analysis of variance (ANOVA) tests were conducted to compare mean measurements across 6 ethnic groups (P < 0.05). Results Twenty-seven articles were included. Every continent was represented except Antarctica and Australia. Men were...

Research paper thumbnail of Electroencephalography Might Improve Diagnosis of Acute Stroke and Large Vessel Occlusion

Stroke, 2020

Background and Purpose: Clinical methods have incomplete diagnostic value for early diagnosis of ... more Background and Purpose: Clinical methods have incomplete diagnostic value for early diagnosis of acute stroke and large vessel occlusion (LVO). Electroencephalography is rapidly sensitive to brain ischemia. This study examined the diagnostic utility of electroencephalography for acute stroke/transient ischemic attack (TIA) and for LVO. Methods: Patients (n=100) with suspected acute stroke in an emergency department underwent clinical exam then electroencephalography using a dry-electrode system. Four models classified patients, first as acute stroke/TIA or not, then as acute stroke with LVO or not: (1) clinical data, (2) electroencephalography data, (3) clinical+electroencephalography data using logistic regression, and (4) clinical+electroencephalography data using a deep learning neural network. Each model used a training set of 60 randomly selected patients, then was validated in an independent cohort of 40 new patients. Results: Of 100 patients, 63 had a stroke (43 ischemic/7 he...

Research paper thumbnail of Ten-Year experience with vertical rectus abdominis myocutaneous flap for reconstruction of abdominoperineal resection defects

JPRAS Open, 2021

We evaluate outcomes of our single center using vertical rectus abdominis myocutaneous (VRAM) fla... more We evaluate outcomes of our single center using vertical rectus abdominis myocutaneous (VRAM) flaps for reconstruction after abdominoperineal resection (APR). Our goal was to analyze factors that may affect perineal wound healing, a problematic complication with APR reconstructions due to location and high frequency of neoadjuvant chemoradiation. Methods: This single-center, retrospective study analyzed all VRAM flap perineal reconstruction patients after APR defect over a 10-year period (from July 2008 to June 2018). Outcome measures focused on factors that may affect perineal wound healing complication rates: cancer stage (I/II vs III/IV), neoadjuvant chemoradiation, surgeon's years in practice (< 5 years vs > 5 years), and pelvic closed suction drain use. Results: Twenty-eight patients met inclusion criteria. The overall major perineal wound complication rate was 14.3% (4 patients). Lack of perioperative closed suction pelvic drain use was associated with a significantly higher rate of major perineal wound complications (28.6% vs 0% and p = 0.031). All four major wound complications occurred in patients who did not have a pelvic drain. The major perineal wound complication rate for patients * Corresponding author.

Research paper thumbnail of The ENIGMA Stroke Recovery Working Group: Big data neuroimaging to study brain–behavior relationships after stroke

Human Brain Mapping, 2020

The goal of the Enhancing Neuroimaging Genetics through Meta-Analysis (ENIGMA) Stroke Recovery wo... more The goal of the Enhancing Neuroimaging Genetics through Meta-Analysis (ENIGMA) Stroke Recovery working group is to understand brain and behavior relationships using well-powered meta-and mega-analytic approaches. ENIGMA Stroke Recovery has data from over 2,100 stroke patients collected across 39 research studies and K01HD091283,

Research paper thumbnail of Factors contributing to cancer worry in the skin cancer population

Journal of the American Academy of Dermatology, 2019

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Research paper thumbnail of Patient-reported Aesthetic Satisfaction following Facial Skin Cancer Module Surgery Using the FACE-Q Skin Cancer

Plastic and Reconstructive Surgery - Global Open, 2019

BACKGROUND Over 5 million basal and squamous cell skin cancers are diagnosed in the United States... more BACKGROUND Over 5 million basal and squamous cell skin cancers are diagnosed in the United States each year. 1,2 Seventy to 80% of these cancers occur in the head and neck region, for which surgical excision is the standard of treatment. 3 Diagnosis and treatment can be stressful for patients and families, affecting psychosocial well-being, social interactions, and other aspects of health-related quality of life. 4,5 In addition, treatment of facial skin cancers can result in scars or physical disfigurement, which are particularly distressing. 6 Patients are concerned about changes in their facial appearance following reconstruction and desire meaningful data to help them better understand expected outcomes. 4,5,7 As patient satisfaction and quality of life are among the most important outcomes in plastic and reconstructive surgery, 5,8 understanding patient perceptions of aesthetic postoperative outcomes is critical. 9-11 Patient-reported outcome measures (PROMs) are questionnaires developed with direct input from patients.

Research paper thumbnail of Factors Influencing Access to Cochlear Implantation in Deaf and Hard-of-Hearing Children in Southern California

Otology & Neurotology, 2019

Objective: To determine the epidemiologic relationship of family demographics and educational res... more Objective: To determine the epidemiologic relationship of family demographics and educational resources with parental knowledge of and willingness for their children to receive cochlear implantation (CI) for deaf and hard-of-hearing (DHH) children. Methods: A total of 213 parents of DHH children were surveyed at local schools, specialized camps, and clinics in Southern California. Data on parents were solicited, including income, insurance status, education level, hearing status, primary language, and motivations towards CI. Results: Sixty-six surveys were included in the analysis. Three of these patients had already undergone CI, thus of the 63 children without CI, 59% had been presented with the option of CI by a healthcare professional and 27% were willing to have their child undergo CI. Willingness for children to undergo CI was statistically higher in families with an annual income less than 15,000ormorethan15,000 or more than 15,000ormorethan75,000 (p ¼ 0.02), and children enrolled in specialized schools for DHH (p ¼ 0.02). The leading reasons for unwillingness to undergo CI were risks of surgery (17%) and discouragement from others (14%). Conclusion: A significant gap exists between the number of CI candidates and families and willingness to undergo CI. The difference could be related to socioeconomic status and the patient's school type. This underscores the importance of parental education through the use of a multidisciplinary team to ensure all hearing rehabilitation options are explained.

Research paper thumbnail of Mesenchymal stem cell dysfunction in diabetes

Molecular Biology Reports, 2018

Diabetes mellitus (DM) is a chronic disease that results in a variety of systemic complications. ... more Diabetes mellitus (DM) is a chronic disease that results in a variety of systemic complications. Recently, stem cell-based therapies have been proposed as potential modalities to manage DM related complications. Mesenchymal stem cell (MSC) based therapies are often considered as an ideal stem cell-based treatment for DM management due to their immunosuppressive characteristics, anti-inflammatory properties and differentiation potential. While MSCs show tremendous promise, the underlying functional deficits of MSCs in DM patients is not well understood. Using the MEDLINE database to define these functional deficits, our search yielded 1826 articles of which 33 met our inclusion criteria. This allowed us to review the topic and illuminate four major molecular categories by which MSCs are compromised in both Type 1 DM and Type II DM models which include: (1) changes in angiogenesis/vasculogenesis, (2) altered pro-inflammatory cytokine secretion, (3) increased oxidative stress markers and (4) impaired cellular differentiation and decreased proliferation. Knowledge of the deficits in MSC function will allow us to more clearly assess the efficacy of potential biologic therapies for reversing these dysfunctions when treating the complications of diabetic disease.

Research paper thumbnail of A large, open source dataset of stroke anatomical brain images and manual lesion segmentations

Stroke is the leading cause of adult disability worldwide, with up to two-thirds of individuals e... more Stroke is the leading cause of adult disability worldwide, with up to two-thirds of individuals experiencing long-term disabilities. Large-scale neuroimaging studies have shown promise in identifying robust biomarkers (e.g., measures of brain structure) of long-term stroke recovery following rehabilitation. However, analyzing large rehabilitation-related datasets is problematic due to barriers in accurate stroke lesion segmentation. Manually-traced lesions are currently the gold standard for lesion segmentation on T1-weighted MRIs, but are labor intensive and require anatomical expertise. While algorithms have been developed to automate this process, the results often lack accuracy. Newer algorithms that employ machine-learning techniques are promising, yet these require large training datasets to optimize performance. Here we present ATLAS (Anatomical Tracings of Lesions After Stroke), an open-source dataset of 304 T1-weighted MRIs with manually segmented lesions and metadata. This...

Research paper thumbnail of Evaluating the Laboratory Risk Indicator to Differentiate Cellulitis from Necrotizing Fasciitis in the Emergency Department

The western journal of emergency medicine, 2017

Necrotizing fasciitis (NF) is an uncommon but rapidly progressive infection that results in gross... more Necrotizing fasciitis (NF) is an uncommon but rapidly progressive infection that results in gross morbidity and mortality if not treated in its early stages. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score is used to distinguish NF from other soft tissue infections such as cellulitis or abscess. This study analyzed the ability of the LRINEC score to accurately rule out NF in patients who were confirmed to have cellulitis, as well as the capability to differentiate cellulitis from NF. This was a 10-year retrospective chart-review study that included emergency department (ED) patients ≥18 years old with a diagnosis of cellulitis or NF. We calculated a LRINEC score ranging from 0-13 for each patient with all pertinent laboratory values. Three categories were developed per the original LRINEC score guidelines denoting NF risk stratification: high risk (LRINEC score ≥8), moderate risk (LRINEC score 6-7), and low risk (LRINEC score ≤5). All cases missing laboratory ...

Research paper thumbnail of Long non-coding RNAs in neurodevelopmental disorders

Frontiers in Molecular Neuroscience, 2013

Recent studies have emphasized an important role for long non-coding RNAs (lncRNA) in epigenetic ... more Recent studies have emphasized an important role for long non-coding RNAs (lncRNA) in epigenetic regulation, development, and disease. Despite growing interest in lncRNAs, the mechanisms by which lncRNAs control cellular processes are still elusive. Improved understanding of these mechanisms is critical, because the majority of the mammalian genome is transcribed, in most cases resulting in non-coding RNA products. Recent studies have suggested the involvement of lncRNA in neurobehavioral and neurodevelopmental disorders, highlighting the functional importance of this subclass of brain-enriched RNAs. Impaired expression of lnRNAs has been implicated in several forms of intellectual disability disorders. However, the role of this family of RNAs in cognitive function is largely unknown. Here we provide an overview of recently identified mechanisms of neuronal development involving lncRNAs, and the consequences of lncRNA deregulation for neurodevelopmental disorders.

Research paper thumbnail of Interactive Ipad-based Patient Education in Breast Reconstruction Planning

Plastic and Reconstructive Surgery - Global Open, 2020

METHODS: Metadata from publicly available Instagram posts containing #PlasticSurgery were collect... more METHODS: Metadata from publicly available Instagram posts containing #PlasticSurgery were collected from December 2018 through January 2020 through an API with Node.JS, an open source JavaScript runtime environment. All posts timestamped within the timeframe were included. Data collected from the posts included username, caption, engagement, time, and tagged location. We then designed and validated a classification algorithm to characterize the user associated with each post. The data were further processed and analyzed using the R programming language.

Research paper thumbnail of Long non-coding RNAs in neurodevelopmental disorders

Frontiers in Molecular Neuroscience, 2013

Research paper thumbnail of Supplemental Table 1

Research paper thumbnail of Necrotizing fasciitis: a cumulative review and new techniques in emergency room diagnosis

Necrotizing fasciitis (NF) is a rare and life threating soft-tissue infection specific to the ski... more Necrotizing fasciitis (NF) is a rare and life threating soft-tissue infection specific to the skin's fascia layer. It is most often encountered in the peripheries, abdominal wall, and perineum and has numerous etiologies and associated pathogens. Early diagnosis and rapid surgical debridement are essential in treating NF as the infection progresses rapidly and mortality rate increases significantly with time. The current difficulty in initial diagnosis is due to the lack of obvious skin findings early on in the infection. Laboratory tests, including the laboratory risk indicator for necrotizing fasciitis (LRINEC) score, gas on imaging tests, and physical exam findings are the current clues to an early diagnosis but official diagnosis can only be confirmed by surgical exploration and discovery of a lack of resistance to dissection in the fascia layer. The LRINEC score analyzes one variable, specifically C-reactive protein (CRP), which is often not included in routine laboratory tests skin infections at the emergency department (ED). Furthermore, no specific set of physical exam findings has been distinctly associated with diagnosis of NF over other soft-tissue infections and the most specific imaging tests are too expensive for routine use. A new and modified LRINEC score based only on routine ED laboratory tests as well as an additional objective scoring system for physical exam findings are the next steps toward rapid diagnosis. This approach requires large-scale retrospective vii statistical analyses of NF cases across the country for identification of the most prevalent physical exam findings and abnormal laboratory values. viii

Research paper thumbnail of Facial Fractures Have Similar Outcomes When Managed by Either Otolaryngology or Plastic Surgery: Encounters From a Single Level I Trauma Center

Craniomaxillofacial Trauma and Reconstruction, 2021

Retrospective cohort. Traumatic facial fractures (FFs) often require specialty consultation with ... more Retrospective cohort. Traumatic facial fractures (FFs) often require specialty consultation with Plastic Surgery (PS) or Otolaryngology (ENT); however, referral patterns are often non-standardized and institution specific. Therefore, we sought to compare management patterns and outcomes between PS and ENT, hypothesizing no difference in operative rates, complications, or mortality. We performed a retrospective analysis of patients with FFs at a single Level I trauma center from 2014 to 2017. Patients were compared by consulting service: PS vs. ENT. Chi-square and Mann-Whitney-U tests were performed. Of the 755 patients with FFs, 378 were consulted by PS and 377 by ENT. There was no difference in demographic data ( P > 0.05). Patients managed by ENT received a longer mean course of antibiotics (9.4 vs 7.0 days, P = 0.008) and had a lower rate of open reduction internal fixation (ORIF) (9.8% vs. 15.3%, P = 0.017), compared to PS patients. No difference was observed in overall opera...

Research paper thumbnail of Traction Osteogenesis: A Novel Approach to Growing the Pruzansky 3 Mandible

Plastic and Reconstructive Surgery - Global Open, 2021

Research paper thumbnail of Newly Identified Developmental Delays in a Large Population of Children with Nonsyndromic Cleft Lip and/or Palate

Plastic and Reconstructive Surgery - Global Open, 2021

Research paper thumbnail of Historical Tools of Anthropometric Facial Assessment: A Systematic Raw Data Analysis on the Applicability of the Neoclassical Canons and Golden Ratio

Aesthetic Surgery Journal, 2021

Background The fundamental tenets of facial aesthetic surgery education have not changed in centu... more Background The fundamental tenets of facial aesthetic surgery education have not changed in centuries. Research is beginning to demonstrate that the Neoclassical Canons and the Golden Ratio, Phi, have limited utilization in populations other than those of White European extraction. Objectives The purpose of this study was to analyze comparable raw data in the literature to determine (1) if there is interethnic variability in Neoclassical Canon and Phi measurements, and (2) if the measurements in these representative samples differ from the “ideal.” Methods A PubMed/Scopus search was performed. Manuscripts with raw data and individuals aged ≥16 were included. Measurements were extracted and employed to calculate the Neoclassical Canons and Phi. One-way analysis of variance (ANOVA) tests were conducted to compare mean measurements across 6 ethnic groups (P < 0.05). Results Twenty-seven articles were included. Every continent was represented except Antarctica and Australia. Men were...

Research paper thumbnail of Electroencephalography Might Improve Diagnosis of Acute Stroke and Large Vessel Occlusion

Stroke, 2020

Background and Purpose: Clinical methods have incomplete diagnostic value for early diagnosis of ... more Background and Purpose: Clinical methods have incomplete diagnostic value for early diagnosis of acute stroke and large vessel occlusion (LVO). Electroencephalography is rapidly sensitive to brain ischemia. This study examined the diagnostic utility of electroencephalography for acute stroke/transient ischemic attack (TIA) and for LVO. Methods: Patients (n=100) with suspected acute stroke in an emergency department underwent clinical exam then electroencephalography using a dry-electrode system. Four models classified patients, first as acute stroke/TIA or not, then as acute stroke with LVO or not: (1) clinical data, (2) electroencephalography data, (3) clinical+electroencephalography data using logistic regression, and (4) clinical+electroencephalography data using a deep learning neural network. Each model used a training set of 60 randomly selected patients, then was validated in an independent cohort of 40 new patients. Results: Of 100 patients, 63 had a stroke (43 ischemic/7 he...

Research paper thumbnail of Ten-Year experience with vertical rectus abdominis myocutaneous flap for reconstruction of abdominoperineal resection defects

JPRAS Open, 2021

We evaluate outcomes of our single center using vertical rectus abdominis myocutaneous (VRAM) fla... more We evaluate outcomes of our single center using vertical rectus abdominis myocutaneous (VRAM) flaps for reconstruction after abdominoperineal resection (APR). Our goal was to analyze factors that may affect perineal wound healing, a problematic complication with APR reconstructions due to location and high frequency of neoadjuvant chemoradiation. Methods: This single-center, retrospective study analyzed all VRAM flap perineal reconstruction patients after APR defect over a 10-year period (from July 2008 to June 2018). Outcome measures focused on factors that may affect perineal wound healing complication rates: cancer stage (I/II vs III/IV), neoadjuvant chemoradiation, surgeon's years in practice (< 5 years vs > 5 years), and pelvic closed suction drain use. Results: Twenty-eight patients met inclusion criteria. The overall major perineal wound complication rate was 14.3% (4 patients). Lack of perioperative closed suction pelvic drain use was associated with a significantly higher rate of major perineal wound complications (28.6% vs 0% and p = 0.031). All four major wound complications occurred in patients who did not have a pelvic drain. The major perineal wound complication rate for patients * Corresponding author.

Research paper thumbnail of The ENIGMA Stroke Recovery Working Group: Big data neuroimaging to study brain–behavior relationships after stroke

Human Brain Mapping, 2020

The goal of the Enhancing Neuroimaging Genetics through Meta-Analysis (ENIGMA) Stroke Recovery wo... more The goal of the Enhancing Neuroimaging Genetics through Meta-Analysis (ENIGMA) Stroke Recovery working group is to understand brain and behavior relationships using well-powered meta-and mega-analytic approaches. ENIGMA Stroke Recovery has data from over 2,100 stroke patients collected across 39 research studies and K01HD091283,

Research paper thumbnail of Factors contributing to cancer worry in the skin cancer population

Journal of the American Academy of Dermatology, 2019

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Research paper thumbnail of Patient-reported Aesthetic Satisfaction following Facial Skin Cancer Module Surgery Using the FACE-Q Skin Cancer

Plastic and Reconstructive Surgery - Global Open, 2019

BACKGROUND Over 5 million basal and squamous cell skin cancers are diagnosed in the United States... more BACKGROUND Over 5 million basal and squamous cell skin cancers are diagnosed in the United States each year. 1,2 Seventy to 80% of these cancers occur in the head and neck region, for which surgical excision is the standard of treatment. 3 Diagnosis and treatment can be stressful for patients and families, affecting psychosocial well-being, social interactions, and other aspects of health-related quality of life. 4,5 In addition, treatment of facial skin cancers can result in scars or physical disfigurement, which are particularly distressing. 6 Patients are concerned about changes in their facial appearance following reconstruction and desire meaningful data to help them better understand expected outcomes. 4,5,7 As patient satisfaction and quality of life are among the most important outcomes in plastic and reconstructive surgery, 5,8 understanding patient perceptions of aesthetic postoperative outcomes is critical. 9-11 Patient-reported outcome measures (PROMs) are questionnaires developed with direct input from patients.

Research paper thumbnail of Factors Influencing Access to Cochlear Implantation in Deaf and Hard-of-Hearing Children in Southern California

Otology & Neurotology, 2019

Objective: To determine the epidemiologic relationship of family demographics and educational res... more Objective: To determine the epidemiologic relationship of family demographics and educational resources with parental knowledge of and willingness for their children to receive cochlear implantation (CI) for deaf and hard-of-hearing (DHH) children. Methods: A total of 213 parents of DHH children were surveyed at local schools, specialized camps, and clinics in Southern California. Data on parents were solicited, including income, insurance status, education level, hearing status, primary language, and motivations towards CI. Results: Sixty-six surveys were included in the analysis. Three of these patients had already undergone CI, thus of the 63 children without CI, 59% had been presented with the option of CI by a healthcare professional and 27% were willing to have their child undergo CI. Willingness for children to undergo CI was statistically higher in families with an annual income less than 15,000ormorethan15,000 or more than 15,000ormorethan75,000 (p ¼ 0.02), and children enrolled in specialized schools for DHH (p ¼ 0.02). The leading reasons for unwillingness to undergo CI were risks of surgery (17%) and discouragement from others (14%). Conclusion: A significant gap exists between the number of CI candidates and families and willingness to undergo CI. The difference could be related to socioeconomic status and the patient's school type. This underscores the importance of parental education through the use of a multidisciplinary team to ensure all hearing rehabilitation options are explained.

Research paper thumbnail of Mesenchymal stem cell dysfunction in diabetes

Molecular Biology Reports, 2018

Diabetes mellitus (DM) is a chronic disease that results in a variety of systemic complications. ... more Diabetes mellitus (DM) is a chronic disease that results in a variety of systemic complications. Recently, stem cell-based therapies have been proposed as potential modalities to manage DM related complications. Mesenchymal stem cell (MSC) based therapies are often considered as an ideal stem cell-based treatment for DM management due to their immunosuppressive characteristics, anti-inflammatory properties and differentiation potential. While MSCs show tremendous promise, the underlying functional deficits of MSCs in DM patients is not well understood. Using the MEDLINE database to define these functional deficits, our search yielded 1826 articles of which 33 met our inclusion criteria. This allowed us to review the topic and illuminate four major molecular categories by which MSCs are compromised in both Type 1 DM and Type II DM models which include: (1) changes in angiogenesis/vasculogenesis, (2) altered pro-inflammatory cytokine secretion, (3) increased oxidative stress markers and (4) impaired cellular differentiation and decreased proliferation. Knowledge of the deficits in MSC function will allow us to more clearly assess the efficacy of potential biologic therapies for reversing these dysfunctions when treating the complications of diabetic disease.

Research paper thumbnail of A large, open source dataset of stroke anatomical brain images and manual lesion segmentations

Stroke is the leading cause of adult disability worldwide, with up to two-thirds of individuals e... more Stroke is the leading cause of adult disability worldwide, with up to two-thirds of individuals experiencing long-term disabilities. Large-scale neuroimaging studies have shown promise in identifying robust biomarkers (e.g., measures of brain structure) of long-term stroke recovery following rehabilitation. However, analyzing large rehabilitation-related datasets is problematic due to barriers in accurate stroke lesion segmentation. Manually-traced lesions are currently the gold standard for lesion segmentation on T1-weighted MRIs, but are labor intensive and require anatomical expertise. While algorithms have been developed to automate this process, the results often lack accuracy. Newer algorithms that employ machine-learning techniques are promising, yet these require large training datasets to optimize performance. Here we present ATLAS (Anatomical Tracings of Lesions After Stroke), an open-source dataset of 304 T1-weighted MRIs with manually segmented lesions and metadata. This...

Research paper thumbnail of Evaluating the Laboratory Risk Indicator to Differentiate Cellulitis from Necrotizing Fasciitis in the Emergency Department

The western journal of emergency medicine, 2017

Necrotizing fasciitis (NF) is an uncommon but rapidly progressive infection that results in gross... more Necrotizing fasciitis (NF) is an uncommon but rapidly progressive infection that results in gross morbidity and mortality if not treated in its early stages. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score is used to distinguish NF from other soft tissue infections such as cellulitis or abscess. This study analyzed the ability of the LRINEC score to accurately rule out NF in patients who were confirmed to have cellulitis, as well as the capability to differentiate cellulitis from NF. This was a 10-year retrospective chart-review study that included emergency department (ED) patients ≥18 years old with a diagnosis of cellulitis or NF. We calculated a LRINEC score ranging from 0-13 for each patient with all pertinent laboratory values. Three categories were developed per the original LRINEC score guidelines denoting NF risk stratification: high risk (LRINEC score ≥8), moderate risk (LRINEC score 6-7), and low risk (LRINEC score ≤5). All cases missing laboratory ...

Research paper thumbnail of Long non-coding RNAs in neurodevelopmental disorders

Frontiers in Molecular Neuroscience, 2013

Recent studies have emphasized an important role for long non-coding RNAs (lncRNA) in epigenetic ... more Recent studies have emphasized an important role for long non-coding RNAs (lncRNA) in epigenetic regulation, development, and disease. Despite growing interest in lncRNAs, the mechanisms by which lncRNAs control cellular processes are still elusive. Improved understanding of these mechanisms is critical, because the majority of the mammalian genome is transcribed, in most cases resulting in non-coding RNA products. Recent studies have suggested the involvement of lncRNA in neurobehavioral and neurodevelopmental disorders, highlighting the functional importance of this subclass of brain-enriched RNAs. Impaired expression of lnRNAs has been implicated in several forms of intellectual disability disorders. However, the role of this family of RNAs in cognitive function is largely unknown. Here we provide an overview of recently identified mechanisms of neuronal development involving lncRNAs, and the consequences of lncRNA deregulation for neurodevelopmental disorders.

Research paper thumbnail of Interactive Ipad-based Patient Education in Breast Reconstruction Planning

Plastic and Reconstructive Surgery - Global Open, 2020

METHODS: Metadata from publicly available Instagram posts containing #PlasticSurgery were collect... more METHODS: Metadata from publicly available Instagram posts containing #PlasticSurgery were collected from December 2018 through January 2020 through an API with Node.JS, an open source JavaScript runtime environment. All posts timestamped within the timeframe were included. Data collected from the posts included username, caption, engagement, time, and tagged location. We then designed and validated a classification algorithm to characterize the user associated with each post. The data were further processed and analyzed using the R programming language.

Research paper thumbnail of Long non-coding RNAs in neurodevelopmental disorders

Frontiers in Molecular Neuroscience, 2013