Epidermal growth factor preserves myelin and promotes astrogliosis after intraventricular hemorrhage.

Intraventricular hemorrhage (IVH) leads to reduced myelination and astrogliosis of the white matter in premature infants. No therapeutic strategy exists to minimize white matter injury in survivors with IVH. Epidermal growth factor (EGF) enhances myelination, astrogliosis, and neurologic recovery in animal models of white matter injury. Here, we hypothesized that recombinant human (rh) EGF treatment would enhance oligodendrocyte precursor cell (OPC) maturation, myelination, and neurological recovery in preterm rabbits with IVH. In addition, rhEGF would promote astrogliosis by inducing astroglial progenitor proliferation and GFAP transcription. We tested these hypotheses in a preterm rabbit model of IVH and evaluated autopsy samples from human preterm infants. We found that EGF and EGFR expression were more abundant in the ganglionic eminence relative to the cortical plate and white matter of human infants and that the development of IVH reduced EGF levels, but not EGFR expression. Accordingly, rhEGF treatment promoted proliferation and maturation of OPCs, preserved myelin in the white matter, and enhanced neurological recovery in rabbits with IVH. rhEGF treatment inhibited Notch signaling, which conceivably contributed to OPC maturation. rhEGF treatment contributed to astrogliosis by increasing astroglial proliferation and upregulating GFAP as well as Sox9 expression. Hence, IVH results in a decline in EGF expression; and rhEGF treatment preserves myelin, restores neurological recovery, and exacerbates astrogliosis by inducing proliferation of astrocytes and enhancing transcription of GFAP and Sox9 in pups with IVH. rhEGF treatment might improve the neurological outcome of premature infants with IVH. GLIA 2016;64:1987-2004.

Social Media Use Among Hand Surgeons.

Background: Recently social media use within healthcare has increased significantly. Today, it is common for patients to browse the Internet, including physicians' social media pages, to learn about their medical conditions and search for providers. The purpose of this study is to analyze the use of social media among hand surgeons, and to compare this use between academic and private surgeons. Methods: Using the American Society for Surgery of the Hand's (ASSH) online directory, all active members practicing within the ten most populated U.S. cities were identified. Social media presence was determined by an Internet search of platforms. Members were stratified by practice model (academic vs. private). Chi-square and t-tests were used to compare categorical and continuous variables, and a multivariable logistic regression was performed for the binary variable practice model. Results: Two hundred and fifty-six hand surgeons were identified with 150 (59%) in academic and 106 (41%) in private practice. For ResearchGate accounts, 51 (82%) were academic and 11 (18%) were private. Mean PubMed publications was 38 for academic and 9 for private. YouTube presence was 69 (70%) in academic and 29 (30%) in private. On multivariable analysis, the odds of having ResearchGate and YouTube presence were higher for academic practice. There was no statistically significant difference by practice type for Facebook, Twitter, LinkedIn, and Instagram. Conclusions: With the recent social media expansion, surgeons have adopted social media platforms to reach patients. While the literature has shown that private practices are more active in social media, our results show they are not more active than academic practices in the ten most populated U.S. cities. Level of Evidence: IV.

Risk Stratification Algorithm for Orthopedic Trauma Patients at Risk for Fat Embolism Syndrome.

BACKGROUND: Fat embolism syndrome (FES) is commonly reported in the setting of long bone and pelvic fractures, but the etiology and pathogenesis are unclear. The aim of this study was to identify clinical characteristics and laboratory findings that may place orthopedic trauma patients at a higher risk of developing FES. METHODS: Electronic medical records were reviewed of all patients aged 18-89 years from 2015 to 2020 with a mention of FES in the patient chart who met Gurd and Wilson's criteria for diagnosis after experiencing orthopedic trauma. A 3:1 matched pair analysis was performed between FES patients and those with similar age, gender, and FES-associated fracture (femur, tibia, humerus, or pelvis fracture). RESULTS: 18 patients with FES who met inclusion criteria were identified. Hypomagnesemia (OR = 7.43), hyperphosphatemia (OR = 6.24), hypoalbuminemia (OR = 3.78), blunt traumatic mechanism of injury (OR = 7.16) and a greater number of bones fractured (Avg/SD = 2.89/1.53) were seen more often in FES patients (all p-values < 0.05). CONCLUSION: Findings of this study suggest that patients with hypomagnesemia, hyperphosphatemia, hypoalbuminemia, a blunt trauma mechanism of injury, and an increased number of bones fractured are at increased risk for the development of FES. This may be related to their roles in physiologic oncotic pressure and inflammatory response, and thus further investigation of these variables is necessary for the evaluation of FES prevention. LEVEL OF EVIDENCE: Level 3.

The effects of the COVID-19 pandemic on patients with obesity undergoing bariatric care.

BACKGROUND: Patients with obesity are at increased risk of developing severe COVID-19. The pandemic has caused delays in preoperative preparation, progression, and completion of bariatric surgeries. OBJECTIVES: The aim of this study was to evaluate the impact of COVID-19 restrictions on bariatric surgery patients and assess their concern of COVID-19 as they continue the preoperative process. SETTING: Philadelphia, Pennsylvania METHODS: A questionnaire was administered to patients to assess the impact of COVID-19 on their weight loss goals, physical activity, and diet. Time points assessed were initial bariatric consultation (T1), as well as the beginning (T2), and the end (T3) of lockdown restrictions in the region. RESULTS: Seventy-four participants were invited and 50 completed the survey, for a response rate of 67.6%. The average age of participants was 44.1 years. Two-thirds of patients reported significant concern that COVID-19 would affect their weight loss goals. Patients reported significant improvements in their diet from T1 to T2 (P < .01). However, at T3, some patients returned to behaviors held at T1, with snacking behaviors significantly increasing between T2 and T3 (P < .01). Physical activity decreased in 60% of patients between T2 to T3. The vast majority (90%) wanted to have their surgery as soon as possible; 56% reported low levels of concern for COVID-19 infection. CONCLUSION: Bariatric patients were highly motivated to proceed with bariatric surgery despite the risks imposed by the pandemic.