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Variation In Laboratory & Radiographic Workup And Outcome In Children Hospitalized With Common Musculoskeletal Infections, Emily Bonanni 2022 Children's Mercy Hospital

Variation In Laboratory & Radiographic Workup And Outcome In Children Hospitalized With Common Musculoskeletal Infections, Emily Bonanni

Research Days

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Background: Common pediatric musculoskeletal infections (MSKIs) require prompt recognition & treatment to prevent significant morbidity and mortality. Variation in initial workup of these infections & associations with clinical outcomes is not well studied and could aid development of evidence-based guidelines to provide high-value care for all MSKIs.

Objectives/Goal: Examine variation in initial lab testing & imaging obtained in patients hospitalized for common MSKIs and explore association with clinical outcomes (length of stay (LOS), cost, 30-day readmission).

Methods/Design: We performed a retrospective, multicenter cohort study of hospitalized children aged 6 months to 18 years with a diagnosis of acute osteomyelitis, septic arthritis or pyomyositis from 1/1/16 to 6/30/20 using the Pediatric Health Information System (PHIS) database. We collected rates of common lab testing (complete blood count [CBC], inflammatory marker [IM], blood culture) & radiographic studies (ultrasound [US], xray [XR], magnetic resonance imaging [MRI], computed tomography [CT] scan) obtained on hospital days 0 & 1. K-means clustering grouped hospitals based on frequency of which lab and imaging studies were obtained. Logistic regression was used to determine associations between overall cluster utilization & risk-adjusted patient outcomes.

Results: We identified 6597 children admitted from 44 hospitals with an included MSKI diagnosis. More than 50% were 2-10 years of age, with a majority being male (Table 1). Most children ( > 84%) had CBC or IM, with some variation across diagnoses. MRI and XR imaging were used most frequently (56 and 59%, respectively), also with variation across diagnoses (Table 1). Cluster 1 (n=15) showed slightly higher lab utilization and lower US use (Figure 1) with significantly shorter hospital LOS for patients with acute osteomyelitis (3.7 vs. 4.0 days, p-value 0.043; Table 2) but no significant difference in cost or readmission rates. There were no outcome differences for patients with septic arthritis or pyomyositis.

Conclusions: Despite a lack of universal practice guidelines in the work up & management of pediatric MSKIs, little variation existed in workup or outcomes across hospitals. This may be due to similar initial presentation of many MSKIs. Future investigation of differences in detailed patient-level clinical factors (e.g., lab results, vitals) on initial presentation or downstream hospital management could elucidate if associations with outcomes ...


Corticosteroid Wrist Injections Provide Better Symptomatic Relief Than Nocturnal Wrist Splints For Short Term Improvement Of Mild-To-Moderate Carpal Tunnel Syndrome, Christopher Bracken 2022 Wayne State University

Corticosteroid Wrist Injections Provide Better Symptomatic Relief Than Nocturnal Wrist Splints For Short Term Improvement Of Mild-To-Moderate Carpal Tunnel Syndrome, Christopher Bracken

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using

Chesterton LS, Blagojevic-Bucknall M, Burton C, et al. The clinical and cost-effectiveness of corticosteroid injection versus night splints for carpal tunnel syndrome (INSTINCTS trial): an open-label, parallel group, randomised controlled trial. Lancet. 2018;392(10156):1423-1433. https://doi.org/10.1016/S0140-6736(18)31572-1

for a patient requiring short-term relief from carpal tunnel syndrome.


Quadruped Gait And Regulation Of Apoptotic Factors In Tibiofemoral Joints Following Intra-Articular Rhprg4 Injection In Prg4 Null Mice, Daniel S. Yang, Edward E. Dickerson, Ling X. Zhang, Holly Richendrfer, Padmini N. Karamchedu, Gary A. Badger, Tannin A. Schmidt, Alger M. Fredericks, Khaled A. Elsaid, Gregory D. Jay 2022 Brown University

Quadruped Gait And Regulation Of Apoptotic Factors In Tibiofemoral Joints Following Intra-Articular Rhprg4 Injection In Prg4 Null Mice, Daniel S. Yang, Edward E. Dickerson, Ling X. Zhang, Holly Richendrfer, Padmini N. Karamchedu, Gary A. Badger, Tannin A. Schmidt, Alger M. Fredericks, Khaled A. Elsaid, Gregory D. Jay

Pharmacy Faculty Articles and Research

Camptodactyly-arthropathy-coxa vara-pericarditis (CACP) syndrome leads to diarthrodial joint arthropathy and is caused by the absence of lubricin (proteoglycan 4—PRG4), a surface-active mucinous glycoprotein responsible for lubricating articular cartilage. In this study, mice lacking the orthologous gene Prg4 served as a model that recapitulates the destructive arthrosis that involves biofouling of cartilage by serum proteins in lieu of Prg4. This study hypothesized that Prg4-deficient mice would demonstrate a quadruped gait change and decreased markers of mitochondrial dyscrasia, following intra-articular injection of both hindlimbs with recombinant human PRG4 (rhPRG4). Prg4−/− (N = 44) mice of both sexes were injected with rhPRG4 and ...


The Use Of Mobility And Medication On Patient’S Perception Of Pain In Hospitalized Patients With Chronic Back Pain Benchmark Study, Katherine E. Zaske Merenda Mrs., Katherine Merenda 2022 University of Texas at Tyler

The Use Of Mobility And Medication On Patient’S Perception Of Pain In Hospitalized Patients With Chronic Back Pain Benchmark Study, Katherine E. Zaske Merenda Mrs., Katherine Merenda

MSN Capstone Projects

According to Boss & Huether, twenty-nine percent of Americans have been diagnosed with chronic low back pain (CLBP). This pain can affect every part of their lives leading to lost wages and decreased quality of life. CLBP is an issue experienced by many hospitalized patients. These patients may not be able to mitigate their pain as they normally would due to safety protocols in hospital settings. Exercise or mobility has been shown to decrease a person’s perception of pain. The importance of exercise and mobility in a hospital setting to help decrease a patient’s perception of pain needs further ...


Efficacy And Safety Of Direct Oral Anticoagulants With And Without Aspirin: A Systematic Review And Meta-Analysis, Talal Almas, Adeena Musheer, Arooba Ejaz, Fahd Niaz Shaikh, Anousheh Awais Paracha, Fizza Raza, Maryam Sarwar Khan, Fahad Masood, Faiza Siddiqui, Muhammad Hasnain Mankani 2022 RCSI University of Medicine and Health Sciences

Efficacy And Safety Of Direct Oral Anticoagulants With And Without Aspirin: A Systematic Review And Meta-Analysis, Talal Almas, Adeena Musheer, Arooba Ejaz, Fahd Niaz Shaikh, Anousheh Awais Paracha, Fizza Raza, Maryam Sarwar Khan, Fahad Masood, Faiza Siddiqui, Muhammad Hasnain Mankani

Medical College Documents

Background: Various anticoagulant therapies are prescribed to patients under physicians' discretion and recently Direct Oral Anticoagulants(DOAC) have been under trials to evaluate their safety and efficacy. In addition to this, the regimen of DOACs and Aspirin is of keen interest as researchers continue to find an optimal regimen to treat blood clots in patients. This study is a systematic review and meta-analysis of randomized controlled trials and observational studies that asses the safety and efficacy of DOAC with and without Aspirin.
Methods: We queried MEDLINE and Cochrane CENTRAL from their inception to April 2021, for published and randomized ...


Dissecting Mutational Allosteric Effects In Alkaline Phosphatases Associated With Different Hypophosphatasia Phenotypes: An Integrative Computational Investigation, Fei Xiao, Ziyun Zhou, Xingyu Song, Mi Gan, Jie Long, Gennady M. Verkhivker, Guang Hu 2022 Soochow University

Dissecting Mutational Allosteric Effects In Alkaline Phosphatases Associated With Different Hypophosphatasia Phenotypes: An Integrative Computational Investigation, Fei Xiao, Ziyun Zhou, Xingyu Song, Mi Gan, Jie Long, Gennady M. Verkhivker, Guang Hu

Mathematics, Physics, and Computer Science Faculty Articles and Research

Hypophosphatasia (HPP) is a rare inherited disorder characterized by defective bone mineralization and is highly variable in its clinical phenotype. The disease occurs due to various loss-of-function mutations in ALPL, the gene encoding tissue-nonspecific alkaline phosphatase (TNSALP). In this work, a data-driven and biophysics-based approach is proposed for the large-scale analysis of ALPL mutations-from nonpathogenic to severe HPPs. By using a pipeline of synergistic approaches including sequence-structure analysis, network modeling, elastic network models and atomistic simulations, we characterized allosteric signatures and effects of the ALPL mutations on protein dynamics and function. Statistical analysis of molecular features computed for the ALPL ...


Outcome Measures In Facioscapulohumeral Muscular Dystrophy Clinical Trials, Mehdi Ghasemi, Charles P. Emerson Jr., Lawrence J. Hayward 2022 UMass Chan Medical School

Outcome Measures In Facioscapulohumeral Muscular Dystrophy Clinical Trials, Mehdi Ghasemi, Charles P. Emerson Jr., Lawrence J. Hayward

UMass Chan Medical School Faculty Publications

Facioscapulohumeral muscular dystrophy (FSHD) is a debilitating muscular dystrophy with a variable age of onset, severity, and progression. While there is still no cure for this disease, progress towards FSHD therapies has accelerated since the underlying mechanism of epigenetic derepression of the double homeobox 4 (DUX4) gene leading to skeletal muscle toxicity was identified. This has facilitated the rapid development of novel therapies to target DUX4 expression and downstream dysregulation that cause muscle degeneration. These discoveries and pre-clinical translational studies have opened new avenues for therapies that await evaluation in clinical trials. As the field anticipates more FSHD trials, the ...


Imyoblasts For Ex Vivo And In Vivo Investigations Of Human Myogenesis And Disease Modeling, Dongsheng Guo, Katelyn Daman, Jennifer Jc Chen, Meng-Jiao Shi, Jing Yan, Zdenka Matijasevic, Rene Maehr, Oliver D. King, Lawrence J. Hayward, Charles P. Emerson Jr. 2022 UMass Chan Medical School

Imyoblasts For Ex Vivo And In Vivo Investigations Of Human Myogenesis And Disease Modeling, Dongsheng Guo, Katelyn Daman, Jennifer Jc Chen, Meng-Jiao Shi, Jing Yan, Zdenka Matijasevic, Rene Maehr, Oliver D. King, Lawrence J. Hayward, Charles P. Emerson Jr.

UMass Chan Medical School Faculty Publications

Skeletal muscle myoblasts (iMyoblasts) were generated from human induced pluripotent stem cells (iPSCs) using an efficient and reliable transgene-free induction and stem cell selection protocol. Immunofluorescence, flow cytometry, qPCR, digital RNA expression profiling, and scRNA-Seq studies identify iMyoblasts as a PAX3+/MYOD1+ skeletal myogenic lineage with a fetal-like transcriptome signature, distinct from adult muscle biopsy myoblasts (bMyoblasts) and iPSC-induced muscle progenitors. iMyoblasts can be stably propagated for > 12 passages or 30 population doublings while retaining their dual commitment for myotube differentiation and regeneration of reserve cells. iMyoblasts also efficiently xenoengrafted into irradiated and injured mouse muscle where they undergo differentiation ...


Novel Gamma-Sarcoglycan Interactors In Murine Muscle Membranes, Tara C. Smith, Georgios Vasilakos, Scott A. Shaffer, Jason M. Puglise, Chih-Hsuan Chou, Elisabeth R. Barton, Elizabeth J. Luna 2022 University of Massachusetts Medical School

Novel Gamma-Sarcoglycan Interactors In Murine Muscle Membranes, Tara C. Smith, Georgios Vasilakos, Scott A. Shaffer, Jason M. Puglise, Chih-Hsuan Chou, Elisabeth R. Barton, Elizabeth J. Luna

Radiology Publications

BACKGROUND: The sarcoglycan complex (SC) is part of a network that links the striated muscle cytoskeleton to the basal lamina across the sarcolemma. The SC coordinates changes in phosphorylation and Ca(++)-flux during mechanical deformation, and these processes are disrupted with loss-of-function mutations in gamma-sarcoglycan (Sgcg) that cause Limb girdle muscular dystrophy 2C/R5.

METHODS: To gain insight into how the SC mediates mechano-signaling in muscle, we utilized LC-MS/MS proteomics of SC-associated proteins in immunoprecipitates from enriched sarcolemmal fractions. Criteria for inclusion were co-immunoprecipitation with anti-Sgcg from C57BL/6 control muscle and under-representation in parallel experiments with Sgcg-null muscle ...


Meeting Report: The 2021 Fshd International Research Congress, Sujatha Jagannathan, Jessica C. de Greef, Lawrence J. Hayward, Kyoko Yokomori, Davide Gabellini, Karlien Mul, Sabrina Sacconi, Jamshid Arjomand, June Kinoshita, Scott Q. Harper 2022 University of Colorado

Meeting Report: The 2021 Fshd International Research Congress, Sujatha Jagannathan, Jessica C. De Greef, Lawrence J. Hayward, Kyoko Yokomori, Davide Gabellini, Karlien Mul, Sabrina Sacconi, Jamshid Arjomand, June Kinoshita, Scott Q. Harper

UMass Chan Medical School Faculty Publications

Facioscapulohumeral muscular dystrophy (FSHD) is the second most common genetic myopathy, characterized by slowly progressing and highly heterogeneous muscle wasting with a typical onset in the late teens/early adulthood [1]. Although the etiology of the disease for both FSHD type 1 and type 2 has been attributed to gain-of-toxic function stemming from aberrant DUX4 expression, the exact pathogenic mechanisms involved in muscle wasting have yet to be elucidated [2-4]. The 2021 FSHD International Research Congress, held virtually on June 24-25, convened over 350 researchers and clinicians to share the most recent advances in the understanding of the disease mechanism ...


Patient Satisfaction With Care Is Associated With Better Outcomes In Function And Pain 1 Year After Lumbar Spine Surgery, Björn Knutsson, Bakir Kadum, Ted Eneqvist, Sebastian Mukka, Arkan S. Sayed-Noor 2022 Umeå University

Patient Satisfaction With Care Is Associated With Better Outcomes In Function And Pain 1 Year After Lumbar Spine Surgery, Björn Knutsson, Bakir Kadum, Ted Eneqvist, Sebastian Mukka, Arkan S. Sayed-Noor

Journal of Patient-Centered Research and Reviews

Purpose: There has been increasing interest in patient-reported experience measures (PREMs) to evaluate the patient experience and satisfaction with care. We conducted a prospective multicenter cohort study to determine any association between patients’ satisfaction of care and their outcomes 1 year after lumbar spine surgery.

Methods: Satisfaction with care was recorded through telephone interviews and a standardized questionnaire. Baseline data collection (300 patients) and 1-year follow-up (209 patients) were conducted through The Swedish National Register for Spine Surgery (Swespine). Exposures were patient experiences, health care professional (HCP) attitudes, shared decision-making, and overall satisfaction with care. Associations were evaluated using adjusted ...


Physical Activity Interventions In Children With Juvenile Idiopathic Arthritis: A Systematic Review Of Randomized Controlled Trials, Maura D. Iversen, Marie Andre, Johan von Heideken 2022 Sacred Heart University

Physical Activity Interventions In Children With Juvenile Idiopathic Arthritis: A Systematic Review Of Randomized Controlled Trials, Maura D. Iversen, Marie Andre, Johan Von Heideken

Physical Therapy Faculty Publications

Introduction: Children with juvenile arthritis (JA) experience pain, stiffness, fatigue, and decreased motion leading to difficulties with daily activities and low physical activity (PA). PA is critical to improve health and function and mitigate JA-associated symptoms. This study evaluated the evidence for PA interventions in children with JA.

Materials and methods: A systematic review of randomized controlled trials (RCTs) of PA interventions in children with JA was conducted. Ovid (Medline), Cochrane Library, EMBASE, and CINAHL databases were searched for papers published in English between 1/1/1946 and 9/1/2021. Studies which concurrently assessed medical interventions were excluded. Participant ...


Patient Perspectives On Health Care Provider Practices Leading To An Axial Spondyloarthritis Diagnosis: An Exploratory Qualitative Research Study, Kate L. Lapane, Catherine E. Dube, Katarina A. Ferrucci, Sara K. Khan, Kristine A. Kuhn, Esther Yi, Jonathan Kay, Shao-Hsien Liu 2021 University of Massachusetts Medical School

Patient Perspectives On Health Care Provider Practices Leading To An Axial Spondyloarthritis Diagnosis: An Exploratory Qualitative Research Study, Kate L. Lapane, Catherine E. Dube, Katarina A. Ferrucci, Sara K. Khan, Kristine A. Kuhn, Esther Yi, Jonathan Kay, Shao-Hsien Liu

Population and Quantitative Health Sciences Publications

BACKGROUND: The average time to a diagnosis for people with axial spondyloarthritis (axSpA) is 7-10 years. Delayed diagnosis may result in increased structural damage, worse physical function, and worse quality of life relative to patients with a timely axSpA diagnosis. Understanding patient experiences may provide insights for how to reduce diagnostic delays.

OBJECTIVE: To provide foundational knowledge about patient experiences with healthcare providers leading to an axSpA diagnosis.

METHODS: We conducted an exploratory qualitative research study with six focus groups interviews with participants recruited from three rheumatology clinics within the United States (MA (n = 3); CO (n = 2); PA (n ...


Minimizing Musculoskeletal Injury Risk In Health Care Professionals With Education On Safe Patient Handling, Aubrey Graves 2021 Murray State University

Minimizing Musculoskeletal Injury Risk In Health Care Professionals With Education On Safe Patient Handling, Aubrey Graves

Honors College Theses

Introduction: Nursing is a high-risk occupation for musculoskeletal injuries due to the strenuous activity of patient handling. These tasks include, assisting a patient in bed, moving a patient from the bed to a wheelchair, and assisting with walking. These work-related tasks can create a large amount of stress on the body, especially the back if proper technique is not utilized and/or if excessive loads are applied. The purpose of this study is to examine if teaching proper body mechanics and the dangers of not performing the tasks properly is an effective way of reducing musculoskeletal injuries.

Methods: The NUR ...


The Effect Of Twist1b And Twist2 Knockdown On Tgf-Beta Signaling Expression In Tendon Progenitors, Marinia N. Bishay 2021 Belmont University

The Effect Of Twist1b And Twist2 Knockdown On Tgf-Beta Signaling Expression In Tendon Progenitors, Marinia N. Bishay

Honors Theses

Somites are important mesoderm structures that form in regularly timed intervals from the anterior end of the paraxial mesoderm at the end of gastrulation during embryogenesis. Cells of the ventromedial portion of the somite, the sclerotome, undergo epithelial to mesenchymal transition, surround the notochord, and give rise to connective tissues of the axial skeleton including the vertebrae, tendons, and ligaments. We are interested in understanding how the sclerotome is compartmentalized into the region that makes tendons. Genes expressed in the sclerotome, twist1 and twist2, are likely involved in the downstream differentiation of sclerotome to tendon progenitors. Previous studies have shown ...


Investigating The Role Of The Skeletal Muscle In Amyotrophic Lateral Sclerosis Neuromuscular Junction Dysfunction, Agnes Badu-Mensah 2021 University of Central Florida

Investigating The Role Of The Skeletal Muscle In Amyotrophic Lateral Sclerosis Neuromuscular Junction Dysfunction, Agnes Badu-Mensah

Electronic Theses and Dissertations, 2020-

Neuromuscular junction (NMJ) dysfunction has been identified as one of the earliest events in Amyotrophic Lateral Sclerosis (ALS) pathology. However, which tissue type induces NMJ disruption; be it the motoneurons (hMN), Schwann cells or skeletal muscle (hSKM) remains unresolved. While mechanisms by which ALS hMN contribute to NMJ dysfunction are well-described in literature, limited information exist on how the other tissue types in the tripartite synapse (hSKM and Schwann cells) induce and/or contribute to ALS NMJ disruption. A fair understanding of the role of each tissue type in NMJ dysfunction would help shape the trajectory of future ALS research ...


Conservative Management Of Low Back Pain, Se Won Lee, Dan Nguyen, Denny Mack, Eric Aguila, Mary Thomas, Karyn Doddy 2021 MountainView Medical Center-Nevada

Conservative Management Of Low Back Pain, Se Won Lee, Dan Nguyen, Denny Mack, Eric Aguila, Mary Thomas, Karyn Doddy

HCA Healthcare Journal of Medicine

Low back pain (LBP) is frequently encountered in outpatient clinics and affects individual patients and society in general with decreased physical function, quality of life, disability, and/or economic burden. Although most acute LBP resolves on its own, recurrent and chronic LBP is a common reason for outpatient clinic visits. This review explores pragmatic approaches to LBP in the clinical setting, focusing on recognizing prognostic factors, initial approaches to evaluation, including selective imaging, and conservative management including patient education, therapeutic exercises and bracing.


Accelerometer-Determined Physical Behavior Metrics And Their Associations With Sarcopenia Among Oldest-Old Adults, Eric M. Eberl 2021 University of Massachusetts Amherst

Accelerometer-Determined Physical Behavior Metrics And Their Associations With Sarcopenia Among Oldest-Old Adults, Eric M. Eberl

Masters Theses

INTRODUCTION: Sarcopenia is a loss of muscle function and muscle mass which frequently occurs among the oldest-old adult population (aged 85+ years). The analysis of accelerometer-determined physical behavior volumes and patterns of oldest-old adults might provide novel insights into the associations with sarcopenia and its components. METHODS: A total of 145 participants in the primary sample and 87 participants in the subsample with a mean age of 88.2 (2.5) years from the Health, Aging, and Body Composition study cohort provided cross-sectional data of handgrip strength, appendicular lean mass, gait speed, and accelerometry. Probable, confirmed, and severe sarcopenia were ...


Applicability Of Small-Molecule Inhibitors In The Study Of Peptidyl Arginine Deiminase 2 (Pad2) And Pad4, Maria Teresa. Martin Monreal, Alexandra Stripp Rebak, Laura Massarenti, Santanu Mondal, Ladislav Senolt, Niels Odum, Michael L. Nielsen, Paul R. Thompson, Claus H. Nielsen, Dres Damgaard 2021 Copenhagen University Hospital

Applicability Of Small-Molecule Inhibitors In The Study Of Peptidyl Arginine Deiminase 2 (Pad2) And Pad4, Maria Teresa. Martin Monreal, Alexandra Stripp Rebak, Laura Massarenti, Santanu Mondal, Ladislav Senolt, Niels Odum, Michael L. Nielsen, Paul R. Thompson, Claus H. Nielsen, Dres Damgaard

UMass Chan Medical School Faculty Publications

Citrullination, the conversion of peptidyl-arginine into peptidyl-citrulline, is involved in the breakage of self-tolerance in anti-CCP-positive rheumatoid arthritis. This reaction is catalyzed by peptidyl arginine deiminases (PADs), of which PAD2 and PAD4 are thought to play key pathogenic roles. Small-molecule PAD inhibitors such as the pan-PAD inhibitor BB-Cl-amidine, the PAD2-specific inhibitor AFM-30a, and the PAD4-specific inhibitor GSK199 hold therapeutic potential and are useful tools in studies of citrullination. Using an ELISA based on the citrullination of fibrinogen, we found that AFM-30a inhibited the catalytic activity of PADs derived from live PMNs or lysed PBMCs and PMNs and of PADs in ...


Rhabdomyolysis And Covid-19, Brett T. Swanson 2021 Gettysburg College

Rhabdomyolysis And Covid-19, Brett T. Swanson

Student Publications

This paper seeks to summarize recent research findings concerning the link between rhabdomyolysis and COVID-19. While most commonly known as a respiratory disease, COVID-19 has strong direct effects on the kidneys which presents a serious challenge to treatment and care of patients. New research also suggests that COVID-19 directly damages skeletal muscle tissue as well, and rhabdomyolysis induced as a result of viral attack or secondary factors can also place major strain on the kidneys. Both COVID-19 and rhabdomyolysis can lead to acute kidney injury on their own, and their combined effects can present severe clinical complications. This body of ...


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