Medical Specialties Commons^™

Cricopharyngeal Myotomy In National Surgical Quality Improvement Program (Nsqip): Complications For Otolaryngologists Versus Non-Otolaryngologists, Ellen M. Piccillo, David Adkins, Mohamed Elrakhawy, Michele M. Carr

Otolaryngology--Head & Neck Surgery Resident Research

OBJECTIVE: Comparing outcomes after cricopharyngeal myotomy (CM) performed by otolaryngologists (OTO) and non-otolaryngologists (NO).

METHODS: A retrospective analysis of the 2014-19 ACS-NSQIP database (American College of Surgeons National Surgical Quality Improvement Program) of patients who underwent open CM (CPT code 43030) as their primary procedure. Analyzed variables include medical comorbidities, operative time, the total length of stay, readmission, reoperation, concurrent procedures, postoperative complications, and postoperative diagnoses. 183 patients were included, 97 (53%) females and 86 (47%) males. 120 had surgery by OTO and 63 by NO.

RESULTS: There were no differences in preoperative morbidity. OTO had more outpatient surgeries compared …

Agents Of Exposure In Transgender Patient Cases Managed By A Toxicologist: An Analysis Of The Toxicology Investigator’S Consortium (Toxic) Registry, Gillian A. Beauchamp Md, Olivia A. Hardy, Alexandra M. Amaducci, Judith N. Sabino, Beth Careyva, Matthew D. Cook Do, Kenneth D. Katz Md, Marna Greenberg Do, Mph, Ryan M Surmaitis Do, Andrew Koons, Joseph B. Zackary Md

Department of Family Medicine

No abstract provided.

Prediction Of Fall Risk Among Community-Dwelling Older Adults Using A Wearable System, Thurmon Lockhart, Rahul Soangra, Hyunsoo Yoon, Teresa Wu, Christopher W. Frames, Raven Weaver, Karen A. Roberto

Physical Therapy Faculty Articles and Research

Falls are among the most common cause of decreased mobility and independence in older adults and rank as one of the most severe public health problems with frequent fatal consequences. In the present study, gait characteristics from 171 community-dwelling older adults were evaluated to determine their predictive ability for future falls using a wearable system. Participants wore a wearable sensor (inertial measurement unit, IMU) affixed to the sternum and performed a 10-m walking test. Measures of gait variability, complexity, and smoothness were extracted from each participant, and prospective fall incidence was evaluated over the following 6-months. Gait parameters were refined …

The Factors Influencing Cesarean-Section Rates-A Narrative Review From Pakistan, Bakhtawar M H. Khowaja, Farida Bibi Mughal, Komal Valliani

Department of Obstetrics & Gynaecology

The significant increase in the rate of cesarean section is a major public health issue. The World Health Organization recommends C-section rates not to be greater than 10% and not lower than 5% as both the indicated limits can adversely affect maternal and newborn health. The rate of C-section deliveries is 22% according to recent Pakistan demographics and Health Survey of 2017-2018. This study contributes to the existing literature by examining the factors influencing high C-section rates in Pakistan. A narrative review of published literature between 2000 to 2020, on “factors influencing C-section rates in Pakistan” was done. The findings …

Outcomes Of A Positive Patient Id Campaign At A Pediatric Quaternary Care Center, Taylor Kim Md, Arjun M. Dangre Bds Mph, Andrea L. Davis Mph Cic, Betty J. Reeves Mha, Mt (Ascp), Omobola T. Durojaiye Msn, Rn-Bc

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Introduction. Positive patient identification (PPID) is critical to safe and accurate labeling of patient lab specimens. Accurate PPID is also an important priority of The Joint Commission’s National Safety Goals. Inadequate PPID compromises may lead to waste of time and resources, and in the worst-case scenario can lead to significant patient morbidity and mortality. With a focus on PPID, this initiative examined the occurrence of mislabeled and unlabeled lab specimens as well as compliance with wearing ID bands in a cohort of hematology/oncology and bone marrow transplant inpatients at a large pediatric quaternary care center.

Methods. Using the Plan-Do-Study-Act Model, …

Energy Compensation And Adiposity In Humans, Vincent Careau, Lewis G Halsey, Herman Pontzer, Philip N Ainslie, Lene F Andersen, Liam J Anderson, Lenore Arab, Issad Baddou, Kweku Bedu-Addo, Ellen E Blaak, Stephane Blanc, Alberto G Bonomi, Carlijn V C Bouten, Maciej S Buchowski, Nancy F Butte, Stefan G J A Camps, Graeme L Close, Jamie A Cooper, Sai Krupa Das, Richard Cooper, Lara R Dugas, Simon D Eaton, Ulf Ekelund, Sonja Entringer, Terrence Forrester, Barry W Fudge, Annelies H Goris, Michael Gurven, Catherine Hambly, Asmaa El Hamdouchi, Marije B Hoos, Sumei Hu, Noorjehan Joonas, Annemiek M Joosen, Peter Katzmarzyk, Kitty P Kempen, Misaka Kimura, William E Kraus, Robert F Kushner, Estelle V Lambert, William R Leonard, Nader Lessan, Corby K Martin, Anine C Medin, Erwin P Meijer, James C Morehen, James P Morton, Marian L Neuhouser, Theresa A Nicklas, Robert M Ojiambo, Kirsi H Pietiläinen, Yannis P Pitsiladis, Jacob Plange-Rhule, Guy Plasqui, Ross L Prentice, Roberto A Rabinovich, Susan B Racette, David A Raichlen, Eric Ravussin, John J Reilly, Rebecca M Reynolds, Susan B Roberts, Albertine J Schuit, Anders M Sjödin, Eric Stice, Samuel S Urlacher, Giulio Valenti, Ludo M Van Etten, Edgar A Van Mil, Jonathan C K Wells, George Wilson, Brian M Wood, Jack Yanovski, Tsukasa Yoshida, Xueying Zhang, Alexia J Murphy-Alford, Cornelia U Loechl, Amy H Luke, Jennifer Rood, Hiroyuki Sagayama, Dale A Schoeller, William W Wong, Yosuke Yamada, John R Speakman, Iaea Dlw Database Group

Children’s Nutrition Research Center Staff Publications

Understanding the impacts of activity on energy balance is crucial. Increasing levels of activity may bring diminishing returns in energy expenditure because of compensatory responses in non-activity energy expenditures.

Allografts For Skin Closure During In Utero Spina Bifida Repair In A Sheep Model, Lovepreet K Mann, Jong Hak Won, Rajan Patel, Eric P Bergh, Jeannine Garnett, Meenakshi B Bhattacharjee, Ponnada A Narayana, Ranu Jain, Stephen A Fletcher, Dejian Lai, Ramesha Papanna

Faculty, Staff and Student Publications

OBJECTIVES: Use of off-label tissue graft materials, such as acellular dermal matrix (ADM), for in utero repair of severe spina bifida (SB), where primary skin layer closure is not possible, is associated with poor neurological outcomes. The cryopreserved human umbilical cord (HUC) patch has regenerative, anti-inflammatory, and anti-scarring properties, and provides watertight SB repair. We tested the hypothesis that the HUC is a superior skin patch to ADM for reducing inflammation at the repair site and preserving spinal cord function.

METHODS: In timed-pregnant ewes with twins, on gestational day (GD) 75, spina bifida was created without a myelotomy (functional model). …

Stroke Care In Pakistan, Anjum Farooq, Narayanaswamy Venketasubramanian, Mohammad Wasay

Section of Neurology

Increasing incidence of stroke and lack of infrastructure in both urban and rural areas needs immediate attention in Pakistan. There is a high proportion of young stroke with poor stroke outcomes. Acute stroke care is scarce in Pakistan due to the small number of neurologists (1 neurologist per 1 million population), few stroke units, and limited availability of alteplase (recombinant tissue plasminogen activator) in the country.

A Rare Case Of Acute Hepatitis C Causing Coagulopathy And Severe Transaminitis, Timothy Kuchera, Md, Muyi Li, Md, Corey O'Brien, Md

Department of Medicine Posters

• Although Hepatitis C (HCV) is extremely common, diagnosis of acute HCV is as rare as it is typically asymptomatic.
• The following is an uncommon presentation of symptomatic acute HCV resulting in sepsis, transaminitis, jaundice, and coagulopathy.

Hyperckemia : Psychosis-Induced Non-Traumatic Rhabdomyolysis, Mackenzie Kramer, Joann Butkus, Vincent Chan, Nathaniel Rosal, Stephanie Tzarnas, Eunha Kim

Abington Jefferson Health Posters

Rhabdomyolysis is a clinical syndrome that results from skeletal muscle breakdown and the release of intracellular enzymes into systemic circulation. We present a case of transaminitis and serum Creatinine Kinase (CK) levels exceeding 590,000 U/L without myoglobinuria or subsequent Acute Kidney Injury (AKI) after an acute psychotic episode. Case reports regarding such extreme serum CK elevations without myoglobinuria or ensuing renal failure in a non-traumatic case of rhabdomyolysis are minimal.

Metastatic Choriocarcinoma In A Young Woman Presenting As Thyroid Storm: A Case Report, Muhammad Saleem, Sher Sethi, Abrar Ali, Zareen Kiran,

Department of Medicine

Background: Thyroid storm is an endocrine emergency and life-threatening condition discovered in 1926. There is no specific laboratory parameter that can differentiate or distinguish between thyroid storm and primary hyperthyroidism. Diagnosis is made on a clinical scoring system, including the Burch-Wartofsky point scale and Japanese Thyroid Association scoring system. The management is early diagnosis, immediate initiation of anti-thyroid medications, intensive care monitoring, and prevention of multiorgan failure.
Case presentation: A 30-year-old Pakistani female presented with complaint of headache, vomiting, and generalized weakness for 3 weeks. She had an episode of seizure-like activity at home, and so was rushed to the …

Clinical Challenges In The Diagnosis And Treatment In Neurosarcoidosis And Neurosyphilis, Mackenzie Kramer, Melissa Margolis, Neelima Manda, Rehan Saeed, Stephanie Tzarnas, Nathaniel R. Rosal, Daniel Puga, Rebecca Fallis

Abington Jefferson Health Posters

Syphilis and sarcoidosis, both known as the "great mimickers," cause a wide range of symptoms making clinical differentiation between the two difficult.

We present a case in which both neurosarcoidosis and neurosyphilis were considered in the differential diagnosis, posing a unique challenge in decision making.

Radiolucent Mechanical Valve: Chest Radiography Conundrum, Mohamad S. Alabdaljabar, Genya Turgul, Adelaide M. Arruda-Olson, Jeffrey B. Geske

Journal of the Saudi Heart Association

No abstract provided.

Pharmacy Students As Volunteer Medical Staff For American Diabetes Association Summer Camp, Emily Harvath

Purdue Journal of Service-Learning and International Engagement

For children living with a diagnosis of diabetes, com-munity support and education about proper disease management are critical for the mental and physical health of the child and their family. The experiences offered at summer camps hosted by the American Diabetes Association address both of these needs for the pediatric diabetes community. These camps provide children with the opportunity to participate in a traditional camp experience—swimming, rock climbing, tubing, and more—while giving parents peace of mind in the knowledge that their child’s diabetes will be closely monitored by a team of health care professionals. During my time as volunteer medical …

Super-Resolution Microscopy Reveals Photoreceptor-Specific Subciliary Location And Function Of Ciliopathy-Associated Protein Cep290, Valencia L Potter, Abigail R Moye, Michael A Robichaux, Theodore G Wensel

Faculty, Staff and Students Publications

Mutations in the cilium-associated protein CEP290 cause retinal degeneration as part of multiorgan ciliopathies or as retina-specific diseases. The precise location and the functional roles of CEP290 within cilia and, specifically, the connecting cilia (CC) of photoreceptors, remain unclear. We used super-resolution fluorescence microscopy and electron microscopy to localize CEP290 in the CC and in the primary cilia of cultured cells with subdiffraction resolution and to determine effects of CEP290 deficiency in 3 mutant models. Radially, CEP290 localizes in close proximity to the microtubule doublets in the region between the doublets and the ciliary membrane. Longitudinally, it is distributed throughout …

Effectiveness Of Pfizer-Biontech Mrna Vaccination Against Covid-19 Hospitalization Among Persons Aged 12-18 Years - United States, June-September 2021., Samantha M. Olson, Margaret M. Newhams, Natasha B. Halasa, Ashley M. Price, Julie A. Boom, Leila C. Sahni, Katherine Irby, Tracie C. Walker, Stephanie P. Schwartz, Pia S. Pannaraj, Aline B. Maddux, Tamara T. Bradford, Ryan A. Nofziger, Benjamin J. Boutselis, Melissa L. Cullimore, Elizabeth H. Mack, Jennifer E. Schuster, Shira J. Gertz, Natalie Z. Cvijanovich, Michele Kong, Melissa A. Cameron, Mary A. Staat, Emily R. Levy, Brandon M. Chatani, Kathleen Chiotos, Laura D. Zambrano, Angela P. Campbell, Manish M. Patel, Adrienne G. Randolph, Overcoming Covid-19 Investigators

Manuscripts, Articles, Book Chapters and Other Papers

Pfizer-BioNTech COVID-19 vaccine is authorized for use in children and adolescents aged 12-15 years and is licensed by the Food and Drug Administration (FDA) for persons aged ≥16 (1). A randomized placebo-controlled trial demonstrated an efficacy of 100% (95% confidence interval [CI] = 75.3%-100%) in preventing outpatient COVID-19 in persons aged 12-15 years (2); however, data among adolescents on vaccine effectiveness (VE) against COVID-19 in real-world settings are limited, especially among hospitalized patients. In early September 2021, U.S. pediatric COVID-19 hospitalizations reached the highest level during the pandemic (3,4). In a test-negative, case-control study at 19 pediatric hospitals in 16 …

Diagnostic Accuracy Of Dobutamine Stress Echocardiography For Detection Of Cardiac Allograft Vasculopathy In Orthotopic Heart Transplant Patients, Mohammed Mahmoodurrahman, Josef Marek, Talal Al Otaibi, Vera Maria Cury Salemi, Najmeddine Echahidi, Jehad Al Buraiki, Bahaa M. Fadel, Dania Mohty

Journal of the Saudi Heart Association

Objective Cardiac allograft vasculopathy is one of the leading causes of late graft failure and subsequent death in orthotopic heart transplant. Although invasive coronary angiography is the gold standard modality for detection of cardiac allograft vasculopathy, dobutamine stress echocardiography has been recently frequently used as an alternative. Our aim was to evaluate the diagnostic performance of dobutamine stress echocardiography for detection of cardiac allograft vasculopathy in transplant patients. Methods A retrospective analysis was conducted using a total of 150 dobutamine stress echocardiographic exams that were performed on 99 patients in our institution, with paired coronary angiogram and no acute rejection, …

The Impact Of The Covid-19 Pandemic On Newborn Hearing Screening Programs In Western States, Nathan A. Blaseg, Hannah M. Williams, Shelby Jepperson, Jessica J. Messersmith

Journal of Early Hearing Detection and Intervention

The primary objective of this study was to determine the impact of the COVID-19 pandemic on newborn hearing screening guideline adherence and the respective rates of screening, diagnosis, and intervention. This was a review of newborn hearing screening data compiled from the Departments of Health of six states for the time periods of March-September 2019 and March-September 2020. Endpoints included the numbers of live births as well as the numbers and timeframes of screening, diagnostic, and intervention events. Two-tailed paired t-tests were performed to determine statistical significance. 181,662 births in six states were assessed. Compared to March-September 2019, March-September 2020 …

Should Covid Vaccination Be Required In Heart Transplantation & Left Ventricular Assist Device Implantation?, Mustafa M. Ahmed, Manjula G. Ananthram, Susan M. Joseph

The VAD Journal

This letter to the editor does not have an abstract.

Improved Radiation Expression Profiling In Blood By Sequential Application Of Sensitive And Specific Gene Signatures, Eliseos J. Mucaki, Ben C. Shirley, Peter K. Rogan

Biochemistry Publications

Purpose. Combinations of expressed genes can discriminate radiation-exposed from normal control blood samples by machine learning based signatures (with 8 to 20% misclassification rates). These signatures can quantify therapeutically-relevant as well as accidental radiation exposures. The prodromal symptoms of Acute Radiation Syndrome (ARS) overlap those present in Influenza and Dengue Fever infections. Surprisingly, these human radiation signatures misclassified gene expression profiles of virally infected samples as false positive exposures. The present study investigates these and other confounders, and then mitigates their impact on signature accuracy.

Methods. This study investigated recall by previous and novel radiation signatures independently derived …

Pairwise Correlation Analysis Of The Alzheimer’S Disease Neuroimaging Initiative (Adni) Dataset Reveals Significant Feature Correlation, Erik D. Huckvale, Matthew W. Hodgman, Brianna B. Greenwood, Devorah O. Stucki, Katrisa M. Ward, Mark T. W. Ebbert, John S. K. Kauwe, The Alzheimer’S Disease Neuroimaging Initiative, The Alzheimer’S Disease Metabolomics Consortium, Justin B. Miller

Sanders-Brown Center on Aging Faculty Publications

The Alzheimer’s Disease Neuroimaging Initiative (ADNI) contains extensive patient measurements (e.g., magnetic resonance imaging [MRI], biometrics, RNA expression, etc.) from Alzheimer’s disease (AD) cases and controls that have recently been used by machine learning algorithms to evaluate AD onset and progression. While using a variety of biomarkers is essential to AD research, highly correlated input features can significantly decrease machine learning model generalizability and performance. Additionally, redundant features unnecessarily increase computational time and resources necessary to train predictive models. Therefore, we used 49,288 biomarkers and 793,600 extracted MRI features to assess feature correlation within the ADNI dataset to determine the …

Therapeutic Resistance In Pancreatic Ductal Adenocarcinoma: Current Challenges And Future Opportunities, Aditi Jain, Phd, Vikas Bhardwaj

Kimmel Cancer Center Faculty Papers

Pancreatic ductal adenocarcinoma (PDAC) is the third leading cause of cancerrelated deaths in the United States. Although chemotherapeutic regimens such as gemcitabine+ nab-paclitaxel and FOLFIRINOX (FOLinic acid, 5-Fluroruracil, IRINotecan, and Oxaliplatin) significantly improve patient survival, the prevalence of therapy resistance remains a major roadblock in the success of these agents. This review discusses the molecular mechanisms that play a crucial role in PDAC therapy resistance and how a better understanding of these mechanisms has shaped clinical trials for pancreatic cancer chemotherapy. Specifically, we have discussed the metabolic alterations and DNA repair mechanisms observed in PDAC and current approaches in targeting …

Complications After Surgical Repair Of Congenital Heart Disease In Infants. An Experience From Tertiary Care Center, Farrukh Javed, Nabil Abdulrahman Aleysae, Abdulmajid Yahya Al-Mahbosh, Amal Ali Zubani, Ali Mohammed Atash, Hanan Bin Salem, Mohamed Abdallah, Omaima Alkhatib, Ashraf Abu-Adas, Maymoona Abdelmouz Hrays, Nawal Ali Alqarni, Alla Felemban, Saad Abdullah Alsaedi, Ahmed Abdullah Jamjoom

Journal of the Saudi Heart Association

Objectives. This study aimed to describe the incidence and spectrum of postoperative complications in infants who underwent their first cardiac surgery for the repair of congenital heart diseases. Methods. This is a single-center retrospective study. Data of infants admitted to King Faisal Specialist Hospital & Research Center; Jeddah; Saudi Arabia, from January 2015 to December 2019 who underwent the first cardiac procedure for congenital heart disease at an age of less than 3 months, were analyzed. The primary outcome is the prevalence and spectrum of postoperative complications during hospitalization. Data were analyzed by using descriptive and analytical statistics using SAS …

Simultaneous Bicarotid And Microscope-Assisted Coronary Revascularization As An Individual Surgical Strategy, Andrey N. Semchenko

Journal of the Saudi Heart Association

A 59-year-old man presented with complaints of giddiness caused by changes in body position, an unsteady gait, daily episodes of vision loss, breathlessness, and chest pain flowing minor physical exertion. Computed tomography revealed an occlusion of the right common carotid artery, a critical stenosis of the left common carotid artery, and a significant stenosis of the left internal carotid artery. A coronarography detected a stenosis of the left main trunk and a triple coronary artery obstructive disease. A simultaneous aortic-bicarotid bifurcation prosthesis and coronary artery bypass grafting were performed. The patient showed a satisfactory postoperative outcome.

Simultaneous Monitoring Cytoplasmic Calcium Ion And Cell Surface Phosphatidylserine In The Necrotic Touch Neurons Of Caenorhabditis Elegans, Yoshitaka Furuta, Zheng Zhou

Faculty, Staff and Students Publications

Calcium ions trigger many cellular events, including the release of neurotransmitters at the synaptic terminal and excitotoxic cell death. Recently, we have discovered that a transient increase in the level of cytoplasmic Ca2+ triggers the exposure of phosphatidylserine (PS) on the surfaces of necrotic cells in the nematode Caenorhabditis elegans. PS serves as an “eat me” signal that attracts engulfing cells to engulf and degrade necrotic cells. During the above study, we developed a microscopic imaging protocol for real-time monitoring the levels of cytoplasmic Ca2+ and cell surface PS in Caenorhabditis elegans touch neurons. Previously, Ca2+ dynamics was monitored …

Lipomatous Infiltration In Tuberous Sclerosis Complex - A Case Series And Literature Review., Mohammed Ilyas, Julio Quezada, Erin K. Opfer

Manuscripts, Articles, Book Chapters and Other Papers

Diffuse Lipomatosis is a dermatological lesion consisting of a poorly circumscribed, infiltrative overgrowth of mature adipose tissue that usually affects the trunk and the extremities. The lesions in the Tuberous Sclerosis Complex (TSC) are usually hamartomatous in nature, but lesions arising from adipocytes are rare. There are only three previous reports of association of TSC with diffuse lipomatosis. Herein we present a case series of diffuse lipomatosis in three subjects with TSC and proceed to review the literature for any other reported cases. On the basis of the three index cases and identification of three more cases in the literature, …

Evaluation The Effectiveness Of Abridged Imnci (7-Day) Course V Standard (11-Day) Course In Pakistan, Shabina Ariff, Kamran Sadiq, Uswa Jiwani, Khalil Ahmad, Khadija N Humayun, Shakeel Ahmed, Shaikh Qamaruddin Nizami, Iqtidar Khan, Nabeela Ali, Sajid Bashir Soofi, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: The conventional IMCI training for healthcare providers is delivered in 11 days, which can be expensive and disruptive to the normal clinical routines of the providers. An equally effective, shorter training course may address these challenges.
Methods: We conducted a quasi-experimental study in two provinces (Sindh and Punjab) of Pakistan. 104 healthcare providers were conveniently selected to receive either the abridged (7-day) or the standard (11-day) training. Knowledge and clinical skills of the participants were assessed before, immediately on conclusion of, and six months after the training.
Results: The improvement in mean knowledge scores of the 7-day and 11-day …

Covid-19 Newsletter (Vol. 91), Center For Disaster Medicine, New York Medical College

COVID-19 Newsletter

No abstract provided.

Health And Economic Benefits Of Achieving Hepatitis C Virus Elimination In Pakistan: A Modelling Study And Economic Analysis, Aaron G. Lim, Nick Scott, Josephine G. Walker, Saeed Hamid, Margaret Hellard, Peter Vickerman

Section of Gastroenterology

Background: Modelling suggests that achieving the WHO incidence target for hepatitis C virus (HCV) elimination in Pakistan could cost US$3.87 billion over 2018 to 2030. However, the economic benefits from integrating services or improving productivity were not included.
Methods and findings: We adapt a HCV transmission model for Pakistan to estimate the impact, costs, and cost-effectiveness of achieving HCV elimination (reducing annual HCV incidence by 80% by 2030) with stand-alone service delivery, or partially integrating one-third of initial HCV testing into existing healthcare services. We estimate the net economic benefits by comparing the required investment in screening, treatment, and healthcare …

Oxidative Stress Induced By Reactive Oxygen Species (Ros) And Nadph Oxidase 4 (Nox4) In The Pathogenesis Of The Fibrotic Process In Systemic Sclerosis: A Promising Therapeutic Target, Sonsoles Piera-Velazquez, Sergio A. Jimenez

Department of Dermatology and Cutaneous Biology Faculty Papers

Numerous clinical and research investigations conducted during the last two decades have implicated excessive oxidative stress caused by high levels of reactive oxygen species (ROS) in the development of the severe and frequently progressive fibrotic process in Systemic Sclerosis (SSc). The role of excessive oxidative stress in SSc pathogenesis has been supported by the demonstration of increased levels of numerous biomarkers, indicative of cellular and molecular oxidative damage in serum, plasma, and other biological fluids from SSc patients, and by the demonstration of elevated production of ROS by various cell types involved in the SSc fibrotic process. However, the precise …