Research Spotlight

Milligan, G. P., A. Alam and C. Guerrero-Miranda (2020). “Recognizing Right Ventricular Dysfunction in Coronavirus Disease-2019-Related Respiratory Illness.” J Card Fail May 11;S1071-9164(20)30497-8. [Epub ahead of print].

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We have read the article by Tersalvi and colleagues1 detailing mechanisms of elevated troponin in patients with coronavirus disease 2019 (COVID-19), and we write to encourage recognition of acute right ventricular (RV) strain as an additional possibility. [No abstract; excerpt from article].

Menter, M. A., G. J. Murakawa, H. Glover, A. M. Mendelsohn, J. Parno, S. J. Rozzo, D. Davidson and A. K. Gupta (2020). “Clearance of head and neck involvement in plaque psoriasis with tildrakizumab treatment in the phase 3 reSURFACE 1 study.” J Eur Acad Dermatol Venereol May 20. [Epub ahead of print].

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Scalp, face, and neck involvement in psoriasis negatively impacts patient quality of life.(1-3) In the phase 3 double-blind, randomised, placebo-controlled reSURFACE 1 trial (NCT01722331), Psoriasis Area and Severity Index (PASI) response rates in patients with moderate to severe plaque psoriasis were high and durable following treatment with interleukin (IL)-23p19 inhibitor tildrakizumab, with acceptable safety.(4

McCrum, M. L., K. A. Davis, H. Kaafarani, H. Santry, S. Shafi and M. Crandall (2020). “Current Opinion on Emergency General Surgery Transfer and Triage Criteria.” J Trauma Acute Care Surg May 26. [Epub ahead of print].

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The objective of this opinion piece is to propose a list of criteria, similar to trauma triage criteria, that may be used to inform decisions to transfer a patient from a smaller facility to a higher level of care. We have approached this by considering three essential elements: the underlying disease, the degree of physiologic derangement and available hospital resources. Consideration of each of these factors will help guide patient triage in the field or emergency department. [No abstract; excerpt from article].

Malik, F., R. T. Zreik, D. J. Hedges, J. Nakitandwe, S. Lee, R. A. Ward, M. B. McCarville, A. Pappo and A. Bahrami (2020). “Primary bone sarcoma with BCOR internal tandem duplication.” Virchows Arch 476(6): 915-920.

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BCOR internal tandem duplications (ITDs) and rearrangements are implicated in the oncogenesis of a subset of undifferentiated sarcomas. To date, BCOR ITD sarcomas have been exclusively found in non-appendicular infantile soft tissues, whereas BCOR-rearranged sarcomas occur in both bones and soft tissues affecting a wider patient age range. Little is known about patient outcome in BCOR ITD sarcomas. We present a BCOR-expressing, primary bone, undifferentiated sarcoma case involving an adolescent male’s left tibia that, unexpectedly, harbored a BCOR ITD instead of a BCOR rearrangement. Furthermore, the patient achieved a partial histologic response after receiving a Ewing sarcoma chemotherapy regimen. Our case expands the clinical spectrum of BCOR ITD sarcomas and suggests that childhood and adult BCOR-expressing sarcomas with an undifferentiated histology should be considered for both BCOR rearrangement and ITD screening. Accurate BCOR mutation identification in undifferentiated sarcomas is essential to define their clinical spectrum and to develop effective management strategies.

Malek, A. J., B. D. Robinson, A. R. Hitt, C. N. Shaver, B. Tharakan and C. L. Isbell (2020). “Doxycycline improves traumatic brain injury outcomes in a murine survival model.” J Trauma Acute Care Surg May 26. [Epub ahead of print].

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BACKGROUND: Traumatic brain injury (TBI) has significant morbidity and cost implications. Primary treatment modalities aim to decrease intracranial pressure; however, therapies targeting the underlying pathophysiology of a TBI are limited. TBI-induced microvascular leak and secondary injury are largely due to proteolysis of the blood-brain barrier (BBB) by matrix metalloproteinase-9 (MMP-9). We previously observed doxycycline’s inhibitory affinity on MMP-9 resulting in preserved BBB integrity in non-survival murine studies. This study sought to determine the effect of doxycycline on functional motor and behavioral outcomes in the setting of a TBI murine survival model. METHODS: C57BL/6J mice were assigned to a sham, TBI, or TBI with doxycycline arm. A moderate TBI was induced utilizing a controlled cortical impactor. The TBI with doxycycline cohort received a dose of doxycycline (20mg/kg) two hours after injury and every 12 hours until postoperative day (POD)-6. All mice underwent preoperative testing for weight, modified neurological severity score (mNSS), wire grip, and ataxia analysis (DigiGait). Postoperative testing was performed on POD-1, POD-3, and POD-6 for the same measures. SAS 9.4 was used for comparative analysis. RESULTS: 15 sham mice, 15 TBI mice, and 10 TBI with doxycycline mice were studied. Mice treated with doxycycline had significantly improved mNSS and wire grip scores at POD-1 (all p < 0.05). Mice treated with doxycycline had significantly improved ataxia scores by POD-3 and POD-6 (all p < 0.05). There was no significant difference in rate of weight change between the three groups. CONCLUSIONS: Mice treated with doxycycline following TBI demonstrated improved behavioral and motor function suggesting doxycycline's role in preserving murine BBB integrity. Examining the role of doxycycline in human TBIs is warranted given the relative universal accessibility, affordability, and safety profile of doxycycline. LEVEL OF EVIDENCE: Animal study.