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Injuries associated with electric-powered bikes and scooters: analysis of US consumer product data

DiMaggio, Charles J; Bukur, Marko; Wall, Stephen P; Frangos, Spiros G; Wen, Andy Y
BACKGROUND:Powered, two-wheeled transportation devices like electric bicycles (E-bikes) and scooters are increasingly popular, but little is known about their relative injury risk compared to pedal operated bicycles. METHODS:Descriptive and comparative analysis of injury patterns and trends associated with E-bikes, powered scooters and pedal bicycles from 2000 to 2017 using the US National Electronic Injury Surveillance System. RESULTS:While persons injured using E-bikes were more likely to suffer internal injuries (17.1%; 95% CI 5.6 to 28.6) and require hospital admission (OR=2.8, 95% CI 1.3 to 6.1), powered scooter injuries were nearly three times more likely to result in a diagnosis of concussion (3% of scooter injuries vs 0.5% of E-bike injuries). E-bike-related injuries were also more than three times more likely to involve a collision with a pedestrian than either pedal bicycles (OR=3.3, 95% CI 0.5 to 23.6) or powered scooters (OR=3.3, 95% CI 0.3 to 32.9), but there was no evidence that powered scooters were more likely than bicycles to be involved in a collision with a pedestrian (OR=1.0, 95% CI 0.3 to 3.1). While population-based rates of pedal bicycle-related injuries have been decreasing, particularly among children, reported E-bike injuries have been increasing dramatically particularly among older persons. CONCLUSIONS:E-bike and powered scooter use and injury patterns differ from more traditional pedal operated bicycles. Efforts to address injury prevention and control are warranted, and further studies examining demographics and hospital resource utilisation are necessary.
PMID: 31712276
ISSN: 1475-5785
CID: 4185102

Vaping-associated lung injury caused by inhalation of cannabis oil [Case Report]

Abeles, Michael; Popofsky, Stephanie; Wen, Andy; Valsamis, Christina; Webb, Angela; Halaby, Claudia; Pirzada, Melodi
Vaping is a growing concern in adolescents, and a growing proportion is using electronic devices to inhale cannabis oil. The short-term and long-term effects of cannabis oil inhalation are not well understood. We report on a case of severe acute lung injury secondary to inhalation of cannabis oil via a vape pen, and propose a new term that describes lung injury related to vaping.
PMID: 31746559
ISSN: 1099-0496
CID: 4209022

Reversal of cancer gene expression identifies novel therapeutics for diffuse intrinsic pontine glioma [Meeting Abstract]

Zhao, G; Newbury, P; Zeng, W; Muldoon, D; Glicksberg, B S; Wen, A; Liu, K; Chen, B; Nicolaides, T
INTRODUCTION: Diffuse intrinsic pontine glioma (DIPG) is an aggressive type of brainstem cancer that targets young children. Complete resection is not possible, and chemotherapy and radiotherapy are currently only palliative. To identify potential therapeutic agents, we used a recently developed computational pipeline to perform an in silico screen for novel drugs. We then tested the identified drugs against a panel of patient-derived DIPG cell lines.
METHOD(S): We used a systematic computational approach with publicly available databases of gene expression signatures in DIPG, as well as gene expression data of cancer cell lines before and after treatment in conjunction with a massive library of clinically available drugs. We identified three drug hits with the ability to reverse a DIPG gene signature to one that matches normal tissue background. We used three DIPG cell lines (SF8628, DIPG4, DIPG-NYU) along with immortalized normal human astrocytes (NHA) as control to test these drugs. Flow cytometry, immunob-lot analysis, viability assays, and RNA-Seq before and after drug treatment were performed. In vivo experiments are currently underway.
RESULT(S): All three drugs showed potency against the primary DIPG4 cell line compared to NHA control. Triptolide showed the most potency against primary DIPG cell lines bearing H3K27M mutations (SF8628 and DIPG4, with IC50's in the nanomolar range after 72 hours treatment), while the effect on DIPG cell line without H3K27M mutation (DIPG-NYU) was less potent. Immunoblot data also suggested a correlation between drug potency and H3K27M levels in these cell lines.
CONCLUSION(S): Using a computational approach, we identified clinically available drugs with the ability to reverse DIPG gene expression signatures and signifcantly decreased the growth rate of primary DIPG cells in vitro. This novel approach can repurpose drugs and signif-cantly decrease the cost and time normally required in drug discovery
EMBASE:628912121
ISSN: 1523-5866
CID: 4060372

High frequency percussive ventilation in a child with severe acute respiratory distress syndrome from pulmonary hemorrhage [Meeting Abstract]

Wen, A; Salas, A; Santos, L; Jacobowitz, R; Conyers, J; Albanese, K
Aims & Objectives: High frequency percussive ventilation (HFPV) rapidly delivers subphysiologic tidal volumes using a volume-diffusive respirator and provides similar or improved oxygenation and ventilation at lower peak, mean, and end-expiratory pressures when compared with conventional ventilation (CV). We present the case of a child with acute respiratory distress syndrome (ARDS) from pulmonary hemorrhage treated with HFPV. Methods Case Report Results A ventilator-dependent 5-year-old male with pyruvate dehydrogenase deficiency presented with acute hypoxemic respiratory failure. Chest radiography showed bilateral pulmonary infiltrates and tracheal aspirate revealed hemosiderin laden macrophages. Methylprednisolone and empiric antibiotics were administered for pulmonary hemorrhage and severe ARDS. The patient was placed on high-frequency oscillatory ventilation (HFOV) then HFPV (Figure 1). Subsequent dislodgement of a blood clot was followed by improvement in OI and chest radiography (Figure 2). The patient was discharged on home ventilator settings on HD#11. (Figure prsented). Conclusions HFPV has been shown to decrease morbidity and mortality by improving mucociliary clearance. To our knowledge this is the first reported case of HFPV use in a pediatric patient with ARDS from pulmonary hemorrhage. Early implementation of HFPV may be a safe and effective ECMO-sparing strategy to improve oxygenation in patients with ARDS due to pulmonary hemorrhage
EMBASE:623816073
ISSN: 1947-3893
CID: 3287352

Adolescent with Ehlers danlos syndrome and acute pulmonary hemorrhage [Meeting Abstract]

Salas, A; Patel, A; Hart, L; Wen, A
Aims & Objectives: Patients with Ehlers-Danlos syndrome (EDS) have abnormal collagen production or secretion leading to hyperextensibility of the skin, hypermobility of the joints, and increased tissue fragility. Although uncommon, respiratory manifestations of EDS have been described. The typical causes of death in patients with EDS are viscus rupture and arterial hemorrhage. Some deaths have been attributed to pulmonary hemorrhage. We report a case of acute pulmonary hemorrhage as the presenting finding of granulatomatosis with polyangiitis in a child with EDS. Methods Case Report Results A 14-year-old female with EDS presented with a 2-month history of fever, fatigue, unintentional weight loss, arthralgias, myalgias, and progressive dyspnea. Chest radiography revealed diffuse alveolar opacities and laboratory evaluation revealed anemia and thrombocytopenia. Chest computed tomography (CT) showed pulmonary hemorrhage. Anti-neutrophil cytoplasmic antibodies targeting proteinase 3 were positive for granulomatosis with polyangiitis. She was admitted on highflow nasal cannula oxygen therapy and given pulse-dose intravenous methylprednisolone. Subsequent improvement in respiratory status was observed; she was treated with rituximab and weaned off oxygen. Patient was discharged home in stable condition on hospital day #5 and remained on oral prednisone, with a 4-week course of rituximab, and was started oral azathioprine. (Figure prsented). Conclusions To our knowledge this is the first reported case of polyangiitis with granulomatosis presenting with pulmonary hemorrhage in a child with EDS. An increased index of suspicion may improve outcomes
EMBASE:623815443
ISSN: 1947-3893
CID: 3287362

MALIGNANT HYPERTHERMIA-ASSOCIATED LIVER FAILURE TREATED WITH N-ACETYLCYSTEINE IN A 5-YEAR-OLD BOY [Meeting Abstract]

Dapul, Heda; Chopra, Arun; Cohn, Moshe; Ramirez, Michelle; Santos, Laura; Wen, Andy; Zawistowski, Christine; Al-Qaqaa, Yasir
ISI:000436794300493
ISSN: 0090-3493
CID: 3507712

DESIGN AND IMPLEMENTATION OF A PROTOCOL FOR PICU PATIENTS AT HIGH RISK OF UNPLANNED EXTUBATION [Meeting Abstract]

Dapul, Heda; Folks, Tiffany; Rose, Mary; Wen, Andy; Chopra, Arun; Navarro, Jorge
ISI:000436796200498
ISSN: 0090-3493
CID: 3507812

STANDARDIZATION OF ENDOTRACHEAL TUBE SECUREMENT TO REDUCE UNPLANNED EXTUBATIONS IN THE PEDIATRIC ICU [Meeting Abstract]

Dapul, Heda; Folks, Tiffany; Rose, Mary; Pantor, Stacy; Pierre-Louis, Joelle; Wen, Andy; Chopra, Arun; Navarro, Jorge
ISI:000436796200508
ISSN: 0090-3493
CID: 3507842

Extracorporeal Membrane Oxygenation for Infant of a Diabetic Mother with Congenital Heart Defect [Meeting Abstract]

Wen, A. Y.; Chadha, T.; Dapul, H. M.; Fisher, J. C.; Chopra, A.
ISI:000449980301279
ISSN: 1073-449x
CID: 3513062

A 15-Year-Old with Aphasia and Right Hemiparesis [Case Report]

Wadowski, Benjamin; Chadha, Tanya; Wen, Andy Y
Takayasu arteritis (TA) is the third most common vasculitis in childhood, peaking in the second to third decades of life but affecting patients as young as 6 months of age. It often presents with nonspecific systemic symptoms, although at late stages, it may present with cardiac, renal, or focal neurologic sequelae of vascular compromise. In this case, we describe a 15-year-old patient who presented acutely with stroke. In the absence of more classic rheumatological symptoms and significant laboratory abnormalities on initial testing, the diagnosis of TA was only reached through extensive vascular imaging following consultation with multiple subspecialty teams. This case demonstrates the need to maintain a high index of suspicion for vasculitis in pediatric patients presenting with new onset stroke in the absence of known predisposing factors. Doing so may reduce the time to diagnosis, hasten treatment, and optimize outcomes.
PMCID:6260307
PMID: 31073452
ISSN: 2146-4618
CID: 3891742