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The Effects Of Benzo-Α-Pyrene On The Insulin-Like Growth Factor-I Gene, Brittany Albright Epperson
The Effects Of Benzo-Α-Pyrene On The Insulin-Like Growth Factor-I Gene, Brittany Albright Epperson
Yale Medicine Thesis Digital Library
The purpose of this study was to look at the genotoxic and cytotoxic effects of benzo-α-pyrene (BαP), a chemical mutagen that is present in cigarette smoke, on the insulin-like growth factor-I (IGF-I) gene. Women who smoke during pregnancy are more likely to have a growth-restricted baby. We hypothesized that BαP exerts its effects through genotoxic and cytotoxic avenues. The cytotoxicity is manifested by chromosomal abnormalities and a decrease in the rate of cell division. The genotoxicity is manifested by changes in certain genes known to be important in mammalian fetal development such as IGF-I. IGF-I is implicated in intrauterine growth …
The Impact Of High Density Lipoprotein Cholesterol On Five-Year Mortality In Older Adults, Lisa Millman
The Impact Of High Density Lipoprotein Cholesterol On Five-Year Mortality In Older Adults, Lisa Millman
Yale Medicine Thesis Digital Library
The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III) guidelines have defined a high density lipoprotein cholesterol (HDL-C) of <50 mg/dL in women and <40 mg/dL in men as a risk factor for cardiovascular disease. Our research aim was to examine the relationship between untreated HDL-C levels below this recommended level on five year cardiovascular, stroke, and all-cause mortality in adults over 71 years of age. The Established Populations for Epidemiologic Studies of the Elderly (EPESE) is a prospective cohort study of community dwelling adults over 65 years of age in East Boston, MA; Iowa and Washington Counties, IA; New Haven, CT; and Durham, NC. The National Institutes of Aging (NIA) started EPESE to study health, social, psychological, and economic aspects of older adults lives through extensive annual interviews. The EPESE dataset is further enriched by serum measures including low-density lipoprotein cholesterol (LDL-C), HDL-C, total cholesterol, triglycerides, glucose, BUN and creatinine, which were obtained at the sixth annual follow-up interview. Our primary outcome was all-cause mortality with secondary mortality outcomes of acute myocardial infarction (AMI), coronary artery disease (CAD) not AMI, and congestive heart failure (CHF). The mean age of our cohort was 78.7 years with the majority being female (63.86%), white (88.15%), and married (52.80%). Just over half (52.07%) of our cohort met the criteria for low HDL-C as defined by ATP III. Chi square and Fisher exact test were used to compare demographics (age, gender, race, marital status, education), clinical variables (history of MI, cancer, diabetes, angina, smoking, alcohol use), and functional variables (activities of daily living, gross mobility, cognitive status) at baseline and five year follow-up. Cox proportional hazard models were created using a step-wise approach to assess the impact of low HDL-C on mortality. Low HDL-C was not significantly associated with crude all-cause (P= .413), AMI (P= .473), CHF (P= .259), and stroke (P= .345) mortality. HDL-C was significantly associated with unadjusted CAD (P= .033) mortality. However, after adjustment for demographics, clinical, and functional variables as well as the other blood values all outlined above, HDL-C was not associated with five year all-cause, AMI, CAD, CHF or stroke mortality with adjusted hazard ratios of (HR=1.03, 95% CI 0.90-1.18), (HR=1.09, 95% CI 0.70-1.71), (HR=1.33, 95% CI 0.91-1.92), (HR=1.07, 95% CI 0.63-1.81) and (HR=0.80, 95% CI 0.51-1.27) respectively. In older community dwelling adults enrolled in EPESE, low HDL-C levels as stratified by current recommended guidelines (<50 mg/dL in women and <40 mg/dL in men) were not associated with increased risk of five-year cardiovascular, stroke or all-cause mortality. HDL-C alone may have minimal effect on future longevity in older adults due to competing risk and co-morbid conditions. Further studies are required to determine whether the movement toward more aggressive lipid profile interventions specifically to raise HDL-C in older adults would prove beneficial in this growing segment of our population.
The Prevalence Of Undiagnosed Hypertension In Ambulatory Emergency Department Patients And Lack Of Adequate Referral, Andrew Nerlinger
The Prevalence Of Undiagnosed Hypertension In Ambulatory Emergency Department Patients And Lack Of Adequate Referral, Andrew Nerlinger
Yale Medicine Thesis Digital Library
OBJECTIVES: According to a WHO estimate, 1 in every 8 deaths worldwide is due to high blood pressure (BP). The Emergency Department (ED) provides an opportunity to identify individuals with undiagnosed hypertension (HTN) and refer them for BP recheck. The study objectives were to quantify the population in need referral for BP recheck and to determine the frequency of referral from the ED. METHODS: A retrospective, structured chart review of all patients > 18 years old seen in an urban adult ED over 5 days, excluding major trauma and pregnant pts. Patients with any systolic BP (SBP) > 140 or diastolic BP …
Effect Of Soy Isoflavone Protein And Soy Lecithin On Endothelial Function In Healthy Postmenopausal Women, Mary Pearson
Effect Of Soy Isoflavone Protein And Soy Lecithin On Endothelial Function In Healthy Postmenopausal Women, Mary Pearson
Yale Medicine Thesis Digital Library
The purpose of this study was to assess the effects of soy isoflavone protein concentrate and soy lecithin on endothelial function measured as flow mediated dilation (FMD) of the brachial artery in healthy postmenopausal women. In this randomized, double-blind, placebo controlled crossover trial, twenty-five subjects (mean age 61 years; BMI 25.46 kg/m2) were recruited from the general population of southwestern Connecticut. Subjects underwent endothelial function testing using high frequency ultrasound at baseline and following 4 weeks of each randomly assigned treatment with intervening 4-week washout periods. Treatment assignment included: soy isoflavone protein (SP, 25gm/day) or soy lecithin (SL, 20gm/day) alone …
Uterine Arterial Embolization: Classification Of Leiomyomas To Determine Predictors Of Response, Trusher Patel
Uterine Arterial Embolization: Classification Of Leiomyomas To Determine Predictors Of Response, Trusher Patel
Yale Medicine Thesis Digital Library
The purpose of this study is to determine features of uterine leiomyoma on Magnetic Resonance Imaging (MRI) that identify predictors of response to Uterine Arterial Embolization (UAE). MRI images were obtained before and after UAE in 35 women. These images were analyzed for uterine and fibroid size changes along with fibroid border characteristics and location for a total of 73 fibroids. Fibroids were classified as either smooth or lobulated based on border appearance on MR imaging to determine any differences in mean fibroid volume reduction post-embolization. The mean decrease in fibroid volume from pre-embolization to post-embolization was 48.1% ± 28.6 …
Upregulation Of Hypoxia-Inducible Genes In Endothelial Cells To Create Artificial Vasculature, Robert Schonberger
Upregulation Of Hypoxia-Inducible Genes In Endothelial Cells To Create Artificial Vasculature, Robert Schonberger
Yale Medicine Thesis Digital Library
This study explored the possibility that upregulation of Hypoxia Inducible Factor-1 (Hif-1)-responsive genes in Human Umbilical Vein Endothelial Cells (HUVEC) would promote and stabilize HUVEC formation into inchoate vascular beds within artificial collagen gels. This experiment was designed to explore the above possibility by sub-cloning Hif-1α, the related chimeric construct Hif-1α/VP16, and the marker gene dsRed into retroviral expression vectors, producing retroviral vectors containing these genes, and stably transducing HUVEC using these retroviruses. Transduced HUVEC were to be observed in cell culture as well as after implantation into artificial collagen gels that have previously supported vascular bed formation by HUVEC. …
Routine Anal Cytology Screening For Anal Squamous Intraepithelial Lesions In An Ethnically Diverse Urban Hiv Clinic, Hyman Scott
Routine Anal Cytology Screening For Anal Squamous Intraepithelial Lesions In An Ethnically Diverse Urban Hiv Clinic, Hyman Scott
Yale Medicine Thesis Digital Library
Anal cancer, like cervical cancer, is associated with Human Papillomavirus (HPV) infection. HIV+ patients have 38-60 fold increased risk of anal cancer compared to HIV- patients prompting many to suggest routine screening given the success of cervical Pap screening. Our goal is to describe our experience with routine anal Pap screening, determine which patients are most likely to have abnormal results, if anal disease on physical exam is predictive of cytology, and correlate cytology with histology findings. Charts of all patients with an anal Pap followed at the Hospital of Saint Raphael HIV Clinic were reviewed. Demographics, immune status, sexually …
Effect Of Counterface Roughness On The Cross-Path Wear Of Ultra-High Molecular Weight Polyethylene, Mary Turell
Effect Of Counterface Roughness On The Cross-Path Wear Of Ultra-High Molecular Weight Polyethylene, Mary Turell
Yale Medicine Thesis Digital Library
Ultra-high molecular weight polyethylene (UHMWPE) is used worldwide as a bearing material in total joint replacement prostheses. Despite its excellent biocompatibility and high wear resistance, wear of UHMWPE components continues to be a major problem limiting the clinical lifespan of UHMWPE-containing orthopaedic implant devices. Multi-directional motion or cross-path motion is known to affect wear rates of UHMWPE in total knee and hip replacement prostheses. The purpose of this study was to quantify the effect of counterface roughness on the cross-path wear of UHMWPE and to determine if the previously established unified theory of wear model could accurately predict wear rates …
Search For The Basolateral Potassium Channel In The Shark Rectal Gland: Functional And Molecular Identification Of A Task-1 Channel Coupled To Chloride Secretion, Conner Telles
Yale Medicine Thesis Digital Library
In the shark rectal gland (SRG), apical Cl- secretion through CFTR channels is tightly coupled to a basolateral K+ conductance. The identity of this K+ conductive pathway is unknown. Studies were performed in the isolated perfused SRG with 16 K+ channel inhibitors at their IC50 and with acidic perfusate. During maximal chloride secretion stimulated by forskolin and IBMX, secretion was inhibited >90% by barium chloride, a non-selective inhibitor of K+ channels. Specific inhibitors of calcium sensitive, voltage sensitive, ATP sensitive, and inward rectifying K+ channels had no effect on chloride secretion. The inhibitors quinidine, quinine, bupivicaine, anandamide, and low perfusate …
Injection And Non-Injection Drug Users' Beliefs On Mandatory Newborn Hiv Testing Laws In The State Of Connecticut, Odicie Fielder
Injection And Non-Injection Drug Users' Beliefs On Mandatory Newborn Hiv Testing Laws In The State Of Connecticut, Odicie Fielder
Yale Medicine Thesis Digital Library
We examined health beliefs among drug users about mandatory HIV testing of newborns and voluntary versus mandatory testing of pregnant women. We also examined to what extent negative experiences and stigmatization affect attitudes towards HIV testing. Baseline structured interviews of active drug users from 1997-2001 were examined. Multivariate data analysis was performed using SAS statistical software. Subsequently, five distinct focus groups were conducted in September 2003. Focus groups were transcribed, coded and analyzed using Microsoft Word 2000. Of 610 drug users interviewed, nearly all (89%) had been previously HIV tested. Nearly all (91%) subjects believed pregnant women should be tested …
Mega-Doses Of L-Ascorbic Acid Alter The Antineoplastic Effects Of Ionizing Radiation In Emt6 Cells In Vitro, Karina Lund
Mega-Doses Of L-Ascorbic Acid Alter The Antineoplastic Effects Of Ionizing Radiation In Emt6 Cells In Vitro, Karina Lund
Yale Medicine Thesis Digital Library
Despite the common usage of high-dose vitamin C among breast cancer patients, the published medical literature is not in agreement as to how mega-dose vitamin C may interact with conventional therapy to affect clinical outcomes. The purpose of this study was to investigate the interaction of mega-dose vitamin C with radiation therapy and with doxorubicin in the treatment of breast cancer. Cultures of EMT6 mouse mammary tumor cells were treated concurrently with varying dose of vitamin C and either radiation or doxorubicin. A clonogenic assay was then performed to determine the surviving fraction of the cells. The surviving fractions of …
Mother Knows Best: Maternal Experience And Choice Of Infant Sleep Position, Meghan Lane
Mother Knows Best: Maternal Experience And Choice Of Infant Sleep Position, Meghan Lane
Yale Medicine Thesis Digital Library
Purpose: The purpose of this project was to examine the associations between maternal child-rearing experience, choice of infant sleeping position, and the source, nature and trust of advice received about infant sleeping position in a high-risk, primarily African-American population. Background: The number of deaths attributed to Sudden Infant Death Syndrome (SIDS) has decreased since the initiation of the Back to Sleep campaign in 1994. Although this change has benefited all ethnic groups, African-American infants are still twice as likely to succumb to SIDS as Caucasian infants. Design/Methods: We conducted 668 face-to-face standardized interviews with mothers of infants in Connecticut, Georgia …
Hypoxic Regulation Of Vegf And Pai-1 Expression By Hif-1Α And Hif-2Α In First Trimester Trophoblasts, Eliza Meade
Hypoxic Regulation Of Vegf And Pai-1 Expression By Hif-1Α And Hif-2Α In First Trimester Trophoblasts, Eliza Meade
Yale Medicine Thesis Digital Library
Preeclampsia results from incomplete trophoblast invasion of the spiral arteries during early pregnancy. Vascular endothelial growth factor (VEGF) and plasminogen activator inhibitor-1 (PAI-1) are critical factors involved in angiogenesis, invasion and hemostasis at the maternal-fetal interface. Both factors are transcriptionally regulated by hypoxia inducible factor (HIF), a heterodimeric complex consisting of HIF-1β and either HIF-1α or -2α whose specificity or redundancy in gene regulation is cell-type specific. This study uses siRNA technology to dissect the mechanisms of hypoxia-mediated regulation of PAI-1 and VEGF expression in first trimester trophoblasts. Immortalized first trimester human extravillous trophoblasts (HTR8/SVneo cells) were maintained in serum-free …
Quality Of Life In Macular Degeneration Between Photodynamic Therapy And Pegaptanib Treatment Groups, Sara Nayeem
Quality Of Life In Macular Degeneration Between Photodynamic Therapy And Pegaptanib Treatment Groups, Sara Nayeem
Yale Medicine Thesis Digital Library
The purpose of this study was to examine quality of life (QOL) in age-related macular degeneration (AMD), particularly across photodynamic therapy (PDT) and pegaptanib sodium injection treatment groups. Patients with AMD were either mailed or were administered in person a modified version of the Visual Function Questionnaire (VFQ-25). Subgroup analysis of the VFQ-25 was performed per NEI prescribed algorithms and additional analyses regarding questions on treatment side effects were also performed. A two-tailed student t-test and mean were calculated for each treatment group and correlations between visual acuity and subgroup outcomes were calculated. Correlations between the subgroup and treatment-related subgroup …
Intracranial Aneurysm As A Paradigm For The Genetic Analysis Of Complex Human Traits, Ali Ozturk
Intracranial Aneurysm As A Paradigm For The Genetic Analysis Of Complex Human Traits, Ali Ozturk
Yale Medicine Thesis Digital Library
The genetic analysis of complex human traits is hampered by its multifactorial nature, since potentially many genes are imparting a relatively small effect on the disease trait. This makes it considerably more difficult to identify these genes as compared to single-gene diseases, whereby the disease trait is attributable to only one locus, due mostly to the difficulties of carrying out robust linkage analyses. Several strategies have been employed in order to overcome the obstacles of complex human traits, including the candidate gene, non-parametric, and parametric linkage approaches. Of these, the latter two enjoy the benefit of being genome-wide, while carrying …
The Physiological Effects Of Hockey Protective Equipment On High Intensity Intermittent Exercise, Benjamin Noonan
The Physiological Effects Of Hockey Protective Equipment On High Intensity Intermittent Exercise, Benjamin Noonan
Yale Medicine Thesis Digital Library
Ice hockey is a contact sport played in a cold environment which leads to assumptions that players are not exposed to a thermal challenge. The purpose of this study was to test the hypothesis that the wearing of hockey protective equipment during an exercise protocol designed to simulate a hockey game would induce a thermal challenge and lead to decrements in performance. In order to test this hypothesis and qualify the physiological responses, subjects performed a standardized protocol performed on a stationary cycle ergometer in an environmental chamber set at typical (12ºC) ice hockey ambient conditions. The simulation was performed …
The Role Of Ectopic Lymphoid Tissue In Allograft Rejection, Michael Reel
The Role Of Ectopic Lymphoid Tissue In Allograft Rejection, Michael Reel
Yale Medicine Thesis Digital Library
The location of the immunologic response to an allograft is not known with certainty. However, organized collections of T cells, B cells and antigen presenting cells have been found in peripheral tissue, in close proximity to organs undergoing rejection. It is hypothesized that this tertiary lymphoid tissue may be a location in which activation of lymphocytes can occur, leading to rejection of an allograft. We report here that in a splenectomized aly/aly mouse, which is devoid of secondary lymphoid organs and will normally fail to reject an allograft, the presence of tertiary lymphoid organs is associated with graft rejection. We …
The Effects Of Menstrual Phase On The Response Of Cutaneous Microvasculature, Margaret Rose
The Effects Of Menstrual Phase On The Response Of Cutaneous Microvasculature, Margaret Rose
Yale Medicine Thesis Digital Library
Estrogen is well-known to be protective against cardiovascular disease in women. In addition to improving lipid metabolism, it also decreases vascular resistance and enhances vascular reflexes, thereby improving vasomotor stability and increasing the arterial capacity for dilatation. Laser Doppler flowmetry (LDF) has demonstrated these changes in research trials, and is emerging as having potential application in many clinical and surgical situations. In this study, our aim was to examine the impact of estrogen upon baseline blood flow as well as the response to vasodilatory interventions and to further evaluate the utility of laser Doppler as a clinical non-invasive measurement of …
Pain As The Subjective Fifth Vital Sign Among Patients Undergoing Knee Or Hip Arthroplasty, Lindsey Sukay
Pain As The Subjective Fifth Vital Sign Among Patients Undergoing Knee Or Hip Arthroplasty, Lindsey Sukay
Yale Medicine Thesis Digital Library
The purpose of this study was, among patients undergoing knee or hip arthroplasty, to examine patients expectations for and experiences of postoperative pain, their perceptions of the quality of their pain management, and to identify potential barriers to effective pain management. This was a prospective cohort study of 68 patients undergoing knee or hip arthroplasty at Yale-New Haven Hospital. Patients were interviewed within 48 hours after surgery using a modified version of the American Pain Society Satisfaction Survey and were asked the amount of pain they expected to have postoperatively (EP) and the actual pain that they experienced in the …
Overcoming Barriers To Enrolling Minorities In Medical Research: What Does The Evidence Say?, Stacy Uybico
Overcoming Barriers To Enrolling Minorities In Medical Research: What Does The Evidence Say?, Stacy Uybico
Yale Medicine Thesis Digital Library
Background: Despite the pervasive underrepresentation of minorities in health research studies, little is known about strategies that aim to increase minority enrollment in research. Purpose: The purpose of this study was to identify whether elder African American and Latinos were more likely to refuse research participation, identify tangible and specific incentives to improve research participation in this population, and to review the successes and data reporting of recruitment interventions attempted on diverse populations at large, including the non-elderly. Methods: We conducted a review of Yale OAIC studies to determine minority vs. non-minority research enrollment rates, interviewed key informants about likely …
Multiple Laser Photocoagulation Treatments For The Management Of Diabetic Macular Edema, Sadhna Vora
Multiple Laser Photocoagulation Treatments For The Management Of Diabetic Macular Edema, Sadhna Vora
Yale Medicine Thesis Digital Library
The purpose of this study was to evaluate functional and funduscopic outcomes amongst patients receiving multiple treatments with macular laser photocoagulation for clinically significant diabetic macular edema. A record review was conducted of patients who had multiple macular laser treatments for diabetic macular edema. As part of routine follow-up for diabetic macular edema, visual acuity and funduscopic findings were assessed before a given laser treatment and at 6 months afterwards. The study included 64 eyes from 41 patients. There was no statistically significant difference between the proportion of eyes that showed funduscopic improvement after treatment 1 versus the proportion of …
Small Interfering Rna Decreases Vegf Mrna Expression And Proliferation Of Colorectal Cancer Cells, Stephen Ward
Small Interfering Rna Decreases Vegf Mrna Expression And Proliferation Of Colorectal Cancer Cells, Stephen Ward
Yale Medicine Thesis Digital Library
Vascular endothelial growth factor (VEGF-A) was first described in 1989 for its angiogenic and mitogenic properties. Early studies indicated that VEGF-A acts primarily in a paracrine pathway which is limited to vascular endothelium. Further investigation showed that VEGF-A and VEGF receptor-2 (VEGFR-2) are expressed by many solid tumors and improve cell growth and survival. Therefore, VEGF-A may act via an autocrine pathway that effects tumor cellular proliferation by binding VEGFR-2 at the cell surface. This study utilizes small interfering RNA (siRNA) technology to investigate the presence of an autocrine loop in human RKO colorectal cancer cells. RT-PCR demonstrated the expression …
Cellular Oxidative Efficiency: A New Approach To Calculating Theoretical P/O Ratios, Douglas Walled
Cellular Oxidative Efficiency: A New Approach To Calculating Theoretical P/O Ratios, Douglas Walled
Yale Medicine Thesis Digital Library
For decades the oxidative efficiency of cellular metabolism has been under investigation. After numerous reports of varied stoichiometric measurements, consensus in the literature has begun moving toward two currently accepted theoretical P/O ratios (the number of adenosine triphosphate (ATP) molecules formed for every oxygen atom consumed): 2.5 for NADH-linked substrates and 1.5 for FADH2-linked substrates. It is shown here, however, that the currently accepted theoretical values are inappropriately calculated underestimates, and that P/O ratios of real biochemical systems are variable. The complete oxidative metabolism of glucose, beta-hydroxybutyrate, malate, pyruvate, and succinate, utilizing three different electron shuttles (or exclusive mitochondrial metabolism) …
The Effect Of General Anesthesia On Acupuncture: A Functional Mri Study, Dana Weiss
The Effect Of General Anesthesia On Acupuncture: A Functional Mri Study, Dana Weiss
Yale Medicine Thesis Digital Library
We performed a study to examine brain activity as assessed by functional-MRI when acupuncture is administered to awake volunteers as compared to acupuncture administered to volunteers under general anesthesia. Healthy, acupuncture-naive volunteers were recruited for this cross-over study. Volunteers underwent two experimental sessions that included a sequence of 4-20 seconds of on and off manual acupuncture stimulation for a period of 3 minutes while awake and while under propofol general anesthesia. The acupuncture intervention was performed at left stomach 36. General anesthesia was induced and maintained with propofol. BOLD signal images were obtained in a 1.5 T MRI scanner in …
The Effects Of Posttraumatic Stress Disorder On Pregnancy Outcomes, Shari Rogal
The Effects Of Posttraumatic Stress Disorder On Pregnancy Outcomes, Shari Rogal
Yale Medicine Thesis Digital Library
The purpose of this study was to determine the effect of posttraumatic stress disorder (PTSD), diagnosed prospectively during pregnancy, on the occurrence of low birthweight (<2500 grams) and preterm delivery (<37 weeks gestational age). A cohort of 1362 women was recruited from prenatal care visits and screened for depression, panic disorder, posttraumatic stress disorder, and substance use. Current episodes of PTSD were assessed using the MINI International Neuropsychiatric Interview. Pregnancy outcomes were abstracted from hospital records after delivery, and the data were analyzed using logistic regression. Two hundred sixty two women (33%) were lost to follow-up due to unavailable medical records, leaving 1100 women in the final analyses. Among these 1100 women, 31 (3%) were found to have PTSD during pregnancy. Substance use in pregnancy, panic disorder, major and minor depressive disorders, and prior preterm delivery were significantly associated with PTSD in the sample, while age, language spoken, and race were not. Low birthweight (LBW) was present in 6.5% of sampled women and was not significantly associated with a diagnosis of PTSD in pregnancy when adjusting for potential confounders. However, LBW was significantly associated with minor depressive disorder OR= 1.82 (CI=1.01, 3.29). Preterm delivery occurred in 7.0% of those without and 16.1% of those with PTSD (p=0.055). Because prior preterm delivery data were not available for 33% of women with PTSD, this variable was included only in secondary analyses. However, the association between PTSD and preterm delivery depended on this variable, with OR= 2.82 (0.95, 8.38) before controlling for prior preterm delivery and OR=3.35 (1.04, 10.85) after controlling for prior preterm delivery. These data suggest that a possible association of PTSD and preterm delivery was limited by the low rates of PTSD in this cohort and the inability to control for all confounders. Taken together, these findings provide limited support for the hypothesized association between PTSD and preterm delivery and no support for an association of PTSD with LBW.
Patterns Of Resistance To Antiretroviral Therapy Among Hiv+ Patients In Clinical Care, Akash Shah
Patterns Of Resistance To Antiretroviral Therapy Among Hiv+ Patients In Clinical Care, Akash Shah
Yale Medicine Thesis Digital Library
HIV-1 antiretroviral resistance has posed major challenges to treatment advances of the last decade. However, few studies have analyzed the prevalence and time trends of drug resistance among HIV+ patients on antiretroviral therapy followed longitudinally in clinical care. The purpose of this study is to determine the cumulative prevalence of HIV genotypic drug resistance and the dynamics of resistance development in HIV+ patients in care. We hypothesized that a >5% increase in resistance would occur per 6-month period and a >15% increase in drug resistance would occur over 18 months. This retrospective longitudinal study consisted of patients from the two …
Large, Single Institution Review Of Prognostic Factors In Oligodendroglioma, Heather Mckee
Large, Single Institution Review Of Prognostic Factors In Oligodendroglioma, Heather Mckee
Yale Medicine Thesis Digital Library
Studies have demonstrated an association between loss of heterozygosity on chromosome 1p and chromosome 19q in oligodendrogliomas with both chemosensitivity and prolonged survival. This represents the first time genetic mutations have been utilized to guide clinical decision making. Studies have also found these genetic mutations to be associated with magnetic resonance imaging (MRI) features including indistinct tumor borders on T1-weighted imaging, susceptibility effect, and mixed signal intensity. However, no study has yet demonstrated an association between imaging features and survival. We seek to confirm the clinical utility of known prognostic factors such as age and tumor grade while investigating the …
A Proposed Method For Noninvasive Assessment Of Endothelial Damange, Kirsten Menn
A Proposed Method For Noninvasive Assessment Of Endothelial Damange, Kirsten Menn
Yale Medicine Thesis Digital Library
Transdermal microvascular studies of endothelial cell function have typically used iontophoresis to facilitate acetylcholine absorption, but iontophoresis introduces an important confounding stimulus that can alter the behavior of the microvasculature. This study examines a non-iontophoretic technique for transdermal microvascular studies using acetylcholine and nitroglycerin and demonstrates a relatively impaired vasodilatory response to these substances in a population with known microvascular pathology. Ten subjects without known vascular disease or diabetes were recruited for laser Doppler flowmetry (LDF) monitoring. Topical acetylcholine chloride, nitroglycerin, and placebo were applied to subjects foreheads directly below LDF probes. Readings increased by averages of 406% (245%-566%) and …
Prevalence And Predictors Of Chronic Liver Disease In An Urban Hiv Population, Sunanda Pejavar
Prevalence And Predictors Of Chronic Liver Disease In An Urban Hiv Population, Sunanda Pejavar
Yale Medicine Thesis Digital Library
Chronic liver disease (CLD) is a leading cause of morbidity and mortality in HIV-infected individuals. The purposes of this study were to determine the prevalence and etiologies of CLD in an urban HIV-infected population and to identify CLD risk factors. We conducted a retrospective chart review of 799 HIV-infected patients seen at four New Haven health centers from 2002 to 2003. We applied the New Haven County Liver Study definition to identify patients with CLD. 65% were male, 44% were African American, and 23% were of Hispanic ethnicity. The mean age was 45 years. 30% had a history of alcohol …
Differential Endogenous Estrogen Exposure Influences Prefrontal Cortex Response To Acute Stress, Katya Rubinow
Differential Endogenous Estrogen Exposure Influences Prefrontal Cortex Response To Acute Stress, Katya Rubinow
Yale Medicine Thesis Digital Library
The present study was conducted to determine the effect of differential endogenous estrogen exposure in rats on stress-induced changes in spatial working memory. Subjects comprised male (n=8) and female (n=10) Sprague-Dawley rats, which were trained to complete a T maze, delayed alternation task. Performance was scored as a percentage of trials during which the correct maze arm was selected. Subjects scores were recorded after 1 and 2 hours of restraint stress, as well as after 1 hour of unimpeded movement in a cage placed in the testing room. Restraint stress was effected through physical confinement within plastic, cylindrical tubing. Female …