Medicine and Health Sciences Commons^™

Point-Of-Care Versus Central Testing Of Hemoglobin During Large Volume Blood Transfusion., Justin Herman, Brian Park, Bharat K. Awsare, Frances Mae West, Denine Crittendon, Lilah Evans, Mary Harach, Julie Karp, Alexis R. Peedin, Marianna Lanoue, Barbara Goldsmith, Eugene P. Warnick, Michael Baram

Division of Pulmonary and Critical Care Medicine Faculty Papers

BACKGROUND: Point-of-care (POC) hemoglobin testing has the potential to revolutionize massive transfusion strategies. No prior studies have compared POC and central laboratory testing of hemoglobin in patients undergoing massive transfusions.

METHODS: We retrospectively compared the results of our point-of-care hemoglobin test (EPOC®) to our core laboratory complete blood count (CBC) hemoglobin test (Sysmex XE-5000™) in patients undergoing massive transfusion protocols (MTP) for hemorrhage. One hundred seventy paired samples from 90 patients for whom MTP was activated were collected at a single, tertiary care hospital between 10/2011 and 10/2017. Patients had both an EPOC® and CBC hemoglobin performed within 30 min …

Mechanisms Of Simvastatin Myotoxicity: The Role Of Autophagy Flux Inhibition., Arya Emami, Shahla Shojaei, Simone C. Da Silva Rosa, Mahmoud Aghaei, Ehsan Samiei, Amir Reza Vosoughi, Forouh Kalantari, Philip Kawalec, James Thliveris, Pawan Sharma, Amir A. Zeki, Mohsen Akbari, Joseph W. Gordon, Saeid Ghavami

Center for Translational Medicine Faculty Papers

Statins are some of the most widely used drugs worldwide, but one of their major side effects is myotoxicity. Using mouse myoblast (C2C12) and human alveolar rhabdomyosarcoma cell lines (RH30) in both 2-dimensional (2D) and 3-dimensional (3D) cell culture, we investigated the mechanisms of simvastatin's myotoxicity. We found that simvastatin significantly reduced cell viability in C2C12 cells compared to RH30 cells. However, simvastatin induced greater apoptosis in RH30 compared to C2C12 cells. Simvastatin-induced cell death is dependent on geranylgeranyl pyrophosphate (GGPP) in C2C12 cells, while in RH30 cells it is dependent on both farnesyl pyrophosphate (FPP) and GGPP. Simvastatin inhibited …

The Role Of Diagnostic Bronchoscopy In Refractory Asthma Management, Christopher Mcgrath, Md, Tuhina Raman, Md, Jessica Most, Md

Division of Pulmonary and Critical Care Medicine Posters

Refractory asthma is an uncommon entity, manifesting in less than five percent of asthmatics and characterized by high medication requirements, persistent symptoms, frequent exacerbations, and significant airflow obstruction despite standard medical therapy.[1] Bronchoscopy may be an effective tool for identifying refractory asthma phenotypes.[3] The objective of this case series is to demonstrate the use of bronchoscopy to personalize treatment among a population of refractory asthmatics.

The Case For Patient Navigation In Lung Cancer Screening In Vulnerable Populations: A Systematic Review., Christine S Shusted, Julie A Barta, Michael Lake, Rickie Brawer, Brooke Ruane, Teresa E Giamboy, Baskaran Sundaram, Nathaniel R Evans, Ronald E Myers, Gregory C Kane

Division of Pulmonary and Critical Care Medicine Faculty Papers

Patient navigation has been proposed to combat cancer disparities in vulnerable populations. Vulnerable populations often have poorer cancer outcomes and lower levels of screening, adherence, and treatment. Navigation has been studied in various cancers, but few studies have assessed navigation in lung cancer. Additionally, there is a lack of consistency in metrics to assess the quality of navigation programs. The authors conducted a systematic review of published cancer screening studies to identify quality metrics used in navigation programs, as well as to recommend standardized metrics to define excellence in lung cancer navigation. The authors included 26 studies evaluating navigation metrics …

Bitter Taste Receptors For Asthma Therapeutics., Ajay P. Nayak, Sushrut D. Shah, James V. Michael, Deepak A. Deshpande

Center for Translational Medicine Faculty Papers

Clinical management of asthma and chronic obstructive pulmonary disease (COPD) has primarily relied on the use of beta 2 adrenergic receptor agonists (bronchodilators) and corticosteroids, and more recently, monoclonal antibody therapies (biologics) targeting specific cytokines and their functions. Although these approaches provide relief from exacerbations, questions remain on their long-term efficacy and safety. Furthermore, current therapeutics do not address progressive airway remodeling (AR), a key pathological feature of severe obstructive lung disease. Strikingly, agonists of the bitter taste receptors (TAS2Rs) deliver robust bronchodilation, curtail allergen-induced inflammatory responses in the airways and regulate airway smooth muscle (ASM) cell proliferation and mitigate …

Patient Registries In Idiopathic Pulmonary Fibrosis., Daniel A. Culver, Jürgen Behr, John A. Belperio, Tamera J. Corte, Joao A. De Andrade, Kevin R. Flaherty, Mridu Gulati, Tristan J. Huie, Lisa H. Lancaster, Jesse Roman, Christopher J. Ryerson, Hyun J. Kim

Division of Pulmonary and Critical Care Medicine Faculty Papers

Over the past decade, several large registries of patients with idiopathic pulmonary fibrosis (IPF) have been established. These registries are collecting a wealth of longitudinal data on thousands of patients with this rare disease. The data collected in these registries will be complementary to data collected in clinical trials because the patient populations studied in registries have a broader spectrum of disease severity and comorbidities and can be followed for a longer period of time. Maintaining the quality and completeness of registry databases presents administrative and resourcing challenges, but it is important to ensuring the robustness of the analyses. Data …

We Got The Beat: Improving Cpr Quality With Real-Time Metrics, Juergen Kloo, Md, Frances Mae West, Md, Michael Haviland, Rn, Bsn

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Introduction

High quality chest compressions have been linked to improved survival from sudden cardiac arrest.

The 2015 AHA guidelines recommend the following:

• Rate of compressions between 100 120 CPM
• Depth of compressions between 2 2.4 inches
• Allow full recoil between compressions
• Target CPR fraction at least 60% of the time, ideally 80%
• Avoid hyperventilation
• Collect and use data to improve performance

We set out to show that our clinicians would have a minimum 25% improvement in CPR quality with the use of real time feedback using the new R series ZOLL defibrillators.

Hermansky-Pudlak Syndrome 1 And 2 Have Differential Effects On Lung Fibroblast Behavior, Karina Cuevas-Mora, Dominic Sales, Hoora Shaghaghi, Ross Summer, Freddy Romero

Center for Translational Medicine Posters

Objective

To determine whether mitochondrial function and/or the proteasome system is altered in fibroblasts from the HPS mouse lung.

The In Vivo Effects Of Alcohol In Lung And Liver Are At Least Partially Mediated Through The Alpha 4 Nicotinic Acetylcholine Receptor, J. Ritzenthaler, E. Torres-Gonzalez, G. E. Arteel, J. Roman

Division of Pulmonary and Critical Care Medicine Posters

Rational: Chronic alcohol abuse is a major risk factor for the development of acute lung injury, with 40% of annual cases in the U.S. linked to this disorder. Alcohol is not only associated with increased incidence of acute lung injury in at-risk individuals, but also increased mortality. The exact mechanisms by which alcohol abuse renders the host susceptible to acute lung injury remain poorly defined. We have reported that α4 nicotinic acetylcholine receptors (α4 nAChRs) may serve as potential sensors for alcohol in lung fibroblasts; however, we have not tested their role in vivo.

Methods: To test the role of …

The Fibrosis Across Organs Symposium: A Roadmap For Future Research Priorities., Jesse Roman, Teresa R. Barnes, Dolly J. Kervitsky, Gregory P. Cosgrove, Dennis E. Doherty, Andrew M. Tager, Luca Richeldi, Eric S. White, David A. Brenner, Lynn M. Schnapp, Timothy D. Hewitson, Bodh I. Jugdutt, Timothy A. Mckinsey, John D. Tosi, Stephen Crane, Kevin K. Brown

Division of Pulmonary and Critical Care Medicine Faculty Papers

No abstract provided.

Right Ventricular Outflow Tract Velocity Time Integral-To-Pulmonary Artery Systolic Pressure Ratio: A Non-Invasive Metric Of Pulmonary Arterial Compliance Differs Across The Spectrum Of Pulmonary Hypertension., Priyanka T. Bhattacharya, Gregory S. Troutman, Frances Mao, Arieh L. Fox, Monique S. Tanna, Payman Zamani, E. Wilson Grandin, Jonathan N. Menachem, Edo Y. Birati, Julio A. Chirinos, Sula Mazimba, Kerri Akaya Smith, Steven M. Kawut, Paul R. Forfia, Anjali Vaidya, Jeremy A. Mazurek

Student Papers, Posters & Projects

Pulmonary arterial compliance (PAC), invasively assessed by the ratio of stroke volume to pulmonary arterial (PA) pulse pressure, is a sensitive marker of right ventricular (RV)-PA coupling that differs across the spectrum of pulmonary hypertension (PH) and is predictive of outcomes. We assessed whether the echocardiographically derived ratio of RV outflow tract velocity time integral to PA systolic pressure (RVOT-VTI/PASP) (a) correlates with invasive PAC, (b) discriminates heart failure with preserved ejection-associated PH (HFpEF-PH) from pulmonary arterial hypertension (PAH), and (c) is associated with functional capacity. We performed a retrospective cohort study of patients with PAH (n = 70) and …

Multidisciplinary Care For Adult Hermansky-Pudlak Syndrome Patients In Puerto Rico, Isabel Becerra, Shirley Martinez, Atencio Xavier, Torrens Jonathan, Juan Alemany, Eric Cruz, Felix Rivera Borges, Monica Egozcue, Jesse Roman, Rosa Roman

Division of Pulmonary and Critical Care Medicine Posters

Background: Hermansky-Pudlak syndrome (HPS) is an autosomal recessive rare disease characterized by oculo-cutaneous albinism, bleeding diathesis due to platelet dysfunction, and is sometimes accompanied by immunodeficiency, granulomatous colitis, and/or interstitial lung disease / pulmonary fibrosis. Puerto Rico houses the highest concentration of patients with HPS, especially HPS-1, which is considered quite severe and often associated with pulmonary fibrosis. We believe that the establishment of an HPS Multidisciplinary Clinic in Puerto Rico would improve outcomes.

Methods: A multidisciplinary clinic was started in November 2018 and another was held in February 2019 at the Mayaguez Medical Center located in the Southwest region …

Stressed Out With Sepsis., Robert Hilton, Michael Baram

Division of Pulmonary and Critical Care Medicine Faculty Papers

No abstract provided.

Sociodemographic Background Characteristics Of Patients Who Participate In A Lung Cancer Screening Program, Amber Zhang, Marcella Pimpinelli, Brooke Ruane, Russell K. Mcintire, Julie Barta, Md, Hee-Soon Juon, Bridget Jackson

Phase 1

Introduction: Despite decreasing lung cancer incidence and mortality rates, disparities in prevalence and outcomes persist between Black and White patients. Secondary analysis of the National Lung Screening Trial found screening with low-dose CT (LDCT) reduced lung cancer mortality more in Blacks than Whites. However, it is unknown if racial disparities exist in screening results, and the involved sociodemographic factors.

Objective: The study aims to analyze characteristics that may predict screening outcomes (Lung-RADS category) in patients who received LDCT through the Jefferson Lung Cancer Screening Program (LCSP).

Methods: Retrospective data (n=733, May 2015 to July 2017) were merged with prospective …

Bova Is Superior To Spesi In Identification Of High Risk Pulmonary Embolism Patients, J. Dibello, P. Khaing, E. Gupta, C. Au, T. Chengsupanimit, B. K. Awsare, M. Baram, F. M. West, G. C. Kane

Phase 1

Introduction: Prognostic models exist for the purpose of stratifying patients with acute pulmonary embolism. Of these, the Pulmonary Embolism Severity Index (PESI) and the simplified PESI (sPESI) are the most well-known, although more recent composite models, like the BOVA score, are now being studied and implemented. Comparative efficacy of these scores to predict long term mortality is not well established.

Methods: We performed a retrospective analysis of all consecutive patients diagnosed with PE using computed tomography scan from 2014-2016 at an urban tertiary-referral medical center. Cox proportional hazard analyses were performed to compare the performance of two prognostic …

Global Epidemiology Of Lung Cancer., Julie A. Barta, Md, Charles A. Powell, Juan P. Wisnivesky

Division of Pulmonary and Critical Care Medicine Faculty Papers

While lung cancer has been the leading cause of cancer-related deaths for many years in the United States, incidence and mortality statistics - among other measures - vary widely worldwide. The aim of this study was to review the evidence on lung cancer epidemiology, including data of international scope with comparisons of economically, socially, and biologically different patient groups. In industrialized nations, evolving social and cultural smoking patterns have led to rising or plateauing rates of lung cancer in women, lagging the long-declining smoking and cancer incidence rates in men. In contrast, emerging economies vary widely in smoking practices and …