Anatomy Commons^™

New Paradigms In The Treatment Of Acute Complicated And Uncomplicated Type B Aortic Dissection, Eric S. Weiss

Aurora Heart Failure / Transplant Faculty

The treatment of acute type B aortic dissection is a rapidly evolving field, due in a large part to the advent of thoracic endovascular aortic repair (TEVAR). This review will summarize the current literature on the management of both complicated and uncomplicated type B dissections, with special attention paid to emerging evidence supporting earlier aggressive treatment.

Mechanisms Of Left Ventricular Thrombus Formation In Heart Failure With Reduced Ejection Fraction: Novel Insights From Two-Dimensional Speckle Tracking Echocardiography, Dhruv Chawla, Tracy Hammonds, Tadele Mengesha, Matt Umland, Khawaja Afzal Ammar, Vinay Thohan

Aurora Heart Failure / Transplant Faculty

Background: Patients suffering from heart failure with reduced ejection fraction (HFrEF) are at increased risk for left ventricular (LV) thrombus and subsequent thromboembolism, yet anticoagulation is not routinely recommended for left ventricular ejection fraction (LVEF) alone. We sought to determine the role of two-dimensional speckle tracking echocardiography (2D-STE) to quantify regional changes in cardiac function associated with LV thrombus, which may prospectively guide anticoagulation.

Purpose: Help enable cardiovascular clinicians to use 2D-STE to evaluate regional strain patterns among patients with HFrEF with and without LV thrombus. Our results suggest that statistically lower regional longitudinal strain patterns in a well-matched cohort …

A Rare Case Of Paradoxical Left Sided Endocarditis Through Patent Foramen Ovale., George M. Yousef, Paul I. Okhumale, Haytham Aljoudi, Silvestre Cansino

Silvestre P. Cansino

A 36 -year old woman IV drug abuser admitted with Right-Sided Infective Endocarditis (RSIE) as demonstrated by transthoracic echocardiogram. Patient was admitted 8 weeks later with recurrence of symptoms, moreover signs of systemic embolization were noted. Transthoracic and Transesophageal Echocardiograms revealed tricuspid valve vegetation, severe tricuspid regurgitation, left atrial mass, Patent Foramen Ovale (PFO), severely dilated right atrium and prominent Chiari's network. Systemic embolization included brain and Left iliacus abscesses. Patent Foramen ovale is the proposed mechanism leading to extensive systemic embolization in the present case.

A Rare Case Of Paradoxical Left Sided Endocarditis Through Patent Foramen Ovale., George M. Yousef, Paul I. Okhumale, Haytham Aljoudi, Silvestre Cansino

George M. Yousef

A 36 -year old woman IV drug abuser admitted with Right-Sided Infective Endocarditis (RSIE) as demonstrated by transthoracic echocardiogram. Patient was admitted 8 weeks later with recurrence of symptoms, moreover signs of systemic embolization were noted. Transthoracic and Transesophageal Echocardiograms revealed tricuspid valve vegetation, severe tricuspid regurgitation, left atrial mass, Patent Foramen Ovale (PFO), severely dilated right atrium and prominent Chiari's network. Systemic embolization included brain and Left iliacus abscesses. Patent Foramen ovale is the proposed mechanism leading to extensive systemic embolization in the present case.

Assessment Of Chronic Disease To Determine Appropriateness Of Implantable Cardioverter-Defibrillator Therapy, Bilal M. Omery, Maharaj Singh, Randy S. Turkel, Robyn Shearer, Arshad Jahangir, M. Eyman Mortada, Jasbir S. Sra, Indrajit Choudhuri

Indrajit Choudhuri, MD

Background: Implantable cardioverter-defibrillator (ICD) therapy is considered appropriate when a patient is felt to have a reasonable expectation of 1-year survival. Chronic diseases have been estimated to be associated with greater than 10% annual mortality and may reduce benefits of ICD therapy. Frailty has been estimated to be associated with greater than 20% annual mortality and has been suggested to contraindicate ICD therapy.

Purpose: Determine a risk score that may identify patients in whom ICD implantation may not be appropriate.

Methods: Patients who received an ICD for primary and secondary prevention from 2008 through 2013 at the Aurora Health Care …

Disaggregating The Relative Influence Of Genetic, Environmental And Individual Factors On Lcl And Hdl Cholesterols And Bmi For A Sample Of African American (Aa) Mothers And Daughters, C. Jayne Brahler, Jewel Harden, Michelle Mchone, Matthew Soules, Eric Evans, Ann Alyanak, Fred Diakpieng, Paul M. Vanderburgh

Paul M. Vanderburgh

There are many reports about the associations between blood lipids, body mass index (BMI) and dietary cholesterol intakes both within the individual and between related individuals. The purpose of this descriptive research project was to investigate the relationships between LDL and HDL cholesterols, body mass index and dietary cholesterol intakes for a sample of African American (AA) mothers and their daughters and to attempt to separate the contribution of genetic versus environmental factors. Mother and daughter participants (n =42 and 66, respectively) were 12-14-hours fasted when blood samples were drawn, heights and weights measured, and 24 hour food recalls completed.

New Paradigms In The Treatment Of Acute Complicated And Uncomplicated Type B Aortic Dissection, Eric S. Weiss

Eric Weiss, MD, MPH

The treatment of acute type B aortic dissection is a rapidly evolving field, due in a large part to the advent of thoracic endovascular aortic repair (TEVAR). This review will summarize the current literature on the management of both complicated and uncomplicated type B dissections, with special attention paid to emerging evidence supporting earlier aggressive treatment.

The Contribution Of Individual Exercise Training Components To Clinical Outcomes In Randomised Controlled Trials Of Cardiac Rehabilitation: A Systematic Review And Meta-Regression, Bridget Abell, Paul Glasziou, Tammy Hoffmann

Paul Glasziou

Background While the clinical benefits of exercise-based cardiac rehabilitation are well established, there is extensive variation in the interventions used within these trials. It is unknown whether variations in individual components of these exercise interventions provide different relative contributions to overall clinical outcomes. This study aims to systematically examine the relationship between individual components of the exercise intervention in cardiac rehabilitation (such as intensity and frequency) and clinical outcomes for people with coronary heart disease. Methods In this systematic review, eligible trials were identified via searches of databases (PubMed, Allied and Complementary Medicine, EMBASE, PEDro, Science Citation Index Expanded, CINAHL, …

Lead Burden As A Factor For Higher Complication Rate In Patients With Implantable Cardiac Devices, Christopher Kolibash, Naoyo Mori, Jasbir Sra, Masood Akhtar, M. Eyman Mortada

Mohammad Mortada, MD, FACC, FHRS

Purpose Lead revisions have increased over the last decade. Patients who do not undergo lead extraction face an increased lead burden. Consequences of increased lead burden have not been fully defined. We sought to characterize the complication rate and outcomes in patients with sterile redundant leads. Methods We retrospectively reviewed 242 consecutive patients [mean age 74 ± 12 years; 66.9% male] who underwent lead revision that resulted in an abandoned lead from January 2005 to June 2010. Patients were placed in a cohort based on number of leads after last recorded procedure (Group A: ≤2 [n=58]; Group B: 3-4 [n=168]; …

Score Big For Decreasing Mortality: Icd Risk Score Model, Linda Francaviglia, Rachel Petersen, Maria Stone, M. Eyman Mortada

Mohammad Mortada, MD, FACC, FHRS

Background: Aurora Health Care, a system of 14 acute care hospitals in eastern Wisconsin, has been a long-time participant in the American College of Cardiology’s National Cardiovascular Data Registries, submitting data to its ICD Registry™ since 2005. Our system’s implantable cardioverter-defibrillator (ICD) procedure volume averages 930 cases annually. During 2012 we experienced an increase in in-hospital mortality/morbidity for ICD cases.

Purpose: A single-center study examining in-hospital mortality/morbidity post-ICD implant before and after changes in practice and patient selection.

Methods: ICD implants and generator changes discharged from January 1, 2009, to December 31, 2012, were included in developing a risk model …

Lead Burden As A Factor For Higher Complication Rate In Patients With Implantable Cardiac Devices, Christopher Kolibash, Naoyo Mori, Jasbir Sra, Masood Akhtar, M. Eyman Mortada

Masood Akhtar, MD, FACC, FACP, FAHA, FHRS, MACP

Purpose

Lead revisions have increased over the last decade. Patients who do not undergo lead extraction face an increased lead burden. Consequences of increased lead burden have not been fully defined. We sought to characterize the complication rate and outcomes in patients with sterile redundant leads.

Methods

We retrospectively reviewed 242 consecutive patients [mean age 74 ± 12 years; 66.9% male] who underwent lead revision that resulted in an abandoned lead from January 2005 to June 2010. Patients were placed in a cohort based on number of leads after last recorded procedure (Group A: ≤2 [n=58]; Group B: 3-4 [n=168]; …

Load Carriage Distance Run And Pushups Tests: No Body Mass Bias And Occupationally Relevant, Paul M. Vanderburgh, Nicholas S. Mickley, Philip A. Anloague, Kimber Lucius

Philip A. Anloague

Recent research has demonstrated body mass (M) bias in military physical fi tness tests favoring lighter, not just leaner, service members. Mathematical modeling predicts that a distance run carrying a backpack of 30 lbs would eliminate M-bias. The purpose of this study was to empirically test this prediction for the U.S. Army push-ups and 2-mile run tests. Two tests were performed for both events for each of 56 university Reserve Offi cer Training Corps male cadets: with (loaded) and without backpack (unloaded). Results indicated signifi cant M-bias in the unloaded and no M-bias in the loaded condition for both events. …

Acute Effects Of Whole-Body Vibration On Lower Extremity Muscle Performance In Persons With Multiple Sclerosis, Kurt Jackson, Harold L. Merriman, Paul M. Vanderburgh, C. Jayne Brahler

Harold L. Merriman

Background and Purpose: Whole-body vibration (WBV) is a relatively new form of exercise training that may influence muscle performance. This study investigated the acute effects of high (26 Hz) and low (2 Hz) frequency WBV on isometric muscle torque of the quadriceps and hamstrings in persons with multiple sclerosis (MS). Participants and Method: Fifteen individuals (mean age = 54.6 years, SD = 9.6) with MS and Expanded Disability Status Scale (EDSS) scores ranging from 0-6.5 (mean = 4.2, SD = 2.3) participated in this randomized cross-over study. Following baseline measures of isometric quadricep and hamstring torque, subjects were exposed to …

Evaluation Of Cardiac Involvement In Children With Dengue By Serial Echocardiographic Studies, Tawatchai Kirawittaya, In-Kyu Yoon, Sineewanlaya Wichit, Sharone Green, Francis A. Ennis, Robert V. Gibbons, Stephen J. Thomas, Alan L. Rothman, Siripen Kalayanarooj, Anon Srikiatkhachorn

Sharone Green

BACKGROUND: Infection with dengue virus results in a wide range of clinical manifestations from dengue fever (DF), a self-limited febrile illness, to dengue hemorrhagic fever (DHF) which is characterized by plasma leakage and bleeding tendency. Although cardiac involvement has been reported in dengue, the incidence and the extent of cardiac involvement are not well defined. METHODS AND PRINCIPAL FINDINGS: We characterized the incidence and changes in cardiac function in a prospective in-patient cohort of suspected dengue cases by serial echocardiography. Plasma leakage was detected by serial chest and abdominal ultrasonography. Daily cardiac troponin-T levels were measured. One hundred and eighty …

How Useful Is Youtube In Learning Heart Anatomy?, Athanasios Raikos, Pasan Waidyasekara

Athanasios Raikos

Nowadays more and more modern medical degree programs focus on self-directed and problem-based learning. That requires students to search for high quality and easy to retrieve online resources. YouTube is an emerging platform for learning human anatomy due to easy access and being a free service. The purpose of this study is to make a quantitative and qualitative analysis of the available human heart anatomy videos on YouTube. Using the search engine of the platform we searched for relevant videos using various keywords. Videos with irrelevant content, animal tissue, non-English language, no sound, duplicates, and physiology focused were excluded from …

Assessment Of Obesity As A Cardiovascular Disease Risk Factor In A Geriatric Rural Texas Community - A Six Month Follow-Up, Alberto Coustasse Md, Mba

Alberto Coustasse, DrPH, MD, MBA, MPH

Coustasse, Alberto, Assessment of Obesity as a Cardiovascular Disease Risk Factor in a Geriatric Rural Texas Community – A Six Month Follow-up. Master of Public Health Track, Public Health Administration, December 1999, 22 pp., 9 tables, 9 illustrations, bibliography, 7 titles. The health fair approach was used as a method to establish individual and population health status baselines and to provide a mechanism to follow-up with an elderly population in a rural Texas community. A controlled trial sample of forty-four seniors was initially screened in a primary care clinic in August 1998. Patients were reevaluated at six months and results …

Mcnamara 2014 Mmb1075 - Low Magnification Confocal Microscopy Of Tumor Angiogenesis, George Mcnamara

George McNamara

McNamara 2014 MMB1075 - Low Magnification Confocal Microscopy of Tumor Angiogenesis

Book chapter from Paddock 2014 Confocal Microscopy

Book is online at http://www.springer.com/us/book/9781588293510

Validation Of A 5k Age And Weight Run Handicap Model, Paul M. Vanderburgh, Lloyd L. Laubach

Paul M. Vanderburgh

Though increasing age and body weight (BW) have been widely known to be associated with slower distance run times, the common convention in 5K road races is to categorize competitors by age and, sometimes, BW. This has the disadvantage of assigning only small numbers of competitors to age categories and giving advantage to runners close to the minimum age or BW values allowable. Using recent advances in the modeling of distance run performance by BW combined with empirical evidence quantifying the independent effect of age on cardiovascular endurance, we previously published the derivation of the 5K Handicap (5KH), an age …

Body Weight Penalties In The Physical Fitness Tests Of The Army, Air Force, And Navy, Paul M. Vanderburgh, Todd A. Crowder

Paul M. Vanderburgh

Recent research has empirically documented a consistent penalty against heavier service members for events identical or similar to those in the physical fitness tests of the Army, Air Force, and Navy. These penalties, not related to body fatness, are based on biological scaling models and have a physiologic basis. Using hypothetical cases, we quantified the penalties for males, 60 vs. 90 kg body weight, and females, 45 vs. 75 kg, to be 15-20% for the fitness tests of these three services. Such penalties alone can adversely impact awards and promotions for heavier service members. To deal equitably with these penalties …

Body Mass Bias In A Competition Of Muscle Strength And Aerobic Power, Paul M. Vanderburgh, Lloyd L. Laubach

Paul M. Vanderburgh

Recently, a fitness competition called the Pump and Run (PR) has been popularized. Composed of 2 events, a 5-km road race time (RT) in seconds and a maximal-repetition bench press (BPR) with resistance based on a percentage of body mass (M), the final score (RTadj) equals RT - 30(BPR). From published findings, the authors hypothesized that the PR would impose a bias against heavier competitors. Furthermore, the potential for age bias in this event has not been evaluated. Therefore, the purpose of this study was to investigate M and age bias in the PR for men and women. For 74 …

Correction Factors For Body Mass In Military Physical Fitness Tests, Paul M. Vanderburgh

Paul M. Vanderburgh

Recent research findings combined with the theoretical laws of biological similarity make the compelling case that all physical fitness test items for the Army, Air Force, and Navy impose a 15-20% physiologic bias against heavier, not fatter, men and women. Using the published findings that actual scores of muscle and aerobic endurance scale by body mass raised to the 1/3 power, correction factor tables were developed. This correction factor can be multiplied by one’s actual score (e.g., push-ups, sit-ups, abdominal crunches, or curl-ups repetitions or distance run time) to yield adjusted scores that are free of body mass bias. These …

Derivation Of An Age And Weight Handicap For The 5k Run, Paul M. Vanderburgh, Lloyd L. Laubach

Paul M. Vanderburgh

The adverse effect of increasing age and/or body weight on distance run performance has been well documented. Accordingly, nearly all five kilometer (5K) road races employ age categories and, sometimes, a heavier body weight classification. Problems with such conventions include small numbers of runners within older age categories and the advantage given to the lightest runners within each weight category. We developed a 5K Handicap (5KH), a model that calculates an adjusted run time based on the inputs of actual 5K run time, age, and body weight for men and women. This adjusted time, then, can be compared between runners …

Occupational Relevance And Body Mass Bias In Military Physical Fitness Tests, Paul M. Vanderburgh

Paul M. Vanderburgh

Recent evidence makes a compelling case that U.S. Army, Navy, and Air Force health-related physical fitness tests penalize larger, not just fatter, service members. As a result, they tend to receive lower scores than their lighter counterparts, the magnitude of which can be explained by biological scaling laws. Larger personnel, on the other hand, tend to be better performers of work-related fitness tasks such as load carriage, heavy lifting and materiel handling. This has been explained by empirical evidence that lean body mass and lean body mass to dead mass ratio (dead mass = fat mass and external load to …

Load Carriage Distance Run And Pushups Tests: No Body Mass Bias And Occupationally Relevant, Paul M. Vanderburgh, Nicholas S. Mickley, Philip A. Anloague, Kimber Lucius

Paul M. Vanderburgh

Recent research has demonstrated body mass (M) bias in military physical fi tness tests favoring lighter, not just leaner, service members. Mathematical modeling predicts that a distance run carrying a backpack of 30 lbs would eliminate M-bias. The purpose of this study was to empirically test this prediction for the U.S. Army push-ups and 2-mile run tests. Two tests were performed for both events for each of 56 university Reserve Offi cer Training Corps male cadets: with (loaded) and without backpack (unloaded). Results indicated signifi cant M-bias in the unloaded and no M-bias in the loaded condition for both events. …

Validity Of Boston Marathon Qualifying Times, Paul M. Vanderburgh

Paul M. Vanderburgh

Purpose: To assess the validity of Boston Marathon qualifying (BMQ) standards for men and women. Methods: Percent differences between BMQ and current world records (WR) by sex and age group were computed. WR was chosen as the criterion comparison because it is not confounded by intensity, body composition, lifestyle, or environmental factors. A consistent difference across age groups would indicate an appropriate slope of the age-vs-BMQ curve. Inconsistent differences were corrected by adjusting BMQ standards to achieve a uniform percentage difference from WR. Results: BMQ standards for men were consistently ~50% slower than WR (mean 51.5% ± 1.4%, range 49.6–54.4%), …

Contributions Of Body Fat And Effort In The 5k Run: Age And Body Weight Handicap, Anne R. Crecelius, Paul M. Vanderburgh, Lloyd L. Laubach

Paul M. Vanderburgh

The 5K handicap (5KH), designed to eliminate the body weight (BW) and age biases inherent in the 5K run time (RT), yields an adjusted RT (RTadj) that can be compared between runners of different BW and age. As hypothesized in a validation study, however, not all BW bias may be removed, because of the influences of body fatness (BF) and effort (run speed; essentially the inverse as measured by rating of perceived exertion (RPE)). This study's purpose was to determine the effects of BF and RPE on BW bias in the 5KH. For 99 male runners in a regional 5K …

Contributions Of Body Fat And Effort In The 5k Run: Age And Body Weight Handicap, Anne R. Crecelius, Paul M. Vanderburgh, Lloyd L. Laubach

Anne R. Crecelius

The 5K handicap (5KH), designed to eliminate the body weight (BW) and age biases inherent in the 5K run time (RT), yields an adjusted RT (RTadj) that can be compared between runners of different BW and age. As hypothesized in a validation study, however, not all BW bias may be removed, because of the influences of body fatness (BF) and effort (run speed; essentially the inverse as measured by rating of perceived exertion (RPE)). This study's purpose was to determine the effects of BF and RPE on BW bias in the 5KH. For 99 male runners in a regional 5K …

Reactive Hyperemia Occurs Via Activation Of Inwardly-Rectifying Potassium Channels And Na+/K+-Atpase In Humans, Anne R. Crecelius, Jennifer C. Richards, Gary J. Luckasen, Dennis G. Larson, Frank A. Dinenno

Anne R. Crecelius

Rationale: Reactive hyperemia (RH) in the forearm circulation is an important marker of cardiovascular health, yet the underlying vasodilator signaling pathways are controversial and thus remain unclear. Objective: We hypothesized that RH occurs via activation of inwardly rectifying potassium (KIR) channels and Na+/K+-ATPase and is largely independent of the combined production of the endothelial autocoids nitric oxide (NO) and prostaglandins in young healthy humans. Methods and Results: In 24 (23±1 years) subjects, we performed RH trials by measuring forearm blood flow (FBF; venous occlusion plethysmography) after 5 minutes of arterial occlusion. In protocol 1, we studied 2 groups of 8 …

Developing A Risk Model For In-Hospital Adverse Events Following Implantable Cardioverter-Defibrillator Implantation.Pdf, Michael Mirro

Michael Mirro, MD

Endothelial Cell Cortactin Phosphorylation By Src Contributes To Polymorphonuclear Leukocyte Transmigration In Vitro, L. Yang, Jennifer R. Kowalski, X. Zhan, S. M. Thomas, F. W. Luscinskas

Jennifer Kowalski

The underlying mechanisms that regulate leukocyte transendothelial migration through the vascular endothelium remain unclear. Cortactin is a substrate of Src tyrosine kinases and a regulator of cytoskeletal dynamics. Previous studies demonstrated a role for Src phosphorylation of cortactin in clustering of E-selectin and intercellular cell adhesion molecule-1 around adherent leukocytes. In the current study, we used an in vitro flow model to investigate the role of Src-induced cortactin phosphorylation in endothelium during polymorphonuclear leukocyte (PMN) transmigration through human umbilical vein endothelium (HUVEC) monolayers preactivated with tumor necrosis factor-{alpha}. Inhibition of Src in HUVEC using Src kinase inhibitors PP2 and SU6656 …