Digital Commons Network^™

Differential Microrna Profiling Of Blood L1cam And Bulk Extracellular Vesicles In Bipolar Disorder, Gabriel R Fries, Salahudeen Mirza, Jun Wang, Camila N C Lima, Wei Zhang, Marcela Carbajal Tamez, Giselli Scaini, Jair C Soares, Joao Quevedo

Faculty, Staff and Students Publications

Objective: This preliminary study aimed to identify microRNA (miRNA) signatures associated with bipolar disorder (BD) by profiling blood-derived extracellular vesicles (EVs) of both putative neuronal origin and from all sources.

Method: In two parallel studies of individuals with BD and controls (CON), we characterized miRNA expression profiles of blood EVs selected for L1CAM, a putative marker of neuronal origin (n = 20 BD/20 CON), as well as bulk EVs (n = 21 BD/20 CON). For each study, analyses identified miRNAs differentially expressed between groups, followed by functional interrogation and testing for associations with clinical features.

Results: Results of …

Vaccine Hesitancy At Nine Community Sites Across The United States, Early In Covid-19 Vaccine Rollout, Aneeka Ratnayake, Julie H Hernandez, Jessica Justman, Jason E Farley, Yael Hirsch-Moverman, Ken Ho, Stockton Mayer, Abiodun Oluyomi, Magdalena E Sobieszczyk, Shobha Swaminathan, Timothy Skalland, Jean De Dieu Tapsoba, Patricia J Kissinger

Faculty, Staff and Students Publications

Background: Vaccine hesitancy has been a significant concern throughout the COVID-19 pandemic. Vaccine hesitancy can be attributed to lack of confidence in vaccines, complacency about the health threat, or lack of convenience of vaccination. To date, few studies have used methods designed to include populations underrepresented in research when identifying factors associated with vaccine hesitancy.

Methods: Between January and July 2021, potential participants were recruited from community venues selected through time-location sampling in 15 defined communities in the United States. Study staff administered a questionnaire on demographics, COVID-19 behaviors and attitudes, and vaccination status or intention to consenting individuals. Vaccine …

Publisher Correction: Piezo1 Regulates Meningeal Lymphatic Vessel Drainage And Alleviates Excessive Csf Accumulation, Dongwon Choi, Eunkyung Park, Joshua Choi, Renhao Lu, Jin Suh Yu, Chiyoon Kim, Luping Zhao, James Yu, Brandon Nakashima, Sunju Lee, Dhruv Singhal, Joshua P Scallan, Bin Zhou, Chester J Koh, Esak Lee, Young-Kwon Hong

Faculty, Staff and Students Publications

No abstract provided.

A Review Of The Efficacy Of Complementary And Alternative Medicines In Managing Dermatologic Infectious Diseases, Promise Ufomadu, Bartley Joseph Gill, Ikue Shimizu, Ida Orengo, Theodore Rosen

Faculty, Staff and Students Publications

Dermatologic infections, particularly fungal and viral, are globally prevalent and often lead patients to seek complementary and alternative medicines (CAMs). This review critically evaluates 17 studies investigating CAM efficacy in treating dermatologic infectious diseases, focusing on those evaluated in randomized controlled trials (RCTs). Tea tree oil shows modest benefit for fungal infections such as tinea pedis and onychomycosis, though studies are limited by poor blinding and dropout rates. For herpes simplex virus (HSV), propolis and Melissa officinalis demonstrate potential antiviral effects, but findings are limited by subjective outcomes and industry sponsorship. Green tea extract (polyphenon E) shows efficacy in treating …

Managing Conflict Case: The Difficult Consultant, Amrita Vempati, Suzanne Bentley, Anita Rohra, Daniela Ortiz, David Fernandez, Shagun Berry, Colleen Donovan, Nicole Novotny, Stephanie Cohen, Stephanie Stapleton, Tiffany Moadel

Faculty, Staff and Students Publications

Audience: This communication case is intended for emergency medicine (EM) resident physicians and junior faculty preparing for the ABEM Certifying Exam.

Introduction: Conflict management is a common and significant challenge in the emergency department (ED), with potential negative impact on both physicians and patients. At the individual level, hospital-based conflicts can lead to emotional stress, impaired concentration, decreased trust among providers, and feelings of dehumanization.1 For patients, conflicts between physicians can compromise the quality of care and contribute to delays in treatment.1 In the ED, conflict often arises between emergency physicians (EPs) and various stakeholders, including patients, family members, nursing …

Patient-Centered Communication Case: Threatened Miscarriage, Anita Rohra, Daniela Ortiz, Shagun Berry, Colleen Donovan, Nicole Novotny, Stephanie Cohen, Charles Lei, Alaa Aldalati, Stephanie Stapleton, David Fernandez

Faculty, Staff and Students Publications

Audience: This communication case is intended for EM residents of all levels.

Introduction: Patient-centered communication is a necessary skill in the practice of emergency medicine. This style of communication is crucial for promoting high-quality healthcare by prioritizing patient needs, perspectives, and values. This patient-centered communication case centers on miscarriage, a diagnosis where patient-centered communication is requisite. Approximately one in six or 17.1% of patients with a final diagnosis of miscarriage, also known as early pregnancy loss, present initially to the emergency department.1 Advising a patient of the diagnosis of miscarriage requires excellent communication skills including facile rapport building, empathy, nonverbal …

Difficult Conversation Case: Death Notification, Charles Lei, Tiffany Moadel, Suzanne Bentley, Amrita Vempati, David Fernandez, Daniela Ortiz, Anita Rohra, Stephanie Stapleton, Hillary Moss

Faculty, Staff and Students Publications

Audience: This case is meant for senior emergency medicine (EM) resident physicians as a preparatory tool for the American Board of Emergency Medicine Certifying Exam. However, it is applicable for EM residents at all levels of training.

Introduction: Difficult conversations are an integral part of the practice of emergency medicine. Competent EM physicians routinely engage in challenging conversations with patients and their families (eg, delivering bad news, disclosing medical errors, providing death notifications).1 Despite their importance, communication skills are often not formally taught in residency training.2 Instead, learners frequently rely on role modeling to develop the skills necessary to navigate …

Epidemiological Patterns And Variability In Acute Brain Injury: A Multicenter Registry Analysis In South Korea's Neurocritical Care Units, Heewon Jeong, So Hee Park, Yoon-Hee Choo, Dong-Wan Kang, Yong Soo Kim, Bosco Seong Kyu Yang, Huimahn Alex Choi, Sung-Min Cho, Eun Jin Ha, Jiwoong Oh, Han-Gil Jeong

The Brown Foundation: Institute of Molecular Medicine

Background: Specialized neurocritical care (NCC) improves outcomes in acute brain injury (ABI), but significant variability exists in practices across and hospitals within South Korea's developing national NCC system. This study aims to assess clinical variability among patients with ABI across six tertiary NCC units (NCCUs) in South Korea and evaluate center-specific effects on clinical outcomes.

Methods: A multicenter registry of patients with ABI admitted to NCCUs between April 2023 and April 2024 was analyzed. A descriptive analysis was conducted to evaluate demographic, clinical, and treatment characteristics across centers. Variability across centers was quantified using the average standardized mean difference (SMD) …

Ddt Exposure Induces Microglial Activation And Disease-Associated Microglial Signatures: Relevance To Mechanisms Of Alzheimer’S Disease, Isha Mhatre-Winters, Aseel Eid, Nicole Blum, Yoonhee Han, Ferass M Sammoura, Long-Jun Wu, Jason R Richardson

The Brown Foundation: Institute of Molecular Medicine

Background: Alzheimer's disease (AD) is characterized by the presence of amyloid-β plaques, neurofibrillary tangles, and neuroinflammation. Previously, we reported that serum levels of dichlorodiphenyldichloroethylene (DDE), the primary metabolite of the pesticide dichlorodiphenyltrichloroethane (DDT), were significantly higher in AD patients compared to age-matched controls and that DDT exposure worsened AD pathology in animal models.

Objective: Here, we investigated the effect of DDT on neuroinflammation in primary mouse microglia (PMG) and C57BL/6J mice.

Methods: DDT-induced inflammatory and disease-associated microglial (DAM) gene expression were determined in PMG by qPCR and immunocytochemistry, with and without pretreatment with the sodium channel antagonist tetrodotoxin (TTX). Furthermore, …

A Prognostic Classification System For Extent Of Resection In Idh-Mutant Grade 2 Glioma: An International, Multicentre, Retrospective Cohort Study With External Validation By The Rano Resect Group, Philipp Karschnia, Jacob S Young, Maarten M J Wijnenga, Tommaso Sciortino, Nico Teske, Alba Corell, Arthur Wagner, Gilbert Youssef, Yae Won Park, Levin Häni, Stephanie T Jünger, Antonio Dono, Felix Ehret, Eduardo E Mendoza Mireles, Nicolas Neidert, Francesco Bruno, Chad A Tuchek, Thijs Van Der Vaart, Marco Rossi, Marco Conti Nibali, Lorenzo Gay, Alfred Gramelt, Nitin Tandon, Sung Soo Ahn, Jong Hee Chang, Michael Weller, Arnaud J P E Vincent, Roland Goldbrunner, Daniel P Cahill, Raymond Y Huang, Andreas Raabe, Bernhard Meyer, Juergen Beck, Annette M Molinaro, Susan M Chang, Michael A Vogelbaum, Roberta Rudà, Einar O Vik-Mo, Jorg Dietrich, Yoshua Esquenazi, Stefan J Grau, Patrick Y Wen, Asgeir S Jakola, Oliver Schnell, Lorenzo Bello, Martin J Van Den Bent, Shawn Hervey-Jumper, Mitchel S Berger, Joerg-Christian Tonn

Faculty, Staff and Student Publications

Background: The efficacy of resection in IDH-mutant grade 2 gliomas remain controversial since terminology for the extent of resection has been inconsistently applied across studies. We aimed to establish a standardised classification for the extent of resection and assess the association between supramaximal resection and survival across molecular subtypes.

Methods: In this international, multicentre, retrospective study, patients aged 18 years and older with newly diagnosed grade 2 IDH-mutant glioma were identified from institutional databases across 16 centres in the USA, Europe, and Asia between between Sept 1, 1993, and May 10, 2024. We used Cox proportional hazard regressions to analyse …

Peripheral Blood Gene Expression Profiling And Prognostic Significance For The Course Of Interstitial Lung Disease In Patients With Systemic Sclerosis, Shervin Assassi, Christopher P Denton, Matthias Zwick, Ramona Schmid, Carina Ittrich, Tobias Litzenburger, Sudha Visvanathan

Faculty, Staff and Student Publications

Objective: We used data from the placebo arm of the Safety and Efficacy of Nintedanib in Systemic Sclerosis (SENSCIS) trial to determine the prognostic/predictive significance of peripheral blood cell (PBC) transcript modules for the course of forced vital capacity (FVC) in patients with systemic sclerosis-associated interstitial lung disease (SSc-ILD) with and without mycophenolate mofetil (MMF) treatment.

Methods: Patients had SSc-ILD with first non-Raynaud symptom within 7 years. MMF treatment was permitted if taken at a stable dose for ≥6 months. PBC RNA samples were taken at baseline. Global RNA sequencing was performed, followed by a modular analysis using 62 curated …

Unmasking Hidden Clues In Cutaneous Viral Infections: Histopathological Insights Into Keratinocytic Features Of Herpes Simplex Virus, Varicella Zoster Virus, And Molluscum Contagiosum, Tania Platero Portillo, Dilshad Dhaliwal, Sepideh Mehravaran, Megan Ketcham, Julie Wu, Nisha Ramani, Abdul Hafeez Diwan

Faculty, Staff and Students Publications

Objective: This case study aimed to explore primarily the keratinocytic changes of cutaneous viral infections caused by herpes simplex virus (HSV), varicella-zoster virus (VZV), and molluscum contagiosum (MC). The focus was on identifying features and diagnostic clues in cases without typical findings.

Methods: A retrospective analysis encompassing 14 HSV/VZV cases (January 2000 to October 2023) and 22 MC cases (January 2013 to December 2015) was conducted.

Results: In HSV/VZV cases, 71% (10 of 14) exhibited distinctive histopathological features in the adjacent keratinocytes, including nucleolar enlargement and atypical features. Immunohistochemical studies in 40% of the cases (4 of 10) revealed positive …

Abca4-Mutant Human Retinal Organoids Sequencing Reveals Organoids Application In Inherited Retinal Diseases, Yourong Bao, Sujung Soh, Jean Li, Zhen Zuo, Salma Ferdous, Xinye Qian, Jin Li, Jiaxiong Lu, Xuesen Cheng, Anna Matynia, Yumei Li, Rui Chen

Faculty, Staff and Students Publications

In the studies of Inherited Retinal Diseases (IRDs), the knockout of traditional animal models like mice often fails to accurately replicate human phenotypes due to genetic and anatomical differences. Human retinal organoids (ROs) derived from stem cells have emerged as promising developmental models in retinal studies to delineate cell growth, but their ability to represent the characteristics of late-onset IRDs remains unclear. This study aims to validate ROs as a disease model for Stargardt's Disease (STGD) caused by ABCA4 mutations. Using single-cell RNA sequencing, ROs from 2 STGD patients were compared with healthy control-derived ROs at two developmental stages on …

Impact Of Propofol Or Sevoflurane On The Renoprotective Effect Of Remote Ischaemic Preconditioning In Cardiac Surgery: The Hypnorenalrip Randomised Clinical Trial, Alexander Zarbock, Ludwig Maximilian Schöne, John A Kellum, Joachim Gerss, Raphael Weiss, Hendrik Booke, Melanie Meersch

Faculty, Staff and Student Publications

Background: Remote ischaemic preconditioning (RIPC) might reduce acute kidney injury after cardiac surgery. Protective effects appear to be restricted to patients with early and transient increases in two cell cycle arrest markers, tissue inhibitor of metalloproteinases-2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7), in urine. Studies suggest that propofol can attenuate the preconditioning effect on the myocardium. This study investigated whether propofol diminishes the renoprotective effect associated with the early transient increases in TIMP-2 and IGFBP7.

Methods: This was a single-centre, prospective randomised double-blind 2×2 factorial clinical trial of high-risk patients undergoing cardiac surgery. Patients were randomised to receive …

Allogeneic Bone Marrow-Derived Mesenchymal Stem Cells For Parkinson's Disease: A Randomized Trial., Mya C Schiess, Jessika Suescun, Juan D Martinez-Lemus, Charles Green, Tia S Thomas, Mohammad Shahnawaz, Emily Tharp, Nikunj B Satani, Jerome G Saltarrelli, Christopher Adams, Marie-Francoise Doursout, Vanessa Thyne, Rula Abuamouneh, Elsa M Rodarte, Sean I Savitz, Timothy M Ellmore

Faculty, Staff and Student Publications

Background: Neuroinflammation contributes to Parkinson's disease (PD) progression and motor dysfunction. Allogeneic human mesenchymal stem cells (allo-hMSCs) may reduce neuroinflammation and improve motor symptoms.

Objectives: To evaluate the efficacy of repeated intravenous doses of 10 × 106/kg allo-hMSCs in improving motor symptoms in patients with PD (PwP).

Methods: In this phase 2, randomized, placebo-controlled trial (November 2020-July 2023), mild-to-moderate PwP received either three allo-hMSC infusions, one placebo followed by two allo-hMSC infusions, or three placebo infusions at 18-week intervals. Follow-up lasted 88 weeks. The primary outcome was a >70% posterior probability (PP) of a difference in the proportion of participants …

Prospective Trial Of Cerebrospinal Fluid Filtration After Aneurysmal Subarachnoid Hemorrhage Via Lumbar Catheter Extension (Pillar-Xt), Spiros L Blackburn, Marc A Babi, Andrew W Grande, Omar A Choudhri, Erik F Hauck, Christopher P Kellner, Michael C Giordano, Shivanand P Lad, Aaron R Mccabe

Faculty, Staff and Student Publications

Background: There is a growing consensus that blood in the cerebrospinal fluid (CSF) is deleterious to outcomes in patients with aneurysmal subarachnoid hemorrhage. The extracorporeal filtration of subarachnoid hemorrhage via spinal catheter extension study evaluated the safety, tolerability, and filtration curve of blood and its lysis products from hemorrhagic CSF using the Neurapheresis CSF Management System.

Methods: After aneurysm repair, a dual-lumen intrathecal catheter was inserted into the study participant's spinal canal. CSF was extracorporeally filtered for up to 72 h, removing blood products from the lumbar cistern, and reintroducing filtered CSF to the thoracic subarachnoid space. Neurological examinations were …

Short-Term Preeclampsia Prediction: Cutoff Variations For Sflt-1/Plgf In U.S. Patients With Or Without Hypertensive Disorders, Yaxin Li, Kristen Cagino, Jim Yee, Caroline Andy, Dajana Borova, Ayush Shah, Isla Racine, Tracy B Grossman, Zhen Zhao

Faculty, Staff and Student Publications

Background: Preeclampsia (PE) is a complex disorder with significant maternal and fetal risks. The soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) ratio shows promise as a diagnostic tool, but its adoption in the U.S. remains limited due to the lack of accessible testing platforms, U.S.-based studies, and evidence-based implementation guidelines.

Patients/materials and methods: We conducted a cohort study to evaluate the sFlt-1/PlGF ratio for predicting PE within two weeks among pregnant individuals ≥18 years, ≥20 weeks gestation. Serum samples were obtained from routine prenatal visits or triage evaluations. sFlt-1/PlGF ratios were measured using Roche Elecsys assays, and …

Assessment Of Postoperative Range Of Motion In Pediatric Patients Undergoing Surgical Reduction And Fixation Of Lateral Condyle Fractures, Gabrielle Rogie, Timothy Borden, Lindsay Crawford, Surya Mundluru, Brennan Roper, Rohini Mahajan Vanodia, Shiraz Younas

Faculty, Staff and Student Publications

Purpose: The objective of this study was to evaluate the outcomes of various methods of fixation for pediatric lateral condyle fractures. The null hypothesis was that there would be no difference between the three treatment groups and time of return to the full range of motion.

Method: There were three fixation groups-Algemeinshaft fur osteosynthesegragen (AO) cannulated screws (n = 11), buried Steinmann pins (n = 13), and unburied Steinmann pins (n = 36). Variables evaluated were time to return to full range of motion of the elbow, whether therapy was required, average number of follow-up visits, fracture …

Prone Percutaneous Jungbluth For Reduction Of Irreducible Posterior Pelvic Ring Injuries: A Technical Trick, Joseph M Radley, Jonathan A Copp, Daniel S Gloekler, Jonathan G Eastman

Faculty, Staff and Student Publications

Unstable pelvic ring injuries represent a challenge due to the complex anatomy. Further, surgical access to the pelvic ring is altered by patient positioning in the supine versus prone position. Certain injury patterns present with the posterior pelvis in a fixed displaced position. These injuries can be exceedingly challenging to reduce from a supine position. In the prone position, these injuries can be reduced more directly with an open approach, but this is associated with wound healing complications. The technical trick herein demonstrated a successful technique utilizing a large Jungbluth clamp percutaneously applied to the posterior superior iliac spines with …

Efficacy Of Platelet Rich Plasma Versus Placebo For Improvement In Olfactory Function In Adults With Olfactory Dysfunction: A Systematic Review And Meta-Analysis, Ali B Jafar, Ghabrielle Almeida, Fatima Al Mousawi, Eric Delgado Rendon, Amber U Luong

Faculty, Staff and Student Publications

Background: Olfactory dysfunction significantly impairs quality of life. Conventional treatments such as corticosteroids and olfactory training offer limited and inconsistent efficacy. Platelet-rich plasma (PRP), a biologically active agent, has shown potential regenerative effects in olfactory neuroepithelium. This study systematically evaluates the efficacy of PRP compared to placebo in improving olfactory function.

Methods: A systematic review and meta-analysis was conducted according to PRISMA guidelines and was registered in PROSPERO (CRD 420251045079). The databases searched included PubMed, Scopus, Embase, Central, and Web of Science. Seven studies (four RCTs, three non-RCTs) involving 789 patients were included. Subjective and objective outcomes were extracted and …

Developing Consensus For A More Provider-Friendly Next-Generation Sequencing Molecular Biomarker Report: A Joint Consensus Recommendation Of The Association For Molecular Pathology And College Of American Pathologists, Jane Gibson, Hanadi El Achi, Dana Altenburger, Noah Brown, Amy S Clark, Joshua Coleman, Rajyasree Emmadi, Amber M Fussell, Meera Hameed, Danielle Jordan, Jennifer Laudadio, Anthony Provenzano, Robyn L Temple-Smolkin, Christopher G Suciu

Faculty, Staff and Student Publications

Despite the increasing availability of next-generation sequencing (NGS) gene panel analysis for cancers, published reports suggest underutilization of testing, citing the shortage of credentialed professionals available to assist with the interpretation of test results among the key barriers. Obtaining a multidisciplinary consensus regarding a shared best practice NGS molecular biomarker reporting section template may facilitate introduction and/or increased testing for institutions that adopt similar report structures by improving report effectiveness and efficiency for both health care providers and laboratory professionals, leading to improved patient care. To address this challenge, the Association for Molecular Pathology convened a multidisciplinary collaborative expert working …

Early Identification For Spasticity Patient Referral Needs: An Inter-Rater Reliability Study Of The Post-Stroke Spasticity Referral Tool, Jorg Wissel, Atul Patel, Ganesh Bavikatte, Xiao Li, Sophie L Musson, Elizabeth Torres, Nabilah Alibhai, Tiziana Musacchio, Gerard E Francisco

Faculty, Staff and Student Publications

Background: The post-stroke spasticity (PSS) Referral Tool was developed to assist health care professionals in the early identification of patient referral needs. An inter-rater reliability (IRR) study using videos of patients with different stages of or without predictors of PSS was performed to validate its utility in clinical practice.

Research design and methods: This prospective study had 3 parts: patient video production (Part A); expert panel classification of patient videos into PSS Referral Tool categories (Part B; Urgent Referral [UR; red], Routine Referral [RR; yellow], Periodic Monitoring [PM; green]), and an IRR analysis from global clinician raters (Part C). IRR …

Real-World Disease Burden And Health Care Resource Utilization For Patients With Barth Syndrome, Lindsay Marjoram, Yonglin Huang, Mary Kay Koenig, Bruce H Cohen, Eric Anderson

Faculty, Staff and Student Publications

Background: Barth syndrome (BTHS) is an ultra-rare, X-linked genetic disorder for which there is limited economic data. Because compiling such data that target rare indications is difficult, we assessed real-world data to increase understanding of the cost of BTHS based on disease burden and health care resource utilization (HCRU).

Methods: A search of the published medical literature identified individual case studies and registry data used to assess the burden of disease and potential costs associated with BTHS, including the potential ability of developing treatments to positively impact those costs. In addition, a claims database analysis was conducted to assess HCRU …

Trends In Preservation Rhinoplasty Publications: A Bibliometric Analysis Of Presented Data Originality, Rakan Saadoun, W Katherine Kao, Tang Ho

Faculty, Staff and Student Publications

Background: Recent literature on dorsal preservation rhinoplasty (DPR) has seen a resurgence. This study performs a bibliometric analysis of publications and co-authorships within this research area, considering factors such as gender, country of origin, international collaboration, and the originality of the presented data.

Methods: The PubMed-indexed literature on DPR from 2018 to 2024 was extracted and reviewed, limited to English publications. Descriptive statistics were performed regarding the contributors by gender, country, publishing journal, authorship rank, and department of affiliation. Association tests were used to determine the association between the originality of the data presented and the affiliation's country and department. …

Whipple Disease Initial Presentation As Supraclavicular Lymphadenopathy In A Patient With Rheumatoid Arthritis: A Diagnostic Challenge, Sara E Amin, Swati Gite, Audrey Wanger, Violeta Chavez, Jacob Armstrong, Beenu Thakral, Patricia Navarro, Jennifer Makhoul, Amer Wahed, Navneet Narula, Karan Saluja

Faculty, Staff and Student Publications

Whipple disease is a rare systemic disease caused by Tropheryma whipplei. It can present with a wide range of nonspecific symptoms that might overlap with underlying medical conditions, posing a diagnostic challenge. We present a 61-year-old man with a past medical history of rheumatoid arthritis and chronic inflammatory demyelinating polyneuropathy, who presented with persistent leukocytosis and supraclavicular lymphadenopathy. A positron emission tomography scan revealed hypermetabolic activity in the supraclavicular, abdominal, and pelvic lymph nodes along with a myocardial hypermetabolic lesion, concerning a lymphoproliferative disorder versus sarcoidosis. A supraclavicular lymph node excisional biopsy revealed complete architectural effacement by a diffuse foamy …

Nocturnal Oxygen Therapy For Central Sleep Apnea In Patients With Heart Failure: A Multisite, Double-Blind, Sham-Controlled Randomized Clinical Trial (Loft-Hf), Susan Redline, Dongdong Li, Shahrokh Javaheri, Sanjay R Patel, Sairam Parthasarathy, James C Fang, Lee K Brown, Mark Dunlap, M Safwan Badr, Neomi Shah, Luqi Chi, Ruckshanda Majid, Mihaela Teodorescu, Garrick Stewart, Eileen Hsich, Tamar Polonsky, Justin Vader, Maryl R Johnson, Dennis Auckley, Henry Klar Yaggi, Andrew Kao, Ali Azarbarzin, Raichel Alex, Michael Rueschman, Lisa Wolfe, Daniel J Gottlieb, Scott A Sands, Phyllis C Zee, Reena Mehra, Babak Mokhlesi, Rami Khayat, Eldrin F Lewis, William T Abraham, Rui Wang

Faculty, Staff and Student Publications

Rationale: There are insufficient data to inform the management of central sleep apnea (CSA) in patients with heart failure with reduced ejection fraction (HFrEF). Nocturnal oxygen therapy (NOT) has been postulated to benefit CSA patients with HFrEF but has not been rigorously studied. Objectives: To compare NOT with sham NOT (control) in heart failure (HF) patients receiving guideline-based HF therapy on the composite outcome of first occurrence of either mortality due to any cause, a lifesaving cardiovascular intervention, or an unplanned hospitalization for worsening HF, together with other secondary outcomes.

Methods: A multisite, double-blind, sham-controlled randomized clinical trial was conducted …

Combining Pirfenidone With Mycophenolate Mofetil For Systemic Sclerosis-Related Interstitial Lung Disease (Scleroderma Lung Study Iii): An Investigator-Initiated, Multicenter, Randomized, Double-Blind, Placebo-Controlled Phase 2 Trial, Dinesh Khanna, Cathie Spino, Donald P Tashkin, Elana J Bernstein, Jonathan Goldin, Eric C Kleerup, Airi Harui, Grace Ibrahim, Grace Hyun J Kim, Suiyuan Huang, Richard Mclain, Yi-Hsuan Tu, Vivek Nagaraja, Richard M Silver, Virginia D Steen, S Samuel Weigt, Joyce S Lee, Aryeh Fischer, Mary Beth Scholand, Jessica K Gordon, Paul F Dellaripa, Ivan O Rosas, Gary M Hunninghake, Marcin A Trojanowski, Robert W Simms, Jane E Dematte, Vivien M Hsu, Robyn T Domsic, Ganesh Raghu, Maureen D Mayes, Ryan D Boente, Michael D Roth

Faculty, Staff and Student Publications

Objective: Mycophenolate mofetil (MMF) can stabilize or improve lung function in systemic sclerosis-related interstitial lung disease (SSc-ILD). We hypothesized that combining MMF with pirfenidone (PFD) would produce a significantly more rapid and/or greater improvement in lung function.

Methods: A randomized (1:1), double-blind, placebo (PLA)-controlled phase 2 trial was conducted in SSc-ILD in which patients received PFD or PLA (801 mg three times daily) along with MMF (1,500 mg twice daily) for 18 months. The primary outcome was change in percent predicted forced vital capacity (FVC-%). Linear mixed-effects models assessed treatment differences in a modified intention-to-treat population.

Results: Only fifty-one of …

Revisiting Soluble Guanylate Cyclase Pharmacology: Additive Potential Of Stimulators And Activators, Alexandra Petraina, Mahmoud H Elbatreek, Christopher T Neullens, Theodora Saridaki, Vu Thao-Vi Dao, Rebecca D Szepanowski, Emil Martin, Wolfgang Sippl, Ana I Casas, Harald H H W Schmidt

Faculty, Staff and Student Publications

Nitric oxide (NO) is a key gasotransmitter that binds to soluble guanylate cyclase (sGC), thereby stimulating cGMP production. Under disease conditions, reactive oxygen species disrupt this signaling by either: (1) scavenging NO, or (2) promoting heme-free, NO-insensitive apo-sGC due to impaired heme incorporation or oxidative damage. To counteract these conditions, two pharmacological approaches have emerged: sGC stimulators, which allosterically enhance sGC sensitivity to low NO levels; and sGC activators, which directly activate apo-sGC (heme-free sGC) by binding to its empty heme pocket, inducing a conformation that mimics NO-bound sGC. Thus, sGC stimulators are thought to target only sGC. Instead, we …

Alk5 Inhibitor Impact On Bleomycin-Induced Systemic Sclerosis Mouse Model Via Multifunctional Optical Coherence Tomography, Pavel V Nikitin, Harshdeep S Chawla, Jessica Gutierrez, Geethangili Madamanchi, Manmohan Singh, Salavat R Aglyamov, Minghua Wu, Jerry Alonso, Matthew Fronheiser, Juliana Coculo, Shuyan Du, Shervin Assassi, Kirill V Larin

Faculty, Staff and Student Publications

Systemic sclerosis (SSc) is a chronic autoimmune disease characterized by fibrosis, vascular dysfunction, and immune dysregulation, leading to significant morbidity and mortality. Noninvasive imaging techniques are critical for monitoring disease progression and evaluating therapeutic interventions. This study investigates the technical feasibility of multifunctional optical coherence tomography (OCT)-based methods for longitudinal assessment of skin thickness, stiffness, and microvasculature in a murine SSc model as a translational, noninvasive, and quantitative method to study disease progression and treatment response. Our findings demonstrate significant structural, biomechanical, and vascular changes in the skin's stiffness, indicative of fibrosis, a hallmark of SSc. The application of SB …

Fam13a Polymorphism Is Associated With A Usual Interstitial Pneumonia Pattern In Patients With Systemic Sclerosis-Associated Interstitial Lung Disease, Elana J Bernstein, Francesco Boin, Brett Elicker, Yiming Luo, Yawen Ren, Meng Zhang, John Varga, Shervin Assassi

Faculty, Staff and Student Publications

Objectives: The MUC5B promoter single nucleotide polymorphism (SNP) rs35705950 has been associated with idiopathic pulmonary fibrosis (IPF) and RA-related interstitial lung disease (ILD), but not with SSc-ILD. We hypothesized that the MUC5B promoter polymorphism or other IPF susceptibility loci are associated with an increased risk for the uncommon SSc-usual interstitial pneumonia (UIP) endophenotype, rather than SSc-ILD in general.

Methods: We performed a cross-sectional study of SSc-ILD patients from four US Scleroderma Programs to investigate the frequency of MUC5B rs35705950 and 12 additional IPF susceptibility loci. SSc-ILD patients were stratified by high resolution chest CT (HRCT) imaging findings into UIP and …