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Heterogeneity Of Left Ventricular Signal Characteristics In Response To Acute Vagal Stimulation During Ventricular Fibrillation In Dogs, Alireza Nazeri, Macarthur A Elayda, Lubomir Dragnev, Christopher M Frank, Jihong Qu, Valtino X Afonso, Abdi Rasekh, Mohammad Saeed, Jie Cheng, Mossaab Shuraih, Ali Massumi, Mehdi Razavi

The Texas Heart Institute Journal

Studies have shown that long-term vagal stimulation is protective against ventricular fibrillation; however, the effects of acute vagal stimulation during ventricular fibrillation in the normal heart have not been investigated. We examined the effects of acute vagal stimulation on ventricular fibrillation in a canine model. In 4 dogs, we induced 30-second periods of ventricular fibrillation by means of intraventricular pacing. During 2 of the 4 periods of fibrillation that we analyzed, vagal stimulation was delivered through electrodes in the caudal ends of the vagus nerves. Noncontact unipolar electrograms were recorded from 3 ventricular regions: the basal septum, apical septum, and …

Central Venous Pressure And Pulmonary Capillary Wedge Pressure, Tony S Ma, Biykem Bozkurt, David Paniagua, Biswajit Kar, Kumudha Ramasubbu, Carl F Rothe

The Texas Heart Institute Journal

Heart-failure phenotypes include pulmonary and systemic venous congestion. Traditional heart-failure classification systems include the Forrester hemodynamic subsets, which use 2 indices: pulmonary capillary wedge pressure (PCWP) and cardiac index. We hypothesized that changes in PCWP and central venous pressure (CVP), and in the phenotypes of heart failure, might be better evaluated by cardiovascular modeling. Therefore, we developed a lumped-parameter cardiovascular model and analyzed forms of heart failure in which the right and left ventricles failed disproportionately (discordant ventricular failure) versus equally (concordant failure). At least 10 modeling analyses were carried out to the equilibrium state. Acute discordant pump failure was …

Prehypertension: A Meta-Analysis Of The Epidemiology, Risk Factors, And Predictors Of Progression, Xiaofan Guo, Liling Zou, Xingang Zhang, Jue Li, Liqiang Zheng, Zhaoqing Sun, Jian Hu, Nathan D Wong, Yingxian Sun

The Texas Heart Institute Journal

We investigated the prevalence and risk factors of prehypertension, as well as the predictors of progression from prehypertension to hypertension. To do this, we performed a systematic review and meta-analysis of cross-sectional and longitudinal studies, after unrestricted searches of PubMed and The Cochrane Library through September 2010. In addition, we reviewed references, major textbooks, and review articles. Pooled prevalence, standardized mean differences, and odds ratios were estimated by using a random-effects model.

Twenty-six articles met our inclusion criteria; these included 20 cross-sectional and 6 longitudinal studies, with a total sample of 250,741 individuals. The overall pooled prevalence of prehypertension was …

Endovascular Repair Of Aortoesophageal And Aortobronchial Fistulae, Roberto Chiesa, Andrea Kahlberg, Yamume Tshomba, Enrico M Marone, Massimiliano M Marrocco-Trischitta, Germano Melissano

The Texas Heart Institute Journal

Aortoesophageal fistulae (AEF) and aortobronchial fistulae (ABF) are uncommon, but are in general fatal if left untreated. Conventional treatment requires surgical replacement of the thoracic aorta, along with several adjunctive procedures to repair the esophageal or tracheobronchial lesion.The mortality rates associated with open surgery reach 61% in cases of primary fistula and 78% in secondary fistula.

Thoracic endovascular aortic repair (TEVAR) has been proposed as an alternative strategy to surgical management.Although less invasive, this technique has important limitations in treating AEF and ABF, the chief of which is the high risk of graft contamination. Moreover, we still lack sufficient data …

Paclitaxel Induces Thrombomodulin Downregulation In Human Aortic Endothelial Cells, Huang-Joe Wang, Te-Ling Lu, Haimei Huang, Huey-Chun Huang

The Texas Heart Institute Journal

Patients with paclitaxel-eluting stents are at risk of developing stent thrombosis upon premature discontinuation of dual antiplatelet therapy. In this study, we set out to clarify whether paclitaxel can modulate thrombomodulin expression in human aortic endothelial cells. Human aortic endothelial cells were stimulated with paclitaxel. Methoxyphenyl tetrazolium inner salt cell viability assay, Western blot analysis, real-time polymerase chain reaction, and immunohistochemical assay were performed. In human aortic endothelial cells, paclitaxel (10(-5) to 10(-9) mol/L) treatment for 13 hours caused significant cytotoxicity at drug concentrations greater than 10(-7) mol/L. Paclitaxel (10(-5) to 10(-9) mol/L) treatment for 5 hours downregulated thrombomodulin expression …

Cardiac Surgery: A Century Of Progress, Allen B Weisse

The Texas Heart Institute Journal

Well into the first decades of the 20th century, medical opinion held that any surgical attempts to treat heart disease were not only misguided, but unethical. Despite such reservations, innovative surgeons showed that heart wounds could be successfully repaired. Then, extracardiac procedures were performed to correct patent ductus arteriosus, coarctation of the aorta, and tetralogy of Fallot. Direct surgery on the heart was accomplished with closed commissurotomy for mitral stenosis. The introduction of the heart-lung machine and cardiopulmonary bypass enabled the surgical treatment of other congenital and acquired heart diseases. Advances in aortic surgery paralleled these successes. The development of …

Heart Disease And Hormones, Stephanie A Coulter

The Texas Heart Institute Journal

Results from more than 40 observational studies conducted in women over 3 decades have repeatedly indicated the cardioprotective effects of postmenopausal hormone replacement therapy (HRT). Women taking estrogen in these observational trials experienced a consistent 30% to 50% reduction in cardiovascular (CV) events. The biologic benefit of estrogen has been attributed to improvements in lipid profiles and endothelial function.

A Dosing Study Of Bone Marrow Mononuclear Cells For Transendocardial Injection In A Pig Model Of Chronic Ischemic Heart Disease, Guilherme V Silva, Marlos R Fernandes, Cristiano O Cardoso, Ricardo R Sanz, Edie M Oliveira, Pilar Jimenez-Quevedo, Javier Lopez, Franca S Angeli, Yi Zheng, James T Willerson, Emerson C Perin

The Texas Heart Institute Journal

We studied the effect of the dose of bone marrow mononuclear cells, delivered via transendocardial injection, upon capillary density and fibrosis in pigs with chronic ischemic heart disease.

Pigs (n = 16) that had undergone ameroid constrictor placement (left circumflex coronary artery) to induce chronic ischemia were divided equally into 4 groups on the basis of bone marrow mononuclear cell dose: control (saline injection) and 50, 100, or 200 × 106 bone marrow mononuclear cells. Thirty days after ameroid placement, each pig received 13 transendocardial NOGA-guided injections. An implantable loop recorder monitored possible arrhythmias caused by cell transplantation. Thirty days …

Surgical Management Of Double-Chambered Right Ventricle In Adults, Ahmad K Darwazah, Mohammed Eida, Vivian Bader, Mohammed Khalil

The Texas Heart Institute Journal

Double-chambered right ventricle is a congenital anomaly in which the right ventricle is divided into 2 portions by anomalous muscle bundles. These cases often present in children, but rarely in adults.

We discuss 2 cases of double-chambered right ventricle, in patients aged 42 and 35 years. When cases remain asymptomatic until adulthood, they can present with unusual symptoms that lead to incorrect diagnosis. Our cases represent 2 very different manifestations of double-chambered right ventricle, which differ in presentation, in the site of abnormal obstructive muscle bundles, and in the presence of associated lesions. Both of our patients underwent successful surgical …

Onco-Cardiology: The Time Has Come, Edward T H Yeh

The Texas Heart Institute Journal

No abstract provided.

Micro-Ultrasonographic Imaging Of Atherosclerotic Progression And Correlation With Inflammatory Markers In Apolipoprotein-E Knockout Mice, Rong-Juan Li, Ya Yang, Yan-Hong Wang, Jin-Jie Xie, Li Song, Zheng Wang, Yao-Zhong Zhang, Yan-Wen Qin, Zhi-An Li, Xiao-Shan Zhang

The Texas Heart Institute Journal

We studied prospectively whether atherosclerotic progression in apolipoprotein-E knockout mice could be noninvasively and accurately measured by use of high-resolution ultrasonographic biomicroscopy. We examined the correlation between the ultrasonographic characterization of ascending aortic atherosclerotic plaque and plasma C-reactive protein, interleukin-1, and interleukin-6 levels in these mice.

In 4 age groups (8, 16, 24, and 32 wk) of 8 male knockout mice each (atherosclerotic groups) and age-matched male C57BL/6 mice (control groups), we used ultrasonographic biomicroscopy to measure maximal plaque thickness or intima-media thickness in the ascending aorta. We compared the findings with corresponding histologic measurements, and we measured plasma C-reactive …

Closure Of A Para-Valvular Aortic Leak With The Use Of 2 Amplatzer Devices And Real-Time 2− And 3-Dimensional Transesophageal Echocardiography, Kurt S Hoffmayer, Christian Zellner, Damon M Kwan, Suma Konety, Elyse Foster, Phillip Moore, Yerem Yeghiazarians

The Texas Heart Institute Journal

Paravalvular leaks are well-recognized sequelae of mechanical aortic valve implantation. Clinical manifestations include hemolysis, arrhythmias, and congestive heart failure. Frequently, patients who receive mechanical aortic valves are poor candidates for repeat valve surgery, and the reoperative mortality rate is high. Percutaneous intervention has recently become an alternative to surgery in selected patients. Herein, we describe the percutaneous closure of an aortic paravalvular leak in a 45-year-old man who had undergone 2 aortic valve replacements with mechanical valves. The patient, who was at high surgical risk due to comorbidities, underwent the implantation of 2 AMPLATZER devices with the use of real-time …

Left Atrial Ablation For Atrial Fibrillation: Creating The “Box Lesion” With A Bipolar Radiofrequency Device, Leonid Sternik, Hartzel V Schaff, David Luria, Michael Glikson, Alexander Kogan, Ateret Malachy, Maya First, Ehud Raanani

The Texas Heart Institute Journal

The maze procedure is the gold standard for the ablation of atrial fibrillation, and the “box lesion” around the pulmonary veins is the most important part of this procedure. We have created this lesion with a bipolar radiofrequency ablator, abandoning the usual use of this device (to achieve bilateral epicardial isolation of the pulmonary veins).

From March 2004 through the end of May 2010, we performed surgical ablation of atrial fibrillation in 240 patients. Of this number, 205 underwent operation by a hybrid maze technique and the remaining 35 (our study cohort) underwent the creation of a box lesion around …

High-Risk Diabetic Patients With Unprotected Left Main Coronary Artery Disease: Characteristics And Medium-Term Outcomes Of Percutaneous Revascularization With Drug-Eluting Stents, Jose F Díaz Fernández, Carlos Sánchez González, Manuel Jiménez Navarro, Juan C Fernández Guerrero, Antonio Gómez Menchero, Juan H Alonso Briales, Rosa María Cardenal Piris, Juan Herrador, Manuel Guzmán Herrera, Jose M Hernández García

The Texas Heart Institute Journal

Percutaneous coronary intervention with drug-eluting stents is an alternative for patients with high-risk unprotected left main coronary artery disease; those with diabetes mellitus are at even higher risk. Recent advances in percutaneous coronary intervention could lead to better results. The aim of this study was to evaluate medium-term results in a real-world sample of high-risk diabetic patients undergoing percutaneous coronary intervention with drug-eluting stents for unprotected left main coronary artery disease.

From 3 tertiary hospitals, we retrospectively identified 334 high-risk patients, of whom 141 (42%) were diabetic and 193 (58%) were nondiabetic. The diabetes mellitus group showed a higher prevalence …

Rosuvastatin Therapy Does Not Affect Serum Mmp-13 Or Timp-1 Levels In Hypercholesterolemic Patients, Cihan Cevik, Kenneth Nugent, Gary Meyerrose, Mohammad Otahbachi, Cemil Izgi, Mark Lyte, R David Fish

The Texas Heart Institute Journal

Matrix metalloproteinases degrade the collagen content of atherosclerotic plaque and reduce plaque stability. In tissue sections of atherosclerotic plaque, the expression of matrix metalloproteinases is increased. 3-Hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) decrease the tissue expression of matrix metalloproteinases-1, -2, -3, and -9 in atheromatous plaque by attenuating the inflammatory process that leads to increased expression. However, it is not known whether statins decrease levels of matrix metalloproteinase-13—an enzyme crucial to the initiation of collagen degradation—as part of their plaque-stabilizing effect.

We prospectively examined the effect of statin therapy on serum levels of matrix metalloproteinase-13, tissue inhibitor of metalloproteinase-1, and …

Altered Leptin Signaling On Dendritic Cells As A Potential Mechanism For Cancer Immunotherapy, Lorena Y. De Los Santos

Open Access Theses & Dissertations

Leptin is a pleiotropic hormone synthesized primarily by white adipocytes and its receptors are expressed in a variety of tissues and cells such as in the hypothalamus and cells of the immune system. Multiple cell types can produce a considerable amount of leptin such as skeletal muscle, placenta, and osteoblasts to name a few and its synthesis has been shown to be regulated by sex hormones and a broad range of inflammatory mediators. Although leptin has been shown to directly affect immune response, we are interested in how leptin affects dendritic cell function and their ability to induce a proper …

A Concept Mapping Needs Assessment Of Young Families With Parental Cancer, Richard P. Durant

Antioch University Dissertations & Theses

The purpose of this research is to investigate the support needs of young families living with and beyond a parental diagnosis of cancer. The sample includes 56 participants comprised of 31 professional stakeholders and 25 patient stakeholders affiliated with the Charles R. Wood Cancer Center. It was hypothesized there would be differences in how the groups of stakeholders rated needs in terms of importance, satisfaction, and utilization. Differences in ratings are thought to be barriers to effective program development. While not a formal research hypothesis, it was anticipated other program development barriers germane to naturalistic clinical settings would emerge from …

Development Of A Novel Metallo-Lipid Microparticle Delivery System For A Leishmania Mexicana Dna Vaccine Candidate, Joanna B. Valencia

Open Access Theses & Dissertations

ABSTRACT

Background and Significance.

The leishmaniases are an important group of neglected tropical parasitic diseases caused by parasitic protozoa of the genus Leishmania. International health authorities estimate that 350 million people around the world are at risk for contracting leishmaniasis. Two million new cases occur each year and 12 million people are presently infected worldwide. Leishmaniasis is endemic throughout the Americas region including all of Central America, most of South America, Mexico and southern Texas. Leishmania is also considered a threat to the military readiness of U.S. troops deployed to the Middle East or Latin America.

First- and second-line treatments …

Using Lean Principals To Improve Patient Flow, Keith Weinhold Mha, Fache, Eliot L. Friedman Md, Darlene Matthias Rn, Ms, Ocn, Mary R. Greenberg, Amy E. Levan Rn, Bsn, Ocn, Jill Korn Rn, Bsn, Ocn, Melissa Kratz Rn, Msn, Aocn, Mandy Melocheck Rn, Msn, Ocn, Cindy J. Fenton Rn, Ocn, Janine Barnaby Rph, Bcop, Jeanne Kenna Rn, Ocn, Jennifer Mesker Pharmad, Kyle Sabatino Rn, Msn, Aocn, Lori Turnbach, Maura Price Rn, Bsn, Ocn, Pamela Tobias Ms, Rhia, Patricia Shearburn Rn, Msn, Aocn, Ramona E. Chase Crnp, Stephanie Thomas, Pamela Repetz, Barbara Versage Rn, Mba, Cphq

Administration & Leadership

No abstract provided.

Geriatric Experience Following Cardiac Arrest At Six Interventional Cardiology Centers In The United States 2007-2011, David B. Seder Md, Nainesh Patel Md, John A. Mcpherson Md, Paul W. Mcmullan Md, Karl B. Kern Md, Barbara T. Unger Rn, J Browning, Sudip Nanda Md, Facp, Melkon Hacobian Md, Michael B. Kelley Md, Niklas Nielsen Md, Phd, Michael R. Mooney Md

Department of Medicine

No abstract provided.

Developing A Multidisciplinary Perioperative Safety Course, William Bond Md, Ms, Hope L. Johnson Msn, Rn, Cnor, Michael Pasquale Md, Facs, Fccm, Melissa B. Walsh Bs, Deborah Arnold Msn, Rn, Cmsrn, Matthew W. Leclair, Kelly L. Lago Ms, Jeanne P. Luke Msn, Rn, Cnor

Department of Emergency Medicine

No abstract provided.

Using Teach Back To Reduce Readmission Rates In Hospitalized Heart Failure Patients, Michael Pistoria Do, Facp, Sfhm, Debra Peter Msn, Rn, Bc, Cmsrn, Paula Robinson Msn, Rn, Bc, Kim Jordan Mha, Bsn, Rn, Ne-Bc, Susan Lawrence Ms, Cmac

Department of Medicine

No abstract provided.

Association Of Retinoic Acid Receptor Genes With Meningomyelocele, Phong X Tran, Kit Sing Au, Alanna C Morrison, Jack M Fletcher, Kathryn K Ostermaier, Gayle H Tyerman, Hope Northrup

Faculty, Staff and Student Publications

BACKGROUND: Neural tube defects (NTDs) occur in as many as 0.5-2 per 1000 live births in the United States. One of the most common and severe neural tube defects is meningomyelocele (MM) resulting from failed closure of the caudal end of the neural tube. MM has been induced by retinoic acid teratogenicity in rodent models. We hypothesized that genetic variants influencing retinoic acid (RA) induction via retinoic acid receptors (RARs) may be associated with risk for MM.

METHODS: We analyzed 47 single nucleotide polymorphisms (SNPs) that span across the three retinoic acid receptor genes using the SNPlex genotyping platform. Our …

Immunopathology Of Postprimary Tuberculosis: Increased T-Regulatory Cells And Dec-205-Positive Foamy Macrophages In Cavitary Lesions, Kerry J Welsh, Semyon A Risin, Jeffrey K Actor, Robert L Hunter

Faculty, Staff and Student Publications

Postprimary tuberculosis occurs in immunocompetent people infected with Mycobacterium tuberculosis. It is restricted to the lung and accounts for 80% of cases and nearly 100% of transmission. Little is known about the immunopathology of postprimary tuberculosis due to limited availability of specimens. Tissues from 30 autopsy cases of pulmonary tuberculosis were located. Sections of characteristic lesions of caseating granulomas, lipid pneumonia, and cavitary stages of postprimary disease were selected for immunohistochemical studies of macrophages, lymphocytes, endothelial cells, and mycobacterial antigens. A higher percentage of cells in lipid pneumonia (36.1%) and cavitary lesions (27.8%) were positive for the dendritic cell marker …

Alterations In Content And Localization Of Defensins In Rat Ileum And Jejunum Following Ischemia-Reperfusion Specific Peptides, In Specific Places, For Specific Jobs?, Rosemary A Kozar, Rachel J Santora, Brian J Poindexter, Stephen M Milner, Roger J Bick

Faculty, Staff and Student Publications

Objective: To determine alterations in quantities and distributions of natural antimicrobials following ischemia-reperfusion injury. We hypothesized that these compounds would be upregulated in areas of small intestine where changes in permeability and cellular disruption were likely and where protective mechanisms would be initiated. Methods: Rats with ischemia-reperfusion underwent superior mesenteric artery clamping and reperfusion. Shams were subjected to laparotomy but no clamping. Ileum and jejunum were harvested and sectioned, and subjected to fluorescence deconvolution microscopy for determinations of content and localization of rat beta defensins, 1, 2, 3; rat neutrophil protein-1; and cathelicidin LL-37. Modeling was performed to determine cellular …

Chondrosarcoma Of The Mobile Spine And Sacrum, Ryan M Stuckey, Rex A W Marco

Faculty, Staff and Student Publications

Chondrosarcoma is a rare malignant tumor of bone. This family of tumors can be primary malignant tumors or a secondary malignant transformation of an underlying benign cartilage tumor. Pain is often the initial presenting complaint when chondrosarcoma involves the spine. In the mobile spine, chondrosarcoma commonly presents within the vertebral body and shows a predilection for the thoracic spine. Due to the resistance of chondrosarcoma to both radiation and chemotherapy, treatment is focused on surgery. With en bloc excision of chondrosarcoma of the mobile spine and sacrum patients can have local recurrence rates as low as 20%.

Case Of “Slow” Stroke From Carotid Artery Occlusion Treated By Delayed But Cautious Endovascular Intervention, Kachi Illoh, Emilio Supsupin, Hashem M Shaltoni, Edwin D Cacayorin

Faculty, Staff and Student Publications

In a challenging case of carotid occlusion with slowly evolving stroke, we used brain imaging to facilitate endovascular revascularization resulting in the relief of the patient's symptoms. Patients with carotid occlusion and continued neurological worsening or fluctuations present enormous treatment challenges. These patients may present "slow" strokes with subacute infarcts that present significant challenges and risks during attempts at revascularization of the occluded artery. We present such a case in which we used multimodal imaging techniques, including MR-perfusion, to facilitate endovascular revascularization. Our approach of delayed but cautious intra-arterial thrombolytic therapy, guided by brain imaging, and followed by stent placement …

Complete Genome Sequence Of Treponema Paraluiscuniculi, Strain Cuniculi A: The Loss Of Infectivity To Humans Is Associated With Genome Decay, David Smajs, Marie Zobaníková, Michal Strouhal, Darina Cejková, Shannon Dugan-Rocha, Petra Pospíšilová, Steven J Norris, Tom Albert, Xiang Qin, Kym Hallsworth-Pepin, Christian Buhay, Donna M Muzny, Lei Chen, Richard A Gibbs, George M Weinstock

Faculty, Staff and Student Publications

Treponema paraluiscuniculi is the causative agent of rabbit venereal spirochetosis. It is not infectious to humans, although its genome structure is very closely related to other pathogenic Treponema species including Treponema pallidum subspecies pallidum, the etiological agent of syphilis. In this study, the genome sequence of Treponema paraluiscuniculi, strain Cuniculi A, was determined by a combination of several high-throughput sequencing strategies. Whereas the overall size (1,133,390 bp), arrangement, and gene content of the Cuniculi A genome closely resembled those of the T. pallidum genome, the T. paraluiscuniculi genome contained a markedly higher number of pseudogenes and gene fragments (51). In …

New Perspectives On Melanoma: The Role Of Pax3, Sandra Medic

Theses: Doctorates and Masters

Background: Cutaneous melanoma is an aggressive form of skin cancer, arising in cutaneous melanocytes. The transcription factor PAX3 is critical for the proper development of neural crest lineages including melanocytes. Melanocytic cells show continued PAX3 expression from melanoblast formation in the neural crest to their differentiation into melanocytes. While many studies clarify the importance of PAX3 in embryonic development of melanocytes, less well understood, and more perplexing, is the continued PAX3 expression in adult skin melanocytes. By contrast PAX3 is frequently found in melanomas and naevi, and its expression correlates with melanoma staging. In this study we explore the multiple …

The Impact Of Assessment On Repeat Deliberate Self-Harm, Kellie Jones

Theses: Doctorates and Masters

Deliberate self-harm is a pervasive issue that is the topic of worldwide clinical and research focus. Among the extensive research findings two salient issues emerge that provide the foundation for this study. The first is that a deliberate self-harm attempt is a significant risk factor for future attempts. The second is that a comprehensive assessment of a person presenting with an incident of deliberate self-harm can reduce further deliberate self-harming behaviour. A limitation of existing research is that no study has clearly identified the nature of assessments that impact on the likelihood of future self-harm attempts. The initial aim of …