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Research Annual Report 2008, Children's Mercy Hospital

Research Annual Reports

Annual report of the research at Children's Mercy Hospital in Kansas City MO, a pediatric medical center.

Graduate Medical Education 2008 Annual Report, Children's Mercy Hospital

GME Annual Reports

Annual report of the Children's Mercy Hospital Graduate Medical Education department, including pediatric residency, internal medicine/pediatrics residency, and fellowship programs.

Image Processing Of Oct Glaucoma Images And Information Theory Analysis, Shuting Wang

Electronic Theses and Dissertations

Glaucoma is a group of optic nerve disease with progressive structural changes leading to loss of visual function. A careful examination and detection of changes in the optic nerve is the key to early diagnosis of glaucoma. Optical Coherence Tomography (OCT) is one of the known techniques of diagnosis of glaucoma. The patients' eyes are scanned and sub-surface images are captured from optical nerves. Captured OCT images usually suffer from noise and therefore image enhancement techniques can help doctors in better analysis of OCT images and diagnosis of glaucoma. In this thesis, we propose three successful algorithms for enhancing the …

High Adsorption Rate Is Detrimental To Bacteriophage Fitness In A Biofilm-Like Environment., Romain Gallet, Yongping Shao, Ing-Nang Wang

Department of Cancer Biology Faculty Papers

BACKGROUND: Bacterial biofilm is ubiquitous in nature. However, it is not clear how this crowded habitat would impact the evolution of bacteriophage (phage) life history traits. In this study, we constructed isogenic lambda phage strains that only differed in their adsorption rates, because of the presence/absence of extra side tail fibers or improved tail fiber J, and maker states. The high cell density and viscosity of the biofilm environment was approximated by the standard double-layer agar plate. The phage infection cycle in the biofilm environment was decomposed into three stages: settlement on to the biofilm surface, production of phage progeny …

Ua94/6/1 Student / Alumni Personal Papers Western Kentucky University Small Collections, Wku Archives

WKU Archives Collection Inventories

Small collections of personal papers and oral histories relating to the Western Kentucky University.

Snai1 And Snai2 Are Asymmetrically Expressed At The 2-Cell Stage And Become Segregated To The Te In The Mouse Blastocyst., Christine E Bell, Andrew J Watson

Obstetrics & Gynaecology Publications

SNAI1 and SNAI2 are transcription factors that initiate Epithelial-to-Mesenchymal cell transitions throughout development and in cancer metastasis. Here we show novel expression of SNAI1 and SNAI2 throughout mouse preimplantation development revealing asymmetrical localization of both SNAI1 and SNAI2 in individual blastomeres beginning at the 2-cell stage through to the 8-cell stage where SNAI1 and SNAI2 are then only detected in outer cells and not inner cells of the blastocyst. This study implicates SNAI1 and SNAI2 in the lineage segregation of the trophectoderm and inner cell mass, and provides new insight into these oncogenes.

A Dissociation Between Perception And Action In The Material‐Weight Illusion, Gavin Buckingham, Jonathan S. Cant, Kai-Ling C. Kao, Melvyn A. Goodale

Psychology Presentations

We examined what forces are applied to objects that elicit this illusion when they are lifted.We predicted that:

(1) Forces on early trials will scale to each participant’s expectations of how much a particular block will weigh ‐ excessive force will be applied to the metal block and insufficient force applied to the polystyrene block.

(2) Forces on later trials will scale to the real weight of each block ‐ identical levels of force applied to all the blocks.

(3) MWI will persist throughout ‐ polystyrene block will feel the heaviest, metal block will feel the lightest.

Grasping And Lifting Different Materials, Gavin Buckingham, Jonathan S. Cant, Melvyn A. Goodale

Psychology Presentations

The material from which an object is made can determine how heavy it feels (Seashore, 1899). Interestingly, a metal block that has been adjusted to have the same size and mass as a polystyrene block will feel lighter than the polystyrene block. We recently showed that participants experiencing this material-weight illusion’ (MWI) do not apply forces that match their perceptual experience of heaviness ‐ just like in the size‐weight illusion ( Flanagan & Beltzner, 2000).

Our previous study showed that forces on early trials were scaled to each participant’s expectations of how much a particular block should weigh ‐ excessive …

Identification Of Wnt/Β-Catenin Signaling Pathway Components In Human Cumulus Cells, Hong-Xing Wang, Francis R. Tekpetey, Gerald M. Kidder

Physiology and Pharmacology Publications

Signaling via the conserved WNT/β-CATENIN pathway controls diverse developmental processes. To explore its potential role in the ovary, we investigated the expression of WNTs, frizzled (FZD) receptors and other pathway components in human cumulus cells obtained from oocytes collected for in vitro fertilization. Proteins were detected in cultured cells using immunofluorescence microscopy. Protein–protein interactions were analyzed by means of immunoprecipitation. WNT2, FZD2, FZD3 and FZD9 were identified but WNT1, WNT4 and FZD4 were not detected. WNT2 is co-expressed with FZD2, FZD3 and FZD9. Co-immunoprecipitation using WNT2 antibody demonstrated that WNT2 interacts with both FZD3 and FZD9, but only FZD9 antibody …

Adaptive Radiation Therapy For Localized Mesothelioma With Mediastinal Metastasis Using Helical Tomotherapy., James Renaud, Slav Yartsev, A Rashid Dar, Jacob Van Dyk

Oncology Publications

The purpose of this study was to compare 2 adaptive radiotherapy strategies with helical tomotherapy. A patient having mesothelioma with mediastinal nodes was treated using helical tomotherapy with pretreatment megavoltage CT (MVCT) imaging. Gross tumor volumes (GTVs) were outlined on every MVCT study. Two alternatives for adapting the treatment were investigated: (1) keeping the prescribed dose to the targets while reducing the dose to the OARs and (2) escalating the target dose while maintaining the original level of healthy tissue sparing. Intensity modulated radiotherapy (step-and-shoot IMRT) and 3D conformal radiotherapy (3DCRT) plans for the patient were generated and compared. The …

Indications For Resection Of Metastatic Liver Lesions, Vivian Mcalister

Surgery Presentations

No abstract provided.

Children's Mercy Hospital Annual Report 2008, Children's Mercy Hospital

Children's Mercy Annual Reports

Annual report for The Children's Mercy Hospital in Kansas City MO, a pediatric medical center.

Hyperandrogenism And Obesity: Ominous Co-Morbidities, Amit M. Deokar, Shawn J. Smith, Amanda J. Goodwin, Hatim A. Omar

Pediatrics Faculty Publications

This review has a two-fold objective. One, it addresses the association of hyperandrogenism and obesity and the complex metabolic derangements that are part of the problem. Clinical management of these co-morbidities is challenging and complex. Second, this article will aid health care providers with the key features to an early diagnosis and intervention to decrease the morbidities in the short as well as long term. Method: Systematic review of articles and information on the topic of interest that were published in the last 15 years. Conclusion: Obesity and hyperandrogenism are integral parts of Metabolic Syndrome/Polycystic Ovarian Syndrome (PCOS)/Hyperandrogenism, Insulin resistance, …

Emerging Role Of Garcinol, The Antioxidant Chalcone From Garcinia Indica Choisy And Its Synthetic Analogs, Subhash Padhye, Aamir Ahmad, Nikhil Oswal, Fazlul H. Sarkar

Wayne State University Associated BioMed Central Scholarship

Abstract

Garcinol, harvested from Garcinia indica, has traditionally been used in tropical regions and appreciated for centuries; however its biological properties are only beginning to be elucidated. There is ample data to suggest potent antioxidant properties of this compound which have been used to explain most of its observed biological activities. However, emerging evidence suggests that garcinol could be useful as an anti-cancer agent, and it is increasingly being realized that garcinol is a pleiotropic agent capable of modulating key regulatory cell signaling pathways. Here we have summarized the progress of our current research knowledge on garcinol and its observed …

A Unique Case Of Urinary Bladder Simple Melanosis: A Case Report And Review Of The Literature, Bo Jin, Syed Y. Zaidi, Melvin Hollowell, Christopher Hollowell, Husain Saleh

Wayne State University Associated BioMed Central Scholarship

Abstract

Melanosis refers to abnormal or excessive deposition of melanin pigment in the cells and/or tissue, which can be seen in any organ but commonly in skin and oral mucosa. Melanosis of the urinary bladder is an extremely rare benign condition and only a handful of cases been reported in the English literature before. In this article, we report a new case of urinary melanosis, describe the differential diagnostic features from pseudomelanosis and offer clues for correct diagnosis. We also provide comprehensive review of the literature on the subject.

Prevalence, Evaluation And Management Of Overactive Bladder In Primary Care, Wellman W. Cheung, Nadia H. Khan, Karmina K. Choi, Martin H. Bluth, Miriam T. Vincent

Wayne State University Associated BioMed Central Scholarship

Abstract

Background

Patients with overactive bladder (OAB) are under-diagnosed in the primary care setting. Primary care physicians (PCP) approach to the patient and appropriate patient disclosure may contribute to under-diagnosis.

Methods

An outpatient primary care setting was used to determine the prevalence and characteristics of OAB. Patients who visited the family medicine outpatient clinic were invited to answer a self-administered questionnaire. It included questions on evidence of lower urinary tract symptoms (modified Overactive Bladder-Validated 8-question Screener [OAB-V8]), relevant medical and surgical history, and demographic data. Relationship between OAB and other independent variables were analyzed using chi-square and risk ratio (RR) …

Lymphomatoid Granulomatosis Masquerading As Interstitial Pneumonia In A 66-Year-Old Man: A Case Report And Review Of Literature, Ashima Makol, Kalyan Kosuri, Deimante Tamkus, Wanderley De M Calaca, Howard T. Chang

Wayne State University Associated BioMed Central Scholarship

Abstract

Lymphomatoid granulomatosis (LG) is a rare, Epstein-Barr virus (EBV)-associated systemic angiodestructive lymphoproliferative disorder that may progress to a diffuse large B cell lymphoma. Pulmonary involvement may mimic other more common lung pathologies including pneumonias. Therapeutic standards have not been established for LG, but rituximab, interferon-α2b (INF-α2b), and chemotherapy have shown to improve symptoms and long term prognosis.

We report a case of rapid respiratory deterioration in a 66-year-old man with clinical presentation, chest radiography, pulmonary function testing and high resolution computed tomography (HRCT) findings consistent with idiopathic interstitial pneumonia, but very poor response to antibiotics and low dose steroids. …

Overweight Children And Adolescents: Impact On Psychological And Social Development, Kimberly K. Mcclanahan, Marlene B. Huff, Hatim A. Omar

Pediatrics Faculty Publications

The global epidemic of childhood and adolescent overweight has become a major public health concern. Not only are these youth more likely to become obese as adults, and thus more prone to obesity-related diseases than their non overweight peers, they are also likely to suffer emotional and social effects associated with overweight. Overweight in youth has been linked to depression, low self-esteem, eating disorders, negative body image, and stigma. It appears to be bi-directional in nature, with overweight sometimes predicting certain psychological effects and psychosocial issues sometimes predicting overweight. Effective assessment and treatment of psychological and mental health issues in …

Shoulder Impingement Syndrome: Outcome Of Arthroscopic Subacromial Decompression, Attiq Ur Rehman, Muhammad Abdul Wajid, Tashfeen Ahmad

Section of Orthopaedic Surgery

Objective: To describe the outcome of cases with subacromial impingement syndrome managed with arthroscopic subacromial decompression.
Study Design: Quasi-experimental study.
Place and Duration of Study: Section of Orthopaedics, Department of Surgery, The Aga Khan University Hospital, Karachi from April 2005 to March 2006.
Methodology: Thirty patients with impingement syndrome who underwent arthroscopic subacromial decompression after failed conservative treatment were included. The Constant and Murley shoulder scoring system was used for the clinical assessment of pain and function pre-operatively and 1, 6 and 24 weeks postoperatively.
Results: The postoperatively significant improvement was observed in the Constant and Murley scores in all …

Rhizopus Necrotizing Fasciitis Of Caesarean Wound: A Rare Life Threatening Condition, Abdul Rehman Alvi, Ghina Shamsi

Section of General Surgery

Mucormycosis is a rare cause of necrotizing fasciitis in immunocompromised patients. We report a young female, who developed rhizopus necrotizing fasciitis of caesarean wound. The lady died secondary to non-responding sepsis and irreversible multi-organ failure. High index of suspicion can lead to early diagnosis by frozen section of histopathology and fungal culture technique. Aggressive surgical debridement and intravenous anti-fungal medication is the main stay of treatment. A delay in diagnosis and treatment may cause multi-organ failure leading to high mortality.

Non-Traumatic Right Hepatic Artery Pseudoaneurysm: An Unusual Cause Of Hemobilia And Obstructive Jaundice, Abdul Rehman Alvi, Shahida Bibi, Ziaur Rehman, Salma Khan

Section of General Surgery

Most hepatic artery pseudoaneurysms (HAPA) are post traumatic, and non-traumatic pseudoaneurysm is rarely reported. It is a potentially life threatening vascular disorder and difficult to diagnose before rupture. Early diagnosis and prompt nonoperative intervention of this lesion could be life saving. The authors report the case of a patient with hemobilia caused by ruptured right hepatic artery pseudoaneurysm and subsequently developed right hepatic duct stricture, which has not been reported previously. This patient was successfully treated with endovascular stent graft of pseudoaneurysm and endoscopic stenting of right hepatic duct stricture.

Severe Road Traffic Injuries In Kenya, Quality Of Care And Access, William Macharia, F. Muli-Musiime, V. Nantulya, Erastus K. Njeru

Paediatrics and Child Health, East Africa

Background: Road traffic injuries (RTI) are on increase in developing countries. Health care facilities are poorly equipped to provide the needed services.

Objective: Determine access and quality of care for RTI casualties in Kenya.

Design: Cross-sectional survey

Setting: 53 large and medium size private, faith-based and public hospitals.

Participants: In-patient road traffic crash casualties and health personnel in the selected hospitals were interviewed on availability of emergency care and resources. Onsite verification of status was undertaken.

Results: Out of 310 RTI casualties interviewed, 72.3%, 15.6% and 12.2% were in public, faith-based and private hospitals, respectively. Peak age of the injured …

Four-Country Surveillance Of Intestinal Intussusception And Diarrhoea In Children, Shally Awasthi, Girdhar Agarwal, Vikas Mishra, Vijay Laxmi Nag, Hesham Fathey El Sayed, Antonio Da Cunha, Alvaro Madeiro, Dipty Jain, William Macharia, James Ndung'u, Saumya Awasthi, Ashish Wakhlu

Paediatrics and Child Health, East Africa

Aim: Establishment of baseline epidemiology of intussusception in developing countries has become a necessity with the possibility of reintroduction of rotavirus vaccine. The current study assessed the seasonal trend in cases admitted with intussusceptions and dehydrating acute watery diarrhoea in children aged 2 months to 10 years.

Methods: In a prospective surveillance study, teaching and research hospital sites in India (Lucknow and Nagpur), Brazil (Fortazela), Egypt (Ismailia) and Kenya (Nairobi) established a surveillance where a network of hospitals with surgical facilities catered to a reference population of about 1-2 million for reporting of intussusception. One large hospital per site also …

Characteristics Of Hiv-Infected Children Seen In Western Kenya, W Nyandiko, A. Mwangi, S. O. Ayaya, E. C. Nabakwe, C. N. Tenge, R. C. Vreeman, Peter Gisore

Paediatrics and Child Health, East Africa

Objectives: To describe the characteristics and outcomes of children registered for care in a large HIV care programme in Western Kenya.

Design: A retrospective descriptive study.

Setting: USAID-AMPATH HIV clinics in health centres; district and sub-district hospitals; Moi Teaching and Referral Hospital in Western Kenya.

Subjects: HIV-infected children below age of 15 years seen in a network of 18 clinics in Western Kenya.

Interventions: Paediatric HIV diagnosis and care including treatment and prevention of opportunistic infections and provision of combination antiretroviral therapy (CART).

Main outcome measures: Diagnosis, clinical stage and immune status at enrollment and follow-up; hospitalisation and death. Descriptive …

A Comparison Of The Observation Of Movement Method And Electromyography Method Of Determining Motor Threshold In Transcranial Magnetic Stimulation, Berry Stephen Anderson

MUSC Theses and Dissertations

Clinicians are using transcranial magnetic stimulation (TMS) as a noninvasive tool to treat depression; however, standards for determining the motor threshold (MT), which often determines the final location of the TMS coil and the intensity of simulation for the depression treatment, are not clear. This study compared the observation of movement (OM) method and electromyography (EMG) method of determining motor threshold in a group of experienced TMS administrators and nurses with no previous MT knowledge. We hypothesized that between methods and groups the MT estimates would vary by ≤ 5% of stimulator output and the ideal motor scalp location between …

Dilemma In The Diagnosis Of Mediastinal Adenopathy In The South Asian Population-Role Of Ct Guided Biopsy, Mediastinoscopy And Video-Assisted Thoracoscopy (Vats), Marium Muzaffar, Hashim M Hanif, Saulat H. Fatimi

Section of Cardiothoracic Surgery

The diagnosis of mediastinal adenopathy is a dilemma amongst treating physicians especially in South Asia. This is because although tuberculosis is endemic in this region, many a times lymphoma and sarcoidosis cannot be excluded. Often patients are being treated with medications without a confirmed diagnosis. The Video-assisted thoracoscopy (VATS) has revolutionized the way mediastinal adenopathy is diagnosed and managed in this part of the world.

Molecular Confirmation Of The Causes Of Inherited Visual Impairment In Northern Pakistan, Mehreen Adhi, Yasmin Rashid, Syed Hussain Jafri, Chris F. Inglehearn, Martin Mckibbin

Section of Ophthalmology

Families with inherited visual impairment were identified and examined from January 2000 to December 2005 and given a clinical diagnosis. Known genes and loci were screened for mutations or linkage at Institute of Ophthalmology and Neurosciences, University of Leeds, in order to provide molecular confirmation. Inherited retinal disease was the most common cause of inherited visual impairment in 38 of 57 families (66.6%) with Leber's congenital amaurosis, rod-cone dystrophy and cone-rod dystrophy being the most common diagnoses in 22, 8 and 3 families respectively. Anterior segment dysgenesis was diagnosed in 8 families (14%). Mutations in known genes or linkage to …

The Effects Of An Integrated Behavioral Health Initiative On The Behavior Of Providers In An Ob/Gyn Primary Care Clinic, Dean Moritz

Walden Dissertations and Doctoral Studies

The separation between behavioral services and traditional medicine is increasingly being seen as counterproductive on personal and societal levels. Despite this, there has been little research examining how integrated models blending mental and physical health services could be implemented. The literature revealed that behavioral interventions have been incorporated into traditional medical treatments, but this often has been piecemeal in nature and has yielded equivocal results. This study examined the assertion that effective integration between behavioral and medical services will increase the standard of care for the patient. Integration in this study was accomplished by colocating a psychologist on the primary …

Violence Against Women Raises Risk Of Cervical Cancer, Ann L. Coker, Claudia Hopenhayn, Christopher P. Desimone, Heather M. Bush, Leslie Crofford

CRVAW Faculty Journal Articles

Background: An emerging literature suggests that violence against women (VAW), particularly sexual violence, may increase the risk of acquiring a sexually transmitted infection (STI) and, therefore, may be associated with cervical cancer development. The purpose of this cross-sectional analysis was to determine if women who had experienced violence had higher prevalence rates of invasive cervical cancer.

Methods: Women aged 18–88 who joined the Kentucky Women’s Health Registry (2006–2007) and completed a questionnaire were included in the sample. Multivariate logistic regression analyses were used to adjust odds ratio (OR) for confounders (e.g., age, education, current marital status, lifetime illegal drug use, …

Hpv Vaccine Acceptance Among Latina Mothers By Hpv Status, Maureen Sanderson, Ann L. Coker, Katherine S. Eggleston, Maria E. Fernandez, Concepcion D. Arrastia, Mary Kay Fadden

CRVAW Faculty Journal Articles

Objective: We investigated whether Latina mothers who were and were not human papillomavirus (HPV) positive differed in their knowledge and acceptance of the HPV vaccine for their children.

Methods: We conducted a cross–sectional survey among women aged 18–64 years between April 2007 and April 2008. Data collectors conducted in-person interviews in community clinics with 215 HPV-negative women and 190 HPV-positive women (with respective response rates of 64% and 84%). Most (83%) HPV-positive women were recruited at dysplasia clinics. Although no HPV-negative women were recruited at dysplasia clinics, they were recruited at other low-income public and private clinics.

Results: After adjustment …