Digital Commons Network^™

Expanding Our Knowledge Of Menstrual Irregularities Reported By Females With Tuberous Sclerosis Complex, Kate Mowrey, Hope Northrup, Syed Shahrukh Hashmi, David Rodriguez-Buritica

Faculty, Staff and Student Publications

PURPOSE: The purpose of our study is to expand the knowledge regarding intrinsic reproductive dysfunction in females with TSC and to explore the impact of mTOR inhibitors (mTORi) on menstrual irregularity in the Tuberous Sclerosis Complex (TSC) community.

METHODS: An electronic survey composed of author-designed questions set out to evaluate reproductive history, presence of menstrual irregularities, mTORi use, as well as maternal reproductive history among females with TSC.

RESULTS: Of the 68 responses from females with TSC regarding age of menarche, the average age was 12.3 years. 56.5% (

CONCLUSIONS: Our data expands the knowledge regarding intrinsic menstrual dysregulation present …

Use Of Modeling To Inform Decision Making In North Carolina During The Covid-19 Pandemic: A Qualitative Study, Karl Johnson, Caitlin B Biddell, Kristen Hassmiller Lich, Julie Swann, Paul Delamater, Maria Mayorga, Julie Ivy, Raymond L Smith, Mehul D Patel

Faculty, Staff and Student Publications

Background. The COVID-19 pandemic has popularized computer-based decision-support models, which are commonly used to inform decision making amidst complexity. Understanding what organizational decision makers prefer from these models is needed to inform model development during this and future crises. Methods. We recruited and interviewed decision makers from North Carolina across 9 sectors to understand organizational decision-making processes during the first year of the COVID-19 pandemic (N = 44). For this study, we identified and analyzed a subset of responses from interviewees (n = 19) who reported using modeling to inform decision making. We used conventional content analysis to …

Editorial: How Can Wearable Robotic And Sensor Technology Advance Neurorehabilitation?, Shuo-Hsiu Chang, Shih-Chiao Tseng, Hao Su, Gerard E Francisco

Faculty, Staff and Student Publications

No abstract provided.

Novel Oppositional Defiant Disorder 6 Months After Traumatic Brain Injury In Children And Adolescents, Daniel S Lowet, Anish Kolan, Florin Vaida, John R Hesselink, Harvey S Levin, Linda Ewing-Cobbs, Russell J Schachar, Sandra B Chapman, Erin D Bigler, Elisabeth A Wilde, Ann E Saunders, Tony T Yang, Olga Tymofiyeva, Hattan Arif, Jeffrey E Max

Faculty, Staff and Student Publications

OBJECTIVE: The investigators aimed to assess predictive factors of novel oppositional defiant disorder (ODD) among children and adolescents in the first 6 months following traumatic brain injury (TBI).

METHODS: Children ages 5-14 years who experienced a TBI were recruited from consecutive admissions to five hospitals. Testing of a biopsychosocial model that may elucidate the development of novel ODD included assessment soon after injury (baseline) of preinjury characteristics, including psychiatric disorders, adaptive function, family function, psychosocial adversity, family psychiatric history, socioeconomic status, injury severity, and postinjury processing speed (which may be a proxy for brain injury). MRI analyses were also conducted …

Effective Connectivity In The Default Mode Network After Paediatric Traumatic Brain Injury, Kelly A Vaughn, Dana Demaster, Jeong Hwan Kook, Marina Vannucci, Linda Ewing-Cobbs

Faculty, Staff and Student Publications

Children who experience a traumatic brain injury (TBI) are at elevated risk for a range of negative cognitive and neuropsychological outcomes. Identifying which children are at greatest risk for negative outcomes can be difficult due to the heterogeneity of TBI. To address this barrier, the current study applied a novel method of characterizing brain connectivity networks, Bayesian multi-subject vector autoregressive modelling (BVAR-connect), which used white matter integrity as priors to evaluate effective connectivity-the time-dependent relationship in functional magnetic resonance imaging (fMRI) activity between two brain regions-within the default mode network (DMN). In a prospective longitudinal study, children ages 8-15 years …

Complete Corpus Callosotomy Using A Frameless Navigation Probe Through A Minicraniotomy In Children With Medically Refractory Epilepsy: A Case Series And Technical Note, Ahmed Belal, Gretchen Von Allmen, Indira Kommuru, Jeremy Lankford, John C Mosher, Manish Shah, Michael Funke, Michael Watkins, Rajan Patel

Faculty, Staff and Student Publications

BACKGROUND: Medically refractory epilepsy constitutes up to one-third of the epilepsy pediatric patients. Corpus callosotomy (CC) has been used for the treatment of medically refractory epilepsy in children with atonic seizures and generalized tonic-clonic (GTC) seizures. In this case series study, we are describing a novel technique for CC using the frameless navigation probe through a minicraniotomy.

METHODS: Thirteen pediatric patients with the diagnosis of medically refractory epilepsy predominantly GTC with drop attack who underwent extensive Phase I. An L-shape was done, then through a 4 × 3 cm craniotomy, we were able to open the interhemispheric fissure until the …

Renal Disease And The Heart, Hassan N Ibrahim

Faculty, Staff and Student Publications

No abstract provided.

A Tapered Cuff Tracheal Tube Decreases The Need For Cuff Pressure Adjustment After Surgical Retraction During Anterior Cervical Spine Surgery: A Randomized Controlled, Double-Blind Trial, Yi-Shiuan Li, Elise Chia-Hui Tan, Yueh-Ju Tsai, Mercedes Susan Mandell, Shiang-Suo Huang, Ting-Yun Chiang, Wen-Cheng Huang, Wen-Kuei Chang, Ya-Chun Chu

Faculty, Staff and Student Publications

Background: Surgical retraction to expose the vertebrae during anterior cervical spine surgery increases tracheal tube cuff pressure and may worsen postoperative sore throat and dysphonia. This randomized double-blind study investigated the effect of cuff shape on intraoperative cuff pressure and postoperative sore throat and dysphonia.

Methods: Eighty patients were randomized to tracheal intubation with a tapered cuff or a conventional cylindrical high-volume low-pressure cuff (control) during anesthesia. Intraoperative cuff pressures were compared. The primary outcome was the incidence of pressure adjustment needed when the cuff pressure increased to > 25 mm Hg after surgical retraction. The secondary outcome was the incidence …

Interictal Localization Of The Epileptogenic Zone: Utilizing The Observed Resonance Behavior In The Spectral Band Of Surrounding Inhibition, Omar A Alamoudi, Adeel Ilyas, Sandipan Pati, Leon Iasemidis

Faculty, Staff and Student Publications

Introduction

The gold standard for identification of the epileptogenic zone (EZ) continues to be the visual inspection of electrographic changes around seizures’ onset by experienced electroencephalography (EEG) readers. Development of an epileptogenic focus localization tool that can delineate the EZ from analysis of interictal (seizure-free) periods is still an open question of great significance for improved diagnosis (e.g., presurgical evaluation) and treatment of epilepsy (e.g., surgical outcome).

Methods

We developed an EZ interictal localization algorithm (EZILA) based on novel analysis of intracranial EEG (iEEG) using a univariate periodogram-type power measure, a straight-forward ranking approach, a robust dimensional reduction method and …

Catalytic Asymmetric Synthesis Of Carbocyclic C-Nucleosides, Sourabh Mishra, Florian C T Modicom, Conor L Dean, Stephen P Fletcher

Faculty, Staff and Student Publications

Access to carbocyclic C-nucleosides (CC-Ns) is currently restricted. The few methods available to make CC-Ns suffer from long syntheses and poor modularity, hindering the examination of potentially important chemical space. Here we report an approach to CC-Ns which uses an asymmetric Suzuki-Miyaura type reaction as the key C-C bond forming step. After coupling the densely functionalized racemic bicyclic allyl chloride and heterocyclic boronic acids, the trisubstituted cyclopentenyl core is elaborated to RNA analogues via a hydroborylation-homologation-oxidation sequence. We demonstrate that the approach can be used to produce a variety of enantiomerically enriched CC-Ns, including a carbocyclic derivative of Showdomycin.

Arthroscopic Stabilization Of Posterior Shoulder Instability Without Glenoid Bone Loss, Shawn D Feinstein, James M Gregory

Faculty, Staff and Student Publications

BACKGROUND: Contact athletes who experience posterior shoulder instability have a high likelihood of recurrence necessitating surgery.

INDICATIONS: Patients with posterior shoulder instability without glenoid or humeral head bone loss who have failed activity modification, bracing, and physical therapy may benefit from arthroscopic stabilization surgery.

TECHNIQUE DESCRIPTION: We describe a technique for arthroscopic labral repair with capsular plication through 4 portals in the lateral decubitus position.

RESULTS: Arthroscopic capsulolabral reconstruction is an effective and reliable treatment for posterior shoulder instability with good patient-reported outcomes, low recurrence rates, and high rate of return-to-play.

DISCUSSION/CONCLUSION: Arthroscopic capsulolabral reconstruction in the lateral decubitus position …

Digital Rehabilitation For Hand And Wrist Pain: A Single-Arm Prospective Longitudinal Cohort Study, Fabíola Costa, Dora Janela, Maria Molinos, Robert G Moulder, Jorge Lains, Gerard E Francisco, Virgílio Bento, Vijay Yanamadala, Steven P Cohen, Fernando Dias Correia

Faculty, Staff and Student Publications

Introduction: Wrist and hand represent the third most common body part in work-related injuries, being associated with long-term absenteeism. Telerehabilitation can promote access to treatment, patient adherence, and engagement, while reducing health care-related costs.

Objective: Report the results of a fully remote digital care program (DCP) for wrist and hand pain (WP).

Methods: A single-arm interventional study was conducted on individuals with WP applying for a DCP. Primary outcome was the mean change in the Numerical Pain Rating Scale after 8 weeks (considering a minimum clinically important change of 30%). Secondary outcomes were: disability (Quick Disabilities of the Arm, Shoulder, …

Emerging Evidence For Intrathecal Management Of Neuropathic Pain Following Spinal Cord Injury, Jay Karri, James Doan, Christian Vangeison, Marissa Catalanotto, Ameet S Nagpal, Sheng Li

Faculty, Staff and Student Publications

A high prevalence of patients with spinal cord injury (SCI) suffer from chronic neuropathic pain. Unfortunately, the precise pathophysiological mechanisms underlying this phenomenon have yet to be clearly elucidated and targeted treatments are largely lacking. As an unfortunate consequence, neuropathic pain in the population with SCI is refractory to standard of care treatments and represents a significant contributor to morbidity and suffering. In recent years, advances from SCI-specific animal studies and translational models have furthered our understanding of the neuronal excitability, glial dysregulation, and chronic inflammation processes that facilitate neuropathic pain. These developments have served advantageously to facilitate exploration into …

Targeting Etosis By Mir-155 Inhibition Mitigates Mixed Granulocytic Asthmatic Lung Inflammation, Ji Young Kim, Patrick Stevens, Manjula Karpurapu, Hyunwook Lee, Joshua A Englert, Pearlly Yan, Tae Jin Lee, Navjot Pabla, Maciej Pietrzak, Gye Young Park, John W Christman, Sangwoon Chung

Faculty, Staff and Student Publications

Asthma is phenotypically heterogeneous with several distinctive pathological mechanistic pathways. Previous studies indicate that neutrophilic asthma has a poor response to standard asthma treatments comprising inhaled corticosteroids. Therefore, it is important to identify critical factors that contribute to increased numbers of neutrophils in asthma patients whose symptoms are poorly controlled by conventional therapy. Leukocytes release chromatin fibers, referred to as extracellular traps (ETs) consisting of double-stranded (ds) DNA, histones, and granule contents. Excessive components of ETs contribute to the pathophysiology of asthma; however, it is unclear how ETs drive asthma phenotypes and whether they could be a potential therapeutic target. …

Dysregulated Hypothalamic-Pituitary-Adrenal Axis Is Associated With Increased Inflammation And Worse Outcomes After Ischemic Stroke In Diabetic Mice, Sehee Kim, Eun S Park, Peng R Chen, Eunhee Kim

Faculty, Staff and Student Publications

Diabetic patients have larger infarcts, worse neurological deficits, and higher mortality rate after an ischemic stroke. Evidence shows that in diabetes, the hypothalamic-pituitary-adrenal (HPA) axis was dysregulated and levels of cortisol increased. Based on the role of the HPA axis in immunity, we hypothesized that diabetes-dysregulated stress response exacerbates stroke outcomes via regulation of inflammation. To test this hypothesis, we assessed the regulation of the HPA axis in diabetic mice before and after stroke and determined its relevance in the regulation of post-stroke injury and inflammation. Diabetes was induced in C57BL/6 mice by feeding a high-fat diet and intraperitoneal injection …

Clinicopathological Correlations In Heart Transplantation Recipients Complicated By Death Or Re-Transplantation, Michelle M Mcdonald, Maks Mihalj, Bihong Zhao, Sriram Nathan, Stanislava Matejin, Giulia Ottaviani, Mateja K Jezovnik, Rajko Radovancevic, Biswajit Kar, Igor D Gregoric, L Maximilian Buja

Faculty, Staff and Student Publications

PURPOSE: This study aimed to identify and correlate pathological findings with clinical outcomes in patients after orthotopic heart transplantation (OHT) who either died or underwent a re-transplantation.

METHODOLOGY AND STUDY DESIGN: Single-center retrospective analysis of primary OHT patients who died or were re-transplanted between October 2012 and July 2021. Clinical data were matched with corresponding pathological findings from endomyocardial biopsies on antibody-mediated rejection, cellular rejection, and cardiac allograft vasculopathy. Re-assessment of available tissue samples was performed to investigate acute myocardial injury (AMI) as a distinct phenomenon. These were correlated with clinical outcomes, which included severe primary graft dysfunction. Patients were …

Enhancing Mesenchymal Stromal Cell Potency: Inflammatory Licensing Via Mechanotransduction, Max A Skibber, Scott D Olson, Karthik S Prabhakara, Brijesh S Gill, Charles S Cox

Faculty, Staff and Student Publications

Mesenchymal stromal cells (MSC) undergo functional maturation upon their migration from bone marrow and introduction to a site of injury. This inflammatory licensing leads to heightened immune regulation via cell-to-cell interaction and the secretion of immunomodulatory molecules, such as anti-inflammatory mediators and antioxidants. Pro-inflammatory cytokines are a recognized catalyst of inflammatory licensing; however, biomechanical forces, such as fluid shear stress, are a second, distinct class of stimuli that incite functional maturation. Here we show mechanotransduction, achieved by exposing MSC to various grades of wall shear stress (WSS) within a scalable conditioning platform, enhances the immunomodulatory potential of MSC independent of …

Structure Of The Hsp110:Hsc70 Nucleotide Exchange Machine, Yusra Ahmed, Jeremy Miciak, W Pat Taylor, David J Francis

Faculty, Staff and Student Publications

We evaluate the direct and inferential mediation (DIME) model for reading comprehension with a sample of struggling readers in Grades 3 to 5 (N = 364) in the context of a large-scale randomized controlled trial (RCT) investigating two theoretically distinct reading interventions (text processing + foundational skills [n = 117] or text processing only [n = 120]) and a control condition (n = 127). We investigate whether the intervention affects not just reading comprehension levels, but also how variables within the reading system interrelate. This approach allows the focus to shift from intervention as influencing a …

The Novel Use Of Biplane Imaging For Ultrasound-Guided Regional Anesthesia, Yusra Ahmed, Shawn Kent, Paul T Cirino, Milena Keller-Margulis

Faculty, Staff and Student Publications

Research suggests that executive function, motivation, transcription, and composition processes are implicated in the writing quality and productivity of children with and without learning difficulties. However, numerous components embedded within these constructs create both conceptual and empirical challenges to the study of written expression. These challenges are reflected in the writing research by way of poor delineation of constructs and insufficient distinction among domain general resources (e.g. working memory) versus processes related to the academic domain of writing (e.g. pre-planning), as well as among lower- (e.g. handwriting) and higher-order (e.g. editing) writing-specific processes. The current study utilizes the Not-so-Simple View …

Informal Science, Technology, Engineering And Math Learning Conditions To Increase Parent Involvement With Young Children Experiencing Poverty, Tricia A Zucker, Gloria Yeomans Maldonado, Michael Assel, Cheryl Mccallum, Cindy Elias, John M Swint, Lincy Lal

Faculty, Staff and Student Publications

Broadening participation in early science, technology, engineering and math (STEM) learning outside of school is important for families experiencing poverty. We evaluated variations of the Teaching Together STEM pre-kindergarten program for increasing parent involvement in STEM learning. This informal STEM, family engagement program was offered in 20 schools where 92% of students received free/reduced lunch. The core treatment included a series of family education workshops, text messages, and family museum passes. The workshops were delivered at school sites by museum outreach educators. We randomly assigned schools to business-as-usual control or one of three additive treatment groups. Using an additive treatment …

Beth Levine's Legacy: From The Discovery Of Becn1 To Therapies A Mentees' Perspective, Zhenyi An, Wei-Chung Chiang, Álvaro F Fernández, Luis H Franco, Congcong He, Shu-Yi Huang, Eunmyong Lee, Yang Liu, Salwa Sebti, Sanae Shoji-Kawata, Shyam Sirasanagandla, Richard C Wang, Yongjie Wei, Yuting Zhao, Silvia Vega-Rubin-De-Celis

Faculty, Staff and Student Publications

With great sadness, the scientific community received the news of the loss of Beth Levine on 15 June 2020. Dr. Levine was a pioneer in the autophagy field and work in her lab led not only to a better understanding of the molecular mechanisms regulating the pathway, but also its implications in multiple physiological and pathological conditions, including its role in development, host defense, tumorigenesis, aging or metabolism. This review does not aim to provide a comprehensive view of autophagy, but rather an outline of some of the discoveries made by the group of Beth Levine, from the perspective of …

Diagnostic Accuracy Of Calculated Tumor Volumes And Apparent Diffusion Coefficient Values In Predicting Endometrial Cancer Grade, Chandan Kakkar, Kamini Gupta, Kunal Jain, Vikram Narang, Aminder Singh, Kavita Saggar, Namita Bansal, Dania Cioni, Emanuele Neri

Faculty, Staff and Student Publications

BACKGROUND: Magnetic resonance imaging (MRI) has been shown to be an accurate imaging technique for the preoperative assessment of local staging of endometrial cancer and for evaluating the depth of myometrial invasion.

MATERIALS AND METHODS: This was a single-center retrospective study performed on patients with histopathologically proven endometrial carcinoma who underwent an MRI examination of the pelvis between October 2017 and May 2020.

RESULTS: In the present analysis, mean apparent diffusion coefficient (ADC) values for each histologic grade were 0.72 ± 0.13 × 10

CONCLUSION: Preoperative noninvasive radiological assessment for tumor volume, TV/ UV or tumor volume/uterine volume is important …