Digital Commons Network^™

Bringing Team Science To The Ambulatory Diagnostic Process: How Do Patients And Clinicians Develop Shared Mental Models?, Aubrey Samost-Williams, Eric J Thomas, Olivia Lounsbury, Scott I Tannenbaum, Eduardo Salas, Sigall K Bell

Faculty, Staff and Student Publications

The ambulatory diagnostic process is potentially complex, resulting in faulty communication, lost information, and a lack of team coordination. Patients and families have a unique position in the ambulatory diagnostic team, holding privileged information about their clinical conditions and serving as the connecting thread across multiple healthcare encounters. While experts advocate for engaging patients as diagnostic team members, operationalizing patient engagement has been challenging. The team science literature links improved team performance with shared mental models, a concept reflecting the team's commonly held knowledge about the tasks to be done and the expertise of each team member. Despite their proven …

Immigration Status Checks, Emergency Medicaid Utilization, And Health Care Access For Uninsured Individuals With Kidney Disease, Katherine Rizzolo, Ryan Murray, Jade Teakell, Eric Kerns, Prakrati Acharya, Priti Patel, Prachi Sharma, Lilia Cervantes

Faculty, Staff and Student Publications

No abstract provided.

Immunogenomic Determinants Of Exceptional Response To Immune Checkpoint Inhibition In Renal Cell Carcinoma, Tejas Jammihal, Renee Maria Saliby, Chris Labaki, Hanna Soulati, Juan Gallegos, Arnau Peris, Dustin Mccurry, Chunlei Yu, Valisha Shah, Deepak Poduval, Talal El Zarif, Nourhan El Ahmar, Yasmin Nabil Laimon, Marc Eid, Aseman Bagheri Sheshdeh, Katherine M Krajewski, Florian A Büttner, Matthias Schwab, Daniel Heng, Rafael C Casellas, Kunal Rai, Niki M Zacharias Millward, Pavlos Msaouel, Jose Karam, Sabina Signoretti, Eliezer Van Allen, Toni K Choueiri, David A Braun, Sachet A Shukla

Faculty, Staff and Student Publications

Immune checkpoint inhibitors can lead to 'exceptional', durable responses in a subset of persons. However, the molecular basis of exceptional response (ER) to immunotherapy in metastatic clear cell renal cell carcinoma (mccRCC) has not been well characterized. Here we analyzed pretherapy genomic and transcriptomic data in treatment-naive persons with mccRCC treated with standard-of-care immunotherapies: (1) combination of programmed cell death protein and ligand 1 (PD1/PDL1) and cytotoxic T lymphocyte-associated protein 4 inhibitors (IO/IO) or (2) combination of PD1/PDL1 and vascular endothelial growth factor (VEGF) receptor inhibitors (IO/VEGF). In the IO/IO cohort, clonal neoantigen load was significantly higher in persons with …

Community Outreach, Engagement, And Mentoring Program For Underrepresented Scholars In Cancer Health Disparities, Lorna H Mcneill, Cassandra L Harris, Terrence R Adams, Berta R Salazar, Crystal L Roberson, Leonetta B Thompson, Kamisha H Escoto, Kayce D Solari Williams, Shine Chang, Tzuan A Chen, Birnur Buzcu-Guven, Lorraine R Reitzel

Faculty, Staff and Student Publications

Objective:

Racial/ethnic minorities and women are affected by cancer and cancer risk factors at higher rates; however, they are largely underrepresented in scientific professions focused on health disparities. One way to reduce disparities is to increase diversity within the workforce by planning training activities for minority scholars, paying close attention to community outreach. This paper describes the outcomes of a robust community outreach plan engaging communities in education, research, and clinical trials to increase the number of underrepresented student scholars in cancer disparities research through research training, mentorship, and service-learning activities provided within local organizations.

Methods:

The program provided two …

Re: Prevalence Of Cancer Survivors In The United States, Shine Chang

Faculty, Staff and Student Publications

No abstract provided.

Molecular Profiling Of Bladder Cancer Xenografts Defines Relevant Molecular Subtypes And Provides A Resource For Biomarker Discovery, Sharada Mokkapati, Ganiraju Manyam, Alexis R Steinmetz, Côme Tholomier, Alberto Martini, Woonyoung Choi, Bogdon Czerniak, Byron H Lee, Colin P Dinney, David J Mcconkey

Faculty, Staff and Student Publications

Bladder cancer (BLCA) genomic profiling has identified molecular subtypes with distinct clinical characteristics and variable sensitivities to frontline therapy. BLCAs can be categorized into luminal or basal subtypes based on their gene expression. We comprehensively characterized nine human BLCA cell lines (UC3, UC6, UC9, UC13, UC14, T24, SCaBER, RT4V6 and RT112) into molecular subtypes using orthotopic xenograft models. Patient-derived, luciferase-tagged BLCA cell lines were cultured in vitro and engrafted into bladders of NSG mice. Tumor growth was monitored using bioluminescence imaging and mRNA-based molecular classification was used to characterize xenografts into molecular subtypes. RNAseq analysis and basal, luminal, and epithelial-mesenchymal …

The Metabolic Basis Of Cancer-Related Fatigue, Robert Dantzer, Brandon Chelette, Elisabeth G Vichaya, A Phillip West, Aaron Grossberg

Faculty, Staff and Student Publications

Although we are all familiar with the sensation of fatigue, there are still profound divergences on what it represents and its mechanisms. Fatigue can take various forms depending on the condition in which it develops. Cancer-related fatigue is considered a symptom of exhaustion that is often present at the time of diagnosis, increases in intensity during cancer therapy, and does not always recede after completion of treatment. It is usually attributed to the inflammation induced by damage-associated molecular patterns released by tumor cells during cancer progression and in response to its treatment. In this review, we argue that it is …

Hsp90 Inhibitor Auy922 Suppresses Tumor Growth And Modulates Immune Response Through Yap1-Tead Pathway Inhibition In Gastric Cancer, Katsuhiro Yoshimura, Gengyi Zou, Yibo Fan, Kohei Yamashita, Lingzhi Wang, Jingjing Wu, Ruiping Wang, Shan Shao, Ailing W Scott, Jiankang Jin, Melissa Pool Pizzi, Xiaodan Yao, Calena-Abel Brown, Linghua Wang, Qiong Gan, Rebecca E Waters, Feng Yin, Shumei Song, Shilpa S Dhar, Jaffer A Ajani

Faculty, Staff and Student Publications

Heat shock protein 90 (HSP90), a vital chaperone involved in the folding and stabilization of various cellular proteins, regulates key functions in many tumor cells. In the context of gastric adenocarcinoma (GAC), where HSP90's role remains largely unexplored, we aimed to investigate the significance of HSP90 inhibitor, AUY922, in regulating the YAP1/TEAD pathway and its association with the tumor immune microenvironment (TME). Our results showed that AUY922 effectively inhibited GAC aggressiveness in both the invitro and invivo models, induced apoptosis, and cell-cycle arrest. Various functional assays elucidated that AUY922 potently inhibited the expression and interaction among YAP1/TEAD and HSP90, resulting …

Radiotherapy In The Treatment Of Primary Cutaneous Cd4+ Small/Medium T-Cell Lymphoproliferative Disorder, Susan Y Wu, Ethan P Damron, Jie Xu, Penny Q Fang, Julia Dai, Ranjit Nair, Luis E Malpica Castillo, Luis E Fayad, Carlos A Torres-Cabala, L Jeffrey Medeiros, Francisco Vega, Roberto N Miranda, Madeleine Duvic, Chelsea C Pinnix, Bouthaina S Dabaja, Swaminathan P Iyer, Auris O Huen, Jillian R Gunther

Faculty, Staff and Student Publications

Background: Primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder (PCSM-LPD) is an increasingly recognized entity with heterogeneous management strategies that may include radiotherapy.

Objective: Our aim was to characterize treatment options for PCSM-LPD, with a focus on the role of radiotherapy.

Methods: This is a retrospective review of 46 patients seen in the Cutaneous Lymphoma Program at the University of Texas MD Anderson Cancer Center, with a clinicopathologic review consistent with PCSM-LPD. All patients were biopsied and underwent observation, topical/intralesional steroids, and/or radiotherapy. Patients were confirmed to have residual disease prior to radiotherapy.

Results: All patients achieved a complete response (CR). …

Bills To Restrict Access To And Harm From Indoor Tanning Facilities In Us State Legislatures, 1992‒2023, David B Buller, Julia Berteletti, Carolyn Heckman, Kevin R J Schroth, Alan C Geller, Jerod L Stapleton, Irene Adjei, Anna Mitarotondo, Samantha R Guild, Jeffrey E Gershenwald, Robert Dellavalle, Sherry Pagoto

Faculty, Staff and Student Publications

Objectives. To describe progression, content, and stringency of state legislation regulating indoor tanning and association with state government political party leadership.

Methods. Trained research assistants used legal mapping methods to code legislative bills on indoor tanning introduced in US states, the District of Columbia, and Puerto Rico. We calculated composite scores on the stringency of age restrictions and of warnings, operator requirements, and enforcement. We evaluated associations of the political party of the legislative sponsor and legislature majority.

Results. Between 1992 and 2023, 184 bills were introduced in 49 of 50 states and DC (56 laws were enacted, and 126 …

Healthcare Costs In The United States By Demographic Characteristics And Comorbidity Status, Naomi N Adjei, Allen Haas, Charlotte C Sun, Hui Zhao, Paul G Yeh, Sharon H Giordano, Iakovos Toumazis, Larissa A Meyer

Faculty, Staff and Student Publications

Objectives: Current, real-world healthcare cost information is needed to project future expenditures and inform policy. We estimated the healthcare costs for adults in 2019 in the United States by age, sex, race/ethnicity, geographic region, and comorbidity.

Methods: We aggregated and summarized the healthcare costs in 2021 US dollars using claims data derived from Optum's deidentified Clinformatics® Data Mart Database, which includes inpatient, outpatient, and prescription claims for commercial and Medicare Advantage beneficiaries nationwide.

Results: A total of 9 227 901 adults were included in the analysis. The largest group represented was 71 to 75 years old (13%), female (53%), White …

Cost Of Ovarian Cancer By The Phase Of Care In The United States, Naomi N Adjei, Allen M Haas, Charlotte C Sun, Hui Zhao, Paul G Yeh, Sharon H Giordano, Iakovos Toumazis, Larissa A Meyer

Faculty, Staff and Student Publications

Background: Ovarian cancer is associated with delayed diagnosis and poor survival; thus, interest is high in identifying predictive and prognostic biomarkers and novel therapeutic agents. Although the costs of ovarian cancer care are likely to increase as newer, more effective, but more expensive treatment regimens become available, information on the current costs of care for ovarian cancer-across the care continuum from diagnosis to the end of life-are lacking.

Objective: This study aimed to estimate real-world mean and median costs of ovarian cancer care within the first 5 years after diagnosis by patients' phase of care, age, race/ethnicity, and geographic region. …

Management Of Isolated Partial Acl Tears: A Survey Of International Acl Surgeons, Christopher S Frey, Kinsley J Pierre, Nicole S Pham, Geoffrey D Abrams, Seth L Sherman, Tim Spalding, Marc R Safran

Faculty, Staff and Student Publications

Background: Partial anterior cruciate ligament (ACL) tears, particularly injuries detected with magnetic resonance imaging (MRI) but stable on ligamentous examination, appear to be recognized more frequently; however, there remains no consensus management for this complex pathology.

Purpose: To present the results of a survey of a group of international ACL experts on the management of partial ACL injuries.

Study design: Survey study; Level of evidence, 5.

Methods: The ACL Study Group is an international group of orthopaedic surgeons with a special interest in the ACL. There are 169 members overall, with 135 clinically active surgeons. A branching logic survey was …

Deformity Considerations In Cervical Laminoplasty: A Narrative Review, Joseph P Drain, Paul Alvarez, William Ryan Spiker, Elizabeth Yu

Faculty, Staff and Student Publications

Objectives: We discuss the incidence of postoperative kyphosis following laminoplasty and its impact on outcomes, as well as critical radiographic parameters, intraoperative technical factors, and postoperative protocols that can be used to improve results.

Summary of background data: When appropriately selected, cervical laminoplasty is a motion-sparing treatment option for cervical myelopathy and is a valid alternative to laminectomy and fusion procedures. However, like other posterior-based cervical decompression techniques, laminoplasty can cause postoperative kyphosis.

Methods: A PubMed search was performed to gather articles that focus on cervical deformity in the context of cervical laminoplasty.

Results: The reported conversion rates of lordotic …

In Which Patients Should A Custom-Made Acetabular Implant (Triflange Cup) Be Used?, Alisagib A Dzhavadov, Wei Huang, Huiwu Li, Syed Shahid Noor, Javad Parvizi, Alisina Shahi, Neil P Sheth, Kevin Tetsworth, Rashid M Tikhilov, Jorge A Villafuerte, Luigi Zagra

Faculty, Staff and Student Publications

No abstract provided.

Is There A Difference Between Modular Versus Monoblock Femoral Stems Used During Revision Total Hip Arthroplasty?, Alisina Shahi, Hari Bezwada, Daniel Kendoff, Fouad Sadek, Margarita Veloso Duran, Heinz Winkler, Weijun Wang, Xiaogang Zhang

Faculty, Staff and Student Publications

No abstract provided.

Respiratory Outcomes Of Infants Born Extremely Preterm In The Necrotizing Enterocolitis Surgery Trial, Sara B Demauro, Erik A Jensen, Scott A Mcdonald, Susan Hintz, Jon Tyson, David K Stevenson, Martin L Blakely

Faculty, Staff and Student Publications

The multicenter Necrotizing Enterocolitis Surgery Trial compared initial peritoneal drainage with laparotomy among infants with extremely low birth weight and surgical necrotizing enterocolitis or intestinal perforation. In this post hoc analysis of trial data, initial drainage was associated with adverse respiratory outcomes, both in hospital and through 2 years corrected age.

Adipose Tissue Deficiency Impairs Transient Lipid Accumulation And Delays Liver Regeneration Following Partial Hepatectomy In Male Seipin Knockout Mice, Qianqian Dong, Ziwei Liu, Yidan Ma, Xin Chen, Xiaowei Wang, Jinye Tang, Kexin Ma, Chenxi Liang, Mengyu Wang, Xiaoqin Wu, Yang Liu, Yaru Zhou, Hongyuan Yang, Mingming Gao

Faculty, Staff and Student Publications

Background: Liver diseases pose significant health challenges, underscoring the importance of understanding liver regeneration mechanisms. Systemic adipose tissue is thought to be a primary source of lipids and energy during this process; however, empirical data on the effects of adipose tissue deficiency are limited. This study investigates the role of adipose tissue in liver regeneration, focusing on transient regeneration-associated steatosis (TRAS) and hepatocyte proliferation using a Seipin knockout mouse model that mimics severe human lipodystrophy. Additionally, the study explores therapeutic strategies through adipose tissue transplantation.

Methods: Male Seipin knockout (Seipin-/-) and wild-type (WT) mice underwent 2/3 partial hepatectomy (PHx). Liver …

Psychiatric Manifestations Of Encephalitis, Paris Bean, Ashley Heck, Ralph Habis, Swathi Sowmitran, Zoe Cartaina, Rajesh Gupta, John Probasco, Rodrigo Hasbun, Arun Venkatesan

Faculty, Staff and Student Publications

Objective: Encephalitis is a serious and potentially life-threatening condition of infectious or autoimmune cause. We aim to characterize the frequency and clinical spectrum of presenting psychiatric symptoms in encephalitis in order to inform earlier recognition and initiation of treatment.

Methods: This was a retrospective study of adult patients who met the 2013 International Encephalitis Consortium (IEC) and/or 2016 Graus criteria between February 2005 and February 2023. The study included two hospital systems in Houston, Texas, and Baltimore, Maryland and included a total of 642 patients. Psychiatric manifestations were grouped into five high-level categories: behavior, psychosis, mood, sleep disturbances, and catatonia. …

The Role Of Double-Zero-Event Studies In Evidence Synthesis: Evaluating Robustness Using The Fragility Index, Zelin Wang, Xing Xing, Eun-Young Mun, Chong Wu, Lifeng Lin

Faculty, Staff and Student Publications

Rationale: Zero-event counts are common in clinical studies, particularly when assessing rare adverse events. These occurrences can result from low event rates, short follow-up periods, and small sample sizes. When both intervention and control groups report zero events in a clinical trial, the study is referred to as a double-zero-event study, which presents methodological challenges for evidence synthesis. There has been ongoing debate about whether these studies should be excluded from evidence synthesis, as traditional two-stage meta-analysis methods may not estimate an effect size for them. Recent research suggests that these studies may still contain valuable clinical and statistical information. …

From Stable Teamwork To Dynamic Teaming In The Ambulatory Care Diagnostic Process, Scott I Tannenbaum, Eric J Thomas, Sigall K Bell, Eduardo Salas

Faculty, Staff and Student Publications

Dynamic teaming is required whenever people must coordinate with one another in a fluid context, particularly when the fundamental structures of a team, such as membership, priorities, tasks, modes of communication, and location are in near-constant flux. This is certainly the case in the contemporary ambulatory care diagnostic process, where circumstances and conditions require a shifting cast of individuals to coordinate dynamically to ensure patient safety. This article offers an updated perspective on dynamic teaming commonly required during the ambulatory diagnostic process. Drawing upon team science, it clarifies the characteristics of dynamic diagnostic teams, identifies common risk points in the …

Protein Arginine Methyltransferases As Regulators Of Cellular Stress, Julia Zaccarelli-Magalhães, Cristiane Teresinha Citadin, Julia Langman, Drew James Smith, Luiz Henrique Matuguma, Hung Wen Lin, Mariana Sayuri Berto Udo

Faculty, Staff and Student Publications

Arginine modification can be a "switch" to regulate DNA transcription and a post-translational modification via methylation of a variety of cellular targets involved in signal transduction, gene transcription, DNA repair, and mRNA alterations. This consequently can turn downstream biological effectors "on" and "off". Arginine methylation is catalyzed by protein arginine methyltransferases (PRMTs 1-9) in both the nucleus and cytoplasm, and is thought to be involved in many disease processes. However, PRMTs have not been well-documented in the brain and their function as it relates to metabolism, circulation, functional learning and memory are understudied. In this review, we provide a comprehensive …

All Three Supersystems-Nervous, Vascular, And Immune-Contribute To The Cortical Infarcts After Subarachnoid Hemorrhage, Jens P Dreier, Alexander Joerk, Hiroki Uchikawa, Viktor Horst, Coline L Lemale, Helena Radbruch, Devin W Mcbride, Peter Vajkoczy, Ulf C Schneider, Ran Xu

Faculty, Staff and Student Publications

The recently published DISCHARGE-1 trial supports the observations of earlier autopsy and neuroimaging studies that almost 70% of all focal brain damage after aneurysmal subarachnoid hemorrhage are anemic infarcts of the cortex, often also affecting the white matter immediately below. The infarcts are not limited by the usual vascular territories. About two-fifths of the ischemic damage occurs within ~ 48 h; the remaining three-fifths are delayed (within ~ 3 weeks). Using neuromonitoring technology in combination with longitudinal neuroimaging, the entire sequence of both early and delayed cortical infarct development after subarachnoid hemorrhage has recently been recorded in patients. Characteristically, cortical …

Melanoma Risk In Turner Syndrome: A Case-Control Study In Surveillance, Epidemiology, And End Results-Medicare, Gabriella V Alvarez, Kai-Ping Liao, Mackenzie R Wehner, Megan N Rogge

Faculty, Staff and Student Publications

No abstract provided.

The Dynamics Of Tubulogenesis In Development And Disease, Adrian Romero, Brandy L Walker, Vanja Krneta-Stankic, Kamryn Gerner-Mauro, Lydia Youmans, Rachel K Miller

Faculty, Staff and Student Publications

Tubes are crucial for the function of many organs in animals given their fundamental roles in transporting and exchanging substances to maintain homeostasis within an organism. Therefore, the development and maintenance of these tube-like structures within organs is a vital process. Tubes can form in diverse ways, and advances in our understanding of the molecular and cellular mechanisms underpinning these different modes of tubulogenesis have significant impacts in many biological contexts, including development and disease. This Review discusses recent progress in understanding developmental mechanisms underlying tube formation.

A Phase 2 Basket Study Of Talabostat, A Small-Molecule Inhibitor Of Dipeptidyl Peptidases, Administered In Combination With Pembrolizumab In Patients With Advanced Solid Cancers, Jibran Ahmed, Filip Janku, Daniel D Karp, Sarina A Piha-Paul, Apostolia M Tsimberidou, Timothy Anthony Yap, Bettzy Stephen, Yali Yang, Serdar Gurses, Qian Liu, Juhee Song, Funda Meric-Bernstam, Aung Naing

Faculty, Staff and Student Publications

Background: Talabostat, an oral small molecule inhibitor of dipeptidyl peptidases (DPP4 and DPP8/9), has shown synergistic activity with immune checkpoint inhibitors in preclinical studies. This open label, phase 2 basket trial assessed the antitumor activity of combining talabostat and pembrolizumab (anti-programmed death-1 antibody) in advanced solid tumor patients.

Methods: The primary objective was assessment of dose-limiting toxicity (DLT) rates in the first six patients (lead-in stage) and response rate (efficacy stage; included cohort A [checkpoint inhibitor (ICI) naive] and cohort B [ICI pretreated]) for the study treatment using the Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 and immune RECIST …

Establishment Of The Nichols Strain As The Type Strain Of Treponema Pallidum, Steven J Norris

Faculty, Staff and Student Publications

In this article, it is proposed that the Nichols strain of Treponema pallidum be established as the type strain. T. pallidum was first identified as the causative agent of syphilis in 1905, and the Nichols strain was isolated in 1912 by inoculation of a rabbit with cerebrospinal fluid from a patient with neurosyphilis. The Nichols strain has been maintained by serial passage in rabbits for over a century, and historically most studies of T. pallidum have been conducted using this strain. In recent years, a procedure for continuous in vitro culture of T. pallidum in a tissue culture system has …

Impact Of Body Mass Index On Outcomes Of Multiple Myeloma Patients Undergoing Upfront Autologous Stem Cell Transplant, Curtis Marcoux, Sarah Pasyar, Denái R Milton, Hina N Khan, Mark R Tanner, Qaiser Bashir, Samer Srour, Neeraj Saini, Paul Lin, Jeremy Ramdial, Yago Nieto, Niraj Neupane, Hans C Lee, Krina K Patel, Guilin Tang, Yosra Aljawai, Partow Kebriaei, Sheeba K Thomas, Robert Z Orlowski, Elizabeth J Shpall, Richard Champlin, Muzaffar H Qazilbash, Oren Pasvolsky

Faculty, Staff and Student Publications

No abstract provided.

Regulation Of Artificial Intelligence In Healthcare: Clinical Laboratory Improvement Amendments (Clia) As A Model, Brian R Jackson, Mark P Sendak, Anthony Solomonides, Suresh Balu, Dean F Sittig

Faculty, Staff and Student Publications

Objectives: To assess the potential to adapt an existing technology regulatory model, namely the Clinical Laboratory Improvement Amendments (CLIA), for clinical artificial intelligence (AI).

Materials and methods: We identify overlap in the quality management requirements for laboratory testing and clinical AI.

Results: We propose modifications to the CLIA model that could make it suitable for oversight of clinical AI.

Discussion: In national discussions of clinical AI, there has been surprisingly little consideration of this longstanding model for local technology oversight. While CLIA was specifically designed for laboratory testing, most of its principles are applicable to other technologies in patient care. …

Patient Outcomes Following Parasagittal Interlaminar Epidural Steroid Injections For Bilateral Lumbar Radicular Symptoms: Correlation Of Contrast Spread With Symptom Relief, Jamal Hasoon, Omar Viswanath, Alan D Kaye, Alberto Pasqualucci, Giustino Varrassi

Faculty, Staff and Student Publications

Introduction Bilateral lumbar radicular symptoms are commonly treated with interlaminar epidural steroid injections (ILESIs). The parasagittal approach often results in unilateral contrast spread, which may influence the degree of bilateral symptom relief. This study evaluates whether unilateral contrast spread correlates with symptom improvement in both ipsilateral and contralateral symptoms. Methods A retrospective review of six patients with bilateral lumbar radiculopathy secondary to lumbar degenerative disc disease, spondylosis, or disc herniation was conducted. All patients underwent ILESIs using a parasagittal approach. The injectate consisted of bupivacaine, preservative-free normal saline, and triamcinolone. Contrast spread was assessed fluoroscopically, and symptom relief was evaluated …