Medicine and Health Sciences Commons^™

Does Anyone Remember "Fingerprints On An X-Ray?", Vincent L. Sorrell

Gill Heart & Vascular Institute Faculty Publications

No abstract provided.

Intensive Care Bundle With Blood Pressure Reduction In Acute Cerebral Hemorrhage Trial (Interact3): Study Protocol For A Pragmatic Stepped-Wedge Cluster-Randomized Controlled Trial, Lili Song, Xin Hu, Lu Ma, Xiaoying Chen, Menglu Ouyang, Laurent Billot, Qiang Li, Paula Muñoz-Venturelli, Carlos Abanto, Mohammad Wasay

Section of Neurology

Background: Early intensive blood pressure (BP) lowering remains the most promising treatment for acute intracerebral hemorrhage (ICH), despite discordant results between clinical trials and potential variation in the treatment effects by approach to control BP. As the third in a series of clinical trials on this topic, the INTEnsive care bundle with blood pressure Reduction in Acute Cerebral hemorrhage Trial (INTERACT3) aims to determine the effectiveness of a goal-directed care bundle protocol of early physiological control (intensive BP lowering, glycemic control, and pyrexia treatment) and reversal of anticoagulation, in acute ICH.
Methods: INTERACT3 is a pragmatic, international, multicenter, stepped-wedge (4 …

The Similarities And Differences Between Glomerular Vs. Non-Glomerular Diagnoses On Intelligence And Executive Functions In Pediatric Chronic Kidney Disease: A Brief Report., Stephen R. Hooper, Rebecca J. Johnson, Marc Lande, Matthew Matheson, Shlomo Shinnar, Amy J. Kogon, Lyndsay Harshman, Joann Spinale, Arlene C. Gerson, Bradley A. Warady, Susan L. Furth

Manuscripts, Articles, Book Chapters and Other Papers

Pediatric chronic kidney disease (CKD) appears to be a heterogeneous group of conditions, but this heterogeneity has not been explored with respect to its impact on neurocognitive functioning. This study investigated the neurocognitive functioning of those with glomerular (G) vs. non-glomerular (NG) diagnoses. Data from the North American CKiD Study were employed and the current study included 1,003 children and adolescents with mild to moderate CKD. The G Group included 260 participants (median age = 14.7 years) and the NG Group included 743 individuals (median age = 9.0 years). Neurocognitive measures assessed IQ, inhibitory control, attention regulation, problem solving, working …

Can Activated Titanium Interbody Cages Accelerate Or Enhance Spinal Fusion? A Review Of The Literature And A Design For Clinical Trials, Nathaniel Toop, Connor Gifford, Rouzbeh Motiei-Langroudi, Arghavan Farzadi, Daniel Boulter, Reza Forghani, H. Francis Farhadi

Neurosurgery Faculty Publications

While spinal interbody cage options have proliferated in the past decade, relatively little work has been done to explore the comparative potential of biomaterial technologies in promoting stable fusion. Innovations such as micro-etching and nano-architectural designs have shown purported benefits in in vitro studies, but lack clinical data describing their optimal implementation. Here, we critically assess the pre-clinical data supportive of various commercially available interbody cage biomaterial, topographical, and structural designs. We describe in detail the osteointegrative and osteoconductive benefits conferred by these modifications with a focus on polyetheretherketone (PEEK) and titanium (Ti) interbody implants. Further, we describe the rationale …

Spontaneous Globe Subluxation: A Case Report And Review Of The Literature, Tesfaye Yadete, Ian Isby, Ketan Patel, Alex Lin

Emergency Medicine Faculty Publications

Background: Spontaneous globe subluxation (SGS) is an atraumatic anterior dislocation of the eyeball. It is exceedingly rare. Understanding SGS predisposing factors may help uncover its etiology and undertake vision-saving management. Case presentation: A 48-year-old female presented to the ED with her right eye out of its socket. She reported blurry vision, photophobia, and pain in the affected eye. She was unable to close her right eyelid and was in obvious distress. On arrival, her blood pressure was elevated. Her medical history was notable for hypertension and obesity. On physical examination, extraocular eye movements were not intact, and the globe appeared …

Effects Of Subthalamic Deep Brain Stimulation On Treating Motor Symptoms In Early Parkinson's Disease, Emily Reale, Gina Legaluppi

Physician Assistant Capstones, 2020-current

Objective: Assess the efficacy of subthalamic nucleus deep brain stimulation (STN DBS) versus solely optimal pharmacological use in early Parkinson's Disease to improve motor dysfunction. Design: Systematic Literature Review. Methods: Searches were completed on PubMed utilizing the MeSH terms: “subthalamic, deep brain stimulation, and early parkinson.” Using PubMed the following limits and terms were used: published in the last 10 years, randomized controlled trial, English, human, and removing duplicates. A total of three studies resulted after the search. Results: All three studies showed statistically significant results in reduction in disease progressive motor symptoms. Additionally, at the end of each study …

Endovascular Approach In The Management Of Idiopathic Myointimal Hyperplasia Of The Inferior Mesenteric Vein, Yash B Shah, Derek Lee, Tamim S Khaddash

Department of Medicine Faculty Papers

Background: Idiopathic myointimal hyperplasia of the mesenteric vein (IMHMV) is a rare, often undiagnosed pathology affecting the colon. Patients typically present with severe abdominal pain and inflammation caused by smooth muscle proliferation of the veins, leading to arterialization, stenosis, and potential occlusion. The etiology remains unclear, but it has been hypothesized that an arteriovenous connection may be associated with the pathology. This is the first reported case indicating such an association. This case additionally highlights the potential utility of endovascular treatment, as endovascular embolization is generally a less invasive alternative to surgical resection in the treatment of such vascular disorders. …

The Effects Of Physical Activity On Cancer Patients Undergoing Treatment With Immune Checkpoint Inhibitors: A Scoping Review., Amy L Shaver, Swapnil Sharma, Nikita Nikita, Daniel S Lefler, Atrayee Basu-Mallick, Jennifer M Johnson, Meghan Butryn, Grace Lu-Yao

Department of Medical Oncology Faculty Papers

BACKGROUND: Cancer therapies are associated with multiple adverse effects, including (but not limited to) cancer-related fatigue (CRF). Fatigue is one of the most common side effects of immune checkpoint inhibitors (ICIs), occurring in up to 25% of patients. Physical activity has been shown to help reduce CRF through modulating the immune system, and may synergistically aid in the anti-tumor effects of ICIs. This review describes the nature and scope of evidence for the effects associated with concurrent physical activity while undergoing ICI therapy.

METHOD: Scoping review methodology was utilized to identify studies, extract data, and collate and summarize results.

RESULTS: …

The Effects Of Physical Activity On Cancer Patients Undergoing Treatment With Immune Checkpoint Inhibitors: A Scoping Review, Amy L Shaver, Swapnil Sharma, Nikita Nikita, Daniel S Lefler, Atrayee Basu Mallick, Jennifer Johnson, Meghan Butryn, Grace Lu-Yao

Department of Medical Oncology Faculty Papers

Background: Cancer therapies are associated with multiple adverse effects, including (but not limited to) cancer-related fatigue (CRF). Fatigue is one of the most common side effects of immune checkpoint inhibitors (ICIs), occurring in up to 25% of patients. Physical activity has been shown to help reduce CRF through modulating the immune system, and may synergistically aid in the anti-tumor effects of ICIs. This review describes the nature and scope of evidence for the effects associated with concurrent physical activity while undergoing ICI therapy.

Method: Scoping review methodology was utilized to identify studies, extract data, and collate and summarize results.

Results: …

Breakthroughs In Hormonal Male Contraception, Alexander Patton, Seth Vann

Physician Assistant Capstones, 2020-current

Objective: Assess the efficacy of a nestorone plus testosterone gel at suppressing progestin levels and spermatogenesis.

Design: Systematic literature review.

Methods: Searches were done in PubMed and Dartmouth library using the terms nestorone, randomized control trial, human, and male. Limits used while searching included published in the last 10 years, randomized control trials, and English.

Results: Using the search criteria the following three studies were found that met the inclusion/exclusion criteria of this study: Ilani et al, Zitzmann et al, and Anawalt et al. All three studies were found on PubMed and reference the Ilani et al study.

Conclusion: Nestorone …

Feasibility Of An Assessment Tool As A Data-Driven Approach To Reducing Racial Bias In Biomedical Publications., Siobhan Wescott, Ronn Johnson, Sangeeta Lamba, Devon Olson, Yolanda Haywood, Carolyn C Meltzer, Ricardo Correa

Emergency Medicine Faculty Publications

No abstract provided.

The Effect Of Platelet Rich Plasma On The Treatment Of Androgenetic Alopecia Compared To Placebo, Mackenzie D. Comstock, Hannah E. Stephenson

Physician Assistant Capstones, 2020-current

Objective: To assess the efficacy of plasma rich proteins (PRP) compared to placebo in the treatment of androgenetic alopecia (AGA).

Design: Systematic literature review

Methods: Searches were done in PubMed utilizing the terms PRP, plasma rich protein, autologous activated PRP, autologous activated plasma rich protein, androgenetic alopecia, placebo, hair count, hair density, hair follicles, hair loss, therapeutic effect, growth factors, dermatology, and regenerative medicine. Articles were excluded if they were published before 2013, involved animal studies, compared minoxidil only in their research, included only female participants, non-English articles, studies with no quantifiable data, review research articles, and injections besides the …

Ketamine As A Treatment Modality For Treatment-Resistant Depression, Tracy Wulff, Shen Cao

Physician Assistant Capstones, 2020-current

Many recent studies have demonstrated the ability of ketamine, an NMDA receptor antagonist, to produce antidepressant effects that may be effective in helping reduce treatment-resistant major depression. In particular, three double-blinded randomized control trials have been conducted to assess the viability and effectiveness of this medication for treatment. This systematic literature review will analyze these studies and determine if the overall research indicates that ketamine is useful in improving depression as measured by the Montgomery–Asberg Depression Rating Scale (MADRS)¹.

Objective: Assess the effectiveness of IV Ketamine in reducing treatment-resistant major depressive disorder as measured by the Montgomery–Asberg …

The Relationship Between Discoid Meniscus And Articular Cartilage Thickness: A Quantitative Observational Study With Mri, Joseph Brutico, Margaret Wright, Sarah Kamel, Adam C Zoga, Kirsten Poehling-Monaghan, Sommer Hammoud

Rothman Institute Faculty Papers

Background: Several cadaveric imaging studies have demonstrated that the articular cartilage thickness on the tibial plateau varies depending on coverage by native meniscal tissue. These differences are thought to partially contribute to the rates of cartilage degeneration and development of osteoarthritis after meniscectomy. Because there is greater tibial plateau coverage with meniscal tissue in the setting of a discoid meniscus, these findings may also have implications for the long-term health of the knee after saucerization of a torn discoid meniscus.

Purpose: To evaluate the relationship between lateral compartment articular cartilage thickness and the presence or absence of a discoid meniscus. …

Development Of A Muc16-Targeted Near-Infrared Antibody Probe For Fluorescence-Guided Surgery Of Pancreatic Cancer, Madeline T. Olson

Theses & Dissertations

Pancreatic cancer (PDAC) is an extremely lethal disease with an overall survival rate of 10%. Surgery remains the only potentially curative treatment option, but resections are complicated by infiltrative disease, proximity of critical vasculature, peritumoral inflammation, and dense stroma. Surgeons are limited to tactile and visual cues to differentiate cancerous tissue from normal tissue. Furthermore, translating preoperative images to the intraoperative setting poses additional challenges for tumor detection, and can result in undetected and unresected lesions. Thus, PDAC has high rates of incomplete resections, and subsequently, disease recurrence. Fluorescence-guided surgery (FGS) has emerged as a method to improve intraoperative detection …

Evaluation Of Stratified Antibiograms For Use In Laboratory And Antimicrobial Stewardship, Linsey Donner

Theses & Dissertations

Antibiograms are critical for choosing empiric antimicrobial therapy. Cumulative antibiograms, which aggregate susceptibility data, can mask differences within specific patient subsets or clinical syndromes. This dissertation was done to determine if antibiotic susceptibilities showed substantial differences when comparing stratified antibiograms to cumulative antibiograms.

Antibiotic susceptibility data was retrospectively obtained from Nebraska Medicine January 1, 2017 – December 31, 2019 for Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Staphylococcus aureus, and Enterococcus faecalis. The University of Nebraska Medical Center’s web antibiogram clinical decision support tool was used to export the data. Bacteria-antibiotic susceptibility rates of stratified antibiograms …

Post-Transplant Hepatic Graft Fibrosis In Pediatric Liver-Inclusive Transplant Recipients, Hanh D. Vo

Theses & Dissertations

Hepatic graft fibrosis is a common histologic finding following pediatric liver transplant (LT) that may affect the long-term graft outcome. Hence, it is essential to identify hepatic graft fibrosis at a stage where fibrosis is not yet clinically apparent but has the potential for progression to initiate appropriate intervention and prevent its progression. Liver biopsy is the gold standard for fibrosis staging, but it is invasive, requires general anesthesia in children, and has potential complications. Our long-term goal is to implement non-invasive tests to assess and monitor the progression of hepatic graft fibrosis in liver-inclusive transplant children. The work presented …

Glad To Be Out. I Was Running Out Of Womb: A Study Of Omega-6 And Omega-3 Fatty Acid Metabolites At Delivery And Their Relationship To Infant Growth, Prematurity, And Admission To The Neonatal Intensive Care Unit, Maranda Thompson

Theses & Dissertations

Normal pregnancy relies on inflammation for implantation, placentation, and parturition, but uncontrolled it can lead to poor infant outcomes. Maternal diet is one modifiable factor that can impact inflammation. Omega-3 and omega-6 fatty acids have been shown to be metabolized into bioactive metabolites that effect inflammation. The presence and importance of these metabolites at the time of delivery are not well understood. Therefore, the purpose of this dissertation was to first quantify omega-3 and omega-6 metabolites in maternal plasma, cord plasma, and placental tissue. Then the relationships between metabolites and infant outcomes, including birth weight percentile, length percentile, head circumferences …

The Ecology Of Mental Health And The Impact Of Barriers On Mental Health Service Utilization, Alisha Aggarwal

Theses & Dissertations

Mental health has emerged as a major public health concern in recent times with several disparities and barriers related to adequate health service utilization. Different age groups experience diverse symptoms and face distinct barriers in accessing and utilizing healthcare. Policies like Mental Health Parity and Addiction Equity Act and the Patient Protection and Affordable Care Act were launched to improve insurance coverage and delivery of mental health services. However, a large gap of unmet needs exists for adequate mental health service utilization in the country. This dissertation aims to describe the financial and non-financial barriers to mental health service utilization …

The Rotator Cuff Tendon-To-Bone Interface: Maturation, Aging, And 3d Bioprinting For Regeneration, Xiping Jiang

Theses & Dissertations

Rotator cuff tendon injuries often occur at the tendon-to-bone interface (i.e., enthesis) area with a high prevalence for the elderly population. In addition, regeneration of the gradient structure of the enthesis is still a significant clinical challenge. Our studies aim to identify the histological, molecular, and biomechanical alterations of the rotator cuff enthesis with maturation and aging, and develop a novel therapeutic method using three-dimensional (3D) bioprinting technique to regenerate a functional enthesis. Striking variations of the entheses were observed both histologically and biomechanically during the maturation process. The histological features did not show many differences at the insertion site …

Improving Lymphedema Self-Management And Screening In Newly Diagnosed Breast Cancer Clients Through The Use Of A Self-Management Lymphedema Toolkit, Kescia Gray

Doctor of Nursing Practice (DNP) Manuscripts

Background and Significance: With breast cancer effecting women at much younger ages and modern treatments prolonging the life span, survivors are at increased risk of developing breast cancer-related lymphedema (BCRL), a chronic, progressive condition that can cause disability.

Purpose: The purpose of the project was to determine the level of knowledge and awareness of BCRL in newly diagnosed breast cancer clients; and to provided education on self-care after treatment, using of a self-management lymphedema toolkit (SMLT), to decrease risks of treatment-related lymphedema, improve self-efficacy, and enhance quality of life (QOL).

Methods: Newly diagnosed breast cancer clients (N=10) from the Breast …

Utility Of S100a12 As An Early Biomarker In Patients With St-Segment Elevation Myocardial Infarction, Xiaolin Zhang, Minghui Cheng, Naijing Gao, Yi Li, Chenghui Yan, Xiaoxiang Tian, Dan Liu, Miaohan Qiu, Xiaozeng Wang, Bo Luan, Jie Deng, Shouli Wang, Hongyan Tian, Geng Wang, Xin-Liang Ma, Gregg W Stone, Yaling Han

Department of Emergency Medicine Faculty Papers

Importance: S100A12 is a calcium binding protein which is involved in inflammation and progression of atherosclerosis.

Objective: We sought to investigate the utility of S100A12 as a biomarker for the early diagnosis and prognostication of patients presenting with ST-segment elevation myocardial infarction (STEMI).

Design, Setting, and Participants: S100A12 was measured in 1023 patients presenting to the emergency department with acute chest pain between June 2012 and November 2015. An independent cohort of 398 patients enrolled at 3 different hospitals served as a validation cohort.

Main Outcomes and Measures: The primary clinical endpoint of interest was major adverse cardiac and cerebral …

Does Digital Literacy Empower Adolescent Girls In Low- And Middle-Income Countries: A Systematic Review, Salima Meherali, Komal Abdul Rahim, Sandra Campbell, Zohra S. Lassi

School of Nursing & Midwifery

Background: The vast majority (90%) of the world's adolescents aged 10-19 live in low- and middle-income countries (LMICs); and in those resource-limited settings, girls face distinct challenges across multiple health, social, and economic domains. Gender equality and girls' empowerment are key goals in their own right and are central to all other development goals. Digital literacy is a great enabler for the empowerment of young girls. This systematic review aims to assess the range and nature of digital literacy interventions implemented to empower adolescent girls in LMICs and identify evidence about adolescent girls' access and use of digital technologies in …

A Step-By-Step Guide To Implementing A Multidisciplinary Endocarditis Team, Sami El-Dalati, Daniel Cronin, James Riddell, Michael Shea, Richard L. Weinberg, Emily Stoneman, Twisha Patel, Kirra Ressler, George Michael Deeb

Internal Medicine Faculty Publications

Over the last several years multiple studies, primarily from European centers have demonstrated the clinical and outcomes benefits of multidisciplinary endocarditis teams. Despite this literature, adoption of this approach to patient care has been slower in the United States. While there is literature outlining the optimal composition of an endocarditis team, there is little information to guide providers as they attempt to transform practice from a fragmented, disjointed process to an efficient, collaborative care model. In this review, the authors will outline the steps they took to create and implement a successful multidisciplinary endocarditis team at the University of Michigan. …

Risk Factors For Poor Outcomes Among Patients With Extensively Drug-Resistant Tuberculosis (Xdr-Tb): A Scoping Review, Karan Varshney, Beverly Anaele, Matthew Molaei, Rosemary Frasso, Vittorio Maio

College of Population Health Faculty Papers

In recent years, there has been an upsurge in cases of drug-resistant TB, and strains of TB resistant to all forms of treatment have begun to emerge; the highest level of resistance is classified as extensively drug-resistant tuberculosis (XDR-TB). There is an urgent need to prevent poor outcomes (death/default/failed treatment) of XDR-TB, and knowing the risk factors can inform such efforts. The objective of this scoping review was to therefore identify risk factors for poor outcomes among XDR-TB patients. We searched three scientific databases, PubMed, Scopus, and ProQuest, and identified 25 articles that examined relevant risk factors. Across the included …

The Curious Case Of Hla-Dr-Positive Apl, Kanta Devi, Natasha Bahadur Ali

Section of Haematology/Oncology

The triad of weak/absent CD34, negative HLA-DR expression, and positivity to CD117 is pathognomonic for the diagnosis of acute promyelocytic leukemia. However, in rare cases, strong positivity to HLD-DR and CD34 may be noted.

Phase 3 Safety And Efficacy Of Azd1222 (Chadox1 Ncov-19) Covid-19 Vaccine, Ann R Falsey, Magdalena E Sobieszczyk, Ian Hirsch, Stephanie Sproule, Merlin L Robb, Lawrence Corey, Kathleen M Neuzil, William Hahn, Julie Hunt, Mark J Mulligan, Charlene Mcevoy, Edwin Dejesus, Michael Hassman, Susan J Little, Barbara A Pahud, Anna Durbin, Paul Pickrell, Eric S Daar, Larry Bush, Joel Solis, Quito Osuna Carr, Temitope Oyedele, Susan Buchbinder, Jessica Cowden, Sergio L Vargas, Alfredo Guerreros Benavides, Robert Call, Michael C Keefer, Beth D Kirkpatrick, John Pullman, Tina Tong, Margaret Brewinski Isaacs, David Benkeser, Holly E Janes, Martha C Nason, Justin A Green, Elizabeth J Kelly, Jill Maaske, Nancy Mueller, Kathryn Shoemaker, Therese Takas, Richard P Marshall, Menelas N Pangalos, Tonya Villafana, Antonio Gonzalez-Lopez

Journal Articles

BACKGROUND: The safety and efficacy of the AZD1222 (ChAdOx1 nCoV-19) vaccine in a large, diverse population at increased risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the United States, Chile, and Peru has not been known.

METHODS: In this ongoing, double-blind, randomized, placebo-controlled, phase 3 clinical trial, we investigated the safety, vaccine efficacy, and immunogenicity of two doses of AZD1222 as compared with placebo in preventing the onset of symptomatic and severe coronavirus disease 2019 (Covid-19) 15 days or more after the second dose in adults, including older adults, in the United States, Chile, and Peru.

RESULTS: …

Accuracy Of Routine 2d Echocardiography To Estimate Pda Type And Dimension And Predict Device Selection For Successful Pda Occlusion, Mohammed Omar Galal, Zaheer Ahmed, Arif Hussain, Masroor Sharfi, Yahia El Mahdi, Fayzah El Khattab, Amjad Alkouatli, Riad Abou Zahr

Journal of the Saudi Heart Association

Background: Assessment of the shape and dimensions of PDA is usually done angiographically and in the majority of cases need arterial access. Our aim was to evaluate the value of routine 2 D echocardiography (ECHO) in predicting type, dimensions of PDA and to anticipate device size to be used during the intervention. Material and Methods: The charts of all patients who underwent transcatheter closure of PDA between January 2015 and December 2020 were reviewed. Their pre-procedure ECHO and catheterization details at the time of device closure were analyzed. Results: Total of 139 patients were reviewed and 8 were excluded because …

Persistent Polypharmacy And Fall Injury Risk: The Health, Aging And Body Composition Study, Lingshu Xue, Robert M. Boudreau, Julie M. Donohue, Janice C. Zgibor, Zachary A. Marcum, Tina Costacou, Anne B. Newman, Teresa M. Waters, Elsa S. Strotmeyer

Health Management and Policy Faculty Publications

Background

Older adults receive treatment for fall injuries in both inpatient and outpatient settings. The effect of persistent polypharmacy (i.e. using multiple medications over a long period) on fall injuries is understudied, particularly for outpatient injuries. We examined the association between persistent polypharmacy and treated fall injury risk from inpatient and outpatient settings in community-dwelling older adults.

Methods

The Health, Aging and Body Composition Study included 1764 community-dwelling adults (age 73.6 ± 2.9 years; 52% women; 38% black) with Medicare Fee-For-Service (FFS) claims at or within 6 months after 1998/99 clinic visit. Incident fall injuries (N = 545 in …

Role Of Serum Amyloid A In Abdominal Aortic Aneurysm And Related Cardiovascular Diseases, Preetha Shridas, Avery C. Patrick, Lisa R. Tannock

Internal Medicine Faculty Publications

Epidemiological data positively correlate plasma serum amyloid A (SAA) levels with cardiovascular disease severity and mortality. Studies by several investigators have indicated a causal role for SAA in the development of atherosclerosis in animal models. Suppression of SAA attenuates the development of angiotensin II (AngII)-induced abdominal aortic aneurysm (AAA) formation in mice. Thus, SAA is not just a marker for cardiovascular disease (CVD) development, but it is a key player. However, to consider SAA as a therapeutic target for these diseases, the pathway leading to its involvement needs to be understood. This review provides a brief description of the pathobiological …