Medicine and Health Sciences Commons^™

Cancer Care Annual Report 2014-2015, Children's Mercy Hospital

Cancer Center Annual Reports

Annual report of cancer care and oncology services at the Children's Mercy Hospital, Kansas City MO, a pediatric medical center. This report has a focus on germ cell tumors.

A Fatal Twist: Volvulus Of The Small Intestine In A 46-Year-Old Woman, Jared Klein, Kathryn Baxstrom, Stephen Donnelly, Patrick Feasel, Paul Koles

Pediatrics Publications

A 46-year-old woman presented to two emergency departments within 12 hours because of acute abdominal pain. Physical exam demonstrated tenderness and epigastric guarding. An ultrasound was interpreted as negative; she was discharged home. Later that evening, she was found dead. Postmortem exam revealed acute hemorrhagic necrosis of a segment of jejunum secondary to volvulus. Clinical clues suggesting presentations of small bowel volvulus are usually nonspecific; the diagnosis is typically confirmed at surgery. Her unremitting abdominal pain, persistent vomiting, and absolute neutrophilia were consistent with an acute process. The etiology of this volvulus was caused by an elastic fibrous band at …

Γ-Secretase Inhibitor Alleviates Acute Airway Inflammation Of Allergic Asthma In Mice By Downregulating Th17 Cell Differentiation, Weixi Zhang, Xueya Zhang, Anqun Sheng, Cuiye Weng, Tingting Zhu, Wei Zhao, Changchong Li

Pediatrics Publications

T helper 17 (Th17) cells play an important role in the pathogenesis of allergic asthma. Th17 cell differentiation requires Notch signaling. γ-Secretase inhibitor (GSI) blocks Notch signaling; thus, it may be considered as a potential treatment for allergic asthma. The aim of this study was to evaluate the effect of GSI on Th17 cell differentiation in a mouse model of allergic asthma. OVA was used to induce mouse asthma model in the presence and absence of GSI. GSI ameliorated the development of OVA-induced asthma, including suppressing airway inflammation responses and reducing the severity of clinical signs. GSI also significantly …

Exosomes In Cancer Research, S. R. Vaiselbuh

Journal Articles

No abstract provided.

Hiv Status Non-Disclosure In Hiv- Infected Families, Saptharishi Lalgudi Ganesan

Data and Test Instruments

No abstract provided.

Maintenance Intravenous Fluids For Children With Central Nervous System Infections, Saptharishi Lalgudi Ganesan, Sunit C. Singhi, Karthi N.

Data and Test Instruments

No abstract provided.

Proven Family-Based Interventions In The Treatment Of Pediatric Obesity, Sarah Winter

Physician Assistant Scholarly Project Posters

• Childhood obesity continues to be ever expanding.

• This is leading to increasing health care needs and costs.

• Despite numerous interventions, the rates continue to climb.

• The purpose of this study is to identify family-based childhood obesity interventions that are proven to decrease the rates of childhood obesity.

• A literature review explores multiple different family-based childhood obesity interventions.

• The effective interventions are examined closely to discover commonalities between the interventions.

• Family-based interventions that decrease childhood obesity share similar attributes.

• The proven interventions may indicate the need to focus coordination of care with the …

10 Steps To Collaborating With Pediatric Medical Providers, American Dental Association

Action for Dental Health

No abstract provided.

Impact Of Poor Air Quality On Chronic Respiratory Problems Among The Elderly, James D. Blando, My Ngoc Nguyen, Manasi Sheth-Chandra, Muge Akpinar-Elci

Community & Environmental Health Faculty Publications

[First Paragraph] There is a considerable body of evidence that suggests poor ambient air quality contributes to increased mortality and morbidity. ^1,2,3,4,5 The impact of ambient air quality on different segments of the general population, including children and among the elderly has also been investigated.^6,7,8,9 In light of the well documented public health significance of air pollution, it is imperative that investigators continue to evaluate details regarding the impact of poor air quality. In particular, it is interesting to note that some research has indicated an increased risk of the young and the elderly being admitted to the hospital …

Work-Life Balance Is An Illusion: Replace Guilt With Acceptance., Tessie W. October

Pediatrics Faculty Publications

No abstract provided.

Acid-Suppressing Agents And Risk For Clostridium Difficile Infection In Pediatric Patients, Katelyn E. Brown, Chad A. Knoderer, Kristen R. Nichols, Ashley S. Crumby

Scholarship and Professional Work – COPHS

Background. Acid-suppressing agents have been associated with increased Clostridium difficile infection (CDI) in adults. The objective of this study was to evaluate the association of acid-suppressing therapy with the development of CDI in the pediatric population.

Methods. This was a retrospective case-control study. Children aged 1 through 17 years with a positive C difficile polymerase chain reaction (PCR) result obtained between June 1, 2008, and June 1, 2012, were randomly matched to a control population selected from patients with negative PCR.

Results. A total of 458 children were included. No difference was observed in acid-suppressive therapy prior …

Success With Extended-Infusion Meropenem After Recurrence Of Baclofen Pump-Related Achromobacter Xylosoxidans Meningitis In An Adolescent, Kristen R. Nichols, Chad A. Knoderer, Nicholas G. Jackson, John J. Manaloor, John C. Christenson

Scholarship and Professional Work – COPHS

A 13-year-old female experienced a recurrence of baclofen pump-related central nervous system (CNS) infection caused by Achromobacter, despite absence of retained foreign material. Due to the failure of meropenem (120 mg/kg/d in divided doses every 8 hours and infused over 30 minutes) in the initial infection, the dose was infused over 4 hours during the recurrence. Meropenem is an antibiotic for which efficacy is time dependent, and 4-hour versus 30-minute infusions have been shown to prolong the time the concentration of the antibiotic exceeds the minimum inhibitory concentration (MIC) of the organism at the site of infection (T>MIC). …

Late-Occurring Vancomycin-Associated Acute Kidney Injury In Children Receiving Prolonged Therapy, Chad A. Knoderer, Allison L. Gritzman, Kristen R. Nichols, Amy C. Wilson

Scholarship and Professional Work – COPHS

Background: Acute kidney injury (AKI) in patients receiving vancomycin has been associated with trough concentrations ≥15 mg/L and longer therapy duration. The objective of this study was to determine the incidence and factors associated with late AKI in children receiving ≥8 days of vancomycin therapy. Methods: Children aged 30 days to 17 years who were admitted to our institution and received intravenous vancomycin for at least 8 days during January to December of 2007 and 2010 and had a suspected or proven gram-positive infection were included. Late AKI was categorized as AKI occurring after the first 7 days of therapy …

Educational Neuroscience, Constructivism, And The Mediation Of Learning And Creativity In The 21st Century., M. Layne Kalbfleisch

Pediatrics Faculty Publications

No abstract provided.

Absolute Reticulocyte Count Acts As A Surrogate For Fetal Hemoglobin In Infants And Children With Sickle Cell Anemia., Emily Riehm Meier, Colleen Byrnes, Maxine Weissman, Y Terry Lee, Jeffery L Miller

Pediatrics Faculty Publications

Hemoglobin switching is largely complete in humans by six months of age. Among infants with sickle cell anemia (HbSS, SCA), reticulocytosis begins early in life as fetal hemoglobin (HbF) is replaced by sickle hemoglobin (HbS). The objective of this study was to determine if absolute reticulocyte count (ARC) is related to HbF levels in a cohort of pediatric SCA patients. A convenience sample of 106 children with SCA between the ages of 1 month and 20 years who were not receiving hydroxyurea or monthly blood transfusions were enrolled in this observational study. Hematologic data, including ARC and HbF levels, were …

Characterizing The Propagation Of Uterine Electrophysiological Signals Recorded With A Multi-Sensor Abdominal Array In Term Pregnancies., Diana Escalona-Vargas, Rathinaswamy B. Govindan, Adrian Furdea, Pam Murphy, Curtis L Lowery, Hari Eswaran

Pediatrics Faculty Publications

The objective of this study was to quantify the number of segments that have contractile activity and determine the propagation speed from uterine electrophysiological signals recorded over the abdomen. The uterine magnetomyographic (MMG) signals were recorded with a 151 channel SARA (SQUID Array for Reproductive Assessment) system from 36 pregnant women between 37 and 40 weeks of gestational age. The MMG signals were scored and segments were classified based on presence of uterine contractile burst activity. The sensor space was then split into four quadrants and in each quadrant signal strength at each sample was calculated using center-of-gravity (COG). To …

Making The Leap From Research Laboratory To Clinic: Challenges And Opportunities For Next-Generation Sequencing In Infectious Disease Diagnostics., Brittany Goldberg, Heike Sichtig, Chelsie Geyer, Nathan Ledeboer, George M Weinstock

Pediatrics Faculty Publications

Next-generation DNA sequencing (NGS) has progressed enormously over the past decade, transforming genomic analysis and opening up many new opportunities for applications in clinical microbiology laboratories. The impact of NGS on microbiology has been revolutionary, with new microbial genomic sequences being generated daily, leading to the development of large databases of genomes and gene sequences. The ability to analyze microbial communities without culturing organisms has created the ever-growing field of metagenomics and microbiome analysis and has generated significant new insights into the relation between host and microbe. The medical literature contains many examples of how this new technology can be …

Graduate Medical Education 2014-2015 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, fellowship programs, medical students, continuing medical education, and library services.

Nfkb1 Activation By The E26 Transformation-Specific Transcription Factors Pu.1 And Spi-B Promotes Toll-Like Receptor-Mediated Splenic B Cell Proliferation, Stephen K.H. Li, Ali K. Abbas, Lauren A. Solomon, Gaëlle M.N. Groux, Rodney P. Dekoter

Paediatrics Publications

Generation of antibodies against T-independent and T-dependent antigens requires Toll-like receptor (TLR) engagement on B cells for efficient responses. However, the regulation of TLR expression and responses in B cells is not well understood. PU.1 and Spi-B (encoded by Sfpi1 and Spib, respectively) are transcription factors of the E26 transformation-specific (ETS) family and are important for B cell development and function. It was found that B cells from mice knocked out for Spi-B and heterozygous for PU.1 (Sfpi1^+/- Spib^-/- [PUB] mice) proliferated poorly in response to TLR ligands compared to wild-type (WT) B cells. The NF-κB family member …

Estimation Of Gfr Using Β-Trace Protein In Children, Samantha H. Witzel, Shih Han S. Huang, Branko Braam, Guido Filler

Paediatrics Publications

Background and objectives Sexmay affect the performance of smallmolecularweight proteins as markers of GFR because of differences in fat mass between the two sexes. The hypothesis was that the diagnostic performance of b-trace protein, a novel marker of GFR, would be significantly better in boys than in girls. Design, setting, participants, & measurements GFR, height, weight, serum creatinine, and β-trace protein were measured in 755 children and adolescents (331 girls) undergoing 99technetium diethylenetriamine penta–acetic acid renal scans from July of 1999 to July of 2006. Boys and girls were separated into formula generation cohorts (284 boys and 220 girls) and …

Ventilator-Associated Pneumonia Or Bacterial Colonization Of The Airway, What Do Probiotics Decrease?, Saptharishi Lalgudi Ganesan, Sunit C. Singhi, M. Baalaaji

Data and Test Instruments

No abstract provided.

Children's Mercy Hospital Annual Report 2014, 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.

Optical Measurement Of Skin Temperature In Mr-Hifu, Daniel Yang, Haydar Celik, Doug Wackerle, David Kinnaird, Avinash Eranki, Matthew E. Oetgen, Aerang Kim, Karun Sharma, Harry Kim, Peter Kim, Pavel Yarmolenko

Pediatrics Posters and Presentations

No abstract provided.

Impact Of Prenatal Environmental Stress On Cortical Development, Seiji Ishii, Kazue Hashimoto-Torii

Pediatrics Faculty Publications

Prenatal exposure of the developing brain to various types of environmental stress increases susceptibility to neuropsychiatric disorders such as autism, attention deficit hyperactivity disorder and schizophrenia. Given that even subtle perturbations by prenatal environmental stress in the cerebral cortex impair the cognitive and memory functions, this review focuses on underlying molecular mechanisms of pathological cortical development. We especially highlight recent works that utilized animal exposure models, human specimens or/and induced Pluripotent Stem (iPS) cells to demonstrate: 1. molecular mechanisms shared by various types of environmental stressors, 2. the mechanisms by which the affected extracortical tissues indirectly impact the cortical development …

Dual Transcriptomic Profiling Of Host And Microbiota During Health And Disease In Pediatric Asthma., Marcos Pérez-Losada, Eduardo Castro-Nallar, Matthew L. Bendall, Robert J. Freishtat, Keith A. Crandall

Pediatrics Faculty Publications

BACKGROUND: High-throughput sequencing (HTS) analysis of microbial communities from the respiratory airways has heavily relied on the 16S rRNA gene. Given the intrinsic limitations of this approach, airway microbiome research has focused on assessing bacterial composition during health and disease, and its variation in relation to clinical and environmental factors, or other microbiomes. Consequently, very little effort has been dedicated to describing the functional characteristics of the airway microbiota and even less to explore the microbe-host interactions. Here we present a simultaneous assessment of microbiome and host functional diversity and host-microbe interactions from the same RNA-seq experiment, while accounting for …

Integrating Microbial And Host Transcriptomics To Characterize Asthma-Associated Microbial Communities., Eduardo Castro-Nallar, Ying Shen, Robert J. Freishtat, Marcos Pérez-Losada, Solaiappan Manimaran, Et Al.

Pediatrics Faculty Publications

BACKGROUND: The relationships between infections in early life and asthma are not completely understood. Likewise, the clinical relevance of microbial communities present in the respiratory tract is only partially known. A number of microbiome studies analyzing respiratory tract samples have found increased proportions of gamma-Proteobacteria including Haemophilus influenzae, Moraxella catarrhalis, and Firmicutes such as Streptococcus pneumoniae. The aim of this study was to present a new approach that combines RNA microbial identification with host gene expression to characterize and validate metagenomic taxonomic profiling in individuals with asthma.

METHODS: Using whole metagenomic shotgun RNA sequencing, we characterized and compared the microbial …

Pharmacologically-Induced Mitotic Synchrony In Airway Epithelial Cells As A Mechanism Of Action Of Anti-Inflammatory Drugs, Robert J. Freishtat, Gustavo Nino, Y. Tsegaye, Sarah E. Alcala, Angela S. Benton, Alan M. Watson, E.K.M. Reeves, S. K. Haider, Jesse M. Damsker

Pediatrics Faculty Publications

Background

Mitotic synchrony is the synchronous progression of a population of cells through the cell cycle and is characteristic of non-diseased airway epithelial cells. However, we previously showed that asthmatic airway epithelial cells are characterized by mitotic asynchrony and are pro-inflammatory as a result. Glucocorticoids can induce mitotic synchrony that in turn suppresses the pro-inflammatory state of diseased cells, suggesting a novel anti-inflammatory mechanism of action. Herein, we benchmarked traditional glucocorticoids against the ability of a new clinical-stage dissociative steroidal drug, VBP15, for mitotic resynchronization and associated anti-inflammatory activity in asthmatic airway epithelial cells.

Methods

Primary airway epithelial cells differentiated …

Are Immune Modulating Single Nucleotide Polymorphisms Associated With Necrotizing Enterocolitis?, Ashanti L Franklin, Mariam Said, Clint D Cappiello, Heather Gordish-Dressman, Zohreh Tatari-Calderone, Stanislav Vukmanovic, Khodayar Rais-Bahrami, Naomi L.C. Luban, Joseph M. Devaney, Anthony D. Sandler

Pediatrics Faculty Publications

Necrotizing enterocolitis (NEC) is a devastating gastrointestinal emergency. The purpose of this study is to determine if functional single nucleotide polymorphisms (SNPs) in immune-modulating genes pre-dispose infants to NEC. After Institutional Review Board approval and parental consent, buccal swabs were collected for DNA extraction. TaqMan allelic discrimination assays and BglII endonuclease digestion were used to genotype specific inflammatory cytokines and TRIM21. Statistical analysis was completed using logistic regression. 184 neonates were analyzed in the study. Caucasian neonates with IL-6 (rs1800795) were over 6 times more likely to have NEC (p = 0.013; OR = 6.61, 95% CI 1.48-29.39), and over …

St Segment Depression After Norwood/Systemic-Pulmonary Artery Shunt, Ashraf Harahsheh, Craig A. Sable, Pranava Sinha, Richard A. Jonas

Pediatrics Faculty Publications

A three-month-old girl with double inlet left ventricle (S;D;D), hypoplastic outlet ventricle, restrictive bulboventricular foramen, d-transposition of great arteries and interrupted aortic arch underwent Norwood stage 1 operation, systemic to pulmonary artery (PA) shunt and atrial septectomy, and developed ectopic atrial tachycardia that responded to digoxin therapy. She developed fussiness lasting two hours, not associated with cyanosis, and not relieved by feeding. Her pulse oximetry was 88% while breathing room air, and she had no differential blood pressure gradient.

Prevalence Of Vitamin D Deficiency In Exclusively Breastfed Infants At The Aga Khan University Hospital, Nairobi, Nusrat. A. Said

Master of Medicine in Paediatrics and Child Health

Introduction: Vitamin D deficiency in infants is a recognized cause of rickets. In the last few years, evidence has emerged of its association with lower respiratory tract infections, food allergy, type 1 diabetes, schizophrenia and various other extra skeletal health effects. Exclusively breastfed infants are especially vulnerable to vitamin D deficiency due to their dependence on previous trans-placental transfer of vitamin D from the mother, dietary vitamin D from breast milk and cutaneous synthesis of vitamin D on exposure to sunlight. The worldwide epidemic of Vitamin D deficiency in pregnancy and the low content of vitamin D in breast milk …