Medicine and Health Sciences Commons^™

Efficacy Of Female Rat Models In Translational Cardiovascular Aging Research, Kevin M. Rice, J. C. Fannin, C. Gillette, Eric Blough

Pharmaceutical Science and Research

Cardiovascular disease is the leading cause of death in women in the United States. Aging is a primary risk factor for the development of cardiovascular disease as well as cardiovascular-related morbidity and mortality. Aging is a universal process that all humans undergo; however, research in aging is limited by cost and time constraints. Therefore, most research in aging has been done in primates and rodents; however it is unknown how well the effects of aging in rat models translate into humans. To compound the complication of aging gender has also been indicated as a risk factor for various cardiovascular diseases. …

Unilateral Heat Accelerates Bone Elongation And Lengthens Extremities Of Growing Mice, Maria A. Serrat, Thomas J. Schlierf, Morgan L. Efaw, Franklin D. Shuler, Justin Godby, Laura M. Stanko

Orthopaedics

Linear growth failure results from a broad spectrum of systemic and local disorders that can generate chronic musculoskeletal disability. Current bone lengthening protocols involve invasive surgeries or drug regimens, which are only partially effective. Exposure to warm ambient temperature during growth increases limb length, suggesting that targeted heat could noninvasively enhance bone elongation. We tested the hypothesis that daily heat exposure on one side of the body unilaterally increases femoral and tibial lengths. Mice (N = 20) were treated with 40 °C unilateral heat for 40 min/day for 14 days post-weaning. Non-treated mice (N = 6) served as controls. Unilateral …

Hip Fracture Evaluation With Alternatives Of Total Hip Arthroplasty Versus Hemiarthroplasty (Health): Protocol For A Multicentre Randomised Trial, Mohit Bhandari, P. J. Devereaux, Thomas A. Einhorn, Lehana Thabane, Emil H. Schemitsch, Kenneth J. Koval, Frede Frihagen, Rudolf W. Poolman, Kevin Tetsworth, Ernesto Guerra-Farfán, Kim Madden, Sheila Sprague, Gordon Guyatt, Ali Oliasharazi, Franklin D. Shuler, Jonathon Salva, James Day, Tigran Garabekyan, Felix Cheung, Linda Morgan, Timothy Wilson-Byrne Md, Mary Beth Cordle

Orthopaedics

Introduction: Hip fractures are a leading cause of mortality and disability worldwide, and the number of hip fractures is expected to rise to over 6 million per year by 2050. The optimal approach for the surgical management of displaced femoral neck fractures remains unknown. Current evidence suggests the use of arthroplasty; however, there is lack of evidence regarding whether patients with displaced femoral neck fractures experience better outcomes with total hip arthroplasty (THA) or hemiarthroplasty (HA). The HEALTH trial compares outcomes following THA versus HA in patients 50 years of age or older with displaced femoral neck fractures.

Methods and …

Too Smart To Fail: Guide For The Struggling Medical Student, Michael Andyryka, Timothy Wilson-Byrne Md, Sean Fitzpatrick, Marie Veitia, Ryan Orwig, Franklin D. Shuler Md, Phd

MIIR Faculty Research

Medicine is a vocation of perpetual independent learning; long-term success is critically dependent on finding the right resources and establishing effective study methods and test-taking strategies. Students who struggle with the academic transition in medical school have common risk factors and characteristics. We highlight key resources that are available for struggling medical students with an emphasis on West Virginia's HELP, ASPIRE, and STAT programs.

3,4,5-Trichloroaniline Nephrotoxicity In Vitro: Potential Role Of Free Radicals And Renal Biotransformation, Christopher Racine, Dakota Ward, Dianne K. Anestis, Travis Ferguson, Deborah Preston, Gary O. Rankin

Pharmaceutical Science and Research

Chloroanilines are widely used in the manufacture of drugs, pesticides and industrial intermediates. Among the trichloroanilines, 3,4,5-trichloroaniline (TCA) is the most potent nephrotoxicant in vivo. The purpose of this study was to examine the nephrotoxic potential of TCA in vitro and to determine if renal biotransformation and/or free radicals contributed to TCA cytotoxicity using isolated renal cortical cells (IRCC) from male Fischer 344 rats as the animal model. IRCC (~4 million cells/mL; 3 mL) were incubated with TCA (0, 0.1, 0.25, 0.5 or 1.0 mM) for 60–120 min. In some experiments, IRCC were pretreated with an antioxidant or a …

Management Of Severe Hyponatremia: Infusion Of Hypertonic Saline And Desmopressin Or Infusion Of Vasopressin Inhibitors?, Antonios H. Tzamaloukas Md, Joseph I. Shapiro Md, Dominic S. Raj Md, Glen H. Murata Md, Robert H. Glew Phd, Deepak Malhotra Md, Phd

Pharmaceutical Science and Research

Rapid correction of severe hyponatremia carries the risk of osmotic demyelination. Two recently introduced methods of correction of hyponatremia have diametrically opposite effects on aquaresis. Inhibitors of vasopressin V2 receptor (vaptans) lead to the production of dilute urine, whereas infusion of desmopressin causes urinary concentration. Identification of the category of hyponatremia that will benefit from one or the other treatment is critical. In general, vaptans are effective in hyponatremias presenting with concentrated urine and, with the exception of hypovolemic hyponatremia, can be used as their primary treatment. Desmopressin is effective in hyponatremias presenting with dilute urine or developing urinary dilution …

Rgs16, A Novel P53 And Prb Cross-Talk Candidate Inhibits Migration And Invasion Of Pancreatic Cancer Cells, Miranda B. Carper, James Denvir, Goran Boskovic, Donald A. Primerano, Pier Paolo Claudio

Biochemistry and Microbiology

Data collected since the discovery of p53 and pRb/RB1 suggests these tumor suppressors cooperate to inhibit tumor progression. Patients who have mutations in both p53 and RB1 genes have increased tumor reoccurrence and decreased survival compared to patients with only one tumor suppressor gene inactivated. It remains unclear how p53 and pRb cooperate toward inhibiting tumorigenesis. Using RNA expression profiling we identified 179 p53 and pRb cross-talk candidates in normal lung fibroblasts (WI38) cells exogenously coexpressing p53 and pRb. Regulator of G protein signaling 16 (RGS16) was among the p53 and pRb cross-talk candidates and has been implicated in inhibiting …

Availability And Perceived Value Of Bachelor Of Science Programs In Pharmaceutical Marketing And Management In The United States, Omar F. Attarabeen, Fadi M. Alkhateeb

Pharmacy Practice & Administration

Several academic institutions across the United States offer Bachelor of Science degree programs in Pharmaceutical Marketing and/or Management. In general, these programs are designed to provide students with stronger foundations and a broader understanding of the business side of pharmacy. The purpose of this study was to explore the availability of the Bachelor of Science programs in pharmaceutical marketing and management in the United States. Internet search was conducted in order to collect information about the programs of interest. Results showed that a total of 8 schools and colleges offer the Bachelor of Science degree programs. The total number of …

Managed Care And Accountable Care Organizations, David P. Paul, Diego Arroyo, Bethany Daniel, Heather Graves, Krisitn Neal, Alberto Coustasse

Management Faculty Research

Managed care generally, and more specifically, accountable care organizations (ACOs) have attempted to provide coordination of patient care in order to eliminate or reduce unnecessary procedures and or test redundancy. The purpose of this research was to study the effects of managed care in accountable care organizations by decreasing health care costs by increasing efficiency in health care.

Helicobacter-Pylori Negative Gastritis In Children—A New Clinical Enigma, Yoram Elitsur, Deborah L. Preston

Biochemistry and Microbiology

The decrease in the prevalence of Helicobacter pylori (Hp) infection in children in the world gave rise to a new pathological finding termed as Hp-negative gastritis. Unfortunately, the term “Hp-negative gastritis” has not been identified as a pathological process and has the status of a “second cousin”; in most publications it was never mentioned as a subject to be dealt with, but was “left over” data that was never the topic of the manuscripts’ discussions. Only recently has the topic captured the attention of the pathologists who described this phenomenon in adults, yet the pathological and/or clinical spectrum or significance …

From Lcme Probation To Compliance: The Marshall University Joan C Edwards School Of Medicine Experience, Bobby Miller, Brian Dzwonek, Aaron Mcguffin, Joseph I. Shapiro Md

Biochemistry and Microbiology

The Joan C Edwards School of Medicine (Marshall University, Huntington, WV, USA) was placed on probation by the Liaison Committee on Medical Education (LCME) in June 2011. In the following 2 years, extensive changes were made to address the numerous citations that resulted in this probation. In October 2013, the LCME lifted probation. In this article, we detail the challenges and solutions identified relevant to our struggle with compliance.

Can Utilizing A Computerized Provider Order Entry (Cpoe) System Prevent Hospital Medical Errors And Adverse Drug Events?, Krista Charles Ms, Margaret Cannon Ms, Robert Hall Ms, Alberto Coustasse Drph, Md, Mba, Mph

Management Faculty Research

Computerized provider order entry (CPOE) systems allow physicians to prescribe patient services electronically. In hospitals, CPOE essentially eliminates the need for handwritten paper orders and achieves cost savings through increased efficiency. The purpose of this research study was to examine the benefits of and barriers to CPOE adoption in hospitals to determine the effects on medical errors and adverse drug events (ADEs) and examine cost and savings associated with the implementation of this newly mandated technology. This study followed a methodology using the basic principles of a systematic review and referenced 50 sources. CPOE systems in hospitals were found to …

A Business Case For Tele-Intensive Care Units, Alberto Coustasse, Stacie Deslich, Deanna Bailey, Alesia Hairston, David Paul

Management Faculty Research

Objectives: A tele-intensive care unit (tele-ICU) uses telemedicine in an intensive care unit (ICU) setting, applying technology to provide care to critically ill patients by off-site clinical resources. The purpose of this review was to examine the implementation, adoption, and utilization of tele-ICU systems by hospitals to determine their efficiency and efficacy as identified by cost savings and patient outcomes.

Methods: This literature review examined a large number of studies of implementa­tion of tele-ICU systems in hospitals.

Results: The evidence supporting cost savings was mixed. Implementation of a tele- ICU system was associated with cost savings, shorter lengths of stay, …

Normative Scores For The Nih Toolbox Dynamic Visual Acuity Test From 3 To 85 Years, Carol Li, Jennifer L. Beaumont, Rose Marie Rine, Jerry Slotkin, Michael C. Schubert

Physical Therapy Faculty Research

As part of the National Institutes of HealthToolbox initiative, a computerized test of dynamic visual acuity (cDVA) was developed and validated as an easy-to-administer, cost- and timeefficient test of vestibular and visual function. To establish normative reference values, 3,992 individuals, aged 3–85 years, without vestibular pathology underwent cDVA testing at multiple clinical research testing facilities across the United States. Test scores were stratified by sociodemographic characteristics. cDVA was worse in males (p <0.001) and those subjects 50 years or older, while there was no difference in dynamic visual acuity across age groups binned from 3 to 49 years. Furthermore, we used these normative cDVA data as a criterion reference to compare both the long (validated) and short versions of the test. Both versions can distinguish between those with and without vestibular pathology (p D0.0002 long; p D0.0025 short). The intraclass correlation coefficient between longand short-cDVA tests was 0.86.

Ho-1 Upregulation Attenuates Adipocyte Dysfunction, Obesity, And Isoprostane Levels In Mice Fed High Fructose Diets, Zeid Khitan, Mohit Harsh, Komal Sodhi, Joseph I. Shapiro Md, Nader G. Abraham

Pharmaceutical Science and Research

Background. Fructose metabolism is an unregulated metabolic pathway and excessive fructose consumption is known to activate ROS.HO-1 is a potent antioxidant gene that plays a key role in decreasing ROS and isoprostanes.We examinedwhether the fructosemediated increase in adipocyte dysfunction involves an increase in isoprostanes and that pharmacological induction ofHO-1would decrease both isoprostane levels and adipogenesis. Methods and Results. We examined the effect of fructose, on adipogenesis in human MSCs in the presence and absence of CoPP, an inducer of HO-1. Fructose increased adipogenesis and the number of large lipid droplets while decreasing the number of small lipid droplets (𝑃 < 0.05). Levels of heme and isoprostane in fructose treated MSC-derived adipocytes were increased. CoPP reversed these effects andmarkedly increasedHO-1 and theWnt signaling pathway. Thehigh fructose diet increased heme levels in adipose tissue and increased circulating isoprostane levels (𝑃 < 0.05 versus control). Fructose diets decreasedHO-1 and adiponectin levels in adipose tissue. Induction ofHO-1 by CoPP decreased isoprostane synthesis (𝑃 < 0.05 versus fructose). Conclusion. Fructose treatment resulted in increased isoprostane production and adipocyte dysfunction, which was reversed by the increased expression of HO-1.

West Virginia Nursing Homes: Are They Up To The Standard?, Guillermo Madero Md, Shirley M. Neitch Md

Internal Medicine

Quality measurement and performance monitoring are under continuous assessment in Nursing Homes (NH). Through this research project we assess the quality of care provided in the NH in the state of West Virginia by publicly accessible quality measurements. The methodology for this research study was through the retrieval of data from the Nursing Home Compare website in which a total of 80 NH were located and analyzed. The results demonstrate that more than 50% of NH in West Virginia are at or above the national average when compared using the Five Star Rating System by CMS, in overall rating (59%), …

High Mobility Group Box-1 (Hmgb1) Participates In The Pathogenesis Of Alcoholic Liver Disease (Ald), Xiaodong Ge, Daniel J. Antoine, Yongke Lu, Elena Arriazu, Tung-Ming Leung, Arielle L. Klepper, Andrea D. Branch, Maria Isabel Fiel, Natalia Nieto

Pharmacology, Physiology and Toxicology

Growing clinical and experimental evidence suggests that sterile inflammation contributes to alcoholic liver disease (ALD). High mobility group box-1 (HMGB1) is highly induced during liver injury; however, a link between this alarmin and ALD has not been established. Thus, the aim of this work was to determine whether HMGB1 contributes to the pathogenesis of ALD. Liver biopsies from patients with ALD showed a robust increase in HMGB1 expression and translocation, which correlated with disease stage, compared with healthy explants. Similar findings were observed in chronic ethanol-fed wild-type (WT) mice. Using primary cell culture, we validated the ability of hepatocytes from …

Safety And Immunogenicity Of Human Serum Albumin-Free Mmr Vaccine In Us Children Aged 12–15 Months, Maurice A. Mufson, Clemente Diaz, Michael Leonardi, Christopher J. Harrison, Stanley Grogg, Antonio Carbayo, Simon Carlo-Torres, Robert Jean Freau, Ana Quintero-Del-Rio, Gisele Bautista, Michael Povey, Christopher Da Costa, Ouzama Nicholson, Bruce L. Innis

Internal Medicine

Background: M-M-RTMII (MMRII; Merck & Co) is currently the only measles-mumps-rubella (MMR) vaccine licensed in the United States. Another licensed vaccine would reinforce MMR supply. This study assessed the immunogenicity of a candidate vaccine (PriorixTM, GlaxoSmithKline Vaccines [MMR-RIT]) when used as a first dose among eligible children in the United States.

Methods: In this exploratory Phase-2, multicenter, observer-blind study, 1220 healthy subjects aged 12–15 months were randomized (3:3:3:3) and received 1 dose of 1 of 3 MMR-RIT lots with differing mumps virus titers (MMR-RIT-1 [4.8 log10]; MMR-RIT-2 [4.1 log10]; MMR-RIT-3 [3.7 log10] CCID50) or MMRII co-administered with hepatitis Avaccine (HAV), …

The Trade-Off Between Dietary Salt And Cardiovascular Disease; A Role For Na/K-Atpase Signaling?, Joe X. Xie, Anna Pearl Shapiro, Joseph I. Shapiro Md

Biochemistry and Microbiology

It has been postulated for some time that endogenous digitalis-like substances, also called cardiotonic steroids (CTS), exist, and that these substances are involved in sodium handling. Within the past 20 years, these substances have been unequivocally identified and measurements of circulating and tissue concentrations have been made. More recently, it has been identified that CTS also mediate signal transduction through the Na/K-ATPase, and consequently been implicated in profibrotic pathways. This review will discuss the mechanism of CTS in renal sodium handling and a potential “trade-off” effect from their role in inducing tissue fibrosis.

Personal Health Records: Is Rapid Adpoption Hindering Interoperability?, Jana Studeny, Alberto Coustasse

Management Faculty Research

The establishment of Meaningful Use criteria has created a critical need for robust interoperability. A universal definition for a Personal Health Records (PHRs) has not been agreed upon. Standardized code sets have been built for specific entities but integration between them has not been supported. The purpose of this research study was to explore the hindrance and promotion of interoperability standards in relationship to PHRs to describe interoperability progress in this area. The methodology for this study was conducted following the basic principles of a systematic review, with 61 articles used for this research study. Lagging interoperability has been stemmed …

In Vitro Metabolic Stability Study Of New Cyclen Based Antimalarial Drug Leads Using Rp-Hplc And Lc-Ms/Ms, Apoorva V. Rudraraju, Mohammad F. Hossain, Anjuli Shrestha, Prince N.A. Amoyaw, Babu L. Tekwani, M. O. Faruk Khan

Pharmaceutical Science and Research

Metabolic stability of the new antimalarial drug leads is determined using Human Liver Microsome (HLM) and specific cytochrome P450 enzyme (CYP2C8) taking the clinically used antimalarial drug chloroquine as a positive control. Experiment is done using standard methods. All the assays were conducted in 0.5 M phosphate buffer at pH 7.4. In general the metabolic reaction was initiated by adding 1 mM NADPH and 0.5 mg of enzyme. Incubations were done with time frequency of 0 hr, 1 hr, and 2 hrs at 37°C and the reactions were terminated by adding acetonitrile in the equal amounts of the assay mixture …

Update On Adolescent Tobacco Cessation, Madeline Keyser, Lynne J. Goebel

Internal Medicine

Adolescent tobacco use is decreasing in West Virginia, a state which features the Not on Tobacco (NOT) and RAZE programs. This manuscript gives an overview of recent studies in adolescent tobacco cessation, what works and what doesn’t. More research is needed to improve cessation rates in adolescents.

E-Cigarettes: An Up To Date Review And Discussion Of The Controversy, Zachary Sanford, Lynne J. Goebel Md

Internal Medicine

Electronic cigarettes (e-cigarettes) present a novel method for nicotine delivery that is reportedly advantageous when compared to traditional cigarette usage. Manufacturers and consumers claim reduced chemical exposure, decreased symptom profiles, and efficacy in smoking reduction and cessation greater than conventional nicotine replacement therapies (NRT). However these products present new challenges and concerns to legislators, clinicians, and public health advocates. Questions of authority in state and federal legislation, establishing product quality control, assessing long-term studies on e-cigarettes and quantifying usefulness in harm reduction represent only a portion of the many unanswered topics being discussed. The purpose of this article is to …

Medicare Fraud In The United States: Can It Ever Be Stopped?, Chelsea Hill, Alex Hunter, Leslie Johnson, Alberto Coustasse

Management Faculty Research

The majority of the United States health care fraud has been focused on the major public program, Medicare. The yearly financial loss from Medicare fraud has been estimated at about $54 billion. The purpose of this research study was to explore the current state of Medicare fraud in the United States, identify current policies and laws that foster Medicare fraud, and determine the financial impact of Medicare fraud. The methodology for this study was a literature review. Research was conducted using a scholarly online database search and government Web sites. The number of individuals charged with criminal fraud increased from …

Acquisition Of Medical Immunology Knowledge: A Preliminary Study Of The Knowledge Structures Of Medical Students, Charles A. Gullo Phd

Biochemistry and Microbiology

Medical students from both Duke-NUS and NUS participated in a study that attempted to assess their knowledge structure in the medical immunology domain. Students had to perform a sorting task with a list of concepts derived from immunology experts. We collected demographic information as well as sorting data and the diversity of the sorts are presented in this article.

The Anatomical And Functional Benefit Of Bevacizumab In The Treatment Of Macular Edema Associated With Purtscher-Like Retinopathy, B. Lw. Nesmith, Maya Bitar, S. Schaal

Ophthalmology

We read the article by Miguel et al1 regarding Purtscher’s and Purtscher-like retinopathies with great interest. As the authors well describe, ‘Purtscher-like retinopathy’ is diagnosed in patients with fundus findings similar to Purtscher’s retinopathy, without a history of trauma but with known systemic associations.¹ Current proposed mechanisms for the underlying pathogenesis include leukocyte aggregation by activated complement factor 5 (C5a).² As noted by the authors’ systematic review, there is currently no established treatment for Purtscher-like retinopathy, although the literature consists of several case reports of treatment with corticosteroids, without certainty as to effect on the clinical course.1 Herein, …

Expanding Technology In The Icu: The Case For The Utilization Of Telemedicine, Stacie Deslich, Alberto Coustasse

Management Faculty Research

Introduction: Telemedicine has been utilized in various healthcare areas to achieve better patient outcomes, lower costs of providing services, and increase patient access to care. Tele-intensive care unit (ICU) technology has been introduced as a way to provide effective ICU services to patients with reduced access, as well as to decrease costs and improve patient care.

Materials and Methods: The methodology for this qualitative study was a literature search and review of case studies. The search was limited to sources published in the last 10 years (2003–2013) in the English language. In total, 55 references were used for this research …

Safety Of Infliximab In Children With Ibd: The Experience Of An Academic Center In Wv, Michael Northcutt Md, Awni Al-Subu Md, Brooke Bella Rn, Yoram Elitsur Md

Biochemistry and Microbiology

BACKGROUND: The immune-modulating drug, infliximab, is approved for Inflammatory Bowel Disease (IBD) treatment in children. Chronic therapy with infliximab is associated with the development of early and delayed infusion reactions. We reviewed our experience with infliximab treatment and its side effects in a cohort of children diagnosed with IBD who were treated in our clinic.

METHODS: A retrospective analysis of all IBD children treated with infliximab in our center from 2006-2011 was performed. The demographic, chronological and clinical data were recorded. The infliximab infusion was given at 5mg/ kg according to a standard protocol after pre-treatment with low dose …

Preventing Falls With Vitamin D, Franklin D. Shuler Md, Phd, Thomas Schlierf, Matthew Wingate

Orthopaedics

Falls are the number one cause for injury-related morbidity and mortality in West Virginia’s seniors. Multiple independent variables contribute to the risk of a fall: previous falls, alterations in balance and vision, impairments in gait and strength, and medications most highly correlate with the risk for a fall. Vitamin D supplementation is emerging as an easy, safe and well-tolerated fall reduction/prevention strategy due to the beneficial effects on the musculoskeletal system with improvements in strength, function and navigational abilities. From meta-analysis data, maximal fall reduction benefit in seniors is achieved when correcting vitamin D deficiency and when using adjunctive calcium …

Compassion In Medicine, Lawrence M. Wyner M.D.

Surgery

“Doctor, you know this patient’s HIV-positive.” The scrub nurse’s words hit me like a ton of bricks. I had been called into the operating room to assist one of my colleagues, a good friend and a good surgeon, who had requested my help after he had inadvertently gotten into the bladder during a hernia repair. I scrubbed in and took a look – the bladder neck was almost completely detached from the bladder. A small papillary tumor was visible just lateral to the left ureteral orifice. I snipped off the tumor with the Metzenbaum scissors, fulgurated its base, and proceeded …