Medicine and Health Sciences Commons^™

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 …

Mistrust, Neighborhood Deprivation, And Telehealth Use In African Americans With Diabetes., Barry W. Rovner, Robin J. Casten, Anna Marie Chang, Judd E. Hollander, Kristin Rising

Department of Emergency Medicine Faculty Papers

This study explored the relationship between trust in physicians and telehealth use during the COVID pandemic in 162 African Americans with diabetes. More than 90% of patients had internet-capable devices and internet service but only 61 patients (39%) had a telehealth visit. Compared to the latter, participants with no telehealth visits had less trust in physicians' ability to diagnose COVID, less trust in physicians' ability to treat via telehealth, and resided in more deprived neighborhoods. There were no differences in age, sex, education, nor literacy. For African Americans with diabetes, health disparities may increase unless fundamental issues such as trust …

A Prospective Examination Of Sex Differences In Posttraumatic Autonomic Functioning., Antonia V Seligowski, Elizabeth R Steuber, Rebecca Hinrichs, Mariam H Reda, Charis N Wiltshire, Cassandra P Wanna, Sterling J Winters, Karlye A Phillips, Stacey L House, Francesca L Beaudoin, Xinming An, Jennifer S Stevens, Donglin Zeng, Thomas C Neylan, Gari D Clifford, Sarah D Linnstaedt, Laura T Germine, Kenneth A Bollen, Guia Guffanti, Scott L Rauch, John P Haran, Alan B Storrow, Christopher Lewandowski, Paul I Musey, Phyllis L Hendry, Sophia Sheikh, Christopher W Jones, Brittany E Punches, Michael C Kurz, Vishnu P Murty, Meghan E Mcgrath, Lauren A Hudak, Jose L Pascual, Mark J Seamon, Elizabeth M Datner, Anna Marie Chang, Claire Pearson, David A Peak, Roland C Merchant, Robert M Domeier, Niels K Rathlev, Brian J O'Neil, Leon D Sanchez, Steven E Bruce, Mark W Miller, Robert H Pietrzak, Jutta Joormann, Deanna M Barch, Diego A Pizzagalli, John F Sheridan, Beatriz Luna, Steven E Harte, James M Elliott, Karestan C Koenen, Ronald C Kessler, Samuel A Mclean, Kerry J Ressler, Tanja Jovanovic

Department of Emergency Medicine Faculty Papers

Background: Cross-sectional studies have found that individuals with posttraumatic stress disorder (PTSD) exhibit deficits in autonomic functioning. While PTSD rates are twice as high in women compared to men, sex differences in autonomic functioning are relatively unknown among trauma-exposed populations. The current study used a prospective design to examine sex differences in posttraumatic autonomic functioning.

Methods: 192 participants were recruited from emergency departments following trauma exposure (

Results: 2-week systolic BP was significantly higher in men, while 2-week HR was significantly higher in women, and a sex by PTSD interaction suggested that women who developed PTSD demonstrated the highest HR …

Building Trauma And Ems Systems Capacity In Rwanda: Lessons And Recommendations, Sudha Jayaraman, Faustin Ntirenganya, Menelas Nkeshimana, Ashley Rosenberg, Theophile Dushime, Ignace Kabagema, Jean Marie Uwitonze, Eric Uwitonize, Jeanne D'Arc Nyinawankusi, Robert Riviello, Irene Bagahirwa, Kenneth L Williams, Elizabeth Krebs, Rebecca Maine, Paulin Banguti, Stephen Rulisa, Patrick Kyamanywa, Jean Claude Byiringiro

Department of Emergency Medicine Faculty Papers

Background: Surgical capacity building has gained substantial momentum. However, care at the hospital level depends on improved access to emergency services. There is no established model for facilitating trauma and EMS system capacity in LMIC settings. This manuscript describes our model for multi-disciplinary collaboration to advance trauma and EMS capacity in Rwanda, along with our lessons and recommendations.

Methods: After high-level meetings at the Ministry of Health in Rwanda (MOH), in 2016, a capacity building plan focusing on improved clinical services, quality improvement/research and leadership capacity across prehospital and emergency settings. The main themes for the collaborative model included for …

Coaching Junior Faculty For The Uncertainties Of Academic Professional Practice, Richard Mcknight, Dimitrios Papanagnou

Department of Emergency Medicine Faculty Papers

No abstract provided.

Emergency Medicine And Covid-19: Now And Next Year, Theodore A. Christopher, Adrienne N. Christopher

Department of Emergency Medicine Faculty Papers

The COVID-19 pandemic is responsible for infecting to date more than 93 million people worldwide and causing more than 2 million deaths. That the vast majority of deaths have occurred in the United States (U.S.) can be attributed to nonadherence by Americans to basic public health mitigation strategies that are known to curtail coronavirus spread. Emergency Departments (ED’s) throughout the U.S. experienced a dramatic decrease in patient visits during the first surge of COVID-19, followed by an ED patient visit rebound to approximately 80% of pre-COVID-19 numbers, which have remained relatively stable through the current second COVID-19 surge. The pandemic …

Towards A Medical School Curriculum For Uncertainty In Clinical Practice, Dimitrios Papanagnou, Nethra S. Ankam, David Ebbott, Deborah Ziring

Department of Emergency Medicine Faculty Papers

Uncertainty abounds in the clinical environment. Medical students, however, are not explicitly prepared for situations of uncertainty in clinical practice, which can cause anxiety and impact well-being. To address this gap, we sought to capture how students felt in various clinical scenarios and identify programs they found helpful as they worked through uncertainty in their clerkships to better inform curriculum that prepares them to acknowledge and navigate this uncertainty. This is an observational cross-sectional study of third-year medical students surveyed at the end of core clerkships. The survey consisted of the General Self-Efficacy (GSE) Scale and Intolerance of Uncertainty Scale …

The Relationship Between Vitamin C Or Thiamine Levels And Outcomes For Severe Sepsis Patients Admitted To The Icu., Nandan Prasad, Anne V. Grossestreuer, Nuala J. Meyer, Sarah M. Perman, Mark E. Mikkelsen, Judd Hollander, David F. Gaieski

Department of Emergency Medicine Faculty Papers

Preliminary data have produced conflicting results regarding whether initial vitamin C levels in patients with severe sepsis correlate with mortality outcomes. We hypothesized that low plasma ascorbic acid or thiamine levels in severe sepsis patients admitted from the Emergency Department (ED) to the Intensive Care Unit (ICU) would be associated with increased mortality and an increased incidence of shock. Retrospective analysis of a prospective database of severe sepsis patients admitted to the ICU at an urban, academic medical center. Ascorbic acid and thiamine levels were analyzed in relation to survivors vs. non-survivors and shock vs. non-shock patients. 235 patients were …

Pre-Operative Fluid Resuscitation In The Emergency General Surgery Septic Patient: Does It Really Matter?, Benjamin Moran, Erin Major, Joseph A Kufera, Samuel A Tisherman, Jose Diaz

Department of Emergency Medicine Faculty Papers

OBJECTIVE: Emergency general surgery (EGS) patients presenting with sepsis remain a challenge. The Surviving Sepsis Campaign recommends a 30 mL/kg fluid bolus in these patients, but recent studies suggest an association between large volume crystalloid resuscitation and increased mortality. The optimal amount of pre-operative fluid resuscitation prior to source control in patients with intra-abdominal sepsis is unknown. This study aims to determine if increasing volume of resuscitation prior to surgical source control is associated with worsening outcomes.

METHODS: We conducted an 8-year retrospective chart review of EGS patients undergoing surgery for abdominal sepsis within 24 h of admission. Patients in …

Developing Standardized Patient-Based Cases For Communication Training: Lessons Learned From Training Residents To Communicate Diagnostic Uncertainty., Dimitrios Papanagnou, Matthew R Klein, Xiao Chi Zhang, Kenzie A Cameron, Amanda Doty, Danielle M Mccarthy, Kristin L. Rising, David H Salzman

Department of Emergency Medicine Faculty Papers

Health professions education has benefitted from standardized patient (SP) programs to develop and refine communication and interpersonal skills in trainees. Effective case design is essential to ensure an SP encounter successfully meets learning objectives that are focused on communication skills. Creative, well-designed case scenarios offer learners the opportunity to engage in complex patient encounters, while challenging them to address the personal and emotional contexts in which their patients are situated. Therefore, prior to considering the practical execution of the patient encounter, educators will first need a clear and structured strategy for writing, organizing, and developing cases. The authors reflect on …

Lncrna Nonhsat069381 And Nonhsat140844 Increase In Aging Human Blood, Regulating Cardiomyocyte Apoptosis., Jinyang Zhao, Xiaolong Lin, Haoxuan Sun, Donghui Zhao, Qin Ma, Wayne Bond Lau, Zichao Cheng, Fanqi Li, Jinghua Liu, Qian Fan

Department of Emergency Medicine Faculty Papers

Aging augments postischemic apoptosis via incomplete mechanisms. Our previous animal study suggests that in addition to proapoptotic effects, lncRNAs also exert antiapoptotic effects in cardiomyocytes. However, whether this unexpected phenomenon exists in humans is unknown. In the present study, we investigated the relationship between aging and apoptosis regulation in human blood samples and confirmed their role by utilizing the cardiomyocyte lines (AC16 cells). Human blood samples were collected from 20 pairs of older adult and young volunteers. Age-different apoptotic regulatory lncRNAs and miRNAs were identified by microarray and bioinformatics analysis. The results indicated that lncRNA (NONHSAT069381 and NONHSAT140844) and miRNA …

Female With Intermittently Bleeding Abdominal Wall Mass., Evan Osterman, Rebecca Lisowski, Arthur Au

Department of Emergency Medicine Faculty Papers

No abstract provided.

Nicotine Aggravates Vascular Adiponectin Resistance Via Ubiquitin-Mediated Adiponectin Receptor Degradation In Diabetic Apolipoprotein E Knockout Mouse, Jia Gao, Jianghong Fan, Zhijun Meng, Rui Wang, Caihong Liu, Jing Liu, Bin Liang, Jing Wang, Yaoli Xie, Jing Zhao, Rui Guo, Jianli Zhao, Xin-Liang Ma, Xiangying Jiao, Jimin Cao, Yajing Wang

Department of Emergency Medicine Faculty Papers

There is limited and discordant evidence on the role of nicotine in diabetic vascular disease. Exacerbated endothelial cell dysregulation in smokers with diabetes is associated with the disrupted adipose function. Adipokines possess vascular protective, anti-inflammatory, and anti-diabetic properties. However, whether and how nicotine primes and aggravates diabetic vascular disorders remain uncertain. In this study, we evaluated the alteration of adiponectin (APN) level in high-fat diet (HFD) mice with nicotine (NIC) administration. The vascular pathophysiological response was evaluated with vascular ring assay. Confocal and co-immunoprecipitation analysis were applied to identify the signal interaction and transduction. These results indicated that the circulating …

Goals-Of-Care Course For Emergency Physicians During The Covid-19 Pandemic., Mari Siegel, Erica Westlake

Department of Emergency Medicine Faculty Papers

BACKGROUND

COVID-19 increased the need for goals of care (GOC) discussions in the Emergency Department (ED). Many Emergency Physicians (EPs) report no formal training in holding GOC discussions. COVID-19 created unique teaching challenges given social distancing requirements.

METHODS

Eight teaching sessions were held using Zoom in March and April at an urban institution in the United States. Sessions were limited to 4-8 participants. They were comprised of a 30-minute lecture and 15 minutes of role-playing, in which providers read scripts to practice communication skills. The lecture introduced vocabulary and models to shape GOC discussions. Participants were invited to complete an …

Analysis Of An Obstetrics Point-Of-Care Ultrasound Training Program For Healthcare Practitioners In Zanzibar, Tanzania., Elizabeth A Hall, Danielle Matilsky, Rachel Zang, Naomasa Hase, Ali Habibu Ali, Patricia C Henwood, Anthony J Dean

Department of Emergency Medicine Faculty Papers

BACKGROUND: A point-of-care ultrasound education program in obstetrics was developed to train antenatal healthcare practitioners in rural Zanzibar. The study group consisted of 13 practitioners with different training backgrounds: physicians, clinical officers, and nurse/midwives. Trainees received an intensive 2-week antenatal ultrasound course consisting of lectures and hands-on practice followed by 6 months of direct supervision of hands-on scanning and bedside education in their clinical practice environments. Trainees were given a pre-course written exam, a final exam at course completion, and practical exams at 19 and 27 weeks. Trainees were expected to complete written documentation and record ultrasound images of at …

The Protective Effect Of Traditional Chinese Medicine On Liver Ischemia-Reperfusion Injury., Wen Ma, Songling Tang, Dina Xie, Guoqiang Gu, Lu Gan

Department of Emergency Medicine Faculty Papers

Liver ischemia-reperfusion (I/R) injury occurs during transplantation and major hepatic surgery, which may lead to postoperative liver dysfunction. More and more traditional Chinese medicines (TCMs) have been used to treat liver ischemia-reperfusion injury. The purpose of this review is to evaluate the different protective effects of TCMs in the treatment of liver ischemia-reperfusion injury and to summarize its possible mechanisms. The results indicate that TCMs attenuate liver I/R injury via multiple mechanisms, including antioxidation stress, anti-inflammatory response, antiapoptosis, and inhibiting endoplasmic reticulum stress. However, the in-depth mechanism of the protective effects of these traditional Chinese medicines still remains unknown.

Monitoring Tissue Oxygenation Index Using Near-Infrared Spectroscopy During Pre-Hospital Resuscitation Among Out-Of-Hospital Cardiac Arrest Patients: A Pilot Study, Jumpei Tsukuda, Shigeki Fujitani, Mahbubur Rahman, Kenichiro Morisawa, Takeshi Kawaguchi, Yasuhiko Taira

Department of Emergency Medicine Faculty Papers

BACKGROUND: Tissue oxygenation index (TOI) using the near infrared spectroscopy (NIRS) has been demonstrated as a useful indicator to predict return of spontaneous circulation (ROSC) among out-of-hospital cardiac arrest (OHCA) patients in hospital setting. However, it has not been widely examined based on pre-hospital setting.

METHODS: In this prospective observational study, we measured TOI in pre-hospital setting among OHCA patients receiving cardio-pulmonary resuscitation (CPR) during ambulance transportation between 2017 and 2018. Throughout the pre-hospital CPR procedure, TOI was continuously measured. The study population was divided into two subgroups: ROSC group and non-ROSC group.

RESULTS: Of the 81 patients included in …

Identification Of A Ctrp9 C-Terminal Polypeptide Capable Of Enhancing Bone-Derived Mesenchymal Stem Cell Cardioprotection Through Promoting Angiogenic Exosome Production., Demin Liu, Guoqiang Gu, Lu Gan, Wenjun Yan, Zhen Zhang, Peng Yao, Di Zhu, Wayne Bond Lau, Dina Xie, Sisi Wu, Zhijun Meng, Jumpei Tsukuda, Theodore Christopher, Bernard Lopez, Jianli Zhao, Erhe Gao, Walter Koch, Xin-Liang Ma, Yajing Wang

Department of Emergency Medicine Faculty Papers

BACKGROUND: Mesenchymal stem cell therapy improves ischemic heart failure via incompletely understood mechanisms. C1q-TNFα related protein-9 (CTRP9) is a novel anti-oxidative cardiokine capable of improving the local microenvironment and cell survival by its c-terminal active globular domain (gCTRP9). The current study attempted to: 1) identify active gCTRP9 c-terminal polypeptides with stem cell protective function; 2) determine whether a lead polypeptide may enable/enhance cortical bone-derived mesenchymal stem cell (CBSC) cardioprotection against post-myocardial infarction (post-MI) remodeling; and 3) define the responsible underlying cellular/molecular mechanisms.

METHODS AND RESULTS: Utilizing I-TASSER structure prediction and 3-D active site modeling, we cloned and purified 3 gCTRP9 …

C1q Complement/Tumor Necrosis Factor-Associated Proteins In Cardiovascular Disease And Covid-19, Yaoli Xie, Zhijun Meng, Jia Gao, Caihong Liu, Jing Wang, Rui Guo, Jianli Zhao, Bernard Lopez, Theodore Christopher, Daniel Lee, Xin-Liang Ma, Yajing Wang

Department of Emergency Medicine Faculty Papers

With continually improving treatment strategies and patient care, the overall mortality of cardiovascular disease (CVD) has been significantly reduced. However, this success is a double-edged sword, as many patients who survive cardiovascular complications will progress towards a chronic disorder over time. A family of adiponectin paralogs designated as C1q complement/tumor necrosis factor (TNF)-associated proteins (CTRPs) has been found to play a role in the development of CVD. CTRPs, which are comprised of 15 members, CTRP1 to CTRP15, are secreted from different organs/tissues and exhibit diverse functions, have attracted increasing attention because of their roles in maintaining inner homeostasis by regulating …

Atg16l1 As A Novel Biomarker And Autophagy Gene For Diabetic Retinopathy., Xinxiao Gao, Yunhui Du, Wayne Bond Lau, Yu Li, Siquan Zhu, Xin-Liang Ma

Department of Emergency Medicine Faculty Papers

Objective: Accumulating evidence suggests the critical role of autophagy in the pathogenesis of diabetic retinopathy (DR). In the current study, we aim to identify autophagy genes involved in DR via microarray analyses.

Methods: Gene microarrays were performed to identify differentially expressed lncRNAs/mRNAs between normal and DR retinas. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses of lncRNA-coexpressed mRNAs were used to determine the related pathological pathways and biological modules. Real-time polymerase chain reactions (PCR) were conducted to validate the microarray analyses.

Results: A total of 2474 significantly dysregulated lncRNAs and 959 differentially expressed mRNAs were identified in the …

Global Point-Of-Care Ultrasound Education And Training In The Age Of Covid-19., Onyinyechi F Eke, Patricia C. Henwood, Grace W Wanjiku, Abiola Fasina, Sigmund J Kharasch, Hamid Shokoohi

Department of Emergency Medicine Faculty Papers

The COVID-19 pandemic has disrupted traditional global point-of-care ultrasound (POCUS) education and training, as a result of travel restrictions. It has also provided an opportunity for innovation using a virtual platform. Tele-ultrasound and video-conferencing are alternative and supportive tools to augment global POCUS education and training. There is a need to support learners and experts to ensure that maximum benefit is gained from the use of these innovative modalities.

Early Hemodynamic Assessment Using Nicom In Patients At Risk Of Developing Sepsis Immediately After Emergency Department Triage., Steve B Chukwulebe, David F. Gaieski, Abhishek Bhardwaj, Lakeisha Mulugeta-Gordon, Frances S Shofer, Anthony J Dean

Department of Emergency Medicine Faculty Papers

BACKGROUND: One factor leading to the high mortality rate seen in sepsis is the subtle, dynamic nature of the disease, which can lead to delayed detection and under-resuscitation. This study investigated whether serial hemodynamic parameters obtained from a non-invasive cardiac output monitor (NICOM) predicts disease severity in patients at risk for sepsis.

METHODS: Prospective clinical trial of the NICOM device in a convenience sample of adult ED patients at risk for sepsis who did not have obvious organ dysfunction at the time of triage. Hemodynamic data were collected immediately following triage and 2 hours after initial measurement and compared in …

"Trauma To The Eye"-A Low Fidelity Resident Teaching Module For Identifying And Treating A Retrobulbar Hematoma., Jared Raikin, R. Hall, Dimitrios Papanagnou, Md

Department of Emergency Medicine Faculty Papers

Introduction: A retrobulbar hematoma (RH) is a serious time-dependent diagnosis due to its potential for permanent damage of the optic nerve, resulting in blindness. Emergency medicine (EM) physicians face the challenge of recognizing this time-sensitive injury and treating it before irreversible damage occurs. Due to its relative infrequency in the emergency department, residents may not have adequate experience in recognizing and treating RH.

Methods: This educational intervention outlined a simulated scenario that we developed to educate EM residents to diagnose RH and perform an emergent lateral canthotomy and cantholysis (LCC). Participating residents were asked to obtain a history and perform …