Medicine and Health Sciences Commons^™

Multivitamin Supplementation In Hiv Infected Adults Initiating Antiretroviral Therapy In Uganda: The Protocol For A Randomized Double Blinded Placebo Controlled Efficacy Trial., David Guwatudde, Amara E. Ezeamama, Danstan Bagenda, Rachel Kyeyune, Fred Wabwire-Mangen, Henry Wamani, Ferdinand Mugusi, Donna Spiegelman, Molin Wang, Yukari C. Manabe, Wafaie W. Fawzi

Journal Articles: Epidemiology

BACKGROUND: Use of multivitamin supplements during the pre-HAART era has been found to reduce viral load, enhance immune response, and generally improve clinical outcomes among HIV-infected adults. However, immune reconstitution is incomplete and significant mortality and opportunistic infections occur in spite of HAART. There is insufficient research information on whether multivitamin supplementation may be beneficial as adjunct therapy for HIV-infected individuals taking HAART. We propose to evaluate the efficacy of a single recommended daily allowance (RDA) of micronutrients (including vitamins B-complex, C, and E) in slowing disease progression among HIV-infected adults receiving HAART in Uganda.

METHODS/DESIGN: We are using a …

Inla Promotes Dissemination Of Listeria Monocytogenes To The Mesenteric Lymph Nodes During Food Borne Infection Of Mice, Elsa N. Bou Ghanem, Grant S. Jones, Tanya Myers-Morales, Pooja D. Patil, Achmad N. Hidayatullah, Sarah E. F. D'Orazio

Microbiology, Immunology, and Molecular Genetics Faculty Publications

Intestinal Listeria monocytogenes infection is not efficient in mice and this has been attributed to a low affinity interaction between the bacterial surface protein InlA and E-cadherin on murine intestinal epithelial cells. Previous studies using either transgenic mice expressing human E-cadherin or mouse-adapted L. monocytogenes expressing a modified InlA protein (InlA(m)) with high affinity for murine E-cadherin showed increased efficiency of intragastric infection. However, the large inocula used in these studies disseminated to the spleen and liver rapidly, resulting in a lethal systemic infection that made it difficult to define the natural course of intestinal infection. We describe here a …

The Fear Factor In Takotsubo Cardiomyopathy: A Retrospective Cohort Study, Lex Denysenko, Md, Robin Hanson, Md, Jessica Mosier, Md, Ethan J. Halpern, Md

Department of Psychiatry and Human Behavior Faculty Papers

Presented at: Academy of Psychosomatic Medicine in Atlanta Georgia.

BACKGROUND

•Takotsubo cardiomyopathy (TCM) is a transient, reversible acute cardiac syndrome that mimics acute MI

•Reportedly frequently precipitated by an emotionally stressful event

•Excessive catecholamine release is a possible pathophysiologic mechanism¹

•Prevalence of anxiety and mood disorders in TCM patients varies among studies, ranging from 21-40%^2,3

Building A Statistical Model For Predicting Cancer Genes, Ivan P. Gorlov, Christopher J. Logothetis, Shenying Fang, Olga Y. Gorlova, Christopher Amos

Dartmouth Scholarship

More than 400 cancer genes have been identified in the human genome. The list is not yet complete. Statistical models predicting cancer genes may help with identification of novel cancer gene candidates. We used known prostate cancer (PCa) genes (identified through KnowledgeNet) as a training set to build a binary logistic regression model identifying PCa genes. Internal and external validation of the model was conducted using a validation set (also from KnowledgeNet), permutations, and external data on genes with recurrent prostate tumor mutations. We evaluated a set of 33 gene characteristics as predictors. Sixteen of the original 33 predictors were …

Transforming Growth Factor Alpha (Tgfα) Regulates Granulosa Cell Tumor (Gct) Cell Proliferation And Migration Through Activation Of Multiple Pathways., Cheng Wang, Xiangmin Lv, Chao Jiang, Crystal M. Cordes, Lan Fu, Subodh M. Lele, John S. Davis

Journal Articles: Obstetrics & Gynecology

Granulosa cell tumors (GCTs) are the most common ovarian estrogen producing tumors, leading to symptoms of excessive estrogen such as endometrial hyperplasia and endometrial adenocarcinoma. These tumors have malignant potential and often recur. The etiology of GCT is unknown. TGFα is a potent mitogen for many different cells. However, its function in GCT initiation, progression and metastasis has not been determined. The present study aims to determine whether TGFα plays a role in the growth of GCT cells. KGN cells, which are derived from an invasive GCT and have many features of normal granulosa cells, were used as the cellular …

Immune Correlates Of Aging In Outdoor-Housed Captive Rhesus Macaques (Macaca Mulatta), Elizabeth S. Didier, Chie Sugimoto, Lisa C. Bowers, Imtiaz A. Khan, Marcelo J. Kuroda

Microbiology, Immunology, and Tropical Medicine Faculty Publications

Background

Questions remain about whether inflammation is a cause, consequence, or coincidence of aging. The purpose of this study was to define baseline immunological characteristics from blood to develop a model in rhesus macaques that could be used to address the relationship between inflammation and aging. Hematology, flow cytometry, clinical chemistry, and multiplex cytokine/chemokine analyses were performed on a group of 101 outdoor-housed captive rhesus macaques ranging from 2 to 24 years of age, approximately equivalent to 8 to 77 years of age in humans.

Results

These results extend earlier reports correlating changes in lymphocyte subpopulations and cytokines/chemokines with increasing …

Exploring The Depths Of Health Literacy Are We Teaching This And Why Does It Matter?, Susan Toth-Cohen, Phd, Otr/L, Tracey Vause-Earland, Ms, Otr/L

Department of Occupational Therapy Posters and Presentations

Background: Why does Health Literacy Matter?

• Healthcare practitioners often work with older persons with low health literacy without realizing that this issues limiting the success of their interventions. They may also lack awareness of the serious impact that low health literacy can have, since it is associated with lower reported health status, increased hospitalizations, and increased morbidity (Levasseur & Carrier, 2011).
• The current US healthcare system places increase demands on consumers to manage their own health (Smith & Gutman, 2011).
• Educators in the health professions must instill a sense of responsibility in future practitioners to understand the important role they …

Breast Cancer Incidence In Black And White Women Stratified By Estrogen And Progesterone Receptor Statuses., Michael X. Gleason, Tengiz Mdzinarishvili, Simon Sherman

Journal Articles: Eppley Institute

BACKGROUND: There is increasing evidence that breast cancer is a heterogeneous disease presented by different phenotypes and that white women have a higher breast cancer incidence rate, whereas black women have a higher mortality rate. It is also well known that white women have lower incidence rates than black women until approximately age 40, when rate curves cross over and white women have higher rates. The goal of this study was to validate the risk of white and black women to breast cancer phenotypes, stratified by statuses of the estrogen (ER) and progesterone (PR) receptors.

METHODOLOGY/PRINCIPAL FINDINGS: SEER17 data were …

Nurse Practitioner Home-Based Care, Nicole Peters Kroll

Nursing Theses and Dissertations

The United States is currently faced with the challenge of how and where to care for its aging population. Nurse practitioner (NP) home-based care is a potential solution to meet this challenge. Current research indicates that care provision by advanced practice nurses reduces cost, decreases length of stay and readmission to hospitals, and improves patient quality of life. The purpose of this research was to examine the state of the science regarding home-based geriatric care by NPs and to determine the current status and potential expansion of NPs in home-based care for elderly patients. Advanced practice nurses are able to …

Ambiguity, Ambivalence, And Apprehensions Of Taking Hiv-1 Pre-Exposure Prophylaxis Among Male Couples In San Francisco: A Mixed Methods Study, Parya Saberi, Kristine Elizabeth Gamarel, Torsten B. Neilands, Megan Comfort, Nicolas Sheon, Lynae A. Darbes, Mallory O. Johnson

Publications and Research

Objective: We conducted a mixed-methods study to examine serodiscordant and seroconcordant (HIV-positive/HIVpositive) male couples’ PrEP awareness, concerns regarding health care providers offering PrEP to the community, and correlates of PrEP uptake by the HIV-negative member of the couple.

Design: Qualitative sub-study included one-on-one interviews to gain a deeper understanding of participants’ awareness of and experiences with PrEP and concerns regarding health care providers offering PrEP to men who have sex with men (MSM). Quantitative analyses consisted of a cross-sectional study in which participants were asked about the likelihood of PrEP uptake by the HIV-negative member of the couple and level …

Targeting Astrocytes Ameliorates Neurologic Changes In A Mouse Model Of Alzheimer's Disease, Jennifer L. Furman, Diana M. Sama, John C. Gant, Tina L. Beckett, M. Paul Murphy, Adam D. Bachstetter, Linda J. Van Eldik, Christopher M. Norris

Pharmacology and Nutritional Sciences Faculty Publications

Astrocytes are the most abundant cell type in the brain and play a critical role in maintaining healthy nervous tissue. In Alzheimer's disease (AD) and most other neurodegenerative disorders, many astrocytes convert to a chronically "activated" phenotype characterized by morphologic and biochemical changes that appear to compromise protective properties and/or promote harmful neuroinflammatory processes. Activated astrocytes emerge early in the course of AD and become increasingly prominent as clinical and pathological symptoms progress, but few studies have tested the potential of astrocyte-targeted therapeutics in an intact animal model of AD. Here, we used adeno-associated virus (AAV) vectors containing the astrocyte-specific …

Perceptual, Acoustic, And Kinematic Effects Of Sentence-Initial, Single-Phoneme Prolongation In People Who Do And Do Not Stutter, Darrell Sharp Matthews

Theses and Dissertations

This study examined a sentence-initial one-second sound prolongation as a possible fluency-inducing condition in people who stutter. The effects of this prolongation technique on the single sentence utterances of five people who stutter (PWS) and five age- and gender-matched controls were investigated. Variables tested included stuttering percentages, speaking rate, duration of phonated intervals, and correlation between upper lip and lower lip/jaw. Results showed a non-significant trend for less stuttering to occur when participants used the prolongation technique. Significant findings included longer durations of phonated intervals and more negatively correlated upper- and lower-lip movements during the prolongation condition. Rate of speech …

Venoarterial Extracorporeal Membrane Oxygenation (Ecmo) For Support During Whole Lung Lavage For Pulmonary Alveolar Proteinosis., Hitoshi Hirose, Julie Monteagudo, Nicholas C. Cavarocchi, Boyd Hehn, Naveed Hasan

Department of Surgery Faculty Papers

INTRODUCTION ECMO as support during whole lung lavage (WLL) for pulmonary alveolar proteinosis is reserved for severe cases where oxygenation is inadequate to support the patient using the ventilator alone. While most publications describe a venovenous cannulation with variable results we present a successful case using venoarterial cannulation and discuss the potential benefits of this mode of ECMO support. CASE PRESENTATION We present the case of a 44 year old female with a past medical history of Behcets disease and a BMI of 37 who was diagnosed with pulmonary alveolar proteinosis (PAP) on a lung biopsy after presenting with dyspnea. …

Novel Approach To Monitoring Renal Perfusion With The Use Of Continuous Renal Oximetery In The Setting Of Aortic Dissection, Hitoshi Hirose, Philip Batista, Nicholas C. Cavarocchi

Department of Surgery Faculty Papers

INTRODUCTION: Aortic dissections commonly extend beyond the renal arteries with varying effects ranging from asymptomatic to renal failure. We report a case of aortic dissection with initial renal compromise, which was continuously monitored utilizing direct renal oximetry for evaluation of real-time renal perfusion and function. CASE PRESENTATION: A 65 year-old female with a long history of uncontrolled hypertension presented with acute retrosternal chest pain radiating to the back for 12 hours. She was in stable condition except for a serum creatinine of 1.6mg/dl. Magnetic resonance angiography (MRA) demonstrated a type A dissection extending from the aortic root to the left …

Sternal Pain After Rigid Fixation: A Pilot Study Of Randomization Rigid Vs Conventional Wire Closure., Hitoshi Hirose, Hong Mun Kong, Shigeki Tabata, Kentaro Yamane, Margaret Lusardi, Linda J. Bogar, James Diehl

Department of Surgery Faculty Papers

Objective: Rigid sternal fixation may provide better sternal closure than conventional sternal wire closure. We performed a prospective randomized study to investigate if rigid closure reduces postoperative sternal pain. Methods: Patients undergoing CABG ± valve surgery between July 2011 and January 2012 were prospectively randomized into conventional wire closure (group C) or rigid fixation using sternal plates (group R). Pain scores were determined at 6 AM using a numeric rating scale (0 no pain, 5 moderate pain, 10 worst possible pain). Narcotic pain medication requirement from day 1 to 5 was collected and converted into intravenous morphine equivalent. Results: Among …

Fate Of The Lower Extremity In Patients With Va-Ecmo Via Femoral Cannulation, Hitoshi Hirose, Kathleen Lamb, Neil Moudgill, Paul Dimuzio, Megan Mccullough, Pawel Karbowski, Atul Rao, Nicholas Cavarocchi, Joshua Eisenberg

Department of Surgery Faculty Papers

Background: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a salvage therapy in patients with severe cardiopulmonary failure. Femoral cannulation is associated with limb complications including ischemia, limb loss, arterial infections and wound infections. This study aims to evaluate these complications and management related to successful outcomes. Methods: A retrospective review was conducted in 17 patients requiring VA- ECMO support via femoral cannulation from 1/ 2010 till 4/2012. After cannulation, all patients had near infared spectroscopy (NIRS) monitoring after cannula placement and most had placement of distal arterial perfusion catheters (DPC). At decannulation, all patients had femoral cutdown with closure of arteriotomies …

Percutaneous Gastrostomy (Peg) Tube Placement In Patients With Continuous Flow Left Ventricular Assist Device. (Lvad)., Hitoshi Hirose, Chris Rizzi, Linda Bogar, Jay S. Jenoff, Nicholas Cavarocchi

Department of Surgery Faculty Papers

Percutaneous gastrostomy (PEG) tube placement in patients with continuous flow left ventricular assist device. (LVAD). CHRIS RIZZI, BS, Linda Bogar, MD, Jay Jenoff, MD, Nicholas Cavarocchi, MD, Hitoshi Hirose, MD. Department of Surgery, Thomas Jefferson University, Philadelphia, PA. Introduction: Inadequate nutritional support after LVAD placement is known to increase postoperative infections and to decrease survival. The LVAD patients with complicated postoperative recovery requiring prolonged mechanical ventilation may require long-term tube feedings. Placement of a PEG requires knowledge of the location of the LVAD pocket and driveline to avoid device infection and injury. Methods: Between August 2008 and December 2011, 39 …

Successful Liver Failure Management Using Molecular Adsorbents Recirculating System During Complicated Veno-Arterial Extracorporeal Membrane Oxygenation As A Bridge To A Left Ventricular Assist Device Placement, Hitoshi Hirose, Shigeki Tabata, Nicholas Cavarocchi

Department of Surgery Faculty Papers

Successful liver failure management using molecular adsorbents recirculating system during complicated veno-arterial extracorporeal membrane oxygenation as a bridge to a left ventricular assist device placement. SHIGEKI TABATA, MD, Nicholas Cavarocchi, MD, Hitoshi Hirose, MD. Department of Surgery, Division of Cardiothoracic Surgery Thomas Jefferson University Hospital, Philadelphia, PA Introduction: Extracorporeal membrane oxygenation (ECMO) is a well-established therapy for the patients with cardiogenic shock. We present a patient who developed severe complications while on ECMO. Case presentation: A 49-year-old female presented with severe heart failure and was placed on veno-arterial ECMO for bridge to decision. While on ECMO, the patient developed massive …

Recovery Of End-Organs And Improved Mortality In Adult Patient On Ecmo., Hitoshi Hirose, Joshua Wong, Vei Shaun Siow, Thomas N. Smith, Harrsion Pitcher, Linda Bogar, Nicholas C. Carvarocchi

Department of Surgery Faculty Papers

Title: Recovery of End-Organs and Improved Mortality in Adult Patients on ECMO Joshua K Wong, BS1, Vei Shaun Siow, BS1, Thomas N Smith, BS1, Harrison Pitcher, MD2, Linda Bogar, MD2, Hitoshi Hirose, MD2 and Nicholas C Cavarocchi, MD2. 1Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, United States, 19107 and 2Division of Cardiothoracic Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States, 19107. Body: With increasing use of ECMO in adults, we seek to objectively measure End-Organ recovery and correlate intensive care mortality scores and complications with patient survival. This is a retrospective review of patients who were placed on …

Efficacy Of Miniaturized Imacor Trans-Esophageal Echocardiografm (Tee) Prove In Mechanical Circulatory Support., Hitoshi Hirose, Christopher Y. Kang, Joshua K. Wong, Harrison T. Pitcher, Caitlyn M. Johnson, Konrad Sarosiek, Linda J Bogar, Nicholas C. Cavarocchi

Department of Surgery Faculty Papers

Application of the miniaturized ImaCor Trans-Esophageal Echocardiogram (TEE) probe in Heart Transplant/Mechanical Cardiac Support Patients In the surgical cardiac care unit (SCCU), therapeutic interventions often need to be done at the bedside, necessitating the need for a rapidly employable diagnostic tool for the cardiac intensivist. We report the clinical utility of the miniature ImaCor TEE-probe in guiding management of post heart transplant (H-Txp) and mechanical cardiac support patients (MCS) and describe the economic benefit of such a device. This is an IRB approved retrospective review of MCS/H-Txp patients who had ImaCor TEE monitoring in the SCCU of our institution in …

An Old Problem With A New Therapy: Gi Bleeding In Vad Patients And Deep Bowel Enteroscopy (Double Balloon. Spiral Enteroscopy)., Hitoshi Hirose, Konrad Sarosiek, Linda Bogar, Pitcher Harrison, Barbara Ebert, Nicholas Cavarocchi

Department of Surgery Faculty Papers

An old problem with a new therapy: GI Bleeding in VAD patients and deep bowel enteroscopy (Spiral and Double Balloon Enteroscopy) Purpose: Evidence suggests that patients treated with non-pulsatile ventricular assist devices (VAD) are at an increased risk for gastrointestinal bleeding (GIB) beyond what is expected from routine anticoagulation. Diagnostic and treatment algorithms are currently undefined. We reviewed our experience of GIB in VAD patients and propose a new algorithm utilizing deep bowel enteroscopy (DBE) aimed to speed diagnosis and limit transfusions. (471) Methods & Procedures From 2004 to 2011, we studied 62 patients who received a non-pulsatile VAD at …

The Influence Of Climatic Conditions On The Transmission Dynamics Of The 2009 A/H1n1 Influenza Pandemic In Chile, Gerardo Chowell, Sherry Towers, Cecile Viboud, Rodrigo Fuentes, Viviana Sotomayor, Lone Simonsen, Mark A. Miller, Mauricio Lima, Claudia Villarroel, Monica Chiu, Jose E. Villarroel, Andrea Olea

Global Health Faculty Publications

No abstract provided.

2012 November 13 - Medical Student Education Committee Minutes, Medical Student Education Committee, East Tennessee State University

Medical Student Education Committee Minutes

No abstract provided.

Muc4 And Muc1 Expression In Adenocarcinoma Of The Stomach Correlates With Vessel Invasion And Lymph Node Metastasis: An Immunohistochemical Study Of Early Gastric Cancer., Yukihiro Tamura, Michiyo Higashi, Sho Kitamoto, Seiya Yokoyama, Masahiko Osako, Michiko Horinouchi, Takeshi Shimizu, Mineo Tabata, Surinder K. Batra, Masamichi Goto, Suguru Yonezawa

Journal Articles: Biochemistry & Molecular Biology

We have previously reported that MUC4 expression is a poor prognostic factor in various carcinomas. Our previous study also showed that MUC1 expression in gastric cancers, including the early and advanced stages is a poor prognostic factor. In the present study, the expression profiles of MUC4 and MUC1 were examined by immunohistochemistry (IHC) using two anti-MUC4 monoclonal antibodies (MAbs), 8G7 and 1G8, and anti-MUC1 MAb DF3 in 104 gastrectomy specimens of early gastric adenocarcinoma with submucosal invasion (pT1b2), including 197 histological subtype lesions. Before the IHC study of the human specimens, we evaluated the specificity of the two MAbs by …

Correlation Between Adherence To A Ventilator Weaning Protocol And Successful Extubations In An Intensive Care Nursery, James Gibson, Bs, Rrt, Brian Glynn, Bs, Rrt, Ursula Nawab, Md, Erin Mcdermott

Division of Pulmonary, Allergy, and Critical Care Medicine Faculty Papers

Presented at: American Association of Respiratory Care.

Background

Chronic lung disease (CLD) is a multi-factorial respiratory disease of the preterm neonate for which mechanical ventilation is a significant contributor. Mechanical ventilator weaning protocols have been shown to reduce the duration of mechanical ventilation. A ventilator weaning protocol (VWP) based on Level I-III evidence was instituted in 2004. Compliance with existing VWP is unknown. CLD rates in our unit have increased over the past 3 years. Assessment of and understanding protocol compliance is an important first step in identifying internal factors which may contribute to CLD. Based on increasing rates of …

Les Femmes Manutentionnaires : Un Point De Vue Biomécanique Et Ergonomique, André Plamondon, Denys Denis, Christian Larivière, Alain Delisle, Denis Gagnon, Marie St-Vincent, Iuliana Nastasia

Rapports de recherche scientifique

De nombreuses femmes exercent le métier de manutentionnaire. À tort, on a négligé de s’intéresser à cette population parce que le métier de manutentionnaire est largement pratiqué par des hommes. Il existe des études qui ont observé des différences significatives entre les hommes et les femmes dans leurs façons d’effectuer les tâches de manutention, mais leur nombre est limité. Quoique le nombre de manutentionnaires féminins soit beaucoup moins élevé dans certains types d’activité comme le transport et la machinerie, dans d’autres secteurs comme l’alimentation et les services, les femmes constituent souvent près de la moitié de la main-d'œuvre qui, de …

Quantitative, Spectrally-Resolved Intraoperative Fluorescence Imaging, Pablo A. Valdés, Frederic Leblond, Valerie L. Jacobs, Brian C. Wilson, Keith D. Paulsen, David W. Roberts

Dartmouth Scholarship

Intraoperative visual fluorescence imaging (vFI) has emerged as a promising aid to surgical guidance, but does not fully exploit the potential of the fluorescent agents that are currently available. Here, we introduce a quantitative fluorescence imaging (qFI) approach that converts spectrally-resolved data into images of absolute fluorophore concentration pixel-by-pixel across the surgical field of view (FOV). The resulting estimates are linear, accurate, and precise relative to true values, and spectral decomposition of multiple fluorophores is also achieved. Experiments with protoporphyrin IX in a glioma rodent model demonstrate in vivo quantitative and spectrally-resolved fluorescence imaging of infiltrating tumor margins for the …

Medical School Watercooler Newsletter - November 11, 2012, Lindsey Lyle

Watercooler Newsletter

This is the November 11, 2012 edition of the Frederick P. Whiddon College of Medicine's newsletter - Watercooler.

Contents Include:

• USA Department of Family Medicine Receives Funding to Improve Primary Care Delivery
• USA Biomedical Librarian Approved For Membership in Academy of Health Information Professionals
• November Med School Café - 'Pulmonary Hypertension: The Other BP'
• Veterans Day 2012: Honoring Our Heroes

Activating Healthcare Advocates: A Collaboration Between Npa And The Ihi Open School, Ashlee Goldsmith, Md, Valerie Pracilio, Mph, Cpps

Department of Rehabilitation Medicine Faculty Papers

Presented at: National Physician's Alliance National Conference in Alexandria Virginia.

AIM

To facilitate opportunities for interdisciplinary learning and aligning the missions of the two organizations, we organized an educational program for current and future healthcare professionals focused on the relationship between quality and cost using the Top 5 lists to promote good stewardship in clinical practice, initially developed by the NPA, as a tool to initiate collaboration.

Smokers’ Vs. Non-Smokers’ Attitudes Toward Tobacco Usage, Jeff W. Totten, Betty J. Cayton

Atlantic Marketing Journal

The purpose of the study was to collect attitudinal and behavioral data on a sample of college students from a Southern state university regarding tobacco usage. The sample was designed to include both smokers and non-smokers. A non-probability sample of 508 college students was collected by handing out surveys in classes and in campus buildings. The questionnaire was designed by the students and the authors and included half of Pechmann and Shih’s (1999) smoking perceptions scale items. Users made up 36.6% of the sample. The average length of time reported using tobacco products was five years, with 78.3% stating they …