Medicine and Health Sciences Commons^™

Three-Dimensional Soft Tissue Changes Upon Smiling, Clayton Mcentire

Theses and Dissertations

As esthetic improvement continues to be a primary goal of orthodontic patients and practitioners, it is important to understand the soft tissue movements that occur during the transition from rest to smile. Advances in technology allow capture of 3-dimesional photographs. The purpose of this study was to quantify the soft tissue changes that occur upon smiling and to compare changes between males and females using 3-dimensional photography. Fifty-four participants had resting and smiling photographs taken with the 3dMDface camera system. The two images were registered on stable facial surfaces, landmarks were placed, and measurements were recorded. Three-dimensional changes occurred in …

Service-Learning Programs Impact On Dental Students' Confidence In Treating Pediatric Population, Bushra Bhatti

Theses and Dissertations

Purpose: In 2011, Clinical Service-Learning (DENS 762) became a formal university-designated course required to all senior dental students at VCU School of Dentistry. The interest of this study was to measure students' experience in treating pediatric patients and to determine the effect the course had on students' self-perceived confidence in treating the pediatric population. Methods: This was an observational study of the VCU class of 2012 who were enrolled in the clinical service-learning class. Following their service-learning rotations, fourth-year dental students were surveyed about their experiences on their service-learning rotation. Out of 105 students, 76 completed the survey. Results: The …

Comparison Of Injection Discomfort And Anesthetic Duration Of Plain Polocaine Versus Epinephrine Containing Articaine And Lidocaine, Dana Doan

Theses and Dissertations

Purpose: To determine possible differences in the pain level and soft tissue anesthesia duration of plain polocaine versus epinephrine-containing articaine and lidocaine during intraoral injections. Methods: Forty-eight subjects received plain polocaine and one epinephrine-containing anesthetic. Injections were randomized according to the first injection a)left or right buccal sulcus and b)epinephrine or not. The second injections were the opposite conditions. Subjects then recorded discomfort on a VAS and the time anesthesia wore off. Result: The second injection’s pain rating was influenced by the first. This carry-over effect makes it impossible to analyze all of the data. An analysis of the first …

Principled Variance Reduction Techniques For Real Time Patient-Specific Monte Carlo Applications Within Brachytherapy And Cone-Beam Computed Tomography, Andrew Sampson

Theses and Dissertations

This dissertation describes the application of two principled variance reduction strategies to increase the efficiency for two applications within medical physics. The first, called correlated Monte Carlo (CMC) applies to patient-specific, permanent-seed brachytherapy (PSB) dose calculations. The second, called adjoint-biased forward Monte Carlo (ABFMC), is used to compute cone-beam computed tomography (CBCT) scatter projections. CMC was applied for two PSB cases: a clinical post-implant prostate, and a breast with a simulated lumpectomy cavity. CMC computes the dose difference between the highly correlated dose computing homogeneous and heterogeneous geometries. The particle transport in the heterogeneous geometry assumed a purely homogeneous environment, …

Risk Factors For Postoperative Cognitive Dysfunction In Older Adults Undergoing Major Noncardiac Surgery, Osama Shoair

Theses and Dissertations

Background: Postoperative cognitive dysfunction (POCD) is a deterioration in cognitive function that occurs after surgery as measured by neuropsychological tests. The purpose of this study was to determine the incidence and risk factors for POCD in older adults three months after major noncardiac surgery. Methods: This is a prospective study of patients aged 65 years and older who underwent major noncardiac surgery. Patients’ cognitive function was assessed before and three months after surgery using a computerized neurocognitive battery. Blood samples were withdrawn from patients before surgery to identify patients with high level of C-reactive protein (CRP), and patients who had …

Corticosteroids As Adjuvant Therapy For Ocular Toxoplasmosis., Smitha Jasper, Satyanarayana S. Vedula, Sheeja S. John, Saban Horo, Yasir J. Sepah, Quan Dong Nguyen

Journal Articles: Ophthalmology

BACKGROUND: Ocular infestation with Toxoplasma gondii, a parasite, may result in inflammation in the retina, choroid, and uvea and consequently lead to complications such as glaucoma, cataract, and posterior synechiae.

OBJECTIVES: The objective of this systematic review was to assess the effects of adjunctive use of corticosteroids for ocular toxoplasmosis.

SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 9), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE, (January 1950 to October 2012), EMBASE (January 1980 to October 2012), Latin American and Caribbean …

What's Happening: April 29, 2013, Maine Medical Center

What's Happening

No abstract provided.

Dsm V: Hope Or Hype?, Amresh Srivastava

Data and Test Instruments

DSM V: HOPE OR HYPE? Amresh Shrivastava, MD,MPM,MRCPsych,FRCPC Associate professor of Psychiatry Western University London, Ontario Since more than 50 years psychiatric diagnostic is being developed by a number of organisations. As research has advanced in understanding mental illnesses,need for a common language has been felt in order to provide best possible care to our patients. The process of psychiatric diagnosis has evolved significantly. WHO as well APA both have made significant advances in developing diagnostic systems. DSM 5 recently approved by board of trustees by Americal psychiatric Association is scheduled to be released on 18th of May. This document …

Memantine Protects Cholinergic And Glutamatergic Septal Neurons From Aβ1-40-Induced Toxicity, Luis V. Colom, María Teresa Castañeda Licón, D. Aleman, Ahmed Touhami

Health & Biomedical Sciences Faculty Publications

The medial septal region (medial septum and diagonal band of Broca, MS/DB) controls hippocampal excitability and synaptic plasticity. MS/DB cholinergic neurons degenerate early in Alzheimer’s disease (AD). The presence of MS/DB glutamatergic neurons that project to the hippocampus and are vulnerable to Aβ suggests that excitotoxicity plays a role in AD septal degeneration and hippocampal dysfunction. To demonstrate the presence of excitotoxicity in Aβinduced septal damage, we compared rats injected with Aβ1–40 into the MS/DB with animals treated with memantine prior, during and after Aβ1–40 injections. Controls were injected with phosphate buffered saline (PBS). MS/DB cholinergic, glutamatergic and GABAergic neurons …

Characterizing The Role Of Cdk2ap1 In Primary Human Fibroblasts And Human Embryonic Stem Cells, Khaled Alsayegh

Theses and Dissertations

Cyclin Dependent Kinase-2 Associated Protein-1 (CDK2AP1) plays an important role in cell cycle regulation, by inhibiting CDK2 and by targeting it for proteolysis. It is also known to bind the DNA polymerase alpha-primase complex and regulate the initiation step of DNA synthesis. Its overexpression has been shown to inhibit growth, reduce invasion and increase apoptosis in a number of cancer cell lines. In studies in which mouse embryonic stem cells (mESCs) with targeted deletion of the Cdk2ap1 gene were used, Cdk2ap1 was shown to be required for epigenetic silencing of Oct4 during differentiation. The goal of this thesis was to …

Microbial Dna Receptor Expression In Chronic Periodontitis, Stephanie Voth

Theses and Dissertations

AIM: The aim of this study was to determine the expression of microbial nucleic acid receptors including Toll like receptor 9 “TLR-9”, DNA-dependent activator of interferon-regulatory factors “DAI” and absent in melanoma “AIM-2” in chronic periodontitis (P) versus healthy (H) tissues. METHODS: 33 chronic periodontitis (P) and 27 periodontally-healthy (H) gingival biopsies were included. The gene and protein expression for each receptor was determined using real-time quantitative PCR and immunohistochemistry. RESULTS: Our results revealed statistically significant up-regulation of TLR-9 (p<0.006) and DAI (p<0.001) gene expression in P tissues compared to H sites. We were also able to demonstrate significant correlation among three DNA receptors (p<0.05). Immunohistochemistry further confirmed the expression of DNA sensors in gingival tissues. CONCLUSION: This study highlights a possible role for nucleic acid sensing in periodontal inflammation. Further investigations will determine whether cytoplasmic receptors and their ligands can be targeted to improve clinical outcomes in periodontitis.

Pain Management And Menopausal Health Outcomes In Multiple Sclerosis, Rachel Jawahar

Theses and Dissertations

Background: Previous studies have addressed multiple sclerosis (MS) symptom management and improved health-related quality of life (HrQOL). Yet lowered estrogen levels in post-menopasual women with MS may further worsen physical function and symptomology and not all types of pain management have been examined. Objectives: For post-menopausal women with MS, we evaluated the extent to which smoking is associated with worsened health outcomes and HrQOL, and the extent to which menopausal hormone treatment (MHT) improves health outcomes and HrQOL. For all adult men and women with clinically diagnosed MS, we systematically reviewed pharmacological and non-pharmacological strategies for the reduction of pain. …

Celiac Disease And Neurological Symptoms, Lauren V. Cook

Senior Honors Theses

New research has revealed that Celiac disease, an autoimmune illness affecting the small intestine, has more ties with neurological side effects than once was thought. The classic and most well known presentation of Celiac disease is gastrointestinal, including symptoms such as abdominal pains, nausea, diarrhea, and flatulence. Researchers have more recently found a correlation between Celiac disease and neurological illnesses such as epilepsy, depression, dementia, and ADHD. Physician awareness of the disease and the neurological side of the illness should be heightened in order for patients to receive earlier diagnosis and a better quality of life. Because of the difficulty …

The Effects Of Nursing Care On The Patient Experiencing A Stillborn Birth, Katherine Totten

Senior Honors Theses

Childbirth has the potential of being one of the most joyous and fulfilling experiences a woman goes through in her entire life. Being a mom, driving the kids to soccer practice, and sitting around the Christmas tree with the family can easily be seen as an ideal life. Conversely, the negative experiences with childbirth are rarely discussed. There is an overlooked category: moms who conceive but lose the baby in the womb. Not only are these women overlooked, but also the hospital care they receive proves inconsistent with the latest research. Nurses and doctors should be aware of the latest …

Influence Of Facial Profile On Social Perceptions: A 3d Video Imaging Study., Lisa Babb

Theses and Dissertations

The purpose of this study was to evaluate the influence of facial convexity on the perception of social attributes in a young adult population. Nine models were asked to pose for a 3 dimensional photograph that was then modified to represent ideal, retrognathic, and prognathic facial convexity angles. Survey evaluators were shown digital videos of models with ideal and non-ideal profiles and asked to rate their perception of the following 4 social attributes: intelligence, athleticism, popularity, and leadership ability using a visual analog scale. Results gathered from 271 evaluators showed that the model images with ideal facial convexity angles were …

Time Dependent Cone-Beam Ct Reconstruction Via A Motion Model Optimized With Forward Iterative Projection Matching, David Staub

Theses and Dissertations

The purpose of this work is to present the development and validation of a novel method for reconstructing time-dependent, or 4D, cone-beam CT (4DCBCT) images. 4DCBCT can have a variety of applications in the radiotherapy of moving targets, such as lung tumors, including treatment planning, dose verification, and real time treatment adaptation. However, in its current incarnation it suffers from poor reconstruction quality and limited temporal resolution that may restrict its efficacy. Our algorithm remedies these issues by deforming a previously acquired high quality reference fan-beam CT (FBCT) to match the projection data in the 4DCBCT data-set, essentially creating a …

A Comparative Effectiveness Study Of Continuous Positive Airway Pressure (Cpap) Related Skin Breakdown When Using Different Nasal Interfaces In The Extremely Low Birth Weight (Elbw) Neonate, Katherine Newnam

Theses and Dissertations

Nasal continuous positive airway pressure (CPAP) is reportedly superior to mechanical ventilation in the neonatal population by reducing bronchopulmonary dysplasia (BPD). The neonate is vulnerable to injury secondary to immature physiological systems and skin structures and the current CPAP devices place constant pressure on nares, nasal septum and forehead, increasing injury risk. Through the framework of comparative effectiveness research an examination of nasal interfaces currently used during neonatal CPAP was conducted in an effort to provide scientifically supported recommendations and improve clinical outcomes. The primary aim of this study was to determine differences in the frequency, severity and specific types …

Evidence For Tankyrases As Antineoplastic Targets In Lung Cancer, Alexander M. Busch, Kevin C. Johnson, Radu V. Stan, Aarti Sanglikar, Yashi Ahmed, Ethan Dmitrovsky, Sarah J. Freemantle

Dartmouth Scholarship

Background: New pharmacologic targets are urgently needed to treat or prevent lung cancer, the most common cause of cancer death for men and women. This study identified one such target. This is the canonical Wnt signaling pathway, which is deregulated in cancers, including those lacking adenomatous polyposis coli or β -catenin mutations. Two poly-ADP-ribose polymerase (PARP) enzymes regulate canonical Wnt activity: tankyrase (TNKS) 1 and TNKS2. These enzymes poly-ADP-ribosylate (PARsylate) and destabilize axin, a key component of the β -catenin phosphorylation complex. Methods: This study used comprehensive gene profiles to uncover deregulation of the Wnt pathway in murine transgenic and …

Liposomal Fasudil, A Rho-Kinase Inhibitor, For Prolonged Pulmonary Preferential Vasodilation In Pulmonary Arterial Hypertension, Vivek Gupta, Nilesh Gupta, Imam H. Shaik, Reza Mehvar, Ivan F. Mcmurty, Masahiko Osa, Eva Nozik-Grayck, Fakhrul Ahsan

Pharmacy Faculty Articles and Research

Current pharmacological interventions for pulmonary arterial hypertension (PAH) require continuous infusions, multiple inhalations, or oral administration of drugs that act on various pathways involved in the pathogenesis of PAH. However, invasive methods of administration, short duration of action, and lack of pulmonary selectivity result in noncompliance and poor patient outcomes. In this study, we tested the hypothesis that encapsulation of an investigational anti-PAH molecule fasudil (HA-1077), a Rho-kinase inhibitor, into liposomal vesicles results in prolonged vasodilation in distal pulmonary arterioles. Liposomes were prepared by hydration and extrusion method and fasudil was loaded by ammonium sulfate-induced transmembrane electrochemical gradient. Liposomes were …

Determination Of Biomechanical Differences Between Elite And Novice San Shou Female Athletes, Chuanyin Jiang, Michael W. Olson, Li Li

Health Sciences & Kinesiology: Faculty Publications

Determining the key factors in athletic performance is important for developing the technique and strength of athletes. Many martial arts forms have been studied, but a relatively new form of martial arts competition, San Shou, has not been analyzed. The purpose of this study was to determine key attributes necessary in the development of the San Shou athlete, particularly in female participants. Six elite and six novice competitors performed 30 continuous repetitions of cyclic extension and flexion of the trunk segment, knee joints, and elbows joints at two velocities, 60°/second and 180°/second, using an isokinetic dynamometer. Variables of interest were …

The Impact Of Medicare Prescription Drug Coverage On The Use Of Antidementia Drugs, Nicole R. Fowler, Yi-Fan Chen, Christiana A. Thurton, Aiju Men, Eric G. Rodriguez, Julie M. Donohue

Publications and Research

Background Cholinesterase inhibitors and memantine are prescribed to slow the progression dementia. Although the efficacy of these drugs has been demonstrated, their effectiveness, from the perspective of patients and caregivers, has been questioned. Little is known about whether the demand for cholinesterase inhibitors and memantine are sensitive to out-of-pocket cost. Using the 2006 implementation of Medicare Part D as a natural experiment, this study examines the impact of changes in drug coverage on use of cholinesterase inhibitors and memantine by comparing use before and after Medicare Part D implementation among older adults who did and did not experience a change …

Dehumanization Of The Clinician And The Demise Of The Healing Relationship, Bro. Ignatius Perkins, O.P.

Faculty Conference Presentations

Presented at the conference, Catholic Principles in Health Care: Are They Compatible in a Secular Society, April 27, 2013. Aquinas College, Nashville, Tennessee & John Carroll Catholic High School, Birmingham, Alabama.

Abstract:

Professional literature in health care ethics today frequently reports discussions on the multiple variables that threaten the human dignity and vulnerability of the sick person. Unfortunately, little attention is given to understanding how human dignity of the clinician is threatened and violated in the current health care environment.

Today’s technologically and economically-driven health care environment is influenced by moral relativism, reductionism, and a clinical focus on specialization, technology …

The Line Between Addiction And Medication: Alcohol, Anesthesia, And Analgesia, Priya Joshi, B.S., Emanual Rubin, Md

Department of Pathology Honors Program Student Research Symposium

Alcohol is a particularly dangerous addiction because its consumption is legal even in excess, despite its harmful effects. Because alcohol has a multitude of targets in the central nervous system that are modified during chronic exposure, medications with overlapping targets such as anesthetics and analgesics must be modified when given to alcoholics. Unfortunately, as relatively little is known about the mechanism of addiction, it is difficult to predict how medications will be affected by central adaptation to chronic alcohol exposure. This review summarizes the consequences of alcohol exposure with particular attention to the GABA_Areceptor, and discusses the reasons …

Effects Of Clostridium Difficile On The Human Immune Response, Mike Mcgovern

Honors Projects in Science and Technology

Clostridium difficile is a bacterium that is rapidly becoming a large issue in the medical community due to its tendency to infect hospital patients and its resistance to antibiotics. By studying the way in which the pathogen interacts with the human immune system, it is possible to better understand how the body naturally fights off the disease. This knowledge can allow medical professionals to develop treatments that can help curtail the infection before serious symptoms occur. Working under a grant program alongside Professors Kirsten Hokeness and Chris Reid, I was able to research the effects that exposure to the C. …

An In-Depth Look At Recent Influenza Seasons And Vaccine Effectiveness, Ariana Ricci

Honors Projects in Science and Technology

This paper aims to present an in-depth exploration of immunology, the influenza virus, vaccination, and vaccination’s effectiveness with respect to influenza. It also delves into the possible causes behind the large increase in early childhood deaths during the 2003-2004 influenza season, which was a turning point in terms of influenza incident reporting. Finally, data analysis on the relationship between childhood flu vaccine coverage and childhood outpatient ILI (influenza-like illness) visits by region is presented as a measurement of vaccine effectiveness and identifier of trends. Although this relationship was not statistically significant (alpha=0.05) regionally, this simply points to alternate factors that …

Transfusion Related Acute Lung Injury, Nadia Abidi, Jay Herman, Md, Julie Karp, Md

Department of Pathology Honors Program Student Research Symposium

A 74 year old woman presented with hematemesis. Her medical history was significant for pulmonary embolism treated with warfarin anticoagulation, fibromyalgia treated with NSAIDs/steroids, and a prior bleeding event from a gastric ulcer. On admission she was stable with a hemoglobin of 8.7 g/dL and a therapeutic INR of 3.19. A type and screen determined a blood type of AB positive. In anticipation of endoscopy, the patient received one unit of red blood cells and four units of type AB plasma. Following transfusion, her INR was 1.83. The patient received an additional four units of type AB plasma to further …

Morphologic And Endoscopic Evaluation Of Collagenous Gastritis, Annie Ashok, Ashlie L. Burkart, Md, Cm

Department of Pathology Honors Program Student Research Symposium

Collagenous gastritis (CG) is a rare gastrointestinal condition of unknown etiology and pathogenesis characterized by the presence of a gastric subepithelial collagen band of variable thickness. While little is known about the disease, children and young adults often present with anemia, abdominal pain, and nodular gastric mucosa on endoscopy. In contrast, adults often present with chronic watery diarrhea and normal gastric mucosa on endoscopy. Disease associations (usually in adult cases) include celiac disease, collagenous colitis, collagenous sprue, and lymphocytic colitis. This study aims to further characterize the clinical, endoscopic and morphologic spectrum of CG.

Lumbar Chordoma: A Primary Bone Tumor, Andrew N. Fleischman, Bs, Brian O'Hara, Md

Department of Pathology Honors Program Student Research Symposium

INTRODUCTION

• Primary malignant bone tumor of embryonic notochord remnants
• 1-4% of primary bone tumors, <0.1 per 100,000
• Location: Sacral (50%), Skull base (35%), Vertebral column (15%)
• Classic, chondroid (5-15%), and dedifferentiated (5%) variants
• Most commonly in late middle age (50s to 60s)
• Low-grade, slow growing tumor
• But locally aggressive, high rate of local recurrence (20% in 1^st year)
• Local recurrence is most important predictor of mortality
• Metastasis only occurs very late in disease
• Median survival of about 6 years, less than 12 months with mets
• 5 year survival of 70%, 10 year survival of 40%
• Primary therapy- aggressive surgical resection (if possible) …

An Unexpected Immunohistochemical Profile In An Ovarian Lesion, Kate Fritton, Joanna Chan, Md

Department of Pathology Honors Program Student Research Symposium

A 27 year old female presented with pelvic pain and a palpable pelvic mass. Upon histological examination, the cystic mass contained a multi-cellular lining with nuclear grooves. Negative inhibin staining ruled out a follicular cyst and granulosa cell tumor while pan-cytokeratin positivity suggested an epithelial lesion. The lesion stained positive for thrombomodulin, ultimately suggesting a diagnosis of a Brenner cell tumor, although CD56 positivity in the tumor questions the known immunohistochemical profile of Brenner cell tumors. This unusual result opens the door to future research into the role CD56 in the diagnosis of ovarian neoplasms.

Myeloid Sarcoma: Extramedullary Relapse After Allogeneic Bone Marrow Transplant For Chronic Myelogenous Leukemia, Maria Gubbiotti, Alina Dulau Florea, Md, Renu Bajaj, Phd

Department of Pathology Honors Program Student Research Symposium

Myeloid sarcoma (MS) is an extramedullary tumor of myeloid precursor cells, which can precede or occur concomitantly with acute myeloid leukemia, myelodysplastic syndrome, or myeloproliferative neoplasms. Although MS can involve any organ, it is more common in the central nervous system (CNS) and gonads, sites known as “pharmacologic sanctuaries” where leukemic cells can survive despite systemic chemotherapy. Less often, this tumor can be the manner of relapse after allogeneic bone marrow transplantation.

The diagnosis is based on morphology and immunophenotype by either flow cytometry or immunohistochemistry of paraffin-embedded tissue, and confirmed by FISH or molecular studies. Myeloid sarcomas usually express …