Medicine and Health Sciences Commons^™

Exome-Based Variant Detection In Core Promoters., Yeong C. Kim, Jian Cui, Jiangtao Luo, Fengxia Xiao, Bradley Downs, San Ming Wang

Journal Articles: Genetics, Cell Biology & Anatomy

Core promoter controls the initiation of transcription. Core promoter sequence change can disrupt transcriptional regulation, lead to impairment of gene expression and ultimately diseases. Therefore, comprehensive characterization of core promoters is essential to understand normal and abnormal gene expression in biomedical studies. Here we report the development of EVDC (Exome-based Variant Detection in Core promoters) method for genome-scale analysis of core-promoter sequence variation. This method is based on the fact that exome sequences contain the sequences not only from coding exons but also from non-coding region including core promoters generated by random fragmentation in exome sequencing process. Using exome data …

Malignant Hyperthermia, Leonid Levertov

Nursing Student Class Projects (Formerly MSN)

Providing patient care in the operating room as a nurse anesthetist is rewarding and challenging. There is a paramount level of responsibility that lies on certified registered nurse anesthetist (CRNA). Recognition of serious life threatening conditions by CRNA must be prompt and treated urgently. As a student registered nurse anesthetist and future CRNA, knowing how to recognize and treat developed emergency conditions while patient is under anesthesia or recovering from anesthesia is an absolute requirement. Malignant hyperthermia (MH), is a rare autosomal dominant hypermetabolic life threatening disorder of skeletal muscle. Malignant hyperthermia is caused by volatile anesthetics (desflurane, sevoflurane, isoflurane) …

Chronic Bronchitis, Dhwani Chotalia

Nursing Student Class Projects (Formerly MSN)

Overall incidence of chronic bronchitis is increasing in the community. Long-term side effects negatively affect quality of life of patients. This poster presentation attempts to provide more details on chronic bronchitis. Extensive details on the pathophysiology, signs & symptoms, nursing implications are provided to help the reader understand the disease process, management and prevention strategies of chronic bronchitis.

Cerebral Venous Thrombosis, Jennifer C. Lyons

Nursing Student Class Projects (Formerly MSN)

A deeper dive into Cerebral Venous Thrombosis including, pathological process, risk factors, signs and symptoms, how to diagnose, treatment, nursing implications and a case study.

Chemotherapy Induced Neutropenia And Increased Risk For Sepsis, Megan E. Moore-Weber

Nursing Student Class Projects (Formerly MSN)

Available treatment options for patients diagnosed with cancer include surgery, the administration of chemotherapeutic agents, radiation therapy, or a combination of these modalities. Chemotherapeutic agents utilized to treat cancer have a variety of potential side effects. One of the most common and well known side effects associated with the administration of chemotherapeutic agents is neutropenia. Neutropenia places oncology patients at an increased risk of contracting infections which may lead to a life threatening complication known as sepsis. Sepsis is an extremely dangerous oncologic emergency requiring prompt medical treatment. Failure to recognize symptoms associated with sepsis in the neutropenic patient and …

Comparison Of Testosterone Replacement Therapy Medications In The Treatment Of Hypogonadism, Christopher M. Williams, Donna S. Freeborn, Karlen Luthy

Student Works

Hypogonadism is one of the most common endocrinologic syndromes seen in clinical practice. Testosterone replacement therapy (TRT) is one possible treatment option for men with hypogonadism. When TRT is a viable treatment option, routes of administration, effectiveness, patient compliance, cost, and potential side effects should be carefully considered by the Nurse Practitioner. In the United States TRT is available via intramuscular, nasal, buccal, and topical routes. All transdermal testosterone is the most effective when regulating testosterone levels. Depotestosterone, an injectable form of testosterone, promotes patient compliance, is considered safe, and is affordable. Nurse Practitioners should initiate TRT with Depotestosterone.

Apoe Ε4 Allele Modifies The Association Of Lead Exposure With Age-Related Cognitive Decline In Older Individuals, Diddier Prada, Elena Colicino, Melinda C. Power, Marc G Weisskopf, Jia Zhong, Lifang Hou, Avron Spiro, Pantel Vokonas, Plus 4 Others...

Epidemiology Faculty Publications

BACKGROUND: Continuing chronic and sporadic high-level of lead exposure in some regions in the U.S. has directed public attention to the effects of lead on human health. Long-term lead exposure has been associated with faster cognitive decline in older individuals; however, genetic susceptibility to lead-related cognitive decline during aging has been poorly studied.

METHODS: We determined the interaction of APOE-epsilon variants and environmental lead exposure in relation to age-related cognitive decline. We measured tibia bone lead by K-shell-x-ray fluorescence, APOE-epsilon variants by multiplex PCR and global cognitive z-scores in 489 men from the VA-Normative Aging Study. To determine global cognitive …

Prospective Evaluation Of The Influence Of Iterative Reconstruction On The Reproducibility Of Coronary Calcium Quantification In Reduced Radiation Dose 320 Detector Row Ct., Andrew D. Choi, Eric S Leifer, Jeannie Yu, Sujata M Shanbhag, Kathie Bronson, Andrew E Arai, Marcus Y Chen

Radiology Faculty Publications

BACKGROUND: Coronary artery calcium (CAC) predicts coronary heart disease events and is important for individualized cardiac risk assessment. This report assesses the interscan variability of CT for coronary calcium quantification using image acquisition with standard and reduced radiation dose protocols and whether the use of reduced radiation dose acquisition with iterative reconstruction (IR; "reduced-dose/IR ") allows for similar image quality and reproducibility when compared to standard radiation dose acquisition with filtered back projection (FBP; "standard-dose/FBP") on 320-detector row computed tomography (320-CT).

METHODS: 200 consecutive patients (60 ± 9 years, 59% male) prospectively underwent two standard- and two reduced-dose acquisitions (800 …

Selective Serotonin-Norepinephrine Reuptake Inhibitors-Induced Takotsubo Cardiomyopathy, Rahul Vasudev, Upamanyu Rampal, Hiten Patel, Kunal Patel, Mahesh Bikkina, Fayez Shamoon

NYMC Faculty Publications

CONTEXT: Takotsubo translates to "octopus pot" in Japanese. Takotsubo cardiomyopathy (TTC) is characterized by a transient regional systolic dysfunction of the left ventricle. Catecholamine excess is the one most studied and favored theories explaining the pathophysiology of TTC.

CASE REPORT: We present the case of a 52-year-old Hispanic female admitted for venlafaxine-induced TTC with a review literature on all the cases of Serotonin-norepinephrine reuptake inhibitors (SNRI)-associated TTC published so far.

CONCLUSION: SNRI inhibit the reuptake of catecholamines into the presynaptic neuron, resulting in a net gain in the concentration of epinephrine and serotonin in the neuronal synapses and causing iatrogenic …

Takotsubo Cardiomyopathy: The Pathophysiology Of Broken Heart Syndrome, Mason Murrey

Nursing Student Class Projects (Formerly MSN)

First identified in 1992 in Japan, Takotsubu Cardiomyopathy is a stress-induced cardiomyopathy that presents identically to ST-segment elevated myocardial infarction (STEMI). Termed Broken Heart Syndrome for its correlation to stressful events such as the loss of a spouse or family member, Takotsubo is a complex phenomenon in the world of cardiac care. Over-saturation of endogenous catecholamines is the most popular explanation for this clinical condition, but other explanations such as parasympathetic nervous system dysfunction and coronary artery vasospasm are also revealing themselves as causative factors.

Impact Of Lung Function On Exacerbations, Health Care Utilization, And Costs Among Patients With Copd, Xuehua Ke, Jessica Marvel, Tzy-Chyi Yu, Debra Wertz, Caroline Geremakis, Liya Wang, Judith J. Stephenson, David M. Mannino

Preventive Medicine and Environmental Health Faculty Publications

Objective: To evaluate the impact of lung function, measured as forced expiratory volume in 1 second (FEV₁) % predicted, on health care resource utilization and costs among patients with COPD in a real-world US managed-care population.

Methods: This observational retrospective cohort study utilized administrative claim data augmented with medical record data. The study population consisted of patients with one or more medical claims for pre- and postbronchodilator spirometry during the intake period (July 1, 2012 to June 30, 2013). The index date was the date of the earliest medical claim for pre- and postbronchodilator spirometry. Spirometry results were …

Third-Party Reproductive Practices: Legislative Inertia And The Need For Nuanced Empirical Data, Susan Markens

Publications and Research

In their article, ‘Gamete donor anonymity and limits on numbers of offspring: the views of three stakeholders’, Margaret K. Nelson, Rosanna Hertz and Wendy Kramer draw on survey data from gamete donors, parents who used gametes to conceive, and donor-conceived offspring in order to understand the position that various stakeholders are likely to hold regarding the regulation of two issues pertaining to gamete donation: anonymity and limits on numbers of offspring.1 This commentary elaborates on the politics underlying conflicts and agreements among various stakeholders involved with third-party reproduction and details the need for data to better inform legislation regarding assisted …

Cytojournal Quiz Cases: Publishing Open-Access, Pubmed-Searchable Cytopathology Cases With Educational Messages, Katherine G. Akers, Vinod B. Shidham

Library Scholarly Publications

No abstract provided.

Mechanisms Of Progranulin Action And Regulation In Genitourinary Cancers., Ryuta Tanimoto, Kuojung G Lu, Shi-Qiong Xu, Simone Buraschi, Antonino Belfiore, Renato V. Iozzo, Andrea Morrione

Department of Urology Faculty Papers

The growth factor progranulin has emerged in recent years as a critical regulator of transformation in several cancer models, including breast cancer, glioblastomas, leukemias, and hepatocellular carcinomas. Several laboratories, including ours, have also demonstrated an important role of progranulin in several genitourinary cancers, including ovarian, endometrial, cervical, prostate, and bladder tumors, where progranulin acts as an autocrine growth factor thereby modulating motility and invasion of transformed cells. In this review, we will focus on the mechanisms of action and regulation of progranulin signaling in genitourinary cancers with a special emphasis on prostate and bladder tumors.

Breast Cancer Risk Assessment: Calculating Lifetime Risk Using The Tyrer-Cuzick Model, Deborah O. Himes Phd, Aprn-Bc, Beth E. Luthy, Aubri E. Root, Amanda Gammon

Faculty Publications

One size does not fit all for breast cancer screening. Early detection and prevention are most effective for those most at risk. Several United States organizations recommend offering annual screening breast magnetic resonance imaging in addition to mammography for women with > 20% lifetime risk for breast cancer using models that take extensive family history into account. The purpose of this article is to help nurse practitioners make critical decisions about breast cancer screening and referrals to genetic services for women based on their lifetime risk for breast cancer. This article reviews several software-based risk assessment models and provides instructions for …

Hearing And Vision Screening Tools For Long-Term Care Residents With Dementia: Protocol For A Scoping Review, Katherine Mcgilton, Fiona Hobler, Jennifer Campos Ph.D, Kate Dupuis, Tammy Labreche, Dawn M. Guthrie, Jonathan Jarry, Walter Wittich

Kinesiology and Physical Education Faculty Publications

Introduction Hearing and vision loss among long-term care (LTC) residents with dementia frequently goes unnoticed and untreated. Despite negative consequences for these residents, there is little information available about their sensory abilities and care assessments and practices seldom take these abilities or accessibility needs into account. Without adequate knowledge regarding such sensory loss, it is difficult for LTC staff to determine the level of an individual's residual basic competence for communication and independent functioning. We will conduct a scoping review to identify the screening measures used in research and clinical contexts that test hearing and vision in adults aged over …

Cell Therapy Must Be Regulated As Medicine, Zihai Li, Delong Liu

NYMC Faculty Publications

Background

The current standard of care for relapsed and refractory acute lymphoblastic leukemia (ALL) is combination chemotherapy.

Case presentation

We report a case of highly refractory ALL who was treated with blinatumomab. The ALL in this patient relapsed within a month after completion of hyperCVAD regimen and was refractory to high dose mitoxantrone/cytarabine and CLAG regimens.

Conclusion This highly refractory pre-B Ph− ALL was induced to complete remission after one course of single agent blinatumomab.

Complete Remission After Single Agent Blinatumomab In A Patient With Pre-B Acute Lymphoid Leukemia Relapsed And Refractory To Three Prior Regimens: Hypercvad, High Dose Cytarabine Mitoxantrone And Clag, Katherine Linder, Deepthi Gandhiraj, Madhura Hanmantgad, Karen Seiter, Delong Liu

NYMC Faculty Publications

BACKGROUND: The current standard of care for relapsed and refractory acute lymphoblastic leukemia (ALL) is combination chemotherapy.

CASE PRESENTATION: We report a case of highly refractory ALL who was treated with blinatumomab. The ALL in this patient relapsed within a month after completion of hyperCVAD regimen and was refractory to high dose mitoxantrone/cytarabine and CLAG regimens.

CONCLUSION: This highly refractory pre-B Ph(-) ALL was induced to complete remission after one course of single agent blinatumomab.

Ovarian Tumour Growth Is Characterized By Mevalonate Pathway Gene Signature In An Orthotopic, Syngeneic Model Of Epithelial Ovarian Cancer., James B Greenaway, Carl Virtanen, Kata Osz, Tamas Revay, Daniel Hardy, Trevor Shepherd, Gabriel Dimattia, Jim Petrik

Physiology and Pharmacology Publications

Epithelial ovarian cancer (EOC) is the most lethal gynecological cancer and often is not detected until late stages when cancer cells transcoelomically metastasize to the abdomen and typically become resistant to therapy resulting in very low survival rates. We utilize an orthotopic, syngeneic mouse model to study late stage disease and have discovered that the tumor cells within the abdominal ascites are irreversibly re-programmed, with an increased tumorigenicity and resistance to apoptosis. The goal of this study was to characterize the reprogramming that occurred in the aggressive ascites-derived cells (28-2 cells) compared to the original cell line used for tumor …

A Century Of Trends In Adult Human Height, Con Burns, Tara Coppinger

Publications

Being taller is associated with enhanced longevity, and higher education and earnings. We reanalysed 1472 population-based studies, with measurement of height on more than 18.6 million participants to estimate mean height for people born between 1896 and 1996 in 200 countries. The largest gain in adult height over the past century has occurred in South Korean women and Iranian men, who became 20.2 cm (95% credible interval 17.5–22.7) and 16.5 cm (13.3–19.7) taller, respectively. In contrast, there was little change in adult height in some sub-Saharan African countries and in South Asia over the century of analysis. The tallest people …

Human Herpesvirus Multiplex Ddpcr Detection In Brain Tissue From Low- And High-Grade Astrocytoma Cases And Controls., Cheng-Te Major Lin, Emily C Leibovitch, M Isabel Almira-Suarez, Steven Jacobson

Pathology Faculty Publications

BACKGROUND: Glioblastoma (GBM) is a fatal CNS malignancy, representing 50 % of all gliomas with approximately 12-18 months survival time after initial diagnosis. Recently, the human herpesvirus cytomegalovirus (CMV) has been suggested to have an oncogenic role, yet this association remains controversial. In addition, human herpesvirus 6 (HHV-6) and Epstein-Barr virus (EBV) have also been associated with low-grade gliomas, but few studies have examined HHV-6 and EBV in glioblastomas. Droplet digital PCR (ddPCR) is a highly precise diagnostic tool that enables the absolute quantification of target DNA. This study examines the association between multiple human herpesviruses and astrocytomas.

METHODS: This …

Sarcoidosis Activates Diverse Transcriptional Programs In Bronchoalveolar Lavage Cells., Sina A. Gharib, Anagha Malur, Isham Huizar, Barbara P. Barna, Mani S. Kavuru, Lynn M. Schnapp, Mary Jane Thomassen

Division of Pulmonary, Allergy, and Critical Care Medicine Presentations and Grand Rounds

BACKGROUND: Sarcoidosis is a multisystem immuno-inflammatory disorder of unknown etiology that most commonly involves the lungs. We hypothesized that an unbiased approach to identify pathways activated in bronchoalveolar lavage (BAL) cells can shed light on the pathogenesis of this complex disease.

METHODS: We recruited 15 patients with various stages of sarcoidosis and 12 healthy controls. All subjects underwent bronchoscopy with lavage. For each subject, total RNA was extracted from BAL cells and hybridized to an Affymetrix U133A microarray. Rigorous statistical methods were applied to identify differential gene expression between subjects with sarcoidosis vs.

CONTROLS: To better elucidate pathways differentially activated …

Mir-27a And Mir-27b Regulate Autophagic Clearance Of Damaged Mitochondria By Targeting Pten-Induced Putative Kinase 1 (Pink1), Jaekwang Kim, Fabienne C. Fiesel, Krystal C. Belmonte, Roman Hudec, Wang-Xia Wang, Chaeyoung Kim, Peter T. Nelson, Wolfdieter Springer, Jungsu Kim

Pathology and Laboratory Medicine Faculty Publications

Background: Loss-of-function mutations in PINK1 and PARKIN are the most common causes of autosomal recessive Parkinson’s disease (PD). PINK1 is a mitochondrial serine/threonine kinase that plays a critical role in mitophagy, a selective autophagic clearance of damaged mitochondria. Accumulating evidence suggests mitochondrial dysfunction is one of central mechanisms underlying PD pathogenesis. Therefore, identifying regulatory mechanisms of PINK1 expression may provide novel therapeutic opportunities for PD. Although post-translational stabilization of PINK1 upon mitochondrial damage has been extensively studied, little is known about the regulation mechanism of PINK1 at the transcriptional or translational levels.

Results: Here, we demonstrated that microRNA-27a (miR-27a) and …

Comparison Of A Powdered, Acidified Liquid, And Non-Acidified Liquid Human Milk Fortifier On Clinical Outcomes In Premature Infants., Melissa Thoene, Elizabeth R. Lyden, Kara Weishaar, Elizabeth Elliott, Ruomei Wu, Katelyn White, Hayley Timm, Ann Anderson-Berry

Journal Articles: Pediatrics

We previously compared infant outcomes between a powdered human milk fortifier (P-HMF) vs. acidified liquid HMF (AL-HMF). A non-acidified liquid HMF (NAL-HMF) is now commercially available. The purpose of this study is to compare growth and outcomes of premature infants receiving P-HMF, AL-HMF or NAL-HMF. An Institutional Review Board (IRB) approved retrospective chart review compared infant outcomes (born < 2000 g) who received one of three HMF. Growth, enteral nutrition, laboratory and demographic data were compared. 120 infants were included (P-HMF = 46, AL-HMF = 23, NAL-HMF = 51). AL-HMF infants grew slower in g/day (median 23.66 vs. P-HMF 31.27, NAL-HMF 31.74 (p < 0.05)) and in g/kg/day, median 10.59 vs. 15.37, 14.03 (p < 0.0001). AL-HMF vs. NAL-HMF infants were smaller at 36 weeks gestational age (median 2046 vs. 2404 g, p < 0.05). However AL-HMF infants received more daily calories (p = 0.21) and protein (p < 0.0001), mean 129 cal/kg, 4.2 g protein/kg vs. P-HMF 117 cal/kg, 3.7 g protein/kg , NAL-HMF 120 cal/kg, 4.0 g protein/kg. AL-HMF infants exhibited lower carbon dioxide levels after day of life 14 and 30 (p < 0.0001, p = 0.0038). Three AL-HMF infants (13%) developed necrotizing enterocolitis (NEC) vs. no infants in the remaining groups (p = 0.0056). A NAL-HMF is the most optimal choice for premature human milk-fed infants in a high acuity neonatal intensive care unit (NICU).

Phenotypes Associated With Knockouts Of Eight Dense Granule Gene Loci (Gra2-9) In Virulent Toxoplasma Gondii, Leah M. Rommereim, Valeria Bellini, Barbara A. Fox, Graciane Pètre, Camille Rak, Bastien Touquet, Delphine Aldebert, Jean-François Dubremetz, Marie-France Cesbron-Delauw, Corinne Mercier, David J. Bzik

Dartmouth Scholarship

Toxoplasma gondii actively invades host cells and establishes a parasitophorous vacuole (PV) that accumulates many proteins secreted by the dense granules (GRA proteins). To date, at least 23 GRA proteins have been reported, though the function(s) of most of these proteins still remains unknown. We targeted gene knockouts at ten GRA gene loci (GRA1-10) to investigate the cellular roles and essentiality of these classical GRA proteins during acute infection in the virulent type I RH strain. While eight of these genes (GRA2-9) were successfully knocked out, targeted knockouts at the GRA1 and GRA10 loci were not …

Vaccination Policies Of Utah Family Practice Clinics, Karlen Beth Luthy, Levi R. Kohler, Janelle L B Macintosh, Lacey M. Eden, Renea L. Beckstrand, Emily L. Wright, Katherine Edmonds

Faculty Publications

Background and Purpose: The purpose of this study was to collect information regarding healthcare worker (HCW) vaccination policies in Utah family practice clinics. Methods: The study was conducted in Utah family practice clinics in the most densely populated counties in the state and was a cross-sectional descriptive design. Data were collected from 155 family practice clinic managers. Analyses included frequencies and percentages for quantitative items and a content analysis for open-ended items. Conclusions: HCWs are employed in environments where infectious diseases can be easily spread from person to person, thus, vaccinations can be instrumental in protecting the health of HCWs …

Comparison Of A Powdered, Acidified Liquid, And Non-Acidified Liquid Human Milk Fortifier On Clinical Outcomes In Premature Infants., Melissa Thoene, Elizabeth Lyden, Kara Weishaar, Elizabeth Elliott, Ruomei Wu, Katelyn White, Hayley Timm, Ann Anderson-Berry

Journal Articles: Medical Nutrition

We previously compared infant outcomes between a powdered human milk fortifier (P-HMF) vs. acidified liquid HMF (AL-HMF). A non-acidified liquid HMF (NAL-HMF) is now commercially available. The purpose of this study is to compare growth and outcomes of premature infants receiving P-HMF, AL-HMF or NAL-HMF. An Institutional Review Board (IRB) approved retrospective chart review compared infant outcomes (born < 2000 g) who received one of three HMF. Growth, enteral nutrition, laboratory and demographic data were compared. 120 infants were included (P-HMF = 46, AL-HMF = 23, NAL-HMF = 51). AL-HMF infants grew slower in g/day (median 23.66 vs. P-HMF 31.27, NAL-HMF 31.74 (p < 0.05)) and in g/kg/day, median 10.59 vs. 15.37, 14.03 (p < 0.0001). AL-HMF vs. NAL-HMF infants were smaller at 36 weeks gestational age (median 2046 vs. 2404 g, p < 0.05). However AL-HMF infants received more daily calories (p = 0.21) and protein (p < 0.0001), mean 129 cal/kg, 4.2 g protein/kg vs. P-HMF 117 cal/kg, 3.7 g protein/kg , NAL-HMF 120 cal/kg, 4.0 g protein/kg. AL-HMF infants exhibited lower carbon dioxide levels after day of life 14 and 30 (p < 0.0001, p = 0.0038). Three AL-HMF infants (13%) developed necrotizing enterocolitis (NEC) vs. no infants in the remaining groups (p = 0.0056). A NAL-HMF is the most optimal choice for premature human milk-fed infants in a high acuity neonatal intensive care unit (NICU).

Student Perception Of The Impact Of Audience Response Software In A Team-Based Learning Self-Care Course, Clark Kebodeaux, Leslie Woodyard, Golden Peters, Patrick Finnegan

Pharmacy Practice and Science Presentations

Objectives: Evidence evaluating audience response systems (ARS) used in team-based learning (TBL) compared to traditional classes is limited. The objectives of this study are to evaluate student perceptions of the technology and compare students’ assessment of technology with their performance.

Method: TBL was implemented in the required self-care course (PP2120: Introduction to Pharmaceutical Care: Non-prescription drugs) at St. Louis College of Pharmacy, and an audience response system was implemented in Fall 2015. At the conclusion of the course, a web-based survey was administered to students.

Results: Of the 29 students who successfully completed the course, 23 (79%) completed the survey. …

Urinary Tract Infection, Amanda Weilbacher

Nursing Student Class Projects (Formerly MSN)

Abstract

Urinary tract infection (UTI) is a common infection that affects numerous men and women throughout their lives. UTI is an inflammation of the urinary epithelium often caused by bacteria from the gastrointestinal tract or vaginal colonization when uropathogens adhere to uroepithelial cells and travel up the urethra. UTI is the second most common infection in the use of antimicrobial treatment in primary and secondary care setting. The prominence of UTIs and the increased antimicrobial resistance in the population has created a need for further knowledge of UTI pathology and its prevention in primary care settings. Research on the identification …

Aortic Stenosis, Cody Houseman

Nursing Student Class Projects (Formerly MSN)

A recent influx of patients undergoing the transcatheter aortic valve replacement (TAVR) procedure sparked interest in the pathophysiologic process of Aortic Stenosis (AS), especially in the geriatric population. AS is mostly asymptomatic until later stages of the disease, which delays treatment and intervention leading to poor outcomes and prognosis, especially for those who are not surgical candidates. The TAVR procedure has allowed patients who are otherwise not candidates for open heart surgery undergo valve replacement in a low risk fashion, prolonging life and improving quality of life. AS causes an increase in afterload, decreasing outflow of blood from the left …