Medicine and Health Sciences Commons^™

Oral Health Status And Related Risk Factors Among Adolescents Attending High Schools In Khartoum, Sudan: A Cross-Sectional Study, Hajir Omara, Amal Elamin

All Works

Objectives Effective dental services must be based on reliable evidence of oral diseases status and treatment needs. The aim of this study was to assess oral health status and associated risk factors among adolescents attending high school in Khartoum, Sudan. Methods A school-based survey was conducted among 420 adolescents (13–18 years old). Participants completed a questionnaire about their socio-demographics and oral habits. They received clinical examination, assessing their oral health status using the World Health Organization (WHO) oral health survey for dentition and periodontal status; mean Decayed, Missing and Filled Teeth (DMFT), and Community Periodontal Index (CPI). Results High dental …

Targeting Myeloid Protein Kinase C Signaling To Overcome Immune Suppression And Improve Immunotherapy In Cancer, Mehdi Chaib

Theses and Dissertations (ETD)

Checkpoint immunotherapy unleashes T cell antitumor potential which has revolutionized cancer treatment showing unprecedented long-term responses. However, most patients do not respond to immunotherapy which often correlates with a dysfunctional or immunosuppressive myeloid compartment. Immunosuppressive myeloid cells comprise Myeloid-derived suppressor cells (MDSCs) and tumor-associated macrophages (TAMs) and can suppress T cells via production of immunosuppressive factors. Conversely, efficient cytotoxic T cell priming is dependent on the ability of antigen-presenting cells (APCs), mainly conventional dendritic cells (cDCs) and macrophages, to present or cross-present tumor antigens to T cells. Thus, targeting immunosuppressive myeloid cells while simultaneously enhancing APCs represents a promising strategy …

The Detection Of Clozapine In Oral Fluid Via A Kinetic Interaction Of Microparticles In Solution (Kims) Assay, Elizabeth Gunning

Student Theses

In recent years, the use of antipsychotic medications has rapidly increased. Most of these medications have a high risk potential. Due to this risk potential, patients who are prescribed these medications have to be monitored. Therapeutic drug monitoring (TDM) has become extremely important in the clinical environment. Physicians rely on TDM to make sure patients are adhering to their prescription and to make decisions about whether the medication is working. Clozapine is a very popular antipsychotic used in the treatment of schizophrenia. The current method for TDM for clozapine is a blood test. This causes challenges for physicians, who need …

Tobacco 21 Laws May Reduce Smoking And Tobacco-Related Health Disparities Among Youth In The U.S., David C. Colston, Yanmel Xie, Megan E. Patrick, Jim F. Thrasher Ph.D., Ma, Ms, Andrea R. Titus, Michael R. Elliot, David T. Levy, Nancy L. Fleischer

Faculty Publications

The goal of our study is to understand the impact of Tobacco 21 (T21) laws on youth smoking and health equity. We conducted modified Poisson regression models using 2014–2019 Monitoring the Future data to measure the impact of attending school in a county 100% covered by a T21 law versus counties with <100% T21 coverage on past 30-day smoking participation (n = 262,632), first cigarette smoking initiation (n = 189,698), and daily smoking initiation among 8th, 10th, and 12th graders (n = 214,496), separately. Additive interactions were tested between T21 coverage and sex, race/ethnicity, parental education, and college plans. T21 coverage was associated with a lower likelihood of smoking participation among 12th graders. T21 coverage was most strongly associated with a lower likelihood of smoking participation among: Hispanic and NH (Non-Hispanic) Other/Multiracial individuals; respondents with parents who had less than a college education; and respondents who were not definitely planning on attending college. T21 laws were associated with a lower likelihood of smoking participation among 12th graders. T21 policies were most impactful for individuals disproportionately impacted by tobacco, indicating T21 laws might help reduce tobacco-related health disparities.

Carbonic Anhydrase Ix Proteoglycan-Like And Intracellular Domains Mediate Pulmonary Microvascular Endothelial Cell Repair And Angiogenesis, Reece P. Stevens, Mikhail F. Alexeyev, Natalia Kozhukhar, Viktoria Pastukh, Sunita S. Paudel, Jessica Bell, Dhananjay T. Tambe, Troy Stevens, Ji Young Lee

University Faculty and Staff Publications

The lungs of patients with acute respiratory distress syndrome (ARDS) have hyperpermeable capillaries that must undergo repair in an acidic microenvironment. Pulmonary microvascular endothelial cells (PMVECs) have an acid-resistant phenotype, in part due to carbonic anhydrase IX (CA IX). CA IX also facilitates PMVEC repair by promoting aerobic glycolysis, migration, and net- work formation. Molecular mechanisms of how CA IX performs such a wide range of functions are unknown. CA IX is composed of four domains known as the proteoglycan-like (PG), catalytic (CA), transmembrane (TM), and intracellular (IC) domains. We hypothesized that the PG and CA domains mediate PMVEC pH …

Hyperinsulinemic Hypoglycemia And Growth Hormone Deficiency Secondary To 20p11 Deletion, Erica Wee, Kavitha Dileepan, Sarah Tsai, Emily Paprocki

Posters

No abstract provided.

Hemoglobin A1c Increase In Youth At Risk For Developing Type 2 Diabetes Mellitus During The Covid-19 Pandemic, Erica Wee, Ashley Sherman, Mark A. Clements, Kelsee Halpin, Yun Yan

Posters

No abstract provided.

Myocardial Work By Strain Echocardiography: A Predictor Of Exercise Capacity In The Fontan Population, Amulya Buddhavarapu, Suma Goudar, David A. White, Daniel Forsha, Doaa Aly

Posters

INTRODUCTION: Global myocardial work index (GWI) obtained by non-invasive pressure-strain loops is a fast-emerging tool to assess myocardial contractility, independent of loading conditions. Data about the feasibility and utility of this modality in single ventricles are still lacking. AIM: We aimed to explore the relationship between the non-invasive myocardial work indices and exercise parameters in the Fontan population. METHOD: Fontan patients were prospectively evaluated by exercise testing and echocardiography. The systemic ventricle was tracked in 3 orthogonal apical planes for global longitudinal strain (GLS). Pressure-strain loops were generated against brachial blood pressure (surrogate for ventricular systolic pressure in the absence …

Social Worker Student’S Anxiety, And Alcohol Consumption During The Covid-19 Pandemic, David Adler

Electronic Theses, Projects, and Dissertations

The COVID-19 pandemic has been extremely impactful on a vast majority of the population, either from losing a possible loved one, or the pandemonium that arose in its wake. The purpose of this study is to better understand how much of an impact the COVID-19 pandemic has had on social worker students’ mental health, specifically, how it has affected their levels of stress, anxiety, and levels of alcohol consumption. This study is significant because the pandemic has had a substantial impact on the mental health of so many individuals, and it is important to research just how large these effects …

Inflammatory Diseases And Resections Of The Digestive Tract Influence The Risk Of Circulating Food-Specific-Igg, Jacques Izard, Walker Carson, Joseph Baumert, Jennifer Clarke

Department of Food Science and Technology: Faculty Publications

Objectives: Individuals affected with inflammatory diseases of the digestive tract or have had surgical removal of sections of the digestive tract are often in need to adjust their diet. The symptomatology associated with food intake issues is often informally reported as food sensitivity. We investigated the circulating food-specific-IgG among ten conditions.

Conclusion: The risk of the having circulating food-specific IgG differed widely among the conditions investigated. The maintenance of a colonic environment might influence the risk of food sensitivity in ostomates.

Retained Lens Fragment Presenting 32 Years After Cataract Extraction, Thomas Tien, Marcos A Crespo, Tatyana Milman, Zeba Syed

Wills Eye Hospital Papers

Purpose: To report a patient with retained lens material presenting over three decades after initial cataract extraction with fluctuating corneal edema and intraocular inflammation.

Observations: A 66-year-old man presented with a first episode of decreased vision and photophobia 32 years after cataract extraction without intraocular lens implantation in the right eye. Slit lamp examination revealed a tan-colored oblong mass in the inferior angle, in addition to corneal edema and an anterior chamber reaction. The patient was aphakic with traumatic mydriasis, and accordingly it was noted that the mass shifted location between anterior and posterior chambers over subsequent evaluations. The anterior …

The 5th Edition Of The World Health Organization Classification Of Haematolymphoid Tumours: Lymphoid Neoplasms, Rita Alaggio, Catalina Amador, Ioannis Anagnostopoulos, Ayoma D. Attygalle, Iguaracyra Barreto De Oliveira Araujo, Emilio Berti, Govind Bhagat, Anita Maria Borges, Daniel Boyer, Shahin Sayed

Pathology, East Africa

We herein present an overview of the upcoming 5th edition of the World Health Organization Classification of Haematolymphoid Tumours focussing on lymphoid neoplasms. Myeloid and histiocytic neoplasms will be presented in a separate accompanying article. Besides listing the entities of the classification, we highlight and explain changes from the revised 4th edition. These include reorganization of entities by a hierarchical system as is adopted throughout the 5th edition of the WHO classification of tumours of all organ systems, modification of nomenclature for some entities, revision of diagnostic criteria or subtypes, deletion of certain entities, and introduction of new entities, as …

Adopting Clinical Practice Guidelines For Pharmacologic Management Of Acute Spinal Cord Injury From A Developed World Context To A Developing Global Region, Seyed Behnam Jazayeri, Seyed Farzad Maroufi, Zahra Ghodsi, Heshmatollah Ghawami, Ahmad Pourrashidi, Abbas Amirjamshidi, Mojtaba Mojtahedzadeh, Jalil Arabkheradmand, Farzin Farahbakhsh, Maryam Shabany, Morteza Faghih-Jouibari, Michael G Fehlings, Brian K Kwon, James Harrop, Vafa Rahimi-Movaghar

Department of Neurosurgery Faculty Papers

Background: Proper utilization of high-quality clinical practice guidelines (CPGs) eliminates the dependence of patients' outcomes on the ability and knowledge of "individual" health care providers and reduces unwarranted variation in care. The aim of this study was to adapt/adopt two CPGs for pharmacologic management of acute spinal cord injury (SCI) using guideline adaptation methods.

Methods: This study was conducted based on the ADAPTE process. Following establishment of an organizing committee and choosing the health topics, we appraised the quality of the CPGs using the Appraisal of Clinical Guidelines for Research & Evaluation II (AGREE II). Then, the authors extracted and …

The Urinary Microbiome And Biological Therapeutics: Novel Therapies For Urinary Tract Infections, Ciara Kenneally, Craig P. Murphy, Roy D. Sleator, Eamonn P. Culligan

Department of Biological Sciences Publications

The discovery of microbial communities in the urinary tract (the urobiome) has fundamentally altered the previous doctrine regarding urine sterility and associated urinary disorders. Recent advances in culturing and culture-independent DNA sequencing technologies have characterised the resident microbial community in the urobiome, and has, in turn, demonstrated how community imbalances potentially contribute to infection and disease. As we enter a post-antibiotic era, the effectiveness of standard antimicrobial treatments against multi-drug resistant (MDR) uropathogens is vastly diminished. Preliminary research is accumulating surrounding microbiome-based therapies, and their potential as non-antibiotic therapeutics. In this context, the urobiome is significantly underexplored, and knowledge regarding …

Maternal Socioeconomic Status And Infant Low Birth Weight: Interactions Across Generations, Kira M. Anderson

University Honors Theses

This article examines the interplay between low birth weight (LBW) and socioeconomic status (SES) across generations. Transgenerational research of LBW and SES is limited and poses certain challenges and nuances. A literature review was conducted which gathered studies that analyze both LBW and SES for two or more generations. Results of these studies are mixed, but the body of research is suggestive of patterns in which LBW and low SES may mutually exacerbate each other across generations. Furthermore, the research suggests that these patterns may be more severe among Black women. This paper calls into question the consequences that these …

Real-Time Fmri Neurofeedback And Ptsd: Efficacy In Symptom Relief And Neural Circuit Restoration, Sophia F. Ryker

University Honors Theses

Background: Posttraumatic stress disorder (PTSD) is recognized by the DSM-V as resulting from exposure to a traumatic event and the subsequent, prolonged experience of intrusive symptoms, avoidance behavior, altered cognitive functioning and hyperarousal. Current treatments often do not provide relief from symptoms and there is a need for neuro-scientifically informed interventions.

Methods: Through the review of all available studies using real-time fMRI neurofeedback (rt-fMRI-NF) as a treatment for PTSD, the efficacy of this therapeutic intervention was analyzed in order to make specific recommendations for the neurofeedback protocols of future studies.

Results: Evidence demonstrated successful reduction in symptom severity and normalizing …

Are Pregnant Women With Disability Prescribed Opioids More And At Higher Dosages Than Those Without Disability?: A Retrospective Cohort Study Of South Carolina Medicaid Beneficiaries, Chelsea L. Richard Phd, Msph, Bryan L. Love Pharm.D., Nansi Boghossian, James Hardin Ph.D., Suzanne Mcdermott

Faculty Publications

Background: Nationally, individuals with disability have higher rates of opioid use and misuse and are prescribed higher doses than those without disability. Opioid prescriptions during pregnancy are associated with adverse birth outcomes. Objective: To understand the difference in opioid prescribing during pregnancy over time by disability status among Medicaid beneficiaries who gave birth from 2008 to 2017 in South Carolina. Methods: Data from hospital discharges, vital records, and pharmacy were linked to determine the mother's disability status, opioid prescriptions filled during pregnancy, and other maternal characteristics. Disability status was characterized into physical disability, inflammatory conditions, intellectual and developmental disabilities (IDD), …

Group B Streptococcus Infection During Pregnancy And Infancy: Estimates Of Regional And Global Burden, Bronner P. Gonçalves, Simon R. Procte, Proma Paul, Jaya Chandna, Alexandra Lewin, Farah Seedat, Artemis Koukounari, Ziyaad Dangor, Shannon Leahy, Amina Abubakar

Institute for Human Development, East Africa

Background: Group B streptococcus (GBS) colonisation during pregnancy can lead to invasive GBS disease (iGBS) in infants, including meningitis or sepsis, with a high mortality risk. Other outcomes include stillbirths, maternal infections, and prematurity. There are data gaps, notably regarding neurodevelopmental impairment (NDI), especially after iGBS sepsis, which have limited previous global estimates. In this study, we aimed to address this gap using newly available multicountry datasets.

Methods: We collated and meta-analysed summary data, primarily identified in a series of systematic reviews published in 2017 but also from recent studies on NDI and stillbirths, using Bayesian hierarchical models, and …

Mental Health And Climate Change In Africa, Lukoye Atwoli, Joy Muhia, Zul Merali

Brain and Mind Institute

It is now widely acknowledged that low- and middle-income countries in Africa are among global hotspots for high vulnerability to climate change, despite making comparatively low contributions to this phenomenon. Climate change has been shown to affect mental health as a result of disruption of social and economic structures that populations depend on for good health, including mental health. After decades of neglect, recent efforts by governments such as in Kenya to address the twin issues of climate change and mental health demonstrate the growing importance of these issues. Here we briefly review the evidence of climate change impacts on …

The Racial And Ethnic Diversity Of The Family Physician Workforce In Non-Metropolitan And Metropolitan Counties, Lars E. Peterson, Zachary J. Morgan

Rural & Underserved Health Research Center Publications

Overview of Key Findings

• The family physician workforce is becoming more racially diverse; however, non-metropolitan family physicians are not.
• Using data from over 24,000 family physicians who either registered to continue their American Board of Family Medicine (ABFM) certification or completed the graduate survey from 2017 to 2019, we found that early career family physicians are more diverse than later career physicians (66.9% vs. 72.8% White; 58.3% vs. 44.0% female) but, in both groups, the percentage of White non-metropolitan family physicians was even higher (82.7% to 90.5%).
• Minority non-metropolitan family physicians, particularly Black and Native American/Alaska Native physicians, are more …

Anesthetic Effects Of Dexmeditomidine-Tiletamine/Zolazepam Combination In Cats Undergoing Ovariohysterectomy, Nunnapas Jiwlawat, Cholawat Pacharinsak, Sumit Durongphongtorn

The Thai Journal of Veterinary Medicine

Common injectable anesthetics in cats are alpha-2 receptor agonists and tiletamine/zolazepam. Xylazine shows higher rate of side effects because its lower specificity to alpha-2 receptors than dexmeditomidine. However, the use of drug combinations in cats is not much known. Therefore, alternative anesthetic combination should be investigated. Here, we examined the use of tiletamine/zolazepam with two doses of dexmedetomidine in cats. A total of 24 female cats, weight 3.05 ± 0.10 kg (mean ± SEM). Cats were randomly blinded given intramuscularly injection (IM) with either of such drug combination, representing dosage of low dose dexmedetomidine 7.5 μg/kg with tiletamine/zolazepam 3 mg/kg; …

Serological Diagnostic For Bovine Paratuberculosis In The Municipality Of Sotaquirá, Colombia, Alejandra Buitrago-López, Alejandra Buitrago-López, Alejandra Buitrago-López, Diana M. Bulla-Castañeda, Adriana M. Díaz-Anaya, Diego J. Garcia-Corredor, Julio Tobón Torreglosa, Diego Ortiz Ortega, Martín O. Pulido-Medellín

The Thai Journal of Veterinary Medicine

Bovine Paratuberculosis (BPT) or Johne’s disease is a pathology caused by Mycobacterium avium subsp. paratuberculosis (MAP). The parasite causes chronic granulomatous enteritis in domestic and wild grazers. Oral-fecal transmission is the most common form of transmission with calves less than six months old being the most susceptible but not presenting clinical symptoms until five years later. It is a disease that spreads during dairy production generating economic loss due to low productive yield and the early discarding of infected animals. The objective of our study was to perform a serological diagnostic of BPT in herds from the municipality of Sotaquirá, …

Complementary Effects Of White Rose Petal Extract On Canine Atopic Dermatitis, Seo-Jin Park, Taesik Yun, Yoonhoi Koo, Yeon Chae, Dohee Lee, Jooyoung Park, Yujin Choi, Ehn-Kyoung Choi, Hakhyun Kim, Yun-Bae Kim, Mhan-Pyo Yang, Byeong-Teck Kang

The Thai Journal of Veterinary Medicine

This study aimed to investigate the therapeutic efficacy of white rose petal extract (WRPE) in canine atopic dermatitis (CAD). Experiment 1 involved clinical assessments using atopic dogs and experiment 2 used beagles with experimentally induced dermatitis. The atopic dogs were divided into four groups: 1% WRPE solution (group 1), 0.5% WRPE solution (group 2), 1% WRPE cream (group 3) and 1% WRPE cream containing lipid granules (group 4). Three normal beagles were used for the experimental induction of dermatitis. Experimental dermatitis was induced by intradermal injections of histamine dihydrochloride, compound 48/80 or substance P. WRPE solution or cream was applied …

Occurrence And Characteristics Of Salmonella Isolated From Various Vegetable Sources: Potential For The Human-Food Interface In Salmonellosis In Vientiane, The Capital Of Laos Pdr, Dethaloun Meunsene, Thanaporn Eiamsam-Ang, Prapas Patchanee, Ratchadaporn Boripun, Phacharaporn Tadee, Sayaphet Rattanavong, Manivanh Vongsouvath, Pakpoom Tadee

The Thai Journal of Veterinary Medicine

Salmonella is one of the most frequently reported causes of bacterial foodborne outbreaks in the world. Despite this, cases associated with raw vegetable consumption have increased, however very few studies have focused on this. The present study is an overview of the role of vegetables as a concern for Salmonella circulating in Vientiane, the capital of the Lao People's Democratic Republic (Lao PDR). A cross-sectional study was surveyed during the first half 2019 on various types of vegetable sold in retailers in the area. The prevalence, serotype, antimicrobial resistance pattern and genetic profile of Salmonella were investigated. In this study, …

Diagnostic Imaging And Hematological And Cytological Analyses Play A Vital Role In Clinical Investigation And Selection Of Therapeutic Approaches In A Polo Pony With Septic Olecranon Bursitis, Rungrueang Yodsheewan, Ravisara Limsripan, Metha Chanda

The Thai Journal of Veterinary Medicine

A 19-year-old gelding polo pony was presented with a prominent protuberance at the tip of the right elbow and five days later, developed a marked swelling on the entire right foreleg with a high fever. Ultrasonography, performed on the caudal elbow region, demonstrated heterogeneous echogenic materials encapsulated in the fibrous capsule. The initial hematological analysis revealed anemia and a normal white blood count (WBC). Hyperbilirubinemia was detected biochemically. Pale yellow/turbid fluid was aspirated from the protuberance area, which showed septic exudate characteristics and contained Streptococcus spp. The pony was diagnosed with septic olecranon bursitis associated with streptococcal infection. The fluid-filled …

Mycotic Pyogranulomatous Enteritis In A German Shepherd: Imaging Diagnosis And Treatment, Phasamon Saisawart, Somchin Sutthigran, Apichart Srifawattana, Onjira Mitroupathum, Tanhatai Krajarngjang, Anudep Rungsipipat, Nan Choisunirachon

The Thai Journal of Veterinary Medicine

A five-year old, intact male, German Shepherd dog was presented to the hospital due to a history of depression, anorexia, vomiting and diarrhea. Physical examination revealed moderate emaciation and showed mild abdominal pain when Palpation. Abdominal radiographs and ultrasounds showed the distension of the small bowel loop due to partial obstruction of the colon by mural concentric thickening. Computed tomography (CT) scan showed an homogeneous, soft tissue mass with asymmetric thickening of the cecum traversing the colonic wall. Pre-operative blood profiles indicated normocytic normochromic mild anemia, hypoalbuminemia and mild hyperglobulinemia. Intestinal resection and anastomosis at the distal ileum to the …

Association Of Alcohol Use And Physical Activity With Body Mass Index In Mexican-Origin Adults, Natalia I Heredia, Qiong Dong, Shine Chang, Lorna H Mcneill

Faculty, Staff and Student Publications

BACKGROUND: Studies across racial/ethnic groups indicate that physical activity (PA) and alcohol consumption are positively associated, and that alcohol consumption is negatively associated with body mass index (BMI), but this relationship is less often evaluated in Hispanics. The purpose of this study was to assess the relationships between alcohol consumption, PA, and BMI in Hispanic adults.

METHODS: In this secondary data analysis of a Mexican-American cohort, we collected self-reported PA, alcohol consumption, and demographics, and measured height and weight. Linear regression assessed the association between PA and alcohol consumption with BMI, controlling for covariates. Total sample for analyses was n …

External Validation Of A Model Determining Risk Of Neoplastic Progression Of Barrett’S Esophagus In A Cohort Of Us Veterans, Theresa H Nguyen, Aaron P Thrift, Gyanprakash A Ketwaroo, Xianglin L Du, Luis Leon Novelo, Rollin George, Daniel G Rosen, Hashem B El-Serag

Faculty, Staff and Student Publications

BACKGROUND AND AIMS: Risk of esophageal adenocarcinoma (EAC) in those with Barrett's esophagus (BE) is 11-fold greater than the general population. It remains unclear which BE patients are at highest risk of progression to EAC. We aimed to validate a predictive model risk-stratifying BE patients.

METHODS: We conducted a retrospective cohort study at the Houston Veteran Affairs Medical Center of consecutive patients with a new diagnosis of BE from November 1990 to January 2019. Study follow-up was through February 2020. Patients were excluded if they had no follow-up EGD with esophageal biopsy sampling after the initial BE-diagnosing EGD or evidence …

Assessing The Established Competency Categories Of The Biosafety, Infection Prevention, And Public Health Professions: A Guide For Addressing Needed Professional Development Training For The Current And Next Pandemic, Robert J Emery, Scott J Patlovich, Kristin G King, John M Lowe, Janelle Rios

Faculty, Staff and Student Publications

A recent series of widespread infectious disease outbreaks has highlighted commonalities and differences between three key professions that operate on the front lines of response in support of research and/or direct healthcare providers: biosafety, infection prevention, and public health. This assessment, which builds upon previous study by the authors, examines the stated professional competency categories for these three areas, highlighting similarities and differences. This assessment is important as these professions are being drawn together in an operational environment driven by the current pandemic and inevitably future disease outbreaks. Cross-training opportunities for the various professions are proposed.

Leveraging Single Cell Technologies For The Characterization And Treatment Of Refractory Pancreatic Cancer, Maria Monberg

Dissertations and Theses (Open Access)

Heterogeneity is a hallmark of cancer, and the advent of multimodal single-cell technologies has helped uncover heterogeneity in a high-throughput manner in different cancers across varied contexts at an unprecedented resolution. In an effort to improve precision medicine approaches in pancreatic ductal adenocarcinoma (PDAC), a highly lethal malignancy with a mere 11% 5-year survival rate, this dissertation focuses on first questioning the assumptions of the most basic models used to study PDAC via multimodal single-cell characterization methods at multiple levels of biological organization (scCNVseq and snATACseq for DNA assays, scRNAseq for transcriptomics, and paired protein assays such as multiplexed immunofluorescence …