Medicine and Health Sciences Commons^™

Closing Gaps In The Care Of Patients With Heart-Kidney Disease: The Time Is Now., Janani Rangaswami

Department of Medicine Faculty Papers

No abstract present.

Presence And Implications Of Sarcopenia In Non-Alcoholic Steatohepatitis., Gregory Habig, Christa Smaltz, Dina Halegoua-De Marzio

Department of Medicine Faculty Papers

Sarcopenia, defined as the loss of muscle strength, mass, and functionality, confers a poor prognosis in the setting of cirrhosis. Given its clinical significance, a better understanding of the underlying mechanisms leading to cirrhosis, sarcopenia, and their co-occurrence may improve these patients' outcomes. Non-alcoholic steatohepatitis (NASH) shares many of the same etiologies as sarcopenia, including insulin resistance, chronic inflammation, and ectopic adipocyte deposition, which are hallmarks of metabolic syndrome (MS). NASH thus serves as a prime candidate for further exploration into the underlying pathophysiology and relationship between these three conditions. In this review, we discuss the natural history of NASH …

Development And Validation Of A Prediction Model For Stroke, Cardiac, And Mortality Risk After Non-Cardiac Surgery., Sang H Woo, Gregary D. Marhefka, Scott W. Cowan, Md, Lily Ackermann, Md

Department of Medicine Faculty Papers

Background: Commonly used cardiovascular risk calculators do not provide risk estimation of stroke, a major postoperative complication with high morbidity and mortality. We developed and validated an accurate cardiovascular risk prediction tool for stroke, major cardiac complications (myocardial infarction or cardiac arrest), and mortality after non-cardiac surgery.

Methods and Results: This retrospective cohort study included 1 165 750 surgical patients over a 4-year period (2007-2010) from the American College of Surgeons National Surgical Quality Improvement Program Database. A predictive model was developed with the following preoperative conditions: age, history of coronary artery disease, history of stroke, emergency surgery, preoperative serum …

Voxelotor Modulates The Analgesic Effect Of Certain Opioids., Samir K. Ballas

Cardeza Foundation for Hematologic Research

No abstract provided.

Lessons To Be Learned: Case Reports And Complications, John Lawrence, Md, David L. Fischman

Division of Cardiology Faculty Papers

No abstract provided.

Barriers To Psychosocial Support And Quality Of Life For Patients With Inflammatory Bowel Disease: A Survey Study, Rebecca Lawrence, Md, Cuckoo Choudhary, Md

Department of Medicine Faculty Papers

Background: Psychological comorbidities are common among people with inflammatory bowel disease (IBD) and are associated with worse disease outcomes. Evidence-based psychotherapy is an effective means to increase psychosocial support. This study aimed to identify the barriers to attending psychotherapy.

Methods: This electronic survey study included a demographic, quality of life, and barriers to psychotherapy questionnaire. Quality of life was assessed using the Short Inflammatory Bowel Disease Questionnaire (SIBDQ). Barriers were assessed using the Perceived Barriers to Psychological Treatments scale (PBPT). Linear regression was used to identify participant characteristics associated with higher PBPT scores.

Results: One hundred eighty-seven …

Bitter Taste Receptors For Asthma Therapeutics., Ajay P. Nayak, Sushrut D. Shah, James V. Michael, Deepak A. Deshpande

Center for Translational Medicine Faculty Papers

Clinical management of asthma and chronic obstructive pulmonary disease (COPD) has primarily relied on the use of beta 2 adrenergic receptor agonists (bronchodilators) and corticosteroids, and more recently, monoclonal antibody therapies (biologics) targeting specific cytokines and their functions. Although these approaches provide relief from exacerbations, questions remain on their long-term efficacy and safety. Furthermore, current therapeutics do not address progressive airway remodeling (AR), a key pathological feature of severe obstructive lung disease. Strikingly, agonists of the bitter taste receptors (TAS2Rs) deliver robust bronchodilation, curtail allergen-induced inflammatory responses in the airways and regulate airway smooth muscle (ASM) cell proliferation and mitigate …

Post-Pericardiotomy Syndrome Disguised As Fever Of Unknown Origin, Ida Micaily, Md, Bilal Lashari, Md, Aditya Munshi, Md, Zulfiqar Arif, Md

Division of Internal Medicine Faculty Papers & Presentations

Introduction:

Post -Pericardiotomy syndrome (PPS) is a clinical diagnosis characterized by fever, pericardial or pleural effusions, and a pericardial friction rub occurring over several days after cardiac surgery.

The infrequency of PPS can cause delay in recognition and management, thus leading to significant morbidity.

We present a case of fever of unknown origin, pericardial and pleural effusion secondary to postpericardiotomy syndrome 10 days after an Aortic Valve Replacement (AVR)

Poster presented at: American College of Physicians Southeast Regional Meeting on October 15th, 2016

Disseminated Nocardia Cyriacigeorgia Causing Pancreatitis In A Haploidentical Stem Cell Transplant Recipient., Jason Chen, Md, Jonathan Pan, Md, Joanne Filicko-O'Hara, Margaret Kasner, Phyllis Flomenberg

Department of Medicine Faculty Papers

We report the first published case of acute pancreatitis secondary to disseminated nocardiosis in a hematopoietic stem cell transplant (HSCT) recipient on chronic immunosuppression for graft-versus-host disease (GVHD). Nocardiosis in the HSCT population is relatively rare, and has not yet been described in haploidentical HSCT recipients. Our patient is a 28-year-old male with a history of haploidentical HSCT and GVHD of the skin and lung who was admitted to the hospital with acute pancreatitis. The workup for the etiology of his pancreatitis was initially unrevealing. He subsequently developed worsening sepsis and respiratory failure despite broad spectrum antimicrobials. After multiple bronchoscopies …

Book Club At Intern Orientation To Help Frame Professional Identity, Gretchen A. Diemer, Md, Emily Stewart, Md

Department of Medicine Posters

Background

Orientation is a whirlwind of regulations, reminders, rules and usually some social outlets. Very little of it helps new interns foster and celebrate their blossoming professional identity. The book club combats the hidden curriculum emphasizing regulations and policies by nurturing the growing sense of whom they are as physicians, actively placing value on the idea that they are developing a professional identity.

St Elevation Myocardial Infarction In A Young Adult: Expect The Unexpected, Shashank Jain, Md, Priya Rajagopalan, Md, Mitul Kanzaria, Md, Meir Mazuz, Md

Department of Medicine Posters

Background

• Acute myocardial infarction (MI) in young adults can present a diagnostic and therapeutic challenge
• Kawasaki disease (KD) is a vasculitis of unknown etiology that occurs in infancy and childhood
• Coronary artery aneurysms (CAA) are the most serious complication of untreated KD seen in upto 25% of patients
• Thrombosis of these CAA or coronary stenosis can present as MI in less than 2% of cases which mainly occur in the 1^st year of disease onset
• Late presentations in adult life is extremely rare

At The Leading Edge Of Change: Creation Of The Housestaff Quality And Safety Leadership Council, Ruben Rhoades, Md, Adam P. Johnson, Md, Mph, Rebecca C. Jaffe, Md, Bracken Babula, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Background:

The ACGME Clinical Learning Environment Review (CLER) is driving a national re-evaluation of the engagement and alignment of housestaff in institutional Quality and Safety.

In 2008, the concept of a housestaff quality and safety committee was born, as a means of driving practice change

Our CLER data suggested that we need a similar council

Reversibility Of Apixaban Anticoagulation With A Four-Factor Prothrombin Complex Concentrate In Healthy Volunteers., S Nagalla, Lynda Thomson, Y Oppong, B Bachman, I Chervoneva, Walter K. Kraft

Department of Pharmacology and Experimental Therapeutics Faculty Papers

It was hypothesized that the four-factor prothrombin complex concentrate (4F-PCC) Kcentra 25 unit/kg would reverse impairment of thrombin generation in healthy volunteers dosed with apixaban to steady state. In this randomized, two-period crossover, assessor-blinded trial, 12 healthy subjects received 5 mg apixaban every 12 h. Three h after the fifth dose, four-factor prothrombin complex concentrate (4F-PCC) 25 unit/kg or saline were infused. Serial blood samples were assessed for thrombin generation using PPP-reagent and PPP-reagent low, anti-Xa, PT, and PTT assays. Geometric mean ratio was calculated at 30 min postinfusion, and at 24, 48, and 72 h. Peak thrombin generation was …

Patient Perception Of Telehealth Primary Care Video Visits, Rhea E. Powell, Md, Mph, Jeffrey Henstenburg, Bs, Grace Cooper, Ba, Judd Hollander, Md, Kristin L. Rising, Md, Ms

Department of Medicine Posters

Introduction

• Telehealth (TH) is an innovative model of care delivery with potential to provide more patient-centered healthcare, allowing patients to receive care when and where is most convenient.
• To date, little is known about patient perceptions of receiving care with the use of TH video visits.

Ictal Asystole In A Patient With Posterior Reversible Encephalopathy Syndrome (Pres) And Seizures: A Case Report, Joanna Suski, Md, Reginald T. Ho, Md, Maromi Nei, Md

Department of Neurology Posters

BACKGROUND

• Ictal asystole is rare, seen in less than 1% of patients with epilepsy, and typically seen in patients with temporal or frontal lobe seizures, rarely in occipital lobe seizures, and has never been described in a patient with PRES .
• PRES is a clinical-radiologic diagnosis in which there is a breakdown of the blood brain barrier caused by abrupt changes of blood pressure, or cytokines causing endothelial damage and this creates brain edema.
• The typical neurological symptoms of PRES include encephalopathy (50-80%), seizure (60-75%), headache (50%), and visual disturbance (35%).
• Brain imaging in PRES usually reveals vasogenic edema in …

Cell-Free Circulating Mitochondrial Dna Content And Risk Of Hepatocellular Carcinoma In Patients With Chronic Hbv Infection., Ling Li, Hie-Won Hann, Shaogui Wan, Richard Hann, Chun Wang, Yinzhi Lai, Xishan Ye, Alison Evans, Ronald E. Myers, Phd, Dsw, Zhong Ye, Bingshan Li, Jinliang Xing, Hushan Yang

Department of Medicine Faculty Papers

Recent studies have demonstrated a potential link between circulating cell-free mitochondrial DNA (mtDNA) content and cancers. However, there is no study evaluating the association between circulating mtDNA as a non-invasive marker of hepatocellular carcinoma (HCC) risk. We conducted a nested case-control study to determine circulating mtDNA content in serum samples from 116 HBV-related HCC cases and 232 frequency-matched cancer-free HBV controls, and evaluate the retrospective association between mtDNA content and HCC risk using logistic regression and their temporal relationship using a mixed effects model. HCC cases had significantly lower circulating mtDNA content than controls (1.06 versus 2.47, P = 1.7 …

A 22-Year-Old Man With Pleural Tuberculosis Associated Hydropneumothorax: Case Report And Literature Review., Lauren A Sharan, Thea Price, Md, Boyd Hehn, David Manoff, Md, Scott W. Cowan, Md

Department of Medicine Faculty Papers

A 22-year-old Asian male presented with fever, non-productive cough, right-sided pleuritic chest pain and was found to have a large right hydropneumothorax. A chest tube was placed. Pleural fluid analysis revealed a lymphocytic predominant exudate and he was subsequently started on four-drug daily anti-tuberculosis therapy (isoniazid, ethambutol, rifampin, pyrazinamide). Pleural biopsy revealed acid-fast bacilli. Given his persistent pleural effusion, he was given four doses of intrapleural tissue plasminogen activator (tPA) and dornase alpha (DNase) via his chest tube over a period of 6 days resulting in clinical and radiologic improvement. Pleural biopsy and pleural fluid culture specimens later revealed Mycobacterium …

Trends In Survival Of Chronic Lymphocytic Leukemia Patients In Germany And The Usa In The First Decade Of The Twenty-First Century., Dianne Pulte, Felipe A Castro, Lina Jansen, Sabine Luttmann, Bernd Holleczek, Alice Nennecke, Meike Ressing, Alexander Katalinic, Hermann Brenner

Cardeza Foundation for Hematologic Research

BACKGROUND: Recent population-based studies in the United States of America (USA) and other countries have shown improvements in survival for patients with chronic lymphocytic leukemia (CLL) diagnosed in the early twenty-first century. Here, we examine the survival for patients diagnosed with CLL in Germany in 1997-2011.

METHODS: Data were extracted from 12 cancer registries in Germany and compared to the data from the USA. Period analysis was used to estimate 5- and 10-year relative survival (RS).

RESULTS: Five- and 10-year RS estimates in 2009-2011 of 80.2 and 59.5%, respectively, in Germany and 82.4 and 64.7%, respectively, in the USA were …

Orphan Nuclear Receptor Nur77 Inhibits Cardiac Hypertrophic Response To Beta-Adrenergic Stimulation., Guijun Yan, Ni Zhu, Shengdong Huang, Bing Yi, Xiying Shang, Ming Chen, Nadan Wang, Guan-Xin Zhang, Jennifer A Talarico, Douglas G Tilley, Erhe Gao, Jianxin Sun

Center for Translational Medicine Faculty Papers

The orphan nuclear receptor Nur77 plays critical roles in cardiovascular diseases, and its expression is markedly induced in the heart after beta-adrenergic receptor (β-AR) activation. However, the functional significance of Nur77 in β-AR signaling in the heart remains unclear. By using Northern blot, Western blot, and immunofluorescent staining assays, we showed that Nur77 expression was markedly upregulated in cardiomyocytes in response to multiple hypertrophic stimuli, including isoproterenol (ISO), phenylephrine (PE), and endothelin-1 (ET-1). In a time- and dose-dependent manner, ISO increases Nur77 expression in the nuclei of cardiomyocytes. Overexpression of Nur77 markedly inhibited ISO-induced cardiac hypertrophy by inducing nuclear translocation …

Risk Factors Of Pulmonary Hypertension In Brazilian Patients With Sickle Cell Anemia., Clarisse Lopes De Castro Lobo, Emilia Matos Do Nascimento, Renato Abelha, Ana Maria Mach Queiroz, Philippe Connes, Gilberto Perez Cardoso, Samir K. Ballas

Cardeza Foundation for Hematologic Research

This study was a prospective cross-sectional cohort study of 125 patients with sickle cell anemia (SS) between the ages of 16 to 60 years. Enrolled patients were followed-up prospectively for 15 months. Demographic, clinical, hematological and routine biochemical data were obtained on all patients. Six-minute walk test and Doppler Echocardiography were performed on all patients. A tricuspid regurgitant jet velocity (TRJV) < 2.5 m/sec was considered normal, 2.5 ≤ TRJV ≤ 3.0 was considered mild-moderate and > 3.0 m/sec, severe. Patients with abnormal TRJV were significantly older and more anemic, had significantly higher lactate dehydrogenase (LDH) levels, reticulocyte count and incidence of death. The logistic multimodal model implemented for the 125 patients indicated that age was …

Treatment-Induced Changes In Plasma Adiponectin Do Not Reduce Urinary Albumin Excretion In The Diabetes Prevention Program Cohort., Kieren J Mather, Qing Pan, William C Knowler, Tohru Funahashi, George A Bray, Richard Arakaki, Bonita Falkner, Kumar Sharma, Barry J. Goldstein

Department of Medicine Faculty Papers

BACKGROUND AND OBJECTIVES: Molecular data suggests that adiponectin may directly regulate urinary albumin excretion. In the Diabetes Prevention Program (DPP) we measured adiponectin and albuminuria before and after intervention, and we previously reported increases in adiponectin with interventions. Here we have used the DPP dataset to test the hypothesis that treatment-related increases in adiponectin may reduce albuminuria in obesity.

DESIGN, SETTING, PARTICIPANTS AND METHODS: We evaluated cross-sectional correlations between plasma adiponectin and urinary albumin excretion at baseline, and the relationship of treatment-related changes in adiponectin and albuminuria. Baseline and follow-up urine albumin to creatinine ratios (ACR (albumin to creatinine ratio)) …

The Effect Of Aspirin On Bleeding And Transfusion In Contemporary Cardiac Surgery., Jordan E Goldhammer, Gregary D. Marhefka, Constantine Daskalakis, Mark W Berguson, John E Bowen, James Diehl, Jianzhong Sun

Department of Medicine Faculty Papers

OBJECTIVE: Despite evidence that preoperative aspirin improves outcomes in cardiac surgery, recommendations for aspirin use are inconsistent due to aspirin's anti-platelet effect and concern for bleeding. The purpose of this study was to investigate preoperative aspirin use and its effect on bleeding and transfusion in cardiac surgery.

METHODS: This retrospective study involved consecutive patients (n=1571) who underwent CABG, valve, or combined CABG and valve surgery at a single center between March 2007 and July 2012. Of all patients, 728 met the inclusion criteria and were divided into two groups: those using (n=603) or not using (n=125) aspirin within 5 days …

Pleiotropic Effects Of Bitter Taste Receptors On [Ca2+]I Mobilization, Hyperpolarization, And Relaxation Of Human Airway Smooth Muscle Cells., Blanca Camoretti-Mercado, Susan H Pauer, Hwan Mee Yong, Dan'elle C Smith, Deepak A. Deshpande, Phd, Steven S An, Stephen B Liggett

Center for Translational Medicine Faculty Papers

Asthma is characterized by airway inflammation and airflow obstruction from human airway smooth muscle (HASM) constriction due to increased local bronchoconstrictive substances. We have recently found bitter taste receptors (TAS2Rs) on HASM, which increase [Ca2+]i and relax the muscle. We report here that some, but not all, TAS2R agonists decrease [Ca2+]i and relax HASM contracted by G-protein coupled receptors (GPCRs) that stimulate [Ca2+]i. This suggests both a second pathway by which TAS2Rs relax, and, a heterogeneity of the response phenotype. We utilized eight TAS2R agonists and five procontractile GPCR agonists in cultured HASM cells. We find that heterogeneity in the …

The New Oral Anticoagulants For The Treatment Of Venous Thromboembolism: A New Paradigm Shift In Antithrombotic Therapy., Taki Galanis, Gina Keiffer, Geno J Merli

Department of Medicine Faculty Papers

BACKGROUND: Several novel oral anticoagulants have been studied for the prevention and treatment of venous thromboembolism (VTE) in different patient populations. Clinicians will increasingly encounter scenarios in which they must choose among these and conventional anticoagulants for the treatment of this potentially fatal condition.

OBJECTIVE: To review the results of Phase III clinical trials that investigated the novel oral anticoagulants for the treatment of deep vein thrombosis and pulmonary embolism. Potential advantages and disadvantages of these anticoagulant agents with respect to each other and conventional therapy will also be explored through a case-based approach.

METHODS: A literature search in PubMed …

Adrenergic Signaling Regulates Mitochondrial Ca2+ Uptake Through Pyk2-Dependent Tyrosine Phosphorylation Of The Mitochondrial Ca2+ Uniporter., Jin O-Uchi, Bong Sook Jhun, Shangcheng Xu, Stephen Hurst, Anna Raffaello, Xiaoyun Liu, Bing Yi, Huiliang Zhang, Polina Gross, Jyotsna Mishra, Alina Ainbinder, Sarah Kettlewell, Godfrey L Smith, Robert T Dirksen, Wang Wang, Rosario Rizzuto, Shey-Shing Sheu

Department of Medicine Faculty Papers

AIMS: Mitochondrial Ca2+ homeostasis is crucial for balancing cell survival and death. The recent discovery of the molecular identity of the mitochondrial Ca2+ uniporter pore (MCU) opens new possibilities for applying genetic approaches to study mitochondrial Ca2+ regulation in various cell types, including cardiac myocytes. Basal tyrosine phosphorylation of MCU was reported from mass spectroscopy of human and mouse tissues, but the signaling pathways that regulate mitochondrial Ca2+ entry through posttranslational modifications of MCU are completely unknown. Therefore, we investigated α1-adrenergic-mediated signal transduction of MCU posttranslational modification and function in cardiac cells.

RESULTS: α1-adrenoceptor (α1-AR) signaling translocated activated proline-rich tyrosine …

Mitochondrial Ion Channels/Transporters As Sensors And Regulators Of Cellular Redox Signaling., Jin O-Uchi, Shin-Young Ryu, Bong Sook Jhun, Stephen Hurst, Shey-Shing Sheu

Department of Medicine Faculty Papers

SIGNIFICANCE: Mitochondrial ion channels/transporters and the electron transport chain (ETC) serve as key sensors and regulators for cellular redox signaling, the production of reactive oxygen species (ROS) and nitrogen species (RNS) in mitochondria, and balancing cell survival and death. Although the functional and pharmacological characteristics of mitochondrial ion transport mechanisms have been extensively studied for several decades, the majority of the molecular identities that are responsible for these channels/transporters have remained a mystery until very recently.

RECENT ADVANCES: Recent breakthrough studies uncovered the molecular identities of the diverse array of major mitochondrial ion channels/transporters, including the mitochondrial Ca2+ uniporter pore, …

Microrna Expression Differences In Human Hematopoietic Cell Lineages Enable Regulated Transgene Expression., Raúl Teruel Montoya, Xianguo Kong, Shaji Abraham, Lin Ma, Satya P Kunapuli, Michael Holinstat, Chad A Shaw, Steven E. Mckenzie, Leonard Edelstein, Paul Bray

Cardeza Foundation for Hematologic Research

Blood microRNA (miRNA) levels have been associated with and shown to participate in disease pathophysiology. However, the hematopoietic cell of origin of blood miRNAs and the individual blood cell miRNA profiles are poorly understood. We report the miRNA content of highly purified normal hematopoietic cells from the same individuals. Although T-cells, B-cells and granulocytes had the highest miRNA content per cell, erythrocytes contributed more cellular miRNA to the blood, followed by granulocytes and platelets. miRNA profiling revealed different patterns and different expression levels of miRNA specific for each lineage. miR-30c-5p was determined to be an appropriate reference normalizer for cross-cell …

New Payment Models: What’S Driving Them, And What Do They Mean For What It Takes To Be A Good Doctor?, Richard Baron, Md

Department of Medicine Presentations and Grand Rounds

Learning Objectives:

1. Describe details of new non-fee for service payment models, including Bundled Payment, Accountable Care Organizations and Advanced Primary Care
2. Explain administrative structures required to implement these kinds of models
3. Articulate the new values-congruent roles physicians will play under new payment models and the skills they will need to play them.

PowerPoint slides only.

Adiponectin Inhibits Tumor Necrosis Factor-Α-Induced Vascular Inflammatory Response Via Caveolin-Mediated Ceramidase Recruitment And Activation., Yajing Wang, Xiaoliang Wang, Wayne Bond Lau, Yuexing Yuan, David Booth, Jing-Jing Li, Rosario Scalia, Kyle Preston, Erhe Gao, Walter Koch, Xin-Liang Ma

Department of Medicine Faculty Papers

RATIONALE: Anti-inflammatory and vascular protective actions of adiponectin are well recognized. However, many fundamental questions remain unanswered.

OBJECTIVE: The current study attempted to identify the adiponectin receptor subtype responsible for adiponectin's vascular protective action and investigate the role of ceramidase activation in adiponectin anti-inflammatory signaling.

METHODS AND RESULTS: Adiponectin significantly reduced tumor necrosis factor (TNF)α-induced intercellular adhesion molecule-1 expression and attenuated TNFα-induced oxidative/nitrative stress in human umbilical vein endothelial cells. These anti-inflammatory actions were virtually abolished by adiponectin receptor 1 (AdipoR1-), but not AdipoR2-, knockdown (KD). Treatment with adiponectin significantly increased neutral ceramidase (nCDase) activity (3.7-fold; P87% of adiponectin-induced nCDase …

Neuropathy, Neuropathic Pain, And Sickle Cell Disease., Samir K. Ballas, Deepika S Darbari

Cardeza Foundation for Hematologic Research

No abstract provided.