Medicine and Health Sciences Commons^™

Sevoflurane Pre-Conditioning Ameliorates Diabetic Myocardial Ischemia/Reperfusion Injury Via Differential Regulation Of P38 And Erk., Dina Xie, Jianli Zhao, Rui Guo, Liyuan Jiao, Yanqing Zhang, Wayne Bond Lau, Bernard Lopez, Theodore Christopher, Erhe Gao, Jimin Cao, Xin-Liang Ma, Yajing Wang

Department of Emergency Medicine Faculty Papers

Diabetes mellitus (DM) significantly increases myocardial ischemia/reperfusion (MI/R) injury. During DM, cardioprotection induced by conventional pre-conditioning (PreCon) is decreased due to impaired AMP-activated protein kinase (AMPK) signaling. The current study investigated whether PreCon with inhaled anesthetic sevoflurane (SF-PreCon) remains cardioprotective during DM, and identified the involved mechanisms. Normal diet (ND) and high-fat diet (HFD)-induced DM mice were randomized into control and SF-PreCon (3 cycles of 15-minute period exposures to 2% sevoflurane) groups before MI/R. SF-PreCon markedly reduced MI/R injury in DM mice, as evidenced by improved cardiac function (increased LVEF and ±Dp/dt), decreased infarct size, and decreased apoptosis. To determine …

A New Regulatory Mechanism Of Protein Phosphatase 2a Activity Via Set In Acute Myeloid Leukemia., Elena Arriazu, Carmen Vicente, Raffaella Pippa, Irene Peris, Elena Martínez-Balsalobre, Patricia García-Ramírez, Nerea Marcotegui, Ana Igea, Diego Alignani, José Rifón, María C. Mateos, María L. Cayuela, Angel R. Nebreda, María D. Odero

Department of Medical Oncology Faculty Papers

Acute myeloid leukemia (AML) is an aggressive hematologic malignancy. Although novel emerging drugs are available, the overall prognosis remains poor and new therapeutic approaches are required. PP2A phosphatase is a key regulator of cell homeostasis and is recurrently inactivated in AML. The anticancer activity of several PP2A-activating drugs (e.g., FTY720) depends on their interaction with the SET oncoprotein, an endogenous PP2A inhibitor that is overexpressed in 30% of AML cases. Elucidation of SET regulatory mechanisms may therefore provide novel targeted therapies for SET-overexpressing AMLs. Here, we show that upregulation of protein kinase p38β is a common event in AML. We …

Highly Efficient Induced Pluripotent Stem Cell Reprogramming Of Cryopreserved Lymphoblastoid Cell Lines, Satish Kumar, Joanne E. Curran, Erika C. Espinoza, David C. Glahn, John Blangero

School of Medicine Publications

Tissue culture based in-vitro experimental modeling of human inherited disorders provides insight into the cellular and molecular mechanisms involved and the underlying genetic component influencing the disease phenotype. The breakthrough development of induced pluripotent stem cell (iPSC) technology represents a quantum leap in experimental modeling of human diseases, providing investigators with a self-renewing and thus unlimited source of pluripotent cells for targeted differentiation into functionally relevant disease specific tissue/cell types. The existing rich bio-resource of Epstein-Barr virus (EBV) immortalized lymphoblastoid cell line (LCL) repositories generated from a wide array of patients in genetic and epidemiological studies worldwide, many of them …

Building Bodies, Building Minds, Lis Regula

Learning Teaching Forum

Kennedy Union 211

Majors level Human Anatomy has long been taught as a gatekeeping class for medical schools of graduate schools, and has been highly professionalized due to this. It has also been constructed historically in a very hierarchical paradigm that has multiple oppressions supporting both the study of anatomy and the anatomy classroom. Besides these social issues around anatomy, there are the pedagogical issues of treating this material as something to just memorize and not understand that can cause problems for a student of anatomy. Disrupting these processes can be a very powerful force for anti-racism, anti-sexism, and hopefully …

Medicine And The Museum: An Experiential Case Study In Art History Pedagogy And Practice, Marcia Brennan

Art History Pedagogy & Practice

This article brings three scholarly and professional perspectives to bear on museum-based learning experiences for undergraduate pre-medical and STEM students. In the first section, Marcia Brennan describes the seminar on “Medicine and the Museum: Clinical Aesthetics and the Museum of Fine Arts, Houston” that she teaches at Rice University. Brennan is a modernist art historian, and her discussion focuses on the ways in which classes such as this can contribute meaningfully to undergraduate pre-medical and STEM education. Brennan collaborated with Joshua Eyler, who served as Executive Director of Rice University’s Center for Teaching Excellence. In the second section, Eyler discusses …

Investigating The Potential And Pitfalls Of Ev-Encapsulated Micrornas As Circulating Biomarkers Of Breast Cancer, Brian M. Moloney, Katie E. Gilligan, Doireann P. Joyce, Clodagh P. O'Neill, Killian P. O'Brien, Sonja Khan, Claire L. Glynn, Ronan M. Waldron, Ciarán M. Maguire, Emma Holian, Erin Naughton, Mohamed Elhadi, Andrea B. Grealish, Carmel Malone, Emma Mcdermott, Peter Dockery, Thomas Ritter, Adriele Prina-Mello, Michael J. Kerin, Róisín M. Dwyer

Forensic Science Publications

Extracellular vesicles (EVs) shuttle microRNA (miRNA) throughout the circulation and are believed to represent a fingerprint of the releasing cell. We isolated and characterized serum EVs of breast tumour-bearing animals, breast cancer (BC) patients, and healthy controls. EVs were characterized using transmission electron microscopy (TEM), protein quantification, western blotting, and nanoparticle tracking analysis (NTA). Absolute quantitative (AQ)-PCR was employed to analyse EV-miR-451a expression. Isolated EVs had the appropriate morphology and size. Patient sera contained significantly more EVs than did healthy controls. In tumour-bearing animals, a correlation between serum EV number and tumour burden was observed. There was no significant relationship …

Immune-Mediated Genetic Pathways Resulting In Pulmonary Function Impairment Increase Lung Cancer Susceptibility, Linda Kachuri, Mattias Johansson, Sara R. Rashkin, Rebecca E. Graff, Yohan Bossé, Venkata Manem, Neil E. Caporaso, Maria Teresa Landi, David C. Christiani, Paolo Vineis, Geoffrey Liu, Ghislaine Scelo, David Zaridze, Sanjay S Shete, Demetrius Albanes, Melinda C. Aldrich, Adonina Tardón, Gad Rennert, Chu Chen, Gary E. Goodman, Jennifer A. Doherty, Heike Bickeböller, John K. Field, Michael P Davies, M. Dawn Teare, Lambertus A. Kiemeney, Stig E. Bojesen, Aage Haugen, Shanbeh Zienolddiny, Stephen Lam, Loïc Le Marchand, Iona Cheng, Matthew B. Schabath, Eric J. Duell, Angeline S. Andrew, Jonas Manjer, Philip Lazarus, Susanne M. Arnold, James D. Mckay, Nima C. Emami, Matthew T. Warkentin, Yonathan Brhane, Ma'en Obeidat, Richard M. Martin, Caroline Relton, George Davey Smith, Philip C. Haycock, Christopher I. Amos, Paul Brennan, John S. Witte, Rayjean J. Hung

Markey Cancer Center Faculty Publications

Impaired lung function is often caused by cigarette smoking, making it challenging to disentangle its role in lung cancer susceptibility. Investigation of the shared genetic basis of these phenotypes in the UK Biobank and International Lung Cancer Consortium (29,266 cases, 56,450 controls) shows that lung cancer is genetically correlated with reduced forced expiratory volume in one second (FEV₁: r_g = 0.098, p = 2.3 × 10^-8) and the ratio of FEV₁ to forced vital capacity (FEV₁/FVC: r_g = 0.137, p = 2.0 × 10^-12). Mendelian randomization analyses demonstrate that …

Deliver On Your Own: Disrespectful Maternity Care In Rural Kenya, Adelaide Lusambili, Violet Naanyu, Terrance J. Wade, Lindsay Mossman, Michaela Mantel, Rachel Pell, Angela Ng'etich, Kennedy Mulama, Lucy Nyaga, Jerim Obure, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Under the Free Maternity Policy (FMP), Kenya has witnessed an increase in health facility deliveries rather than home deliveries with Traditional Birth Attendants (TBA) resulting in improved maternal and neonatal outcomes. Despite these gains, maternal and infant mortality and morbidity rates in Kenya remain unacceptably high indicating that more needs to be done.

Aim: Using data from the Access to Quality Care through Extending and Strengthening Health Systems (AQCESS) project’s qualitative gender assessment, this paper examines women’s experience of disrespectful care during pregnancy, labour, and delivery. The goal is to promote an improved understanding of the actual care conditions …

Cryo-Em Structure Of Nucleotide-Bound Tel1atm Unravels The Molecular Basis Of Inhibition And Structural Rationale For Disease-Associated Mutations, Luke A Yates, Rhys M Williams, Sarem Hailemariam, Rafael Ayala, Peter Burgers, Xiaodong Zhang

2020-Current year OA Pubs

Yeast Tel1 and its highly conserved human ortholog ataxia-telangiectasia mutated (ATM) are large protein kinases central to the maintenance of genome integrity. Mutations in ATM are found in ataxia-telangiectasia (A-T) patients and ATM is one of the most frequently mutated genes in many cancers. Using cryoelectron microscopy, we present the structure of Tel1 in a nucleotide-bound state. Our structure reveals molecular details of key residues surrounding the nucleotide binding site and provides a structural and molecular basis for its intrinsically low basal activity. We show that the catalytic residues are in a productive conformation for catalysis, but the phosphatidylinositol 3-kinase-related …

Musical Expertise Generalizes To Superior Temporal Scaling In A Morse Code Tapping Task, Matthew A. Slayton, Juan L. Romero-Sosa, Katrina Shore, Dean V. Buonomano, Indre Viskontas

Psychology

A key feature of the brain’s ability to tell time and generate complex temporal patterns is its capacity to produce similar temporal patterns at different speeds. For example, humans can tie a shoe, type, or play an instrument at different speeds or tempi—a phenomenon referred to as temporal scaling. While it is well established that training improves timing precision and accuracy, it is not known whether expertise improves temporal scaling, and if so, whether it generalizes across skill domains. We quantified temporal scaling and timing precision in musicians and non-musicians as they learned to tap a Morse code sequence. We …

What's Happening: January 6, 2020, Maine Medical Center

What's Happening

No abstract provided.

Working Memory In Collegiate Athletes And Non-Athletes: A Comparison Of Team-Sports Athletes, Solo-Sports Athletes, Frequent Exercisers And Infrequent Exercisers, Tara T. Lineweaver, Suneeta Kercood, Elyse B. Morgan, Shelby L. Rampone, Colleen C. Frank, Scott A. Mcluckie

Scholarship and Professional Work - LAS

Past research suggests that exercise is associated with improved working memory (WM) abilities, and that athletes have better executive functioning and WM skills than non-athletes. However, no studies to date have separated the effects of exercise from the effects of athletic participation when examining WM. This study had three primary goals: (1) to determine whether amateur college athletes have better auditory and visual WM than their non-athlete peers who exercise frequently and whether non-athlete frequent exercisers have better WM than non-athlete infrequent exercisers (2) to determine whether amateur participation in particular types of sports (team-based versus solo sports) corresponds to …

Exploring The Experiences Of The Older Adults Who Are Brought To Live In Shelter Homes In Karachi, Pakistan: A Qualitative Study, Laila Akber Cassum, Keith Cash, Waris Qidwai Dr, Samina Vertejee

School of Nursing & Midwifery

Background: The traditional joint family system in a culturally diverse Pakistani society shows great respect and care for older population by the families and their generations. However, in the recent years the phenomenon of population ageing in Pakistan is rapidly increasing due to demographic shift influencing life expectancy, along with changes in socio-cultural values. This transition has resulted in institutionalization of the elderly as an emerging shelter alternative. The aim of this study was to explore the experiences of the elderly people and to identify the reason which compelled them to reside in these shelter homes.
Method: A …

Ada News - 01/06/2020, American Dental Association, Publishing Division

ADA News

Established in 1970 as the official newspaper of the American Dental Association, the ADA News serves practicing dentists and others allied to the dental profession in the U.S. and internationally. It is the No. 1 source of news and information about the many benefits and services the ADA delivers to members daily as well as timely information on scientific, social, political and economic developments affecting dentistry and health care.

The Role Of Occupational Therapy For Homeless Women And Women At-Risk Of Homelessness, Kelcey Storkersen

Student Capstone Papers

This paper seeks to identify the occupational barriers and needs of homeless women and women at risk of homelessness. A qualitative research study was performed to learn more about the lived experience of two women at-risk of homelessness. Themes uncovered in this study are described in order to provide more understanding and advocacy for this population. A program proposal was delivered for future fieldwork students to provide occupational therapy students at this resource center.

Preoperative Maximization To Reduce Complications In Spinal Surgery, Sukanta Maitra, Christopher Mikhail, Samuel K. Cho, Michael D. Daubs

School of Medicine Faculty Research

Study design: Invited narrative review. Objectives: The aim of this review was to summarize current literature regarding risk factors that surgeons can optimize in the preoperative setting in the spinal surgery patient, in order to reduce complications and improve patient-reported outcomes. Methods: Review of the relevant literature by the authors. Results: Modifiable risk factors identified relative to the patient include obesity, malnutrition/nutrient deficiency, diabetes/hyperglycemia, preoperative anemia, vitamin D/DEXA (dual-energy radiograph absorptiometry), nicotine use/smoking, and opioid use/psychosocial factors. Conclusion: By maximizing a patient's physiological and psychological status prior to elective spine surgery, we may move closer to achieving the goals of …

Using Big Data To Promote Precision Oral Health In The Context Of A Learning Healthcare System, Joseph Finkelstein, Frederick Zhang, Seth A. Levitin, David Cappelli

Dental Medicine Faculty Research

There has been a call for evidence‐based oral healthcare guidelines, to improve precision dentistry and oral healthcare delivery. The main challenges to this goal are the current lack of up‐to‐date evidence, the limited integrative analytical data sets, and the slow translations to routine care delivery. Overcoming these issues requires knowledge discovery pipelines based on big data and health analytics, intelligent integrative informatics approaches, and learning health systems. This article examines how this can be accomplished by utilizing big data. These data can be gathered from four major streams: patients, clinical data, biological data, and normative data sets. All these must …

The Operative Management In Bariatric Acute Abdomen (Oba) Survey: Long-Term Complications Of Bariatric Surgery And The Emergency Surgeon's Point Of View., Belinda De Simone, Luca Ansaloni, Massimo Sartelli, Yoram Kluger, Fikri M. Abu-Zidan, Walter L. Biffl, Arianna Heyer, Federico Coccolini, Gian Luca Baiocchi, Oba Trial Supporters

Student Papers, Posters & Projects

Background: The number of bariatric procedures is increasing worldwide. No consensus or guidelines about the emergency management of long-term complications following bariatric surgery are currently available. The aim of this study is to investigate by a web survey how an emergency surgeon approaches this unique group of patients in an emergency medical scenario and to report their personal experience.

Method: An international web survey was sent to 197 emergency surgeons with the aim to collect data about emergency surgeons' experience in the management of patients admitted in the emergency department for acute abdominal pain after bariatric surgery. The survey was …

Tusm Faculty Appointments And Promotions 2019

Journal of Maine Medical Center

No abstract provided.

Reviewer Acknowledgement 2019

Journal of Maine Medical Center

No abstract provided.

Injection Drug Use And Care Charges For Infective Endocarditis, Verity N. Ramirez, Jenny L. Carwile, Kristina Rokas, Wendy Craig, Kinna Thakarar

Journal of Maine Medical Center

No abstract provided.

A Phantom Of The Past: Withdrawal From Meprobamate Presenting With Focal Seizures., Thomas M. Zink, John E. Erickson

Journal of Maine Medical Center

Introduction: Meprobamate (Miltown, Equinil) is a sedative-hypnotic medication that first gained popularity as an anxiolytic and later as a muscle relaxant. It is a major metabolite of the more commonly used muscle relaxant carisoprodol (Soma). In vitro and electroencephalogram studies demonstrated that meprobamate modulates gama-aminobutyric acid (GABA) receptors, similar to barbiturates. Withdrawal from meprobamate manifests in symptoms ranging from mild anxiety to severe autonomic instability and death. Meprobamate is rarely prescribed, but is still given to a small subset of elderly patients.

Clinical findings: In this case of meprobamate withdrawal, the patient initially displayed altered mental status and recurrent seizures …

Toxic Leukoencephalopathy Presenting As Agitation And Social Withdrawal In A Patient With Substance Use Disorder: A Case Report, Andrew R. Beauchesne, Brian F. King

Journal of Maine Medical Center

Introduction: Toxic leukoencephalopathy (TLE) is characterized by damage to myelin of cerebral white matter and is caused by a number of offending agents, including drugs of abuse. The clinical presentation of TLE is variable and not fully understood.

Clinical Findings: A 51-year-old male presented with pneumonia, parapneumonic effusion, and acute kidney injury. His medical course was complicated by neurobehavioral changes, including aggression and social withdrawal.

Diagnoses, interventions, and outcomes: The patient was diagnosed with acute toxic leukoencephalopathy based on diffuse subcortical T2-weighted-fluid-attenuated inversion recovery (T2/FLAIR) on brain MRI, bilateral frontal arrhythmic delta waves on encephalogram, and a …

Small Cell Lung Cancer Presenting With Personality Change, Brian F. King, Heidi Horstman, Katherine Rizzolo

Journal of Maine Medical Center

Introduction: Paraneoplastic limbic encephalitis is a syndrome characterized by autoimmune inflammation of the limbic system in the setting of underlying malignancy. The syndrome presents with acute to subacute neuropsychiatric clinical findings, often before the cancer diagnosis is known.

Clinical Findings: A 57-year-old woman with a 30 pack-year smoking history presented to Maine Medical Center after multiple generalized tonic-clonic seizures. Her family reported periodic odd behavior including confusion, disinhibition, and paranoia--all of which preceded her first seizure by two weeks.

Diagnoses, interventions, and outcomes: MRI brain showed T2/FLAIR signal hyperintensity of the right amygdala and hippocampus with sparing of the right …

Fresh Fruits And Vegetables Really Do Keep The Doctor Away: Symptomatic Vitamin Deficiency In A Middle Aged Man, Matthew J. Turnquist Md, Christina Holt Md, Msc

Journal of Maine Medical Center

Introduction

We present a clinical case of symptomatic vitamin deficiency typically seen only in resource limited environments or alcoholics, presenting in an adult male with frequent oral intake, but limited diet of prepared foods, as well as co-occurring pernicious anemia.

Clinical Findings

The patient presented with complaints of ascending paresthesia leading to near syncope, lower extremity edema and hyperpigmentation on his anterior legs bilaterally which had been present for years.

Diagnosis and interventions

He was found to have mixed B12, thiamine, and folate deficiency. These were attributed to a combination of nutritional deficiency due to a diet of exclusively cooked …

Introducing An Adult Adhd Toolkit For Application In Collaborative Care, C. Jason Mallo

Journal of Maine Medical Center

Introduction: While providers in collaborative care have been challenged to respond to rising patient complaints about attention deficit hyperactivity disorder (ADHD) in adulthood, institutional guidance has been lacking or insufficient. To address this issue, an Adult ADHD Toolkit was created to be used by providers spanning primary care and psychiatry. This article reviews how the toolkit was developed, its contents, and future directions.

Methods: A workgroup of providers from different backgrounds devised materials for the toolkit by reviewing adult ADHD literature and clinical consensus.

Discussion: The toolkit addresses common dilemmas encountered in the evaluation and management of adult ADHD, and …

Northern New England Clinical And Translational Research Network Assesses The Training Needs Of Investigators, Brenda M. Joly, Fleur Hopper, Carolyn Gray

Journal of Maine Medical Center

INTRODUCTION

The Northern New England Clinical and Translational Research (NNE-CTR) Network was created to enhance the region’s research capacity and infrastructure. The NNE-CTR provides research design consultation and technical assistance, research technologies support, professional development opportunities and mentorship, as well as funding for pilot projects. This study sought to describe the characteristics of NNE-CTR investigators and to identify their research interests, training needs, and perceived barriers to research.

METHODS

A registration survey and 13-item needs assessment module were developed and administered to capture data on the characteristics, background, and research-related training needs, interests and barriers among investigators in Maine, New …

Changes In Hospital Utilization By Individuals Experiencing Homelessness After Engaging With Interdisciplinary, Low-Barrier Healthcare Services In Portland, Maine, Sarah Hemphill Ba, Adam Normandin Md, Ms, Debra Rothenberg Md, Phd

Journal of Maine Medical Center

Introduction: The Maine Medical Center Preble Street Learning Collaborative (PSLC) aims to couple medical education with addressing the unmet healthcare needs of those experiencing homelessness in Portland, Maine. The PSLC provides low-barrier medical, psychiatric, dental, and case management services to all-comers and is co-located near many of the city’s social services. The purpose of this study was to evaluate the impact of the PSLC in its first 19 months by describing demographic characteristics and patterns in hospital utilization of patients served by the PSLC.

Methods: We performed a retrospective chart review of 888 patients with one or more …

Virtual Coaching And Deliberate Practice To Enhance Medical Students' Clinical Reasoning During Oral Case Presentations, Nicole Akar-Ghibril Md, Cristina Carter Md, Gabrina Dixon Md, Med, Ellen Goldman Med, Mba, Mary C. Ottolini Md, Mph, Med

Journal of Maine Medical Center

ABSTRACT:

Introduction

Oral case presentations (OP) provide an opportunity for medical students to practice clinical reasoning and communication skills, and for faculty to provide assessment. Specific teaching strategies are needed to improve students’ OP skills.

Objective

To compare the effectiveness of Virtual Coaching (VC) to Small Group (SG) discussion or Traditional Feedback (TF/control) in improving clinical reasoning during OP, using a validated PBEAR (Problem Representation, Background Evidence, Analysis, Recommendation) tool.

Design/Methods

Students from two medical schools were randomly assigned to three groups during their inpatient pediatric clerkship. All completed an eLearning module about using illness scripts to promote clinical reasoning …

End-Of-Life Healthcare Use Of Medicare Patients With Melanoma Based On Patient Characteristics And Year Of Death, Rebecca N. Hutchinson, F. Lee Lucas, Kathleen Fairfield

Journal of Maine Medical Center

Background: Many cancer patients receive overly-intensive care at end-of-life (EOL), despite recognition that this is a marker of poor quality. There is limited knowledge about care received by patients dying with melanoma.

Objective: We characterized healthcare utilization during EOL and patient characteristics associated with variations in care. We also described how utilization changed over time.

Methods: We used the Surveillance, Epidemiology, and End Results-Medicare database to identify 9099 melanoma patients aged 65+ at diagnosis between 2000 and 2009, who died by 12/31/2010. We included patients enrolled in Medicare part A and B six-months prior to diagnosis and not in managed …