Medicine and Health Sciences Commons^™

Risk Of Food Insecurity Reflects Health Status In Adult Relatives Of Prek Children – ​ Data From The Steps Snap-Ed Research Study​, Lisa M B Salinas, Karla Cortez, Brenda Rodriguez, Joseph Reyes, Moises Cisneros, Elizabeth Alanis, Zasha Romero, Lin Wang, Juan C. Lopez-Alvarenga, Roberto Treviño-Peña

Research Symposium

Background: Past research shows a correlation between household food insecurity and chronic medical conditions such as diabetes in the general U.S. population as well as metabolic syndrome-related cardiometabolic markers in Hispanic/Latino youth. Furthermore, minority status, including Hispanic/Latino identity, shows an association with low food security and diabetes. The Hunger Vital Sign (HVS) is a validated screener designed to assess risk of food insecurity within households. This study analyzes associated factors related to the screener’s 2 questions, specifically targeting PreK 4-year-old children and their household relatives. The first question assesses concern about food running out before obtaining more due to financial …

Spontaneous Tumor Lysis Syndrome In A Patient With Recent Diagnosis Of Multiple Myeloma — An Unusual Presentation, Taha Al Hassan, Olga G. Cantu-Rodriguez, Eunbee Cho, Edgar G. Dorsey Trevino

Research Symposium

Background: Tumor lysis syndrome (TLS) is an oncologic emergency that surfaces as a constellation of metabolic imbalances due to the rapid destruction of cancer cells and subsequent dissemination of their contents. However, a markedly rare subtype of TLS, known as spontaneous TLS (STLS), occurs without an evident trigger, such as cytotoxic therapy, and carries a similar mortality risk. It is paramount to recognize high-risk cases early and implement therapeutic measures to prevent complications of STLS.

Case Presentation: We present the case of a 74-year-old gentleman with a recent diagnosis of Kappa-restricted multiple myeloma who presented with worsening weakness, tremors, ataxia, …

Social And Structural Determinants Of Health Associated With Cervical Cancer Screening Uptake In South Texas, Caroline Puckett, Dolores Garcia, Rebecca Jones

Research Symposium

Background: The Mays Cancer Center (MCC) is one of only four National Cancer Institute (NCI)-designated cancer centers in Texas and the only one in South Texas. The MCC serves 38 counties and over 4.9 million residents; 70% of residents are Hispanic, 25 of 38 counties are designated as rural areas; additionally, 25 of the 38 counties have census tracts designated as areas of persistent poverty. Catchment area residents are at disproportionately greater risk of developing liver and intrahepatic bile duct cancer (64%), cervical cancer (46%), gallbladder cancer (8%), gastric cancer (4%), and pediatric leukemia (32%) compared to the nation. Currently …

Revolutionizing Feature Selection: A Breakthrough Approach For Enhanced Accuracy And Reduced Dimensions, With Implications For Early Medical Diagnostics, Shabia Shabir Khan, Majid Shafi Kawoosa, Bonny Bannerjee, Subhash C. Chauhan, Sheema Khan

Research Symposium

Background: The system's performance may be impacted by the high-dimensional feature dataset, attributed to redundant, non-informative, or irrelevant features, commonly referred to as noise. To mitigate inefficiency and suboptimal performance, our goal is to identify the optimal and minimal set of features capable of representing the entire dataset. Consequently, the Feature Selector (Fs) serves as an operator, transforming an m-dimensional feature set into an n-dimensional feature set. This process aims to generate a filtered dataset with reduced dimensions, enhancing the algorithm's efficiency.

Methods: This paper introduces an innovative feature selection approach utilizing a genetic algorithm with an ensemble crossover operation …

Relationship Among Cognitive Performance, Physical Activity (Pa), Demographic, And Individual Lifestyle Characteristics Among Aging Hispanic Population, Ulku Karabulut, Bryan Mixumi, Imtiaz Masfique Dowllah, Murat Karabulut

Research Symposium

Purpose: To investigate the association among different intensity and duration of physical activity (PA), cognitive domains (executive function, processing speed, and memory), and demographic and lifestyle characteristics of aging Hispanic population. PA has been identified as a promising non-pharmaceutical preventative intervention for Alzheimer disease and other dementias. This study aims to provide a better understanding of the effects of different intensities of PA on cognitive performances of aging Hispanic population.

Methods: For this study, 441 Hispanic (age ≥60) participants’ data from NHANES (20112014) were analyzed. The protocol was approved by the NCHS Research Ethics Review Board, and all data …

Proteomic Analysis Of Stress Associated Factor Overexpression In Hepatocellular Carcinoma, Mohammad Shabir Hussain, Sophia Leslie, Amayrani Sanchez, Samantha Lopez, Kyle Doxtater, Manish Kumar Tripathi

Research Symposium

Background: Hepatocellular carcinoma (HCC) constitutes a substantial portion, accounting for 85% to 90% of liver cancers worldwide. Notably, within the Hispanic population, liver cancer mortality rates are notably higher, particularly evident in regions like the South Texas Rio Grande Valley (RGV), where nearly 90% of the populace is Latino/Hispanic. This region grapples with poverty affecting nearly 30% of its residents, coupled with elevated rates of obesity, diabetes, and low-income households, thereby fostering a prevalent environment of stress. Stress can profoundly impact cancer outcomes by compromising immune functionality and triggering inflammatory responses, potentially impairing surveillance against oncogenic triggers. The activation of …

Reactive Oxygen Species In Acute Coronary Syndrome, Fernando Cisneros, Alex Zuo

Research Symposium

Reactive oxygen species (ROS) are formed in metabolism, cellular signaling, immune response, antimicrobial defense, and detoxification. Oxidative damage through overproduction of ROS or dysregulation of ROS regulation may result in oxidative stress associated with DNA damage, protein damage, mitochondrial dysfunction, and lipid peroxidation. Additionally, the accumulation of dysfunction of cellular components may manifest as diseases that contribute to the predisposition of acute coronary syndrome (ACS). This poster meticulously explores the significance of ROS in various cardiovascular stressors, including hypertension, thrombogenesis, vascular remodeling, lipid peroxidation, cellular proliferation, atherogenesis, and vasoconstriction. These stressors collectively contribute to ACS associated with ischemia. Furthermore, autophagic …

Piperlongumine Nanoformulation Attenuates Pancreatic Tumor Desmoplasia And Alter Tumor Immune Responses, Vivek Kumar Kashyap, Neeraj Chauhan, Mohammed Sikander, Eswara N. H. K. Ghali, Bilal Hafeez, Murali M. Yallapu, Meena Jaggi, Subhash C. Chauhan

Research Symposium

Pancreatic cancer (PanCa) is characterized by lack of early diagnosis, poor response to available therapeutic modalities and chemoresistance. Gemcitabine (GEM) is currently considered the most effective therapy for PanCa; however, it shows only a marginal survival benefit of 6 months. This poor drug response has been attributed to desmoplasia, causes suboptimal drug delivery, alters tumor microenvironment (TME), which includes tumor surrounding blood vessels, fibroblasts, immune cells, extracellular matrix, and other signaling molecules and induces chemo-resistance in tumors. To overcome these existing issues associated with chemotherapy, identification and development of novel therapeutic modalities are a pressing need. Piperlongumine (PL) is a …

Oxidative Stress, A Culprit In Cardiovascular Diseases And Resveratrol As A Potential Therapeutic Agent, Alyssa Sepulveda, Justin Z. Heckman, Grace Ochoa, Amin Shah

Research Symposium

Background: Cardiovascular diseases (CVDs) are the leading cause of mortality worldwide. Oxidative Stress (OS) is one of the pathophysiological mechanisms of CVDs such as hypertension, atherosclerosis, myocardial infarction (MI), ischemia reperfusion (I/R) injury, and heart failure. Resveratrol, a natural polyphenol compound has cardioprotective effects acting via several molecular mechanisms including reduction of OS in cardiovascular system. Our goal was to provide an updated overview of the pathophysiological role of OS in CVDs. Furthermore, we explored the cardiovascular effect of resveratrol and its mechanism of actions involved, especially focusing on its role as an antioxidant molecule in CVDs.

Methods: We searched …

Oral Administration Of Ph-Responsive Polymeric Nanoparticles Based On Zein And Their Therapeutic Potential On Cancer., Bruno Alejandro Valades-Aguilar, José Raúl Rangel-López, Jennifer Citlally Leos-Rivera, Moisés Armides Franco-Molina, María Cristina Rodríguez-Padilla, Diana Ginette Zárate-Triviño

Research Symposium

Background: Zein is a water-insoluble protein extracted from the endosperm of corn seeds, this polymer is an attractive matrix to encapsulate hydrophilic compounds because of its high proportion of hydrophobic amino acids, making it a potential smart delivery material for several treatments in the biopharmaceutical industry. nanoparticles have been used as drug delivery systems for the improvement of oral bioavailability; however, the strategies of nanoparticle obtention need the addition of stabilizers. in this study, a modified method to obtain zein nanoparticles was developed.

Methods: Zein nanoparticles (ZNps) were made by a thermal treatment and precipitated into ovalbumin at a ratio …

Optimization Of Gait Analysis System For Clinical Applications, Gerardo Medellin, Katherine S. Bolado, Daniel Salinas, Kelsey Potter-Baker

Research Symposium

Background: Adequate gait function is pivotal for many activities of daily living and high quality of life. Following many neurodegenerative diseases, such as Parkinson’s Disease, gait abnormalities can manifest and range from reduced stride length, inability to turn, foot drop or shuffling. To track and monitor such changes in gait, gait analysis techniques are gaining clinical popularity and have the ability to gather a range of data in a short duration. Gait analysis techniques go beyond simple visual observation and include instrumental gait analysis and weight distribution of the gait cycle. Here, we sought to optimize the gait analysis …

Implementation Of Mindfulness & Stress Reduction Training For Medical Students, Jill Berenato

SACAD: Scholarly Activities

Abstract

This proposal advocates for implementing mandatory mindfulness and stress reduction training sessions for surgical students at Philadelphia College of Osteopathic Medicine (PCOM). It is well-documented that medical students, particularly those in surgical disciplines, experience high levels of stress, which can negatively impact their mental health, academic performance and overall well-being. Mindfulness-based interventions have shown promise in reducing stress and enhancing resilience among medical students. By integrating mindfulness training into the surgical curriculum, PCOM aims to equip students with essential coping skills to effectively manage stress, thereby promoting their mental health and academic success. This handout serves to accompany the …

Risk Of Secondary Malignancies After Pelvic Radiation: A Population-Based Analysis, Connor Mcpartland, Andrew Salib, Joshua Banks, James R. Mark, Costas D. Lallas, Edouard J. Trabulsi, Leonard G. Gomella, Hannan Goldberg, Benjamin Leiby, Robert Den, Thenappan Chandrasekar

Department of Urology Faculty Papers

Background and objective

Radiation therapy has increasingly been used in the management of pelvic malignancies. However, the use of radiation continues to pose a risk of a secondary malignancy to its recipients. This study investigates the risk of secondary malignancy development following radiation for primary pelvic malignancies.

Methods

A retrospective cohort review of the Surveillance, Epidemiology, and End Results database from 1975 to 2016 was performed. Primary pelvic malignancies were subdivided based on the receipt of radiation, and secondary malignancies were stratified as pelvic or nonpelvic to investigate the local effect of radiation.

Key findings and limitations

A total of …

A Highly Selective Mpges-1 Inhibitor To Block Abdominal Aortic Aneurysm Progression In The Angiotensin Mouse Model., Lauren M Weaver, Madeline J Stewart, Kai Ding, Charles D. Loftin, Fang Zheng, Chang-Guo Zhan

Pharmaceutical Sciences Faculty Publications

Abdominal aortic aneurysm (AAA) is a deadly, permanent ballooning of the aortic artery. Pharmacological and genetic studies have pointed to multiple proteins, including microsomal prostaglandin E₂ synthase-1 (mPGES-1), as potentially promising targets. However, it remains unknown whether administration of an mPGES-1 inhibitor can effectively attenuate AAA progression in animal models. There are still no FDA-approved pharmacological treatments for AAA. Current research stresses the importance of both anti-inflammatory drug targets and rigor of translatability. Notably, mPGES-1 is an inducible enzyme responsible for overproduction of prostaglandin E₂ (PGE₂)-a well-known principal pro-inflammatory prostanoid. Here we demonstrate for the first …

Discordance Interpretation Of Left Ventricular Size Between Echocardiography And Cardiac Magnetic Resonance In Pediatric Patients With Aortic/Mitral Regurgitation, Anastasia Barros, Michelle Udine, Chris Spurney, Laura Olivieri, Yue-Hin Loke

Jefferson Hospital Staff Papers and Presentations

PURPOSE: This study investigated discordance between echocardiography (echo) and cardiac magnetic resonance (CMR) measurements of the left ventricle (LV) in pediatric patients with aortic and/or mitral regurgitation (AR/MR).

METHODS: Retrospective cohort study of pediatric patients. The cohorts were comprised of patients with AR/MR vs. non-AR/MR. Left ventricular end diastolic volume (LVEDV) by CMR and left ventricular internal diameter diastolic (LVIDd) by echo were obtained from clinical reports then echo images were reviewed to remeasure LVEDV by bullet method. Left ventricular internal diameter systolic (LVIDs) and left ventricular ejection fraction (LVEF) measurements by echo and LVEF by CMR were obtained from …

Prostate Cancer Survivorship Essentials For Men With Prostate Cancer On Androgen Deprivation Therapy: Protocol For A Randomised Controlled Trial Of A Tele-Based Nurse-Led Survivorship Care Intervention (Pcessentials Hormone Therapy Study), Anna Green, Robert U. Newton, David P. Smith, Haitham Tuffaha, Daniel A. Galvão, Peter Heathcote, Manish I. Patel, David Christie, Sam Egger, Sally A. M. Sara, Nicole Heneka, Suzanne K. Chambers, Jeff Dunn

Research outputs 2022 to 2026

Introduction: Androgen deprivation therapy (ADT) is commonly used to treat men with locally advanced or metastatic prostate cancer. Men receiving ADT experience numerous side effects and frequently report unmet supportive care needs. An essential part of quality cancer care is survivorship care. To date, an optimal effective approach to survivorship care for men with prostate cancer on ADT has not been described. This protocol describes a randomised trial of tele-based nurse-led survivorship that addresses this knowledge gap: (1) determine the effectiveness of a nurse-led survivorship care intervention (PCEssentials), relative to usual care, for improving health-related quality of life (HR-QoL) in …

The Role Of Long Noncoding Rnas In Ocular Angiogenesis And Vascular Oculopathy, Pranali Gandhi, Yuzhi Wang, Guigang Li, Shusheng Wang

School of Medicine Faculty Publications

Background: Long noncoding RNAs (lncRNAs) are RNA transcripts over 200 nucleotides in length that do not code for proteins. Initially considered a genomic mystery, an increasing number of lncRNAs have been shown to have vital roles in physiological and pathological conditions by regulating gene expression through diverse mechanisms depending on their subcellular localization. Dysregulated angiogenesis is responsible for various vascular oculopathies, including diabetic retinopathy, retinopathy of prematurity, age-related macular degeneration, and corneal neovascularization. While anti-VEGF treatment is available, it is not curative, and long-term outcomes are suboptimal, and some patients are unresponsive. Results and summary: To better understand these diseases, …

The Ethics And Practice Of Periviability Care, Alex C Vidaeff, Joseph W Kaempf

Faculty, Staff and Students Publications

Since the 1960s, the gestational age at which premature infants typically survive has decreased by approximately one week per decade [1]. Survival is now reported at remarkably early gestational ages. In 2022, the Vermont Oxford Network reported neonatal intensive care unit (NICU) survival rates of 21%, 46%, and 63% at 22, 23, and 24 weeks’ gestation [2]. Presently, in industrialized nations, the so-called periviability interval refers to the gestational age period of possible survival that extends from approximately 22 to 25 weeks’ gestation. Newborns born within this period are distinguished by their need for extraordinarily complex …

Nursing Education And The Emerging Artificial Intelligence, Somi Nagaraj, Nancy J. Macmullen

Faculty Research Events

The emerging artificial intelligence (AI) is transforming patient care across all domains of nursing practice, including administration, clinical care, education, policy, and research. Nursing researchers are exploring the potential influences of AI health technologies (AIHTs) on nursing in general and on nursing education more specifically. ChatGPT, a trending Artificial Intelligence (AI) tool developed by Open AI. The impact of ChatGPT on the nursing education is profound. The technological evolution in healthcare is advancing. The complexity of curricular revision can create challenges in the face of rapid practice change.

This PowerPoint presentation explains the meaning of Artificial Intelligence (AI), the history …

Desolation, Kiara Adelina Hernandez Padron

UNO Student Research and Creative Activity Fair

Desolation was made in mind with my late aunt's mental illness, schizophrenia. Though I don't know what it's like having it, listening to her in the past and others about her hardships made me think about her mindset constantly throughout her whole life. This sculpture was made by digitally mapping out the composition, cutting out individual pieces of wood with each layer representing the depth of the many heads of emptiness.

Knyaw/Karen Womanhood, Generational Healing And The Interplay Of Faith, Genocide, Gender Roles, And Education In The Face Of Health Diagnosis, Moo Law Eh Soe

UNO Student Research and Creative Activity Fair

During the fall semester of 2023, my honors project aimed to provide representation and shed light on the challenges Knyaw/Karen women encounter as part of their womanhood in traditional and Western communities. The issues are emphasized when these women receive life-altering health diagnosis that not only alters their identities but also requires them to step beyond the invisible parameters of what it means to be a Knyaw/Karen woman. It's worth noting that all the women I interviewed were immigrants from the Thai-Burma Border refugee Camps where Indigenous Knyaw people have been facing at least 70 years of genocide. The project …

Optimization Of Baseline Values For The Bionik Inmotion Arm/Hand Rehabilitation Robot, Marysol Cabello, Diego Rojano, Daniel Salinas, Ramiro Oquita, Victoria Cuello, Kelsey Potter-Baker

Research Symposium

Background: Clinical studies utilizing the Bionik InMotion Arm/Hand robot are increasing in recent years. However, there is a lack of standardized values from healthy participants that can be used to compare to patients with stroke or other neurodegenerative disorders. We aim to create this standardized set of values by employing the new Bionik InMotion Arm/Hand robot on healthy participants. Establishing normative values will allow our lab, and other laboratories, to have a baseline that can be used to track rehabilitation progress in patients with neurological disorders, such as stroke. Creating this standardization may also allow for more tailored rehabilitative approaches …

Ongoing Study Of The Association Of Apoe Gene Polymorphisms With Cognitive Impairment In The Rio Grande Valley Hispanic Population, Jaime Miguel L. Saveron, Daniela Gamez, Chun Xu

Research Symposium

Background: Alzheimer's disease (AD), a prevalent neurodegenerative disorder, exhibits a significant genetic component. In addition, mild cognitive impairment (MCI) is a key risk factor for AD. While certain demographic factors and genetic variants associated with AD and cognitive impairment have been identified in non-Hispanic populations, limited research exists on this subject within the Hispanic population, particularly in the Rio Grande Valley. This study aims to investigate the relationship between the APOE gene, specifically its ε4 allele, and cognitive impairment in the Hispanic population of the Rio Grande Valley.

Methods: A total of 269 Hispanic subjects, aged 60 and above, with …

Novel Strategy To Make Kras Targeted Therapies More Effective For Pdac Treatment, Ana I. Martinez Bulnes, Melissa Elizondo, Orlando Garcia, Poornima Devi Shaji, Swathi Holla, Nirnoy Dan, Anupam Dhasmana, Swati Dhasmana, Shabnam Malik, Murali Yallapu, Stephen Behrman, Subhash Chauhan, Sheema Khan

Research Symposium

Introduction: Pancreatic Ductal Adenocarcinoma (PDAC) patients exhibit extremely poor prognosis. KRAS mutation on codon-12 is present in 70–95% of PDAC cases and it drives PDAC growth and progression. Galectin-1 (Gal-1) is present in both PDAC and stromal cells, being involved in tumor microenvironment, immune cell activation and metastasis. Therefore, this study discusses the efficiency of combined inhibition of mutated KRASG12D and Gal-1 inhibition to effectively suppress PDAC growth and progression. For this we have delivered KRASG12D inhibiting siRNA (siKRASG12D) using a superparamagnetic iron oxide nanoparticle (SPION) and a galectin inhibitor.

Methods: SPION nano-formulation was used to deliver siKRASG12D and investigate …

Newly Diagnosed Ulcerative Colitis In A Young Hispanic Mexican Female At South Texas: A Case Report, Elimar Gonzalez Morales, Jose Gomez Casanovas, Shreel Patel, Khairiya Haj-Yahya

Research Symposium

Introduction: Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) characterized by recurring episodes of inflammation limited to the mucosal layer of the colon. Traditionally, this disease has been associated mostly with white Americans, however in recent years, an increase incidence has been reported in minorities in the US and around the world. In Hispanic population, cases are frequently underdiagnosed, and literature is scarse. In this case, we present a young patient without past medical history who presented with what appeared to be an infectious gastroenteritis and found to have a severe UC.

Case Presentation: A 22-year old Hispanic …

Nebulization Based Inhalation Nanomedicine For Lung Cancer Treatments, Rahul Tiwari, Meghana Kolli, Neeraj Chauhan, Eswara Naga Hanuma, Vivek Kashyap, Subhash Chauhan, Murali Yallapu

Research Symposium

Background: Lung cancer is reported to have a high incidence rate and first leading cause of cancer-related morbidity and mortality across the world including in the United States. Noninvasive nebulized inhalation is a promising delivery strategy for lung, which can enhance the targeting efficiency and detention time interval of nanoparticles in the lung tissue, thus elevating the therapeutic index of therapeutic agent(s) at lower dosages. The aim of this study is to develop inhalable nanoparticles (INPs) for effective delivery of therapeutic agents in lung cancer cell lines and ex vivo models.

Methods: The inhalation nanoparticles (INPs) were prepared by solvent …

Modern Neurosurgical Techniques For Surgical Excision Of Neoplasms, Kevin A. Garcia Valdez, Sonya Bhatia, Natasha Bell, Anesu Karen Murambadoro, Victoria Elizondo, Fernando Cisneros, Kory Punch, Alan N. Francis

Research Symposium

Background: Neurosurgical excision of brain tumors is still regarded as the first line treatment for multiple neoplasms, including meningiomas, gliomas, and metastatic tumors. Advances in technology have allowed neurosurgeons to utilize various approaches that significantly reduce mortality and surgical morbidity. However, the high risk of neurological deficit and tumor recurrence remains. Here, we analyze three neurosurgical approaches: craniotomy, microsurgery with tubular retraction, and tumor ablation. While craniotomy remains as the first line treatment for most brain tumors, we hypothesize that microsurgery and ablation will show greater success of tumor removal with fewer complications.

Methods: Published literature was reviewed from PubMed …

Deficient Dietary Folic Acid And Systemic Dsp-4 Induced Locus Coeruleus Loss Assessed As Neurodegenerative Cognitive Model In Adult Cb57/J6 Mice, Gabriel Kong, Aristotle Zeng, Theo Helm, Simon Khorani, Rohan Rampal, Smayana Kurapati, Riva Ranier, Aidan Schmidt, Maximilian Doane, David B. Green Phd, Susan E. Helm Phd

Seaver College Research And Scholarly Achievement Symposium

DEFICIENT DIETARY FOLIC ACID AND SYSTEMIC DSP-4 INDUCED LOCUS COERULEUS LOSS ASSESSED AS NEURODEGENERATIVE COGNITIVE MODEL IN ADULT CB57/J6 MICE Gabriel Kong, C. Foster Graf, Aristotle Zeng, Theodore Helm, Simon Khorani, Rohan Rample, Smayana Kurapati, Riva Rainier, Aidan Schmidt, Maximilian Doane, David B. Green, and Susan E. Helm Chemistry and Nutritional Science, Pepperdine University, Malibu, California

Dietary deficiency of folic acid (FA) shortened nerve lengths as much as 50% in hippocampal dentate gyrus (DG). Locus coeruleus (LC) is largest noradrenergic nucleus in central nervous system with neurogenic projections widely dispersed in the brain and, notably, a major norepinephrine source in …

Exploring The Impact Of Trusted Patient-Physician Relationship And Effective Health Communication On Patient Empowerment, Mingming Song

UNO Student Research and Creative Activity Fair

Abstract

Empowered patients actively participate in their healthcare decision making, clearly understanding their health conditions, and effectively managing their health care plan. Traditionally, health education has served as the primary method for educating and empowering patients within the healthcare services model, including the care provided by physicians....

Effect Of Three-Month Use Of Assistive Shoes On Gait In Patients With Peripheral Artery Disease, Jonathan Kirkland

UNO Student Research and Creative Activity Fair

Effect of Three-Month Use of Assistive Shoes on Gait in Patients with Peripheral Artery Disease