Hemic and Lymphatic Diseases Commons^™

Hetrombopag Plus Porcine Atg And Cyclosporine For The Treatment Of Aplastic Anaemia: Early Outcomes Of A Prospective Pilot Study, Wenrui Yang, Xin Zhao, Xu Liu, Youzhen Xiong, Huihui Fan, Li Zhang, Jianping Li, Lei Ye, Kang Zhou, Yuan Li, Yang Yang, Guangxin Peng, Liping Jing, Fengkui Zhang

Faculty, Staff and Student Publications

Hetrombopag, a small molecular thrombopoietin-receptor agonist, has shown encouraging efficiency in immunosuppressive therapy refractory or relapsed severe aplastic anaemia. To investigate the response rate of hetrombopag combined with IST as first-line treatment, we designed a prospective pilot study including 32 patients with SAA treated with anti-human T lymphocyte porcine immunoglobulin (p-ATG), cyclosporine, and hetrombopag. In addition, 96 patients with SAA treated with p-ATG and cyclosporine alone were matched as controls. In total, 21.9% of patients treated with hetrombopag achieved complete response (CR) at 3 months, while 5.2% of patients achieved CR in the control group (P = 0.005). At …

Lnc-Uc147 Is Associated With Disease Stage Of Liver, Gastric, And Renal Cancer, Ana Carolina Rodrigues, Erika Pereira Zambalde, Daniel De Lima Bellan, Edvaldo Da Silva Trindade, Enilze Maria De Souza Fonseca Ribeiro, George Calin, Daniela Fiori Gradia, Jaqueline Carvalho De Oliveira

Faculty, Staff and Student Publications

Lnc-uc.147, a long non-coding RNA derived from a transcribed ultraconserved region (T-UCR), was previously evidenced in breast cancer. However, the role of this region in other tumor types was not previously investigated. The present study aimed to investigate lnc-uc.147 in different types of cancer, as well as to suggest lnc-uc.147 functional and regulation aspects. From solid tumor datasets analysis of The Cancer Genome Atlas (TCGA), deregulated lnc-uc.147 expression was associated with the histologic grade of hepatocellular carcinoma, and with the tumor stage of clear cell renal and gastric adenocarcinoma. Considering the epidemiologic relevance of liver cancer, silencing lnc-uc.147 reduced the …

Does The Osteopathic Pedal Pump Reduce Lower Limb Volume In Healthy Subjects?, Jill S. Adams, Sahil H. Parikh, Brandon J. Goodwin, Donald R. Noll

Rowan-Virtua School of Osteopathic Medicine Departmental Research

CONTEXT: Lymphatic treatments are gentle and passive techniques believed to enhance movement of lymph back into the central circulatory system. Animal studies provide supportive evidence, yet there are few studies in humans.

OBJECTIVES: The aim of this study is to investigate whether the osteopathic pedal pump protocol reduces volume in the lower limbs of healthy subjects.

METHODS: A total of 30 first- and second-year medical students were recruited. Subjects were excluded from participating if they had acute asthma, chronic obstructive pulmonary disease (COPD), congestive heart failure, active infections, fractures of the lower extremities, or metastatic cancer. A within-subjects study design …

Thrombectomy Outcomes With General Vs Nongeneral Anesthesia: A Pooled Patient-Level Analysis From The Extend-Ia Trials And Select Study, Amrou Sarraj, Gregory W Albers, Peter J Mitchell, Ameer E Hassan, Michael G Abraham, Spiros Blackburn, Gagan Sharma, Nawaf Yassi, Timothy J Kleinig, Darshan G Shah, Teddy Y Wu, Muhammad Shazam Hussain, Wondwoseen G Tekle, Santiago Ortega Gutierrez, Amin Nima Aghaebrahim, Diogo C Haussen, Gabor Toth, Deep Pujara, Ronald F Budzik, William Hicks, Nirav Vora, Randall C Edgell, Sabreena Slavin, Colleen G Lechtenberg, Laith Maali, Abid Qureshi, Lee Rosterman, Mohammad Ammar Abdulrazzak, Tareq Almaghrabi, Faris Shaker, Osman Mir, Ashish Arora, Sheryl Martin-Schild, Clark W Sitton, Leonid Churilov, Rishi Gupta, Maarten G Lansberg, Raul G Nogueira, James C Grotta, Geoffrey Alan Donnan, Stephen M Davis, Bruce C V Campbell

Faculty, Staff and Student Publications

BACKGROUND AND OBJECTIVES: The effect of anesthesia choice on endovascular thrombectomy (EVT) outcomes is unclear. Collateral status on perfusion imaging may help identify the optimal anesthesia choice.

METHODS: In a pooled patient-level analysis of EXTEND-IA, EXTEND-IA TNK, EXTEND-IA TNK part II, and SELECT, EVT functional outcomes (modified Rankin Scale score distribution) were compared between general anesthesia (GA) vs non-GA in a propensity-matched sample. Furthermore, we evaluated the association of collateral flow on perfusion imaging, assessed by hypoperfusion intensity ratio (HIR) - Tmax > 10 seconds/Tmax > 6 seconds (good collaterals - HIR < 0.4, poor collaterals - HIR ≥ 0.4) on the association between anesthesia type and EVT outcomes.

RESULTS: Of 725 treated with EVT, 299 (41%) received GA …

Antihuman T Lymphocyte Porcine Immunoglobulin Combined With Cyclosporine As First-Line Immunosuppressive Therapy For Severe Aplastic Anemia In China: A Large Single-Center, 10-Year Retrospective Study, Wenrui Yang, Xu Liu, Xin Zhao, Li Zhang, Guangxin Peng, Lei Ye, Kang Zhou, Yuan Li, Jianping Li, Huihui Fan, Yang Yang, Youzhen Xiong, Liping Jing, Fengkui Zhang

Faculty, Staff and Student Publications

BACKGROUND: Antihuman T lymphocyte porcine immunoglobulin (p-ATG) has been the most common ATG preparation in immunosuppressive therapy (IST) in Chinese patients with severe aplastic anemia (SAA) since 2009.

OBJECTIVES: This study aimed to evaluate the early hematologic response and long-term outcomes of a large cohort of patients with SAA who received p-ATG plus cyclosporine (CsA) as first-line therapy from 2010 to 2019.

DESIGN: This is a single-center retrospective study of medical records.

METHODS: We analyzed the data of 1023 consecutive patients with acquired aplastic anemia (AA) who underwent p-ATG combined with CsA as a first-line IST treatment from 2010 to …

Efficacy Of Eltrombopag With Immunosuppressive Therapy For Children With Acquired Aplastic Anemia, Yufei Zhao, Wenrui Yang, Xin Zhao, Xiangrong Hu, Jing Hu, Xu Liu, Jianping Li, Lei Ye, Youzhen Xiong, Yang Yang, Baohang Zhang, Xiaoxia Li, Xiawan Yang, Yimeng Shi, Guangxin Peng, Yuan Li, Huihui Fan, Kang Zhou, Liping Jing, Li Zhang, Fengkui Zhang

Faculty, Staff and Student Publications

BACKGROUND: Eltrombopag (EPAG), an oral thrombopoietin receptor agonist (TPO-RA), has been proven to improve the hematologic response without increasing toxic effects as a first-line therapy combined with standard immunosuppressive treatment (IST) in adults with severe aplastic anemia (SAA). Nevertheless, the clinical evidence on the efficacy of EPAG in children with acquired aplastic anemia is limited and controversial.

METHODS: We performed a single-center, retrospective study to analyze the clinical outcomes of fifteen patients aged ≤18 years with newly diagnosed acquired SAA who received first-line IST and EPAG (EPAG group) compared with those of forty-five patients who received IST alone (IST group) …

Many People With Chronic Lymphocytic Leukemia Or Small Lymphocytic Lymphoma Benefit From Ibrutinib Treatment Up To 8 Years: A Plain Language Summary, Paul M Barr, Carolyn Owen, Tadeusz Robak, Alessandra Tedeschi, Osnat Bairey, Jan A Burger, Peter Hillmen, Claire Dearden, Sebastian Grosicki, Helen Mccarthy, Jian Yong Li, Fritz Offner, Carol Moreno, Mandy Jermain, Cathy Zhou, Emily Hsu, Anita Szoke, Thomas J Kipps, Paolo Ghia

Faculty, Staff and Student Publications

What is this summary about?: This is a plain language summary of a publication describing long-term results from the RESONATE-2 study with up to 8 years of follow-up. The original paper was published in Blood Advances in June 2022.

What were the results?: Researchers looked at 269 adults with chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL) who had not received any treatment for their CLL/SLL. Study participants were randomly divided into two groups: 136 participants received treatment with a drug called ibrutinib, and 133 participants received treatment with a drug called chlorambucil. Participants in the study were treated …

A Case Of Suspected Intracranial Granulocytic Sarcomas Versus Cerebrovascular Hemorrhage In A Young Male With Cml With Aml Transformation, Nicholas C. Rochester, Alicia C. Mccartney, Amol S. Patel, Alexandra Kroes, Angelina Rodriguez, Napatkamon Ayutyanont, Upinder Singh

Far West Division GME Research Day 2023

No abstract provided.

Confusion, Pruritus, And Purple Skin: A Case Of Hypereosinophilic Syndrome, Blane Alost, Asha Kurian

Central & West Texas GME Research Day 2023

No abstract provided.

Unusual Presentation Of B-Cell Acute Lymphocytic Leukemia (All) With Skin Manifestations, Muhammad Bilal, Victoria Brown, Uma Iyer

North Florida Division GME Research Day 2023

No abstract provided.

A Case Of Amiodarone Induced Thyrotoxicosis Presenting With Methimazole Induced Agranulocytosis, Suhail Saadomer, Moises Matos, Mustafa Kinaan

North Florida Division GME Research Day 2023

No abstract provided.

Kikuchi Disease: A Rare Recurrence, R Levi Sundermeyer, Jessica Bautista

Continental, MidAmerica, & Mountain Divisions GME Research Day 2023

No abstract provided.

Multiple Myeloma Diagnosed In A 23-Year-Old Male Presenting With Pathologic Compression Fracture, Kyle Combe, Tristan Myers, Michelle Levy, Greg Schlessinger

Continental, MidAmerica, & Mountain Divisions GME Research Day 2023

No abstract provided.

Spur Cell Hemolytic Anemia: An Uncommon Etiology Of Anemia In Liver Cirrhosis, Hanan Gruhonjic, Austin Van Vliet, Maxwell Tague, Masi Javeed

West Florida Division GME Research Day 2023

No abstract provided.

Pancytopenia, Enterovirus Infection, And Pcr Testing, Stephen Mock, Salome Herzstein, Andrea Horbey

East Florida Division GME Research Day 2023

Introduction: This is a case of a patient presenting with fever, rash, and vomiting. Upon further studies, patient was found to have pancytopenia which started an extensive hospital work up.

Case Description: A previously healthy 9- year-old female presented to the emergency department with 3 days of tactile fever, 2 days of rash, and 1 day of nonbilious nonbloody emesis. The rash initially appeared on the trunk and by the day of admission, had begun to spread peripherally to the extremities. The rash on the abdomen was described as mild, generalized, blanchable and maculopapular. The rash on the extremities was …

Paraneoplastic Leukemoid Reaction In Uterus Carcinosarcoma, Xiaolan Tang, Ashali Jain, Uma Iyer, Jennifer Reppucci

North Florida Division GME Research Day 2023

No abstract provided.

Atypical Hemolytic Uremic Syndrome: A Diagnostic Conundrum, Rebecca Kurian, William Zvagelsky, Suleiman A. Daifallah

Continental, MidAmerica, & Mountain Divisions GME Research Day 2023

No abstract provided.

Hairy Cell Leukemia Presenting As Group B Streptococcus Cellulitis And Abscesses, Hannah Berrett, Mattias D'Anna, Ajay Iyer, Zachary Hancock, Meg Laures, Muzaffar Iqbal

Continental, MidAmerica, & Mountain Divisions GME Research Day 2023

No abstract provided.

Atypical Lymphoma And Monospot Testing: Malignant Deception, Jacob Keeling, Kavanya Feustel, Changlee Pang, Kevin Ky, Jennifer Griffith, Alexander Enurah

Continental, MidAmerica, & Mountain Divisions GME Research Day 2023

No abstract provided.

A Case Of Hemophagocytic Lymphohistiocytosis(Hlh) Secondary To Cytomegalovirus Infection In An Immunocompetent Patient, Marcarthur Limpiado, Simerun Singh, Ajay Iyer, William Zvagelsky, Shruti Verma, Minar Rane, Emadeldeen Elgwairi

Continental, MidAmerica, & Mountain Divisions GME Research Day 2023

No abstract provided.

Opioid-Induced Intrathecal Catheter Tip Granuloma Via Pain Pump In A Patient With Chronic Pain Syndrome: A Case Report, Katherine David, R Blake Kline, Jon Halling

South Atlantic Division GME Research Day 2023

No abstract provided.

Monoclonal Gammopathy Of Renal Significance: A Likely Underrecognized Problem, Ajay Iyer, Angad Singh, Thomas Pritchard, Manoj Khamuani, Minar Rane, Joseph Stilwill, Max Glaser

Continental, MidAmerica, & Mountain Divisions GME Research Day 2023

No abstract provided.

Follicular Lymphoma Presenting As A Small Bowel Obstruction: A Case Report, Erica Roma, Kelsey Staudinger, Emmett Mcguire, Katrina Lancaster Shorts

Continental, MidAmerica, & Mountain Divisions GME Research Day 2023

No abstract provided.

Hyperviscosity Syndrome Induced Bilateral Visual And Auditory Impairment In Therapy Resistant Waldenström Macroglobulinemia With Myd88 And Cxcr4 Mutations, Marie M Plante, Erinmarie O Kimbrough, Amit K Agarwal, Liuyan Jiang, Kirk Bourgeois, Greta C Stamper, Michael W Stewart, Han W Tun

Faculty, Staff and Student Publications

Hyperviscosity syndrome (HVS) is an emergent complication of Waldenström macroglobulinemia (WM) characterized by visual, neurologic, and rarely auditory impairment. We report a 69-year-old female with MYD88 and CXCR4-mutant WM who developed HVS resulting in bilateral blindness and deafness associated with neurologic manifestations including confusion, severe generalized weakness, and imbalance. Ophthalmologic evaluation revealed bilateral central retinal vein occlusion (CRVO), diffuse retinal hemorrhages, macular edema, and serous macular detachments (SMD). Magnetic resonance imaging of the brain showed bleeding in the inner ears. Management was challenging as her WM was resistant to systemic therapies including bendamustine + rituximab (BR) and rituximab + bortezomib …

Refractory Thrombocytopenia During Liver Transplantation Requiring Splenectomy, Ivana Wrobleski Wilder, Alexander Reskallah, Catherine M Pivalizza, John S Bynon, Evan G Pivalizza

Faculty, Staff and Student Publications

Although thrombocytopenia is common in end-stage liver disease, severe, refractory thrombocytopenia during liver transplantation is rare, and if immune based, usually presents months or years later. This case describes an adult woman in whom preoperative evaluation had not determined an immune-related cause of thrombocytopenia. Clot strength was dramatically impaired as measured by thrombelastography during the transplant. Following a lack of response to repeat platelet transfusions, splenectomy was performed after graft reperfusion with rapid temporal restoration of clot strength. This case shows a severe manifestation of perioperative thrombocytopenia during liver transplantation and clinically guided management when measured clot strength is too …

Hypofibrinogenemia Following Injury In 186 Children And Adolescents: Identification Of The Phenotype, Current Outcomes, And Potential For Intervention, Justin Gerard, Jan-Michael Van Gent, Jessica Cardenas, Christian Gage, David E Meyer, Charles Cox, Charles E Wade, Bryan A Cotton

Faculty, Staff and Student Publications

OBJECTIVES: Recent studies evaluating fibrinogen replacement in trauma, along with newly available fibrinogen-based products, has led to an increase in debate on where products such as cryoprecipitate belong in our resuscitation strategies. We set out to define the phenotype and outcomes of those with hypofibrinogenemia and evaluate whether fibrinogen replacement should have a role in the initial administration of massive transfusion.

METHODS: All patients/17-4/21 were reviewed. We then evaluated all patients who received emergency-release and massive transfusion protocol (MTP) products. Patients were defined as hypofibrinogenemic (HYPOFIB) if admission fibrinogen(r-TEG) angleHYPOFIB, the impact on outcomes, and whether early replacement improved mortality. …

Quadricuspid Aortic Valve With Guarded Left Coronary Artery Ostium In An Infant With Myocardial Infarction, Anne Aurelie Tedga, Frank Pigula, Latasha Lewis, Thomas Richard Kimball

Faculty, Staff and Student Publications

• Anatomical variations of the aortic valve include unicuspid, bicuspid, and quadricuspid.
• The bicuspid aortic valve is most common and affects 1%-2% of the general population.
• QAV is generally an isolated malformation, and adults most commonly present with AR.
• Coronary anomalies have been reported in up to 10% of patients with QAV.
• Prompt and accurate imaging will lead to corrective surgery.

Addition Of Aspirin To Venous Thromboembolism Chemoprophylaxis Safely Decreases Venous Thromboembolism Rates In Trauma Patients, Daniel Lammers, Michelle Scerbo, Annamaria Davidson, Matthew Pommerening, Jeffrey Tomasek, Charles E Wade, Jessica Cardenas, Jan Jansen, Charles C Miller, John B Holcomb

Faculty, Staff and Student Publications

Background: Trauma patients exhibit a multifactorial hypercoagulable state and have increased risk of venous thromboembolism (VTE). Despite early and aggressive chemoprophylaxis (CP) with various heparin compounds ("standard" CP; sCP), VTE rates remain high. In high-quality studies, aspirin has been shown to decrease VTE in postoperative elective surgical and orthopedic trauma patients. We hypothesized that inhibiting platelet function with aspirin as an adjunct to sCP would reduce the risk of VTE in trauma patients.

Methods: We performed a retrospective observational study of prospectively collected data from all adult patients admitted to an American College of Surgeons Level I Trauma center from …

Not Just A Pain: A Medical Simulation Case About Biased Communication And Osteomyelitis In Pediatric Sickle Cell Anemia, Adeola A Kosoko, Yakira R Alford, Karl A Upplegger, Gowri S Stevens

Faculty, Staff and Student Publications

Introduction

Biases in communication can be harmful to patient perceptions of care and the medical team's decision-making. Optimal communication must be taught and practiced similarly to the optimal management of the complex medical conditions associated with sickle cell disease (SCD). This simulation is designed to teach about biases, optimizing communication to and about a patient with SCD, and appropriately diagnosing and managing pediatric osteomyelitis as a complication of SCD.

Methods

We designed and implemented a simulation case targeting emergency medicine residents and fellows to raise awareness about biases associated with SCD care and the complication of osteomyelitis in children with …

Good Outcome Associated With Blood-Brain Barrier Disruption And Lower Blood Pressure After Endovascular Therapy, Parth Upadhyaya, Amit Mehta, Marie Luby, Saeed Ansari, John K Lynch, Amie W Hsia, Lawrence L Latour, Yongwoo Kim

Faculty, Staff and Student Publications

OBJECTIVES: To evaluate the association between post-endovascular thrombectomy (EVT) blood-brain barrier (BBB) disruption on MRI or CT and average systolic blood pressure (SBP) with favorable 90-day functional outcome. Observational studies have found elevated SBP associated with worse outcomes post-EVT, while recent randomized trials found no difference in targeted BP reduction. There may be a subgroup of patients who benefit from targeted BP reduction post-EVT.

METHODS: This is a single-center study of 1) anterior large vessel occlusion stroke patients treated with EVT from 2015 to 2021, 2) achieved mTICI grade 2b or 3. Hyperintense acute reperfusion marker (HARM), hemorrhagic transformation (HT), …