Medical Specialties Commons^™

Chitosan Wound Dressing, Simon J. Mccarthy, Kenton W. Gregroy, William P. Wiesmann, Todd D. Campbell

Technology Transfer - Patents

This invention is directed to advanced hemorrhage control wound dressings, and methods of using and producing same. The subject wound dressing is constructed from a non-mammalian material for control of severe 5 bleeding. The wound dressing for controlling severe bleeding is formed of a biomaterial comprising chitosan, a hydrophilic polymer, a polyacrylic polymer or a combination thereof, The kind of severe, life-threatening bleeding contemplated by this invention is typically of the type not capable of being stanched when a conventional gauze wound dressing is applied with conventional 10 pressure to the subject wound. The wound dressing being capable of substantially …

Preventive Care Utilization Among Black Women : Perceived Beliefs, Benefits And Barriers To Mammography Screening, Rowandalla Y. Dunbar

Loma Linda University Electronic Theses, Dissertations & Projects

Blacks, in comparison to other racial or ethnic groups, suffer higher rates of illness and death from many preventable or treatable diseases. Despite the significantly higher rates of mortality and disease, Blacks are least likely to utilize clinical preventive care services. Black women, who are more likely to have advanced breast cancer at time of diagnosis (Chu, Lamar, & Freeman, 2003) are least likely to seek mammography screening (National Health Interview Study, 2000). Allen, Bastani, Bazargan and Leonard (2002) examined predictors of mammography screening among women 40 years old and older residing in the South Central area of Los Angeles, …

Facial Type Analysis Comparison Between Mri, Cbct, And Lateral Cephalometrics, Matthew A. Sanders

Loma Linda University Electronic Theses, Dissertations & Projects

Introduction: Single Cephalometric measurements are comparable between Cone Beam Computed Tomography (CBCT), Magnetic Resonance Imaging (MRl) and Conventional Lateral Cephalometric (LC) imaging methods. This study evaluated the agreement between the three imaging methods in facial type analysis (using a composite of 5 cephalometric measures).

Methods and Materials: Twenty-two subjects participated in this study. Cranial images were generated via three modalities: LC, CBCT and MRl. Cephalometric landmarks were identified on the three images per subject and a facial type analysis performed. An equally weighted facial type calculation composed of 5 cephalometric measurements (facial axis, facial depth, mandibular plane, lower face height, …

Creating Prediction Models For Obstructive Sleep Apnea Based On Gender, Jeffrey Hwang

Loma Linda University Electronic Theses, Dissertations & Projects

Introduction: Obstructive sleep apnea (OSA) is a common chronic disorder that is characterized by repetitive episodes of airflow cessation or reduction occurring during sleep as a result of partial or complete upper airway obstruction. These recurrent events have a tremendous impact on the cardiovascular system with a multitude of dangerous consequences. Numerous studies have been conducted determining etiological risk factors for OSA including anatomical predictors which have been observed with multiple imaging techniques. Cone beam computed tomography (CBCT) is a low-radiation mode of imaging that can be used to accurately identify anatomical landmarks and measure craniofacial relationships and airway dimensions. …

Macrophages Loaded With Gold Nanoshells For Photothermal Ablation Of Glioma: An In Vitro Model, Amani Riad Makkouk

UNLV Theses, Dissertations, Professional Papers, and Capstones

The current median survival of patients with glioblastoma multiforme (GBM), the most common type of glioma, remains at 14.6 months despite multimodal treatments (surgery, radiotherapy and chemotherapy). This research aims to study the feasibility of photothermal ablation of glioma using gold nanoshells that are heated upon laser irradiation at their resonance wavelength. The novelty of our approach lies in improving nanoshell tumor delivery by loading them in macrophages, which are known to be recruited to gliomas via tumor-released chemoattractive agents. Ferumoxides, superparamagnetic iron oxide (SPIO) nanoparticles, are needed as an additional macrophage load in order to visualize macrophage accumulation in …

Effect Of Acute Administration Of Angiopoietin-1 In Experimental Traumatic Spinal Cord Injury: Magnetic Resonance Imaging And Neurobehavioral Studies, Chirag B. Patel

Dissertations and Theses (Open Access)

Spinal cord injury (SCI) is a devastating condition that affects people in the prime of their lives. A myriad of vascular events occur after SCI, each of which contributes to the evolving pathology. The primary trauma causes mechanical damage to blood vessels, resulting in hemorrhage. The blood-spinal cord barrier (BSCB), a neurovascular unit that limits passage of most agents from systemic circulation to the central nervous system, breaks down, resulting in inflammation, scar formation, and other sequelae. Protracted BSCB disruption may exacerbate cellular injury and hinder neurobehavioral recovery in SCI.

In these studies, angiopoietin-1 (Ang1), an agent known to reduce …

Asian Race/Ethnicity As A Risk Factor For Bile Duct Injury During Cholecystectomy., Stephanie R. Downing, Ghazala Datoo, Tolulope A. Oyetunji, Terrence Fullum, David C. Chang, Nita Ahuja

Manuscripts, Articles, Book Chapters and Other Papers

Iatrogenic bile duct injury (BDI) is an uncommon but serious complication of cholecystectomy, with identified risk factors of acute cholecystitis, male sex, older age, and aberrant biliary anatomy. The Nationwide Inpatient Sample (1998-2006) was queried for cholecystectomy performed on hospital day 0 or 1. Bile duct injury repair procedure codes were used as a surrogate for BDI. We identified 377,424 patients who underwent cholecystectomy, with 1124 BDIs (0.3%). On multivariate logistic regression analysis, Asian race/ethnicity was a significant risk factor for BDI (odds ratio [OR], 2.26; 95% confidence interval [CI], 1.59-3.23; P < .001). This persisted for laparoscopic (OR, 2.62; 95% CI, 1.28-5.39; P = .009) and open (2.21; 1.59-3.07; P < .001) cholecystectomies. No other race/ethnicity was identified as a risk factor for BDI. We report a new finding that Asian race/ethnicity is a significant risk factor for BDI in laparoscopic and open cholecystectomies.

Initial Experience With A Miniaturized Multiplane Transesophageal Probe In Small Infants Undergoing Cardiac Operations., Sinai C. Zyblewski, Girish S. Shirali, Geoffrey A. Forbus, Tain-Yen Hsia, Scott M. Bradley, Andrew M. Atz, Meryl S. Cohen, Eric M. Graham

Manuscripts, Articles, Book Chapters and Other Papers

PURPOSE: There has been reluctance to use intraoperative transesophageal echocardiography (TEE) in small infants. We assessed the utility and safety of a new miniaturized multiplane micro-TEE probe in small infants undergoing cardiac operations.

DESCRIPTION: Hemodynamic and ventilation variables were prospectively recorded before and after micro-TEE insertion and removal in infants weighing 5 kg or less undergoing cardiac operations.

EVALUATION: The study included 42 patients with a mean weight of 3.6 +/- 0.9 kg (range, 1.7 to 5 kg). All probe insertions were successful. There were no complications or clinically significant changes in hemodynamic or ventilation variables. Information provided by TEE …

Anxiolytic Effect Of Midazolam Premedication Assessed By Clinical And Platelet Aggregation Profiles, Ehtesham I Khan, Rehana S Kamal, Hameed Ullah

Department of Anaesthesia

BACKGROUND: It is well documented that surgery is associated with increased anxiety, which has an adverse impact on patient's outcome. This study was designed to assess the anxiolytic effect of midazolam in pre-anaesthetic medication by using clinical and platelet aggregation profiles.METHODS: Sixty ASA I and II female patients aged between 35 and 60 years undergoing elective abdominal hysterectomy were randomly divided into two equal groups. Group I received placebo as pre-medication while group II received 0.15 mg/kg midazolam as pre-medication 1 hour preoperatively. They were monitored for visual analogue scale (VAS) for anxiety, observer's anxiety criteria, sedation score, blood pressure, …

Partial And Transitional Atrioventricular Septal Defect Outcomes., L Luann Minich, Andrew M. Atz, Steven D. Colan, Lynn A. Sleeper, Seema Mital, James Jaggers, Renee Margossian, Ashwin Prakash, Jennifer S. Li, Meryl S. Cohen, Ronald V. Lacro, Gloria L. Klein, John A. Hawkins, Pediatric Heart Network Investigators, Girish S. Shirali

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Surgical and perioperative improvements permit earlier repair of partial and transitional atrioventricular septal defects (AVSD). We sought to describe contemporary outcomes in a multicenter cohort.

METHODS: We studied 87 patients undergoing primary biventricular repair of partial or transitional AVSD between June 2004 and February 2006 across seven North American centers. One-month and 6-month postoperative data included weight-for-age z-scores, left atrioventricular valve regurgitation (LAVVR) grade, residual shunts, and left ventricular ejection fraction. Paired methods were used to assess 6-month change.

RESULTS: Median age at surgery was 1.8 years; median weight z-score was -0.88. Median days for ventilation were 1, intensive …

The Power Of Empowerment: An Icf-Based Model To Improve Self-Efficacy And Upper Extremity Function Of Survivors Of Breast Cancer, Mary Insana Fisher, Dana Howell

Physical Therapy Faculty Publications

Breast cancer is one of the most frequently diagnosed cancers among women. Breast cancer treatments often negatively impact the function of the arm, and quality of life and upper extremity function does not always return to a prediagnosis level. Survivors of breast cancer may also experience feelings of diminished self-efficacy related to functional deficits resulting from their physical limitations. The International Classification of Functioning (ICF) provides a framework for rehabilitation practitioners to address physical and psychological impairments, activity limitations, and participation restrictions. Patient outcomes may be improved by fostering self-efficacy through empowerment. This paper explores how the ICF model and …

A Bland–Altman Comparison Of The Lead Care® System And Inductively Coupled Plasma Mass Spectrometry For Detecting Low-Level Lead In Child Whole Blood Samples, Christina Sobin, Tanner Schaub, Natali Parisi, Eva De La Riva

Selected Works Temporary Series

Chronic childhood lead exposure, yielding blood lead levels consistently below 10 μg/dL, remains a major public health concern. Low neurotoxic effect thresholds have not yet been established. Progress requires accurate, efficient, and cost-effective methods for testing large numbers of children. The LeadCare® System (LCS) may provide one ready option. The comparability of this system to the “gold standard” method of inductively coupled plasma mass spectrometry (ICP-MS) for the purpose of detecting blood lead levels below 10 μg/dL has not yet been examined. Paired blood samples from 177 children ages 5.2–12.8 years were tested with LCS and ICP-MS. Triplicate repeat tests …

Does Intra-Amniotic Inflammation Influence Pregnancy Outcome After Cerclage Orprogesterone (17ohp-C) Therapy For Midtrimester Short Cervix?, Orion Rust Md, Daniel Kiefer Md, Sean M. Keeler Md, Morgan R. Peltier Phd, Jolene C. Muscat Md, Nazeeh Hanna Md, Anthony M. Vintzileos Md, Cande V. Ananth Phd, Mph

Department of Obstetrics & Gynecology

No abstract provided.

Quantification Of Circulating Melanoma Cells, Jamie Freeman

Theses : Honours

Current prognostic techniques for Cutaneous Malignant Melanoma (CMM), a highly aggressive and drug resistant skin cancer, are inadequate at managing the disease and identifying early stage patients requiring treatment. It is thought that Circulating Tumour Cells (CTCs), which circulate in patient blood after being shed from solid tumours, may be useful in enhancing prognostic techniques and it has previously been shown in other malignancies that the presence of CTCs in patient blood is associated with poor prognosis. In CMM, CTCs can be detected through RT-PCR for melanoma associated markers, although this technique does not allow CTCs to be quantified. In …

Evaluating Children With Otitis Media For Bacteremia Or Urinary Tract Infection., Daniel Yawman, Patrick Mahar, Aaron Blumkin, Gregory P. Conners

Manuscripts, Articles, Book Chapters and Other Papers

Background. It is unclear if clinicians evaluate for concurrent bacteremia or UTI in young patients diagnosed with acute otitis media (AOM). Objectives. To describe how often, and under which circumstances, emergency providers investigate for bacteremia or UTI in 2-36 month olds with AOM. Methods. Cases of AOM were analyzed from the 2001-2004 National Hospital Ambulatory Medical Care Survey (NHAMCS)-Emergency Department dataset. Results. AOM was diagnosed in 17% of the 10,847 recorded visits of 2-36 month olds. Of these visits, laboratory testing included: CBC: 7%, Blood culture: 4%, urinalysis or urine culture: 5%, and any of these tests: 9%. Rates of …

Effect Of Donor Ethnicity On Kidney Survival In Different Recipient Pairs: An Analysis Of The Optn/Unos Database., C O. Callender, W S. Cherikh, P Traverso, A Hernandez, Tolulope A. Oyetunji, D Chang

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Previous multivariate analysis performed between April 1, 1994, and December 31, 2000 from the Organ Procurement Transplant Network/United Network for Organ Sharing (OPTN/UNOS) database has shown that kidneys from black donors were associated with lower graft survival. We compared graft and patient survival of different kidney donor-to-recipient ethnic combinations to see if this result still holds on a recent cohort of US kidney transplants.

METHODS: We included 72,495 recipients of deceased and living donor kidney alone transplants from 2001 to 2005. A multivariate Cox regression method was used to analyze the effect of donor-recipient ethnicity on graft and patient …

Parent- Versus Child-Reported Functional Health Status After The Fontan Procedure., Linda M. Lambert, L Luann Minich, Jane W. Newburger, Minmin Lu, Victoria L. Pemberton, Ellen A. Mcgrath, Andrew M. Atz, Mingfen Xu, Elizabeth Radojewski, Darlene Servedio, Brian W. Mccrindle, Pediatric Heart Network Investigators, Girish S. Shirali

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: We sought to compare perceptions of functional health status between children who had undergone a Fontan procedure and their parents.

METHODS: Fontan procedure survivors 10 to 18 years of age were included in the study if the child completed the Child Health Questionnaire (CHQ) and the parent completed the parent form to assess the child's functional health status. Comparisons were made between raw domain scores for the parent- and child-completed CHQs.

RESULTS: Between March 2003 and April 2004, 1078 Fontan survivors were screened. Of the 546 eligible and consented patients, 354 were 10-18 years of age and 328 parent/child …

Wnt Pathway Reprogramming During Human Embryonal Carcinoma Differentiation And Potential For Therapeutic Targeting, Grace E. Snow, Allison C. Kasper, Alexander M. Busch, Elisabeth Schwarz, Katherine E. Ewings, Thomas Bee, Michael J. Spinella, Ethan Dmitrovsky, Sarah J. Freemantle

Dartmouth Scholarship

Testicular germ cell tumors (TGCTs) are classified as seminonas or non-seminomas of which a major subset is embryonal carcinoma (EC) that can differentiate into diverse tissues. The pluripotent nature of human ECs resembles that of embryonic stem (ES) cells. Many Wnt signalling species are regulated during differentiation of TGCT-derived EC cells. This study comprehensively investigated expression profiles of Wnt signalling components regulated during induced differentiation of EC cells and explored the role of key components in maintaining pluripotency.

Using Cone Beam Computed Tomography To Identify A Prediction Model For Obstructive Sleep Apnea, Jodi Parker

Loma Linda University Electronic Theses, Dissertations & Projects

Introduction: Obstructive Sleep Apnea (OSA) patients have increased risk of morbidity and mortality. Early diagnosis may reduce morbidity and mortality. Prediction of OSA from imaging may help to identify OSA patients earlier in life. CBCT can be used for OSA diagnostic imaging due to its three-dimensional (3D) visualization of the upper airway and craniofacial complex. Magnification associated with conventional 2D radiography is eliminated with CBCT, and radiation to the patient is significantly less than previous modalities used to measure craniofacial & airway measurements associated with OSA. During a CBCT scan, the patient's image is taken supine, rather than the upright …

Effects Of Functional Appliances On The Tmj And Mandibular Length Of Skeletal Class Ii Patients: A Cone Beam Computed Tomography Study, David C. Lee

Loma Linda University Electronic Theses, Dissertations & Projects

Introduction: Functional appliances have been efficiently used in the treatment of Class II malocclusions caused by retrognathic mandibles. Cone beam computed tomography has enabled us to make more accurate linear measurements by eliminating superimposition of other structures and to analyze skeletal anatomic detail in all three planes of space. This retrospective study evaluated the osseous changes in the temporomandibular joint (TMJ) and length of the mandible in skeletal Class II malocclusion patients treated with the fixed functional appliances and compared measurements with Class I malocclusion patients treated with orthodontic mechanics that did not alter skeletal relationships.

Materials and Methods: Twelve …

Observer Reliability Of Cephalometric Landmark Identification On 3-D Mr Images, Michael S. Pollack

Loma Linda University Electronic Theses, Dissertations & Projects

Introduction: Cephalometric analysis is a cornerstone of orthodontic diagnosis, yet much information is lost when 3-dimensional structures are assessed with 2-dimensional methods. CBCT offers 3-dimensional imaging but at the cost of higher levels of ionizing radiation. Magnetic resonance imaging provides 3-dimensional imaging without ionizing radiation and additionally imparts visualization of soft tissue structures. Prior to employing MR images for cephalometric analysis, reliability of landmark identification must be assessed. The purpose of this study was to evaluate intra- and interobserver reliability in 3-dimensional landmark identification using MR images.

Materials and Methods: Fifteen cranial MR images (3.0 T, MP-RAGE) from subjects between …

Functional State Following The Fontan Procedure., Ismee A. Williams, Lynn A. Sleeper, Steven D. Colan, Minmin Lu, Elizabeth A. Stephenson, Jane W. Newburger, Welton M. Gersony, Meryl S. Cohen, James F. Cnota, Andrew M. Atz, Richard V. Williams, Renee Margossian, Andrew J. Powell, Mario P. Stylianou, Daphne T. Hsu, Pediatric Heart Network Investigators, Girish S. Shirali

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Despite improvements in outcomes after completion of the Fontan circulation, long-term functional state varies. We sought to identify pre- and postoperative characteristics associated with overall function.

METHODS AND RESULTS: We analyzed data from 476 survivors with the Fontan circulation enrolled in the Pediatric Heart Network Fontan Cross-sectional Study. Mean age at creation of the Fontan circulation was 3.4 plus or minus 2.1 years, with a range from 0.7 to 17.5 years, and time since completion was 8.7 plus or minus 3.4 years, the range being from 1.1 to 17.3 years. We calculated a functional score for the survivors by …

Field Testing Adolescent Females For Cardiovascular Disease Risk, C. Jayne Brahler, Wesley R. Stephens, Betsy Donahoe Fillmore

Physical Therapy Faculty Publications

Over-fatness and poor cardiovascular (CV) fitness are well-documented risk factors for cardiovascular disease (CVD) in adults, but less is known about their association with disease risk in adolescents. This study aimed to determine the relationship between anthropometrics, fitness, and CVD risk.

Six anthropometric indicators of body fatness, seven measures of fitness, and seven metabolic and hemodynamic CVD risk factors were measured in a convenience sample of 28 female high school students (15-18 years of age). A tally was made of the number of factors for which each subject was outside the normal reference range (CVD risk).

Correlation analyses were completed …

Using Thermoluminescent Dosimeters To Measure The Dose From High And Low Energy X-Ray Sources, Wesley Leon Boyd

UNLV Theses, Dissertations, Professional Papers, and Capstones

This work focused on using thermoluminescent dosimeters (TLDs) to measure the doses from two x-ray sources, a CT scanner and a linear accelerator (linac). In addition ion chambers were used to determine the isodose contours from the operation of the linac. 1mm x 1mm x 1mm TLD-100 microcubes were placed in a Lawrence Livermore National Laboratory (LLNL) torso phantom and irradiated using a Toshiba Aquilion One 320-Slice CT Scanner. Different thicknesses of shielding composed of antimony and bismuth powder suspended in an ethylene copolymer were used to shield the phantom and the dose reduction was measured. The dose reduction ranged …

Peer-Led Team Learning: A Prospective Method For Increasing Critical Thinking In Undergraduate Science Courses, Ian J. Quitadamo, C. Jayne Brahler, Gregory J. Crouch

Physical Therapy Faculty Publications

This study examined the impact of peer-led team learning (PLTL) on critical thinking gains in science and math courses at a research university in the Pacific Northwest.

Laparoscopic Treatment Of Pancreatic Pseudocysts In Children., Suzanne M. Yoder, Steven Rothenberg, Kuojen Tsao, Mark L. Wulkan, Todd A. Ponsky, Shawn D. St Peter, Daniel J. Ostlie, Timothy D. Kane

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Pancreatic pseudocysts are problematic sequelae of pancreatitis or pancreatic trauma causing persistent abdominal pain, nausea, and gastric outlet obstruction. Due to the low volume of disease in children, there is scant information in the literature on the operative management of pseudocysts with minimally invasive techniques. We conducted a multi-institutional review to illustrate several technical variations utilized in achieving laparoscopic cystgastrostomy in the pediatric population.

METHODS: A retrospective review was conducted of all patients who underwent laparoscopic cystgastrostomy in five institutions. Patient data, operative techniques, and postoperative course were analyzed.

RESULTS: There were 13 patients with a mean age of …

Thoracoscopy In Children: Is A Chest Tube Necessary?, Todd A. Ponsky, Steven S. Rothenberg, Kuojen Tsao, Daniel J. Ostlie, Shawn D. St Peter, G W. Holcomb Iii

Manuscripts, Articles, Book Chapters and Other Papers

PURPOSE: Historically, a chest tube or drain has been left following a thoracic operation to allow drainage of air or fluid in the postoperative period. However, in patients undergoing thoracoscopy, the tube is often the greatest source of postoperative pain. We began excluding chest tubes several years ago and therefore are reviewing our experience to evaluate the safety and efficacy of this approach.

METHODS: A retrospective review of the medical record was performed on patients undergoing thoracoscopy at two centers from 1993 to 2007. Patients who left the operating room without a chest tube were included in this series. Patient …

Universal Screening For Extracardiac Abnormalities In Neonates With Congenital Heart Disease., Javier H. Gonzalez, Girish S. Shirali, Andrew M. Atz, Sarah N. Taylor, Geoffrey A. Forbus, Sinai C. Zyblewski, Anthony M. Hlavacek

Manuscripts, Articles, Book Chapters and Other Papers

Extracardiac or genetic abnormalities (EGA) represent a factor in the morbidity of patients with congenital heart disease. We evaluated the way neonates with CHD are screened at our institution and determined the yield for the screening tests. We reviewed the charts of 223 neonates with structural CHD. Subjects were categorized into 6 groups: univentricular, left-sided obstructive lesions, right-sided obstructive lesions, septal defects, conotruncal defects (CTD), and other. We reviewed which patients underwent cranial ultrasonogram (CUS), abdominal ultrasonogram (AUS), and/or genetic studies (GS) as well as their results. There was a high prevalence of EGA in each group by CUS (32% …

Laparoscopic Duodenojejunostomy For Superior Mesenteric Artery Syndrome., Jason D. Fraser, Shawn D. St Peter, Jenevieve H. Hughes, James M. Swain

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Superior mesenteric artery (SMA) syndrome, also called Wilkie's syndrome, is a rare clinical phenomenon believed to be caused by compression of the third portion of the duodenum by the overlying superior mesenteric artery. We present the case of a 32-year-old female who presented with epigastric pain, weight loss, and vomiting.

METHODS: Her workup included a normal upper endoscopy as well as an abdominal CT scan and upper GI contrast study that confirmed the diagnosis of superior mesenteric artery syndrome. The patient was taken to the operating room and underwent successful treatment with laparoscopic duodenojejunostomy.

RESULTS: The patient achieved complete …

Chronic Elbow Dislocation Treated With Open Reduction And Lateral Ulnar Collateral Ligament Reconstruction, Louis Joseph Rubino, Michael A. Herbenick, Ryan P. Finnan, Philip A. Anloague

Physical Therapy Faculty Publications

In the United States, chronic unreduced elbow dislocations are rare injuries. We report the successful short-term outcome of a chronic elbow dislocation treated with open reduction and lateral ulnar collateral ligament reconstruction using a split semitendinosus allograft in a figure-of-8 technique without use of hinged external fixation. The authors have obtained the patient’s written informed consent for print and electronic publication of the case report.