Medical Specialties Commons^™

Harnessing Teams And Technology To Improve Outcomes In Infants With Single Ventricle., Girish S. Shirali, Lori A. Erickson, Johnathan Apperson, Kathy Goggin, David D. Williams, Kimberly J. Reid, Andrea Bradley-Ewing, Dawn Tucker, Michael Bingler, John Spertus, Leslie Rabbitt, Richard Stroup

Manuscripts, Articles, Book Chapters and Other Papers

Infants with single ventricle require staged cardiac surgery, with stage I typically performed shortly after birth, stage II at 4 to 6 months of age, and stage III at 3 to 5 years of age. There is a high risk of interstage mortality and morbidity after infants are discharged from the hospital between stages I and II. Traditional home monitoring requires caregivers to record measurements of weight and oxygen saturation into a binder and requires families to assume a surveillance role. We have developed a tablet PC-based solution that provides secure and nearly instantaneous transfer of patient information to a …

The Influence Of Mir-99a On Mtor Signaling Regulation In Colorectal Cancer Cell Lines., Jonathan Rice

Electronic Theses and Dissertations

Colorectal cancer (CRC) is the third most common cancer worldwide and the fourth most common cause of death. These are staggering statistics for a disease that can essentially be cured if caught early and the pathology is favorable to therapeutic intervention. There is currently a drastic decrease in five year survival as the cancer stage increases from locally confined disease to metastatic disease. These statistics suggest that although some strides have been made with colon cancer screening and early intervention, there is still much room for improvement in both screening and treatment of CRC. One of the pathways that have …

The Roles Of Malt1 In Nf-Κb Activation And Solid Tumor Progression, Deng Pan

Dissertations and Theses (Open Access)

The transcription factor NF-κB plays a central role in many aspects of biological processes and diseases, such as inflammation and cancer. Although it has been suggested thatNF-κB is critical in tumorigenesis and tumor progression, the molecular mechanism by which NF-κB is activated in solid tumor remains largely unknown. In the current work, we focus on growth factor receptor-induced NF-κB activation and tumor progression, including epidermal growth factor receptor (EGFR)-induced NF-κB in lung cancer and heregulin receptor (HER2)-induced NF-κB in breast cancer. We found that Mucosa-associated lymphoma translocation protein 1 (MALT1), also known as paracaspase, is required for EGFR-induced NF-κB activation …

Cll Metabolism Is Regulated By Prognostic Factors, Modulated By Stroma And Abrogated By Pi3k Inhibition, Hima Vangapandu

Dissertations and Theses (Open Access)

Metabolism of chronic lymphocytic leukemia (CLL), a disease characterized by the relentless accumulation of mature B cells has been little explored. Bone marrow stromal cells provide a survival benefit to CLL cells, in part through PI3K/AKT pathway. Compared with proliferative B-cell lines, metabolic fluxes of oxygen and lactate were low in quiescent malignant B lymphocytes from CLL patients. Glycolysis (extracellular acidification rate, ECAR) was consistently low in CLL samples, but oxygen consumption (OCR) varied considerably. Higher OCR was associated with poor prognostic factors such as ZAP 70 positivity, unmutated IgVH, high β2M levels, and higher Rai stage. Co-culture with the …

Diffusion Modeling And Device Development For Peritoneal Membrane Oxygenation, Liana Hatoum

Department of Mechanical and Materials Engineering: Dissertations, Theses, and Student Research

Acute respiratory distress syndrome (ARDS) is a pulmonary disease that causes hypoxemia and respiratory failure. The mortality rate for ARDS ranges between 27% and 45%. Current treatments including mechanical ventilation and extracorporeal membrane oxygenation (ECMO) are often associated with high risk complications including barotrauma, infection, thrombosis, and hemorrhage. Alternative pulmonary support techniques are needed to improve the survival rate of patients suffering from ARDS. Previous studies introducing pure O₂ gas, perfluorocarbons and red blood cells into the intraperitoneal (IP) cavity have reported no effect or only a mild increase in oxygenation. Here we report peritoneal membrane oxygenation (PMO) using …

Geodemographic Features Of Human Blastomycosis In Eastern Wisconsin, Megan E. Huber, Dennis J. Baumgardner, Jessica J. F. Kram, Melissa A. Lemke

Journal of Patient-Centered Research and Reviews

Purpose

Blastomycosis is an endemic fungal infection. In rural northern Wisconsin, blastomycosis cases are associated with certain environmental features including close proximity to waterways. Other studies have associated blastomycosis with particular soil chemicals. However, blastomycosis also occurs in urban and suburban regions. We explored the geodemographic associations of blastomycosis cases in the more urban/suburban landscape of eastern Wisconsin.

Methods

We conducted a retrospective study of 193 laboratory-identified blastomycosis cases in a single eastern Wisconsin health system, 2007–2015. Controls were 250 randomly selected cases of community-diagnosed pneumonia from a similar time period. Geographic features of home addresses were explored using Google …

Blastomyces: Why Be Dimorphic?, Dennis J. Baumgardner

Journal of Patient-Centered Research and Reviews

In introducing the infectious disease focus for this edition of the Journal of Patient-Centered Research and Reviews, the author describes the unsolved mysteries surrounding the dimorphic fungus Blastomyces and the related pathogenesis of pulmonary blastomycosis.

Epidemiology Crucial To Cracking Elizabethkingia Crisis, Angela Tonozzi

Journal of Patient-Centered Research and Reviews

The author explains the epidemiological methods, tools and personnel required to pinpoint the source of Wisconsin’s 2016 outbreak of Elizabethkingia infections.

Clinical Approach To Nonresponsive Pneumonia In Adults Diagnosed By A Primary Care Clinician: A Retrospective Study, Kiley B. Vander Wyst, Jessica J. F. Kram, Dennis J. Baumgardner

Journal of Patient-Centered Research and Reviews

Purpose

Community-acquired pneumonia (CAP) is commonly diagnosed in the primary care setting. Management of nonresponsive pneumonia (NRP), i.e. failure to respond to CAP treatment, is not clearly understood. The purpose of this study was to describe the initial work-up and treatment of CAP in the ambulatory primary care setting and to determine relative proportion of, diagnostic approach to and treatment of NRP.

Methods

We retrospectively studied adult patients diagnosed with CAP within our large, integrated health care system from October 2006 through July 2013. Cases were defined as patients with CAP who worsened after 4 days, or did not improve …

Geographic Distribution Of Maternal Group B Streptococcus Colonization And Infant Death During Birth Hospitalization: Eastern Wisconsin, Jessica J. F. Kram, Dennis J. Baumgardner, Kiley B. Vander Wyst, Melissa A. Lemke

Journal of Patient-Centered Research and Reviews

Purpose

Maternal group B Streptococcus (GBS) can be transmitted from a colonized mother to newborn during vaginal delivery and may or may not contribute to infant death. This study aimed to explore the geographic distribution and risk factors of maternal GBS colonization and infant death during birth hospitalization.

Methods

We retrospectively studied mothers with live birth(s) in a large eastern Wisconsin hospital system from 2007 through 2013. Associations between maternal and neonatal variables, GBS colonization and infant death were examined using chi-squared, Mann-Whitney U and t-tests. Multivariable logistic regression models also were developed.

Results

Study population (N = 99,305) had …

Is 13-Valent Pneumococcal Conjugate Vaccine (Pcv13) Combined With 23-Valent Pneumococcal Polysaccharide Vaccine (Ppsv23) Superior To Ppsv23 Alone For Reducing Incidence Or Severity Of Pneumonia In Older Adults? A Clin-Iq, Starla Hayward, Lou Ann Thompson, Andrea Mceachern

Journal of Patient-Centered Research and Reviews

Pneumonia infection is a significant cause of morbidity and mortality worldwide. In addition to the public health concerns, pneumonia also accounts for a significant cost to the health care system. Currently there are two leading vaccines targeted against Streptococcus pneumoniae: 23-valent pneumococcal polysaccharide vaccine (PPSV23) and 13-valent pneumococcal conjugate vaccine (PCV13). Until recently, the recommendation for adult pneumonia vaccination has been a single dose of PPSV23 for all adults aged 65 years or older. However, concerns were raised regarding the vaccine’s efficacy due to the persistent burden of pneumococcal disease in the elderly population. This paper focuses on two …

Disease-Causing Fungi In Homes And Yards In The Midwestern United States, Dennis J. Baumgardner

Journal of Patient-Centered Research and Reviews

A number of fungal pathogens that may result in a variety of human diseases are found in residential homes and yards. The growth of these microscopic fungi is often favored by particular characteristics of the dwelling and nearby outdoor environment. Evolved virulence factors or increased ability of specific fungi to grow in diverse, and sometimes harsh, microenvironments presented by the domestic environment may promote growth and pathogenesis. Infection may occur by inhalation or direct inoculation and include endemic fungi in addition to opportunistic or emerging species. Systemic or locally aggressive fungal infections are particularly likely and may be life-threatening in …

A Mir-200c/141-Bmi1 Autoregulatory Loop Regulates Oncogenic Activity Of Bmi1 In Cancer Cells., Mingu Kang, Manjari Dimri, Goberdhan P. Dimri

Biochemistry and Molecular Medicine Faculty Publications

MicroRNAs (miRNAs) are known to function as oncomiRs or tumor suppressors and are important noncoding RNA regulators of oncogenesis. The miR-200c/141 locus on chromosome 12 encodes miR-200c and miR-141, two members of the miR-200 family, which have been shown to function as tumor suppressive miRNAs by targeting multiple oncogenic factors such as polycomb group protein BMI1. Here, we show that BMI1 reciprocally functions as a transcriptional repressor of the miR-200c/141 cluster and that BMI1 inhibitors upregulate expression of miR-200c and miR-141. Our data suggest that BMI1 binds to the miR-200c/141 promoter and regulates it through transcription factor binding motifs E-box …

Gene Expression Profiling In An Alzheimer's Disease Mouse Model, Matthew R. Dalton

Senior Honors Theses

Explaining precisely how Alzheimer’s disease (AD)—the world’s most common form of dementia—materializes in the human brain has proven to be one of the most elusive ends in modern medicine. Progressive memory loss, neurodegeneration, and the presence of abnormal protein aggregates of amyloid-beta (Aβ) and neurofibrillary tangles (NFT) characterize this disease. Genome sequencing provides researchers with the ability to better identify disease-related changes in gene expression, some of which may play a role in the initiation and progression toward the AD-like state. Intimate interactions between tissues have been observed in many diseases, particularly between the brain and blood. This analysis seeks …

Contraception, Abortion And Assisted Fertility Among Muslim Women A Look At Islamic Culture And Policy In Iran And Afghanistan, Hayley Jacobsen

What All Americans Should Know About Women in the Muslim World

Discourse on women's reproductive rights through the lens of Muslim culture. The use of contraception, assisted fertility and abortion, are analyzed in Iran and Afghanistan. The culture surrounding family planning is detailed through a woman’s community, family, religion and the laws that govern the society they live in, which all influence her decision making in these matters. This piece stands as a cultural analysis of women's agency specifically in Middle Eastern Muslim culture, as it stands as a part of a global women's rights movement.

Inadequate Sensitivity Of Laboratory Risk Indicator To Rule Out Necrotizing Fasciitis In The Emergency Department, Elizabeth Burner, Sean Henderson, Guenevere Burke, Jeffrey Nakashioya, Jerome R. Hoffman

Emergency Medicine Faculty Publications

Introduction: Necrotizing fasciitis (NF) is a life-threatening illness, particularly when surgical debridement is delayed. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score was developed to identify patients at higher risk for NF. Despite limited information in this regard, the LRINEC score is often used to "rule out" NF if negative. We describe the sensitivity of the LRINEC score in emergency department (ED) patients for the diagnosis of NF.

Methods: We conducted a chart review of ED patients in whom coding of hospital discharge diagnoses included NF. We employed standard methods to minimize bias. We used laboratory data to …

Time Of Year Affects Surgical Outcome Of Pediatric Congenital Heart Disease, Krystin Sinclair

Honors Projects in Science and Technology

Approximately 35,000 children are born in the US each year with Congenital Heart Disease (CHD). Surgical timing for many of these conditions is elective, and the distribution of surgical cases, therefore, varies with time of year. The hypothesis of this project is that time of the year for surgery is associated with mortality, length of hospital stay (LOS), and total hospital costs. A retrospective, cohort study was performed, using the Pediatric Health Information Systems (PHIS) Database to investigate these relationships.

Effective Interventions To Reduce The Increase In Elective Cesarean Sections In Low Risk Women, Kimberly Kelsey, Crystal Hunter, Brianna-Kirsten Tan, Sara Shea, Heather Holland, Sasha Riley, Mary Uy, Tenzin Tsomo, Fasha Ruys-Solorzano, Dolma Tso

Student Research Posters

According to the Annals of Family Medicine, the amount of babies born via cesarean section has increased from 4.5% in 1965 to 26.1% in 2002 and nearly 40% of all cesarean sections are repeats. After an extensive literature review, results showed that patients need to be educated about the risks and benefits of vaginal delivery and cesarean delivery. It was also found that there needs to be policy changes to decrease the amount of cesarean sections done and increase the labor and delivery support without using interventions. Further study should be focused on morbidity and mortality very low birth weight …

Intimin Likely Used To Cause Disease During Competition With Commensal Escherichia Coli, Dominique J. Richburg

Senior Honors Theses

The intimin gene in the Locus of Enterocyte Effacement (LEE) island of pathogenicity is the primary attachment mechanism in Citrobacter rodentium. Intimin is a bacterial adhesin (protein) that attaches to obtain a niche/nutrient and thrive within the intestine. Intimin was deleted within C. rodentium to study colonization and pathogenesis in the murine intestine. Additionally, C. rodentium is an attaching/effacing pathogen, and a useful murine model in understanding Enterohemorrhagic Escherichia coli (EHEC) infection in humans. E. coli and C. rodentium cause gastroenteritis in humans and mice, respectively. C. rodentium is a murine pathogen commonly used to model gastrointestinal disease because …

Biventricular Myocardial Performance Is Impaired In Proportion To Severity Of Obstructive Sleep Apnea, Selahattin Akyol, Mustafa Cortuk, Ahmet Oytun Baykan, Kemal Kiraz, Abdurrezzak Borekci, Taner Seker, Mustafa Gur, Murat Cayli

The Texas Heart Institute Journal

Obstructive sleep apnea (OSA) is an independent risk factor for cardiovascular morbidity and death. Little information is available regarding the relationship between the severity of OSA and myocardial performance in OSA patients who have normal ejection fractions. We prospectively investigated this relationship, using the tissue-Doppler myocardial performance index (TD-MPI).

We conducted overnight, full-laboratory polysomnographic examinations of 116 patients, and calculated the left and right ventricular TD-MPIs. Patients were classified into 3 groups in accordance with their apnea-hypopnea index (AHI) levels: AHImild (≥5 to <15), AHImoderate (≥15 to <30), and AHIsevere (≥30).

Left and right ventricular TD-MPI values were higher in the AHIsevere group than in the AHImild and …

Cardiac Papillary Fibroelastoma: Single-Institution Experience With 14 Surgical Patients, Walid K Abu Saleh, Odeaa Al Jabbari, Basel Ramlawi, Michael J Reardon

The Texas Heart Institute Journal

In general, treatment for symptomatic and asymptomatic cardiac papillary fibroelastoma is surgical resection-particularly of left-sided lesions, because of the risk of systemic embolization. However, few institutions have enough experience with these tumors to validate this approach. We present our institutional experience with papillary fibroelastoma and discuss our current approach. We searched our institution's cardiac tumor database, identified all patients diagnosed with cardiac papillary fibroelastoma from 1992 through 2014, and recorded the clinical and pathologic characteristics of each case. We found 14 patients (mean age, 60.5 ± 12.3 yr) who had 18 lesions. Eleven patients (79%) were symptomatic; however, we could …

Treatment And Prevention Of Human Rotavirus (Hrv) In Developing Countries: The Potential Of Avian Immunoglobulin Y, Christa Brown

Senior Honors Theses

Rotavirus gastroenteritis is a leading cause of childhood mortality, killing ~1400 children younger than five daily, primarily through severe diarrheal dehydration. Eighty-five percent of this mortality occurs in developing countries where rotavirus vaccines are not widely implemented and are only partially effective. In those countries, it has proven difficult to implement the recommended supportive therapies like oral rehydration therapy (ORT) on a wide scale due to lack of both medical infrastructure and private economic investment combined with cultural bias against ORT. IgY targeting human rotavirus (anti-HRV IgY) shows potential as a passive immunotherapy that reduces rotavirus-associated morbidity and mortality, augments …

Bioprosthetic Aortic Valve Endocarditis In Association With Enterococcus Durans, Luca Fallavollita, Lorena Di Gioacchino, Fabrizio Balestrini

The Texas Heart Institute Journal

Enterococci are common organisms associated with endocarditis, but infection by Enterococcus durans is very rare. To our knowledge, only 3 cases have been reported in the medical literature, and all 3 have involved native valves. Here we publish the first reported case (to our knowledge) of E. durans endocarditis in association with a bioprosthetic aortic valve. After the organism and its antibiotic susceptibility were identified, the 74-year-old male patient was treated successfully with teicoplanin and gentamicin, over a course of 6 weeks.

Advancing A Guiding Catheter Across A Mechanical Aortic Valve, Wassim Shatila, Guilherme V Silva

The Texas Heart Institute Journal

No abstract provided.

Longitudinal Changes In Vascular Risk Markers And Mortality Rates Among A Latino Population With Hypertension, Matthew C Pflederer, Carlin S Long, Brenda Beaty, Edward P Havranek, Philip S Mehler, Angela Keniston, Mori J Krantz

The Texas Heart Institute Journal

Vascular markers such as pulse-wave velocity and carotid intima-media thickness (CIMT) might improve the prediction of incident cardiovascular disease beyond traditional risk factors. These vascular markers have not been well characterized in minority populations and might be more useful than inflammatory biomarkers. We conducted a prospective, longitudinal cohort study among hypertensive patients in an urban safety-net hospital. We evaluated inflammatory biomarkers, arterial pulse-wave velocity, and carotid intima-media thickness at baseline, 1 year, and 2 years. The primary outcome variable was CIMT. Generalized linear mixed-effects models were used to evaluate associations between CIMT and predictive variables accounting for the correlation of …

Rebound Growth Of Infantile Hemangiomas After Propranolol Therapy., Sonal D. Shah, Eulalia Baselga, Catherine Mccuaig, Elena Pope, Julien Coulie, Laurence M. Boon, Maria C. Garzon, Anita N. Haggstrom, Denise Adams, Beth A. Drolet, Brandon D. Newell, Julie Powell, Maria Teresa García-Romero, Carol Chute, Esther Roe, Dawn H. Siegel, Barbara Grimes, Ilona J. Frieden

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND AND OBJECTIVES: Propranolol is first-line therapy for problematic infantile hemangiomas (IHs). Rebound growth after propranolol discontinuation is noted in 19% to 25% of patients. Predictive factors for rebound are not completely understood and may alter the management approach. The goal of the study was to describe a cohort of patients with IHs treated with propranolol and to identify predictors for rebound growth.

METHODS: A multicenter retrospective cohort study was conducted in patients with IHs treated with propranolol. Patient demographic characteristics, IH characteristics, and specifics of propranolol therapy were obtained. Episodes of rebound growth were recorded. Patients' responses to propranolol …

Kidney Disease Progression In Autosomal Recessive Polycystic Kidney Disease., Katherine M. Dell, Matthew Matheson, Erum A. Hartung, Bradley A. Warady, Susan L. Furth

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: To define glomerular filtration rate (GFR) decline, hypertension (HTN), and proteinuria in subjects with autosomal recessive polycystic kidney disease (ARPKD) and compare with 2 congenital kidney disease control groups in the Chronic Kidney Disease in Children cohort.

STUDY DESIGN: GFR decline (iohexol clearance), rates of HTN (ambulatory/casual blood pressures), antihypertensive medication usage, left ventricular hypertrophy, and proteinuria were analyzed in subjects with ARPKD (n = 22) and 2 control groups: aplastic/hypoplastic/dysplastic disorders (n = 44) and obstructive uropathies (n = 44). Differences between study groups were examined with the Wilcoxon rank sum test.

RESULTS: Annualized GFR change in subjects …

Single-Nucleotide Polymorphisms In Psca And The Risk Of Breast Cancer In A Chinese Population., Meng Wang, Xijing Wang, Sidney W. Fu, Zhijun Dai, Tianbo Jin, + 10 Additional Authors

Medicine Faculty Publications

This study explored the associations between common PSCA single-nucleotide polymorphisms (rs2294008, rs2978974, and rs2976392) and breast cancer among 560 breast cancer cases and 583 controls (Chinese Han women). We found rs2294008 was significantly associated with a high risk of breast cancer (homozygote model, odds ratio [OR]: 1.67, 95% confidence interval [CI]: 1.06–2.59; recessive, OR: 1.64, 95% CI: 1.06–2.53). And stratification by menopausal status revealed an association of the minor allele of rs2294008 with breast cancer risk among premenopausal (homozygote model, OR: 2.41, 95% CI: 1.03–5.66; recessive, OR: 2.80, 95 % CI: 1.21–6.47) and postmenopausal women (allele model, OR: 1.29, 95% …

'Refractory Epilepsy': What Lies Beneath?, Syedah Saira Bokhari, Satwat Hashmi

Section of Internal Medicine

A 30-year-old woman presented to the emergency room with recurrent seizures for 5 days. She had been diagnosed with epilepsy 2 years previously but stopped treatment due to the side effects of her medications. She was now experiencing episodes every 15-30 min. While undergoing a brain MRI to investigate for structural central nervous system pathology, she experienced another episode, preceded by prodromal symptoms. Polymorphic ventricular tachycardia was noted during the event. Further investigation revealed a normal QT interval, normal electrolyte panel, normal coronaries and severe left ventricular systolic dysfunction. Cardiac MRI revealed non-ischaemic cardiomyopathy. The patient was managed with heart …

A Dataset To Assess Providers׳ Knowledge And Attitudes Towards The 2013 American College Of Cardiology/American Heart Association Cholesterol Management Guideline, Yashashwi Pokharel, Lynne Steinberg, Winston Chan, Julia M. Akeroyd, Peter H. Jones, Vijay Nambi, Khurram Nasir, Laura Petersen, Christie M. Ballantyne, Salim S. Virani

Office of the Provost

We previously examined provider׳s understanding of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) cholesterol management guideline (DOI: http://dx.doi.org/10.1016/j.jacl.2015.11.002)(Virani et al., 2013) [1], and also assessed whether a case-based educational intervention could improve providers׳ knowledge gaps and attitudes towards the guideline (DOI: 10.1016/j.atherosclerosis.2015.12.044) (Pokharel, et al., 2016) [2]. Here we describe the dataset that we used to examine our objectives.