Medical Specialties Commons^™

A Blueprint For Life And Love, Marilyn Todd

The Texas Heart Institute Journal

No abstract provided.

Memory Potential, Molecular Characterization, And Translational Applications Of The Novel Theo/Tceo T Cell Phenotype, Todd Bartkowiak, Todd Bartkowiak

Dissertations and Theses (Open Access)

T cells comprise a substantial arm of the immune system and are exquisitely adapted to combat pathogens and tumors. The inflammatory environment largely dictates the nature of T cell response. A hallmark of T cell-mediated immunity is formation of immunological memory; the ability to respond more potently to re-encounter with pathogens. The immune system is also capable of recognizing tumors as foreign, much like viral or bacterial pathogens. Tumors have evolved, though, to generate an immunosuppressive environment to avoid destruction. The field of immunotherapy seeks to overcome immune suppression, in part by targeting T cell co-receptors on the cell surface …

Impact Of Kras/Nras Mutational Heterogeneity On Clinical Outcomes In Colorectal Cancer, Jonathan M. Loree

Dissertations and Theses (Open Access)

Introduction: Mutations in KRAS/NRAS (RAS) predict a lack of benefit from anti-EGFR agents in metastatic colorectal cancer (mCRC). As next generation sequencing (NGS) has advanced, we are discovering atypical and low allele frequency mutations. We aimed to evaluate how NGS can optimally define RAS mutant CRC and the role of relative mutant allele frequency (rMAF) as a biomarker.

Methods: Using institutional and public cohorts of mCRC patients with NGS results, we described the prevalence and clinical impact of atypical (not in current guidelines) and low rMAF RAS mutations (RAS MAF by the MAF of the mutated gene with …

Dynamic Assessment Of Nk Cell Interactions With Pediatric Tumor Cells To Predict Response To Immunotherapy, Arianexys Aquino Lopez

Dissertations and Theses (Open Access)

Due to Natural Killer (NK) cells’ capacity to target tumor cells without prior sensitization, adoptive NK cell therapy represents a promising immunotherapy approach for pediatric cancer patients. Our laboratory has developed an NK cell expansion protocol that generates large quantities of NK cells for therapeutic infusion. Given that NK cells are heterogeneous, with variable receptor expression and potential to target tumor cells, the purpose of my study was to determine whether subpopulations of NK cells with enhanced anti-tumor potential could be identified for increased potency of the NK cell infusion product. In addition, we previously showed that our expanded NK …

Membrane Bound Il21 Promotes Natural Killer Cell Expansion Through Mir 124-3p Mediated Regulation, Anitha Somanchi

Dissertations and Theses (Open Access)

Natural Killer (NK) cells are cells of the innate immune system that act as first line of defense against viral infections and participate in tumor immune surveillance. NK cells do not cause graft versus host disease (GvHD), or require prior antigen exposure to exert anti-tumor activity, hence are an attractive choice for immunotherapy applications. Owing to small numbers of NK cells in peripheral blood (1-32%, with a 6% median), ex vivo expansion of NK cells is critical for NK cell adoptive immunotherapy, various expansion platforms have been explored over the decades. We developed a robust platform for ex vivo expansion …

Bioresorbable Scaffolds In Spontaneous Coronary Artery Dissection: Long-Term Follow-Up In 4 Patients, Santiago Jesús Camacho Freire, Antonio Enrique Gómez Menchero, Jessica Roa Garrido, Javier León Jiménez, Rosa Cardenal Piris, José Francisco Díaz Fernández

The Texas Heart Institute Journal

Spontaneous coronary artery dissection is a rare condition, and diagnosis and treatment are challenging among patients who present with acute coronary syndrome. Typically, the condition affects young females who have no underlying atherosclerotic disease. To date, few cases of bioresorbable scaffold implantation for the treatment of spontaneous coronary artery dissection have been reported. Therefore, we describe the cases of 4 patients whom we treated with scaffolds. We evaluated the long-term results by using intravascular ultrasound and optical coherence tomographic scanning.

Recurrent Biatrial Myxoma In A 41-Year-Old Woman After Left Atrial Myxoma Resection, Xiaoming Jia, Anjali Kohli, Jane Jarjour, Chung-Jiah Justin Chen, Brendan Gilmore, Rashed Tabbaa, Edward Lee Poythress

The Texas Heart Institute Journal

Bilateral recurrence of atrial myxoma has been reported only a few times. We describe the case of a 41-year-old woman who had undergone left atrial myxoma resection and presented 9 years later with myxomas in both atria. The patient underwent successful resection of both masses with resolution of symptoms. We discuss the phenomenon of recurrent biatrial myxoma.

Multimodal Imaging Of Anomalous Left Coronary Artery From The Pulmonary Artery In A 75-Year-Old Woman, Margaret M Fuchs, Rachel J Le, Michael W Cullen, Joseph J Maleszewski, Naser M Ammash

The Texas Heart Institute Journal

Anomalous origin of the left coronary artery from the pulmonary artery is rare and typically results in mitral regurgitation, ventricular arrhythmias, heart failure, and sudden death. The condition most often manifests itself in early childhood, but some individuals are diagnosed much later. We describe the case of a 75-year-old woman with heart failure in whom stepwise multimodal imaging revealed anomalous origin of the left coronary artery from the pulmonary artery.

Col4a2 Is Associated With Lacunar Ischemic Stroke And Deep Ich: Meta-Analyses Among 21,500 Cases And 40,600 Controls, Kristiina Rannikmäe, Vhinoth Sivakumaran, Henry Millar, Rainer Malik, Christopher D Anderson, Mike Chong, Tushar Dave, Guido J Falcone, Israel Fernandez-Cadenas, Jordi Jimenez-Conde, Arne Lindgren, Joan Montaner, Martin O'Donnell, Guillaume Paré, Farid Radmanesh, Natalia S Rost, Agnieszka Slowik, Martin Söderholm, Matthew Traylor, Sara L Pulit, Sudha Seshadri, Brad B Worrall, Daniel Woo, Hugh S Markus, Braxton D Mitchell, Martin Dichgans, Jonathan Rosand, Cathie L M Sudlow

Faculty, Staff and Student Publications

OBJECTIVE: To determine whether common variants in familial cerebral small vessel disease (SVD) genes confer risk of sporadic cerebral SVD.

METHODS: We meta-analyzed genotype data from individuals of European ancestry to determine associations of common single nucleotide polymorphisms (SNPs) in 6 familial cerebral SVD genes (

RESULTS: A locus in

CONCLUSIONS: These results provide evidence of shared genetic determinants and suggest common pathophysiologic mechanisms of distinct ischemic and hemorrhagic cerebral SVD stroke phenotypes, offering new insights into the causal mechanisms of cerebral SVD.

Predictors Of High-Sensitivity Cardiac Troponin T Elevation In Patients With Acute Paroxysmal Supraventricular Tachycardia And Ischemic Heart Disease, Mehdi Sayadnik, Akbar Shafiee, Yaser Jenab, Arash Jalali, Saeed Sadeghian

The Texas Heart Institute Journal

We studied the predictors and patterns of high-sensitivity cardiac troponin T (hs-cTnT) elevation in patients with paroxysmal supraventricular tachycardia (PSVT) in the presence and absence of ischemic heart disease.

During calendar year 2013, we enrolled 70 of 72 consecutive adult patients with PSVT who presented at our center within 4 hours after the onset of tachycardia. On the basis of increased hs-cTnT at either of 2 initial measurements, we divided patients into groups (hs-cTnT–positive and hs-cTnT–negative), to study the predictors of enzyme elevation. We then divided the hs-cTnT–positive patients into 2 groups—those with and those without ischemic heart disease—and compared …

Left Circumflex Coronary Artery As The Culprit Vessel In St-Segment-Elevation Myocardial Infarction, Diab Ghanim, Fabio Kusniec, Wadi Kinany, Dahud Qarawani, David Meerkin, Khaled Taha, Offer Amir, Shemy Carasso

The Texas Heart Institute Journal

The prevalence of the left circumflex coronary artery (LCx) as the culprit vessel in ST-segment-elevation myocardial infarction (STEMI) is reportedly lowest among that of the 3 main epicardial arteries, and has not been described for non-STEMI (NSTEMI) and stable angina pectoris. We sought to define the distribution of culprit arteries in these clinical presentations and suggest mechanisms for the differences.

We reviewed 189 coronary angiograms of patients with STEMI, 203 with NSTEMI, and 548 with stable angina (n=940), and compared distributions of stenotic and culprit coronary arteries (lesions prompting intervention).

Obstructive coronary lesions (≥50% narrowing) were more prevalent in the …

The Rise And Fall Of Estrogen Therapy: Is Testosterone For "Manopause" Next?, Briana T Costello, Keri Sprung, Stephanie A Coulter

The Texas Heart Institute Journal

No abstract provided.

Management Of Chronic Venous Disease, Michael Mcardle, Eduardo A Hernandez-Vila

The Texas Heart Institute Journal

No abstract provided.

A Blessing, Jeremy A Ross

The Texas Heart Institute Journal

No abstract provided.

Project Echo: A Telementoring Program For Cervical Cancer Prevention And Treatment In Low-Resource Settings, Melissa S Lopez, Ellen S Baker, Andrea M Milbourne, Rose M Gowen, Ana M Rodriguez, Cesaltina Lorenzoni, Catherine Mwaba, Susan Citonje Msadabwe, José Humberto Tavares, Georgia Fontes-Cintra, Gustavo Zucca-Matthes, Donato Callegaro-Filho, Danielle Ramos-Martin, Icaro Thiago De Carvalho, Robson Coelho, Renato Moretti Marques, Thiago Chulam, Mila Pontremoli-Salcedo, Fernanda Nozar, Veronica Fiol, Mauricio Maza, Sanjeev Arora, Ernest T Hawk, Kathleen M Schmeler

Faculty, Staff and Student Publications

Cervical cancer incidence and mortality rates are significantly higher in low- and middle-income countries compared with the United States and other developed countries. This disparity is caused by decreased access to screening, often coupled with low numbers of trained providers offering cancer prevention and treatment services. However, similar disparities are also found in underserved areas of the United States, such as the Texas-Mexico border, where cervical cancer mortality rates are 30% higher than in the rest of Texas. To address these issues, we have adopted the Project ECHO (Extension for Community Healthcare Outcomes) program, a low-cost telementoring model previously proven …

Effects Of Once-Weekly Exenatide On Cardiovascular Outcomes In Type 2 Diabetes, Rury R Holman, M Angelyn Bethel, Robert J Mentz, Vivian P Thompson, Yuliya Lokhnygina, John B Buse, Juliana C Chan, Jasmine Choi, Stephanie M Gustavson, Nayyar Iqbal, Aldo P Maggioni, Steven P Marso, Peter Öhman, Neha J Pagidipati, Neil Poulter, Ambady Ramachandran, Bernard Zinman, Adrian F Hernandez

Faculty, Staff and Student Publications

BACKGROUND: The cardiovascular effects of adding once-weekly treatment with exenatide to usual care in patients with type 2 diabetes are unknown.

METHODS: We randomly assigned patients with type 2 diabetes, with or without previous cardiovascular disease, to receive subcutaneous injections of extended-release exenatide at a dose of 2 mg or matching placebo once weekly. The primary composite outcome was the first occurrence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. The coprimary hypotheses were that exenatide, administered once weekly, would be noninferior to placebo with respect to safety and superior to placebo with respect to efficacy.

RESULTS: …

Impact Of Vitamin A And Carotenoids On The Risk Of Tuberculosis Progression, Omowunmi Aibana, Molly F Franke, Chuan-Chin Huang, Jerome T Galea, Roger Calderon, Zibiao Zhang, Mercedes C Becerra, Emily R Smith, Alayne G Ronnenberg, Carmen Contreras, Rosa Yataco, Leonid Lecca, Megan B Murray

Faculty, Staff and Student Publications

BACKGROUND: Low and deficient levels of vitamin A are common in low- and middle-income countries where tuberculosis burden is high. We assessed the impact of baseline levels of vitamin A and carotenoids on tuberculosis disease risk.

METHODS: We conducted a case-control study nested within a longitudinal cohort of household contacts (HHCs) of pulmonary tuberculosis case patients in Lima, Peru. We defined case patients as human immunodeficiency virus (HIV)-negative HHCs with blood samples in whom tuberculosis disease developed ≥15 days after enrollment of the index patient. For each case patient, we randomly selected 4 controls from among contacts in whom tuberculosis …

Skin Necrosis Induced By Coumarin Congeners, Herbert L Fred

The Texas Heart Institute Journal

No abstract provided.

Optical Coherence Tomographic Evaluation Of Hyperacute Bivalirudin-Induced Coronary Stent Thrombosis, Jorge L Peñalver, Wassim Shatila, Emerson Perin

The Texas Heart Institute Journal

Thrombus formation after stent deployment has been linked to the use of heparin and of antithrombotic agents, such as bivalirudin, during percutaneous coronary intervention. Fluoroscopy has been used to identify stent thrombosis, typically after patients become symptomatic. We describe our use of optical coherence tomography to diagnose and evaluate intraprocedural stent thrombosis in a 68-year-old man who was given bivalirudin just before a percutaneous coronary procedure. This imaging method enabled immediate therapeutic intervention.

Bigeminy And A Pacemaker, Luke Cunningham, Yochai Birnbaum

The Texas Heart Institute Journal

No abstract provided.

Selective Upper-Body Perfusion Technique For Removal Of Renal Cell Carcinoma Extending Into The Inferior Vena Cava And Right Atrium, Selim Aydin, Bora Cengiz, Banu Vural Gokay, Anar Mammadov, Remzi Emiroglu, Saadettin Eskicorapci, Ersin Erek

The Texas Heart Institute Journal

Invasion of a renal cell carcinoma thrombus into the inferior vena cava and right atrium is infrequent. Reaching and completely excising a tumor from the inferior vena cava is particularly challenging because the liver covers the surgical field. We report the case of a 61-year-old man who underwent surgery for a renal cell carcinoma of the right kidney that extended into the inferior vena cava and right atrium. During dissection of the liver to expose the inferior vena cava, transesophageal echocardiograms revealed right atrial mass migration into the tricuspid valve. On emergency sternotomy, the tumor embolized into the main pulmonary …

Echocardiographic Classification And Surgical Approaches To Double-Outlet Right Ventricle For Great Arteries Arising Almost Exclusively From The Right Ventricle, Kun-Jing Pang, Hong Meng, Sheng-Shou Hu, Hao Wang, David Hsi, Zhong-Dong Hua, Xiang-Bin Pan, Shou-Jun Li

The Texas Heart Institute Journal

Selecting an appropriate surgical approach for double-outlet right ventricle (DORV), a complex congenital cardiac malformation with many anatomic variations, is difficult. Therefore, we determined the feasibility of using an echocardiographic classification system, which describes the anatomic variations in more precise terms than the current system does, to determine whether it could help direct surgical plans. Our system includes 8 DORV subtypes, categorized according to 3 factors: the relative positions of the great arteries (normal or abnormal), the relationship between the great arteries and the ventricular septal defect (committed or noncommitted), and the presence or absence of right ventricular outflow tract …

Improving Nk Cell Therapy For Osteosarcoma, Jennifer Foltz

Dissertations and Theses (Open Access)

Osteosarcoma (OS) is the most common primary bone tumor. Despite new treatment options, 5-year survival for metastatic OS has remained at only 30% for the last 30 years. Adoptive transfer of Natural Killer (NK) cells holds promise for a new, non-toxic therapy for OS. NK cells are part of the innate immune system and readily kill metastatic and chemotherapy-resistant OS in vitro and in murine models. However, there is little data regarding their efficacy in animal models with an intact immune system. In addition, the OS tumor microenvironment is highly suppressive, producing TGFβ which impedes NK cell killing of solid …

Improvements In Four-Dimensional And Dual Energy Computed To Mography, Rachael M. Martin

Dissertations and Theses (Open Access)

Dual energy and 4D computed tomography (CT) seek to address some of the limitations in traditional CT imaging. Dual energy CT, among other purposes, allows for the quantification and improved visualization of contrast materials, and 4D CT is often used in radiation therapy applications as it allows for the visualization and quantification of object motion. While much research has been done with these technologies, areas remain for potential improvement, both in preclinical and clinical settings, which will be explored in this dissertation. Preclinical dual energy cone-beam CT (CBCT) can benefit from wider separation between the peak energy of the two …

Hsp27 And Chemotherapy-Induced Autophagy As Biomarkers In Osteosarcoma, John Andrew Livingston

Dissertations and Theses (Open Access)

Survival for patients with osteosarcoma has not improved for > 30 years. Despite aggressive multi-agent chemotherapy combined with surgical resection, a significant fraction of patients with localized disease relapse after optimal treatment. We evaluated the occurrence of cytoplasmic LC3B (light chain 3B)-positive puncta (a marker of autophagy) and presence of HSP27 (heat shock protein 27) in cancer cells within pre-treatment biopsy, post-treatment surgical resection, and metastatic osteosarcoma specimens by immunohistochemistry in 260 patients. LCB3+ puncta expression was seen in 34% of pre-treatment. 50% of resection, and 67% of metastasis samples. Sixty-six percent of all specimens were scored positive for HSP27 (85% …

Evaluation Of Chest Pain After Implantable Cardioverter-Defibrillator Placement, Amir Gahremanpour, Mohammad Saeed, Yochai Birnbaum

The Texas Heart Institute Journal

No abstract provided.

Transcatheter Tricuspid Valve-In-Valve Replacement With An Edwards Sapien 3 Valve, Pranav Loyalka, Angelo Nascimbene, Benjamin Metz, Igor D Gregoric, Ajay Sundara Raman, Biswajit Kar

The Texas Heart Institute Journal

A few case reports and case series have documented the outcomes in patients with tricuspid bioprosthetic valvular degeneration who underwent transcatheter implantation of the Medtronic Melody and the Edwards Sapien XT and Sapien 3 valves. In this report, we describe the case of a 49-year-old woman with severe bioprosthetic tricuspid valvular stenosis and multiple comorbidities who underwent transcatheter tricuspid valve replacement with a Sapien 3 valve.

Unproven Stem Cell-Based Interventions: Advancing Policy Through Stakeholder Collaboration, Kirstin R W Matthews, Ana S Iltis

The Texas Heart Institute Journal

No abstract provided.

White Blood Cell Subtypes Are Associated With A Greater Long-Term Risk Of Death After Acute Myocardial Infarction, Arthur Shiyovich, Harel Gilutz, Ygal Plakht

The Texas Heart Institute Journal

We evaluated the association between white blood cell counts and long-term mortality rates in 2,129 patients (mean age, 65.3 ± 13.5 yr; 69% men) who had survived acute myocardial infarction. We obtained white blood cell counts and differential counts of white blood cell subtypes within the first 72 hours of hospital admission. The primary outcome was all-cause death at 1, 5, and 10 years after acute myocardial infarction.

In regard to death in the long term, we found significant negative linear associations (lymphocytes), positive linear associations (neutrophils and the neutrophil-to-lymphocyte ratio), and nonlinear U-shaped associations (basophils, eosinophils, monocytes, and total …

The Two Anomalies Of Wilhelm Ebstein, Magdalena Mazurak, Jacek Kusa

The Texas Heart Institute Journal

The year 2016 was the 180th anniversary of Wilhelm Ebstein's birth and the 150th anniversary of his description of the congenital tricuspid valve malformation that came to be known as Ebstein anomaly. We present a brief history of the life and work of Dr. Wilhelm Ebstein. Despite his distinguished career, he is seemingly forgotten in his own birthplace. We include a review of the relevant historical medical literature.