Medical Specialties Commons^™

Management Of Forehead Scars, Ryan N. Heffelfinger, Akshay Sanan, Lucas M. Bryant

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

This article provides an overview of scar management within the forehead region. It addresses the unique challenges specific to the treatment of forehead wounds. A logical, stepwise approach is used. A subsite based treatment algorithm is provided along with a review of current best practices. Pertinent case examples are included for demonstration purposes.

Prone Position: Does It Help With Acute Respiratory Distress Syndrome (Ards) Requiring Extracorporeal Membrane Oxygenation (Ecmo)?, Nava Azimzadeh, Michael Baram, Nicholas C. Cavarocchi, Hitoshi Hirose

Department of Surgery Faculty Papers

Introduction: Lung protective ventilation therapy with low tidal volume-high PEEP is the standard treatment for the patients with acute respiratory distress syndrome (ARDS). Oscillators are occasionally used for salvage ventilation in cases where poor compliance restricts the use of traditional ventilation with ARDS. In addition to ventilator therapy, prone positioning has been used to improve oxygenation. We presented a challenging case of ARDS, which failed medical management extracorporeal membrane oxygenation (ECMO) support and oscillatory ventilation. Prone positioning was initiated which improved oxygenation, respiratory compliance and posterior atelectasis. Case presentation: A 41-year-old morbid obese female developed ARDS due to influenza pneumonia. …

Associations Of Emergency Department Length Of Stay With Publicly Reported Quality-Of-Care Measures., Anna Marie Chang, Amber Lin, Rongwei Fu, K. John Mcconnell, Benjamin Sun

Department of Emergency Medicine Faculty Papers

OBJECTIVE: The Institute of Medicine identified emergency department (ED) crowding as a critical threat to patient safety. We assess the association between changes in publicly reported ED length of stay (LOS) and changes in quality-of-care measures in a national cohort of hospitals.

METHODS: Longitudinal analysis of 2012 and 2013 data from the American Hospital Association (AHA) Survey, Center for Medicare and Medicaid Services (CMS) Cost Reports, and CMS Hospital Compare. We included hospitals reporting Hospital Compare timeliness measure of LOS for admitted patients. We used AHA and CMS data to incorporate hospital predictors of interest. We used the method of …

Academic Primer Series: Five Key Papers For Consulting Clinician Educators., Teresa M. Chan, Michael Gottlieb, Antonia Quinn, Kory S. London, Lauren W. Conlon, Felix Ankel

Department of Emergency Medicine Faculty Papers

INTRODUCTION: Clinician educators are often asked to perform consultations for colleagues. Invitations to consult and advise others on local problems can help foster great collaborations between centers, and allows for an exchange of ideas between programs. In this article, the authors identify and summarize several key papers to assist emerging clinician educators with the consultation process.

METHODS: A consensus-building process was used to generate a list of key papers that describe the importance and significance of educational consulting, informed by social media sources. A three-round voting methodology, akin to a Delphi study, determined the most impactful papers from the larger …

Prospects And Limitations Of Improving Skeletal Growth In A Mouse Model Of Spondyloepiphyseal Dysplasia Caused By R992c (P.R1192c) Substitution In Collagen Ii., Machiko Arita, Jolanta Fertala, Cheryl Hou, James Kostas, Andrzej Steplewski, Andrzej Fertala

Department of Orthopaedic Surgery Faculty Papers

Skeletal dysplasias form a group of skeletal disorders caused by mutations in macromolecules of cartilage and bone. The severity of skeletal dysplasias ranges from precocious arthropathy to perinatal lethality. Although the pathomechanisms of these disorders are generally well defined, the feasibility of repairing established aberrant skeletal tissues that developed in the presence of mutant molecules is currently unknown. Here, we employed a validated mouse model of spondyloepiphyseal dysplasia (SED) that enables temporal control of the production of the R992C (p.R1192C) collagen II mutant that causes this disease. Although in our earlier studies we determined that blocking the expression of this …

Challenges To Smartphone Applications For Melanoma Detection, Jordan V. Wang, Lance W. Chapman, Matthew S. Keller

Department of Dermatology and Cutaneous Biology Faculty Papers

This commentary addresses the emerging market for health-related smartphone applications. Specific to dermatology, there has been a significant increase not only in applications that promote skin cancer awareness and education but also in those meant for detection. With evidence showing that 365 dermatology-related applications were available in 2014--up from 230 in 2012--and that 1 in 5 patients under the age of 50 have used a smartphone to help diagnose a skin problem, there is clearly a large subset of patients participating in this growing trend. Therefore, we are obligated to take a closer look into this phenomenon. Studies have shown …

From Emt To Hsc To Aml: Zeb2 Is A Cell Fate Switch., Sara E. Meyer

Department of Cancer Biology Faculty Papers

In this issue of Blood, complimentary studies by J. Li et al¹ and H. Li et al² identify the transcription factor ZEB2 as a critical regulator of multilineage differentiation in both normal and malignant hematopoiesis. In particular, these studies show that ZEB2 is an inhibitor of normal granulocyte production, and in acute myeloid leukemia (AML), antagonizing ZEB2 function releases the granulocytic differentiation block, creating an antileukemic therapeutic effect.

Ladarixin, A Dual Cxcr1/2 Inhibitor, Attenuates Experimental Melanomas Harboring Different Molecular Defects By Affecting Malignant Cells And Tumor Microenvironment., Daria Marley Kemp, Alyson Pidich, Mary Larijani, Rebecca Jonas, Elizabeth Lash, Takami Sato, Mizue Terai, Maria De Pizzol, Marcello Allegretti, Olga Igoucheva, Vitali Alexeev

Department of Dermatology and Cutaneous Biology Faculty Papers

CXCR1 and CXCR2 chemokine receptors and their ligands (CXCL1/2/3/7/8) play an important role in tumor progression. Tested to date CXCR1/2 antagonists and chemokine-targeted antibodies were reported to affect malignant cells in vitro and in animal models. Yet, redundancy of chemotactic signals and toxicity hinder further clinical development of these approaches. In this pre-clinical study we investigated the capacity of a novel small molecule dual CXCR1/2 inhibitor, Ladarixin (LDX), to attenuate progression of experimental human melanomas. Our data showed that LDX-mediated inhibition of CXCR1/2 abrogated motility and induced apoptosis in cultured cutaneous and uveal melanoma cells and xenografts independently of the …

Fsd-C10, A Fasudil Derivative, Promotes Neuroregeneration Through Indirect And Direct Mechanisms., Yan-Hua Li, Chong Xie, Yuan Zhang, Xing Li, Hai-Fei Zhang, Qing Wang, Zhi Chai, Bao-Guo Xiao, Rodolfo Thome, Guang-Xian Zhang, Cun-Gen Ma

Department of Neurology Faculty Papers

FSD-C10, a Fasudil derivative, was shown to reduce severity of experimental autoimmune encephalomyelitis (EAE), an animal model of multiple sclerosis (MS), through the modulation of the immune response and induction of neuroprotective molecules in the central nervous system (CNS). However, whether FSD-C10 can promote neuroregeneration remains unknown. In this study, we further analyzed the effect of FSD-C10 on neuroprotection and remyelination. FSD-C10-treated mice showed a longer, thicker and more intense MAP2 and synaptophysin positive signal in the CNS, with significantly fewer CD4(+) T cells, macrophages and microglia. Importantly, the CNS of FSD-C10-treated mice showed a shift of activated macrophages/microglia from …

Maternal And Newborn Health In Karnataka State, India: The Community Level Interventions For Pre-Eclampsia (Clip) Trial's Baseline Study Results., Mrutynjaya B. Bellad, Marianne Vidler, Narayan V. Honnungar, Ashalata Mallapur, Umesh Ramadurg, Umesh Charanthimath, Geetanjali Katageri, Shashidhar Bannale, Avinash Kavi, Chandrashekhar Karadiguddi, Sumedha Sharma, Tang Lee, Jing Li, Beth Payne, Laura Magee, Peter Von Dadelszen, Richard Derman, Shivaprasad S. Goudar

Department of Obstetrics and Gynecology Faculty Papers

Existing vital health statistics registries in India have been unable to provide reliable estimates of maternal and newborn mortality and morbidity, and region-specific health estimates are essential to the planning and monitoring of health interventions. This study was designed to assess baseline rates as the precursor to a community-based cluster randomized control trial (cRCT)-Community Level Interventions for Pre-eclampsia (CLIP) Trial (NCT01911494; CTRI/2014/01/004352). The objective was to describe baseline demographics and health outcomes prior to initiation of the CLIP trial and to improve knowledge of population-level health, in particular of maternal and neonatal outcomes related to hypertensive disorders of pregnancy, in …

T-Cadherin Deficiency Increases Vascular Vulnerability In T2dm Through Impaired No Bioactivity., Han Wang, Ling Tao, Anastasia Ambrosio, Wenjun Yan, Ross Summer, Wayne Bond Lau, Yajing Wang, Xin-Liang Ma

Department of Emergency Medicine Faculty Papers

BACKGROUND: Endothelial dysfunction plays a critical role in the development of type 2 diabetes (T2DM). T-cadherin (T-cad) has gained recognition as a regulator of endothelial cell (EC) function. The present study examined whether T-cad deficiency increases vascular vulnerability in T2DM.

METHODS: Vascular segments were isolated from WT or T-cad knockout mice. Endothelial function, total NO accumulation, and the expression of T-cad related proteins were determined.

RESULTS: Ach and acidified NaNO2 induced similar vasorelaxation in WT groups. T-cad KO mice exhibited normal response to acidified NaNO2, but manifested markedly reduced response to Ach. NO accumulation was also decreased in T-cad KO …

Regulation Of Sleep Plasticity By A Thermo-Sensitive Circuit In Drosophila., Angelique Lamaze, Arzu Öztürk-Çolak, Robin Fischer, Nicolai Peschel, Kyunghee Koh, James E.C. Jepson

Department of Neuroscience Faculty Papers

Sleep is a highly conserved and essential behaviour in many species, including the fruit fly Drosophila melanogaster. In the wild, sensory signalling encoding environmental information must be integrated with sleep drive to ensure that sleep is not initiated during detrimental conditions. However, the molecular and circuit mechanisms by which sleep timing is modulated by the environment are unclear. Here we introduce a novel behavioural paradigm to study this issue. We show that in male fruit flies, onset of the daytime siesta is delayed by ambient temperatures above 29 °C. We term this effect Prolonged Morning Wakefulness (PMW). We show that …

Sports Medicine Potpourri, Marc I. Harwood, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Objectives:

At the conclusion of this talk, the learner will be:

• Thoroughly confused by the whirlwind of information presented
• But...able to delve into any of the topics at greater length when time permits.

Presentation: 52:03

Audio for PowerPoint slides.

Androgen Receptor-Dependent And -Independent Mechanisms Driving Prostate Cancer Progression: Opportunities For Therapeutic Targeting From Multiple Angles., David T. Hoang, Kenneth A. Iczkowski, Deepak Kilari, William See, Marja T. Nevalainen

Student Papers, Posters & Projects

Despite aggressive treatment for localized cancer, prostate cancer (PC) remains a leading cause of cancer-related death for American men due to a subset of patients progressing to lethal and incurable metastatic castrate-resistant prostate cancer (CRPC). Organ-confined PC is treated by surgery or radiation with or without androgen deprivation therapy (ADT), while options for locally advanced and disseminated PC include radiation combined with ADT, or systemic treatments including chemotherapy. Progression to CRPC results from failure of ADT, which targets the androgen receptor (AR) signaling axis and inhibits AR-driven proliferation and survival pathways. The exact mechanisms underlying the transition from androgen-dependent PC …

Urokinase Plasminogen Activator Expression Is Regulated By P53 Harboring The Lung Cancer-Specific Mutation V157f, Julie Barta, Md, Kristen Pauley, Steven B. Mcmahon, Phd

Department of Biochemistry and Molecular Biology Posters

OBJECTIVES

• To define the mutant p53-regulated transcriptome of lung cancer cells with alterations at V157 and R158 in the p53 tumor suppressor.
• To determine the biological effects of lung-enriched p53 mutations in lung cancer cells.

Biological Functions Of Cdk5 And Potential Cdk5 Targeted Clinical Treatments., Alison Shupp, Mathew C. Casimiro, Richard G. Pestell

Department of Cancer Biology Faculty Papers

Cyclin dependent kinases are proline-directed serine/threonine protein kinases that are traditionally activated upon association with a regulatory subunit. For most CDKs, activation by a cyclin occurs through association and phosphorylation of the CDK's T-loop. CDK5 is unusual because it is not typically activated upon binding with a cyclin and does not require T-loop phosphorylation for activation, even though it has high amino acid sequence homology with other CDKs. While it was previously thought that CDK5 only interacted with p35 or p39 and their cleaved counterparts, Recent evidence suggests that CDK5 can interact with certain cylins, amongst other proteins, which modulate …

Transgender Care, Nyasha George, Md, Pgy 3

Department of Family & Community Medicine Presentations and Grand Rounds

Outline:

Objectives

Review of trans epidemiology

Healthcare and the Transcommunity

Cases 1&2

• Taking a transgender history
• CSH indications

Case 3

• Mental Health and Transpersons

Case 4

• Cardiovascular Risks and Estrogen in Transwomen
• Provider Resources

Objectives

My goals for you at the end of this lecture:

Comfort in determining which transgender patients meet criteria for initiating CSH

Appreciation of the overlap between transgender identity and psychiatric disease as mediated primarily by trauma

Improved self efficacy in weighing risks/benefits of CSH therapy

Familiarity with resources available to help support primary care providers take care of transgender patients.

Presentation: 58:36

Hyaline Fibromatosis Syndrome: A Novel Mutation And Recurrent Founder Mutation In The Cmg2/Antxr2 Gene., Leila Youssefian, Hassan Vahidnezhad, Yahya Aghighi, Vahid Ziaee, Sirous Zeinali, Maryam Abiri, Jouni Uitto

Department of Dermatology and Cutaneous Biology Faculty Papers

No abstract provided.

Promoting Family Resilience As A Population Health Strategy, Barry J. Jacobs, Psy.D.

Department of Family & Community Medicine Presentations and Grand Rounds

Today's Talk:

• Why family matters to population health
• Research from two movements
• Steps toward patient and family resilience
• Barriers to integrating family caregivers into healthcare
• Healthcare-based family caregiver support programs: Baylor Scott & White, Concord Hospital

No audio, just PowerPoint slides

William Arbuthnot Lane (1856-1943): Surgical Innovator And His Theory Of Autointoxication., Mackenzie Morris, Thea Price, Scott W. Cowan, Charles J. Yeo, Benjamin Phillips

Department of Surgery Gibbon Society Historical Profiles

William Arbuthnot Lane contributed to the advancement of many fields of orthopedics, otolaryngology, and general surgery. He is credited for his "no-touch technique" and the invention of long-handled instruments, some of which are still in use today, to minimize tissue handling. He is most well known for his hypothesis that slowing of gastric contents could cause a variety of ailments and this became known as Lane's disease. Although his surgical treatment of Lane's disease is now defunct, it advanced the surgical technique in colorectal surgery. It seems likely that some of Lane's "autointoxication" patients would be classified today as patients …

Extracorporeal Membrane Oxygenation With Multiple-Organ Failure: Can Molecular Adsorbent Recirculating System Therapy Improve Survival?, Bailey E. Sparks, Nicholas C. Cavarocchi, Hitoshi Hirose

Department of Surgery Faculty Papers

BACKGROUND: Liver dialysis, molecular adsorbent recirculating system (MARS) particularly, has been used in liver failure to bridge to transplantation. We expanded the indication for MARS to patients with acute shock liver failure and cardiopulmonary failure on extracorporeal membrane oxygenation (ECMO), aiming to improve survival to wean from ECMO.

METHODS: Retrospective chart analysis of patients on ECMO between 2010 and 2015 found 28 patients who met the criteria for acute liver failure, diagnosed by hyperbilirubinemia (total bilirubin ≥10 mg/dl) or by elevated transaminase (alanine transaminase >1,000 IU/liter). Of these patients, 14 underwent MARS treatment (Group M), and 14 were supported with …

Teaching The Emergency Department Patient Experience: Needs Assessment From The Cord-Em Task Force., Kory S. London, Jeffrey Druck, Matthew Silver, Douglas Finefrock

Department of Emergency Medicine Faculty Papers

INTRODUCTION: Since the creation of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction (PS) scores, patient experience (PE) has become a metric that can profoundly affect the fiscal balance of hospital systems, reputation of entire departments and welfare of individual physicians. While government and hospital mandates demonstrate the prominence of PE as a quality measure, no such mandate exists for its education. The objective of this study was to determine the education and evaluation landscape for PE in categorical emergency medicine (EM) residencies.

METHODS: This was a prospective survey analysis of the Council of Emergency Medicine Residency …

Design And Challenges Of A Randomized Clinical Trial Of Medical Expulsive Therapy (Tamsulosin) For Urolithiasis In The Emergency Department., Pamela K. Burrows, Judd E. Hollander, Allan B. Wolfson, Michael C. Kurz, Lorna Richards, Sara Difiore, Phillip Watts, Nivedita Patkar, Jeremy Brown, Stephen Jackman, Ziya Kirkali, John W. Kusek, Chloe Michel, Andrew C. Meltzer

Department of Emergency Medicine Faculty Papers

Urolithiasis or urinary stone disease has been estimated to affect about 1 in 11 Americans. Patients with urinary stone disease commonly present to the emergency department for management of their acute pain. In addition to providing analgesia, administration of drug (medical expulsive therapy) is often prescribed to assist passage of the urinary stone. In this methodology paper, we describe the design of a prospective, multi-center, randomized, double-blind placebo controlled clinical trial of the alpha-adrenergic blocker, tamsulosin, to evaluate its effectiveness as medical expulsive therapy. In addition, we describe the unique challenges of conducting a trial of this type within the …

Characteristics Of Real-Time, Non-Critical Incident Debriefing Practices In The Emergency Department., Nur-Ain Nadir, Suzanne Bentley, Dimitrios Papanagnou, Komal Bajaj, Stephan Rinnert, Richard Sinert

Department of Emergency Medicine Faculty Papers

INTRODUCTION: Benefits of post-simulation debriefings as an educational and feedback tool have been widely accepted for nearly a decade. Real-time, non-critical incident debriefing is similar to post-simulation debriefing; however, data on its practice in academic emergency departments (ED), is limited. Although tools such as TeamSTEPPS® (Team Strategies and Tools to Enhance Performance and Patient Safety) suggest debriefing after complicated medical situations, they do not teach debriefing skills suited to this purpose. Anecdotal evidence suggests that real-time debriefings (or non-critical incident debriefings) do in fact occur in academic EDs;, however, limited research has been performed on this subject. The objective of …

Targeting The Nrf2-Heme Oxygenase-1 Axis After Intracerebral Hemorrhage., Jing Chen-Roetling, Raymond F. Regan

Department of Emergency Medicine Faculty Papers

BACKGROUND: Injury to cells adjacent to an intracerebral hemorrhage (ICH) is likely mediated at least in part by toxins released from the hematoma that initiate complex and interacting injury cascades. Pharmacotherapies targeting a single toxin or pathway, even if consistently effective in controlled experimental models, have a high likelihood of failure in a variable clinical setting. Nuclear factor erythroid-2 related factor 2 (Nrf2) regulates the expression of heme oxygenase-1 (HO-1) and multiple other proteins with antioxidant and antiinflammatory effects, and may be a target of interest after ICH.

METHODS: Studies that tested the effect of HO and Nrf2 in models …

Factors Associated With Post-Arrest Withdrawal Of Life-Sustaining Therapy., Anne V. Grossestreuer, David F. Gaieski, Benjamin S. Abella, Douglas J. Wiebe, Ari Moskowitz, Daniel J. Ikeda, Jason S. Haukoos, Sarah M. Perman

Department of Emergency Medicine Faculty Papers

INTRODUCTION: Most successfully resuscitated cardiac arrest patients do not survive to hospital discharge. Many have withdrawal of life sustaining therapy (WLST) as a result of the perception of poor neurologic prognosis. The characteristics of these patients and differences in their post-arrest care are largely unknown.

METHODS: Utilizing the Penn Alliance for Therapeutic Hypothermia Registry, we identified a cohort of 1311 post-arrest patients from 26 hospitals from 2010 to 2014 who remained comatose after return of spontaneous circulation. We stratified patients by whether they had WLST post-arrest and analyzed demographic, arrest, and post-arrest variables.

RESULTS: In our cohort, 565 (43%) patients …

Adiponectin Partially Rescues High Glucose/High Fat-Induced Impairment Of Mitochondrial Biogenesis And Function In A Pgc-1Α Dependent Manner., H. Wang, W.-J. Yan, J.-L. Zhang, F.-Y. Zhang, C. Gao, Y.-J. Wang, W.B. Lau, L. Tao

Department of Emergency Medicine Faculty Papers

OBJECTIVE: Plasma adiponectin (APN) levels are decreased in diabetic patients. Dysfunctional mitochondrial biogenesis is involved in type 2 diabetes (T2DM) pathogenesis, by unclear mechanisms. The present study determined (1) whether myocardial mitochondrial biogenesis was impaired in cardiomyocytes exposed to a high glucose/high fat (HGHF) medium (a T2DM in vitro model), (2) the effects of APN administration upon mitochondrial biogenesis in cardiomyocytes affected by HGHF incubation, and 3) the involved underlying mechanisms.

MATERIALS AND METHODS: Neonatal rat ventricular myocytes (NRVMs) were isolated and incubated in HGHF medium. Mitochondrial function was assessed by ATP content, and fluorescent microscopic analysis of myocardial apoptosis …

New Horizons In Spine Research: Intervertebral Disc Repair And Regeneration., James C Iatridis, James Kang, Rita Kandel, Makarand V. Risbud

Department of Orthopaedic Surgery Faculty Papers

No abstract provided.

Text Messaging In The Patient-Centered Medical Home To Improve Glucose Control And Retinopathy Screening., Janice M Miller, Ann G. Phalen, Albert Crawford, Anthony Frisby, Barry S. Ziring

College of Nursing Faculty Papers & Presentations

Purpose: To evaluate the effectiveness of a text messaging program (TMP) to improve glucose control, retinopathy screening (RS) rates, and self-care behaviors in patients with uncontrolled type 2 diabetes.

Methods: A single-group design with a quasi-systematic random sample (n=20) received educational/exhortational text messages on their cellular phones for 3 months. Subjects, 12 of whom identified as a minority ethnicity, were mostly male, aged 27-73 years.

Results: Glucose control and RS rates improved significantly. Subjects (>70%) reported changes in self-care behaviors.

Conclusion: Leveraging ubiquitous technology, a TMP for patients with limited access to healthcare education, holds promise

Effect Of Pulse Shaping On Subharmonic Aided Pressure Estimation In Vitro And In Vivo., Ipshita Gupta, John R. Eisenbrey, Maria Stanczak, Anush Sridharan, Jaydev K. Dave, Ji-Bin Liu, Christopher Hazard, Xinghua Wang, Ping Wang, Huiwen Li, Kirk Wallace, Flemming Forsberg

Department of Radiology Faculty Papers

OBJECTIVES: Subharmonic imaging (SHI) is a technique that uses the nonlinear oscillations of microbubbles when exposed to ultrasound at high pressures transmitting at the fundamental frequency ie, f

METHODS: Eight waveforms with different envelopes were optimized with respect to acoustic power at which the SHAPE study is most sensitive. The study was run with four input transmit cycles, first in vitro and then in vivo in three canines to select the waveform that achieved the best sensitivity for detecting changes in portal pressures using SHAPE. A Logiq 9 scanner with a 4C curvi-linear array was used to acquire 2.5 MHz …