Medical Specialties Commons^™

The Institutional Context That Supports Team-Based Care For Older Adults, Anna Foucek Tresidder

Dissertations and Theses

The aging population in the U.S. is dramatically increasing; it is predicted that not only will individuals live longer but also that they will live with multiple chronic diseases that could require high levels of medical and social resources. While the aging population increases, the number of health care providers choosing to specialize in caring for the elderly is decreasing just as dramatically. Teams are believed to be a possible response to more efficiently use the providers available, take advantage of alternative provider types, and integrate a range of health and social services to meet patient needs more effectively. Interdisciplinary …

Synchronous And Asynchronous Theta And Gamma Activity During Episodic Memory Formation., John F Burke, Kareem A Zaghloul, Joshua Jacobs, Ryan B Williams, Michael R Sperling, Ashwini D Sharan, Michael J Kahana

Department of Neuroscience Faculty Papers

To test the hypothesis that neural oscillations synchronize to mediate memory encoding, we analyzed electrocorticographic recordings taken as 68 human neurosurgical patients studied and subsequently recalled lists of common words. To the extent that changes in spectral power reflect synchronous oscillations, we would expect those power changes to be accompanied by increases in phase synchrony between the region of interest and neighboring brain areas. Contrary to the hypothesized role of synchronous gamma oscillations in memory formation, we found that many key regions that showed power increases during successful memory encoding also exhibited decreases in global synchrony. Similarly, cortical theta activity …

The Influence Of Obesity On The Outcome Of Treatment Of Lumbar Disc Herniation: Analysis Of The Spine Patient Outcomes Research Trial (Sport)., Jeffrey A Rihn, Mark Kurd, Alan S Hilibrand, Jon Lurie, Wenyan Zhao, Todd Albert, James Weinstein

Rothman Institute Papers

BACKGROUND: Questions remain as to the effect that obesity has on patients managed for symptomatic lumbar disc herniation. The purpose of this study was to determine if obesity affects outcomes following the treatment of symptomatic lumbar disc herniation.

METHODS: An as-treated analysis was performed on patients enrolled in the Spine Patient Outcomes Research Trial for the treatment of lumbar disc herniation. A comparison was made between patients with a body mass index of/m² (nonobese) (n = 854) and those with a body mass index of ≥30 kg/m² (obese) (n = 336). Baseline patient demographic and clinical characteristics were documented. Primary …

Characterization Of High-Voltage-Activated Calcium Channels In Retinal Bipolar Cells, Qi Lu

Wayne State University Dissertations

Retinal bipolar cells, conveying visual information from photoreceptors to ganglion cells, segregate visual information into multiple parallel pathways through their diversified cell types and physiological properties. Voltage-gated Ca²⁺ channels could be particularly important underlying the diversified physiological properties of different BCs. In this dissertation, I investigated the high-voltage-activated (HVA) calcium current in retinal bipolar cells in mice. In the first part of my dissertation, I characterized multiple bipolar cell-expressing GFP and/or Cre transgenic mouse lines. In the second part of my dissertation, by performing whole-cell patch-clamp recordings, I examined the electrophysiological properties of HVA calcium currents among CBCs and …

Impact Of Cryoablation On Tumor Immunity, Jesse Veenstra

Wayne State University Dissertations

Background and Objectives: Percutaneous cryoablation is a minimally invasive procedure for tumor debulking, which has the potential to initiate or amplify tumor immunity through the release of tumor-associated antigens and endogenous danger signals. However, enhanced immunity is rarely observed in treated patients, suggesting the need for mechanistic analysis. The goal is to determine how cryoablation affects tumor specific immunity and if the response can be improved through exogenous TLR9 stimulation.

Methodology: We evaluated anti-Her2/neu immunity following cryoablation in wt BALB/c and tolerant NeuT mice inoculated with neu or Her2 expressing mammary tumors TUBO and D2F2/E2 respectively. Mice were treated with …

Gleevec, An Abl Family Inhibitor, Produces A Profound Change In Cell Shape And Migration, Zaozao Chen, Elizabeth Lessey, Matthew E. Berginski, Li Cao, Jonathan Li, Xavier Trepat, Michelle Itano, Shawn M. Gomez, Maryna Kapustina, Cai Huang, Keith Burridge, George Truskey, Ken Jacobson

Markey Cancer Center Faculty Publications

The issue of how contractility and adhesion are related to cell shape and migration pattern remains largely unresolved. In this paper we report that Gleevec (Imatinib), an Abl family kinase inhibitor, produces a profound change in the shape and migration of rat bladder tumor cells (NBTII) plated on collagen-coated substrates. Cells treated with Gleevec adopt a highly spread D-shape and migrate more rapidly with greater persistence. Accompanying this more spread state is an increase in integrin-mediated adhesion coupled with increases in the size and number of discrete adhesions. In addition, both total internal reflection fluorescence microscopy (TIRFM) and interference reflection …

Castleman Disease In The Pediatric Neck: Case Report And Literature Review, Mindy R. Rabinowitz, Md, Jessica R. Levi, Md, Katrina Conard, Md, Udayan Shah, Md

Department of Otolaryngology - Head and Neck Surgery Presentations and Grand Rounds

Objective: To investigate the common features of cervical pediatric Castleman disease (CD).

Study Design: Case report and literature review of pediatric patients with cervical CD.

Methods: Online medical journal databases were searched for patients aged 18 years or younger. Eighteen published papers were found, comprising 29 cases. One case from our institution was also included for a total of 30 patients.

Results: An asymptomatic mass in level V was the most common presentation. No gender differences were noted. Multiple forms of imaging were pursued, and no particular modality showed signs specific for CD. All cases were treated with complete surgical …

Positive Clinical Neuroscience: Explorations In Positive Neurology, N. Kapur, J. Cole, T. Manly, Indre Viskontas, A. Ninteman, L. Hasher, A. Pascual-Leone

Psychology

Disorders of the brain and its sensory organs have traditionally been associated with deficits in movement, perception, cognition, emotion, and behavior. It is increasingly evident, however, that positive phenomena may also occur in such conditions, with implications for the individual, science, medicine, and for society. This article provides a selective review of such positive phenomena – enhanced function after brain lesions, better-than-normal performance in people with sensory loss, creativity associated with neurological disease, and enhanced performance associated with aging. We propose that, akin to the well-established field of positive psychology and the emerging field of positive clinical psychology, the nascent …

Neuroimaging Of A Pilocytic Astrocytoma With Anaplastic Features And Diffusion Tensor Imaging Characteristics, Lara Walkoff, Andrew J. Degnan, Mark Ghassibi, Robert V. Jones, Jonathan H. Sherman, Lucien M. Levy

Radiology Faculty Publications

We report the magnetic resonance imaging findings of an adult patient with a biopsy-proven pilocytic astrocytoma with anaplastic features. Pilocytic astrocytomas rarely occur in adults, and presentation with anaplastic features such as rapid mitotic activity, hypercellularity, and atypia is particularly uncommon. Accurate neuroimaging diagnosis is essential, but differentiation from more malignant neoplastic lesions may be challenging. Diffusion tensor imaging may potentially provide information on cell proliferation, vascularity, and fiber destruction, which can have implications for treatment and prognosis. In this case, tractography and fractional anisotropy maps demonstrated displacement of adjacent parenchyma and relatively intact fractional anisotropy, which is more suggestive …

Characterizing Inflammatory Breast Cancer Among Arab Americans In The California, Detroit And New Jersey Surveillance, Epidemiology And End Results (Seer) Registries (1988–2008), Kelly A. Hirko, Amr S. Soliman, Mousumi Banerjee, Julie Ruterbusch, Joe B. Harford, Robert M. Chamberlain, John J. Graff, Sofia D. Merajver, Kendra Schwartz

Wayne State University Associated BioMed Central Scholarship

Abstract

Introduction

Inflammatory breast cancer (IBC) is characterized by an apparent geographical distribution in incidence, being more common in North Africa than other parts of the world. Despite the rapid growth of immigrants to the United States from Arab nations, little is known about disease patterns among Arab Americans because a racial category is rarely considered for this group. The aim of this study was to advance our understanding of the burden of IBC in Arab ethnic populations by describing the proportion of IBC among different racial groups, including Arab Americans from the Detroit, New Jersey and California Surveillance, Epidemiology …

Cardiovascular Fitness Associated With Cognitive Performance In Heart Failure Patients Enrolled In Cardiac Rehabilitation, Sarah Garcia, Michael L. Alosco, Mary Beth Spitznagel, Ronald Cohen, Naftali Raz, Lawrence Sweet, Richard Josephson, Joel Hughes, Jim Rosneck, Morgan L. Oberle, John Gunstad

Wayne State University Associated BioMed Central Scholarship

Abstract

Background

Reduced cognitive function is common in persons with heart failure (HF). Cardiovascular fitness is a known contributor to cognitive function in many patient populations, but has only been linked to cognition based on estimates of fitness in HF. The current study examined the relationship between fitness as measured by metabolic equivalents (METs) from a standardized stress test and cognition in persons with HF, as well as the validity of office-based predictors of fitness in this population.

Methods

Forty-one HF patients enrolled in cardiac rehabilitation completed a standardized exercise stress test protocol, a brief neuropsychological battery, the 2-minute step …

Protein Tyrosine Phosphatase-1b Regulates The Tyrosine Phosphorylation Of The Adapter Grb2-Associated Binder 1 (Gab1) In The Retina, Ammaji Rajala, Ashok K. Dilly, Raju Vs Rajala

Wayne State University Associated BioMed Central Scholarship

Abstract

Background

Gab1 (Grb2-associated binder 1) is a key coordinator that belongs to the insulin receptor substrate-1 like family of adaptor molecules and is tyrosine phosphorylated in response to various growth factors, cytokines, and numerous other molecules. Tyrosine phosphorylated Gab1 is able to recruit a number of signaling effectors including PI3K, SHP2 and PLC-γ. In this study, we characterized the localization and regulation of tyrosine phosphorylation of Gab1 in the retina.

Results

Our immuno localization studies suggest that Gab1 is expressed in rod photoreceptor inner segments. We found that hydrogen peroxide activates the tyrosine phosphorylation of Gab1 ex vivo and …

Pten Loss Mediated Akt Activation Promotes Prostate Tumor Growth And Metastasis Via Cxcl12/Cxcr4 Signaling, M Conley-Lacomb, Allen Saliganan, Pridvi Kandagatla, Yong Q. Chen, Michael L. Cher, Sreenivasa R. Chinni

Wayne State University Associated BioMed Central Scholarship

Abstract

Introduction

The chemokine CXCL12, also known as SDF-1, and its receptor, CXCR4, are overexpressed in prostate cancers and in animal models of prostate-specific PTEN deletion, but their regulation is poorly understood. Loss of the tumor suppressor PTEN (phosphatase and tensin homolog) is frequently observed in cancer, resulting in the deregulation of cell survival, growth, and proliferation. We hypothesize that loss of PTEN and subsequent activation of Akt, frequent occurrences in prostate cancer, regulate the CXCL12/CXCR4 signaling axis in tumor growth and bone metastasis.

Methods

Murine prostate epithelial cells from PTEN^+/+, PTEN ^+/− , and PTEN^−/− (prostate …

Transcranial Sonothrombolysis Using High-Intensity Focused Ultrasound: Impact Of Increasing Output Power On Clot Fragmentation, Golnaz Ahadi, Christian S. Welch, Michele J. Grimm, David J. Fisher, Eyal Zadicario, Karin Ernström, Arne H. Voie, Thilo Hölscher

Wayne State University Associated BioMed Central Scholarship

Abstract

Background

The primary goal of this study was to investigate the relationship between increasing output power levels and clot fragmentation during high-intensity focused ultrasound (HIFU)-induced thrombolysis.

Methods

A HIFU headsystem, designed for brain applications in humans, was used for this project. A human calvarium was mounted inside the water-filled hemispheric transducer. Artificial thrombi were placed inside the skull and located at the natural focus point of the transducer. Clots were exposed to a range of acoustic output power levels from 0 to 400 W. The other HIFU operating parameters remained constant. To assess clot fragmentation, three filters of different …

Sequential Bilateral Central Retinal Vein Occlusions In A Cystic Fibrosis Patient With Hyperhomocysteinemia And Hypergamma-Globulinemia, R. Gelman, E. A. Dimango, W. M. Schiff

Journal Articles

PURPOSE: To report a case of sequential bilateral central retinal vein occlusions in a cystic fibrosis patient with hyperhomocysteinemia and hypergamma-globulinemia over 6 years of follow up. METHODS: Observational case report of one patient. RESULTS: A 31 year-old male with a history of cystic fibrosis presented with a central retinal vein occlusion (CRVO) in his left eye, followed by a CRVO in his right eye 4 years later. His medical workup was significant for elevated levels of homocysteine and gamma-globulins, which coincided with initiation of intravenous immunoglobulin (IVIG) proceeding his second CRVO. CONCLUSIONS: We describe a case of sequential bilateral …

Loss Of Dok2 Induces Carboplatin Resistance In Ovarian Cancer Via Suppression Of Apoptosis, E. Lum, M. Vigliotti, N. Banerjee, N. Cutter, K. O. Wrzeszczynski, S. Khan, S. Kamalakaran, D. A. Levine, N. Dimitrova, R. Lucito

Journal Articles

Objective. Ovarian cancers are highly heterogeneous and while chemotherapy is the preferred treatment many patients are intrinsically resistant or quickly develop resistance. Furthermore, all tumors that recur ultimately become resistant. Recent evidence suggests that epigenetic deregulation may be a key factor in the onset and maintenance of chemoresistance. We set out to identify epigenetically silenced genes that affect chemoresistance. Methods. The epigenomes of a total of 45 ovarian samples were analyzed to identify epigenetically altered genes that segregate with platinum response, and further filtered with expression data to identify genes that were suppressed. A tissue culture carboplatin resistance screen was …

Interactions Between Estradiol, Bdnf And Dendritic Spines In Promoting Memory., V. Luine, M. Frankfurt

Journal Articles

Several lines of evidence have converged to indicate that memory formation involves plasticity of dendritic spines in the medial prefrontal cortex (PFC) and the hippocampus. Memory varies with estrogen levels throughout the lifespan of the female. Generally, increased levels of estrogen are related to greater dendritic spine density on pyramidal cells in the PFC and the hippocampus and to improved memory function. Brain-derived neurotrophic factor (BDNF) is a growth factor which increases dendritic spines and enhances memory function. Estrogens increase BDNF levels in the PFC and the hippocampus. In the present review we provide evidence that estradiol and BDNF may …

Igfbp-3 Inhibits Cytokine-Induced Insulin Resistance And Early Manifestations Of Atherosclerosis, Lathika Mohanraj, Ho-Seong Kim, Wei Li, Qing Cai, Ki E. Kim, Hye-Jung Shin, Yong-Jae Lee, Woo J. Lee, Jung H. Kim, Youngman Oh

Pathology Publications

Metabolic syndrome is associated with visceral obesity, insulin resistance and an increased risk of cardiovascular diseases. Visceral fat tissue primarily consists of adipocytes that secrete cytokines leading to a state of systemic inflammation in obese conditions. One of the IGF-independent functions of IGFBP-3 is its role as an anti-inflammatory molecule. Our study in obese adolescents show a decrease in total IGFBP-3 levels and increase in proteolyzed IGFBP-3 in circulation when compared to their normal counterparts and establishes a positive correlation between IGFBP-3 proteolysis and adiposity parameters as well as insulin resistance. In human adipocytes, we show that IGFBP-3 inhibits TNF-α-induced …

Dreams And Wonder, Edward F. Ansello

Director's Editorials from Age in Action

Many centenarians have dreams and a sense of wonder. Many of the very old possess dreams that push or pull them; these seem to act as goals still ahead. Perhaps this orientation to a future impels their continuation.

Being In The Moment, Edward F. Ansello

Director's Editorials from Age in Action

There seems to be a disconnect between the moment in time and really experiencing it. In the past, if one were privileged to reach late life, one would take time to be in that moment, rather than trying to avoid it. This returns us to the observations of being in the moment and having the full experience of it. Reflection is a gift to be opened in late life.

Partnering, Edward F. Ansello

Director's Editorials from Age in Action

Collaborative partnering has been a core value of Virginia Center on Aging. Several members are partnering with institutions of higher education, public schools, community businesses, and talented instructors.

Lessons From A Sequoia Grove, Edward F. Ansello

Director's Editorials from Age in Action

Studies have identified loneliness as a predictor of declines in health and accelerated death. We are assisted by others to become autonomous. Autonomy is a product of an interdependent process. Assisting others to maintain or regain dignity is assisted autonomy in practice. It is community.

Medications As A Risk Factor In Falls By Older Adults With And Without Intellectual Disabilities, Patricia Slattum, Edward F. Ansello

Case Studies from Age in Action

Educational Objectives

1. Review common intrinsic and extrinsic risk factors for falls by older adults.

2. Compare risk factors for older adults with and without intellectual disabilities.

3. Focus on medications as a risk factor among a complexity of risk factors.

4. Suggest steps to improve appropriateness of medication regimens, as a step to help reduce risk for falls.

Virginia Post: Improving Patient- Physician Communication About End Of Life Care, Chris Pile, Laura Pole

Case Studies from Age in Action

Educational Objectives

1. Examine the complexities of medical decision-making at the end of life and the inadequacy of advance directives alone to affect care at the end of life.

2. Demonstrate how effective communication can facilitate medical decision-making and improve congruency between care received and patient goals, priorities, and values.

3. Discuss the National POLST Paradigm and the current status of POST in Virginia.

Falling Down: Assessing The Risk Of Falls In Older Adults, Steven Morrison

Case Studies from Age in Action

Educational Objectives

1. To provide an overview of the problems associated with falling in older adults.

2. To outline the strengths and weaknesses of the various screening tools used for effective evaluation of an individual’s fall risk.

3. To highlight the benefits of assessing physiological function when screening for falls risk.

Timeslips: Creativity For People With Dementia, Anne Davis Basting

Case Studies from Age in Action

Educational Objectives

1. Recognize the value of creative storytelling for people with dementia, with its shift in emphasis from memory to imagination.

2. Understand the impact of creative storytelling upon facilitators, storytellers, audiences, and readers.

3. Explore the potential mechanisms at work in creative storytelling.

Pre-Pregnancy Bmi And Weight Gain: Where Is The Tipping Point For Preterm Birth?, Saba W. Masho, Diane Bishop, Meaghan Munn

Family Medicine and Population Health Publications

Background

Obesity in pregnant women is a major problem affecting both the mother and her offspring. Literature on the effect of obesity on preterm birth is inconsistent and few studies have investigated the influence of weight gain during pregnancy. This study examined the effect of maternal pre-pregnancy BMI and weight gain during pregnancy on preterm birth.

Methods

Data from the Collaborative Perinatal Project (CPP) on 45,824 pregnant women with singleton, live-born infants with no severe congenital anomalies was analyzed. Primary outcome variables included preterm (< 37 weeks of gestation), categorized into spontaneous preterm with and without premature rupture of membrane (PROM) and indicated preterm. Maternal BMI was categorized into underweight (BMI < 18.50), normal weight (BMI =1 8.50 – 24.99), overweight (BMI = 25.00 – 29.99), and obese (BMI ≥ 30.00). Multinomial regression analysis was conducted and OR and 95% CI were calculated.

Results

The rate of spontaneous preterm birth with PROM among overweight women decreased with increasing …

Intraoperative Hyperglycemia In Adult Patients Undergoing An Emergency Craniotomy Following A Traumatic Brain Injury As A Predictor Of Postoperative Outcomes And Mortality, Sara Lynn Hoover

Theses, Dissertations and Capstones

Abstract: The purpose of this study was to determine if there was an association between intraoperative blood glucose ≥150 mg/dl in patients undergoing an emergency craniotomy and Intensive Care Unit (ICU) Length of Stay (LOS), hospital LOS and mortality.

Introduction: Traumatic Brain Injuries (TBI)’s are associated with increased morbidity and mortality. The stress response by the body may cause an increase in blood glucose levels which can cause secondary brain injury. When a patient undergoes an emergency craniotomy following a TBI the increased stress on the body can cause an even higher blood glucose. There is no consensus in …

Antibiotic-Like Actions Of Vitamin D, Franklin D. Shuler Md, Phd, Josh Hendrix, Adam Short, Sammy Hodroge

Orthopaedics

Vitamin D is a secosteroid hormone that has expanding importance for a healthy lifestyle and disease prevention. A multitude of studies have highlighted that vitamin D acts not only in bone and calcium homeostasis but is critically important for human immunity. The discovery that the storage form of vitamin D (25-hydroxyvitamin D3) can be locally converted to the active form (1,25-hydroxyvitamin D3) in immune cells, epithelial cells and numerous other non-renal tissues highlights the importance of maintaining sufficient stores. When responding to a specific external stimulus, like bacterial invasion, intracrine synthesis of active vitamin D has the ability to regulate …

Whole-Body Vibration Improves Functional Mobility, Flexibility, And Relative Risk For Falling In The Assisted Living Elderly: A Case Series, Christina Garrity, Harold L. Merriman, C. Jayne Brahler

Physical Therapy Faculty Publications

Study design: A randomized double blind repeated measures, case series study of whole body vibration (WBV) in the assisted living elderly.

Background: A single exposure to WBV has been shown to have benefit with respect to muscle activity, strength, balance, and power in some studies while other studies have found no benefit. Its overall effectiveness is unknown due to the conflicting findings reported in the literature.

Case description: Six subjects (5 female, 1 male; mean age = 85.4) in an assisted living community volunteered to participate. Subjects were exposed to a single bout of WBV at 0, 2, 20, and …