Medical Specialties Commons^™

Sudden Unexpected Nocturnal Death In Chiari Type 1 Malformation And Potential Role Of Opioid Analgesics, F. Roohi, T. Gropen, R. W. Kula

Journal Articles

BACKGROUND: Chiari malformation type 1 (CM1) is a common congenital anomaly of the craniocervical junction. CM1 is reported to run a usually benign course and patients typically experience no symptoms or chronic, slowly progressive symptoms. However, recent reports indicate that a subset of patients with CM1 may present with acute deterioration and sudden unexpected death (SUD). We report a case of SUD during sleep in a young man with CM1, which we believe was related to the administration of common and therapeutic doses of narcotic analgesics for the management of pain. We will clarify the pathophysiology of acute deterioration and …

A Novel And Practical Cardiovascular Magnetic Resonance Method To Quantify Mitral Annular Excursion And Recoil Applied To Hypertrophic Cardiomyopathy, S. G. Saba, S. Chung, S. Bhagavatula, R. Donnino, M. B. Srichai, M. Saric, S. D. Katz, L. Axel

Journal Articles

BACKGROUND: We have developed a novel and practical cardiovascular magnetic resonance (CMR) technique to evaluate left ventricular (LV) mitral annular motion by tracking the atrioventricular junction (AVJ). To test AVJ motion analysis as a metric for LV function, we compared AVJ motion variables between patients with hypertrophic cardiomyopathy (HCM), a group with recognized systolic and diastolic dysfunction, and healthy volunteers. METHODS: We retrospectively evaluated 24 HCM patients with normal ejection fractions (EF) and 14 healthy volunteers. Using the 4-chamber view cine images, we tracked the longitudinal motion of the lateral and septal AVJ at 25 time points during the cardiac …

Teens Texting, Archana Srinivas, Megan White, Hatim A. Omar

Pediatrics Faculty Publications

In this chapter we summarize the current literature on texting use amongst adolescents. A brief overview will be presented on the prevalence of texting among teenagers, the use of texting for sexting and cyberbullying as well as the dangers of texting while driving. This chapter will serve as a brief overview of these topics in order to bring to light the emerging challenges that texting presents to the mental and physical well-being of adolescents in an effort to evoke further discussion regarding the need for increasing awareness and education to parents, educators, law makers and health care providers concerning these …

Self-Care Of Heart Failure In A House Call Program, Becky Bryant

Doctor of Nursing Practice Program Projects

The incidence and prevalence of persons living with heart failure (HF) is growing in the United States. Heart failure is the most common admission in hospitals among Medicare recipients aged 65 years or older. Self-care of heart failure (SCHF) has been reported to decrease HF hospital admission rates. Elderly patients who are homebound do not have access to typical HF education and follow-up care. The purpose of this evidence-based practice (EBP) project was to implement a SCHF program intervention by nurse practitioners (NPs) with homebound elderly HF patients receiving home visits in a house call program. There were 18 sample …

Differential Eye Movements In Mild Traumatic Brain Injury Vs. Normal Controls, Joanna R. Wares, David X. Cifu, Kathy W. Hoke, Paul A. Wetzel, George Gitchel, William Carne

Department of Math & Statistics Faculty Publications

Objective measures to diagnose and to monitor improvement of symptoms following mild traumatic brain injury (mTBI) are lacking. Computerized eye tracking has been advocated as a rapid, user friendly and field ready technique to meet this need. Eye tracking data collected via a head mounted, video-based binocular eye tracker was used to examine saccades, fixations and smooth pursuit movement in 60 military Service Members with post concussive syndrome (PCS) and 26 asymptomatic control subjects in an effort to determine if eye movement differences could be found and quantified. The diagnosis of mTBI was confirmed by the study physiatrist’s history, physical …

Influence Of Tendon Tears On Ultrasound Echo Intensity In Response To Loading, Kayt E. Frisch, David Marcu, Geoffrey S. Baer, Darryl G. Thelen, Ray Vanderby

Faculty Publications - Biomedical, Mechanical, and Civil Engineering

Acoustoelastic (AE) ultrasound image analysis is a promising non-invasive approach that uses load-dependent echo intensity changes to characterize stiffness of tendinous tissue. The purpose of this study was to investigate whether AE can detect localized changes in tendon stiffness due to partial and full-thickness tendon tears. Ovine infraspinatus tendons with different levels of damage (Intact, 33%, 66% and full thickness cuts initiated on the articular and bursal sides) were cyclically loaded in a mechanical testing system while cine ultrasound images were recorded. The load-induced changes in echo intensity on the bursal and articular side of the tendon were determined. Consistent …

Contraceptive Sabotage, Leah A. Plunkett

Law Faculty Scholarship

This Article responds to the alarm recently sounded by the American College of Obstetricians and Gynecologists over “birth control sabotage”—the “active interference [by one partner] with [the other] partner’s contraceptive methods in an attempt to promote pregnancy.” Currently, sabotage is not a crime, and existing categories of criminal offenses fail to capture the essence of the injury it does to victims. This Article argues that sabotage should be a separate crime—but only when perpetrated against those partners who can and do get pregnant as a result of having sabotaged sex. Using the principle of self-possession—understood as a person’s basic right …

Assessing 2 D-Dimer Age-Adjustment Strategies To Optimize Computed Tomographic Use In Ed Evaluation Of Pulmonary Embolism, A. Gupta, A. S. Raja, I. K. Ip, R. Khorasani

Journal Articles

STUDY OBJECTIVE: Validate the sensitivity and specificity of 2 age adjustment strategies for d-dimer values in identifying patients at risk for pulmonary embolism (PE) compared with traditional D-dimer cutoff value (500 ng/mL) to decrease inappropriate computed tomography pulmonary angiography (CTPA) use. METHODS: This institutional review board-approved, Health Insurance Portability and Accountability Act-compliant retrospective study included all adult emergency department patients evaluated for PE over a 32-month period (1/1/11-8/30/13). Only patients undergoing CTPA and D-dimer testing were included. We used a validated natural language processing algorithm to parse CTPA radiology reports and determine the presence of acute PE. Outcome measures were …

Incidence And Predictors Of Acute Psychological Distress And Dissociation After Motor Vehicle Collision: A Cross-Sectional Study, G. C. Lewis, T. F. Platts-Mills, I. Liberzon, E. Bair, R. Swor, N. Rathlev, D. Lee, R. Domeier, P. Hendry, S. A. Mclean, +2 Additional Authors

Journal Articles

Objective: We examined the incidence and predictors of peritraumatic distress and dissociation after one of the most common forms of civilian trauma exposure: motor vehicle collision (MVC). Method: In this study, patients presenting to the emergency department after MVCs who were without serious injury and discharged to home after evaluation (n = 935) completed an emergency department interview evaluating sociodemographic, collision-related, and psychological characteristics. Results: The incidence and predictors of distress (Peritraumatic Distress Inventory score 23) and dissociation (Michigan Critical Events Perception Scale score >3) were assessed. Distress was present in 355 of 935 patients (38%), and dissociation was present …

Incidence And Predictors Of Neck And Widespread Pain After Motor Vehicle Collision Among Us Litigants And Nonlitigants, S. A. Mclean, J. C. Ulirsch, G. D. Slade, A. C. Soward, R. A. Swor, D. A. Peak, J. S. Jones, N. K. Rathlev, D. C. Lee, E. Bair, +3 Additional Authors

Journal Articles

Debate continues regarding the influence of litigation on pain outcomes after motor vehicle collision (MVC). In this study we enrolled European Americans presenting to the emergency department (ED) in the hours after MVC (n = 948). Six weeks later, participants were interviewed regarding pain symptoms and asked about their participation in MVC-related litigation. The incidence and predictors of neck pain and widespread pain 6 weeks after MVC were compared among those engaged in litigation (litigants) and those not engaged in litigation (nonlitigants). Among the 859 of 948 (91%) participants completing 6-week follow-up, 711 of 849 (83%) were nonlitigants. Compared to …

Substance Use In Clinical High Risk For Psychosis: A Review Of The Literature, J. Addington, N. Case, M. M. Saleem, A. M. Auther, B. A. Cornblatt, K. S. Cadenhead

Journal Articles

AimIn the literature, there is evidence suggesting an association between substance use and psychosis. However, little is known about substance use in those who may be in the pre-psychotic phase, that is, those who are putatively prodromal are considered to be at clinical high risk (CHR) of developing psychosis. MethodsWe conducted a review of publications measuring patterns and rates of substance use in CHR for psychosis individuals and the effects on the transition to psychosis. ResultsOf 5527 potentially relevant research papers, 10 met inclusion criteria of CHR subjects and specifically mentioned substance use in the sample. The results of these …

The Subjective Experience Of Youths At Clinically High Risk Of Psychosis: A Qualitative Study, S. Ben-David, M. L. Birnbaum, M. E. Eilenberg, J. E. Devylder, K. E. Gill, J. Schienle, N. Azimov, E. P. Lukens, L. Davidson, C. M. Corcoran

Journal Articles

Objective: Understanding the experience of individuals across stages of schizophrenia is important for development of services to promote recovery. As yet, little is known about the experience of individuals who exhibit prodromal symptoms of schizophrenia. Methods: Audiotaped interviews were conducted with 27 participants of diverse racial-ethnic backgrounds who were at clinically high risk of psychosis (15 males and 12 females; mean age 21). Phenomenological qualitative research techniques of coding, consensus, and comparison were used. Results: Emergent themes differed by gender. Themes for males were feeling abnormal or "broken," focus on going " crazy," fantasy and escapism, and alienation and despair, …

Effectiveness Of Lurasidone In Schizophrenia Or Schizoaffective Patients Switched From Other Antipsychotics: A 6-Month, Open-Label, Extension Study, L. Citrome, P. J. Weiden, J. P. Mcevoy, C. U. Correll, J. Cucchiaro, J. Hsu, A. Loebel

Journal Articles

Objective. To evaluate the long-term safety and tolerability of lurasidone in schizophrenia and schizoaffective disorder patients switched to lurasidone. Method. Patients in this multicenter, 6-month open-label, flexible-dose, extension study had completed a core 6-week randomized trial in which clinically stable, but symptomatic, outpatients with schizophrenia or schizoaffective disorder were switched to lurasidone. Patients started the extension study on treatment with the same dose of lurasidone taken at study endpoint of the 6-week core study; following this, lurasidone was flexibly dosed (40-120 mg/day), if clinically indicated, starting on Day 7 of the extension study. The primary safety endpoints were the proportion …

Neural Activation During Response Inhibition In Adult Attention-Deficit/Hyperactivity Disorder: Preliminary Findings On The Effects Of Medication And Symptom Severity, E. Congdon, L. L. Altshuler, J. A. Mumford, K. H. Karlsgodt, F. W. Sabb, J. Ventura, E. D. London, T. D. Cannon, R. M. Bilder, R. A. Poldrack, +1 Additional Author

Journal Articles

Studies of adults with attention-deficit/hyperactivity disorder (ADHD) have suggested that they have deficient response inhibition, but findings concerning the neural correlates of inhibition in this patient population are inconsistent. We used the Stop Signal task and functional magnetic resonance imaging (fMRI) to compare neural activation associated with response inhibition between adults with ADHD (N=35) and healthy comparison subjects (N=62), and in follow-up tests to examine the effect of current medication use and symptom severity. There were no differences in Stop Signal task performance or neural activation between ADHD and control participants. Among the ADHD participants, however, significant differences were associated …

Effects Of Aripiprazole Once-Monthly On Domains Of Personal And Social Performance: Results From 2 Multicenter, Randomized, Double-Blind Studies, W. W. Fleischhacker, R. A. Baker, A. Eramo, R. Sanchez, L. F. Tsai, T. Peters-Strickland, P. P. Perry, R. D. Mcquade, B. R. Johnson, W. H. Carson, J. M. Kane

Journal Articles

Objective: To assess the effects of maintenance therapy with aripiprazole once-monthly 400 mg on personal and social functioning. Methods: Data were analyzed from 2 randomized, double-blind trials of patients with schizophrenia requiring chronic antipsychotic treatment. One study was a 52-week trial of aripiprazole once-monthly 400 mg versus placebo; the other was a 38-week trial of aripiprazole once-monthly 400 mg, oral aripiprazole (10-30 mg daily), and aripiprazole once-monthly 50 mg (subtherapeutic dose to test assay sensitivity). Functioning was assessed using the Personal and Social Performance (PSP) scale, comprising 4 domain subscales. Results: In the 52-week study, 403 patients stabilized on aripiprazole …

Predicting Risky Choices From Brain Activity Patterns, S. M. Helfinstein, T. Schonberg, E. Congdon, K. H. Karlsgodt, J. A. Mumford, F. W. Sabb, T. D. Cannon, E. D. London, R. M. Bilder, R. A. Poldrack

Journal Articles

Previous research has implicated a large network of brain regions in the processing of risk during decision making. However, it has not yet been determined if activity in these regions is predictive of choices on future risky decisions. Here, we examined functional MRI data from a large sample of healthy subjects performing a naturalistic risk-taking task and used a classification analysis approach to predict whether individuals would choose risky or safe options on upcoming trials. We were able to predict choice category successfully in 71.8% of cases. Searchlight analysis revealed a network of brain regions where activity patterns were reliably …

Surgical Management Of Ascending Aortic Aneurysm And Its Complications, S. Sran, M. Sran, N. Ferguson, A. N. Makaryus

Journal Articles

Ascending aortic aneurysms involving the proximal aortic arch, arising anywhere from the aortic valve to the innominate artery, represent various problems in which open surgery is generally required. Surgical options include excision of the aortic pathology or wrapping the aneurysm shell with an aortic Dacron graft. Intervention using the latter method can lead to extravasation of blood along the suture lines resulting in continuous bleeding within the periprosthetic space. The Cabrol technique was developed as a method for decompression of postoperative leaks by the formation of a conduit system from the periprosthetic space to the right atrium. The coronary ostia …

Diagnosis Of Abnormal Biliary Copper Excretion By Positron Emission Tomography With Targeting Of (64)Copper-Asialofetuin Complex In Lec Rat Model Of Wilson's Disease, R. Bahde, S. Kapoor, K. K. Bhargava, C. J. Palestro, S. Gupta

Journal Articles

Identification by molecular imaging of key processes in handling of transition state metals, such as copper (Cu), will be of considerable clinical value. For instance, the ability to diagnose Wilson's disease with molecular imaging by identifying copper excretion in an ATP7B-dependent manner will be very significant. To develop highly effective diagnostic approaches, we hypothesized that targeting of radiocopper via the asialoglycoprotein receptor will be appropriate for positron emission tomography, and examined this approach in a rat model of Wilson's disease. After complexing (64)Cu to asialofetuin we studied handling of this complex compared with (64)Cu in healthy LEA rats and diseased …

Ct Perfusion For Detection Of Delayed Cerebral Ischemia In Aneurysmal Subarachnoid Hemorrhage: A Systematic Review And Meta-Analysis, D. I. A. Mir, A. Gupta, A. Dunning, L. Puchi, C. L. Robinson, H. A. B. Epstein, P. C. Sanelli

Journal Articles

BACKGROUND AND PURPOSE: Delayed cerebral ischemia is a significant cause of morbidity and mortality after aneurysmal SAH, leading to poor outcomes. The purpose of this study was to evaluate the usefulness of CTP in determining delayed cerebral ischemia in patients with aneurysmal SAH. MATERIALS AND METHODS: We conducted a systematic review evaluating studies that assessed CTP in patients with aneurysmal SAH for determining delayed cerebral ischemia. Studies using any of the following definitions of delayed cerebral ischemia were included in the systematic review: 1) new onset of clinical deterioration, 2) cerebral infarction identified on follow-up CT or MR imaging, and …

Nuclear Medicine And The Failed Joint Replacement: Past, Present, And Future, C. J. Palestro

Journal Articles

Soon after the introduction of the modern prosthetic joint, it was recognized that radionuclide imaging provides useful information about these devices. The bone scan was used extensively to identify causes of prosthetic joint failure. It became apparent, however, that although sensitive, regardless of how the images were analyzed or how it was performed, the test was not specific and could not distinguish among the causes of prosthetic failure. Advances in anatomic imaging, notably cross sectional modalities, have facilitated the diagnosis of many, if not most, causes of prosthetic failure, with the important exception of infection. This has led to a …

Attenuating The Systemic Inflammatory Response To Adult Cardiopulmonary Bypass: A Critical Review Of The Evidence Base, R. Clive Landis, J. R. Brown, D. Fitzgerald, D. S. Likosky, L. Shore-Lesserson, R. A. Baker, J. W. Hammon

Journal Articles

A wide range of pharmacological, surgical, and mechanical pump approaches have been studied to attenuate the systemic inflammatory response to cardiopulmonary bypass, yet no systematically based review exists to cover the scope of anti-inflammatory interventions deployed. We therefore conducted an evidence-based review to capture "self-identified" anti-inflammatory interventions among adult cardiopulmonary bypass procedures. To be included, trials had to measure at least one inflammatory mediator and one clinical outcome, specified in the "Outcomes 2010" consensus statement. Ninety-eight papers satisfied inclusion criteria and formed the basis of the review. The review identified 33 different interventions and approaches to attenuate the systemic inflammatory …

Comprehensive Analysis Of Human Cytomegalovirus Microrna Expression During Lytic And Quiescent Infection, Zhang-Zhou Shen, Xing Pan, Ling-Feng Miao, Han-Qing Ye, Stéphane Chavanas, Christian Davrinche, Michael Mcvoy, Min-Hua Luo

Pediatrics Publications

Background

Human cytomegalovirus (HCMV) encodes microRNAs (miRNAs) that function as post-transcriptional regulators of gene expression during lytic infection in permissive cells. Some miRNAs have been shown to suppress virus replication, which could help HCMV to establish or maintain latent infection. However, HCMV miRNA expression has not been comprehensively examined and compared using cell culture systems representing permissive (lytic) and semi-permissive vs. non-permissive (latent-like) infection.

Methods

Viral miRNAs levels and expression kinetics during HCMV infection were determined by miRNA-specific stem-loop RT-PCR. HCMV infected THP-1 (non-permissive), differentiated THP-1 (d-THP-1, semi-permissive) and human embryo lung fibroblasts (HELs, fully-permissive) were examined. The impact of …

Traumatic Axillary Artery Pseudoaneurysm Treated With Intravascular Balloon Occlusion And Percutaneous Thrombin Injection, Maria Carratola, Priti Parikh, Kathryn M. Tchorz, Shannon Kauffman

Department of Surgery Faculty Publications

Axillary artery pseudoaneurysms are relatively rare, with few reported cases found in the literature. Furthermore, treatment with percutaneous thrombin injection has not yet been reported. We report the case of a 59-year-old man with a large (10 cm) post-traumatic pseudoaneurysm of the left axillary artery found five weeks after a motorcycle crash. The patient sustained multiple injuries, including fractures of the left scapula and clavicle. Edema was observed at the time of diagnosis. Arteriography with successful ultrasound-guided percutaneous thrombin injection was undertaken. The patient experienced no complications after the procedure.

Wound Healing In Peripheral Arterial Disease: Current And Future Therapy, Jon C. Henry, Laura Peterson, Richard E. Schlanger, Michael R. Go, Chandan K. Sen, Robert S.D. Higgins

Department of Surgery Faculty Publications

Wounds secondary to peripheral arterial disease (PAD) result in substantial morbidity and burden to the healthcare industry. To aid in the care of this patient population, knowledge of the disease process and current standards of therapy is paramount for healthcare providers.The future care of these patients and improvement from our existing standards hinges on the active translational research. To implement new technologies and advances in the treatment of PAD-induced wounds and ensure adequate utilization of our current therapies a PAD-wound team is necessary.

Aggressive Renal Angiomyolipoma Of The Lipomatous Variant With Inferior Vena Cava Thrombus: A Case Report And Review Of The Literature, C. Fox, S. S. Salami, D. M. Moreira, G. S. Landis, D. Chan, O. Yaskiv, M. A. Vira

Journal Articles

Two variants of renal angiomyolipoma (AML)—classic and epithelioid—have been described. Although the epithelioid variant has been reported to demonstrate an aggressive clinical behavior, classic AML is usually benign. Herein, we report a case of a 42-year-old asymptomatic woman with a lipomatous variant of renal AML associated with an inferior vena cava thrombus managed with radical nephrectomy and caval thrombectomy.

Middle Cerebral Artery Arrow Sign, Z. D. Levy, R. E. Temes, A. R. Dehdashti

Journal Articles

No abstract provided.

Can Clinical Decision Support Improve Medication Safety In The Ambulatory Setting?, B. Keber

Journal Articles

No abstract provided.

Appropriate Use Of Ct Perfusion Following Aneurysmal Subarachnoid Hemorrhage: A Bayesian Analysis Approach, R. P. Killeen, A. Gupta, H. Delaney, C. E. Johnson, A. J. Tsiouris, M. E. Fink, H. S. Mangat, A. Z. Segal, A. I. Mushlin, P. C. Sanelli, +1 Additional Author

Journal Articles

These investigators evaluated the test characteristics of CTP in patients with SAH for detection of delayed cerebral ischemia. Ninety-seven patients were assessed with CTP for ischemia and with DSA for vasospasm. The authors concluded that positive CTP findings identified patients who should be carefully considered for induced hypertension, hypervolemia, and hemodilution and/or intra-arterial therapy while negative CTP findings are useful in guiding a no-treatment decision. BACKGROUND AND PURPOSE: In recent years CTP has been used as a complementary diagnostic tool in the evaluation of delayed cerebral ischemia and vasospasm. Our aim was to determine the test characteristics of CTP for …

Cost-Effectiveness Of Ct Angiography And Perfusion Imaging For Delayed Cerebral Ischemia And Vasospasm In Aneurysmal Subarachnoid Hemorrhage, P. C. Sanelli, A. Pandya, A. Z. Segal, A. Gupta, S. Hurtado-Rua, J. Ivanidze, K. Kesavabhotla, D. Mir, A. I. Mushlin, M. G. Hunink

Journal Articles

BACKGROUND AND PURPOSE: Delayed cerebral ischemia and vasospasm are significant complications following SAH leading to cerebral infarction, functional disability, and death. In recent years, CTA and CTP have been used to increase the detection of delayed cerebral ischemia and vasospasm. Our aim was to perform comparative-effectiveness and cost-effectiveness analyses evaluating CTA and CTP for delayed cerebral ischemia and vasospasm in aneurysmal SAH from a health care payer perspective. MATERIALS AND METHODS: We developed a decision model comparing CTA and CTP with transcranial Doppler sonography for detection of vasospasm and delayed cerebral ischemia in SAH. The clinical pathways were based on …

Potholes And Molehills: Bias In The Diagnostic Performance Of Diffusion-Tensor Imaging In Concussion, R. Watts, A. Thomas, C. G. Filippi, J. P. Nickerson, K. Freeman

Journal Articles

PURPOSE: To investigate the extent of bias in a clinical study involving "pothole analysis" of diffusion-tensor imaging (DTI) data used to quantify white matter lesion load in diseases with a heterogeneous spatial distribution of pathologic findings, such as mild traumatic brain injury (TBI), and create a mathematical model of the bias. MATERIALS AND METHODS: Use of the same reference population to define normal findings and make comparisons with a patient group introduces bias, which potentially inflates reported diagnostic performance. In this institutional review board-approved prospective observational cohort study, DTI data were obtained in 20 patients admitted to the emergency department …