Medical Specialties Commons^™

Animal Cruelty And Elder Abuse, Edward F. Ansello

Director's Editorials from Age in Action

Continuing and expanding the American Psychological Association's guidance that those in counseling roles be alert to and ask questions about care of animals could provide some early warnings, perhaps in time to avoid harm to both animals and people. Encouraging our children to interact with kindness towards animals can’t help but pay dividends over the life course. We need to pay attention to the link of indifference or neglect of pets leading to the same with humans, with those in later life.

Fix And Fit To Age In Place, Edward F. Ansello

Director's Editorials from Age in Action

If aging in place is the goal, simple targeted improvements to one’s home and ability to function in it may be central.

Neighborhood Walkability And Health, Edward F. Ansello

Director's Editorials from Age in Action

The apparent benefit of neighborhood walkability suggests that it may be an important health-related consideration in the lives of everyday people. Most of the elements in the walkability index reflect components in the environment, so these may be relevant across the continuum of impairments, meaning that walkable neighborhoods themselves may have positive impact on the daily lives of people with physical or intellectual disabilities.

Palliative Care Is More Care, Not Less, Rachel Selby-Penczak

Case Studies from Age in Action

Educational Objectives:

1. Discuss the origins of hospice and palliative care.

2. Compare and contrast Curative, Palliative, and Hospice Models of Care.

3. Identify when palliative care is appropriate.

Palette: An Intergenerational Art Program To Improve Health Care Delivery And Health Outcomes Of Older Adults, Sadie Rubin

Case Studies from Age in Action

Educational Objectives:

1. Demonstrate the positive out-comes of the PALETTE model in training and educating health pro-fessional students in gerontological experiences.

2. Describe the partnerships devel-oped and their importance in exe-cuting PALETTE programs.

3. Highlight student experiences in intergenerational visual arts and intergenerational movement arts.

Evaluating Commonwealth Coordinated Care: The Experiences Of Individuals Dually Eligible For Medicare And Medicaid, Gerald Craver, Alison Cuellar, Gilbert Gimm

Case Studies from Age in Action

Objectives

1. To understand Virginia’s rationale for implementing the Commonwealth Coordinated Care Program and its approach to evaluating it.

2. To provide a framework for examining the health care experiences of individuals with behavioral health and/or long-term service and support needs who are enrolled in the Commonwealth Coordinated Care Program.

3. To inform policy on future options for improving the quality and health care experiences of similar groups of individuals in Virginia and other states.

Averting Financial Exploitation And Undue Influence Through Legislation, Kathy Pryor

Case Studies from Age in Action

Objectives

1. Explain what financial exploitation is.

2. Examine the elements of undue influence through case studies.

3. Consider the reasons undue influence is so difficult to address legislatively.

Uncovering New Roles For The Aryl Hydrocarbon Receptor (Ahr) In Breast Cancer, Justin Kirk Tomblin

Theses, Dissertations and Capstones

The aryl hydrocarbon receptor (AHR) is a ligand-activated transcription factor that is responsive to many exogenous and endogenous ligands. AHR is of particular interest in cancer, and has been shown to play roles in tumor progression. As such, it has received growing attention as a possible chemotherapeutic target. Obesity increases the risk of breast cancer, complicates treatment of breast cancer, and stimulates the growth of larger, more aggressive mammary tumors. Many breast tumors in obese women are estrogen receptor (ER)-positive and, while targeting hormone receptors like ER is beneficial, many obese women see a recurrence of their cancer after standard …

The Physiological And Clinical Importance Of Sodium Potassium Atpase In Cardiovascular Diseases, Yanling Yan, Joseph I. Shapiro Md

Biochemistry and Microbiology

The Na/K-ATPase has been extensively studied, but it is only recently that its role as a scaffolding and signaling protein has been identified. It has been identified that cardiotonic steroids (CTS) such as digitalis mediate signal transduction through the Na/K-ATPase in a process found to result in the generation of reactive oxygen species (ROS). As these ROS also appear capable of initiating this signal cascade, a feed forward amplification process has been postulated and subsequently implicated in some disease pathways including uremic cardiomyopathy.

Bilayered, Non-Cross-Linked Collagen Matrix For Regeneration Of Facial Defects After Skin Cancer Removal: A New Perspective For Biomaterial-Based Tissue Reconstruction, Shahram Ghanaat, Adorjan Kovacs, Mike Barbeck, Jonas Lorenz, Anna Teiler, Nader Sadeghi, Charles Kirkpatrick, Robert Sader

Surgery Faculty Publications

Classically skin defects are covered by split thickness skin grafts or by means of local or regional skin flaps. In the presented case series for the first time a bilayered, non-crossed-linked collagen matrix has been used in an off-label fashion in order to reconstruct facial skin defects following different types of skin cancer resection. The material is of porcine origin and consists of a spongy and a compact layer. The ratio of the two layers is 1:3 in favour of the spongy layer. The aim of the study was to investigate the potential of this matrix for skin regeneration as …

Interleukin-6 Is A Risk Factor For Atrial Fibrillation In Chronic Kidney Disease: Findings From The Cric Study., Richard L. Amdur, Monica Mukherjee, Alan Go, Ian R Barrows, Ali Ramezani, Jun Shoji, Dominic S. Raj, +13 Additional Authors

Surgery Faculty Publications

Atrial fibrillation (AF) is the most common sustained arrhythmia in patients with chronic kidney disease (CKD). In this study, we examined the association between inflammation and AF in 3,762 adults with CKD, enrolled in the Chronic Renal Insufficiency Cohort (CRIC) study. AF was determined at baseline by self-report and electrocardiogram (ECG). Plasma concentrations of interleukin(IL)-1, IL-1 Receptor antagonist, IL-6, tumor necrosis factor (TNF)-α, transforming growth factor-β, high sensitivity C-Reactive protein, and fibrinogen, measured at baseline. At baseline, 642 subjects had history of AF, but only 44 had AF in ECG recording. During a mean follow-up of 3.7 years, 108 subjects …

Outcomes Of Recurrent Laryngeal Nerve Injury Following Congenital Heart Surgery: A Contemporary Experience., Fahad A Alfares, Conor F Hynes, Ghedak Ansari, Reginald Chounoune, Manelle Ramadan, Conner Shaughnessy, Brian K. Reilly, David Zurakowski, Richard A. Jonas, Dilip S. Nath

Surgery Faculty Publications

OBJECTIVE: Injury to the recurrent laryngeal nerve can lead to significant morbidity during congenital cardiac surgery. The objective is to expand on the limited understanding of the severity and recovery of this iatrogenic condition.

DESIGN: A six-year retrospective review of all congenital heart operations at a single institution from January 1, 2008 to December 31, 2013 was performed. All patients with documented vocal cord paralysis on laryngoscopic examination comprised the study cohort. Evaluation of time to vocal cord recovery and need for further surgical intervention was the primary focus.

RESULTS: The incidence of post-operative vocal cord paralysis was 1.1% (32 …

Mutational Profiles Reveal An Aberrant Tgf-Β-Cea Regulated Pathway In Colon Adenomas., Jian Chen, Gottumukkala S Raju, Wilma Jogunoori, Shoujun Gu, Lopa Mishra, + 27 More

Surgery Faculty Publications

Mutational processes and signatures that drive early tumorigenesis are centrally important for early cancer prevention. Yet, to date, biomarkers and risk factors for polyps (adenomas) that inordinately and rapidly develop into colon cancer remain poorly defined. Here, we describe surprisingly high mutational profiles through whole-genome sequence (WGS) analysis in 2 of 4 pairs of benign colorectal adenoma tissue samples. Unsupervised hierarchical clustered transcriptomic analysis of a further 7 pairs of adenomas reveals distinct mutational signatures regardless of adenoma size. Transitional single nucleotide substitutions of C:G>T:A predominate in the adenoma mutational spectrum. Strikingly, we observe mutations in the TGF-β pathway …

Vitamin D Deficiency Promotes Liver Tumor Growth In Transforming Growth Factor-Β/Smad3-Deficient Mice Through Wnt And Toll-Like Receptor 7 Pathway Modulation., Jian Chen, Lior H Katz, Nina M Muñoz, Shoujun Gu, Ji-Hyun Shin, Lopa Mishra, +13 Additional Authors

Surgery Faculty Publications

Disruption of the TGF-β pathway is associated with liver fibrosis and suppression of liver tumorigenesis, conditions associated with low Vitamin D (VD) levels. However, potential contributions of VD to liver tumor progression in the context of TGF-β signaling remain unexplored. Our analyses of VD deprivation (VDD) in in vivo models of liver tumor formation revealed striking three-fold increases in tumor burden in Smad3(+/-) mice, with a three-fold increase in TLR7 expression compared to controls. ChIP and transcriptional assays confirm Smad3 binding at two TLR7 promoter SBE sites. Molecular interactions between TGF-β pathway and VDD were validated clinically, where an absence …

Transoral Fundoplication Offers Durable Symptom Control For Chronic Gerd: 3-Year Report From The Tempo Randomized Trial With A Crossover Arm, Karim S. Trad, Mark Fox, Gilbert Simoni, Ahmad Shughoury, Peter Mavrelis, Mamoon Raza, Jeffrey Heise, William Barnes

Surgery Faculty Publications

Background

Four randomized controlled trials have demonstrated the short-term efficacy and safety of transoral esophagogastric fundoplication (TF) performed with the EsophyX® device in eliminating troublesome gastroesophageal reflux disease (GERD) symptoms in well-selected patient populations. The aim of this study was to assess the durability of these outcomes at 3 years post-procedure.

Methods

The TF EsophyX versus Medical PPI Open Label trial was conducted in seven US sites. Between June and August 2012, we enrolled patients with small (<2 cm) or absent hiatal hernias who suffered from troublesome GERD symptoms while on PPI therapy for at least 6 months and had abnormal esophageal acid exposure (EAE). Randomization was to TF group (n = 40) or to PPI group (n = 23). Following evaluation at 6 months, all remaining PPI patients (n …

Adult Gli2+/-;Gli3Δ699/+ Male And Female Mice Display A Spectrum Of Genital Malformation., Fei He, Pedram Akbari, Rong Mo, Jennifer J Zhang, Chi-Chung Hui, Peter C. Kim, Walid A Farhat

Surgery Faculty Publications

Disorders of sexual development (DSD) encompass a broad spectrum of urogenital malformations and are amongst the most common congenital birth defects. Although key genetic factors such as the hedgehog (Hh) family have been identified, a unifying postnatally viable model displaying the spectrum of male and female urogenital malformations has not yet been reported. Since human cases are diagnosed and treated at various stages postnatally, equivalent mouse models enabling analysis at similar stages are of significant interest. Additionally, all non-Hh based genetic models investigating DSD display normal females, leaving female urogenital development largely unknown. Here, we generated compound mutant mice, Gli2+/-;Gli3Δ699/+, …

Two Cases Of Monoclonal Nodular Pulmonary Amyloidosis And Review Of The Literature, Kendal Endicott, Conor Hynes, Cindy M. Hsieh, Edina Paal, Gregory D. Trachiotis

Surgery Faculty Publications

Nodular pulmonary amyloidosis (NPA) is an uncommon pathology of insoluble protein depositing in pulmonary parenchyma. This localized pulmonary form of amyloidosis is most often found to contain combinations of kappa and lambda immunoglobulin light chain and immunoglobulin heavy chain proteins with a polyclonal lymphoplasmacystic infiltrate. Herein we present two cases of NPA of the rarely reported monoclonal (light-chain restricted) form with review of the literature and discussion of the clinical, radiographic, and histologic features of NPA.

Surgeon's Guide To Anticoagulant And Antiplatelet Medications Part Two: Antiplatelet Agents And Perioperative Management Of Long-Term Anticoagulation., Louise Y Y Yeung, Babak Sarani, Jordan A Weinberg, Paul B Mcbeth, Addison K May

Surgery Faculty Publications

An increasing number of potent antiplatelet and anticoagulant medications are being used for the long-term management of cardiac, cerebrovascular, and peripheral vascular conditions. Management of these medications in the perioperative and peri-injury settings can be challenging for surgeons, mandating an understanding of these agents and the risks and benefits of various management strategies. In this two part review, agents commonly encountered by surgeons in the perioperative and peri-injury settings are discussed and management strategies for patients on long-term antiplatelet and anticoagulant therapy reviewed. In part one, we review warfarin and the new direct oral anticoagulants. In part two, we review …

Cancer Care Annual Report 2015-16, Children's Mercy Hospital

Cancer Center Annual Reports

Annual report of cancer care and oncology services at the Children's Mercy Hospital, Kansas City MO, a pediatric medical center. This report has a focus on neuroblastoma.

Senior Wellness: The Golden Age, Angela Bourassa, Sarah Cummings, An Harmanli, Minh-Tam Le, Ellen Massey, Besen Sanga, Ahalya Somaskandan, Nkechi Uzoukwu, Kirk Williamson

ISCOPES Posters and Presentations

No abstract provided.

Spatial And Temporal Homogeneity Of Driver Mutations In Diffuse Intrinsic Pontine Glioma., Hamid Nikbakht, Eshini Panditharatna, Leonie G Mikael, Rui Li, Tenzin Gayden, Alan Siu, Roger J. Packer, Javad Nazarian, +16 Additional Authors

Neurology Faculty Publications

Diffuse Intrinsic Pontine Gliomas (DIPGs) are deadly paediatric brain tumours where needle biopsies help guide diagnosis and targeted therapies. To address spatial heterogeneity, here we analyse 134 specimens from various neuroanatomical structures of whole autopsy brains from nine DIPG patients. Evolutionary reconstruction indicates histone 3 (H3) K27M-including H3.2K27M-mutations potentially arise first and are invariably associated with specific, high-fidelity obligate partners throughout the tumour and its spread, from diagnosis to end-stage disease, suggesting mutual need for tumorigenesis. These H3K27M ubiquitously-associated mutations involve alterations in TP53 cell-cycle (TP53/PPM1D) or specific growth factor pathways (ACVR1/PIK3R1). Later oncogenic alterations arise in sub-clones and often …

Dark Blood Late Gadolinium Enhancement Improves Conspicuity Of Ablation Lesions, Peter Kellman, Laura J. Olivieri, Elena Grant, Charles I. Berul, Kendall O'Brien, Kanishka Ratnayaka, Michael Hansen

Pediatrics Posters and Presentations

No abstract provided.

Heart Rhythm Monitoring Strategies For Cryptogenic Stroke: 2015 Diagnostics And Monitoring Stroke Focus Group Report, Gregory W. Albers, Richard A. Bernstein, Johannes Brachmann, John Camm, J. Donald Easton, Jesse M. Pines, +13 Additional Authors

Emergency Medicine Faculty Publications

No abstract provided.

Anticipated Resource Utilization For Injury Versus Non-Injury Pediatric Visits To Emergency Departments, Mark Zonfrillo, Michelle Macy, Lawrence J. Cook, Tomohiko Funai, Rachel M. Stanley, James M. Chamberlain, Rebecca M. Cunningham, Elizabeth Alpern, Pediatric Emergency Care Applied Research Network (Pecarn)

Emergency Medicine Faculty Publications

Background

Childhood injuries are increasingly treated in emergency departments (EDs) but the relationship between injury severity and ED resource utilization has not been evaluated. The objective of this study was to compare resource utilization for pediatric injury-related ED visits across injury-severity levels and with non-injury visits, using standardized, validated scales.

Methods

A retrospective analysis of 2004-2008 ED visits from the Pediatric Emergency Care Applied Research Network Core Data Project. Maximum Abbreviated Injury Scale severity (MAIS) and Severity Classification System (SCS) scores were calculated and compared. MAIS and SCS are ordinal scales from 1 (minor injury) to 6, and 1 (low …

Ultrasound And Perforated Viscus; Dirty Fluid, Dirty Shadows, And Peritoneal Enhancement., Hamid Shokoohi, Keith S. Boniface, Bruce M. Abell, Ali Pourmand, Mohammad Salimian

Emergency Medicine Faculty Publications

Early detection of free air in the peritoneal cavity is vital in diagnosis of life-threatening emergencies, and can play a significant role in expediting treatment. We present a series of cases in which bedside ultrasound (US) in the emergency department accurately identified evidence of free intra-peritoneal air and echogenic (dirty) free fluid consistent with a surgical final diagnosis of a perforated hollow viscus. In all patients with suspected perforated viscus, clinicians were able to accurately identify the signs of pneumoperitoneum including enhanced peritoneal stripe sign (EPSS), peritoneal stripe reverberations, and focal air collections associated with dirty shadowing or distal multiple …

Disparities In Survival With Bystander Cpr Following Cardiopulmonary Arrest Based On Neighborhood Characteristics, Nina Thakkar Rivera, Shari L. Kumar, Rohit K. Bhandari, Sunil D. Kumar

Emergency Medicine Faculty Publications

The American Heart Association reports the annual incidence of out-of-hospital cardiopulmonary arrests (OHCA) is greater than 300,000 with a survival rate of 9.5%. Bystander cardiopulmonary resuscitation (CPR) saves one life for every 30, with a 10% decrease in survival associated with every minute of delay in CPR initiation. Bystander CPR and training vary widely by region. We conducted a retrospective study of 320 persons who suffered OHCA in South Florida over 25 months. Increased survival, overall and with bystander CPR, was seen with increasing income (p = 0.05), with a stronger disparity between low- and high-income neighborhoods (p …

Google Flu Trends Spatial Variability Validated Against Emergency Department Influenza-Related Visits., Joseph Jeffrey Klembczyk, Mehdi Jalalpour, Scott Levin, Raynard E Washington, Jesse M. Pines, Richard E Rothman, Andrea Freyer Dugas

Emergency Medicine Faculty Publications

BACKGROUND: Influenza is a deadly and costly public health problem. Variations in its seasonal patterns cause dangerous surges in emergency department (ED) patient volume. Google Flu Trends (GFT) can provide faster influenza surveillance information than traditional CDC methods, potentially leading to improved public health preparedness. GFT has been found to correlate well with reported influenza and to improve influenza prediction models. However, previous validation studies have focused on isolated clinical locations.

OBJECTIVE: The purpose of the study was to measure GFT surveillance effectiveness by correlating GFT with influenza-related ED visits in 19 US cities across seven influenza seasons, and to …

Anuria Secondary To Bilateral Obstructing Ureteral Stones In The Absence Of Renal Colic., Carolyn A Salter, Christopher Lang, Hernan O Altamar

Emergency Medicine Faculty Publications

BACKGROUND: Obstructing ureteral stones are a rare cause of anuria, which is typically from prerenal or renal etiologies. Classically, obstructive stones cause moderate to severe renal colic. Urolithiasis is rarely considered during evaluation of painless anuria.

CASE PRESENTATION: We present an unusual case of a 73-year-old Caucasian female who presented with anuria and was found to have large bilateral obstructing ureteral stones in the absence of renal colic.

CONCLUSION: Given that patients with obstructive anuria can be asymptomatic, urolithiasis should be considered in all patients presenting with anuria.

A Single Center Observational Study On Emergency Department Clinician Non-Adherence To Clinical Practice Guidelines For Treatment Of Uncomplicated Urinary Tract Infections, Catherine Zatorski, Mark Zocchi, Sara Cosgrove, Cynthia Rand, Gillian Brooks, Larissa May

Emergency Medicine Faculty Publications

Background

The Emergency Department (ED) is a frequent site of antibiotic use; poor adherence with evidence-based guidelines and broad-spectrum antibiotic overuse is common. Our objective was to determine rates and predictors of inappropriate antimicrobial use in patients with uncomplicated urinary tract infections (UTI) compared to the 2010 International Clinical Practice Guidelines (ICPG).

Methods

A single center, prospective, observational study of patients with uncomplicated UTI presenting to an urban ED between September 2012 and February 2014 that examined ED physician adherence to ICPG when treating uncomplicated UTIs. Clinician-directed antibiotic treatment was compared to the ICPG using a standardized case definition for …

Improving Timeliness For Acute Asthma Care For Paediatric Ed Patients Using A Nurse Driven Intervention: An Interrupted Time Series Analysis., Kathleen Brown, Sabah Iqbal, Su-Lin Sun, Jennifer Fritzeen, James Chamberlain, Paul C. Mullan

Emergency Medicine Faculty Publications

Asthma is the most common chronic paediatric disease treated in the emergency department (ED). Rapid corticosteroid administration is associated with improved outcomes, but our busy ED setting has made it challenging to achieve this goal. Our primary aim was to decrease the time to corticosteroid administration in a large, academic paediatric ED. We conducted an interrupted time series analysis for moderate to severe asthma exacerbations of one to 18 year old patients. A multidisciplinary team designed the intervention of a bedside nurse initiated administration of oral dexamethasone, to replace the prior system of a physician initiated order for oral prednisone. …