Medical Specialties Commons^™

The Role Of Adenosine Signaling In Headache: A Review., Nathan T. Fried, Melanie B. Elliott, Michael L. Oshinsky

Department of Neurology Faculty Papers

Migraine is the third most prevalent disease on the planet, yet our understanding of its mechanisms and pathophysiology is surprisingly incomplete. Recent studies have built upon decades of evidence that adenosine, a purine nucleoside that can act as a neuromodulator, is involved in pain transmission and sensitization. Clinical evidence and rodent studies have suggested that adenosine signaling also plays a critical role in migraine headache. This is further supported by the widespread use of caffeine, an adenosine receptor antagonist, in several headache treatments. In this review, we highlight evidence that supports the involvement of adenosine signaling in different forms of …

Reducing Caregiver Burden: Fostering Healthy Aging And Social Support, Maria A. Rodriguez

USF Tampa Graduate Theses and Dissertations

Over 43.5 million Americans provide informal care to a fast-growing elderly population in the United States. Informal care allows care-recipients to remain functional members of society. However, research suggests that the demands of informal care can negatively impact the health of caregivers. For example, caregiver burden increases the risk for poor health in caregivers compared to non-caregivers. Caregiving research is on the rise, but the dynamics of informal care in active retirement communities remains widely unexplored. To provide adequate services to lessen caregiver burden and improve the Quality of Life (QoL) of informal caregivers, the various settings in which informal …

Usage Of 3d Models Of Tetralogy Of Fallot For Medical Education: Impact On Learning Congenital Heart Disease., Yue-Hin Loke, Ashraf S Harahsheh, Axel Krieger, Laura J Olivieri

Pediatrics Faculty Publications

BACKGROUND: Congenital heart disease (CHD) is the most common human birth defect, and clinicians need to understand the anatomy to effectively care for patients with CHD. However, standard two-dimensional (2D) display methods do not adequately carry the critical spatial information to reflect CHD anatomy. Three-dimensional (3D) models may be useful in improving the understanding of CHD, without requiring a mastery of cardiac imaging. The study aimed to evaluate the impact of 3D models on how pediatric residents understand and learn about tetralogy of Fallot following a teaching session.

METHODS: Pediatric residents rotating through an inpatient Cardiology rotation were recruited. The …

Provider Referral Of Patients With Acute Low Back Pain To Physical Therapy: Implications For Outcomes And Costs, Corinne Griggs

DNP Projects

Because most patients with an acute episode of low back pain (LBP) enter the health care system through primary care, it is important primary care providers consider the effects of their decisions on patient outcomes and costs. Although guidelines for primary care management of acute LBP do not place emphasis on physical therapy, they have not been updated since 2007, and more recent evidence supports the use of timely physical therapy in acute LBP patients without “red flags.” Additionally, many studies indicate specialist or surgical consultation is over-utilized, inflating costs and delaying physical therapy. The aim of this project was …

Pulmonary Surfactant Fortified With Cath-2 As A Novel Therapy For Bacterial Pneumonia, Brandon J. Baer

Western Research Forum

Background: Bacterial pneumonia is a leading cause of death worldwide, with high mortality rates persisting even after antibiotic treatment. Current treatments for pneumonia involve administration of antibiotics, however after the bacteria are killed they release toxic substances that induce inflammation and lung dysfunction. Host defense peptides represent a potential solution to this problem through their ability to down regulate inflammation. However, effective delivery to the lung is difficult because of the complex branching structure of the airways. My study addresses this delivery problem by using exogenous surfactant, a pulmonary delivery vehicle capable of improving spreading of these peptides throughout the …

The Soy-Derived Peptide Lunasin Inhibits Invasive Potential Of Melanoma Initiating Cells, Chris Shidal, Jun-Ichi Inaba, Kavitha Yaddanapudi, Keith R. Davis

Plant Pathology Faculty Publications

Lunasin is a 44 amino acid peptide with multiple functional domains including an aspartic acid tail, an RGD domain, and a chromatin-binding helical domain. We recently showed that Lunasin induced a phenotype switch of cancer initiating cells (CIC) out of the stem compartment by inducing melanocyte-associated differentiation markers while simultaneously reducing stem-cell-associated transcription factors. In the present study, we advance the hypothesis that Lunasin can reduce pools of melanoma cells with stem cell-like properties, and demonstrate that Lunasin treatment effectively inhibits the invasive potential of CICs in vitro as well as in vivo in a mouse experimental metastasis model. Mice …

Phase I First-In-Human Study Of Venetoclax In Patients With Relapsed Or Refractory Non-Hodgkin Lymphoma., Matthew S Davids, Andrew W Roberts, John F Seymour, John M Pagel, Brad S Kahl, William G Wierda, Soham Puvvada, Thomas J Kipps, Mary Ann Anderson, Ahmed Hamed Salem, Martin Dunbar, Ming Zhu, Franklin Peale, Jeremy A Ross, Lori Gressick, Monali Desai, Su Young Kim, Maria Verdugo, Rod A Humerickhouse, Gary B Gordon, John F Gerecitano

Articles, Abstracts, and Reports

Purpose B-cell leukemia/lymphoma-2 (BCL-2) overexpression is common in many non-Hodgkin lymphoma (NHL) subtypes. A phase I trial in patients with NHL was conducted to determine safety, pharmacokinetics, and efficacy of venetoclax, a selective, potent, orally bioavailable BCL-2 inhibitor. Patients and Methods A total of 106 patients with relapsed or refractory NHL received venetoclax once daily until progressive disease or unacceptable toxicity at target doses from 200 to 1,200 mg in dose-escalation and safety expansion cohorts. Treatment commenced with a 3-week dose ramp-up period for most patients in dose-escalation cohorts and for all patients in safety expansion. Results NHL subtypes included …

Bioactive Lipids And Circulating Progenitor Cells In Patients With Cardiovascular Disease, Salim S. Hayek, Yuri Klyachkin, Ahmed Asfour, Nima Ghasemzadeh, Mosaab Awad, Iraj Hesaroieh, Hina Ahmed, Brandon Gray, Jinhee Kim, Edmund K. Waller, Arshed A. Quyyumi, Ahmed K. Abdel-Latif

Internal Medicine Faculty Publications

Bone marrow-derived progenitor cells are mobilized into the peripheral blood after acute myocardial injury and in chronic ischemic heart disease. However, the mechanisms responsible for this mobilization are poorly understood. We examined the relationship between plasma levels of bioactive lipids and number of circulating progenitor cells (CPCs) in patients (N = 437) undergoing elective or emergent cardiac catheterization. Plasma levels of sphingosine-1 phosphate (S1P) and ceramide-1 phosphate (C1P) were quantified using mass spectrometry. CPCs were assessed using flow cytometry. S1P levels correlated with the numbers of CD34+, CD34+/CD133+, and CD34+/CXCR4+ CPCs even after adjustment for potential confounding factors. However, …

Performance Of Medication Reconciliation For Internal Medicine Hospital Admissions – Before And After Educational Intervention, Gabriela Andries, Merita Shehu, Dennis Roarke, Syed Zaid, Christopher Nabors, Sachin Sule

NYMC Faculty Posters

No abstract provided.

Camp Signaling Enhances Hiv-1 Long Terminal Repeat (Ltr)-Directed Transcription And Viral Replication In Bone Marrow Progenitor Cells., Anupam Banerjee, Luna Li, Vanessa Pirrone, Fred C. Krebs, Brian Wigdahl, Michael R. Nonnemacher

Kimmel Cancer Center Papers, Presentations, and Grand Rounds

CD34⁺ hematopoietic progenitor cells have been shown to be susceptible to HIV-1 infection, possibly due to a low-level expression of CXCR4, a coreceptor for HIV-1 entry. Given these observations, we have explored the impact of forskolin on cell surface expression of CXCR4 in a cell line model (TF-1). The elevation of intracellular cyclic adenosine monophosphate (cAMP) by forskolin through adenylyl cyclase (AC) resulted in transcriptional upregulation of CXCR4 with a concomitant increase in replication of the CXCR4-utilizing HIV-1 strain IIIB. Transient expression analyses also demonstrated an increase in CXCR4-, CCR5-, and CXCR4-/CCR5-utilizing HIV-1 (LAI, YU2, and 89.6, respectively) promoter …

Polyp Resection - Controversial Practices And Unanswered Questions, Daniel Von Renteln, Heiko Pohl

Dartmouth Scholarship

Detection and complete removal of precancerous neoplastic polyps are central to effective colorectal cancer screening. The prevalence of neoplastic polyps in the screening population in the United States is likely 450%. However, most persons with neoplastic polyps are never destined to develop cancer, and do not benefit for finding and removing polyps, and may only be harmed by the procedure. Further 70–80% of polyps are diminutive (≤5 mm) and such polyps almost never contain cancer. Given the questionable benefit, the high-cost and the potential risk changing our approach to the management of diminutive polyps is currently debated. Deemphasizing diminutive polyps …

Impact Of A National Guideline On Antibiotic Selection For Hospitalized Pneumonia., Derek J Williams, Matthew Hall, Jeffrey S Gerber, Mark I Neuman, Adam L Hersh, Thomas V Brogan, Kavita Parikh, Sanjay Mahant, Anne J Blaschke, Samir S Shah, Carlos G Grijalva

Pediatrics Faculty Publications

BACKGROUND: We evaluated the impact of the 2011 Pediatric Infectious Diseases Society/Infectious Diseases Society of America pneumonia guideline and hospital-level implementation efforts on antibiotic prescribing for children hospitalized with pneumonia.

METHODS: We assessed inpatient antibiotic prescribing for pneumonia at 28 children's hospitals between August 2009 and March 2015. Each hospital was also surveyed regarding local implementation efforts targeting antibiotic prescribing and organizational readiness to adopt guideline recommendations. To estimate guideline impact, we used segmented linear regression to compare the proportion of children receiving penicillins in March 2015 with the expected proportion at this same time point had the guideline not …

A Murine Model To Study Epilepsy And Sudep Induced By Malaria Infection., Paddy Ssentongo, Anna E Robuccio, Godfrey Thuku, Derek G Sim, Ali Nabi, Fatemeh Bahari, Balaji Shanmugasundaram, Myles W Billard, Andrew Geronimo, Kurt W Short, Patrick J Drew, Jennifer Baccon, Steven L Weinstein, Frank G Gilliam, José A Stoute, Vernon M Chinchilli, Andrew F Read, Bruce J Gluckman, Steven J Schiff

Neurology Faculty Publications

One of the largest single sources of epilepsy in the world is produced as a neurological sequela in survivors of cerebral malaria. Nevertheless, the pathophysiological mechanisms of such epileptogenesis remain unknown and no adjunctive therapy during cerebral malaria has been shown to reduce the rate of subsequent epilepsy. There is no existing animal model of postmalarial epilepsy. In this technical report we demonstrate the first such animal models. These models were created from multiple mouse and parasite strain combinations, so that the epilepsy observed retained universality with respect to genetic background. We also discovered spontaneous sudden unexpected death in epilepsy …

A Perspective On Ovarian Cancer Biomarkers: Past, Present And Yet-To-Come, Frederick R. Ueland

Obstetrics and Gynecology Faculty Publications

The history of biomarkers and ultrasonography dates back over more than 50 years. The present status of biomarkers used in the context of ovarian cancer is addressed. Attention is given to new interpretations of the etiology of ovarian cancer. Cancer antigen 125 (CA125) and multivariate index assays (Ova1, Risk of Ovarian Malignancy Algorithm, Overa) are biomarker-driven considerations that are presented. Integration of biomarkers into ovarian cancer diagnostics and screening are presented in conjunction with ultrasound. Consideration is given to the serial application of both biomarkers and ultrasound, as well as morphology-based indices. Attempts are made to foresee how individualized molecular …

Complications From Surgeries Related To Ovarian Cancer Screening, Lauren A. Baldwin, Edward J. Pavlik, Emma Ueland, Hannah E. Brown, Kelsey M. Ladd, Bin Huang, Christopher P. Desimone, John R. Van Nagell, Frederick R. Ueland, Rachel W. Miller

Obstetrics and Gynecology Faculty Publications

The aim of this study was to evaluate complications of surgical intervention for participants in the Kentucky Ovarian Cancer Screening Program and compare results to those of the Prostate, Lung, Colorectal and Ovarian Cancer Screening trial. A retrospective database review included 657 patients who underwent surgery for a positive screen in the Kentucky Ovarian Cancer Screening Program from 1988–2014. Data were abstracted from operative reports, discharge summaries, and office notes for 406 patients. Another 142 patients with incomplete records were interviewed by phone. Complete information was available for 548 patients. Complications were graded using the Clavien–Dindo (C–D) Classification of Surgical …

Apolipoprotein E4 And Insulin Resistance Interact To Impair Cognition And Alter The Epigenome And Metabolome, Lance A. Johnson, Eileen Ruth S. Torres, Soren Impey, Jan F. Stevens, Jacob Raber

Physiology Faculty Publications

Apolipoprotein E4 (E4) and type 2 diabetes are major risk factors for cognitive decline and late onset Alzheimer’s disease (AD). E4-associated phenotypes and insulin resistance (IR) share several features and appear to interact in driving cognitive dysfunction. However, shared mechanisms that could explain their overlapping pathophysiology have yet to be found. We hypothesized that, compared to E3 mice, E4 mice would be more susceptible to the harmful cognitive effects of high fat diet (HFD)-induced IR due to apoE isoform-specific differences in brain metabolism. While both E3 and E4 mice fed HFD displayed impairments in peripheral metabolism and cognition, deficits in …

Atr Mutations Promote The Growth Of Melanoma Tumors By Modulating The Immune Microenvironment., Chi-Fen Chen, Rolando Ruiz-Vega, Priya Vasudeva, Francisco Espitia, Tatiana B Krasieva, Sebastien De Feraudy, Bruce J Tromberg, Sharon Huang, Chad P Garner, Jie Wu, Dave S B Hoon, Anand K Ganesan

Articles, Abstracts, and Reports

Melanomas accumulate a high burden of mutations that could potentially generate neoantigens, yet somehow suppress the immune response to facilitate continued growth. In this study, we identify a subset of human melanomas that have loss-of-function mutations in ATR, a kinase that recognizes and repairs UV-induced DNA damage and is required for cellular proliferation. ATR mutant tumors exhibit both the accumulation of multiple mutations and the altered expression of inflammatory genes, resulting in decreased T cell recruitment and increased recruitment of macrophages known to spur tumor invasion. Taken together, these studies identify a mechanism by which melanoma cells modulate the immune …

Beta Oscillatory Changes And Retention Of Motor Skills During Practice In Healthy Subjects And In Patients With Parkinson’S Disease, Aaron B. Nelson, Clara Moisello, Jing Lin, Priya Panday, Serena Ricci, Andrea Canessa, Alessandro Di Rocco, Angelo Quartarone, Giuseppe Frazzitta, Ioannis U. Isaias, Giulio Tononi, Chiara Cirelli, M. Felice Ghilardi

Publications and Research

Recently we found that modulation depth of beta power during movement increases with practice over sensory-motor areas in normal subjects but not in patients with Parkinson’s disease (PD). As such changesmight reflect use-dependentmodifications, we concluded that reduction of beta enhancement in PD represents saturation of cortical plasticity. A few questions remained open: What is the relation between these EEG changes and retention of motor skills? Would a second task exposure restore beta modulation enhancement in PD? Do practice-induced increases of beta modulation occur within each block? We thus recorded EEG in patients with PD and age-matched controls in two consecutive …

Mortality Associated With Gastrointestinal Bleeding In Children: A Retrospective Cohort Study., Thomas M. Attard, Mikaela Miller, Chaitanya Pant, Ashwath Kumar, Mike Thomson

Manuscripts, Articles, Book Chapters and Other Papers

AIM: To determine the clinical characteristics of children with gastrointestinal bleeding (GIB) who died during the course of their admission.

METHODS: We interrogated the Pediatric Hospital Information System database, including International Classification of Diseases, Current Procedural Terminology and Clinical Transaction Classification coding from 47 pediatric tertiary centers extracting the population of patients (1-21 years of age) admitted (inpatient or observation) with acute, upper or indeterminate GIB (1/2007-9/2015). Descriptive statistics, unadjusted univariate and adjusted multivariate analysis of the associations between patient characteristics and treatment course with mortality was performed with mortality as primary and endoscopy a secondary outcome of interest. All …

Urologists’ Views On Contact With Industry Representatives: A Pilot Survey, Marc Zeffren, Joel Hillelsohn, Michael Stern

NYMC Student Posters

Purpose: The current survey aims to determine the various ways in which urologists at all levels of training view the nature of their relationships with industry representatives, and the effects these relationships may have on clinical practice and behavior. Methods: We sent an anonymous SurveyMonkey® questionnaire to a cohort of approximately 1700 practicing urologists in various urologic subspecialties across the country. The questionnaire elicited information related to demographics, personal awareness of institutional guidelines regarding PR/DMR, and opinions regarding the following: •the ability of industry-supplied gifts to compromise judgment •the utility and appropriateness of industry representatives in the clinical setting •the …

Gastrointestinal-Renal Axis: Role In The Regulation Of Blood Pressure., Jian Yang, Pedro A Jose, Chunyu Zeng

Medicine Faculty Publications

Hypertension is one of the most common and important health problems worldwide.1 It has been estimated that 29% of the world's adult population, or 1.56 billion people, will have hypertension by the year 2025.2The prevalence of high blood pressure and its adverse consequences result in a heavy burden for hypertensive patients from high‐, middle‐, and low‐income countries.2, 3 Many monogenic causes of hypertension have been reported. However, determining the causes of essential hypertension has been hampered because it is a complex disorder with genetic, epigenetic, and environmental determinants. Among numerous environmental factors, sodium intake is …

Effect Of Duration Of Symptoms On Orchiectomy Rates In Testicular Torsion In Patients Under 25: Important Prognostic Trends, Lior Taich, Marc Zeffren, Muhammad Choudhury

NYMC Student Posters

The purpose of this study is to explore the relationship between duration of symptoms in testicular torsion and the effect on orchiectomy rates, with the intention of establishing an updated timeline for clinical management and surgical urgency.

Osborne's Ligament: A Review Of Its History, Anatomy, And Surgical Importance., Andre Granger, Juan P Sardi, Joe Iwanaga, Thomas J Wilson, Lynda Yang, Marios Loukas, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

When discussing the pathophysiology of ulnar neuropathy, Geoffrey Vaughan Osborne described a fibrous band that can be responsible for the symptoms seen in this disorder. In this paper, we take a glimpse at the life of Osborne and review the anatomy and surgical significance of Osborne's ligament. This band of tissue connects the two heads of the flexor carpi ulnaris and thus forms the roof of the cubital tunnel. To our knowledge, no prior publication has reviewed the history of this ligament, and very few authors have studied its anatomy in any detail. Therefore, the aim of the present paper …

Zoledronic Acid Alters Hematopoiesis And Generates Breast Tumor-Suppressive Bone Marrow Cells., Jessalyn M. Ubellacker, Marie-Therese Haider, Molly J. Decristo, Gloria Allocca, Nicola J. Brown, Daniel P. Silver, Ingunn Holen, Sandra S. Mcallister

Department of Medical Oncology Faculty Papers

BACKGROUND: The bone-targeting agent zoledronic acid (ZOL) increases breast cancer survival in subsets of patients, but the underlying reasons for this protective effect are unknown. ZOL modulates the activity of osteoclasts and osteoblasts, which form hematopoietic stem cell niches, and therefore may affect hematopoietic cells that play a role in breast cancer progression.

METHOD: Immunocompetent and immunocompromised strains of mice commonly used for breast cancer research were injected with a single, clinically relevant dose of ZOL (100 μg/kg) or vehicle control. The effects of ZOL on the bone marrow microenvironment (bone volume, bone cell number/activity, extracellular matrix composition) were established …

6-Year Experience Of Outpatient Total And Completion Thyroidectomy, Ethan Frank, Joshua Park Md, Alfred Simental, Christopher Vuong Md, Steve Lee Md, Phd, Pedro Andrade Filho Md, Daniel Kwon Md, Yuan Liu Md

Loma Linda University Student Journal

Outpatient thyroidectomy has become slowly accepted with various published reports predominantly examining partial or subtotal thyroidectomy. Concerns regarding the safety of outpatient total and completion thyroidectomy remain, especially in regards to vocal fold paralysis, hypocalcemia, and catastrophic hematoma. We aimed to evaluate the safety of outpatient thyroid surgery in a large cohort. We conducted a retrospective review comparing outcomes in those who underwent outpatient (n=251) versus inpatient (n= 291) completion or total thyroidectomy between February 2009 and February 2015. Outpatient completion and total thyroidectomy had lower rates of temporary hypocalcemia (6% vs. 24.4%; p< 0.001) and no significant difference in rates of return to emergency department (1.2% vs. 1.4%), hematoma formation (0.8% vs. 0.7%), temporary (2% vs. 4.1%) or permanent (0.4% vs. 0.7%) vocal fold paralysis, or permanent hypocalcemia (0.4% vs. 0%) compared to the inpatient group. Outpatients requiring calcium replacement had shorter duration of postoperative calcium supplementation (44.4±59.3 days vs. 63.3 ±94.4 days; p < 0.001). Our data demonstrates similar safety in outpatient and inpatient total and completion thyroidectomy.

Arrhythmias In Hospitalized Heart Transplanted Patients: A United States National Study, Srikanth Yandrapalli, Prakash Harikrishnan, Zeeshan Solangi, Wilbert S. Aronow, Sachin Sule, Alan L. Gass, Chhaya Aggarwal, William H. Frishman, Sei Iwai, Howard A. Cooper, Julio A. Panza, Gregg M. Lanier

NYMC Faculty Posters

No abstract provided.

Stop The Radiation! Decreasing Ct Scan Utilization In Pediatric Trauma Patients., Catherine Zimel, Taylor Iobst, Carly Crowder, Heather Geist, Keith A. Thatch Md, Marybeth Browne Md

Department of Surgery

No abstract provided.

Postnatal Betamethasone Decreases Respiratory Index In Ventilated Extremely Low Birth Weight Neonates Compared To Conventional Care, Yuanyi Murray, Sanjeet Panda, Dina Finkel, Vanessa Mercado, Edmund F. La Gamma

NYMC Faculty Posters

No abstract provided.

Role Of Corpus Callosum Integrity In Arm Function Differs Based On Motor Severity After Stroke, Jill Campbell Stewart, Pritha Dewanjee, George Tran, Erin Burke Quinlan, Lucy Dodakian, Alison Mckenzie, Jill See, Steven C. Cramer

Physical Therapy Faculty Articles and Research

While the corpus callosum (CC) is important to normal sensorimotor function, its role in motor function after stroke is less well understood. This study examined the relationship between structural integrity of the motor and sensory sections of the CC, as reflected by fractional anisotropy (FA), and motor function in individuals with a range of motor impairment level due to stroke. Fifty-five individuals with chronic stroke (Fugl-Meyer motor score range 14 to 61) and 18 healthy controls underwent diffusion tensor imaging and a set of motor behavior tests. Mean FA from the motor and sensory regions of the CC and from …

Roadmap To A Comprehensive Clinical Data Warehouse For Precision Medicine Applications In Oncology, David J. Foran, Wenjin Chen, Huiqi Chu, Evita Sadimin, Doreen Loh, Gregory Riedlinger, Lauri A. Goodell, Shridar Ganesan, Kim Hirshfield, Lorna Rodriguez, Robert S. Dipaola

Internal Medicine Faculty Publications

Leading institutions throughout the country have established Precision Medicine programs to support personalized treatment of patients. A cornerstone for these programs is the establishment of enterprise-wide Clinical Data Warehouses. Working shoulder-to-shoulder, a team of physicians, systems biologists, engineers, and scientists at Rutgers Cancer Institute of New Jersey have designed, developed, and implemented the Warehouse with information originating from data sources, including Electronic Medical Records, Clinical Trial Management Systems, Tumor Registries, Biospecimen Repositories, Radiology and Pathology archives, and Next Generation Sequencing services. Innovative solutions were implemented to detect and extract unstructured clinical information that was embedded in paper/text documents, including synoptic …