Medical Specialties Commons^™

Two-Component Hydrogel As Biomimetic Vitreous Substitutes, Sruthi Santhanam

McKelvey School of Engineering Graduate Student Theses & Dissertations

The vitreous humor of the eye is a biological hydrogel principally composed of fibrillary collagen interspersed with semi-flexible polyelectrolyte, hyaluronic acid (HA). Certain pathological conditions necessitate its removal and replacement. Current vitreous substitutes, such as silicone oils and perfluorocarbons, are hydrophobic, do not resemble the properties of the vitreous, and have known complications. An ideal vitreous substitute should have properties of the natural vitreous, perform its functions, and be biocompatible in the eye. Inspired by the structure and composition of the natural vitreous, we used bio-mimicry to develop an injectable two-component hydrogel. The hydrogel is composed of a fibrillary gellan, …

Venous Thromboembolism Within Professional American Sport Leagues., Meghan Bishop, Matthew Astolfi, Eric M. Padegimas, Peter F. Deluca, Sommer Hammoud

Department of Orthopaedic Surgery Faculty Papers

Background: Numerous reports have described players in professional American sports leagues who have been sidelined with a deep vein thrombosis (DVT) or a pulmonary embolism (PE), but little is known about the clinical implications of these events in professional athletes.

Purpose: To conduct a retrospective review of injury reports from the National Hockey League (NHL), Major League Baseball (MLB), the National Basketball Association (NBA), and the National Football League (NFL) to take a closer look at the incidence of DVT/PE, current treatment approaches, and estimated time to return to play in professional athletes.

Study Design: Descriptive epidemiology study.

Methods: An …

Ependymomas Overexpress Chemoresistance And Dna Repairrelated Proteins, Sherise D. Ferguson, Shouhao Zhou, Joanne Xiu, Yuuri Hashimoto, Nader Sanai, Lyndon Kim, Santosh Kesari, John De Groot, David Spetzler, Amy B. Heimberger

Department of Neurosurgery Faculty Papers

Background: After surgery and radiation, treatment options for ependymoma are few making recurrence a challenging issue. Specifically, the efficacy of chemotherapy at recurrence is limited. We performed molecular profiling on a cohort of ependymoma cases in order to uncover therapeutic targets and to elucidate the molecular mechanisms contributing to treatment resistance. Results: This ependymoma cohort showed minimal alterations in gene amplifications and mutations but had high expression rates of DNA synthesis and repair enzymes such as RRM1 (47%), ERCC1 (48%), TOPO1 (62%) and class III β-tublin (TUBB3) (57%), which are also all associated with chemoresistance. This cohort also had high …

Novel Therapeutic Strategies For Treatment Of Castration-Resistant Prostate Cancer, Matthew A. Ingersoll

Theses & Dissertations

Prostate cancer (PCa) remains the most commonly diagnosed solid tumor and is the third leading cause of cancer-related death in United States men. While androgen deprivation therapy is the current standard-of-care treatment for metastatic PCa, most patients eventually relapse and develop castration-resistant (CR) tumors, for which there is currently no effective treatment. Therefore, synthesis of novel therapeutic agents and identification of alternative target proteins are necessary to improve treatment. Herein, I investigate the efficacy of novel imidazopyridine and statin derivatives as alternative therapeutic compounds. These molecules not only inhibit androgen receptor signaling, but also block activation of the AKT axis, …

A Case Of Probable Amiodarone-Induced Pancreatitis In The Treatment Of Atrial Fibrillation: A Literature Review And Case Report., Christopher J. Mercogliano, Muhammad Khan, Mussaber Ahmad

Reading Hospital Internal Medicine Residency

Amiodarone is an effective medication used in the treatment of several different arrhythmias. Its most well-known adverse effects include pulmonary fibrosis, thyroid dysfunction, and hepatotoxicity. A less common side effect is acute pancreatitis. A 67-year-old male being treated for atrial fibrillation in rapid ventricular response with Amiodarone developed acute epigastric abdominal pain 24 hours after initiation of therapy. He was diagnosed as having acute pancreatitis based on characteristic findings seen on an abdominal CT scan. Commonly encountered etiologies of pancreatitis were ruled out through a combination of the history, laboratory values, and imaging results. Based on the temporal association of …

Exposure To Environmental Microbiota Explains Persistent Abdominal Pain And Irritable Bowel Syndrome After A Major Flood, Nurfadhilah Yusof, Nurhazwani Hamid, Zheng Feei Ma, Rona Marie Lawenko, Wan Mohd Zahiruddin Wan Mohammad, Deirdre Collins, Min Tze Liong, Toshitaka Odamaki, Jinzhong Xiao, Yeong Yeh Lee

Research outputs 2014 to 2021

Background

After an environmental disaster, the affected community is at increased risk for persistent abdominal pain but mechanisms are unclear. Therefore, our study aimed to determine association between abdominal pain and poor water, sanitation and hygiene (WaSH) practices, and if small intestinal bacterial overgrowth (SIBO) and/or gut dysbiosis explain IBS, impaired quality of life (QOL), anxiety and/or depression after a major flood.

Results

New onset abdominal pain, IBS based on the Rome III criteria, WaSH practices, QOL, anxiety and/or depression, SIBO (hydrogen breath testing) and stools for metagenomic sequencing were assessed in flood victims. Of 211 participants, 37.9 % ( …

Quality And Access To Care For Cardiovascular Disease Prevalence In Women Veterans: Population Estimate Using Electronic Health Records, Meena Marie Kim-Dopp, Vanessa Gow-Lee, Linda Ferry, Sharon Jamie, Ralph Clark, Suma Singh

Loma Linda University Student Journal

Electronic Health Records are used to measure quality indicators for cardiovascular disease (CVD), but have not been tested for sensitivity and specificity. Computerized Patient Record System (CPRS) used by the Veterans Health Affairs (VHA), has active CVD clinical reminders from Healthcare Effectiveness Data & Information Set (HEDIS) that are compared nationally. San Bernardino County, CA has a 7.8% prevalence of self-reported CVD in both genders. For HEDIS measures, there is only a 4 point CVD composite score gender difference for VHA nationally, but at the Loma Linda VHA there is an 18 point gender difference (2016). Women Veterans (WV) are …

Is Engagement Alone Sufficient To Ensure “Active Learning”?, Reed Krause, Amy C. Hayton Md, Jeff Wonoprabowo, Lawrence Loo

Loma Linda University Student Journal

“Active Learning” is commonly defined as any instructional method that engages students in the learning process. However, active learning encompasses a broad range of educational methods and its impact on learning outcomes has been variable. In 2015, our IM clerkship redesigned its half-day learning sessions from a largely passive didactic style of lecturing to more active learning approaches. We further revised the curriculum in 2016 to further convert the sessions to primarily case based learning led by a faculty or resident. The goal of our intervention was to increase the Self-Reported Engagement Measure (STOBE) of each didactic session and improve …

Does Ecg And Arrhythmia Simulation Training In Adjunct To Didactics Improve Medical Students’ Clinical Skills Compared To Didactics Alone?, Reed Krause, Amy C. Hayton Md

Loma Linda University Student Journal

Medical Schools continue to face the challenge of bridging the gap between classroom education and its application in the clinical environment. Several studies have shown utility of incorporating simulation training into a variety of healthcare related topics. We hypothesize that incorporating ECG and arrhythmia simulation training in adjunction to ECG and arrhythmia didactics; it would improve Year-3 medical students’ preparedness for managing arrhythmias in the clinical setting.

Percutaneous Externally Assembled Laparoscopic (Peal) Donor Nephrectomy: A Cohort Pain Comparison, Tyler Miskin, Isaac Kelly, Matthew Pierce, Samuel Abourbih, Duane D. Baldwin

Loma Linda University Student Journal

Donor nephrectomies can be technically demanding. Donors also may not be fully psychologically prepared for their post-operative pain or cosmetic outcome. A novel Percutaneous Externally Assembled Laparoscopic (PEAL) paradigm was developed to decrease incisional pain and laparoscopic scars. The aim of this study is to compare the post-operative outcomes between donor nephrectomies performed with and without the PEAL instruments.

Glycemic Control In Insulin And Non-Insulin Dependent Diabetic Patients With St Elevation Predicts Time To Presentation, Jonathan Evans, David Hamilton, Tigran Khachatryan, Daniel K. Amponsah, Andrew Stewart, Islam Abudayyeh, Kenneth Jutzy, Eric Suh, Anthony Hilliard

Loma Linda University Student Journal

Worldwide, the annual number of people diagnosed with diabetes continues to increase. Classically, Diabetes Mellitus (DM) has been associated with silent or atypical initial symptoms and increased time to presentation in patients presenting with ST elevation myocardial infarction (STEMI) compared to non-DM patients. It is less clear whether the type of treatment or the adequacy of glycemic control impacts the time to presentation and type of symptoms. Therefore, we sought to evaluate the impact of poor glycemic control on these outcomes as measured by hemoglobin A1c.

Magnetically Focused Proton Irradiation Of Small Volume Radiosurgery Targets Using A Triplet Of Quadrupole Magnets, Patrick Mcgee, Grant Mcauley, Andrew Wroe, James M. Slater, Jerry D. Slater

Loma Linda University Student Journal

Proton therapy is an advantageous choice for the irradiation of tumors in proximity of critical structures due to rapid dose fall off and high dose deposition at target compared to dose at the surface of the patient (ie, peak-to-entrance dose ratio (P/E)). However, with target fields below 1.0 cm, as often encountered in proton radiosurgery, multiple Coulomb scattering (MCS) broadens proton beams leading to diminished P/E advantages and reduced dose delivery efficiency (DDE). Magnetic focusing tends to counteract MCS and is a promising method to reduce these undesirable effects. The purpose of this research is to investigate the advantages of …

Diffusion Tensor Imaging Findings In Pediatric Patients With Mild Traumatic Brain Injury, Tshea Dowers, B L. Bartnik, Barbara Holshouser, Stephen Ashwal, Samuel Barnes

Loma Linda University Student Journal

Approximately 14% of school age children with sports-related concussions (SRC) remain symptomatic 3 months after injury. Previous studies have used diffusion tensor imaging (DTI) to detect white matter tract changes in regions of interest in symptomatic patients; however data in the pediatric population remains limited. This study was undertaken to determine whether DTI metrics can provide valuable information in pediatric mTBI patients with persistent symptoms.

Multimodality Minimally Invasive Treatment Of Large Joint Osteoarthritis: A Pilot Trial Of Stromal Vascular Fraction From Autologous Fat Combined With Platelet-Rich Plasma, Phil Giddings, Insiyah Campwala, Subhas Gupta

Loma Linda University Student Journal

Osteoarthritis (OA) is a degenerative joint disease that can cause severe pain in those affected. Currently, there are no therapeutic drugs available to treat osteoarthritis. While total joint arthroplasties (TJA) allow for improved function, there are no less invasive, yet effective procedures that can be done for patients unwilling or unable to undergo major surgery.

Platelet-rich plasma (PRP) has been shown to reduce the symptoms of OA when injected into the affected joint. Patients treated by this method alone have improved self-reported pain (at least a 50% reduction from original value) as well as lower extremity function. While the effects …

Identification Of Unreported Sources Of Objects Containing High Release Nickel, David J. Eng, Mary A. Rasmussen, Chandler Rundle, James K. Parker, Daniel Bergman, Sharon E. Jacob

Loma Linda University Student Journal

Globally, nickel is the leading cause of allergic contact dermatitis (ACD). Nickel is ubiquitous, and published literature continues to index items most frequently associated with Ni-ACD. Unregulated nickel exposure in North America is evident by the unprecedented rates of sensitization seen in patch-tested cohorts, 18.5% in children (ages 0-18 years) and 28.1% in adults.¹ Conservative estimates of ACD within the pediatric population suggest at least one million cases in the US yearly with roughly one-quarter of those cases due to nickel.^2-3 The United States could potentially save $5.7 billion annually in health care costs, extrapolating current cost-saving data …

The Feasibility Of Percutaneous Externally Assembled Laparoscopic Nephrectomy: A New Surgical System, Benjamin West, Jerry Thomas, Mohamed Keheila, Nazih Khater, Samuel Abourbih, Salim Cheriyan, Matthew Pierce, Duane D. Baldwin, Jim Shen

Loma Linda University Student Journal

Laparoendoscopic single-site (LESS) nephrectomy provides excellent cosmetic outcomes, but is technically challenging due to loss of triangulation and increased instrument collision. A novel Percutaneous Externally Assembled Laparoscopic (PEAL) surgical system was developed to simplify minimally invasive surgery while providing a nearly scarless outcome. In this study, the feasibility of the PEAL system for nephrectomy was determined.

Comparing The Vaginal Wall Sling With Autologous Rectus Fascia And Polypropylene Sling On Outcome And Patient Satisfaction, Mohamed Keheila, Salim Cheriyan, Jim Shen, Catalino J. Bautista, Josianne Bailey, Kevin Kim, Marina Germanos, Isaac Kelly, Matthew Pierce, Andrea Staack

Loma Linda University Student Journal

Since 2011 FDA safety update on transvaginal synthetic mesh for treatment of stress urinary incontinence (SUI) and pelvic organ prolapse (POP), providers are encouraged to counsel patients on risks related to synthetic mesh slings, such as dyspareunia, erosion, and extrusion. As an alternative to synthetic slings patients often choose autologous slings. We aim to compare outcome and patient satisfaction in patients, who received an autologous vaginal wall sling (VWS), rectus fascia sling (RFS), or synthetic suburethral sling (SSS) for treatment of SUI.

Assessing Dietary Advancement For Dysphagia Patients At Risk For Aspiration, Cedric Thiel, Thomas Murry, Brianna Crawley, Priya Krishna

Loma Linda University Student Journal

Fiberoptic endoscopic evaluation of swallowing (FEES) evaluates oral intake safety by allowing direct observation of laryngeal function before and after swallowing. The purpose of this study was to delineate the impact of abnormal vocal fold mobility and altered laryngeal sensation on dietary management in hospitalized patients previously diagnosed with aspiration.

Impact Of Macra Legislation And Mips Scores On Cost Effective Analysis For Negative Pressure Wound Therapy Devices, Jeremy W. Kubiak, Subhas Gupta

Loma Linda University Student Journal

The Medicare Access and CHIP Reauthorization Act (MACRA) changes reimbursement from a fee-for-service payment system to fee-for-value. Physicians will be scored according to the quality of their care in the MIPS program and will receive a positive or negative modifier to their Medicare reimbursement based on that score.

Ischemic Time And Risk Factors Associated With The Incidence Of Cardiogenic Shock In Patients Presenting With St Elevation Myocardial Infarction, Daniel K. Amponsah, Jonathan Evans, David Hamilton, Tigran Khachatryan, Andrew Stewart, Islam Abudayyeh, Kenneth Jutzy, Anthony Hilliard

Loma Linda University Student Journal

Cardiogenic shock (CS) is the number one predictor of mortality in patients with ST-elevation myocardial infarction (STEMI). Emergent evaluation and treatment including revascularization when indicated is recommended upon arrival to hospital. There is variation in time to presentation and total ischemic time in this patient population. We sought to evaluate the impact of ischemic time on incidence of CS and variables which may influence its presentation.

The Ability Of Different Imputation Methods To Preserve The Significant Genes And Pathways In Cancer, Rosa Aghdam, Taban Baghfalaki, Pegah Khosravi, Elnaz Saberi Ansari

Publications and Research

Deciphering important genes and pathways from incomplete gene expression data could facilitate a better understanding of cancer. Different imputation methods can be applied to estimate the missing values. In our study, we evaluated various imputation methods for their performance in preserving significant genes and pathways. In the first step, 5% genes are considered in random for two types of ignorable and non-ignorable missingness mechanisms with various missing rates. Next, 10 well-known imputation methods were applied to the complete datasets. The significance analysis of microarrays (SAM) method was applied to detect the significant genes in rectal and lung cancers to showcase …

Interhospital Transfer Before Thrombectomy Is Associated With Delayed Treatment And Worse Outcome In The Stratis Registry (Systematic Evaluation Of Patients Treated With Neurothrombectomy Devices For Acute Ischemic Stroke)., Michael T Froehler, Jeffrey L Saver, Osama O Zaidat, Reza Jahan, Mohammad Ali Aziz-Sultan, Richard P Klucznik, Diogo C Haussen, Frank R Hellinger, Dileep R Yavagal, Tom L Yao, David S Liebeskind, Ashutosh P Jadhav, Rishi Gupta, Ameer E Hassan, Coleman O Martin, Hormozd Bozorgchami, Ritesh Kaushal, Raul G Nogueira, Ravi H Gandhi, Eric C Peterson, Shervin R Dashti, Curtis A Given, Brijesh P Mehta, Vivek Deshmukh, Sidney Starkman, Italo Linfante, Scott H Mcpherson, Peter Kvamme, Thomas J Grobelny, Muhammad S Hussain, Ike Thacker, Nirav Vora, Peng Roc Chen, Stephen J Monteith, Robert D Ecker, Clemens M Schirmer, Eric Sauvageau, Alex Abou-Chebl, Colin P Derdeyn, Lucian Maidan, Aamir Badruddin, Adnan H Siddiqui, Travis M Dumont, Abdulnasser Alhajeri, M Asif Taqi, Khaled Asi, Jeffrey Carpenter, Alan Boulos, Gaurav Jindal, Ajit S Puri, Rohan Chitale, Eric M Deshaies, David H Robinson, David F Kallmes, Blaise W Baxter, Mouhammad A Jumaa, Peter Sunenshine, Aniel Majjhoo, Joey D English, Shuichi Suzuki, Richard D Fessler, Josser E Delgado Almandoz, Jerry C Martin, Nils H Mueller-Kronast

Articles, Abstracts, and Reports

BACKGROUND: Endovascular treatment with mechanical thrombectomy (MT) is beneficial for patients with acute stroke suffering a large-vessel occlusion, although treatment efficacy is highly time-dependent. We hypothesized that interhospital transfer to endovascular-capable centers would result in treatment delays and worse clinical outcomes compared with direct presentation.

METHODS: STRATIS (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke) was a prospective, multicenter, observational, single-arm study of real-world MT for acute stroke because of anterior-circulation large-vessel occlusion performed at 55 sites over 2 years, including 1000 patients with severe stroke and treated within 8 hours. Patients underwent MT with or …

Aging, Inflammation, And Gut Microbiota In Mice, Jody Demeo

Honors Projects

Inflammation and gut microbiota are two areas of study that can be linked to aging in the body. As a person ages, systemic inflammation tends to increase, and changes in microbiota in the gastrointestinal system occur as well.

Iron Reduction Response And Demographic Differences Between Diabetics And Non-Diabetics With Cardiovascular Disease Entered To A Controlled Clinical Trial, Leo Zacharski, Galina Shamayeva, Bruce Chow

Dartmouth Scholarship

Iron-catalyzed oxygen free radical-induced oxidative stress mediates the pathogenesis of diabetes and cardiovascular disease (CVD). Diabetics (n=473) and non-diabetics (n=804) with CVD entered to a randomized trial of iron (ferritin) reduction by calibrated phlebotomy (www.clinicaltrials.gov, Identifier NCT00032357) had comparable iron measures at entry but diabetics had greater burden of CVD and comorbidities, lower hemoglobin and hematocrit levels, and higher glucose levels than non-diabetics. Entry iron measures were lower in diabetics on hypoglycemic therapy compared to diabetics untreated previously. Diabetics and non-diabetics had comparable iron measures during follow-up. Loess analysis of paired ferritin and hemoglobin, and paired ferritin and glucose levels …

Repeat Abortion In Chinese Adolescents: A Cross-Sectional Study In 30 Provinces, Jinlin Liu, Shangchun Wu, Jialin Xu, Marleen Temmerman, Wei-Hong Zhang

Obstetrics and Gynaecology, East Africa

Background: Premarital sex has become more acceptable in China nowadays. The Chinese Family Planning (FP) programme mainly focuses on married couples, and young unmarried women have little access to information or advice about contraception. Abortion is commonly used to end unintended pregnancies in China. This study aimed to determine risk factors related to repeat abortions in Chinese adolescents.

Methods: This cross-sectional study was one component of an EU-funded project and was conducted between March 20, and Oct 5, 2013 in China. We collected data using a questionnaire filled by abortion service providers for all women seeking abortions within 12 weeks …

Beyond The End Line - Putting The Mental Health Of Female Athletes First, Katherine Scholten

Honors Projects

Currently one in five adults are affected by mental illness. Student-athletes are a population that is under diagnosed for mental illness. In the world of college athletics, mental pain is as regular as physical pain. Coaches often push their athletes to suffer in silence for the betterment of the team. The NCAA has recognized the importance of mental health in college athletics, yet there is still much work to be done among universities across the country. This document is to serve as a resource and a guide on the effects of mental health among female student athletes and the best …

Long-Term Follow-Up Of Cardiac Function And Quality Of Life For Patients In Nsabp Protocol B-31/Nrg Oncology: A Randomized Trial Comparing The Safety And Efficacy Of Doxorubicin And Cyclophosphamide (Ac) Followed By Paclitaxel With Ac Followed By Paclitaxel And Trastuzumab In Patients With Node-Positive Breast Cancer With Tumors Overexpressing Human Epidermal Growth Factor Receptor 2, Patricia A. Ganz, Edward H. Romond, Reena S. Cecchini, Priya Rastogi, Charles E. Geyer Jr., Sandra M. Swain, Jong-Hyeon Jeong, Louis Fehrenbacher, Howard M. Gross, Adam M. Brufsky, Patrick J. Flynn, Tanya A. Wahl, Thomas E. Seay, James L. Wade Iii, David D. Biggs, James N. Atkins, Jonathan Polikoff, John L. Zapas, Eleftherios P. Mamounas, Norman Wolmark

Markey Cancer Center Faculty Publications

Purpose

Early cardiac toxicity is a risk associated with adjuvant chemotherapy plus trastuzumab. However, objective measures of cardiac function and health-related quality of life are lacking in long-term follow-up of patients who remain cancer free after completion of adjuvant treatment.

Patients and Methods

Patients in NSABP Protocol B-31 received anthracycline and taxane chemotherapy with or without trastuzumab for adjuvant treatment of node-positive, human epidermal growth factor receptor 2–positive early-stage breast cancer. A long-term follow-up assessment was undertaken for patients who were alive and disease free, which included measurement of left ventricular ejection fraction by multigated acquisition scan along with patient-reported …

Evaluation Of Delivery Methods Of Chemical Dependency And Wellness Education, Marissa Coggin

Doctoral Projects

Anesthesia practice is learned in a stressful environment, and these stressors may lead to the students’ development of maladaptive coping mechanisms. Despite significant improvements in our understanding of addiction and our approaches to combat this problem, the risk of substance misuse remains high in nurse anesthesia students. Education and intervention are imperative when taking preventative measures. The purpose of this Doctor of Nursing Practice (DNP) project was to determine whether delivery method of chemical dependency/wellness educational program effects the level of understanding of anesthesia providers and substance misuse and the development of healthy coping mechanisms.

In determining whether the delivery …

Safety And Efficacy Of Apremilast Through 104 Weeks In Patients With Moderate To Severe Psoriasis Who Continued On Apremilast Or Switched From Etanercept Treatment: Findings From The Liberate Study., K Reich, M Gooderham, A Bewley, L Green, J Soung, R Petric, J Marcsisin, J Cirulli, R Chen, V Piguet

Dermatology Faculty Publications

Background

Apremilast, an oral phosphodiesterase‐4 inhibitor, has demonstrated efficacy in patients with moderate to severe psoriasis.

Objective

To evaluate long‐term efficacy and safety of apremilast in biologic‐naive patients with moderate to severe plaque psoriasis and safety of switching from etanercept to apremilast in the phase 3b LIBERATE trial.

Methods

Two hundred fifty patients were randomized to placebo, apremilast 30 mg BID or etanercept 50 mg QW through Week 16; thereafter, all patients continued or switched to apremilast through Week 104 (extension phase). Skin, scalp and nail involvement at Weeks 16, 52 and 104 were assessed using the Psoriasis Area and …

Bayesian Prediction Intervals For Assessing P-Value Variability In Prospective Replication Studies, Olga A. Vsevolozhskaya, Gabriel Ruiz, Dmitri Zaykin

Biostatistics Faculty Publications

Increased availability of data and accessibility of computational tools in recent years have created an unprecedented upsurge of scientific studies driven by statistical analysis. Limitations inherent to statistics impose constraints on the reliability of conclusions drawn from data, so misuse of statistical methods is a growing concern. Hypothesis and significance testing, and the accompanying P-values are being scrutinized as representing the most widely applied and abused practices. One line of critique is that P-values are inherently unfit to fulfill their ostensible role as measures of credibility for scientific hypotheses. It has also been suggested that while P-values …