Medical Specialties Commons^™

Evaluation Of Respiratory Function Using Blood Gas Parameters In Yucatan Minipigs Following Spinal Cord Injury, Jackson Gallagher, Monique Morgan, Chase Knibbe, Destiny Gibson, Maxwell Boakye

The Cardinal Edge

There are approximately 17,810 new spinal cord injuries (SCI) in the U.S. each year [1]. Physical damage to the spinal cord has the potential to interfere with normal motor, sensory, and/or autonomic function, such as impairment of the respiratory system. In fact, respiratory insufficiency is the number one cause of mortality and morbidity after SCI. The more rostral the injury, the more likely there will be disruption to normal ventilation (generally rostral to T6) [2]. To conduct relevant preclinical research, it has been shown that large animal models, such as the Yucatan minipig, have a better success rate of translating …

Racial Disparities In Diabetes Mellitus Prevalence In Prostate Cancer Patients On Androgen Deprivation Therapy, Sameh Gomaa, William Kelly, Do, Grace Lu-Yao, Phd, Edith Mitchell, Md, Tingting Zhan, Phd, Kuang-Yi Wen, Phd

Department of Medical Oncology Posters

Intro/Background

• Androgen deprivation therapy (ADT) is successfully used in patients with advanced prostate cancer.
• ADT has show to prolong survival.
• The use of ADT is associated with many side effects, most notably an increase in diabetes incidence for patients on ADT.
• African American men have higher prevalence and mortality rates from prostate cancer than White men.
• It is unclear how prostate cancer treatment such as ADT affects these disparities.
• This study examines racial differences in the prevalence of diabetes mellitus in prostate cancer patients based on their ADT status in the US.

Pathogenesis Of Tobacco-Associated Lung Adenocarcinoma Is Closely Coupled With Changes In The Gut And Lung Microbiomes, Casey T Finnicum, Zahraa Rahal, Maya Hassane, Warapen Treekitkarnmongkol, Ansam Sinjab, Rhiannon Morris, Yuejiang Liu, Elizabeth L Tang, Sarah Viet, Jason L Petersen, Philip L Lorenzi, Lin Tan, Joseph Petrosino, Kristi L Hoffman, Junya Fujimoto, Seyed Javad Moghaddam, Humam Kadara

Faculty, Staff and Students Publications

Microbial dysbiosis has emerged as a modulator of oncogenesis and response to therapy, particularly in lung cancer. Here, we investigate the evolution of the gut and lung microbiomes following exposure to a tobacco carcinogen. We performed 16S rRNA-Seq of fecal and lung samples collected prior to and at several timepoints following (nicotine-specific nitrosamine ketone/NNK) exposure in Gprc5a^−/− mice that were previously shown to exhibit accelerated lung adenocarcinoma (LUAD) development following NNK exposure. We found significant progressive changes in human-relevant gut and lung microbiome members (e.g., Odoribacter, Alistipes, Akkermansia, and Ruminococus) that are closely associated with …

Obstetric Complications And Wellbeing Among Us Surgical Residents, Ruojia Li, Joshua Eng, Darci C. Foote, Christine Wu, Julie Johnson, Sarah Easter, Karl Bilimoria, Yue-Yung Hu, Erika Rangel

Conference Presentation Abstracts

No abstract provided.

An International Working Group Consensus Report For The Prioritization Of Molecular Biomarkers For Ewing Sarcoma, David S Shulman, Sarah B Whittle, Didier Surdez, Kelly M Bailey, Enrique De Álava, Jason T Yustein, Adam Shlien, Masanori Hayashi, Alexander J R Bishop, Brian D Crompton, Steven G Dubois, Neerav Shukla, Patrick J Leavey, Stephen L Lessnick, Heinrich Kovar, Olivier Delattre, Thomas G P Grünewald, Cristina R Antonescu, Ryan D Roberts, Jeffrey A Toretsky, Franck Tirode, Richard Gorlick, Katherine A Janeway, Damon Reed, Elizabeth R Lawlor, Patrick J Grohar

Faculty, Staff and Students Publications

The advent of dose intensified interval compressed therapy has improved event-free survival for patients with localized Ewing sarcoma (EwS) to 78% at 5 years. However, nearly a quarter of patients with localized tumors and 60-80% of patients with metastatic tumors suffer relapse and die of disease. In addition, those who survive are often left with debilitating late effects. Clinical features aside from stage have proven inadequate to meaningfully classify patients for risk-stratified therapy. Therefore, there is a critical need to develop approaches to risk stratify patients with EwS based on molecular features. Over the past decade, new technology has enabled …

Pulmonary Hypertension With “Normal” Pulmonary Vascular Resistance, Marwan F. Jumean, Sriram Nathan, Maria Patarroyo Aponte

Journal of Shock and Hemodynamics

Abstracts not available for Perspectives.

Role Of Veno-Arterial Extracorporeal Membrane Oxygenation In Left Ventricular Conditioning After Lung Transplantation, Emily A. Ingebretson

Journal of Shock and Hemodynamics

End-stage pulmonary hypertension alters intracardiac pressures, leading to distention and failure of the right ventricle, leftward shifting of the intraventricular septum, and, thus, underfilling of the left ventricle (LV). Following the resolution of severely elevated pulmonary vascular resistance with bilateral lung transplantation, the LV is exposed to relatively high filling pressures from a potentially hypertrophic right ventricle pushing blood through normalized pulmonary vascular resistance. Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) may be a valuable tool to provide a more gradual exposure of the LV to the newly available preload in the immediate postoperative phase of transplantation, thereby reducing the likelihood …

Scai Shock Stage Classification: What Is Missing From The Latest Update?, Biykem Bozkurt

Journal of Shock and Hemodynamics

The revised Society for Cardiovascular Angiography and Interventions classifications reflect graduation of severity within each stage and pathway by which patients progress or recover. However, they are limited regarding the following: their predictive role to guide therapy; escalation of therapy or referral; variability in diagnostic criteria and interpretation; presence of other disease modifiers and confounders; variability of etiology and reversibility of cause; response to therapy and trajectory to be taken into risk stratification; magnitude and phenotypes of end-organ damage. Thus, we need a modified risk score to predict the necessity to escalate therapy and consider advanced therapies, such as mechanical …

Should All Shock Centers Offer Ecpr? Balancing Futility, Cost Effectiveness, And Hope, Michael Mooney

Journal of Shock and Hemodynamics

There are over 400,000 out-of-hospital cardiac arrests (OHCA) in the United States annually. Of those, 50% are refractory cardiac arrest, defined as the lack of return of spontaneous circulation (ROSC) after 30 minutes of appropriate cardiopulmonary resuscitation (CPR) in the absence of hypothermia. Extracorporeal cardiopulmonary resuscitation (ECPR) has been increasingly used given its potential to improve survival and offer improved neurological outcomes.

Systemic Inflammatory Response Syndrome And Mechanical Circulatory Support Devices, Mircea R. Mihu, Aly El-Banayosy

Journal of Shock and Hemodynamics

Systemic inflammatory response syndrome is an increased inflammatory state affecting the whole body. Mechanical circulatory support (MCS) is a temporary or permanent form of extracorporeal support that may have an associated complication of an exacerbated inflammatory response to the extracorporeal circuit. This brief review will focus on understanding the complex pathophysiology of inflammatory response to MCS, factors that influence the extent of the inflammatory response, the inflammatory response and outcomes as well as potential therapeutic strategies.

Role Of Hypothermia In Cardiogenic Shock, Filio Billia

Journal of Shock and Hemodynamics

While patient management in the intensive care unit has undoubtedly improved over the last 20 years, many questions remain. Neurological prognostication has become very important and aided in improving survival outcomes over time. The limited number of randomized control trials and limitations from currently completed studies leave the field with little certainty regarding targeted temperature management. In addition, implementing hypothermia can use multiple methods and protocols that impact the interpretation and comparison of results.

Management Of Severe Aortic Stenosis In Cardiogenic Shock: Early Percutaneous Mechanical Circulatory Support Or Emergent Transcatheter Aortic Valve Replacement?, Sandeep Nathan

Journal of Shock and Hemodynamics

Aortic stenosis (AS) affects an estimated 1.5 million patients in the United States, with 250,000 patients or more suffering severe, symptomatic aortic stenosis. A subset of these patients also have unrevascularized coronary artery disease and left ventricular dysfunction, representing an extreme risk population of AS patients. Cardiogenic shock (CS) complicates a small minority of AS presentations and/or patients referred for transcatheter aortic valve replacement (TAVR) but is responsible in these cases for a disproportionately high rate of morbidity and mortality. Indeed, CS results in a 4-fold increase in TAVR mortality, proportional to shock severity and largely independent of procedural complications. …

A Case Of Inferior Myocardial Infarction Complicated By Ventricular Septal Rupture Leading To Cardiogenic Shock: Tandem Heart To The Rescue!, Shehab Al-Ansari, Sachin Kumar, Angelo Nascimbene, Manish K. Patel, Igor D. Gregoric

Journal of Shock and Hemodynamics

Ventricular septal rupture (VSR) is a rare but life-threatening complication of acute myocardial infarction. We present a case of VSR-related refractory cardiogenic shock that was successfully managed with TandemHeart® followed by surgical repair.

Early Unloading In Venoarterial Extracorporeal Membrane Oxygenation Shock: When, How, Where, And Why?, Benedikt Schrage

Journal of Shock and Hemodynamics

As extracorporeal membrane oxygenation increases the left ventricular afterload, a successful treatment plan should include strategies to address this issue. One promising approach to do so is the addition of a second device for active left ventricular unloading. However, this relatively new approach is currently only based on retrospective data. This article summarizes the current perspectives on this approach, provides recommendations for its application, and highlights the need for randomized data on this topic.

Microcirculation Versus Macrocirculation In Cardiogenic Shock, Christian Jung

Journal of Shock and Hemodynamics

Macro- and microcirculation are important parameters in cardiogenic shock. Microcirculation is relevant for monitoring organ function and prognosis. Serum lactate might be the best daily life parameter to assess microcirculation, and the crude 8-hour value can be used for outcome prediction. Any treatment should consider the consequences of microcirculation and macrocirculation.

Hemodynamics Of Prolonged Percutaneous Mechanical Circulatory Support – When Vasodilatation Sets, Holger Thiele

Journal of Shock and Hemodynamics

Hemodynamics play an important role in cardiogenic shock assessment for prognosis estimation and for phenotyping cardiogenic shock. This is best done by pulmonary artery catheters. In general, at the beginning of cardiogenic shock, patients have vasoconstriction, which over time may lead to vasodilation. This is often triggered by percutaneous mechanical circulatory support. This review will elucidate the hemodynamics and the factors that possibly lead to vasodilation in patients with mechanical circulatory support.

Society For Improving Medical Professional Learning Collaborative: What’S It All About?, Joseph B. Zwischenberger, Katherine Breetz, Daniel Cooper

Journal of Shock and Hemodynamics

The Society for Improving Medical Professional Learning (SIMPL) Collaborative is a non-profit, educational, quality improvement consortium focused on developing tools, curricula, and policies to improve physician training. The goal is to provide educators and learners with convenient, reliable, and valid evaluation tools for frequent, real-time workplace assessment and feedback. The SIMPL Operating Room application provides this platform. It was developed to provide high-quality, time-sensitive, procedural feedback. Its objective is to facilitate intra-rotation corrections.

SIMPL is available to all residency programs and has matured to include over 175 residency programs, involving 19 different specialties, 4000 trainees, 5000 attendings, and 354,800 evaluations …

Houston Shock: A Practical Scoring System Incorporating Cardiogenic Shock Dynamic Changes, Marwan F. Jumean, Sriram Nathan, Igor D. Gregoric, Biswajit Kar

Journal of Shock and Hemodynamics

Cardiogenic shock has an unacceptably high mortality rate and additional tools are needed to improve outcomes. The Society of Cardiovascular Angiography and Interventions (SCAI) shock severity classification has provided a unified definition of shock severity that has proven to be reproducible and predictive of survival. However, cardiogenic shock assessment goes beyond standardizing its severity, and a uniform and practical approach to comprehensive assessment that may guide therapy in a dynamic state is currently lacking.

Since cardiogenic shock is a rapidly evolving pathophysiological catastrophe, we propose a new assessment tool – the Houston SHOCK Score – which incorporates dynamic changes. The …

An Integrative Review Of Clinical Outcome Assessments Used To Measure Carryover Effects Of Exoskeletons And Functional Electrical Stimulation In Spinal Cord Injury, Martha K. Childress, Olivia M. Biller, Nicole Gerhardt, Ms, Otr/L, Cbis, Namrata Grampurohit, Phd, Otr/L, Rachel Y. Kim, Otd, Otr/L, Mj Mulcahey, Phd, Otr/L

Department of Occupational Therapy Posters and Presentations

Introduction

• Functional electrical stimulation (FES) and exoskeletons are rehabilitation technologies that provide direct functional ability and potential carryover effects
• Carryover effects may be due to neuromuscular recovery, behavioral compensation, or a combination of both (Figure 1)
• Clinical outcome assessments (COAs) are used to measure recovery of function with and without the device on

Clinical Profile, Diagnostic Yield, And Procedural Outcomes Of Single Balloon Enteroscopy: A Tertiary Care Hospital Experience, Maha Inam, Masood Muhammad Karim, Umar Tariq, Faisal Wasim Ismail

Medical College Documents

Background: Single balloon enteroscopy (SBE) allows ease of access for small bowel visualization and has multiple diagnostic and therapeutic indications. It provides the advantage of performing various therapeutic interventions alongside the diagnostic procedure. SBE has also been considered a relatively safe procedure with no major complications.
Aim: To investigate the indications, safety, and clinical yield of SBE, and determine its effect on disease outcome.
Methods: A retrospective, descriptive study was conducted at a tertiary care hospital in Karachi, Pakistan. Medical records of 56 adult patients (≥ 18 years) who underwent SBE between July 2013 and December 2021 were reviewed and …

An Epi-Metabolomics Approach For Studying Epigenetic And Metabolic Changes In Alzheimer’S Disease Brain, Nadia Ashrafi, Sangeetha Vishweswaraiah, Ali Yilmaz, Sumeyya Akyol, Juozas Gordevicius, Stewart Graham

Conference Presentation Abstracts

No abstract provided.

Mild And Severe Traumatic Brain Injury Longitudinally Profiled Using High-Resolution Metabolomics, Ali Yilmaz, Sigal Liraz Zaltsman, Esther Shohami, Juozas Gordevicius, Jack E. Sherman, Ray Bahado-Singh, Stewart F. Graham

Conference Presentation Abstracts

No abstract provided.

A Small Molecule Antagonist Of Smn Disrupts The Interaction Between Smn And Rnap Ii, Yanli Liu, Aman Iqbal, Weiguo Li, Zuyao Ni, Yalong Wang, Jurupula Ramprasad, Karan Joshua Abraham, Mengmeng Zhang, Dorothy Yanling Zhao, Su Qin, Peter Loppnau, Honglv Jiang, Xinghua Guo, Peter J Brown, Xuechu Zhen, Guoqiang Xu, Karim Mekhail, Xingyue Ji, Mark T Bedford, Jack F Greenblatt, Jinrong Min

Faculty, Staff and Student Publications

Survival of motor neuron (SMN) functions in diverse biological pathways via recognition of symmetric dimethylarginine (Rme2s) on proteins by its Tudor domain, and deficiency of SMN leads to spinal muscular atrophy. Here we report a potent and selective antagonist with a 4-iminopyridine scaffold targeting the Tudor domain of SMN. Our structural and mutagenesis studies indicate that both the aromatic ring and imino groups of compound 1 contribute to its selective binding to SMN. Various on-target engagement assays support that compound 1 specifically recognizes SMN in a cellular context and prevents the interaction of SMN with the R1810me2s of RNA polymerase …

Association Between Abnormal Lipid Profile And Inflammation And Progression Of Myelodysplastic Syndrome To Acute Leukemia, Wei Qiao, Elliana Young, Chun Feng, Suyu Liu, Jeff Jin, Laila Noor, Cristhiam M Rojas Hernandez, Gautam Borthakur, Olga Gorlova, Vahid Afshar-Kharghan

Faculty, Staff and Student Publications

Clonal hematopoiesis of indeterminate potential (CHIP) is associated with a small risk of developing hematologic malignancies and a higher risk of cardiovascular diseases (CVD). We asked whether the reverse correlation exists and cardiometabolic risk factors have an impact on the progression of myelodysplastic syndrome (MDS) to acute myeloid leukemia (AML). We investigated the association between abnormal lipid profiles and inflammation in MDS, which shares many genetic mutations with CHIP, and the risk of developing acute leukemia. We examined the medical records of 11071 MDS patients. Among them, 5422 had at least one lipid profile or C-reactive protein (CRP) measurement. In …

Epigenetic Dysregulations In Arsenic-Induced Carcinogenesis, Ranakul Islam, Lei Zhao, Yifang Wang, Grace Lu-Yao, Ling-Zhi Liu

Department of Medical Oncology Faculty Papers

Arsenic is a crucial environmental metalloid whose high toxicity levels negatively impact human health. It poses significant health concerns to millions of people in developed and developing countries such as the USA, Canada, Bangladesh, India, China, and Mexico by enhancing sensitivity to various types of diseases, including cancers. However, how arsenic causes changes in gene expression that results in heinous conditions remains elusive. One of the proposed essential mechanisms that still has seen limited research with regard to causing disease upon arsenic exposure is the dysregulation of epigenetic components. In this review, we have extensively summarized current discoveries in arsenic-induced …

Fibrodysplasia Ossificans Progressiva And Pregnancy: A Case Series And Review Of The Literature, Alexandra D Forrest, Danielle M Vuncannon, Jane E Ellis, Zvi Grunwald, Frederick S Kaplan

Department of Anesthesiology Faculty Papers

Objective: To evaluate maternal and fetal outcomes in pregnant patients with fibrodysplasia ossificans progressiva (FOP; OMIM#135100), an ultrarare genetic disorder characterized by progressive heterotopic ossification of soft tissues and cumulative disability.

Methods: This is a retrospective case series of three patients with FOP who were admitted to Grady Memorial Hospital in Atlanta, Georgia, from to February 2011 to July 2021.

Results: Three women delivered preterm infants at our institution. These cases posed unique anesthetic and obstetric technical challenges, particularly when securing the airway and performing cesarean delivery. Importantly, each patient received perioperative glucocorticoids for prevention of further heterotopic ossification.

Conclusion: …

Overcoming The Cardiac Toxicities Of Cancer Therapy Immune Checkpoint Inhibitors, Omoruyi Credit Irabor, Nicolas Nelson, Yash Shah, Muneeb Khan Niazi, Spencer Poiset, Eugene Storozynsky, Dinender K Singla, D. Craig Hooper, Bo Lu

Division of Cardiology Faculty Papers

Immune checkpoint inhibitors (ICIs) have led recent advances in the field of cancer immunotherapy improving overall survival in multiple malignancies with abysmal prognoses prior to their introduction. The remarkable efficacy of ICIs is however limited by their potential for systemic and organ specific immune-related adverse events (irAEs), most of which present with mild to moderate symptoms that can resolve spontaneously, with discontinuation of therapy or glucocorticoid therapy. Cardiac irAEs however are potentially fatal. The understanding of autoimmune cardiotoxicity remains limited due to its rareness. In this paper, we provide an updated review of the literature on the pathologic mechanisms, diagnosis, …

Mri-Based Digital Models Forecast Patient-Specific Treatment Responses To Neoadjuvant Chemotherapy In Triple-Negative Breast Cancer, Chengyue Wu, Angela M Jarrett, Zijian Zhou, Nabil Elshafeey, Beatriz E Adrada, Rosalind P Candelaria, Rania M M Mohamed, Medine Boge, Lei Huo, Jason B White, Debu Tripathy, Vicente Valero, Jennifer K Litton, Clinton Yam, Jong Bum Son, Jingfei Ma, Gaiane M Rauch, Thomas E Yankeelov

Faculty, Staff and Student Publications

Triple-negative breast cancer (TNBC) is persistently refractory to therapy, and methods to improve targeting and evaluation of responses to therapy in this disease are needed. Here, we integrate quantitative MRI data with biologically based mathematical modeling to accurately predict the response of TNBC to neoadjuvant systemic therapy (NAST) on an individual basis. Specifically, 56 patients with TNBC enrolled in the ARTEMIS trial (NCT02276443) underwent standard-of-care doxorubicin/cyclophosphamide (A/C) and then paclitaxel for NAST, where dynamic contrast-enhanced MRI and diffusion-weighted MRI were acquired before treatment and after two and four cycles of A/C. A biologically based model was established to …

Protocol For Establishing A Protein-Protein Interaction Network Using Tandem Affinity Purification Followed By Mass Spectrometry In Mammalian Cells, Weixiang Bian, Hua Jiang, Shan Feng, Junjie Chen, Wenqi Wang, Xu Li

Faculty, Staff and Student Publications

Identification of protein interactors is fundamental to understanding their functions. Here, we describe a modified protocol for tandem affinity purification coupled with mass spectrometry (TAP/MS), which includes two-step purification. We detail the S-, 2×FLAG-, and Streptavidin-Binding Peptide (SBP)- tandem tags (SFB-tag) system for protein purification. This protocol can be used to identify protein interactors and establish a high-confidence protein-protein interaction network based on computational models. This is particularly useful for identifying

Serologic Versus Molecular Testing For Screening For Hepatitis C Virus Infection In Patients With Hematologic Malignancies, Harrys A Torres, Georgios Angelidakis, Ying Jiang, Minas Economides, Khalis Mustafayev, Marcel Yibirin, Robert Orlowski, Richard Champlin, Srdan Verstovsek, Issam Raad

Faculty, Staff and Student Publications

Testing for antibody against hepatitis C virus (anti-HCV) is a low-cost diagnostic method worldwide; however, an optimal screening test for HCV in patients with cancer has not been established. We sought to identify an appropriate screening test for HCV infection in patients with hematologic malignancies and/or hematopoietic cell transplants (HCT). Patients in our center were simultaneously screened using serological (anti-HCV) and molecular (HCV RNA) assays (February 2019-November 2019). In total, 214 patients were enrolled in this study. Three patients (1.4%) were positive for anti-HCV, and 2 (0.9%) were positive for HCV RNA. The overall percentage agreement was 99.5% (95% CI: …