Medical Specialties Commons^™

Neurocognitive Dysfunction With Neuronal Injury In People With Hiv On Long-Duration Antiretroviral Therapy, Cynthia Mcmahan, Devon K Dietrich, Elizabeth F Horne, Erin Kelly, Katrina Geannopoulos, Peter Selim Siyahhan Julnes, Lillian Ham, Ulisses Santamaria, Chuen-Yen Lau, Tianxia Wu, Hsing-Chuan Hsieh, Anuradha Ganesan, Catherine Berjohn, Suad Kapetanovic, Daniel S Reich, Govind Nair, Joseph Snow, Brian K Agan, Avindra Nath, Bryan R Smith

Staff and Researcher Publications

Background and objectives: Neurologic outcomes in people with HIV (PWH) on long-duration antiretroviral therapy (ART) are not fully understood, and the underlying pathophysiology is unclear. To address this, we established a cohort of such individuals and compared them with HIV-negative controls using a novel matching technique. Both groups underwent extensive cognitive testing, evaluation for psychiatric measures, and MRI and CSF analyses.

Methods: Participants underwent comprehensive neuropsychological testing and completed standardized questionnaires measuring depressive symptoms, perceptions of own functioning, and activities of daily living as part of an observational study. Brain MRI and lumbar puncture were optional. Coarsened Exact Matching was …

Ngr1 Binding To Reovirus Reveals An Unusual Bivalent Interaction And A New Viral Attachment Protein, Danica M Sutherland, Michael Strebl, Melanie Koehler, Olivia L Welsh, Xinzhe Yu, Liya Hu, Rita Dos Santos Natividade, Jonathan J Knowlton, Gwen M Taylor, Rodolfo A Moreno, Patrick Wörz, Zachery R Lonergan, Pavithra Aravamudhan, Camila Guzman-Cardozo, Sukhleen Kour, Udai Bhan Pandey, David Alsteens, Zhao Wang, B V Venkataram Prasad, Thilo Stehle, Terence S Dermody

Faculty, Staff and Students Publications

Nogo-66 receptor 1 (NgR1) binds a variety of structurally dissimilar ligands in the adult central nervous system to inhibit axon extension. Disruption of ligand binding to NgR1 and subsequent signaling can improve neuron outgrowth, making NgR1 an important therapeutic target for diverse neurological conditions such as spinal crush injuries and Alzheimer's disease. Human NgR1 serves as a receptor for mammalian orthoreovirus (reovirus), but the mechanism of virus-receptor engagement is unknown. To elucidate how NgR1 mediates cell binding and entry of reovirus, we defined the affinity of interaction between virus and receptor, determined the structure of the virus-receptor complex, and identified …

Impact Of Adrenomedullin On Mitochondrial Respiratory Capacity In Human Adipocyte, Yuanlin Dong, Vidyadharan Alukkal Vipin, Chellakkan Selvanesan Blesson, Chandrasekhar Yallampalli

Faculty, Staff and Students Publications

Mitochondrial function in adipocyte is an important aspect in maintaining metabolic homeostasis. Our previous observation showed that circulating levels of adrenomedullin (ADM) and mRNA and protein for ADM in omental adipose tissue were higher in patients with gestational diabetes mellitus (GDM), and these alterations are accompanied by glucose and lipid metabolic dysregulation, but the impact of ADM on mitochondrial biogenesis and respiration in human adipocyte remain elusive. The present study demonstrated that: (1) Increasing doses of glucose and ADM inhibit human adipocyte mRNA expressions of mitochondrial DNA (mtDNA)-encoded subunits of electron transport chain, including nicotinamide adenine dinucleotide dehydrogenase (ND) 1 …

June 2023: Region 10 Emerging Special Pathogen Treatment Center (Resptc) At Providence Sacred Heart Medical Center & Children’S Hospital, Providence - Special Pathogens Program

Special Pathogens Newsletters

REGION 10 SPECIAL PATHOGENS NEWSLETTER

Development Of A Biomarker Panel For Assessing Cardiovascular Risk In Diabetic Patients With Chronic Limb-Threatening Ischemia (Clti): A Prospective Study, Elisabetta Nardella, Federico Biscetti, Maria Margherita Rando, Andrea Leonardo Cecchini, Maria Anna Nicolazzi, Enrica Rossini, Flavia Angelini, Roberto Iezzi, Luis H. Eraso, Paul J. Dimuzio, Dario Pitocco, Massimo Massetti, Antonio Gasbarrini, Andrea Flex

Department of Medicine Faculty Papers

BACKGROUND: Lower-extremity endovascular revascularization (LER) is often required for diabetic patients with chronic limb threatening ischemia (CLTI). During the post-revascularization period patients may unpredictably experience major adverse cardiac events (MACE) and major adverse limb events (MALE). Several families of cytokines are involved in the inflammatory process that underlies the progression of atherosclerosis. According to current evidence, we have identified a panel of possible biomarkers related with the risk of developing MACE and MALE after LER. The aim was to study the relationship between a panel of biomarkers - Interleukin-1 (IL-1) and 6 (IL-6), C-Reactive Protein (CRP), Tumor Necrosis Factor-α (TNF-α), …

Front Matter, Arianna Medina

Western Journal of Orthopaedics

No abstract provided.

Back Matter, Arianna Medina

Western Journal of Orthopaedics

No abstract provided.

Principles Of Arthroscopic - Assisted Open Reduction Internal Fixation In The Management Of Displaced Articular Fractures, Nathan Sherman, Matthew Miller, Michael D. Feldman

Western Journal of Orthopaedics

The primary objective of fracture fixation is to obtain anatomic reduction with stable fixation while minimizing damage to the surrounding structures. Displaced articular fractures represent a surgical challenge, but anatomic alignment with restoration of the articular surface is the gold standard of management. Using open techniques, intra-articular visualization can require large dissections and added soft-tissue insult. However, arthroscopic-assisted open reduction internal fixation (AAORIF) may represent a less invasive means of articular fracture management in appropriate patients with select fractures. The general principles of AAORIF are modified from basic arthroscopic principles, including positioning, portal placement, fluid management, visualization, soft-tissue management, and …

Let’S Focus On The Fibrosis: Targeting Ccn2 In Dupuytren’S Disease, Alex G. Lambi, Ryan Dahlberg, Tomas Holy, Joseph T. Tarr, Deana Mercer, Steven N. Popoff, Mary F. Barbe

Western Journal of Orthopaedics

Dupuytren’s disease is a progressive, benign fibroproliferative disorder of the hands that can lead to debilitating hand contractures. Once symptomatic, treatment involves either surgical intervention, specifically fasciectomy or percutaneous needle aponeurotomy, or enzymatic degradation with clostridial collagenase. Currently, collagenase is the only pharmacotherapy that has been approved for the treatment of Dupuytren’s contracture. There is a need for a pharmacotherapeutic that can be administered to limit disease progression and prevent recurrence after treatment. Targeting the underlying fibrotic pathophysiology is critical. The authors propose a novel target to be considered in Dupuytren’s disease – cell communication network factor 2/connective tissue growth …

Complex Lisfranc Injury In A Professional Bull Rider, Elizabeth Eichman, Stephan Sierra, Matthew Ferguson

Western Journal of Orthopaedics

American bull riding is one of the most dangerous sports in the world, with a high prevalence of injury. Due to the high-velocity trauma that is common in this sport, injuries occur frequently and are often classified as severe despite the use of protective equipment. While Lisfranc fracture-dislocations are somewhat common in elite athletes, open Lisfranc fractures are much less common. Consequently, there are little data concerning recovery and return to sport. This case demonstrates an uncommon presentation of open Lisfranc fracture dislocation and first metatarsophalangeal dislocation in a professional bull rider who was able to return to sport at …

Terrible Triad In A Pediatric Patient: A Case Report, Colin J. Carroll, Gonzalo Sumarriva, Russell Parks, Caroline Vasco, Ross Dunbar

Western Journal of Orthopaedics

A terrible triad elbow injury consists of an elbow dislocation with associated radial head and coronoid fractures. This type of injury is rare in the pediatric population. In this case, a 14-year-old adolescent male suffered a right-sided terrible triad elbow injury after falling onto his right elbow. He was taken to the operating room for open reduction and internal fixation. The patient is now three years postoperatively with full range of motion of his elbow with no pain and no incidents of dislocation.

Diversifying The Field: Reflflections Of Female Orthopaedic Residents, Kate M. Parker, Audrey C. Wassef

Western Journal of Orthopaedics

No abstract provided.

Water-Tight Arthrotomy Joint Closure Of Modified Intervastus Approach In Total Knee Arthroplasty, Muthana M. Sartawi, James M. Kohlmann, Karam R. Abdelsamie, Hafizur Rahman

School of Podiatric Medicine Publications

Background: The joint closure technique used for total knee arthroplasty cases can have an impact on outcomes, especially when considering accelerated rehabilitation programs that follow surgery. In this study, we describe the details of the technical steps involved in performing the water-tight arthrotomy joint closure technique that we developed and use. Methods: A total of 536 patients (average age: 62 years, average body mass index: 34 kg/m2) with primary osteoarthritis of the knee underwent total knee arthroplasty using the modified intervastus approach between 2019 and 2021. We used the water-tight arthrotomy joint closure technique to close the knee arthrotomy incision. …

Perioperative Nutritional Considerations In Orthopaedic Surgery: A Review Of The Literature, William Curtis, Timothy Choi, Aamir Ahmad, Christopher Shultz

Western Journal of Orthopaedics

Macronutrients and micronutrients play an essential role in the surgical process, beginning in preoperative preparation and extending well into postoperative recovery. It is important that orthopaedic surgeons and their patients understand the physiological impact of the surgical stress response and the ways in which adequate perioperative nutrition can help combat its negative effects. Throughout this article, the authors discuss the important roles of macronutrients, such as carbohydrates, protein, and fatty acids, and that of micronutrients, including zinc and vitamins C, D, A, and E, in the perioperative period. The authors aim to explain the physiological effects of surgery on nutrition …

Treatment Of An Unusual Infection Following Anterior Cruciate Ligament Reconstruction, Daniel Warren, David Michaeli, Benjamin Estrada, James Slauterbeck

Western Journal of Orthopaedics

The authors present an uncommon complication of pediatric anterior cruciate ligament (ACL) reconstruction involving a rare organism in the setting of multiple patient-specific factors that altered treatment. Management of postoperative mycobacterial infections requires thorough knowledge of the side effects of each medication used. Prolonged use of a fluoroquinolone in the setting of ACL reconstruction graft healing introduces the risk of injury to the graft, and tactful patient counseling must be employed to help diminish this risk. The potential for ototoxicity secondary to extended aminoglycoside use is especially worrisome and should be monitored. This plan required careful balancing of several important …

Pelvic Ring Injury Secondary To Traumatic Vaginal Delivery: A Case For Early Surgical Fixation, Tyler J. Chavez, Taylor P. Gurnea, Hernan Lebensohn, Johnathan P. Jensen, Samer Kakish

Western Journal of Orthopaedics

During the gestational period, the body undergoes a normal physiologic widening of the pubic symphysis in preparation for childbirth. Although exceedingly rare, despite increased laxity, the pelvic ring remains at risk of serious injury during delivery. The current body of literature on this topic includes only a few case reports without clear guidance on the acute management of non-physiologic pubic symphysis widening and pelvic ring injuries following childbirth. The authors present a case of a 31-year-old pregnant woman (G2P0101) who sustained an APC2 (OTA B2.3) pelvic ring injury during vaginal delivery requiring open reduction and internal fixation for failure to …

Reconstruction Of Charcot Foot Deformity Using Circular External Fixators And Fusion: A Case Report, M Bryant Transtrum, Allen Wang, Diego Sanchez, Joshua Tadlock, Ahmed Thabet, Amr Abdelgawad

Western Journal of Orthopaedics

Charcot neuroarthropathy is a complication of the joints in patients with peripheral neuropathy, characterized by massive hyperemia, bone resorption, and joint destruction. The complex deformities that can result may lead to subsequent ulcers, osteomyelitis, and eventually limb amputation. Concurrent soft-tissue pathologies, such as ulcers and infections, complicate operative management. Thus, deformity correction may be necessary for wound healing before final fixation. In this case report, the authors describe a 48-year-old man who presented with a severe Charcot deformity of the foot and accompanying non-healing diabetic foot ulcer overlying the talar head. The authors elected to proceed with staged reconstruction, starting …

Differences In Ct Scan Measurements Of Femoral Neck Shaft Angle And Acetabular Version Among Sex, Age, And Ethnicity From A Large Cadaveric Database, Bryce N. Clinger, Scott Plaster, River S. Fine, Justin R. Marshall, Dustin L. Richter

Western Journal of Orthopaedics

Background: Management of proximal femur and acetabular pathologies, such as femoroacetabular impingement, hip osteoarthritis, or hip fractures, requires an understanding of the patient’s anatomy for accurate diagnosis and treatment. Variability in femoral neckshaft angle (FNA) and acetabular version (AV) has been shown, but little insight into differences between ages, ethnicities, and sexes has been evaluated. Methods: Two hundred and fifty cadaveric specimens from the New Mexico Decedent Image Database were evenly divided by sex and among five ethnic groups (Asian American, Black/African American, Hispanic, Native American, White). Using multiplanar reconstruction, thincut computed tomography scans were reviewed by three independent observers. …

The Orthopaedist’S Role In Preventing Workplace Violence, Nicholas W. Brady, Andrew Paterson

Western Journal of Orthopaedics

No abstract provided.

Imposter Syndrome, Or Not?, Allicia O. Imada

Western Journal of Orthopaedics

No abstract provided.

A Novel Endoscopic Ultrasound-Guided Transluminal Anchor Device, Abhishek Agnihotri, Alexander Schlachterman

Division of Gastroenterology and Hepatology Faculty Papers

No abstract provided.

The Impact Of Covid-19 On Hospitalization Outcomes Of Patients With Acute Myocardial Infarction In The Usa, F.E. Markson, E. Akuna, C.Y. Lim, L. Khemani, A, Amanullah

Einstein Health Papers

Background/study objective: The effect of the COVID-19 pandemic affected health care delivery, as it led to variable outcomes in different disease states including cardiovascular diseases. In this study, we evaluated the impact of coexisting COVID-19 on Acute Myocardial Infarction (AMI). Design/setting: We analyzed discharge records of AMI patients from the National Inpatient Sample (NIS) in the year 2020.

Main outcome measures: Using propensity score matching, we assessed the impact of COVID-19 infection on the in-hospital outcomes of patients presenting with AMI.

Results: There were 1154 patients with concomitant COVID-19 infection and AMI who were matched with 109,990 patients with AMI …

Geriatric Trauma Triage - The Scope Of The Problem, Mya Cubitt, Rachel Key

Journal of Geriatric Emergency Medicine

n/a

Sio-Asco Guideline On Integrative Medicine For Cancer Pain Management: Implications For Racial And Ethnic Pain Disparities, Kevin T. Liou, Rebecca Ashare, Brooke Worster, Katie F. Jones, Katherine A. Yeager, Amanda M. Acevedo, Rebecca Ferrer, Salimah H. Meghani

Department of Medical Oncology Faculty Papers

Racial and ethnic disparities in pain management pose major challenges to equitable cancer care delivery. These disparities are driven by complex interactions between patient-, provider-, and system-related factors that resist reductionistic solutions and require innovative, holistic approaches. On September 19, 2022, the Society for Integrative Oncology and the American Society of Clinical Oncology published a joint guideline to provide evidence-based recommendations on integrative medicine for cancer pain management. Integrative medicine, which combines conventional treatments with complementary modalities from cultures and traditions around the world, are uniquely equipped to resonate with diverse cancer populations and fill existing gaps in pain management. …

Single Cell Clonotypic And Transcriptional Evolution Of Multiple Myeloma Precursor Disease, Minghao Dang, Ruiping Wang, Hans C Lee, Krina K Patel, Melody R Becnel, Guangchun Han, Sheeba K Thomas, Dapeng Hao, Yanshuo Chu, Donna M Weber, Pei Lin, Zuzana Lutter-Berka, David A Berrios Nolasco, Mei Huang, Hima Bansal, Xingzhi Song, Jianhua Zhang, Andrew Futreal, Luz Yurany Moreno Rueda, David E Symer, Michael R Green, Cristhiam M Rojas Hernandez, Michael Kroll, Vahid Afshar-Khargan, Libere J Ndacayisaba, Peter Kuhn, Sattva S Neelapu, Robert Z Orlowski, Linghua Wang, Elisabet E Manasanch

Faculty, Staff and Student Publications

Multiple myeloma remains an incurable disease, and the cellular and molecular evolution from precursor conditions, including monoclonal gammopathy of undetermined significance and smoldering multiple myeloma, is incompletely understood. Here, we combine single-cell RNA and B cell receptor sequencing from fifty-two patients with myeloma precursors in comparison with myeloma and normal donors. Our comprehensive analysis reveals early genomic drivers of malignant transformation, distinct transcriptional features, and divergent clonal expansion in hyperdiploid versus non-hyperdiploid samples. Additionally, we observe intra-patient heterogeneity with potential therapeutic implications and identify distinct patterns of evolution from myeloma precursor disease to myeloma. We also demonstrate distinctive characteristics of …

Leveraging Mid-Infrared Spectroscopic Imaging And Deep Learning For Tissue Subtype Classification In Ovarian Cancer, Chalapathi Charan Gajjela, Matthew Brun, Rupali Mankar, Sara Corvigno, Noah Kennedy, Yanping Zhong, Jinsong Liu, Anil K Sood, David Mayerich, Sebastian Berisha, Rohith Reddy

Faculty, Staff and Student Publications

Mid-infrared spectroscopic imaging (MIRSI) is an emerging class of label-free techniques being leveraged for digital histopathology. Modern histopathologic identification of ovarian cancer involves tissue staining followed by morphological pattern recognition. This process is time-consuming and subjective and requires extensive expertise. This paper presents the first label-free, quantitative, and automated histological recognition of ovarian tissue subtypes using a new MIRSI technique. This optical photothermal infrared (O-PTIR) imaging technique provides a 10× enhancement in spatial resolution relative to prior instruments. It enables sub-cellular spectroscopic investigation of tissue at biochemically important fingerprint wavelengths. We demonstrate that the enhanced resolution of sub-cellular features, combined …

Clinical Significance And Biology Of Circulating Tumor Dna In High-Risk Early-Stage Her2-Negative Breast Cancer Receiving Neoadjuvant Chemotherapy, Mark Jesus M Magbanua, Lamorna Brown Swigart, Ziad Ahmed, Rosalyn W Sayaman, Derrick Renner, Ekaterina Kalashnikova, Gillian L Hirst, Christina Yau, Denise M Wolf, Wen Li, Amy L Delson, Smita Asare, Minetta C Liu, Kathy Albain, A Jo Chien, Andres Forero-Torres, Claudine Isaacs, Rita Nanda, Debu Tripathy, Angel Rodriguez, Himanshu Sethi, Alexey Aleshin, Matthew Rabinowitz, Jane Perlmutter, W Fraser Symmans, Douglas Yee, Nola M Hylton, Laura J Esserman, Angela M Demichele, Hope S Rugo, Laura J Van 'T Veer

Faculty, Staff and Student Publications

Circulating tumor DNA (ctDNA) analysis may improve early-stage breast cancer treatment via non-invasive tumor burden assessment. To investigate subtype-specific differences in the clinical significance and biology of ctDNA shedding, we perform serial personalized ctDNA analysis in hormone receptor (HR)-positive/HER2-negative breast cancer and triple-negative breast cancer (TNBC) patients receiving neoadjuvant chemotherapy (NAC) in the I-SPY2 trial. ctDNA positivity rates before, during, and after NAC are higher in TNBC than in HR-positive/HER2-negative breast cancer patients. Early clearance of ctDNA 3 weeks after treatment initiation predicts a favorable response to NAC in TNBC only. Whereas ctDNA positivity associates with reduced distant recurrence-free survival …

Reducing The Environmental Impact Of Surgery On A Global Scale: Systematic Review And Co-Prioritization With Healthcare Workers In 132 Countries, National Institute For Health And Care Research Global Health Research Unit On Global Surgery

Faculty, Staff and Student Publications

BACKGROUND: Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres.

METHODS: This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their …

Patiromer Utility As An Adjunct Treatment In Patients Needing Urgent Hyperkalaemia Management (Platinum): Design Of A Multicentre, Randomised, Double-Blind, Placebo-Controlled, Parallel-Group Study, Zubaid Rafique, Jeffrey Budden, Carol Moreno Quinn, Youyou Duanmu, Basmah Safdar, Jason J Bischof, Brian E Driver, Charles A Herzog, Matthew R Weir, Adam J Singer, Stephen Boone, Karina M Soto-Ruiz, W Frank Peacock

Faculty, Staff and Students Publications

INTRODUCTION: Hyperkalaemia is common, life-threatening and often requires emergency department (ED) management; however, no standardised ED treatment protocol exists. Common treatments transiently reducing serum potassium (K

METHODS AND ANALYSIS: PLATINUM is a Phase 4, multicentre, randomised, double-blind, placebo-controlled study in participants who present to the ED at approximately 30 US sites. Approximately 300 adult participants with hyperkalaemia (K

ETHICS AND DISSEMINATION: A central Institutional Review Board (IRB) and Ethics Committee provided protocol approval (#20201569), with subsequent approval by local IRBs at each site, and participants will provide written consent. Primary results will be published in peer-reviewed manuscripts promptly following study …

Diet Quality Among Pre-Adolescent African American Girls In A Randomized Controlled Obesity Prevention Intervention Trial, Debbe Thompson, Yiming Mirabile, Noemi Islam, Chishinga Callender, Salma M A Musaad, Julie Miranda, Jennette P Moreno, Jayna M Dave, Tom Baranowski

Faculty, Staff and Students Publications

Consuming an unhealthy diet increases health risks. This study assessed the impact of a culturally adapted behaviorally innovative obesity prevention intervention (The Butterfly Girls and the Quest for Founder’s Rock) on diet quality in pre-adolescent non-Hispanic Black/African American girls. The RCT consisted of three groups (experimental, comparison, and waitlist control); block randomization allocated participants to each group. The two treatment groups varied in terms of whether or not they set goals. Data were collected at baseline (prior to receiving the intervention), post 1 (3 months post-baseline), and post 2 (6 months post-baseline). Two dietitian-assisted 24 h dietary recalls …