Anesthesiology Commons^™

Chronic In Utero Oxycodone Exposure Alters Placental Small Ev Proteome And Fetal Cardiomyopathy-Linked Pathways, Amin Foroughi Nezhad, Dalia Moore, Victoria L. Schaal, Tousif Ahmed Hediyal, Elizabeth Stone, Sree Kolli, Pranavi Athota, Omar Shukri, Sowmya V. Yelamanchili, Gurudutt Pendyala

Journal Articles: Anesthesiology

Aim: The rising prevalence of opioid use during pregnancy poses serious public health concerns. The placenta is a critical organ during gestation, and opioid exposure can disrupt its function and fetal development. However, the molecular mechanisms through which opioids such as oxycodone affect feto-placental development remain poorly understood. This study aimed to investigate the effects of chronic in-utero oxycodone exposure on the composition and signaling functions of placenta-derived small extracellular vesicles (PSEVs) using a rat model.

Methods: Extracellular vesicles (EVs) were isolated from placental tissue and characterized through nanoparticle tracking analysis, transmission electron microscopy, western blotting, and label-free quantitative proteomics. …

Compensatory Responses To Glaucoma Pathology In The Dorsolateral Geniculate Nucleus, Shaylah Mccool, Arnav Jain, Jennie C. Smith, Victoria L. Schaal, Gurudutt Pendyala, Sowmya V. Yelamanchili, Matthew J. Van Hook

Journal Articles: Anesthesiology

Glaucoma disrupts the conveyance of retinal signals to visual regions of the brain such as the dorsolateral geniculate nucleus (dLGN) due to degeneration of retinal ganglion cells (RGCs) and their axons. Although plasticity during development allows altered visual experience to modulate dLGN synapses and excitability, evidence for experience-dependent dLGN plasticity in adults is limited. However, glaucoma might trigger compensatory plasticity in adult dLGN, thereby compensating for diminished RGC synaptic drive. Here, we tested this theory using aged DBA/2J mice, which develop high intraocular pressure and glaucoma. In brain slice recordings, we found that diminished RGC inputs could drive robust action …

Analgesic Safety And Efficacy Of Intrathecal Morphine In Elective Posterior Lumbar Fusion: A Systematic Review With Meta-Analyses, Luke J. Weisbrod, Jordan M. Rasmussen, Cindy Schmidt, Daniel L. Surdell

Graduate Medical Education Research Journal

Background. We evaluated perioperative intrathecal morphine (ITM) compared with placebo or standard postoperative pain strategies in adults undergoing elective posterior lumbar fusion.

Methods. A systematic search of EMBASE, MEDLINE, the Cochrane Library, and Google Scholar (December 12, 2023) identified studies involving ITM in posterior lumbar fusion. Eligible patients were ≥18 years. Two reviewers extracted outcomes and assessed non-randomized studies with the Newcastle- Ottawa scale. Odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI) were calculated using fixed- and random-effects models.

Results. Eleven studies met the inclusion criteria. ITM significantly lowered opioid requirements within 24 hours (MD -0.72, …

A Comprehensive Review On Utilizing Human Brain Organoids To Study Neuroinflammation In Neurological Disorders, Adrian Domene Rubio, Luke Hamilton, Mark Bausch, Mengmeng Jin, Ava Papetti, Peng Jiang, Sowmya V. Yelamanchili

Journal Articles: Anesthesiology

Most current information about neurological disorders and diseases is derived from direct patient and animal studies. However, patient studies in many cases do not allow replication of the early stages of the disease and, therefore, offer limited opportunities to understand disease progression. On the other hand, although the use of animal models allows us to study the mechanisms of the disease, they present significant limitations in developing drugs for humans. Recently, 3D-cultured in vitro models derived from human pluripotent stem cells have surfaced as a promising system. They offer the potential to connect findings from patient studies with those from …

Comprehensive Characterization Of Chronic Midazolam Exposure On Neonates And Long-Term Neurodevelopment, Nghi M. Nguyen, Pranavi Athota, Adrian Flores, Andrew Trease, Daniel Meyer, Vamsi K. Singu, Chandan Krishnamoorthy, Victoria L. Schaal, Reeyan Bhakat, Kunal Sualy, Sathish Kumar Natarajan, Kelly L. Stauch, Sowmya V. Yelamanchili, Gurudutt Pendyala

Journal Articles: Anesthesiology

Approximately 1 in 10 U.S. newborns are born preterm (< 37 weeks of gestation), facing risks of low birth weight, respiratory and birth deficits often requiring surgery, mechanical ventilation, and prolonged sedation. Such long-term exposure to sedatives in these babies can potentially pose neurodevelopmental risks and can further impact changes later in life. The present study focused on midazolam (MDZ), a benzodiazepine class drug commonly used as sedative in the neonatal intensive care unit (NICU). Using a robust preclinical rodent model mimicking chronic MDZ exposure, we did a comprehensive characterization on the phenotypic, molecular, biochemical, and behavioral outcomes in these exposed neonates across key developmental milestones. Our findings indicate that long-term MDZ exposure during the neonatal period negatively affects physical attributes in early childhood. While adult bodyweights between control and MDZ-exposed rats remain comparable, the MDZ rats exhibit accelerated and robust weight gain, potentially indicating a predisposition for binge eating behavior. Additionally, dopamine release in MDZ-exposed rats is markedly reduced in adulthood. Elevated levels of pro-inflammatory cytokines and growth factors in the brain during adulthood suggest a shift in development due to early MDZ exposure. Further, trends of heightened anxiety-like behavior and reduced social interaction during early adolescence compared to other stages were observed. Collectively, our study provides a comprehensive assessment of how long-term MDZ exposure during neonatal stages impacts outcomes throughout life, laying the foundation for understanding mechanisms that contribute to neurodevelopmental complications associated with long-term MDZ use in neonates.

Perioperative Outcomes And Mortality In Liver Transplant Patients 65 And Older, Nathaniel S. Pester, Trevor J. Wilke, V K. Shostrom, Cale A. Kassel

Graduate Medical Education Research Journal

Background: The number of patients over the age of 65 awaiting liver transplantation (LT) continues to grow and an increasing number of patients will undergo liver transplantation. While age is not an absolute contraindication to liver transplantation, understanding the risks to older patients remains essential to ensure good outcomes with the limited number of grafts available.

Methods: This retrospective study included patients undergoing LT at the University of Nebraska Medical Center. A total of 421 patients were enrolled and stratified to patients under 65 years old (351 patients) and patients over 65 (70 patients). Geriatric patients were defined as aged …

The Use Of Abdominal Fascial Plane Blocks For Post-Operative Analgesia In Intestinal Rehabilitation Patients – A Retrospective Comparative Study, Brittany A. Brown, Lauren E. Costello, Elizabeth C. Ternent-Recht, Trevor J. Wilke, Cale A. Kassel

Graduate Medical Education Research Journal

Background: Short gut syndrome affects both pediatric and adult patients often requiring multiple surgical procedures to improve intestinal function. Identifying methods to improve pain control and reduce opioid consumption is an important consideration for this patient population.

Methods: A retrospective chart review of 115 patients less than 12 years of age undergoing abdominal procedures between August 1, 2012, and December 31, 2019, was performed. From this group, 64 patients had a perioperative abdominal wall fascial plane block performed and were compared to 51 patients who did not have a block performed.

Results: Mean opioid use defined as morphine equivalent daily …

Long-Term Neurodevelopmental Outcomes Post-Chronic Midazolam Exposure During Early Life, Nghi M. Nguyen

Theses & Dissertations

In recent decades, the rising number of neonates born in the Neonatal Intensive Care Unit (NICU) due to prematurity has raised concerns about their overall well-being and development. Premature neonates are at higher risk of health complications and often require invasive procedures. These invasive procedures often induce stress and agitation, prompting physicians and healthcare providers to provide sedation or general anesthesia to manage discomfort. Epidemiological studies of human patients have revealed a correlation between childhood exposure to general anesthetic and sedative agents and subsequent cognitive deficits. This association is also supported in animal models, which shows that exposure to anesthetics …

Early Life Exposure To Deltamethrin Impairs Synaptic Function By Altering The Brain-Derived Extracellular Vesicle Proteome, Leandra Koff, Jessica Di Re, Subhash Chand, Yosef Avchalumov, Nghi M. Nguyen, Timothy J. Baumgartner, Aditya K. Singh, Nana A. Goode, Mate Marosi, Lance M. Hallberg, Bill T. Ameredes, Thomas A. Green, Sowmya V. Yelamanchili, Gurudutt Pendyala, Fernanda Laezza

Journal Articles: Anesthesiology

Pyrethroid pesticides have been associated with neurodevelopmental disorders including attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). While behavioral effects of pyrethroid exposure have been previously reported, the underlying mechanisms remain unclear. Here, we hypothesized that exposure to deltamethrin (DM), a widely used pyrethroid pesticide known for its neurotoxicity during early developmental stages, induces brain dysfunction through alterations in brain-derived extracellular vesicle (BDEV) signaling. Using a well-established rodent model of early life DM exposure within the recommended no observable effect level, we isolated BDEVs from postnatal 30-day-old vehicle-exposed (control) and DM-exposed mice using a differential sucrose density gradient. Following …

Molecular Characterization Of Streptococcus Pneumoniae Causing Disease Among Children In Nigeria During The Introduction Of Pcv10 (Gsk), Stephanie W. Lo, Paulina A. Hawkins, Binta Jibir, Fatimah Hassan-Hanga, Mahmoud Gambo, Rasaq Olaosebikan, Grace Olanipekun, Huda Munir, Nicholas Kocmich, Amy J. Rezac-Elgohary, Safiya Gambo, Danstan Bagenda, Paul D. Fey, Robert F. Breiman, Lesley Mcgee, Stephen D. Bentley, Stephen K. Obaro, Community Acquired Pneumonia And Invasive Bacterial Disease Capibd Consortium

Journal Articles: Anesthesiology

Streptococcus pneumoniae (pneumococcus) is a leading vaccine-preventable cause of childhood invasive disease. Nigeria has the second highest pneumococcal disease burden globally, with an estimated ~49 000 child deaths caused by pneumococcal infections each year. Ten-valent pneumococcal conjugate vaccine (GSK; PCV10) was introduced in December 2014 in a phased approach. However, few studies have characterized the disease-causing pneumococci from Nigeria. This study assessed the prevalence of serotypes, antibiotic susceptibility and genomic lineages using whole genome sequencing and identified lineages that could potentially escape PCV10 (GSK). We also investigated the potential differences in pneumococcal lineage features between children with and …

Identification Of Ywhah As A Novel Brain-Derived Extracellular Vesicle Marker Post Long-Term Midazolam Exposure During Early Development, Nghi M. Nguyen, Daniel Meyer, Luke Meyer, Subhash Chand, Jagadesan Sankarasubramanian, Maireen Miravite, Chittibabu Guda, Sowmya V. Yelamanchili, Gurudutt Pendyala

Journal Articles: Anesthesiology

Recently, the long-term use of sedative agents in the neonatal intensive care unit (NICU) has raised concerns about neurodevelopmental outcomes in exposed neonates. Midazolam (MDZ), a common neonatal sedative in the NICU, has been suggested to increase learning disturbances and cognitive impairment in children. However, molecular mechanisms contributing to such outcomes with long-term MDZ use during the early stages of life remain unclear. In this study, we for the first time elucidate the role of brain-derived extracellular vesicles (BDEVs), including mining the BDEV proteome post long-term MDZ exposure during early development. Employing our previously established rodent model system that mimics …

In Utero And Post-Natal Opioid Exposure Followed By Mild Traumatic Brain Injury Contributes To Cortical Neuroinflammation, Mitochondrial Dysfunction, And Behavioral Deficits In Juvenile Rats, Austin M. Gowen, Jina Yi, Kelly L. Stauch, Luke Miles, Sanjay Srinivasan, Katherine Odegaard, Gurudutt Pendyala, Sowmya V. Yelamanchili

Journal Articles: Anesthesiology

Maternal opioid use poses a significant health concern not just to the expectant mother but also to the fetus. Notably, increasing numbers of children born suffering from neonatal opioid withdrawal syndrome (NOWS) further compounds the crisis. While epidemiological research has shown the heightened risk factors associated with NOWS, little research has investigated what molecular mechanisms underly the vulnerabilities these children carry throughout development and into later life. To understand the implications of in utero and post-natal opioid exposure on the developing brain, we sought to assess the response to one of the most common pediatric injuries: minor traumatic brain injury …

Novel Rna-Seq Signatures Post-Methamphetamine And Oxycodone Use In A Model Of Hiv-Associated Neurocognitive Disorders, Pranavi Athota, Nghi M. Nguyen, Victoria L. Schaal, Sankarasubramanian Jagadesan, Chittibabu Guda, Sowmya V. Yelamanchili, Gurudutt Pendyala

Journal Articles: Anesthesiology

In the 21st century, the effects of HIV-associated neurocognitive disorders (HAND) have been significantly reduced in individuals due to the development of antiretroviral therapies (ARTs). However, the growing epidemic of polysubstance use (PSU) has led to concern for the effects of PSU on HIV-seropositive individuals. To effectively treat individuals affected by HAND, it is critical to understand the biological mechanisms affected by PSU, including the identification of novel markers. To fill this important knowledge gap, we used an in vivo HIV-1 Transgenic (HIV-1 Tg) animal model to investigate the effects of the combined use of chronic methamphetamine (METH) and oxycodone …

Performance Of The Universal Vital Assessment (Uva) Mortality Risk Score In Hospitalized Adults With Infection In Rwanda: A Retrospective External Validation Study, Riley Hazard, Danstan Bagenda, Andrew J. Patterson, Julie T. Hoffman, Steven J. Lisco, Olivier Urayeneza, Polyphile Ntihinyurwa, Christopher C. Moore

Journal Articles: Anesthesiology

BACKGROUND: We previously derived a Universal Vital Assessment (UVA) score to better risk-stratify hospitalized patients in sub-Saharan Africa, including those with infection. Here, we aimed to externally validate the performance of the UVA score using previously collected data from patients hospitalized with acute infection in Rwanda.

METHODS: We performed a secondary analysis of data collected from adults ≥18 years with acute infection admitted to Gitwe District Hospital in Rwanda from 2016 until 2017. We calculated the UVA score from the time of admission and at 72 hours after admission. We also calculated quick sepsis-related organ failure assessment (qSOFA) and modified …

Methamphetamine Induces The Release Of Proadhesive Extracellular Vesicles And Promotes Syncytia Formation: A Potential Role In Hiv-1 Neuropathogenesis, Subhash Chand, Catherine Demarino, Austin Gowen, Maria Cowen, Sarah Al-Sharif, Fatah Kashanchi, Sowmya V. Yelamanchili

Journal Articles: Anesthesiology

Despite the success of combinational antiretroviral therapy (cART), the high pervasiveness of human immunodeficiency virus-1 (HIV)-associated neurocognitive disorders (HAND) poses a significant challenge for society. Methamphetamine (meth) and related amphetamine compounds, which are potent psychostimulants, are among the most commonly used illicit drugs. Intriguingly, HIV-infected individuals who are meth users have a comparatively higher rate of neuropsychological impairment and exhibit a higher viral load in the brain than infected individuals who do not abuse meth. Effectively, all cell types secrete nano-sized lipid membrane vesicles, referred to as extracellular vesicles (EVs) that can function as intercellular communication to modulate the physiology …

Periocular Manifestation Of Obstructive Sleep Apnea As A Novel Perioperative Screening Tool, Megan Folsom, James Gigantelli, Brent Timperley, Kurtis Johnson, Danstan Bagenda, Huiling Pang, Sheila Ellis

Journal Articles: Anesthesiology

PURPOSE: Obstructive sleep apnea (OSA) presents perioperative challenges with increased risk for complications. Floppy eyelid syndrome (FES) is associated with OSA yet has not been addressed perioperatively. The current standard for perioperative OSA screening includes assessing patient risk factors or the STOP-BANG tool, which requires an active participant. We aimed to confirm a connection between FES and OSA in presurgical patients and develop a screening method appropriate for patients with perioperative OSA risk.

MATERIALS AND METHODS: 162 presurgical pre-anesthesia clinic patients were enrolled. Screening questions determined eligibility. Those who were pregnant or aged < 19 were excluded. Control group included those with a STOP-BANG score < 3. Experimental group included those with BMI > 35 and OSA diagnosis. Examiners photographed participants' …

Effect Of Combined Methamphetamine And Oxycodone Use On The Synaptic Proteome In An In Vitro Model Of Polysubstance Use, Daniel Meyer, Pranavi Athota, Austin Gowen, Nghi M. Nguyen, Victoria L. Schaal, Sowmya V. Yelamanchili, Gurudutt Pendyala

Journal Articles: Anesthesiology

Polysubstance use (PSU) generally involves the simultaneous use of an opioid along with a stimulant. In recent years, this problem has escalated into a nationwide epidemic. Understanding the mechanisms and effects underlying the interaction between these drugs is essential for the development of treatments for those suffering from addiction. Currently, the effect of PSU on synapses-critical points of contact between neurons-remains poorly understood. Using an in vitro model of primary neurons, we examined the combined effects of the psychostimulant methamphetamine (METH) and the prescription opioid oxycodone (oxy) on the synaptic proteome using quantitative mass-spectrometry-based proteomics. A further ClueGO analysis and …

Distinct Synaptic Vesicle Proteomic Signatures Associated With Pre- And Post-Natal Oxycodone-Exposure, Katherine E. Odegaard, Gabriel Gallegos, Sneh Koul, Victoria L. Schaal, Neetha N. Vellichirammal, Chittibabu Guda, Andrea P. Dutoit, Steven J. Lisco, Sowmya V. Yelamanchili, Gurudutt Pendyala

Journal Articles: Anesthesiology

The current opioid crisis, which has ravaged all segments of society, continues to pose a rising public health concern. Importantly, dependency on prescription opioids such as oxycodone (oxy) during and after pregnancy can significantly impact the overall brain development of the exposed offspring, especially at the synapse. A significant knowledge gap that remains is identifying distinct synaptic signatures associated with these exposed offspring. Accordingly, the overall goal of this current study was to identify distinct synaptic vesicle (SV) proteins as signatures for offspring exposed to oxy in utero (IUO) and postnatally (PNO). Using a preclinical animal model that imitates oxycodone …

Endotracheal Tube Dislodgment In A High Risk Pulmonary Hypertensive Patient Due To Undiagnosed Tracheomegaly: A Case Report, Andrew Peck, Tammer N. Ghaly, Austin J. Adams, Daniel W. Johnson, Rebecca A. Aron

Graduate Medical Education Research Journal

Introduction

Airway enlargement was first described histologically in 1872, but it was not clinically reported until 1932, when Dr. Mounier-Kuhn published his seminal radiographic studies.¹ Since then, it is estimated that several hundred case reports have been published on congenital Mounier-Kuhn Syndrome (MKS), acquired tracheomegaly, and tracheobronchomegaly (TBM), yet only a few comprehensive literature reviews exist.²

Case

This case report details an elective nasal procedure for a patient with a history of significant pulmonary hypertension ad COPD on 5L home O₂ who had a symptomatic facial trauma. He was considered high risk secondary to his pulmonary disease, …

Thoracoscopic Left Atrial Appendage Ligation Complicated By Persistent Left Superior Vena Cava, Rebecca A. Aron, Maria Decastro, Kristina L. Koch, Kenneth Neff, Tyler Gouvea

Graduate Medical Education Research Journal

We herein report a 64 year-old male who had an incidental finding of a persistent left superior vena cava (SVC) revealed by intraoperative transesophageal echocardiography (TEE) during a Maze procedure with left atrial appendage ligation. During the intraoperative TEE, an incidental dilated coronary sinus > 1.1 cm was noted which prompted further evaluation and aided in our ultimate diagnosis. Consequently, significant additional surgical dissection and manipulation were required to isolate the left upper pulmonary vein. This case report reviews the anatomy and embryology of a persistent left SVC, discusses its clinical implications, and identifies surgical considerations for treatment.

Experience Treating Electrical Storm Using An Ultrasound Guided Stellate Ganglion Blockade, Thomas A. Nicholas Iv, Levi Zehr, Han-Jun Wang, Daniel R. Anderson, Steven J. Lisco

Graduate Medical Education Research Journal

Introduction: Electrical storm is a life-threatening condition in an often medically complex patient population. Pharmacologic ultrasound-guided stellate ganglion blockade is a treatment option in combination with maximized systemic antiarrhythmic medications. There is an emerging body of case reports supporting stellate ganglion block efficacy and safety for this condition.

Methods: Retrospective study on ultrasound-guided stellate ganglion blocks for electrical storm investigating patient clinical characteristics, immediate and long-term outcomes, and procedure related complications.

Results: Four (75% men) critically ill patients maximized on standard antiarrhythmic therapy underwent six bedside ultrasound-guided stellate ganglion block procedures. All blocks were unilateral left-sided, two patients underwent repeat …

Extracellular Vesicles From Infected Cells Are Released Prior To Virion Release, Yuriy Kim, Gifty A. Mensah, Sarah Al Sharif, Daniel O. Pinto, Heather Branscome, Sowmya V. Yelamanchili, Maria Cowen, James Erickson, Pooja Khatkar, Renaud Mahieux, Fatah Kashanchi

Journal Articles: Anesthesiology

Here, we have attempted to address the timing of EV and virion release from virally infected cells. Uninfected (CEM), HIV-1-infected (J1.1), and human T cell leukemia virus-1 (HTLV-1)-infected (HUT102) cells were synchronized in G₀. Viral latency was reversed by increasing gene expression with the addition of serum-rich media and inducers. Supernatants and cell pellets were collected post-induction at different timepoints and assayed for extracellular vesicle (EV) and autophagy markers; and for viral proteins and RNAs. Tetraspanins and autophagy-related proteins were found to be differentially secreted in HIV-1- and HTLV-1-infected cells when compared with uninfected controls. HIV-1 proteins were …

Child Health And The Implementation Of Community And District-Management Empowerment For Scale-Up (Codes) In Uganda: A Randomised Controlled Trial, Peter Waiswa, Flavia Mpanga, Danstan Bagenda, Rornald Muhumuza Kananura, Thomas O'Connell, Dorcus Kiwanuka Henriksson, Theresa Diaz, Florence Ayebare, Anne Ruhweza Katahoire, Eric Ssegujja, Anthony Mbonye, Stefan Swartling Peterson

Journal Articles: Anesthesiology

INTRODUCTION: Uganda's district-level administrative units buttress the public healthcare system. In many districts, however, local capacity is incommensurate with that required to plan and implement quality health interventions. This study investigates how a district management strategy informed by local data and community dialogue influences health services.

METHODS: A 3-year randomised controlled trial (RCT) comprised of 16 Ugandan districts tested a management approach, Community and District-management Empowerment for Scale-up (CODES). Eight districts were randomly selected for each of the intervention and comparison areas. The approach relies on a customised set of data-driven diagnostic tools to identify and resolve health system bottlenecks. …

A Comprehensive Study To Delineate The Role Of An Extracellular Vesicle-Associated Microrna-29a In Chronic Methamphetamine Use Disorder, Subhash Chand, Austin Gowen, Mason Savine, Dalia Moore, Alexander Clark, Wendy Huynh, Niming Wu, Katherine Odegaard, Lucas Weyrich, Rick A. Bevins, Howard S. Fox, Gurudutt Pendyala, Sowmya V. Yelamanchili

Journal Articles: Anesthesiology

Extracellular vesicles (EVs), which express a repertoire of cargo molecules (cf. proteins, microRNA, lipids, etc.), have been garnering a prominent role in the modulation of several cellular processes. Here, using both non-human primate and rodent model systems, we provide evidence that brain-derived EV (BDE) miRNA, miR-29a-3p (mir-29a), is significantly increased during chronic methamphetamine (MA) exposure. Further, miR-29a levels show significant increase both with drug-seeking and reinstatement in a rat MA self-administration model. We also show that EV-associated miR-29a is enriched in EV pool comprising of small EVs and exomeres and further plays a critical role in MA-induced inflammation and synaptodendritic …

A Holistic Systems Approach To Characterize The Impact Of Pre- And Post-Natal Oxycodone Exposure On Neurodevelopment And Behavior, Katherine E. Odegaard, Victoria L. Schaal, Alexander R. Clark, Sneh Koul, Jagadesan Sankarasubramanian, Zhiqiu Xia, Melissa Mellon, Mariano Uberti, Yutong Liu, Andrew Stothert, Matthew J. Van Hook, Han-Jun Wang, Chittibabu Guda, Steven J. Lisco, Gurudutt Pendyala, Sowmya V. Yelamanchili

Journal Articles: Anesthesiology

Background: Increased risk of oxycodone (oxy) dependency during pregnancy has been associated with altered behaviors and cognitive deficits in exposed offspring. However, a significant knowledge gap remains regarding the effect of in utero and postnatal exposure on neurodevelopment and subsequent behavioral outcomes. Methods: Using a preclinical rodent model that mimics oxy exposure in utero (IUO) and postnatally (PNO), we employed an integrative holistic systems biology approach encompassing proton magnetic resonance spectroscopy (¹H-MRS), electrophysiology, RNA-sequencing, and Von Frey pain testing to elucidate molecular and behavioral changes in the exposed offspring during early neurodevelopment as well as adulthood. Results: ^{1 …}

Integrated Systems Analysis Of Mixed Neuroglial Cultures Proteome Post Oxycodone Exposure, Rahul Guda, Katherine E. Odegaard, Chengxi Tan, Victoria L. Schaal, Sowmya V. Yelamanchili, Gurudutt Pendyala

Journal Articles: Anesthesiology

Opioid abuse has become a major public health crisis that affects millions of individuals across the globe. This widespread abuse of prescription opioids and dramatic increase in the availability of illicit opioids have created what is known as the opioid epidemic. Pregnant women are a particularly vulnerable group since they are prescribed for opioids such as morphine, buprenorphine, and methadone, all of which have been shown to cross the placenta and potentially impact the developing fetus. Limited information exists regarding the effect of oxycodone (oxy) on synaptic alterations. To fill this knowledge gap, we employed an integrated system approach to …

A Case Of Carcinoid Heart Disease And Echocardiographic Findings, Brandon Alex, Jeffrey Songster, Helenmari L. Merritt, Rebecca A. Aron

Graduate Medical Education Research Journal

Abstract: Carcinoid heart disease occurs in approximately 50% of patients with carcinoid syndrome. Right heart involvement resulting in tricuspid regurgitation, tricuspid stenosis, pulmonic regurgitation and pulmonic stenosis is most common. We report a case of tricuspid heart disease resulting in tricuspid regurgitation, tricuspid stenosis, pulmonic regurgitation and pulmonic stenosis.

The Clinical Relevance Of Cement Volume In Percutaneous Vertebral Augmentation, Ravi G. Mirpuri, Madhuri Are, Virginia Hardie, Michael J. Warden, Robin High

Graduate Medical Education Research Journal

Introduction: Vertebroplasty and Kyphoplasty are two forms of percutaneous vertebral augmentation (PVA), in which polymethylmethacrylate cement is used to stabilize vertebral compression fractures (VCF). This study sought to evaluate the relationship between cement volume and clinical outcomes, including pain reduction, opioid use, and complication rate.

Methods: Retrospective chart review produced 88 patients who received PVA at a tertiary care outpatient pain clinic. Cement volume, type of PVA, gender, level (thoracic vs lumbar) were collected, as well as clinical outcomes of numeric pain score (NPS) reduction, opioid percent change (OPC), and complications. Both pre-procedure and post-procedure (between 2-4 weeks) data were …

Ponv Prophylaxis Failure Disproportionately Affects Female Patients, Despite Intraoperative Computerized Decision Support Guidance, Karl A. Krieser, John B. Riley Iii, Jospeh E. Baus, Julie T. Hoffman, James N. Sullivan Md, Robert L. Lobato

Graduate Medical Education Research Journal

Objectives: To compare postoperative nausea and vomiting (PONV) prophylaxis treatment and outcomes based on patients’ sex, using a retrospective cohort. The setting was the operating room and post-anesthesia care unit of a tertiary care university medical center.

Patients: A total of 678 adult male and female patients with American Society of Anesthesiologist (ASA) scores of 1-4 underwent surgery with general anesthesia. All patients received preoperative PONV risk assessment. PONV prophylaxis was administered at the discretion of the anesthesia care team members with guidance from a computerized decision support system.

Measurements: Adequacy of prophylaxis was retrospectively determined based on individual patient …

Role Of Extracellular Vesicles In Substance Abuse And Hiv-Related Neurological Pathologies, Katherine E. Odegaard, Subhash Chand, Sydney Wheeler, Sneham Tiwari, Adrian Flores, Jordan Hernandez, Mason Savine, Austin Gowen, Gurudutt Pendyala, Sowmya V. Yelamanchili

Journal Articles: Anesthesiology

Extracellular vesicles (EVs) are a broad, heterogeneous class of membranous lipid-bilayer vesicles that facilitate intercellular communication throughout the body. As important carriers of various types of cargo, including proteins, lipids, DNA fragments, and a variety of small noncoding RNAs, including miRNAs, mRNAs, and siRNAs, EVs may play an important role in the development of addiction and other neurological pathologies, particularly those related to HIV. In this review, we summarize the findings of EV studies in the context of methamphetamine (METH), cocaine, nicotine, opioid, and alcohol use disorders, highlighting important EV cargoes that may contribute to addiction. Additionally, as HIV and …