Translational Medical Research Commons^™

Lactate Expression, Mortality, And Length Of Stay In Emergency Department Patients With Sepsis And Intubation, Heaveen Ahdi, Nadine Talia, Ray Lee, Lili Zhao, Ronny Otero, David A. Berger

Conference Presentation Abstracts

Background and Objectives: Studies demonstrate that patients in septic shock with a lactate < 2 have a mortality between 20% to 46%. Our prior work reported that in emergency department (ED) patients with a second lactate ≥2 (lac), there is a two-fold increase in 30-day mortality when compared to patients with a second lactate < 2 (alac). On secondary analysis, we found that intubated patients with a second lactate ≤2 had a longer hospital length of stay (LOS). Our objective is to further scrutinize this 30-day mortality and LOS. Methods: This is a retrospective cohort study of an eight-hospital health system using data from the electronic medical record. Inclusion criteria consisted of patients ≥18 years of age who presented to the ED from 1/1/2017 to 11/30/2022 with ≥2 lactate levels measured in the ED, were diagnosed with sepsis, and admitted to the intensive care unit (ICU) within 24 h. We excluded lactate auto-expressors, pregnant patients, transfers, and those taken for a surgical procedure within 72 h of presentation. Patients were classified based on initial and second lactate as < 2 (alac) or ≥2 (lac). Multivariable regression analysis was performed for 30-day mortality and LOS, adjusting for vitals, BMI, DNR status, and intubation timing. Results: Of the 3100 patients who met inclusion criteria, 1285 patients were intubated and categorized based on their lactate expression: alac -> alac (reference; 111/1285, 8.9%), alac -> lac (28/1285, 2.2%), lac -> alac (259/1285, 20.2%), and lac -> lac (887/1285, 69.0%). Lac -> lac had a significantly higher 30-day mortality (OR = 2.058, 95% CI = [1.353–3.154]) compared to alac -> alac. Lac -> alac had a significantly increased LOS (OR = 1.133 (95% CI = [1.003–1.280]) compared to alac -> alac. Other group comparisons for 30-day mortality and LOS were not significant. Conclusion: Intubated sepsis and septic shock patients in the lac -> lac group had a …

Diuretic Dose Ratio Is Associated With Reduced Hospital Length Of Stay In Acute Heart Failure, Sarah Galla, Yuying Xing, Lihua Qu, David A. Berger

Conference Presentation Abstracts

Background and Objectives: Congestive heart failure (CHF) is anticipated to affect eight million Americans by 2030. Treatment for CHF exacerbation is centered around IV diuretics. There are no current studies indicating an optimal initial diuretic dose in the Emergency Department (ED), and our objective is to test our hypothesis that higher diuretic dose ratio may shorten hospital length of stay (LOS). Methods: We conducted a retrospective cohort study of a large health system from 2016 to 2022. We included patients admitted from the ED with a primary diagnosis of “CHF exacerbation” with a history of CHF and prescribed diuretics. Exclusions …

Using Age-Adjusted D-Dimer Vs Traditional D-Dimer To Rule Out Acute Aortic Syndrome, Jacob Nelson, Divyani Patel, Sylvia Kashat, Gorune Geloian, Karen Childers, David A. Berger, Brett Todd

Conference Presentation Abstracts

Background and Objectives: Acute aortic syndromes (AS), including aortic dissection, are rare and life-threatening diagnoses. Early diagnosis is critical as mortality increases by 1%–2% per hour after symptom onset. D-dimer (DD) Methods: In this retrospective chart review, we identified all patients who presented to any Emergency Department (ED) at a multicenter health system between 2012 and 2021, received a D-dimer test, and underwent CTA Dissection, CTA Coronary Study, or CTA Triple Rule-Out. Patients under the age of 18, pregnant, had prior dissection or thoracic aorta repair, or who presented altered/unresponsive were excluded. For patients with multiple presentations, the first visit …

Breast Cancer In Pms2 Related Lynch Syndrome: Evidence Of A Possible Association?, Ujjwal Karki, Tara Rangarajan, Dana Zakalik

Conference Presentation Abstracts

Background: Lynch syndrome (LS) is a hereditary cancer predisposition syndrome caused by pathogenic variants (PVs) in mismatch repair genes, MLH1, MSH2, MSH6, and PMS2. LS is associated with increased risk of colorectal, and endometrial cancers but breast cancer risk is uncertain, with some studies suggesting MSH6 and PMS2 PVs may have a higher risk for breast cancer. Our study outlines the incidence and clinical characteristics of breast cancer in PMS2-related LS identified at a large academic center. Methods: Patients with PMS2 PVs identified between July 2009 and May 2023 were selected from a database at the Nancy and James Grosfeld …

Characteristics Of Breast Cancer In Carriers Of Pathogenic Variant In Atm In A Large Academic Health Center, Ujjwal Karki, Tara Rangarajan, Dana Zakalik

Conference Presentation Abstracts

Background: Pathogenic variants (PVs) in ATM are associated with an increased risk of breast, pancreas, and other cancers. The clinical and pathological characteristics of ATM-associated breast cancers have not been well defined. Methods: Patients who underwent multigene panel testing between December 2012 and May 2023 and were identified to harbor ATM PVs were included in the study. We analyzed demographics, germline findings, histopathology, genomic recurrence score, and management of ATM PV carriers with breast cancer. Results: A total of 222 individuals were identified to have PVs in ATM, of whom 184 (83%) were female. The majority were Caucasian (n = …

Whole Genome-Based Dna Methylation Profiling In Covid-19 Patients Reveals Alterations In Pathways Linked To Neurological Dysfunctions, Syed Zameer, Juozas Gordevicius, Eman Anis, Qiong Sha, Martha L. Escobar Galvis, Michael Henderson, Andrew Pospisilik, Patrik Brundin, Stewart Graham

Conference Presentation Abstracts

The sever acute respiratory syndrome corona virus 2 (SARS-CoV-2) is a highly transmissible viruswhich causes a life-threatening illness called coronavirus (COVID-19). It has cost millions ofdeath worldwide. This novel RNA betacorona virus is manifested by varying clinical symptomsranging from asymptomatic to mild to severe systemic illness with deadly outcomes. Muchevidence revealed the differences in the severity of COVID-19 infection varied widely accordingto host factors and comorbidities. It is critical to understand the interplay of genetic and epigeneticfactors and host response to this fatal virus. A substantial number of epigenome-wide associationstudies acknowledged that SARS-CoV-2 manipulate the host epigenome via DNA methylation …

Evaluation Of A Novel Lupus Anticoagulant Assay Designed To Reduce False Positive Results Due To Anticoagulation: A Retrospective Study At A Single Health System, Jessica D. Anderson, Tamara Sabih, Yuying Xing, Lili Zhao, Marc D. Smith

Conference Presentation Abstracts

Introduction: Lupus anticoagulants (LA) are antibodies directed against phospholipids/phospholipid-protein complexes involved in coagulation and are associated with thrombotic events and recurrent fetal loss. There is no gold standard test for LA, therefore at least two LA-specific tests are recommended before excluding LA. Potential testing methods involve dilute Russell viper venom time (dRVVT) and hexagonal phase phospholipid assays (HPPA); however, many of these tests are susceptible to interference with anticoagulant therapy which can lead to false positive results. In this study, we compared the performance of our current HPPA, StaClot LA (SCLA), with a novel assay reported to have relatively minimal …

Does Proton Arc Therapy Has Potential Clinical Benefits For Hepatocellular Carcinoma?, Peilin Liu, R Dalfsen, M Soukup, Shupeng Chen, Lewei Zhao, Z Wang, X S. Gao, Thomas Quinn, Craig Stevens, Rohan Deraniyagala, Xiaoqiang Li, Xuanfeng Ding

Conference Presentation Abstracts

Purpose: To investigate the potential clinical benefits and dose-averaged Linear Energy Transfer (LETd) sparing, utilizing proton arc plan for Hepatocellular carcinoma (HCC) patients in comparison with Intensity Modulated Proton Therapy (IMPT). Methods: Ten HCC patients have been retrospectively selected. Two planning groups were created: Proton Arc plans using Monaco ver. 6 and the clinical IMPT plan. Both planning groups used the same robustness parameters. The prescription dose is 67.5 Gy (RBE) in 15 fractions/ 66 GyE in 10 fractions of the Clinical Target Volume (CTV) following clinical IMPT plan. Robustness evaluations were performed to ensure target dose coverage. Normal Tissue …

A Comprehensive Investigation Of Linear Energy Transfer Optimization Effectiveness In Intensity-Modulated Proton Therapy Via Alternating Direction Method Of Multipliers (Impt Let-Admm), Q Fan, G Liu, Lewei Zhao, Xiaoqiang Li, Xuanfeng Ding, S Dai

Conference Presentation Abstracts

Linear energy transfer (LET)-guided optimization in intensity-modulated proton therapy (IMPT) via alternating direction method of multipliers (ADMM) has the potential to improve its biological effectiveness (IMPTLET- ADMM), in which the LET distribution in target can be escalated, while the LET distribution in the organs at risk can be mitigated. This study aims to quantitatively investigate the effectiveness of LET optimization in IMPT via ADMM with different solvers in its iteration loop. Methods: The clinical dose-volume-histogram (DVH) constraint noted dose sub-problem and clinical LET -volume-histogram (LVH) constraint noted LET sub-problem are combined to generate a composite objective function, which is available …

Integrative Analysis Of Metabolome And Methylome Identifies The Correlation Of Aminoacyl-Trna Biosynthesis Metabolitesand Sepsecs Gene Methylation In Huntington’S Disease Brain Tissue, Sangeetha Vishweswaraiah, Ali Yilmaz, Nadia Ashrafi, Nazia Saiyed, Abdulla Khalid, Purvesh R. Koladiya, Xiaobei Pan, Shirin Macias, Uppala Radhakrishna, Stewart F. Graham

Conference Presentation Abstracts

No abstract provided.

Particle Arc Single-Isocenter Stereotactic Radiosurgery Of Multiple Brain Metastases, L Volz, S Mein, T Tessonnier, Peilin Liu, A Mairani, M Durante, Xuanfeng Ding, C Graeff, T Li

Conference Presentation Abstracts

Purpose: To develop spot-scanning proton (SPArc) and heavy ion (SHArc) arc therapy for single-isocenter stereotatic radiosurgery (SISRS) of multiple brain metastases (MBMs). First results achieved with dedicated planning infrastructure are compared to state-of-the -art volumetric modulated photon arc therapy (HA-VMAT). Methods: A multi-institutional collaboration was established to develop bespoke SPArc and SHArc SISRS infrastructure with available research and commercial treatment planning systems. Devised planning and delivery methods considered dedicated energy, spot, and multi-arc selection strategies. SPArc and SHArc (carbon and helium ions) plans were generated for MBM patients exhibiting 3-12 intracranial lesions with GTV volumes between 0.03ccm and 19.8ccm, at …

Human Serum Metabolites Signature The Prodromal Biomarkers Of Parkinson’S Disease: Lrkk2 Longitudinal Stu, Ali Yilmaz, Nadia Ashrafi, Sumeyya Akyol, Ieva Kerševičiūtė, Milda Milčiūtė, Juozas Gordevicius, Stewart Graham

Conference Presentation Abstracts

BACKGROUND: The complex and heterogeneous nature of Parkinson’s disease (PD) and variability in their progression hampers its early diagnosis and treatment. Consequently, there is much interest in developing models that can predict PD progression and help to deepen our understanding of PD pathology. Metabolomics might shed light on the PD imprint seeking a broader view of the biochemical remodeling induced by this disease in an early and pre-symptomatic stage, unveiling potential biomarkers and developing new novel therapeutic targets

METHODS: In this novel study utilizing ¹H NMR and DI-LC-MS/MS we conducted metabolomics investigation on the serum samples from a clinically well …

Metabolic Profiling Reveals Differential Alterations In Serum And Brain Metabolites During The Progression Of Huntington’S Disease In An R6/2 Transgenic Mouse Model, Nadia Ashrafi, Sumeyya Akyol, Sangeetha Vishweswaraiah, Ali Yilmaz, Leva Kerševičiūtė, Juozas Gordevicius, Stewart Graham

Conference Presentation Abstracts

No abstract provided.

Urinary Cytokines As Potential Biomarkers Of Mild Cognitive Impairment And Alzheimer’S Disease: A Pilot Study, Nazia Saiyed, Ali Yilmaz, Sangeetha Vishweswaraiah, Abhishek Maiti, Ilyas Ustun, Sarah Bartolone, Travonia Brown-Hughes, Roland Thorpe Jr, Tammy Osentoski, Stacey Ruff, Amita Pai, Michael E. Maddens, Khaled Imam, Stewart Graham

Conference Presentation Abstracts

No abstract provided.

An Analytic Model Of The External Beam Dose Rate Effect On Immune Cells In Blood Dosimetry, Lewei Zhao, Peilin Liu, G Liu, Xuanfeng Ding

Conference Presentation Abstracts

Purpose: Radiation therapy is a double-edged sword with regard to its immunomodulatory effect. It is critical to find how it is affected by dose rate. Thus, we developed an analytic model for calculating the number of immune cells receiving radiation. Methods: Suppose the blood is received radiation by constant dose rate. The blood is one-way flow without circulation in the radiation delivery at a constant velocity. Two kinds of lung treatment regimens were considered standard delivery 2Gy per fx total 30fx and hypo-fractionation SBRT 12 Gy per fx total 5 fx. Two different dose rates were simulated for standard treatment: …

Investigate The Delivery Efficiency Improvement For Sparc Compared To Impt, Peilin Liu, B A. De Jong, S Chang, Lewei Zhao, G Liu, Craig Stevens, Rohan Deraniyagala, E W. Korevaar, J A. Langendijk, Xiaoqiang Li, Xuanfeng Ding

Conference Presentation Abstracts

Purpose: To assess the efficiency improvement of SPArc compared to IMPT in proton clinical operation.Methods: A random clinical operation day at a proton therapy center with a two room system. Aa total of 10 Head & Neck cancer cases treated on Jan 6th, 2021were selected and SPArc plans were generated for all the cases with similar target coverage and dose constraints of organ at risk (OARs). 3% range uncertainties and 3mm setup uncertainties were applied for robust optimization. The log files of clinical IMPT were exported to calculate true treatment delivery time. The machine-specific delivery sequence model was utilized to …

Iatrogenic Nerve Injuries During Surgeries Of The Neck: A Systematic Review, Tajuldeen Al-Hasani, Jickssa Gemechu, Varna Taranikanti

Posters

Iatrogenic nerve injuries in the neck can present with a wide spectrum of symptoms ranging from mild pain, numbness, or weakness, to devastating consequences for patients such as permanent irreversible damage, disability, or even death. Surgical interventions in the neck region, especially those requiring radical dissections in the neck carry a significant risk of iatrogenic injury to several vital nerves passing through the neck such as vagus, phrenic, brachial plexus, cervical plexus, and ansa cervicalis.

Chief Complaint And Geriatric Depression: Assessing Risk For 30- And 90-Day Readmission, Eric James, Michelle Moccia, Victoria Lucia

Posters

Readmission to the hospital has significant monetary costs and represents a care gap for older adults. This investigation examines how a positive geriatric depression screen and chief complaint contribute to 30- and 90-day readmission risk. Depression recognition with follow-up care is a critical first step to prevent adverse outcomes such as readmission.

Beyond Covid-19: The Impact Of Recent Pandemics On Medical Students And Their Education: A Scoping Review, Moneb Bughrara, Stephanie Swanberg, Victoria Lucia, Keaton Schmitz, Dawn Jung, Tracy Wunderlich-Barillas

Posters

Over the past two years, COVID-19 has greatly altered undergraduate medical education (UME) as well as daily life. Medical schools across the world were disrupted and had to immediately adapt the educational experience to the online environment in order to continue the delivery of quality UME. However, COVID-19 was not the only recent pandemic. This posed the question, were similar disruptions and adaptations also seen in recent past pandemics such as Severe Acute Respiratory Syndrome (SARS) or Middle East Respiratory Syndrome (MERS) that could have prepared UME for COVID-19? This scoping review investigated the educational and personal impact of recent …

A Retrospective Study On The Incidence Of Ckd Diagnosis Post Covid-19 Infection With Variations In Glycemic Control, Eduardo Leon, Jithin John, Nick Ludka, Ramin Homayouni

Posters

The COVID-19 pandemic has emphasized that the virus can cause multi-organ complications, especially in patients with pre-existing conditions such as type-2 diabetes mellitus (T2DM), who are at higher risk for poor outcomes. Some patients may also develop T2DM post-infection due to the virus's effects on insulin secretion and blood glucose regulation. Glycated hemoglobin (HbA1c) is a useful tool for assessing blood glucose levels over time, diagnosing diabetes and monitoring disease management. Elevated levels of HbA1c have been linked to diabetic nephropathy (DN) and chronic kidney disease (CKD), both of which are potential complications of COVID-19 infection. This study aims to …

Incidence Of Myopathy In Post Covid-19 Patients Undergoing Statin Therapy, Jithin John, Eduardo Leon, Ramin Homayouni

Posters

Statin-associated myositis has been documented since its first use, causing an increase in Creatinine Kinase levels. While some suggest avoiding statins in individuals with COVID-19, recent literature suggests that statin use is protective against SARS-CoV-2 infection due to its antioxidant and anti-inflammatory properties. The role of statin therapy in COVID-19 cases, especially regarding myopathy, remains scarce. We hypothesize that different statin therapies prior to SARS-CoV-2 infection are associated with an increased risk of myopathy and an increase in blood CK levels.

Analysis Of The Efficacy Of The Modified Finnegan Scoring System, Benjamin Collaer, Victoria Lucia

Posters

Neonatal Abstinence Syndrome (NAS) is a constellation of opiate withdrawal symptoms including irritability, inadequate feeding/ growth, and seizures in neonates This condition occurs shortly after birth if the fetus had significant exposure to opiates in-utero. Since 2014, each NAS case at Beaumont Royal Oak and Troy Hospitals has had their treatment dictated by their score on the Modified Finnegan Scoring System (MFSS). This scoring system was created to minimize unnecessary opiate-based treatments for neonates with NAS. The main objective of this study is to analyze the efficacy of the MFSS and observe the change in patient outcomes since its implementation …

Telemedicine Success - A Rapid Review, Anna Carman, Victoria Lucia

Posters

Telemedicine involves utilizing telecommunications and technology to deliver healthcare - including diagnosis, consultation, education, care management, and patient self-management - to populations with otherwise limited access to care. It offers a broad-range of benefits, including increased care accessibility, improved continuity of care, and decreased costs, without sacrificing patient satisfaction. However, telemedicine requires unique skills and approaches, unfamiliar to many physicians. We conducted a rapid review of research-validated techniques, across multiple subspecialties, to identify research-validated techniques for maximizing telemedicine appointments, synthesized in a comprehensive list, in order to support clinicians in modern healthcare settings.

Expansion Of The Detrusor Muscular Ring Surrounding The Bladder Neck On Mri: Moving Beyond The Prostate As An Etiology Of Lower Urinary Tract Symptoms Due To Benign Prostatic Hyperplasia, Kiran Nandalur, David Walker, Hong Ye, Sayf A. Al-Katib, Brian Seifman, David Gangwish, Abhay Dhaliwal, Connor Ervin, Kayla Dobies, Channing Sesoko, Sirisha Nandalur, Bernadette Zwaans, Jennifer Nguyen, Jason Hafron

Conference Presentation Abstracts

Purpose: The etiology of lower urinary tract symptoms secondary to benign prostatic hyperplasia (LUTS/BPH) remains uncertain. The purpose of our study was to quantitatively analyze pelvic anatomic characteristics on magnetic resonance imaging (MRI) to assess for independent factors for symptoms.
*Methods and Materials: This retrospective single-institution study evaluated treatment-naïve men who underwent prostate MRI within 3 months of International Prostate Symptom Score (IPSS) from June 2021 to February 2022. Factors measured on MRI included: detrusor muscular ring surrounding the bladder neck measured as area and alternatively diameter, central gland (CG) mean apparent diffusion coefficient (ADC), levator hiatus (LH) volume, intrapelvic …

Augmented Immunomodulation Of Endogenous Marrow-Derived Stem Cells In The Setting Of Acl Rupture, Mackenzie Fleischer, Michael Newton, Samantha Hartner, John A. Driscoll, Anthony Arveschoug, Chritopher C. Vasileff, Kevin Baker

Conference Presentation Abstracts

PURPOSE: Augmentation of MSC immunomodulation is an unexplored, potentially useful therapeutic to combat PTOA following ACLR. Lower kynurenine-to-tryptophan ratios observed in synovial fluid of ACL rupture (ACLR) rats suggests decreased activity of tryptophan metabolizing enzyme, Ido, known to be secreted by MSCs to promote T-reg expansion and Th17 suppression. This study aims to characterize the immunomodulatory capacity of pharmacologically mobilized MSCs in conjunction with exogenously delivered Ido. METHODS: Rats (N = 48) underwent ACLR to evaluate the effects of mobilized MCSs on Ido1 and inflammatory cytokine expression profiles in the synovial fluid. Additionally, rats (N = 160) underwent ACLR to …