Translational Medical Research Commons^™

Global Gene Expression Profiles Of Subcutaneous Adipose And Muscle From Glucose-Tolerant, Insulin-Sensitive, And Insulin-Resistant Individuals Matched For Bmi, Steven C. Elbein, Philip A. Kern, Neda Rasouli, Aiwei Yao-Borengasser, Neeraj K. Sharma, Swapan K. Das

Clinical and Translational Science Faculty Publications

OBJECTIVE - To determine altered gene expression profiles in subcutaneous adipose and skeletal muscle from nondiabetic, insulin-resistant individuals compared with insulin-sensitive individuals matched for BMI.

RESEARCH DESIGN AND METHODS - A total of 62 nondiabetic individuals were chosen for extremes of insulin sensitivity (31 insulin-resistant and 31 insulin-sensitive subjects; 40 were European American and 22 were African American) and matched for age and obesity measures. Global gene expression profiles were determined and compared between ethnic groups and between insulin-resistant and insulin-sensitive participants individually and using gene-set enrichment analysis.

RESULTS - African American and European American subjects differed in 58 muscle …

Research Annual Report 2010, Children's Mercy Hospital

Research Annual Reports

Annual report of the research at Children's Mercy Hospital in Kansas City MO, a pediatric medical center.

Going Viral, Judy Diamond

World of Viruses

Science education is developing new and innovative means of communication that compete directly with global media to reach the ‘YouTube Generation’. The truly interdisciplinary team of the SEPA-funded World of Viruses project is discovering how best to spread the word.

KEY COLLABORATORS
Judy Diamond, Professor, University of Nebraska State Museum
Charles Wood, Director, Nebraska Center for Virology
Moira Rankin, President, Soundprint Media Center, Inc
Carl Zimmer, Science writer and author of WoV book of essays, A Planet of Viruses
David Uttal, Cognitive science professor, Northwestern University
Benjamin Jee, Cognitive scientist, College of Holy Cross
Tom Floyd, Comic illustrator, Nebraska Educational …

Obesity And Cancer Screening According To Race And Gender., Heather Bittner Fagan, Richard Wender, Ronald E Myers, Nicholas Petrelli

Department of Family & Community Medicine Faculty Papers

The relationship between obesity and cancer screening varies by screening test, race, and gender. Most studies on cervical cancer screening found a negative association between increasing weight and screening, and this negative association was most consistent in white women. Recent literature on mammography reports no association with weight. However, some studies show a negative association in white, but not black, women. In contrast, obese/overweight men reported higher rates of prostate-specific antigen (PSA) testing. Comparison of prostate cancer screening, mammography, and Pap smears implies a gender difference in the relationship between screening behavior and weight. In colorectal cancer (CRC) screening, the …

End-Of-Life Care For Hospitalized Patients With Lung Cancer: Utilization Of A Palliative Care Service., Barbara Reville, M.S., Achpn, Marshal N Miller, B.S., Richard W Toner, M.S., Joanne Reifsnyder, Ph.D., Achpn

Department of Family & Community Medicine Faculty Papers

PURPOSE: High symptom burden and hospital mortality among patients with lung cancer argues for early palliative care intervention. Patient characteristics and discharge dispositions in hospitalized patients with lung cancer receiving usual care were compared to those referred to a new palliative care service.

METHODS: A retrospective database review of all lung cancer discharges receiving usual care (UC) and palliative care service (PCS) consultation was conducted. Demographics, length of stay, discharge disposition, and mortality were described and compared. Palliative Performance Scale scores were described according to discharge disposition in the PCS group. Disposition of all patients receiving either chemotherapy or surgery …

Transforming Chronic Care Education: A Longitudal Interprofessional Mentorship Curriculum, Lauren G. Collins, Md, Christine A. Arenson, Md, Christine Jerpbak, Md, Elena Umland, Pharmd, Stephen B. Kern, Phd, Otr/L, Faota, Leigh Ann Hewston, Pt, Med

Department of Family & Community Medicine Faculty Papers

Rationale:

Future state of academic medicine demands preparing students for collaborative, team-based practice.

Interprofessional education (IPE) is widely advocated as a key element to promote an effective redesigned healthcare system

Evidence and curricular resources describing effective IPE remain limited

Insulin Resistance In African-American And Caucasian Women: Differences In Lipotoxicity, Adipokines, And Gene Expression In Adipose Tissue And Muscle, Latasha M. Smith, Aiwei Yao-Borengasser, Tasha Starks, Mark Tripputi, Philip A. Kern, Neda Rasouli

Clinical and Translational Science Faculty Publications

Objectives: We tested whether African-American (AA) women are different from Caucasian women in regard to lipotoxicity, adipokines, and gene expression in adipose tissue and muscle.

Design: Insulin sensitivity (S_I), plasma adipocytokine levels, intramyocellular lipid (IMCL), and the expression of candidate genes in adipose tissue and muscle were measured in AA and Caucasian women.

Setting: This study was performed in an ambulatory general clinical research center.

Subjects: Subjects were healthy, nondiabetic AA and Caucasian women.

Interventions: There were no interventions.

Main Outcome Measures: Comparison of S_I, IMCL, plasma adiponectin, and the expression of candidate genes regulating adipogenesis, …

Matrix Metalloproteinase-9 Is Increased In Obese Subjects And Decreases In Response To Pioglitazone, Resat Unal, Aiwei Yao-Borengasser, Vijayalakshmi Varma, Neda Rasouli, Craig Labbate, Philip A. Kern, Gouri Ranganathan

Clinical and Translational Science Faculty Publications

Context: The study investigated the regulation of matrix metalloproteinases (MMP)-9 in obesity-associated insulin resistance in humans.

Objectives: The objectives of the investigation were to study MMP-9 regulation by insulin resistance and pioglitazone treatment in impaired glucose tolerant subjects using adipose tissue biopsies and study the mechanism of MMP-9 regulation by pioglitazone in adipocyte cultures.

Research Design: 86 nondiabetic, weight-stable subjects between 21 and 66 yr of age were recruited in a university hospital research center setting. All subjects underwent a sc adipose tissue incisional biopsy from the lower abdominal wall and insulin sensitivity testing using a frequently sampled iv glucose …

The Impact Of Exercise Training Compared To Caloric Restriction On Hepatic And Peripheral Insulin Resistance In Obesity, Robert H. Coker, Rick H. Williams, Sophie E. Yeo, Patrick M. Kortebein, Don L. Bodenner, Philip A. Kern, William J. Evans

Clinical and Translational Science Faculty Publications

Context: It has been difficult to distinguish the independent effects of caloric restriction versus exercise training on insulin resistance.

Objective: Utilizing metabolic feeding and supervised exercise training, we examined the influence of caloric restriction vs. exercise training with and without weight loss on hepatic and peripheral insulin resistance.

Design, Participants, and Intervention: Thirty-four obese, older subjects were randomized to: caloric restriction with weight loss (CR), exercise training with weight loss (EWL), exercise training without weight loss (EX), or controls. Based on an equivalent caloric deficit in EWL and CR, we induced matched weight loss. Subjects in the EX group received …

Obesity And Cancer, Rickie Brawer, Phd, Mph, Nancy Brisbon, Md, James Plumb, Md

Department of Family & Community Medicine Faculty Papers

Obesity has become the second leading preventable cause of disease and death in the United States, trailing only tobacco use. Weight control, dietary choices, and levels of physical activity are important modifiable determinants of cancer risk. If multi-factorial approaches to prevention and management are not implemented, obesity will likely become the leading modifiable cause of death in the coming years. Physicians have a key role in integrating these approaches into clinical care and advocating for systemic prevention efforts. This article provides: 1) an introduction to the epidemiology and magnitude of childhood and adult obesity; 2) the relationship of overweight/obesity to …

Persistent Nodular Rash In An Elderly Patient, Daniel Dejoseph, Md, James Studdiford, Md, Amber Stonehouse, Md, Beth Careyva, Md

Department of Family & Community Medicine Faculty Papers

A 62yo white male presented to same day clinic with an erythematous nodular rash. He was initially treated with antibiotics for a furunculosis, but the rash worsened and he was eventually found to have secondary syphilis. He is an MSM who had a prior history of syphilis, putting him at high risk for STI’s and HIV, and should have been undergoing annual screening. He was found to be HIV positive. The rates of STI’s and HIV are increasing in older Americans. Despite this, physicians do not regularly screen this population for unsafe sexual behavior. This case emphasizes the importance of …

The Physician's Response To Climate Change., Mona Sarfaty, Safiya Abouzaid

Department of Family & Community Medicine Faculty Papers

Climate change will have an effect on the health and well-being of the populations cared for by practicing physicians. The anticipated medical effects include heat- and cold-related deaths, cardiovascular illnesses, injuries and mental harms from extreme weather events, respiratory illnesses caused by poor air quality, infectious diseases that emanate from contaminated food, water, or spread of disease vectors, the injuries caused by natural disasters, and the mental harm associated with social disruption. Within several years, such medical problems are likely to reach the doorsteps of many physicians. In the face of this reality, physicians should assume their traditional roles as …

Research Annual Report 2008, Children's Mercy Hospital

Research Annual Reports

Annual report of the research at Children's Mercy Hospital in Kansas City MO, a pediatric medical center.

Intracerebral Hemorrhage For The Palliative Care Provider: What You Need To Know., B Brent Simmons, Susan M Parks

Department of Family & Community Medicine Faculty Papers

Intracerebral hemorrhage (ICH) makes up 10%-30% of all strokes. Palliative care providers are often asked to get involved with ICH cases to aid with development of short-term and long-term goals. Prognosis can be calculated using the ICH score (based on Glasgow Coma Score score, ICH volume, presence of intraventricular hemorrhage, age, and location of origin) or the Essen score (based on age, NIH Stroke Scale [NIHSS], and level of consciousness). Do-not-resuscitate (DNR) status is important to discuss with families. Expert consensus states DNR is appropriate if the patient has two of the following: severe stroke, life-threatening brain damage, or significant …

Endoplasmic Reticulum Stress Markers Are Associated With Obesity In Nondiabetic Subjects, Neeraj K. Sharma, Swapan K. Das, Ashis K. Mondal, Oksana Hackney, Winston S. Chu, Philip A. Kern, Neda Rasouli, Horace J. Spencer, Aiwei Yao-Borengasser, Steven C. Elbein

Clinical and Translational Science Faculty Publications

Objective: Adipocyte and hepatocyte endoplasmic reticulum (ER) stress response is activated in dietary and genetic models of obesity in mice. We hypothesized that ER stress was also activated and associated with reduced insulin sensitivity (S_I) in human obesity.

Research Design and Methods: We recruited 78 healthy, nondiabetic individuals over a spectrum of body mass index (BMI) who underwent oral and iv glucose tolerance tests, and fasting sc adipose and muscle biopsies. We tested expression of 18 genes and levels of total and phosphorylated eukaryotic initiation factor 2α, c-jun, and c-Jun N-terminal kinase 1 in adipose tissue. We compared …

Stearoyl-Coenzyme A Desaturase 1 Gene Expression Increases After Pioglitazone Treatment And Is Associated With Peroxisomal Proliferator-Activated Receptor-Γ Responsiveness, Aiwei Yao-Borengasser, Negah Rassouli, Vijayalakshmi Varma, Angela M. Bodles, Neda Rasouli, Resat Unal, Bounleut Phanavanh, Gouri Ranganathan, Robert E. Mcgehee Jr., Philip A. Kern

Clinical and Translational Science Faculty Publications

Context and Objective: Stearoyl-coenzyme A desaturase (SCD1) is the rate-limiting enzyme that converts palmitoyl- and stearoyl-coenzyme A to palmitoleoyl- and oleoyl-cownzyme A, respectively. SCD-deficient mice are protected from obesity, and the ob/ob mouse has high levels of SCD. This study was designed to better characterize SCD1 gene and protein expression in humans with varying insulin sensitivity.

Design, Participants, and Setting: In a university hospital clinical research center setting, SCD1 gene expression was measured in sc adipose and vastus lateralis muscle of 86 nondiabetic subjects; 10 wk of pioglitazone (45 mg daily) and metformin (1000 mg twice daily) treatment were assessed …

Angioedema After Local Trauma In A Patient On Angiotensin-Converting Enzyme Inhibitor Therapy, B. B. Simmons, Michelle A. Folsom, L.Eslie A. Bryden, James Studdiford

Department of Family & Community Medicine Faculty Papers

Angioedema is a side effect that is often associated with use of angiotensin converting enzyme inhibitor medications. These medications result in increased levels of circulating bradykinins. This case illustrates the result of a local traumatic event to the upper lip, presumably causing marked bradykinin release in a patient who was taking an ACE-inhibitor. The local release of bradykinin from trauma, in addition to decreased bradykinin catabolism secondary to ACE-inhibitor therapy resulted in angioedema predominantly in the upper lip. The angioedema resolved with discontinuation of the ACE-inhibitor.

Increasing Appropriateness Of Hospital Admissions In The Emilia-Romagna Region Of Italy., Daniel Louis, Francesco Taroni, Rita Melotti, Carol Rabinowitz, Maria Vizioli, Monica Fiorini, Joseph Gonnella

Department of Family & Community Medicine Faculty Papers

OBJECTIVES: The Emilia-Romagna region of Italy has reduced the number of available hospital beds and introduced financial incentives to curb hospital use. The goal of this study was to assess the impact of these policies on changes over time in the number of acute hospital admissions classified in diagnosis related groups (DRGs) that could be treated safely and effectively in alternative, less costly settings.

METHODS: The assessment of the appropriate site of care was based on analysis of hospital discharge data for all hospitals for the selected diagnosis related groups in the Emilia-Romagna region for 2001 to 2005. The necessity …

The Management Of Keloids: Hands-On Versus Hands-Off., James Studdiford, Amber Stonehouse, Marc Altshuler, Elliot Rinzler

Department of Family & Community Medicine Faculty Papers

Keloids are benign fibrous growths that appear in scar tissue. The lesions can be severely disfiguring and early recognition of genetic lesions is crucial. This case report outlines and reviews the important management strategies for these lesions and the requirement for extensive counseling for the patient and their family. Many potential medical and surgical interventions exist. Unfortunately, these lesions tend to recur and overall outcomes remain poor. Given patient susceptibility to disfiguring results, surgical intervention should be used with extreme caution.

Thrombospondin-1 Is An Adipokine Associated With Obesity, Adipose Inflammation, And Insulin Resistance, Vijayalakshmi Varma, Aiwei Yao-Borengasser, Angela M. Bodles, Neda Rasouli, Bounleut Phanavanh, Greg T. Nolen, Emily M. Kern, Radhakrishnan Nagarajan, Horace J. Spencer, Mi-Jeong Lee, Susan K. Fried, Charlotte A. Peterson, Philip A. Kern

Clinical and Translational Science Faculty Publications

OBJECTIVE-We examined the relationship between the expression of thrombospondin (TSP)1, an antiangiogenic factor and regulator of transforming growth factor-β activity, obesity, adipose inflammation, and insulin resistance.

RESEARCH DESIGN AND METHODS-TSP1 gene expression was quantified in subcutaneous adipose tissue (SAT) of 86 nondiabetic subjects covering a wide range of BMI and insulin sensitivity, from visceral adipose (VAT) and SAT from 14 surgical patients and from 38 subjects with impaired glucose tolerance randomized to receive either pioglitazone or metformin for 10 weeks. An adipocyte culture system was also used to assess the effects of pioglitazone and coculture with macrophages on …

Research Annual Report 2007, Children's Mercy Hospital

Research Annual Reports

Annual report of the research at Children's Mercy Hospital in Kansas City MO, a pediatric medical center.

An Update On The Diagnosis And Treatment Of Early Lyme Disease: "Focusing On The Bull's Eye, You May Miss The Mark", Amber Stonehouse, James S. Studdiford, C. Amber Henry

Department of Family & Community Medicine Faculty Papers

To confidently diagnose and treat Lyme disease, the clinician must first understand the natural history of this disease, especially its protean early manifestations. Emergency physicians, primary care physicians, and other providers need to be vigilant in terms of the timely recognition of erythema migrans (EM), the unique marker of early localized stage 1 disease. The classic EM, originally described as a slowly expanding bull's eye lesion, is now recognized to be present in only the minority of cases (9%); the dominant morphologic lesion of EM is now recognized to be the diffusely homogenous red plaque or patch, which occurs in …

Retinol Binding Protein 4 Expression In Humans: Relationship To Insulin Resistance, Inflammation, And Response To Pioglitazone, Aiwei Yao-Borengasser, Vijayalakshmi Varma, Angela M. Bodles, Neda Rasouli, Bounleut Phanavanh, Mi-Jeong Lee, Tasha Starks, Leslie M. Kern, Horace J. Spencer Iii, Amir Adel Rashidi, Robert E. Mcgehee Jr., Susan K. Fried, Philip A. Kern

Clinical and Translational Science Faculty Publications

Context: Retinol binding protein 4 (RBP4) was recently found to be expressed and secreted by adipose tissue, and was strongly associated with insulin resistance.

Objective: The aim was to determine the relationship between RBP4 and obesity, insulin resistance, and other markers of insulin resistance in humans.

Design and Patients: RBP4 mRNA levels in adipose tissue and muscle of nondiabetic human subjects with either normal or impaired glucose tolerance (IGT) were studied, along with plasma RBP4. RBP4 gene expression was also measured in adipose tissue fractions, and from visceral and sc adipose tissue (SAT) from surgical patients.

Setting: The study was …

Allergic Contact Dermatitis From Tea Tree Oil

Department of Family & Community Medicine Faculty Papers

The sudden appearance of a pruritic confluent erythematous rash on the anterior neck and upper back prompted a 30-year-old woman to seek medical attention. She had recently started applying 5% tea tree oil to the area to treat chronic, recurrent tinea versicolor. An herbal specialist had recommended this therapy.

Predoctoral Directors: Who Are They And What Do They Do In These Trying Times?, John Gazewood, Katherine Margo, Christine Jerpbak, Sandra Burge, Thea Ballinger, Richard Usatine

Department of Family & Community Medicine Faculty Papers

BACKGROUND AND OBJECTIVES: Family medicine faces declining student interest and funding. Predoctoral directors will help lead efforts to overcome these challenges. Academic success will be important for predoctoral directors to be effective leaders in academic health centers. We therefore sought to describe predoctoral directors and factors associated with their academic success.

METHODS: We carried out a cross-sectional survey of all family medicine predoctoral directors at US allopathic medical schools using a Web-based questionnaire. The response rate was 82%. We measured academic success using a variable combining rank and tenure status. We used bivariate analysis and multiple linear regression …

Development Of A Reliable And Construct Valid Measure Of Nutritional Literacy In Adults, James J. Diamond

Department of Family & Community Medicine Faculty Papers

NOTE: The Nutritional Literacy Scale can be found here: http://jdc.jefferson.edu/nls/1/

Background: Research into the relation of literacy to health status has not included measures of nutritional literacy. This may be a critical area in the study of chronic conditions such as hypertension and diabetes, which can both relate to obesity and nutrition. This paper details the development and psychometric characteristics of the Nutritional Literacy Scale (NLS), offered as a measure of adults' ability to comprehend nutritional information.

Methods: In order to assess the internal consistency and construct validity of the NLS, demographic data, readability statistics, NLS scores and …

Human Visfatin Expression: Relationship To Insulin Sensitivity, Intramyocellular Lipids, And Inflammation, Vijayalakshmi Varma, Aiwei Yao-Borengasser, Neda Rasouli, Angela M. Bodles, Bounleut Phanavanh, Mi-Jeong Lee, Tasha Starks, Leslie M. Kern, Horace J. Spencer Iii, Robert E. Mcgehee Jr., Susan K. Fried, Philip A. Kern

Clinical and Translational Science Faculty Publications

Context: Visfatin (VF) is a recently described adipokine preferentially secreted by visceral adipose tissue (VAT) with insulin mimetic properties.

Objective: The aim of this study was to examine the association of VF with insulin sensitivity, intramyocellular lipids (IMCL), and inflammation in humans.

Design and Patients: VF mRNA was examined in paired samples of VAT and abdominal sc adipose tissue (SAT) obtained from subjects undergoing surgery. Plasma VF and VF mRNA was also examined in SAT and muscle tissue, obtained by biopsy from well-characterized subjects with normal or impaired glucose tolerance, with a wide range in body mass index (BMI) and …

Toward A Biopsychosocial Understanding Of The Patient-Physician Relationship: An Emerging Dialogue, Herbert M. Adler

Department of Family & Community Medicine Faculty Papers

Complexity theory has been used to view the patient-physician relationship as constituted by complex responsive processes of relating. It describes an emergent, psychosocial relational process through which patients and physicians continually and reciprocally influence each other's behavior and experience. As psychosocial responses are necessarily biopsychosocial responses, patients and physicians must likewise be influencing each other's psychobiology. This mutual influence may be subjectively experienced as empathy, and may be skillfully employed by the clinician to directly improve the patient's psychobiology.

Research Annual Report 2006, Children's Mercy Hospital

Research Annual Reports

Annual report of the research at Children's Mercy Hospital in Kansas City MO, a pediatric medical center.

Family Medicine Predoctoral Education: 30-Something, Howard K. Rabinowitz

Department of Family & Community Medicine Faculty Papers

From the introduction:

The specialty of family medicine is now more than 30 years old. Fitting for its stage of life, family medicine predoctoral education has achieved appropriate maturity and parity with other core clinical departments and has assumed its role and responsibility in medical education within the academic health center. Of course, this wasn’t always true.