Anatomy Commons^™

The Treatment Of Obesity In The Context Of The Obesity Paradox In Patients With Heart Failure: A Narrative Review, Pamela L. Alebna, Sarah Martey, Anurag Mehta, Carl J. Lavie, Salvatore Carbone

EVMS School of Health Professions Faculty Publications

Purpose of review

While excess adiposity is a known risk factor for incident heart failure ( HF), once the condition is established, observational data suggest that increased body mass index (BMI) may confer a survival advantage. This paradox has emphasized the underlying roles of cardiorespiratory fitness (CRF), and body composition, particularly lean mass (LM), in influencing clinical outcomes.

Recent findings

In this review, we explore the multifaceted nature of the obesity paradox in HF, with a focus on emerging anti-obesity incretin-mimetic therapies, such as glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) receptor agonists. These agents …

Editor's Choice - International Expert Consensus On The Management Of Acute Aortic Type B Intramural Haematoma And Penetrating Ulcer, Francesco Squizzato, Mario D'Oria, Michele Antonello, Santi Trimarchi, Kevin Mani, Andrew Holden, Tilo Kölbel, Stephan Haulon, Eric Verhoeven, Dittmar Böckler, Tim Resch, Ali Azizzadeh, Joseph Lombardi, Michele Piazza, Aaron Thomas Fargion, Alexander Zimmerman, Ali Azizzadeh, Anders Wanhainen, Andrew Holden, Antonio Freyrie, Adam W. Beck, Adi Bachar, Barend M. E. Mees, Blandine Maurel, Cristoph A. Nienaber, Christos Karkos, Daniela Branzan, Darren Schneider, Randall Demartino, Dittmar Boeckler, Domenico Angiletta, Emanuel J. R. Tenorio, Enrico Gallitto, Eric Verhoeven, Fabio Verzini, Felice Pecoraro, Filippo Benedetto, Firas F. Mussa, Francesco Squizzato, Franco Grego, Gabriele Piffaretti, Emanuele Gatta, Giovanni Pratesi, Giovanni Tinelli, Giuseppe Asciutto, Glenn Wei Leong Tan, Hence Verhagen, Giacomo Isernia, Jean-Paul P. M. De Vries, Jacob Budtz-Lilly, Jorge Fernández-Noya, Jonathan Sobocinski, Joseph Hockley, Kak Khee Yeung, Andrea Kahlberg, Kevin Mani, Joseph V. Lombardi, Luca Bertoglio, Luca Mezzetto, Ludovic Canaud, Manar Khashram, Marcelo Ferreira, Marco Virgilio Usai, Mark G. Davies, Mark Farber, Martin Czerny, Matthew R. Smeds, Mauro Gargiulo, Germano Melissano, Michel Bosiers, Michele Antonello, Michele Piazza, Miranda Witheford, Michel M.P.J. Reijnen, Marc Schermerhorn, Nikolaos Tsilimparis, Nun Dias, Jean Panneton, Kosmas Paraskevas, Gianbattista Parlani, Patrick W.H.E. Vriens, Rafael Malgor, Raffaele Pulli, Ross Milner, Salvatore T. Scali, Sani J. Laukontaus, Santi Trimarchi, Sandro Lepidi, Konstantinos Spanos, Stefano Fazzini, Theodosios Bisdas, Thomas Maldonado, Tilo Koelbel, Tim Resch, Tomasz Jakimowicz, Nicola Troisi, Isabelle Van Herzeele, Vicente Riambau, Wassim Mansour, Wouter Van Den Eynde, Yamume Tshomba

Department Surgery Faculty Publications

Objective

The aim of this study was to achieve an international expert consensus on managing acute type B penetrating aortic ulcers (PAUs) and intramural haematomas (IMHs).

Methods

A modified Delphi consensus process was employed to develop recommendations for the management of acute type B PAU and IMH. Surveys were sent to international experts practicing in high volume aortic centres worldwide. Statements were voted on using a four point Likert scale in a three round Delphi process. Statements achieving grade A (full agreement 75%) or B (overall agreement 80%, full disagreement <  5%) were included as expert recommendations. Consistency of responses was measured using Cohen's κ and the intraclass correlation coefficient.

Results

Eighty three experts were included in the final analysis: …

Endovascular Arch Repair Using A Novel Single Branch Arch Stent Graft: 30-Day Results From The Chronic Dissection Arm Of The Nexus Aortic Arch Clinical Study To Evaluate Safety And Effectiveness Investigational Device Exemption Study, Bradley G. Leshnower, Jean Panneton, Himanshu J. Patel, Adam W. Beck, Mathew Wooster, Kyle W. Eudailey, Shinichi Fukuhara, Jae Cho, Sanford Zeigler, Westley Ohman, Puja Kachroo, Derek Brinster, Shahab Toursavadkohi, Mehrdad Ghoreishi, Brandley Taylor, Frank Arko, Paul Hayes, Ross Milner

Department Surgery Faculty Publications

Objective

Moderate levels of frailty or a previous sternotomy make open repair of aortic arch pathology high risk or even preclude any treatment. This study examined 30-day outcomes from the NEXUS Aortic Arch Clinical Study to Evaluate Safety and Effectiveness investigational device exemption (TRIOMPHE IDE) study of an off-the-shelf stent-graft system for Zone 0 endovascular aortic arch repair in patients with high-risk chronic dissection.

Methods

TRIOMPHE IDE is a prospective, multicenter study evaluating the NEXUS system (Endospan) in chronic aortic dissection (n = 54). Following cervical debranching, NEXUS was delivered into the arch first, followed by an ascending aortic stent-graft. …

Z Variant Heterozygosity In Alpha-1 Antitrypsin Deficiency: Disease Risk And Treatment Implications, Craig P. Hersh, Jeffrey H. Teckman, Pavel Strnad, Aaron Hakim, Tomás P. Carroll, Ian P. Hall, Auyon J. Ghosh, Igor Barjaktarevic, Noel G. Mcelvaney, Joseph E. Kaserman, David A. Lomas, Charlie Strange, M Bradley Drummond, Stephen I. Rennard, Kathi E. Hanna, Virginia C. Clark, Monica P. Goldklang, Peg Iverson, Andrew A. Wilson

Journal Articles: Pulmonary & Critical Care Med

BACKGROUND: Individuals heterozygous for alpha-1 antitrypsin deficiency (AATD) have one copy of the normal "M" allele and one copy of an abnormal allele ("Z", "S", or another variant) in the SERPINA1 gene. Historically, evidence has been lacking to support the concept that heterozygotes are at increased risk for liver and/or lung complications compared to individuals homozygous for the M allele. However, growing evidence suggests that inheritance of a single Z allele increases the risk of disease in some individuals. The Alpha-1 Foundation convened a workshop on October 27, 2023, in Bethesda, Maryland that included stakeholders from the research, pharmaceutical, and …

Pilot Study On The Use Of Multimorbidity Index In Patients Receiving Home Parenteral Nutrition, Michael M. Rothkopf, Mohan Pant, Zachary Rothkopf, Rebecca Brown Rdn, Jaime Haselhorst Rdn, Debbie L. Stevenson Rdn, Andrew Depalma Mba, Michael Saracco

Epidemiology, Biostatistics, & Environmental Health Faculty Publications

Background

Home parenteral nutrition (HPN) patients often have multiple comorbidities. A validated multimorbidity index (MMI) could help determine resource needs and risks with HPN. We evaluated MMI scoring to determine if it predicted HPN resource use and outcomes.

Methods

We performed a secondary analysis of 60 HPN patients from a previous study based on Cumulative Illness Rating Scale (CIRS) scoring. We examined three variables: PN formula changes, hospitalizations, and hospital length of stay (LOS). Density plots were produced to select a CIRS score cutoff value. Spearman correlations among the three variables of interest were computed. The data were then subjected …

The Relationship Between Phone Usage, Activity Participation, And Hand Strength, Debra Gibbs, Will Best, Raegan Adams, Amanda Finke, Rachel Pierce, Salem Swallows, Alisha Yoo

SPARK Symposium Presentations

Smartphone use among university students in the United States is steadily increasing. Longer duration of smartphone use has been associated with increased risk of smartphone addiction, reduced musculoskeletal strength, and engagement in meaningful activities. While prior research has examined these variables separately, limited evidence exists on the associations between smartphone use, hand grip and pinch strength, and extracurricular and leisure activities among U.S. university students. To address this gap, a correlational study was conducted using the Spearman rank correlation to analyze the relationship between phone use, activity participation, and hand strength. A Qualtrics survey including demographic information, phone usage, and …

Radial And Carotid Arterial Pulse Signals For Assessing Cardiovascular Function At Rest And During Post-Exercise Recovery In A Heart Transplant Patient: A Case Study, Md Mahfuzur Rahman, Mamun Hasan, Jennifer F. May, John M. Herre, Leryn Reynolds, Zhili Hao

Mechanical & Aerospace Engineering Faculty Publications

Aim: This study investigates the feasibility of using radial and carotid arterial pulse signals to assess cardiovascular (CV) function at rest and during post-exercise recovery in a heart transplant (HTx) patient. Method: Two micro-fabricated tactile sensors were used to simultaneously acquire arterial pulse signals at the radial artery (RA) and carotid artery (CA). Measurements were taken at rest and at multiple time points post-exercise on three subjects: an HTx patient, a percutaneous coronary intervention (PCI; coronary stent) patient and a healthy control. An SDOF-TF-based time-frequency analysis algorithm was applied to extract a comprehensive set of CV parameters, including heart rate …

What Does The Quality Of Life For Congenital Heart Defect Patients Look Like Across The Lifespan?, Kaylee F. Maynor

Undergraduate Honors Theses

Throughout history, birth defects have left a mark on patients and families across the world. From an infant's first few breaths to an elderly person's last breath, congenital heart birth defects play a major role in that person's life. There are many different types of birth defects that effect the heart. Each defect is unique and has different outcomes on the body. Some congenital heart diseases have multiple defects causing more than one complication. The treatment options for many of the common congenital heart birth defects have come a long way throughout decades of research. By diving into what heart …

Dose-Dependent Developmental Toxicity Of Cisplatin In Zebrafish Embryos, Reagan D. Sellers, Katherine T. Doucet, Jinhee Park, Andrea Florian

SPARK Symposium Presentations

Cisplatin is a widely used chemotherapy drug for treating various types of cancer. Although cisplatin is effective in killing cancer, it can also cause toxic side effects in normal tissues. Because cisplatin can cross the placental barrier, its use during pregnancy is generally avoided, particularly during early embryonic stages of fetal development. Exposure to cytotoxic drugs during embryogenesis may lead to developmental abnormalities, birth defects, or pregnancy complications. Understanding how cisplatin affects early development is therefore important.          
       Zebrafish (Danio rerio) are an established model for studying developmental toxicity due to their rapid external development, transparent embryos, and genetic similarity to …

Bayesian Reanalysis Of Early Remdesivir For The Treatment Of Covid-19 In Outpatients With High Risk Of Progression To Severe Disease, Mazin Abdelghany, Fang Yu, Stephen I. Rennard, Yeongjin Gwon

Journal Articles: Pulmonary & Critical Care Med

BACKGROUND: Though Bayesian methods are flexible, intuitive, and readily incorporated into clinical decision-making, with particular utility when prior information is available, they remain underutilized in the analysis of clinical trials.

METHODS: In PINETREE, a Phase 3 randomized controlled trial (RCT) of remdesivir (RDV) for the treatment of outpatients with COVID-19 at high risk of severe disease, the primary outcome of COVID-19-related hospitalization or all-cause death was reanalyzed using a range of reference and data-driven priors. Posterior probability distributions were used to calculate the probability that the estimated hazard ratio (HR) was below a range of clinically meaningful specified thresholds and …

Bringing Awareness And Education To Rural Areas About The Role Occupational Therapy (Ot) Has In Infant Care, Makenzi Richwald

Occupational Therapy Doctorate Capstone Posters

This capstone project focused on education and advocacy. The aim of my capstone project was to provide education to parents of eastern Kentucky (KY) about what Occupational Therapy (OT) can address with infants aged 0-18 months. I saw a gap in knowledge in the eastern KY community about what OT could do for infants and wanted to address this. Through my research, consultation with my mentors, and collaboration with the occupational therapists at my site (BPT) I discerned 14 areas of development and/or common reasons of needed referral for OT services by this age group. These educational materials aimed to …

Peculiarities Of Phosphatidylserine Externalization By Nano- And Microsecond Electric Pulses, Mantas Silkunas, Alayna Enos, Iurii Semenov, Giedre Silkuniene, Eleni Zivla, Olga N. Pakhomova, Andrei G. Pakhomov

Bioelectrics Publications

Phosphatidylserine (PS) externalization is a hallmark of apoptosis but can also be triggered within seconds by pulsed electric fields (PEFs). Whether PS reaches the outer leaflet by lateral migration through electropores or indirectly through Ca²⁺-dependent signaling and scramblase activation remains debated. We used total internal reflection fluorescence (TIRF) microscopy with Annexin V-Alexa Fluor 568 and/or bovine lactadherin-FITC to resolve PS externalization in HEK293 cells placed on an indium tin oxide (ITO) transparent electrode. PEF exposures produced discrete PS-positive puncta ("freckles") within ~ 10 s after a 20-µs pulse (1.2-2.5 kV/cm) or with a ~ 1-min delay after a …

Non-Invasive Detection Of Intracranial Pressure, Andrei V. Nesterenko

Honors Undergraduate Theses

Intracranial pressure is a critical metric used when managing tumors, strokes, TBIs, hydrocephalus, and other operative conditions. Traditional methods for continuous ICP monitoring, intraparenchymal catheters, epidural transducers etc., are invasive and carry a high risk of infection. Previous attempts to create accurate, easy to use, and non-invasive ICP monitoring techniques have been unsuccessful. In this study, we investigated the utility of supraorbital and posterior auricular photoplethysmography to monitor changes in ICP during orthostatic tilt and hyperventilation, which increase and decrease ICP respectively.

Through a continuous 5-minute recording on a tilt-table we characterized SOA and PAA waveforms in 12 participants (ages …

The Impact Of Hot V. Cold Water Immersion On Post-Exercise Recovery, Cameron Moss, Aaron Krukemeyer

Williams Honors College, Honors Research Projects

Muscle recovery following exercise-induced soreness has been the focus of extensive research and debate, with Cold Water Immersion (CWI) and Hot Water Immersion (HWI) emerging as two of the most widely used modalities. The purpose of this study was to compare the effects of CWI and HWI on muscle recovery by determining changes in maximal force production of knee extension, range of motion (ROM) of the hip joint in flexion, extension, and abduction, and subjective muscle soreness using a validated Likert scale. Seven male recreational athletes participated in hot and cold-water immersion, and passive recovery. Despite thorough data collection, the …

Off-Label Uses Of Deucravacitinib For Inflammatory Skin Conditions: Cases And Literature Review, Alexandra Nigro, Isabel C. Silva, Benjamin Gerstein, Jasper Dayanan, Saakshi Khattri

Department Dermatology Faculty Publications

Deucravacitinib is an oral, selective, allosteric tyrosine kinase 2 (TYK2) inhibitor approved for the treatment of moderate-to-severe plaque psoriasis and psoriatic arthritis. Deucravacitinib may offer a more selective approach compared to traditional Janus kinase (JAK) inhibitors. Emerging data support the use of deucravacitinib in inflammatory dermatoses beyond psoriatic disease. We present our clinical experience using deucravacitinib off-label in patients with challenging inflammatory skin disease and contextualize our findings within the current literature. We report three female patients aged 31–63 years with refractory inflammatory skin conditions, including two with dermatomyositis and one with pityriasis rubra pilaris (PRP). All patients had persistent …

Stim1-Dependent Treg Dysfunction Promotes Cardiometabolic Hfpef: Insights From Patients And Animal Studies, Balaji Srinivas, Alluri Kiran, Hongmei Peng, Jiang Xu, Paula Fortuno, Jennifer May, Ismail El Moudden, Nour-Eddine Rhaleb, John M. Herre, Raymond L. Benza, Khalid Matrougui

Department of Biomedical and Translational Sciences Faculty Publications

Background

Heart failure with preserved ejection fraction (HFpEF) arises from chronic cardiometabolic and vascular stress and is increasingly recognized as an inflammatory syndrome with immune dysregulation. Regulatory T cells (Tregs) are critical modulators of cardiovascular inflammation, yet the mechanisms driving Treg dysfunction in HFpEF remain poorly defined. stromal interaction molecule 1 (STIM1)-dependent calcium signaling is a key stress-responsive pathway in immune cells; however, its role in Treg maladaptation during HFpEF remains unknown.

Methods

Circulating Tregs from patients with and without HFpEF were analyzed for abundance, STIM1 expression, and stress-associated signaling pathways. To establish causality, mice with Treg-specific deletion of STIM1 …

Yk-4-250 Mitigates Gastrointestinal Radiation Syndrome And Promotes Overall Survival Following Partial Body Radiation Injury, Vidya P. Kumar, Yali Kong, Kan Wang, Asa R. Britton-Jenkins, Stanton Dulan, Landon L. Moore, Debra Saunders, Randal May, Rheal Towner, Sanchita P. Ghosh, Courtney W. Houchen, Milton L. Brown

Department of Biomedical and Translational Sciences Faculty Publications

Acute gastrointestinal radiation syndrome (GI-ARS) is a significant health threat following high-dose ionizing radiation (IR) exposure, leading to severe morbidity and mortality. The syndrome is characterized by gastrointestinal tissue damage caused by angiotensin II (Ang II) and reactive oxygen species (ROS), resulting in impaired GI function, systemic bacteremia, multi-organ failure, and eventual death. Dysregulation of the renin-angiotensin system (RAS) via Ang II exacerbates ROS production through activation of the Angiotensin II type 1 receptor (AT1R). This underscores the need for agents capable of both scavenging ROS and inhibiting AT1R activity. To address this, we developed YK-4-250, a Tempol-conjugated angiotensin receptor …

Biomechanical Integrity Of The Female Pelvic Floor: A Comparison Of Military And Civilian Women, Vladimir Egorov, Peter Takacs, Vincent Lucente, Heather Van Raalte, Joy A. Greer, Noune Sarvazyan

Department of Obstetrics & Gynecology Faculty Publications

Introduction

The health of the pelvic floor depends on the integrity of its muscles, connective tissue, ligaments, and their innervation. The female pelvic floor may be more vulnerable to repetitive heavy loads in a military environment than the male pelvic floor because of anatomical and physiological differences. The study aim was to identify and explore possible differences in the female pelvic floor conditions between active military and civilian women with similar demographics.To identify and explore possible differences in the conditions of the female pelvic floor between active military women and civilian women with similar demographics.

Materials and Methods

Military active …

Procedural-Based Contemporary Management Of Bell's Palsy Long-Term Sequelae: A Narrative Review, Robert M. Frederick, Rhorie Kerr, Eric Dobratz, William Dougherty

Department of Otolaryngology (ENT) Faculty Publications

Objective

To describe the long-term sequelae of Bell's palsy and summarize available treatment options, including recent advances, so that general otolaryngologists and other practitioners are aware of the clinical findings and available interventions.

Data Sources

PubMed.

Review Methods

A literature search was performed on December 18, 2024, via PubMed using keywords such as "synkinesis," "selective myectomy," "selective neurectomy," "botulinum toxin," "intervention" in the context of "Bell's palsy" with preference for articles published within the last 5 to 10 years but inclusion of select older articles that provided necessary context for the current topic. Articles included in the review were written …

Severity And Duration-Dependent Aortic Stiffening In A Rabbit Coarctation Model Identifies Constitutive Material Parameters As Promising Regional Biomarkers For Hypertension Progression, Arash Ghorbannia, Jamasp Azarnoosh, John F. Ladisa Jr.

VMASC Publications

Coarctation of the aorta (CoA) alters hemodynamics and drives regional remodeling, yet the influence of severity and duration on constitutive properties is undefined. We quantified mechanical responses from CoA to identify constitutive parameters capturing stiffening across clinical severities and durations. Mild (≤ 12 mmHg), intermediate (13–20 mmHg), and severe (> 20 mmHg) CoA was created in rabbits for short, long, and prolonged durations (~ 1, 3, or 22 weeks, respectively). Stress–stretch curves from proximal and distal regions were fit with multiple constitutive models (Linear Elastic, Neo-Hookean, Yeoh, Ogden, Mooney–Rivlin, Holzapfel). Model performance was evaluated by normalized RMSE and R², with …