2021
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Item Tai Chi and Diabetic Peripheral Neuropathies(2021) Janssen, Allison; Kolenovic, Mersida; Logsdon, Liana; Liu, Howe; Salem, YasserBackground: Every year about 1.5 million Americans are diagnosed with diabetes. A common and major complication these individuals face is the development of peripheral neuropathies, typically due to uncontrolled glucose levels. The purpose of this systematic review is to identify the benefits of Tai Chi as an exercise intervention to alter peripheral sensation and balance related to neuropathy in diabetic patients. Tai Chi is an ancient Chinese martial art that incorporates elements of balance, strength, postural control, and concentration. Methods: This systematic review examines the effects of a Tai Chi program based on studies from PubMed database within the past 20 years. Each intervention program had varying parameters like numbers of forms, session durations and session frequencies. Results: Six studies show improvement in ankle proprioception, quality of life, glucose control, nerve conduction velocities in legs and arms, vascular reactivity index, plantar sensation, and locomotor stability. Each study had less than 60 participants and a Tai Chi program of at least 8 weeks of Yang, Sun, or Cheng style with progressions at the instructor's discretion. Conclusion: Tai Chi is a beneficial intervention for people with peripheral neuropathy. The six studies showed improvement in glucose control, quality of life, sensation and standing balance components. After thorough analysis, this review exposes several deficits in the existing research. Further studies could control for more balance variables, include larger sample sizes, and investigate the efficacy of specific Tai Chi program parameters.Item Finding the PIN in the Haystack: Case report on the localization of a Posterior Interosseous Nerve lesion(2021) Colucci, Patricia; Mirochnitchenko, Alissa; Ooi, PrestonBackground: Posterior interosseous nerve (PIN) lesions are uncommon, with an incidence of 0.003%. This case report investigates a PIN lesion distal to the Arcade of Frohse with an unknown etiology. Case Information: A 45 year old male with a history of multilevel anterior cervical spine discectomy and fusion (ACDF) and right cubital tunnel release presented to clinic with persistent right hand weakness. Although his numbness had improved in the fourth and fifth digits, he still experienced dorsal forearm fatigue and thumb extension weakness on the right side. He denied recent trauma or any other comorbid chronic conditions. Physical exam revealed 5/5 strength in bilateral upper extremities, 1/5 strength in first digit extension and abduction, 2/5 strength in second digit extension, and 4/5 strength in third through fifth digits. A nerve conduction study (NCS) was conducted and revealed appropriate amplitudes, latencies and conduction velocities in the median and ulnar sensory and motor nerves, and radial sensory nerves bilaterally. Electromyography (EMG) revealed residual abnormalities attributed to recent ulnar nerve impingement and chronic findings due to C5-6 ACDF. EMG was further suggestive of a radial neuropathy between the takeoff of the nerve to abductor pollicis longus (APL) and extensor pollicis brevis (EPB). The patient was referred to surgery for further management. Conclusions: This case demonstrates the importance of the investigation of new pathology when multiple, chronic pathologies exist. Furthermore, this case highlights that EMG, NCS, and anatomical knowledge play crucial roles in uncovering complex pathology.Item Chronic Intermittent Hypoxia Alters the Chloride Gradient in Median Preoptic Nucleus (MnPO) Neurons of Rats(2021) Farmer, George E.; Little, Joel; Bachelor, Martha E.; Rybalchenko, Nataliya; Cunningham, JosephRats exposed to chronic intermittent hypoxia (CIH), an animal model simulating the hypoxemia associated with obstructive sleep apnea, exhibit persistent elevations in blood pressure during normoxic periods. In MnPO neurons, angiotensin II type 1 receptor function mediates reductions in GABAa inhibition that become excitatory following CIH. Here, we use the ratiometric Cl- sensor, ClopHensorN, to monitor the chloride flux of MnPO neurons in normoxic (Norm) and CIH treated rats following GABAa activation. Using isoflurane anesthesia, male Sprague-Dawley rats (250-350g) received microinfusions of AAV9-Cre in PVN and DIO-ClopHensorN in MnPO. After recovery, rats underwent 7 consecutive days of CIH (6 min cycles of 3 min 21% O2, 3 min 10% O2 repeated 10x/hr for 8 hours) or Normoxia. For ClopHensorN imaging, rats were anesthetized with isoflurane and coronal slices containing MnPO were cut using standard in vitro slice procedures. Images were captured every 3 sec. Cl- flux was determined from ratiometric responses to 10 s focal application of muscimol (100 uM). Twelve rats (6 Norm, 6 CIH) were used for ClopHensorN studies. In MnPO CIH neurons, 20.1% showed decreased fluorescent ratios while 0.3% showed increased ratios indicative of Cl- efflux. In MnPO Norm neurons, 41.9% showed a muscimol dependent decrease in fluorescent ratio with 0 cells showing an increase. The magnitude of muscimol dependent decreases in fluorescent ratios were reduced in CIH treated rats suggesting reduced GABAa inhibition. Results demonstrate CIH alters Cl- flux of PVN projecting MnPO. These changes may contribute to hypertension associated with CIH.Item Rate of Change with Respect to Time Trends of Net 5-Year Survival in the Absence of Other Causes of Death: Male and Female Adolescent and Young-Adult Cancer Patients(2021) Ewart, Mackenzie; Bowman, William; Dorton, Cody; Bleyer, Archie; Rutledge, LauraRate of Change with Respect to Time Trends of Net 5-Year Survival in the Absence of Other Causes of Death: Male and Female Adolescent and Young-Adult Cancer Patients Cancer is a devastating disease process that affects the lives of millions around the world. Of particular interest, within the field of cancer research, is the measurement of therapeutic progress made throughout time, which is commonly measured through analyses of 5-year survival statistics. While cancer therapies have come a long way, the adolescent and young adult (AYA) cancer patient population faces many unique obstacles such as cancer identification, proper diagnosis, adequate treatment, and continuity of care. These obstacles have led to a lack of improvement in the outcomes for AYA cancer patients when compared with patient populations both younger and older. The derivation of 5-year survival statistics from the Surveillance, Epidemiology, and End Results Program (SEER) 17 registries yields a measurable disparity in the therapeutic improvement of the AYA cancer patient population when analyzed against the derivation of 5-year survival statistics for children and adults in the United States. More initiatives and research are needed to correct the lagging disparities and to improve the overall survival in the AYA population.Item Likelihood of clinics to refer pediatric hypertension patients to nephrology(2021) Noorani, Sahil; Khanna, AlishaPurpose Physician adherence to diagnostic criteria for pediatric hypertension (HTN) remains an area of active research. We investigated which specialty clinics were more likely to appropriately refer hypertensive patients to a nephrology clinic. Methods A retrospective study was conducted on patients, aged 3-18 years, who were referred to the Cook Children's Medical Center (CCMC) nephrology clinic for elevated blood pressure (EBP) over a 3-year period. Patients were excluded if they were referred previously, were referred for other conditions, or did not have ≥1 prior visit at CCMC with blood pressure recorded. Up to 10 prior visits with EBP were recorded for each patient. Analyses were performed to determine which clinics were more or less likely to refer to CCMC nephrology for hypertension. Results There were 120 patients referred with a total of 626 prior visits recorded with EBP; thus, in 16% of recorded visits with EBP, patients were referred to nephrology. Visits to outside clinics (35%) were more likely to give referrals than were visits to CCMC clinics (13%). Primary care (20%), emergency and urgent care (18%), and especially cardiology (29%) clinics were prone to refer. However, endocrinology (13%), neurology (2%), and other specialty clinics (9%) were less likely to refer. Conclusion Cardiology clinics were especially likely to refer, whereas neurology clinics were unlikely to refer for hypertension. This disparity could be attributed to unfamiliarity with the diagnostic criteria apparently linked to specialty-related exposure to this patient population. These results have implications for provider education at CCMC.Item Patient-Physician Trust(2021) Khan, RijaPurpose: This literature review explores factors contributing to the patient-physician relationship from the perspective of both patient and physician. Methods: A literature review was created from initial PubMed search of "patient-physician trust." Papers were: 2 qualitative essays, one about patient-physician trust from a surgeon's perspective and another about shared decision-making; a qualitative study with physician interviews and focus groups describing low and high trust relationships; and two studies analyzing data from patient surveys focusing on associations with patient-provide trust and communication scores. Results: 1- Physician trust factors: a) Patient transparency in providing necessary medical information b) Letting physician know about major changes in condition c) Telling physician about all medications/treatments d) Understanding the physician, being actively involved in managing the condition e) Respecting physician's time and boundaries f) Not making unreasonable demands or manipulating office visits for secondary gain g) Keeping appointments 2-Patient trust factors: a) Social trust refers to trust a patient has of the institution itself. b) Patients self-reporting negative attitudes toward the healthcare system demonstrated significantly lower trust scores (p< 0.001). c) Socioeconomic factors: lower income and education (p= 0.01) d) Public health insurance or no coverage compared to private health insurance reported significantly lower provider-patient communication scores (p< 0.001). Conclusions: This review showed that patient-physician trust is complex and multifactorial. Awareness of these factors are critical for developing a successful healthcare delivery model.Item Physical Inactivity Among High School Students: A Public Health Concern of the 21st Century(2021) Deckard, AmberPurpose: Physical activity among school aged children is a leading public health concern with physical, mental, social, and financial implications. According to the Centers for Disease Control and Prevention (CDC), only 1 in 5 high school students meet the CDC's recommended 60 minutes of daily physical activity. The purpose of this report was two-fold to determine the prevalence of Texas high school students not meeting the CDC's physical activity recommendations and determine the relationship between the student's physical education class attendance. Methods: A web-based analysis was conducted utilizing the Youth Risk Behavior Surveillance System (YRBSS). Responses from individuals in 9th through 12th grade were included. YRBSS Analysis tools were utilized for performing a cross-tabulation and determining statistical significance within the variables of sex, race/ethnicity, grade level, and sexual identity with a (p< 0.05) significance level. Results: The majority of high school students do not meet the recommended minutes of physical activity. Females are more likely than males to not meet guidelines, and Black students and Hispanic students are more likely than White students to not meet guidelines. The relationship between the two measures were statistically significant in which students who did not attend physical education class were not meeting the CDC's recommendations either. Conclusion: Health disparities among students who do not meet physical activity recommendations were identified and need to be addressed. Adopting policies and allocating resources for longer physical education classes, more recreational activities, as well as ensuring safe environments for recreation are recommended next steps.Item Natural Killers: Targeting NK Cells in Cancer Immunotherapies(2021) Buller, Casey W.; Mathew, Stephen O.Natural Killer (NK) cells are innate lymphoid immune cells that have garnered attention for their pivotal role in tumor surveillance and their ability to recognize and clear cancerous cells. NK cells' delicate balance of activating and inhibitory receptors and those receptors' engagement with target cancer cells determines their effector function. NK cells show promise in the treatment of solid and hematologic tumors. Additionally, targeting NK cells to clear cancerous cells offers advantages over CD8+ T cells, such as not relying on major histocompatibility complex (MHC) I. Successful use of NK cell therapies does have challenges that must be overcome. Several strategies include the use of monoclonal antibodies, chimeric antigen receptor (CAR) NK cell therapy, bi- and tri-specific killer engagers (BiKES and TriKES), and immune checkpoint molecules.Item Rats with placental ischemia and preeclampsia-like symptoms have increased circulating cell-free mtDNA(2021) Gardner, Jennifer; Cushen, Spencer; Morton, Jude; Spaans, Floortje; Kirschenman, Raven; Davidge, Sandra; Phillips, Nicole; Goulopoulou, StylianiPreeclampsia (PE) is a hypertensive disorder of pregnancy, which is characterized by placental mitochondrial dysfunction. Increased circulating cell-free mitochondrial DNA (mtDNA) has been also reported in PE. Animal models are commonly used to study the role of placental dysfunction in the maternal syndrome of PE. The objective of this study was to determine the concentrations of circulating mtDNA in rat models of placental ischemia. Placental ischemia was induced in rats on gestational day (GD) 14 by placing clips on a) the abdominal aorta and ovarian arteries (reduced uterine perfusion pressure (RUPP)) and b) ovarian arteries and uterine arteries (selective RUPP (sRUPP)). Sham rats had clips placed on intraabdominal fat. Different groups of rats were exposed to hypoxia (11% O2) or maintained at atmospheric conditions (21% O2) from GD6 to GD21. Blood samples were collected on GD21. Real time PCR quantification of mtDNA was performed on DNA extracts from serum using TaqMan™ probes and chemistry. mtDNA copy number (CN) was greater in RUPP and sRUPP rats compared to their respective controls (Sham (11) vs. RUPP (11): 0.18 ± 0.04 CN/µl vs. 0.30 ± 0.04 CN/µl, p-value: 0.04; Sham (8) vs. sRUPP (10): 24.84 ± 3.29 CN/µl vs. 54.38 ± 3.29 CN/µl, p-value: 0.016)). Hypoxia did not affect mtDNA CN (Control (7) vs. Hypoxia (9): 0.28 ± 0.05 CN/µl vs. 0.36 ± 0.04 CN/µl, p-value: 0.28). Rats with placental ischemia have increased circulating cell-free mtDNA similar to what is seen in pregnant women with PE.Item Evaluating the Relationship between Race and Amblyogenic Risk Factors in Preschool Children in Fort Worth, Texas(2021) Karsaliya, Gopal; Omar, Salma; Manning, Sydney E.; Luna-Smith, Annabel; Aryal, Subhash; Mozdbar, SimaBackground Amblyopia (lazy eye) is the most common cause of vision loss in children. The prevalence is between 2-5% in the United States. Amblyogenic risk factors include early visual deprivation, strabismus, anisometropia, and media opacities such as a cataract. If treatment for amblyopia is not initiated before the age of 7, the likelihood of successful correction begins to drastically decline with age. Previous studies have found correlations between race and various vision abnormalities. This study aims to assess the incidence of myopia, hyperopia, and astigmatism among pre-Kindergarten children of different racial groups in Fort Worth, TX, as well as evaluate any racial differences in the presence of amblyogenic risk factors. Methods Using the PlusoptiX refractometers at 37 local elementary schools, researchers collected refractive error data of N=2,258 children under the age of 6, allowing for the detection of hyperopia, myopia, astigmatism, and anisometropia. The children's age, race, and sex were also recorded. A chi-square test was done to compare proportions of male/female participants, and odds ratios were calculated for each amblyogenic risk factor between racial/ethnic groups. Results Those with at least one amblyogenic risk factor accounted for 27.82% of the sample. There was a significant difference in astigmatism as an amblyogenic risk factor between Black and Hispanic groups (OR=0.6039, 95%CI 0.46-0.79) and between White and Hispanic groups (OR=0.2387, 95%CI 0.17-0.34). Conclusion The results of this study suggest Hispanic children were at increased risk of developing amblyopia compared to Black and White children in Fort Worth.Item In-vitro Blood-Brain Barrier Models: An Emerging Platform for Central Nervous System Drug Discovery and Delivery(2021) Shah, Brijesh; Dong, XiaoweiPurpose: Blood-brain barrier (BBB) and its components protects the brain, but drug delivery sufficient to induce clinical effects is hindered causing challenges for therapeutic translation. To study drugs and their delivery systems across the BBB, numerous in-vitro BBB models have been studied. However, the limitations among them are still unanswered causing poor in-vivo imitation. Therefore, we performed an exhaustive literature study on in-vitro BBB models/methods to summarize which model/method could be futuristic. Method: Literature search in PubMed showed that nearly 400 research and review reports were published in last two decades. Three major models including two-dimensional (2D), stem cell and three-dimensional (3D) models were discussed and compared. Each type of model was reviewed in depth to identify an ideal in-vitro model that could closely mimic the in-vivo BBB microvasculature. Results: In 2D models, while cocultures over monocultures showed improved barrier integrity none of them mimicked shear stress. Additionally, the results between double and triple cocultures were controversial. Irrespective of model types, human stem cells revealed an excellent barrier phenotype against other cellular sources. 3D models such as chip-based and microfluidic encompassing multiple compartments and shear stress imitated the BBB microenvironment more realistically than 2D models. However, cost, complex design and poor scalability are few setbacks of 3D models. Conclusion: Considering key limitations of current in-vitro BBB models, the microfluidic technology in combination with stem cells would be the next generation in-vitro models that could best mimic the BBB phenotype.Item TGFβ2 induces Chronic Endoplasmic Reticulum Stress in Trabecular Meshwork cells(2021) Patil, Shruti; Kasetti, Ramesh; Maddineni, Prabhavathi; Zode, GulabPurpose:TGFβ2 induced extracellular matrix(ECM)accumulation is known to be associated with glaucomatous trabecular meshwork(TM)damage and IOP elevation. Previously, we have demonstrated that abnormal ECM accumulation leads to endoplasmic reticulum(ER)stress in TM. Here, we investigated whether TGFβ2 induces ER stress in TM cells and whether chronic ER stress plays a pathological role in dysfunction of TM cells. Methods:Primary human TM cells were treated with vehicle or recombinant TGFβ2(5ng/mL) to determine its effect on chronic ER stress markers(GRP78,ATF4 and CHOP)and ECM proteins(Fibronectin and Collagen-I/IV). Chronic ER stress-induced ATF4/CHOP were genetically knocked-down using targeted CRISPR/Cas9 expression plasmids, or by transducing with ad5-ATF4deltaRK that inhibits endogenous ATF4 activity. The effect on IOP of intravitreal gene delivery of active-TGFβ2 viral-vector in Chop-/- and C57BL/6J mice was evaluated. Pharmacological inhibition of ER stress using ATF4/CHOP inhibitor ISRIB and chemical chaperon sodium4phenylbutyrate(PBA) was also determined on TGFβ2-treated TM cells. Results:Westernblot and immunostaining demonstrated that TGFβ2 induced chronic ER stress markers along with increased levels of ECM proteins, suggesting TGFβ2-induced ECM deposition is associated with ER stress. Knockdown of key transcriptional factors, ATF4/CHOP, and ISRIB treatment prevented TGFβ2-induced ECM expression and reduced ER stress in TM cells. Moreover, activeTGFβ2 viral delivery caused no IOP elevation in Chop-/-mice compared to control C57BL/6J mice. Treatment of TM cells with PBA also inhibited TGFβ2-induced fibronectin deposition via induced expression and activation of MMP2/9. Conclusion:This study indicates that TGFβ2 induces chronic ER stress, which is associated with increased ECM accumulation.Item Fall Risk Screening in the Elderly(2021) Scribner, Jacob; Colmenero, Evan; Gibson, John; Hadley, LescaPurpose: The purpose of this project was to increase fall screening for patients over the age of 65. Elderly individuals are at increased risk for falling, and at an increased risk of injury from falls. We set out to investigate if implementing more screening for this vulnerable population would identify those at risk. Methods: We used a simple "yes or no" questionnaire during Medicare annual wellness visits that identifies at-risk individuals based on different attributes that put an individual at higher risk for falling. Based on the answers, we evaluated if a patient is at risk, and, if so, what interventions can be implemented in order to decrease the risk of falling. Results: We were able to identify patients who required intervention to prevent future falls. Because there was no prior method of screening patients over the age of 65 for falls at this clinic, our post-intervention data was able to screen 75% of eligible patients. Conclusions: We found that a simple questionnaire can be a useful tool to determine which patients are at an increased risk. There were some limitations; due to COVID-19, many staff members were out for extended periods of time, thus limiting the amount of data collected. Additionally, as the questionnaire required additional time during a patient encounter, there was not time to survey every eligible patient. Moving forward, a systematic implementation for all Medicare visits would streamline the process and allow for further identification of those at risk for falls.Item Perception of pregnant medical students' ability(2021) Toufexis, Andi; Tierny, Emma; Fulda, KimberlyPurpose: Medical school curriculum is very rigorous and many students face challenges in life while struggling to keep up with their studies. Pregnancy is one challenge that some students experience and there is a lack of research on the correlation of pregnancy and medical school performance. We asked about the perceived change in ability in medical school due to pregnancy and the differences in perception between those who have and have not been pregnant in medical school. Methods: A survey was e-mailed to medical students in the fall semester of 2019 with a reminder in the spring semester of 2020. Descriptive statistics are provided to look at responses for all students and those who have been pregnant in medical school. Results: Sixty-eight percent (n=102) of 150 respondents were female, and 8 (5.3%) had been pregnant while in medical school. Students that have never been pregnant in medical school are likely to rate change in academic ability as 'decreased' (n=63, 51.6%) or 'greatly decreased' (n=33, 27.0%) while students who have been pregnant experienced 'decreased' (n=4, 50.0%) or 'no change' (n=4, 50.0%) in ability. Additionally, students who have been pregnant in medical school (n=4, 50%) rate support services higher than their counterparts (n=27, 22.1%). Conclusion: This study suggests that students who have never been pregnant in medical school believe there is a greater decrease in ability than those that have experienced pregnancy while in medical school.Item Pediatric asthma: social, environmental, and potential genetic disparities across racial/ethnic groups(2021) Raju, Shilpa; Moss, Katelyn; Cross, DeannaPurpose: Asthma affects nearly 300 million people worldwide and is the most common chronic condition in children. The purpose of our study was to identify potential disparities between racial and ethnic groups in children with asthma. We analyzed the social and environmental factors contributing to asthma as well as the potential genetic factors. Methods: A literature review was conducted using key words (asthma, children, race, etc.) on PubMed and Center for Children's Health to determine what factors affected asthma diagnosis. To identify genetic contributions to asthma, we used resources such as ClinVar and dbSNP to identify genes associated with asthma. Results: Housing quality, pollution, discrimination, and place of residence all contributed to disparities in asthma prevalence among the pediatric population. Black patients have 1.25 times the asthma prevalence and twice the mortality rates of the U.S general population. Compared with non-Hispanic white children, Asian Indian, Native American and multiple-race children had higher odds for current asthma. Hispanic patients were similar in prevalence patterns to black patients. Genetic loci on 17q21, near IL1RL1, TSLP and IL33 are associated with asthma risk in three ethnic groups while the PYHIN1 and PTCHD3 genes are associated with asthma in the African American population. We identified 19 known asthma-related genes that are still not well characterized for racial/ethnic allelic differences. Conclusions: Environmental factors leading to the disparities in asthma diagnosis have been studied extensively. Further research is needed to analyze gene associations with asthma in ethnic groups and gene- environment interactions.Item CELL-FREE MEMBRANE-BOUND AND MEMBRANE-UNBOUND MITOCHONDRIAL DNA IN MATERNAL CIRCULATION IN PREECLAMPSIA(2021) Cushen, Spencer; Ricci, Contessa; Bradshaw, Jessica L.; Silzer, Talisa; Blessing, Alexandra M.; Sun, Jie; Scroggins, Sabrina; Santillan, Mark; Santillan, Donna; Phillips, Nicole; Goulopoulou, StylianiPURPOSE: Cell-free circulating mitochondrial DNA (CFCmtDNA) is a damage-associated molecular pattern (DAMP) that activates Toll-like receptor-9 (TLR-9). Previous studies suggested that CFCmtDNA may be a potential pathogenic trigger or a contributor to the maintenance of preeclampsia. The main objectives of this study were 1) to determine absolute concentrations of CFCmtDNA, in membrane-bound and -unbound states, independent of nuclear DNA (nDNA) changes, in cases with preeclampsia and healthy controls and 2) to implement a penalized regression analysis to establish the contribution of CFCmtDNA to preeclampsia diagnosis and its interaction with commonly collected patient characteristics. METHODS: Plasma CFCmtDNA (MT-ND5 gene) concentrations were quantified using an absolute quantification protocol. DNase I concentrations in maternal plasma were measured using an enzyme-linked immunosorbent assay and TLR-9 activity was monitored using SEAP reporter 293 cells expressing the human TLR-9 gene. RESULTS: Concentrations of CFCmtDNA were reduced in preeclampsia compared to healthy controls both in lysis buffer-treated samples (P=0.02) and in samples not treated with lysis buffer (P< 0.0001). Even though CFCmtDNA concentrations were reduced, plasma from women with preeclampsia induced greater TLR-9 activation than plasma from gestational age matched controls (P< 0.01). Multivariate analysis showed that high concentrations of nDNA and DNase I, a prior history of preeclampsia, and a lower concentration of CFCmtDNA are predictors of preeclampsia diagnosis. CONCLUSIONS: In conclusion, our data demonstrate an increased immunostimulatory potential of CFCmtDNA and upregulation of DNA degradation mechanisms in women with preeclampsia at the third trimester.Item Determining the cytotoxicity of Clotam and Copper-Clotam against Cardiomyocytes(2021) Siraj, Sohail; Patel, Krishna; Mukka, Lasya; Sankpal, Umesh; Basha, RiyazBackground: Chemotherapy (ChT) is required in the treatment of many cancers. Most ChT agents exhibit unwanted side-effects by causing damage to healthy cells. Side effects from many common ChT agents are leaving pediatric cancer survivors with lasting organ system damage, specifically damage to the heart. Past studies conducted by our group demonstrated the anti-cancer activity of clotam (tolfenamic acid-TA) and copper-clotam (CuTA). Our laboratory demonstrated the anti-cancer activity of CuTA against several cancer cell lines. CuTa is showing higher cytotoxicity against cancer cells even at much lower dose than TA. Our long term objective is to test CuTA to sensitize cancer cells to ChT. Methods: Cardiomyocytes H9c2 (cell line derived from rat heart tissue) originally obtained from the American Type Culture Collection (Manassas, VA) were cultured as per the supplier's instructions. H9c2 cells were treated with TA or Cu-TA or Doxorubicin and combinations (for example, TA and Doxorubicin) and cell viability assay was measured using CellTiterGlo (Promega) kit at 48 hours post-treatment following manufacturer's instructions. Results & Conclusion: We found that TA or CuTA were not cytotoxic in H9c2 cells at tested doses. TA kept more cells alive in conjunction with Doxorubicin than did the control. Our results also demonstrate that the IC50 values of TA and CuTA, determined with cancer cell lines, are not toxic to H9c2 cells. These results provide evidence that CuTA does not induce toxicity in cardiomyocytes and supports further testing for translational application in combination therapy with ChT.Item Eosinophilic Gastritis: An Imposter of Gastric Malignancy(2021) Salim, Hamza; Gajula, Prianka; Raza, AliIntroduction: Eosinophilic gastroenteritis (EGE) is an uncommon condition characterized by eosinophilic infiltration into the lining of the GI tract with a predilection for the stomach and proximal small bowel. Symptoms are non-specific, and the disease is known to take a chronic, relapsing/remitting course. To date, approximately 300 cases are described in literature. Here, we present a case of EGE closely mimicking gastric malignancy. Case Description: A 57-year-old male with a past medical history of DM II, HTN, GERD, and ESRD was admitted to the hospital with 30 lbs weight loss, postprandial fullness, and intractable vomiting. Physical examination showed moderate tenderness to deep palpation in the upper abdomen. CT scan revealed gastric outlet obstruction from an incidental finding of gastric antrum mass. An EGD was performed and revealed a malignant appearing mass in the pre-pyloric region of the stomach. Biopsies showed peptic duodenitis without any evidence of malignancy or H. Pylori infection. After a multi-disciplinary discussion, the decision was made to perform diagnostic laparoscopy, followed by gastrojejunostomy, for the gastric outlet obstruction. Discussion The pathogenesis of EGE is not well understood. Available evidence suggests that it is a hypersensitivity reaction. Histopathological analysis can confirm the diagnosis. Eosinophilic infiltration can involve any layer of the stomach (mucosa, muscularis propria, or serosa), which impacts clinical presentation. The treatment is primarily based on dietary modifications and systemic steroids. In conclusion, eosinophilic gastroenteritis should remain on the differential diagnosis in appropriate clinical cases where the diagnosis of cancer is unclear.Item Ultrasound and Computerized Tomography in Managing Cellulitis: A Case Study(2021) Hall, Marshall; Hurley, Kara; Lim, Henry; Hatch, Jonathan; Surve, SajidCellulitis is a common cutaneous tissue infection that affects approximately 14.5 million people in the United States each year. This skin disease is usually a clinical diagnosis. With the development of technology, especially bedside ultrasound, imaging techniques have become integrated into the physical exam, diagnosis, and treatment of disease. Ultrasound and computerized tomography (CT) have become part of the management of cutaneous infections such as cellulitis, abscess, and necrotizing fasciitis. However, it is still not clear what role these imaging techniques hold. In this case report, we present a patient with cellulitis refractory to standard antibiotic regimens. Ultrasound and CT scan were performed which showed soft-tissue edema, phlegmon without drainable abscess. Without improvement, the patient underwent incision and drainage for possible abscess. Following the surgical procedures, the patient's symptoms resolved, and the patient was discharged. This case raises to the surface limitations that may still exist in imaging studies in the treatment of soft tissue infections. Further research, training, and perhaps technological development are necessary to assist in using imaging studies in the diagnosis of soft tissue infection.Item OCIMUM TENUIFLORUM DECREASES THE RATE OF GROWTH AND METASTATIC POTENTIAL OF MURINE 4T1 MAMMARY CARCINOMA CELLS(2021) Donkor, Michael; Jones, HarlanCombination therapies involving chemotherapy and radiation, aimed at reducing metastasis and mortality have faced challenges, including limiting the effectiveness of immunotherapy. Ocimum tenuiflorum (O. tenuiflorum) has been used traditionally in Indian culture for the treatment of disease and proven scientifically to have immunomodulatory effects. The purpose of this study was to determine the anti-tumor effect of the natural plant O. tenuiflorum on 4T1 murine mammary carcinoma cells (4T1). Hypothesis: O. tenuiflorum decreases the rate of growth and metastatic potential of 4T1 tumor cells. 4T1 cells were grown in culture medium and exposed to increasing concentrations of O. tenuiflorum. The metastatic potential was determined using the scratch assay technique. We were also interested in the mechanism by which O. tenuiflorum decreased the rate of growth and metastatic potential of 4T1 cells. We determined the changes in the mRNA expression of IL-4R, previously reported to drive breast cancer metastasis following exposure of 4T1 tumor cells O. tenuiflorum. Results: Exposing 4T1 cells to various concentrations of O. tenuiflorum decreased the rate of growth and metastatic potential of 4T1 tumor cells. Also, O. tenuiflorum downregulated the expression of IL-4R by 4T1 tumor cells with increasing concentration. We conclude that O. tenuiflorum has the potential to be used as adjunct treatment in management of breast cancer. Further studies will investigate in-depth the mechanism of O. tenuiflorum's on 4T1 including apoptosis, migration and other molecular mechanism on tumor evasiveness.