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Item Psychomotor Videos for Osteopathic Manipulative Medicine (OMM) Instruction(2015-03) Handoyo, Anthony; Seals, Ryan; Gustowski, SharonHypothesis: Osteopathic Manipulative Medicine (OMM) lab often consists of demonstration from the stage by a professor accompanied by small group practice with faculty table trainers. However, given a low faculty to student ratio, class demonstrations do not optimize student’s time with table trainers. We hypothesize that our instructional videos will improve student satisfaction by limiting need for class demonstration, thus increasing one on one instruction with table trainers. Research Design: Prospective Experimental – IRB approved. Materials and Methods: We designed videos with written instructions that incorporate psychomotor learning principles for year 2 osteopathic medical students. Instructional videos for Still and Facilitated Positional Release techniques were used in lieu of faculty demonstration during lab. Three surveys were administered to the second year Texas College of Osteopathic Medicine class to assess their satisfaction with the current teaching method compared to the new instructional videos. Clinical competency scores were also compared to the previous year’s class who did not have the videos. Results: The instructional videos improved student confidence and satisfaction when compared to the traditional method. However, no clear statistical significance was found between exam scores when compared to the previous years’ students. Conclusion: The new instructional videos showed improvements in student satisfaction and confidence compared to traditional methods. Use of the videos could allow more time for feedback from faculty table trainers. Exam scores did not improve, however factors involving small sample size and varying faculty graders could account for this finding. Videos could serve a valuable role in the education of osteopathic students in OMM.Item Tolfenamic Acid Induces Therapeutic Efficacy of Chemotherapeutic Agents in Medulloblastoma Cells(2015-03) Jones, Michelle; Shelake, Sagar; Hernandez, Yazmin; Wadhwani, Anmol; Sankpal, Umesh; Bowman, W. Paul; Murray, Jeffrey; Basha, RiyazMedulloblastoma (MB) is the most common malignant brain tumor of childhood. Currently, MB is treated using a multimodal approach consisting of surgery, craniospinal irradiation, and chemotherapy. Among the most commonly used chemotherapeutic agents are vincristine (Vinc), etoposide (Etop) and Cisplatin (Cis), while doxorubicin (Dox) is also used rarely. All of these agents carry significant delayed consequences for the patients including cognitive deficits. It is imperative that the strategies to improve the therapeutic efficacy of standard chemotherapy will include reduction of side effects in order to have a significant impact for treating MB patients. The primary objective of this study is to determine the effectiveness of a combination treatment to enhance the therapeutic efficacy of chemotherapeutic agents using MB cell lines. We have tested the combination of Tolfenamic Acid (TA), a small molecule and non-steroidal anti-inflammatory drug along with Vinc or Etop or Cis or Dox using MB cell lines, DAOY and D283. These cell lines were purchased from American Type Culture Collection (ATCC), Manassas, VA. TA has been shown to inhibit cell proliferation, induce apoptosis, and decrease the expression of Sp1 and Survivin which play roles in growth and cell survival in MB cells. Our results show that each drug together with TA causes a time and dose dependent decrease of MB cell viability which is more than that of single drug treatment. The cell growth inhibition is accompanied by an induction of apoptotic markers and the decrease in expression of Sp1 and survivin. The preliminary results of this preclinical model are in favor of combining TA with Vinc or Etop or Cis or Dox to achieve maximum therapeutic benefit while limiting the duration of treatment. Further studies are under investigation to precisely understand the underlying mechanisms and to confirm these results via in vivo assays. Addition of TA to current chemotherapy regimen for MB may reduce the dose and amount of time necessary for chemotherapy and therefore potentially reduce the toxicity and side-effects in children.Item Astrocyte AEG-1 regulation of Wnt/β-catenin signaling in HAND(2015-03) Nooka, Shruthi; Ghorpade, AnujaPurpose: Glial induced chronic inflammation contributes to the pathogenesis of HIV-1-associated neurocognitive disorder (HAND), but the molecular mechanisms of inflammatory regulation have not yet been fully understood. Astrocyte elevated gene (AEG-1), an HIV-1 and tumor necrosis factor (TNF)-α inducible gene, is associated with multiple signaling cascades such as nuclear factor (NF)-κB, Wnt/β-catenin during tumor progression. Recently, upregulation of Wnt signaling proteins was observed in spinal cord dorsal horn of HIV-1 patients. In addition, Wnt signaling regulates pro-inflammatory cytokines expression in several inflammatory diseases including rheumatoid arthritis, psoriasis. However, the relationship between AEG-1 and Wnt signaling pathway in HIV-1-associated neuropathogenesis has not been studied. Hereby, we proposed that astrocyte AEG-1 induces inflammation via classical Wnt signaling in HAND. Methods: Cultured human astrocytes were treated with HIV-1DJV, interleukin (IL)-1β and TNF-α. Astrocytes were nucleofected with AEG-1 and β-catenin specific siRNA. Changes in AEG-1, β-catenin and lymphoid enhancing factor (LEF)-1 levels were determined by RT-PCR, western blot analysis and immunocytochemistry. Co-immunoprecipitation (Co-IP) studies were performed to examine AEG-1 interacting proteins and NF-κB dynamics. Pro-inflammatory molecules such as CCL2 and CXCL8 levels were measured by ELISA. Results: HIV-1DJV in combination with IL-1β and TNF-α significantly upregulated AEG-1, β-catenin and LEF-1 mRNA levels. Nuclear translocation of β-catenin decreased significantly in siAEG-1 transfected astrocytes. Further, Co-IP studies showed AEG-1 interacting with β-catenin and LEF-1, and upon activation with pro-inflammatory stimuli, interaction increased in both the cytoplasm and nucleus. Both AEG-1 and β-catenin also interacted with NF-κB, suggesting a common denominator in regulating inflammation. AEG-1 and β-catenin transient knockdown followed by IL-1β treatment altered NF-κB mediated pro-inflammatory cytokines production. Conclusion: In summary, HAND-relevant stimuli upregulated classical Wnt signaling and increased interactions between AEG-1, β-catenin and NF-κB, suggesting AEG-1 mediated Wnt signaling regulation of NF-κB activity in HAND neuropathogenesis.Item Identifying Primary Factors Responsible for the Decline of Obstetric Care by Rural Texas Family Practice Physicians(2015-03) Beaver, Ryan; Chiapa-Scifres, Ana; Bowling, JohnThere is a well-documented decline of family practice physicians (FPs) providing OB, and the known reasons behind the decline are varied and complex. The purpose of this study is to assess which factors are most responsible for the decline in OB provided by FPs, with a specific focus on those in rural Texas communities. Specifically, it seeks to determine: 1.) What rural FPs are currently providing OB services? 2.) What are the primary factors/barriers responsible for the decline of OB services provided by rural FPs? A statewide survey of self-identified rural FPs targeted the degree of OB services currently provided and graded factors/barriers responsible for the decline of obstetric care in their personal practices. Current OB practice characteristics were divided into 3 primary categories: currently performing, previously performed, or never performed. Individual factors/barriers were graded using a scale of 1 through 5 and ranked according to highest arithmetic average. The survey was distributed in both physical and online forms to various professional FP societies in Texas and the data and statistical analysis were recorded in Qualtrics online survey software. 35 FPs volunteered to participate. 2 respondents did not self-identify as rural and were excluded from the analysis. Of the remaining 33, we found that 85% felt as if they had received adequate OB training in residency, yet only 29% were currently performing vaginal deliveries as part of their practice. Another 43% had previously performed vaginal deliveries but were not currently, and 29% had never performed vaginal deliveries as part of their practice. Of those adequately trained in OB, lifestyle (4.36), family (4.00), and sleep issues (3.75) accounted for the top three factors, followed by liability (3.41) and difficulty obtaining back-up coverage (3.14). The lowest ranked factors/barriers were hospital privileges (2.11), concern with skill level (1.96), and credentialing barriers (1.79). This data confirms that qualified FPs are declining to provide OB care. Primary factors responsible include lifestyle/family-related issues, liability, and poor back-up coverage. Factors of least concern were credentialing barriers, concern with skill level, and hospital privileges. This study confirms that non-medical factors are affecting medical care in rural areas, and future solutions must take these factors into account.Item Bacteriomimetic Nanoparticles for Immunotherapy against Breast Cancer(2015-03) Kokate, Rutika; Thamake, Sanjay; Chaudhary, Pankaj; Raut, Sangram; Mott, Brittney; Vishwanatha, Jamboor K.Short description: Immunotherapy represents a potential and innovative means to combat cancer. It essentially harnesses the body’s immune system to fight against cancer. Previous literature suggests that cancer vaccines designed against a specific tumor antigen have been efficiently utilized to trigger immune responses against tumor cells. Despite the preliminary evidence in animal models, low immunogenicity is one of the major hurdles in the development of vaccines in humans. In order to surmount this obstacle, several approaches including the use of an “ideal” tumor antigen, appropriate delivery techniques, immune boosting strategies with co-stimulatory molecules are being explored. Purpose: The purpose of this study was to develop “bacteriomimetic nanoparticles” to enhance adaptive cell-mediated immune responses (CD4+ and CD8+ T cell responses) against tumor antigen as a therapeutic option for cancer treatment. Materials and Methods: NPs were prepared by modified solid/oil/water solvent evaporation method using an ultrasonic processor UP200H system (Hielscher Ultrasonics GmbH, Germany). We used membrane preparations of the 4T1 mouse mammary cancer cell line as a tumor antigen and CpG ODN’s as a “bacteriomimetic” stimulant. Fourteen days before tumor challenge BALB/c female mice (6-8 weeks) were pre-immunized with CpG followed by secondary immunization using respective NPs encapsulated with the membrane antigen preparation. Subsequently, mice (n=5) were challenged subcutaneously (SC) with 105 tumor cells and the primary tumor size was monitored using vernier caliper and bioluminiscence imaging (Caliper Life Sciences Inc., MA, USA). Mice were sacrificed on day fourteen after tumor challenge; spleen cells were used for flow cytometric analysis and primary tumor tissue was used to evaluate effect of NP immunization on tumor growth, survival as well as the immune response (CD4+ and CD8+ T cell) via immunohistochemistry. Results: We found significant reduction in progression of tumor growth in mice immunized with CpG coated NPs containing tumor antigen (CpG-NP-Tag). Histological analysis confirmed that tumors in CpG-NP-Tag mice were relatively well differentiated and of lower grade in contrast to CpG-Blank tumors. Immunofluorescence (IF) data further revealed that CpG-NP-Tag tumors had lesser proliferation and higher apoptotic activity. Tumor CD4+ and CD8+T cell infiltration as well as T cell response in spleen was found be higher in CpG-NP-Tag NP immunized mice as compared to the controls (CpG-NP-Blank and NP-Tag). Conclusions: Primary tumor size, IHC, IF and flow cytometry analysis indicate that CpG-NP-Tag NPs were successfully employed to boost the immune response against tumor cells.Item Use of Yoga in Children with Autism: A Systematic Review of Literature(2015-03) Martel, Rebecca K.; Fugler, Joseph; Yarbrough, Kaitlyn; Wheeler, Allison; Salem, Yasser; Liu, Howe; Young, AmandaUse of Yoga in Children with Autism: A Systematic Review of Literature Purpose and Hypothesis Research examining the use of yoga in children has suggested benefits related to a variety of outcomes; however, there is no review that synthesized research findings for children with autism. The purpose of this review was to examine the evidence concerning the use of yoga exercises for children with autism. Safety concerns, potential benefits and practical application are discussed. Materials/Methods: The databases searched included PubMed, PsychINFO, CINAHL, Cochrane, OVID, PEDro, ProQuest, Access Physiotherapy, and Hooked on Evidence. The search was conducted using the following keywords: ‘yoga’, ‘autism’, and ‘autism spectrum disorder’. Titles and abstracts were assessed manually according to the following criteria: (1) children with autism spectrum disorder, and (2) intervention (yoga program). An additional search, the reference lists of the relevant articles, was explored manually. We screened those articles for duplicate and selection criteria. Results: Seven of the 107 articles that were retrieved met the inclusion criteria. Across all studies, a total of 153 children (age range 13 to 16 years old) with autism were investigated. All studies reported improvements following participation in yoga exercises. Conclusion The result of this review suggests positive effects of yoga exercises in children with autism. The results should be interpreted with caution given the strength of evidence and the quality of reviewed studies and that the number of studies that examined the effects of yoga exercise in children with autism is low.Item Eastern Equine Encephalitis: A Case Report(2015-03) Eisner, Hailey; Amlani, Farah M.; Atkinson, BarbaraPurpose: The purpose of this case report is to discuss a rare case of rapid neurological recovery from eastern equine encephalitis (EEE). Methods: Information and records were obtained on a 53 year old white male diagnosed with eastern equine encephalitis who initially presented to a Fort Worth, Texas emergency department with new onset slurred speech, confusion and weakness upon waking. The patient had a one week history of worsening headaches, waxing and waning fevers, upper back pain, nausea and vomiting. He had been diagnosed with a non-life-threatening viral illness two days prior to presentation. A thorough literature review on EEE was also conducted. Results: Within a few hours of arrival the patient experienced acute flaccid paralysis and a decline in respiratory status requiring emergent intubation. After three days of supportive care in the ICU he was extubated and began rehabilitation therapy. Physical therapy helped to rapidly improve his muscle strength, gait and fine motor skills over the course of one week. At follow-up five weeks later he was able to drive and start working again. He was still in speech therapy twice weekly, but noted improvement. Conclusion: Only 2% of adults infected with the EEE virus develop encephalitis. Of those 2%, 90% become comatose or stuporous. The mortality rate is at least 30%, making it the most severe arboviral encephalitis. Complete recovery among survivors is rare, with the most common sequelae being convulsions, paralysis and mental retardation. This patient was one of the unlucky few to develop encephalitis from the virus. He managed to survive and recover rapidly with no major sequelae.Item Targeted Therapy for Non-Small Cell Lung Cancer Using Antibody-Coated Gold Nanoparticles(2015-03) Koneru, Bhuvaneswari; Shi, Yi; Moron, Sebastian; Di Pasqua, AnthonyPurpose:Lung cancer is the leading cause of cancer-related death in the United States among both men and women. Approximately 85 to 90% of all lung cancers are non-small cell lung cancer (NSCLC). Unfortunately, NSCLC is extremely difficult to treat and survival rates are low (the five year survival rate is Methods: AuNPs with pendant –COOH and –OH groups are synthesized by the reduction of gold ions in the presence of a mixture of alkanethiols. A targeting ligand (mAb) is attached to the AuNPs by EDC-coupling. The size and zeta potential of the AuNPs is determined using dynamic light scattering and TEM, and the amount of antibody conjugation quantified via colorimetry. Uptake of AuNP and AuNP-mAb in various NSCLC cell lines with various levels of expression of the adhesion molecule was then performed Results: AuNP-mAb was synthesized, characterized and uptake tested in cell culture. We anticipate next to attach a platinum prodrug and test for use in targeted therapy for NSCLC.Item Hypertension and Obstructive Sleep Apnea are Associated with Abnormal Pressor Responses to Apnea(2015-03) Jouett, Noah; Mason, Ryan; Niv, Dorene; Watenpaugh, Don E.; Smith, Michael L.Background: Cardiovascular diseases are commonly associated with elevated sympathetic nerve activity (SNA). Previously, we have shown that the blood pressure response to a voluntary apnea is closely correlated with the SNA response in patients with sleep disordered breathing (SDB) and thus may serve as an index of SNA responsiveness. In the current study, we hypothesized that the pressor response to apnea is 1) reduced with effective treatment of SDB in SDB patients, and 2) that it is exaggerated in hypertensive patients (HTN) when compared to healthy control subjects. Methods: 22 OSA patients (14 treated and 8 untreated), 19 treated hypertensive patients and 23 healthy normotensive control subjects were recruited from the UNTHSC Primary Care Center and Sleep Consultants of Texas. Subjects completed a medical history questionnaire and Epworth Sleepiness survey. Blood pressure was measured by standard auscultatory assessment in the seated position. Baseline blood pressure was obtained in triplicate during quiet rest. Then after practicing a voluntary breath hold, subjects repeated three voluntary 20-second breath holds each beginning at end-expiration. Comparisons were made 1) between treated and untreated SDB patients, and 2) between HTN patients and healthy control subjects using a Student t test. Results:Importantly, as in prior studies the pressor response to apnea was not different from zero in the healthy control subjects (-1.0 ± 4.2 mmHg, p>0.05). In the SDB patients, the pressor response was significantly greater than zero in both treated (11.4 ± 3.9 mm Hg) and untreated (24.5 ± 9.8 mm Hg) SDB patients. Conclusions: These data support our hypotheses that the pressor response to voluntary apnea is exaggerated in both untreated SDB and treated HTN patients and that effective treatment of SDB reduces this response, but does not normalize the response. These data suggest that the pressor response to apnea may be a simple physiologic index of exaggerated sympathetic responsiveness.Item A Comparative Study of Rural Communities for Colorectal Cancer Screening by Means of Colonoscopy Provided by Family Physicians(2015-03) Stanley, Russell F.; Deen, Briar; Luz Chiapa-Scifres, Ana; Bowling, JohnPurpose: Colorectal cancer has a high incidence and prevalence in the United States and in particular, rural Texas. Some rural family physicians in Texas do colonoscopy procedures whereas other rural family physicians refer their patients to urban centers. This study will look at whether or not patients with access to family medicine physicians who perform colonoscopy exams within their own rural community are more likely to comply with colorectal cancer screening guidelines as opposed to rural patients in another community who are referred to urban centers. Methods: A 24 question survey pertaining to colon cancer and adapted from the Behavior Risk Factor Surveillance System (BRFSS) was given to patients at primary care clinics in Clifton and Haskell. Both clinics are located in small, rural towns in Texas. The family medicine physicians at the Clifton clinic provide colonoscopies within the community whereas the residents in Haskell drive to urban centers for colonoscopies. In order to take the survey, participants had to be patients of either the Clifton or Haskell clinic and be at least 50 years of age. Logistic regression was used to look at an association between the two clinics and patient colon cancer screening awareness, knowledge of what age a person should be screened for colon cancer and whether or not patients had ever had either a sigmoidoscopy or a colonoscopy. All statistics were done using SAS 9.3. Results: 92 surveys were collected at Clifton and 76 were collected at Haskell for a total of 168 surveys. Of the collected patient surveys, 80.12% patients were white and 62.05% were female with a mean age of 63.90. A higher odds (OR=3.61; CI = (1.11, 11.69)) was seen in Clifton compared to Haskell for patient colon cancer screening awareness after being adjusted for gender, race, age, employment status and family history of colon cancer. There was a higher odds (OR=2.50; CI = (1.13, 5.54) of knowing what age a person should be screened for colon cancer in Clifton compared to Haskell after being adjusted for gender, age, employment status, education level and family history of colon cancer. A higher odds (OR=3.61; CI = (1.42, 9.20)) was seen in Clifton compared to Haskell for patients ever having a colonoscopy or sigmoidoscopy after being adjusted for patient race, age, gender, education, employment status and for the patient not having insurance. Conclusion: This study supports the idea that having family medicine physicians perform colonoscopies within a rural community leads to a higher odds of patients following cancer screening guidelines. Therefore, it is beneficial to have colonoscopies performed locally in a rural community in order to better prevent colorectal cancer.Item Family History Information in Dallas/Fort Worth: What We’re Not Telling Patients(2015-03) Gregorio, Dave; Cross, DeannaPurpose: Patients can be empowered to assess their own family health history (FHH) by providing accurate information that: (1) explains the importance of FHH in the context of heritable conditions and (2) outlines how to take an accurate FHH. The aim of this study is to assess the quality of information provided to patients regarding FHH prior to a clinical encounter in the Dallas/Fort Worth area. Methods: FHH information from local health organizations was collected throughout the Dallas/Fort Worth area. Information was included if published by a local health organization (or national organization with local offices) and FHH was discussed in the capacity of health risk assessment. The information was categorized based on source into the following groups: local electronic, national electronic, print, and health fair. Each source was further assessed for quality of information by a series of questions following the Genetics in Primary Care Institute (GPCI) guidelines for taking FHH and disease-specific questions based on familial risk guidelines. The percentage of positive “Yes” answers is tabulated for each category and assessment question. Results: A search for local information on FHH was conducted between June, 2014 and December, 2014. Information on FHH was provided by 48% (25/52) of outlets searched. 73 sources were included for analysis. 53% came from websites of local health organizations, 16% came from print resources, 11% came from health fairs, and 19% came from national health organizations. Of these sources, 22% were general FHH information and 88% were disease specific. Information from health fairs had the greatest proportion of guideline components (18.8%) and local electronic sources had the fewest components (12.4%). Printed information had a greater percentage of guideline components (15.5%) than electronic (14.6%). General FHH information was more likely to have guideline components (24.3%) than disease specific information. Conclusions: Difficulty in obtaining information on FHH was noted with less than half of potential resource sites providing FHH information. Few sources provided all components recommended by GPCI guidelines and differences in the quality of information between source categories (electronic vs. print) were found. Sharing FHH with a provider was only recommended 59% of the time. Here we have demonstrated a clear need for health organizations to provide FHH information to patients.Item Mechanisms Underlying AMPA-Mediated Excitotoxicity of Retinal Ganglion Cells Under Hypoxic Conditions(2015-03) Park, Yong H.; Broyles, Heather V.; McGrady, Nolan R.; Yorio, ThomasPurpose: Excessive AMPA receptor (AMPAR) stimulation has been implicated in producing excitotoxicity in many neurodegenerative diseases such as glaucoma. The purpose of this study was to investigate if AMPAR desensitization attenuates excitotoxicity in purified retinal ganglion cells (RGCs) under normoxic and hypoxic conditions. Methods: Purified RGCs were treated with AMPAR agonists (100µM s-AMPA (desensitizing), 100µM kainic acid (non-desensitizing)), an AMPAR modulator (100µM cyclothiazide), AMPAR antagonist (50µM CFM-2), and kainate receptor antagonist (50µM UBP301) for 72h in RGC defined medium. To determine if excitotoxicity occurs following hypoxic injury, RGCs were subjected to oxygen-glucose deprivation (OGD) for 4h, followed by s-AMPA treatment under OGD for an additional 4h. Live-Dead Assays were carried out to assess cell viability. AMPA receptor mediated calcium influxes in RGCs were determined by imaging with fura-2 AM following 4h either normoxic-glucose-free or OGD treatments. Results: Significantly enhanced viability was found in RGCs treated with 100µM s-AMPA (84 ± 1% viable) compared to vehicle (0.1% DMSO) group (71 ± 4% viable) alone (ps-AMPA in combination with cyclothiazide or kainic acid significantly reduced cell viability to 50 ± 3% and 54 ± 2%, respectively (ps-AMPA (22 ± 5% viable) following OGD injury compared to those under normoxic-glucose-free conditions (67 ± 4% viable). Additionally, no significant decrease in RGC survival was observed when OGD was carried out for 8h in the presence of s-AMPA in the cell culture medium (85 ± 2% viable). Increased calcium influx was observed when RGCs were maintained in OGD (1085 ± 97 nM) compared to control (764 ± 72 nM). However, there was no difference between treatments of normoxic-glucose-free and RGC medium with RGC defined medium. Conclusions: Desensitization of AMPAR is a key determinant of s-AMPA-mediated excitotoxicity, whereby blocking the desensitization of AMPAR induces cell death. Future studies will determine if AMPAR subunits with greater ion current influx possibly mediate increased sensitivity to excitotoxicity following injury.Item Comparing Long Term Hemodialysis Access Survival between two Non-Autogenous Conduits(2015-03) Islam, TasnimObjectives: In end stage renal disease population, there has been an increase in the utilization of non-autogenous conduits for hemodialysis access over the past decade. In this study, we compare long term functional patency between two non-autogenous conduits: bovine biograft and polytetrafluoroethylene (PTFE). Methods: Study include 120 grafts placed in 98 patients between January 2011 and June 2014 in our institution. Various statistical analyses were run via Univariate methods and Kaplan-Meier and Cox regression to evaluate time to loss of patency and identify its predictors. Log rank tests were used to compute differences in survival functions between both groups. Follow-up began at the first time the graft was used for dialysis and ended with an event such as death or study closure. Results: There was no difference in the survival for functionality between PTFE and biograft (Table 1). There was a six fold increase in the loss of functional secondary patency in PTFE compared to biograft (HR: 6.8 95%CI: 1.7-26.3, P=0.006). The survival function for secondary patency was higher for biografts compared to PTFE (x2=7.69, p=0.02). Functional secondary patency at 6months, 1 year and 18 months for biograft and PTFE are 76%, 72%, 72% and 52%, 46%, 46% respectively. Graft infection rates were higher for PTFE compared to biografts (21% Vs 15%). The predictors of patency loss were high-BMI and hyperlipidemia. Conclusions: In our cohort, intervention-free access survival and thrombosis-free access survival are similar between biografts and prosthetic conduits. But, bovine biografts have a significant advantage over PTFE with regards to access survival until abandoned. Patients with high BMI and hyperlipidemia attracted close graft monitoring to improve access survival.Item The Role of Anxiety in the Arterial Pressure Response to Chemoreflex Stress(2015-03) Doan, James; Jouett, Noah; Nguyen, Amanda; Sharma, Sneha; Franks, Susan; Smith, Michael L.Background: Anxiety disorders are remarkably prevalent in the United States, with an estimated 25% of the population suffering from some kind of anxiety disorder. Many studies have elucidated the link between high anxiety and cardiovascular disease (CVD), indicating a link between mental disorders and cardiovascular control. This study tested the hypothesis that the State-Trait Anxiety Index (STAI) and modified Borg Anxiety Scores can predict the blood pressure response to voluntary apnea. Methods: STAI surveys were given before experimentation, with separate scores calculated for state (conditional/situational anxiety) and for trait (background/intrinsic anxiety). 10 young and healthy subjects (5 male, 5 female) were recruited. Subjects had no reported anxiety disorder and were not taking any anxiety medications. Subjects were exposed to 12% oxygen and then initiated 6 end-expiratory apneas with a 2 minute recovery period in between each apnea. Blood pressure, heart rate and the nadir of SaO2 were measured. Prior to and immediately after each apnea, subjects were asked to rate their level of anxiety on a modified Borg scale (6-20) to capture an instantaneous measure of acute anxiety. Results: We found that trait anxiety had a significant correlation with increases in mean arterial pressure (r = 0.725, P = 0.027) and with changes in systolic blood pressure (r = 0.856, p = 0.003), but not diastolic pressure (P>0.05). There was a trend for a correlation between state anxiety and changes in systolic blood pressure (r = 0.6, P = 0.082), but no trend or significant correlation for diastolic or mean arterial pressure (P>0.05). Modified Borg scales did not predict the systolic, diastolic or mean arterial pressure response (P>0.05) Conclusion: We conclude that background/intrinsic anxiety (trait) is a better predictor of arterial pressure responses to apnea than conditional/situational anxiety (state). Furthermore, instantaneous anxiety as measured via modified Borg scale failed to adequately predict this pressor response. This study offers evidence that psychological functioning and not instantaneous anxiety can alter the physiological response to acute chemoreflex stress.Item Pyruvate induction of Nrf2/ARE-regulated Glyoxalase1 and Glutathione Reductase in porcine brain post-cardiac arrest: enhanced methylglyoxal detoxification(2015-03) Scott, Gary F.; Cherry, Brandon H.; Nguyen, A Q.; Hollrah, Roger A.; Williams, Arthur G. Jr.; Mallet, Robert T.Abstract Pyruvate induction of Nrf2/ARE-regulated Glyoxalase1 and Glutathione Reductase in porcine brain post-cardiac arrest:enhanced methylglyoxal detoxification.Background:After cardiac arrest (CA) and cardio-cerebral resuscitation (CCR), enhanced glycolysis elevates toxic carbonyl methylglyoxal (MG) that contributes to reactive oxidative/nitrosative stress (RONS), enzyme inactivation and death of neurons and astroglia. Post cardiac arrest cognitive deficits may be prevented by pyruvate infusions that boost glyoxalase 1 (GLO1) detoxification of MG and glutathione (GSH) synthesis by glutathione reductase (GR) via Nrf2/ARE (antioxidant response element)-regulated Phase II gene expression.Hypothesis:Pyruvate-induced cytoprotective mechanisms can curtail brain injury and cognitive deficit after cardiac arrest and resuscitation in pigs.Methods:Compared to sham non-arrest animals, pigs were subjected to CA/CCR, infused with either 4 mM pyruvate or NaCl for one hour, recovered 4 hours prior to sacrifice. Post-mortem frontal cortical lysates were assayed for Nrf2/ARE binding activity, GLO1, GR, and GAPDH (rate-limiting for MG production) activity, while plasma glutamate concentrations were measured.Results:Compared with saline controls, pyruvate infused pigs demonstrated increased Nrf2/ARE binding activity (Fig 1) and 3-fold higher GLO1 activity (Fig 2) supporting MG detoxification, while GR (Fig 3) and GAPDH (Fig 4) were similarly stimulated. Plasma glutamate concentrations were reduced by pyruvate (Fig 5), which would support greater brain clearance of excitotoxic glutamate, according to the brain-to-blood glutamate efflux hypothesis.Conclusions:Intravenous pyruvate induces Nrf2-regulated gene activation for augmented GR, and GLO1 biological activity via mechanisms that may lower glutamate-inflicted excitotoxicity and heretofore untreatable cognitive deficits of post-CA/CCR brain injury.Thus pyruvate infusion may also provide therapeutic benefit for several neurodegenerative disorders of similar etiology.Item Nerve Hydrodissection for Impingement of the Suprascapular Nerve(2015-03) Shah, Neel; Clearfield, DanielNerve compressions are common clinical presentations. In this case study, the ability for nerve hydrodissection, a non-surgical technique for the release of a compressed nerve, is established. This patient had a compression of the suprascapular nerve in the posterior shoulder. The patient failed traditional non-operative therapies such as physical therapy and corticosteroid injections prior to this procedure. Immediately after the procedure, the patient noticed a significant decrease in pain with an increase in ROM, and was able to complete physical therapy to maintain a pain free ROM. Therefore, this case study demonstrates that nerve hydrodissection can be a viable non-surgical option for compressed nerves refractory to traditional options.Item Age-related Thymic Involution Perturbs Negative Selection Leading to Autoreactive T Cells That Induce Chronic Inflammation (Inflammaging)(2015-03) Coder, Brandon; Wang, Hongjun; Ruan, Linhui; Su, Dong-MingThe presence of chronic low-level pro-inflammatory factors in elderly individuals (termed inflammaging) is a significant risk factor for morbidity and mortality. Recently, inflammaging has been partially attributed to the persistent activation of immune cells thought to arise from latent viral infection, but the contribution of activated autoreactive T cells towards the development of inflammaging remains unclear. To address our hypothesis that age-related thymic involution leads to the persistent release and activation of autoreactive T cells capable of inducing inflammaging, we performed experiments including: adoptive transfer, kidney capsule transplantation, and tetramer detection of autoreactive T cells on a FoxN1 conditional knock-out (FoxN1-cKO) mouse model that mimics natural thymic involution while maintaining a young periphery. We found that thymic involution leads to T cell activation shortly after thymic egress, which is accompanied by a chronic inflammatory phenotype consisting of cellular infiltration into non-lymphoid tissues and elevated serum IL-6 and TNFα levels. Autoreactive T cell clones were detected in the periphery of FoxN1-cKO mice. A failure of negative selection, facilitated by decreased expression of Aire rather than impaired regulatory T cell (Treg) generation, led to autoreactive T cell generation. Furthermore, the young environment can reverse age-related Treg accumulation but not inflammatory infiltration. Together, these findings identify thymic involution and the persistent activation of autoreactive T cells as a source of chronic age-related inflammation (inflammaging).Item Brief OMT Improves Range of Motion, Reduces Pain & Anxiety As Shown by Interleukin 1-Beta Levels(2015-03) Budhani, Atiq; Sivoravong, Jon; nejtek, vicki; Talari, Deepika; King, Andrew P.Hypothesis: Brief osteopathic manipulative therapy (OMT) will improve range-of-motion (ROM), reduce pain-related anxiety and self-reported somatic pain perceptions as indicated by salivary Interleukin 1- Beta levels (IL-1B). Methods: A prospective 2-week longitudinal treatment intervention trial was designed to examine treatment efficacy of one brief OMT session to improve trunk ROM while reducing anxiety and pain perceptions in 25 acute pain patients for up to 2-weeks later. Salivary IL-1B was analyzed as a biomarker of pre- and post-OMT inflammation, psychosomatic pain and anxiety. Results: Brief OMT delivered one time was significantly related to improved ROM in trunk flexion (t = 2.84, p = 0.009), reduced anxiety as measured by the Generalized Anxiety Disorder questionnaire (F=11.20, p=0.0000). A statistical trend in reduced pain perceptions was evident 2-weeks later (F=23.07, p=0.0000). Levels of IL-1B were significantly correlated to mood and anxiety (r =-0.47, p = 0.05) in the 2-week follow- up condition. Improvement in trunk side bending (right side) after OMT was significantly correlated to reduction in pain related anxiety (r=-0.43, p=0.04). Conclusion: These results suggest that one brief session of OMT effectively increased ROM, reduced pain and anxiety that lasted up to 2-weeks. These OMT benefits were associated with increased post-OMT levels of the inflammatory biomarker, IL-1B. OMT seemed to provide physical pain relief benefits while also reducing psychological pain perceptions and pain-related anxiety.Item Preoperative Hip Fracture Patient Risk Stratification Based on Objective Data(2015-03) Crawford, William; Luttrell, Kevin; Nana, ArvindHypothesis: Patients with isolated fractures of the proximal femur can be stratified by objective data upon admission with respect to relative risk for post-operative complications. Materials and Methods: A retrospective analysis of patients with isolated fractures of the proximal femur, taken from the Harris Methodist Hospital hip fracture registry, was evaluated with regards to preoperative objective data (Body Mass Index (BMI), Total Lymphocyte Count, Prealbumin, Albumin, Age, Vitamin D Level, American Society of Anesthesiologists (ASA) score) and the odds ratio of having a post-operative complication based on having abnormalities of these preoperative lab values. Post-operative complications were defined as transfusion, myocardial infarction, cardiac arrest, cerebrovascular accident, arrhythmia, ICU stay, surgical complication, respiratory failure, gastrointestinal complications, bacteremia/sepsis, acute renal failure, pulmonary embolus, pneumonia, deep venous thrombosis, urinary tract infection, and 1 year mortality. Results: Preliminary statistical analysis demonstrates that patients with a BMI of 1500 also had a protective effect with an odds ratio of 0.36. Conclusions: Patients can be stratified for risk of post-operative complications based on preoperative nutritional status, as evidenced by the increased odds ratios of low preoperative nutritional labs as well as low BMI levels. There was significant limitation in further evaluating a set if criteria with greater than 2 variables as several patients did not have all laboratory values available preoperatively. This would allow for a prospective study to specifically seek out these variables.Item Impact of Hypertension, Diabetes, and Dyslipidemia Comorbidity on Cognition among Hispanic Mexican Americans: An HABLE Study(2015-03) Borden, Ashley N.; Johnson, Leigh; Edwards, Melissa; O'Bryant, SidBackground: Hypertension, hyperlipidemia, and diabetes mellitus are medical diagnoses that occur at high prevalence rates among the Hispanic Mexican American population. Current research shows that each individual diagnosis is linked to cognitive decline, but this assertion is limited in that these studies have been conducted on Non-Hispanic White populations only. Additionally, an insignificant number of studies have investigated the comorbidity of these diagnoses, and how that may impact risk for cognitive impairment. This study seeks to fill this gap in the literature by determining the association between combinations of these diagnoses and cognitive functioning within a Hispanic Mexican-American population. Methods: Data were analyzed from 537 Mexican American participants who met diagnostic criteria for hypertension, dyslipidemia, and diabetes mellitus (Group 1, one diagnosis, n= 148; Group 2, two diagnoses, n=219; Group 3, three diagnoses, n=170) from the Health and Aging Brain study among Latino Elders (HABLE). Information from each participant was obtained via clinical interview (including medical history, current medications, and health behaviors), informant interview, neuropsychological testing, blood draw, and physical examination. Consensus reviews were conducted weekly to review subject data, and to establish cognitive and medical diagnoses according to national guidelines. Linear regressions analyses were utilized to examine cognitive functioning, measured through the domains of memory and verbal fluency as the dependent variable, with the independent variable consisting of the number of medical diagnoses (one, two, or three). Covariates included age, gender, and education. Results: Those in Group 1 displayed poorer performance on measures of immediate (B[SE]= -2.66[1.05], t-test = -2.52, p-value=0.012) and delayed (B[SE]= -1.59[0.77], t-test= -2.04, p-value= 0.041) memory. Differentially, those in Group 2 showed poorer performance on tasks related to verbal fluency (B[SE]=-2.33[0.80], t-test= -2.88, p-value=0.004) and working memory (B[SE]=-0.59[0.24], t-test=-2.42, p-value=0.016). Group 3, which encompassed all three medical diagnoses, was not significantly related to any of the cognitive domains that were examined. Conclusion: These findings suggest that within the Hispanic Mexican American population, domains of cognitive functioning are differentially affected within each group, with Group 3 showing no significant increased risk for cognitive dysfunction. These findings do not support current research, which suggests a higher and more invariable prevalence of cognitive decline, regardless of the comorbidity of these diagnoses. Additional research is needed to investigate the neurological effects of the biological pathways associated with the varying combination of diseases, which may explain the dissimilarity in associated cognitive function.