2018

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2015 Dietary Guidelines Advisory Committee: A Review of the Literature Behind the National Guidelines and a Comparison to Fort Worth Nutritional Standings
(2018-03-14) Kannappan, Anju
Introduction: The 2015 Dietary Guidelines Advisory Committee (DGAC) is a joint effort between the U.S. Departments of Health and Human Services (HHS) and of Agriculture (USDA). Every five years the committee publishes a report containing dietary information and eating habits involving the American public. This study aims to review the literature utilized by the 2015 DGAC to describe the methods of data collection and selected results pertaining to the pediatric population. It will also present the results of the Youth Risk and Behavior Survey conducted amongst Fort Worth high school students to offer comparative data between local and national benchmarks of pediatric nutrition. Methods: A literature review was conducted using the DGAC’s published report index on the www.health.gov website. The primary results were retrieved from the 2007-2010 National Health and Nutrition Survey (NHANES) and the CDC’s Second National Report on Biochemical Indicators of Diet and Nutrition in the US Population. Dietary reference intakes for macro and micronutrients were taken from the Food and Nutrition Board and the Institute of Medicine’s reference manual. Statistics concerning Fort Worth’s population were taken from the Tarrant County Public Health Department and the 2016 FWISD Youth Risk and Behaviors Survey. Results: About 1/3 of children are expected to be obese. Concerning fruit intake, children ages 1 to 8 years meet recommended intakes, however average intakes of fruit are lowest among girls ages 14-18 years. Males and females on both national and local levels are receiving fewer servings of fruits and vegetables than advised, and their protein intake is on the lower end of the recommended range. Overall, all age groups and genders intake more sugar and saturated fats than recommended. Discussion: The target audience for the published Dietary Guidelines results are medical professionals who then work to translate the findings into usable resources for the public. One of the initiatives set forth by the USDA was MyPlate, an online tool that offers ideas for creating healthy eating recipes that encompass all necessary food groups and proper proportions. A local initiative in Fort Worth with similar focus is the Mobile Pantry program. Further studies can assess the success of such initiatives in fostering healthy eating among children.
6-Hydroxydopamine Aggravates Renal Injury and Inflammation in a Murine Model of Systemic Lupus Erythematosus
(2018-03-14) Osazuwa, Billy; Thomas, Orlexia; Vedantam, Shyam; Fancher, Daniel; Mathis, Keisa W.; Pham, Grace
Purpose: Renal inflammation is prevalent in the chronic autoimmune disease systemic lupus erythematosus (SLE) and drives the progression of kidney injury. Inflammation in SLE results from a loss of self-tolerance and the production of autoantibodies against nuclear antigens. However, other immunoregulatory mechanisms, such as the cholinergic anti-inflammatory pathway, may also be dysregulated and contribute to aberrant systemic and renal inflammation in the disease. The cholinergic anti-inflammatory pathway is a protective, neuroimmune mechanism thought to involve neurotransmission between the parasympathetic vagus and the sympathetic splenic nerves. In order to confirm the importance of the splenic nerve in this pathway, others have used 6-hydroxydopamine (6OHDA), a neurotoxin that depletes catecholamines, to chemically denervate the spleen and thereby dampen the sympathetic component of the cholinergic anti-inflammatory pathway. We hypothesized that splenic injection of 6OHDA would further disrupt the cholinergic anti-inflammatory pathway in a mouse model of SLE and result in increased renal inflammation and worsened disease severity, which would highlight the importance of the splenic nerve in quelling renal inflammation. Methods: In the current study, female SLE and control mice were injected with 6OHDA (120 µg in 60 μl saline) or vehicle directly into the spleen at 33 weeks of age (n = 6/group). To confirm splenic denervation with 6OHDA, we utilized the glyoxylic acid condensation reaction on 12 μm spleen sections of representative animals and verified that catecholamine histofluorescence was diminished in 6OHDA-treated mice (205 vs. 111 histofluorescent foci). Results: Renal cortical TNF-α (normalized to total protein) was increased in SLE mice compared to controls (3.1e6 ± 1.2e5 vs. 7.8e5 ± 1.6e4 intensity units; p = 0.029), and 6OHDA exacerbated this pro-inflammatory cytokine in SLE mice (7.6e6 ± 2.4 intensity units; p = 0.048) with no effect in controls (2.4e6 ± 6.6e5 intensity units; p = 0.697). Anti-dsDNA autoantibodies were elevated in SLE mice compared to controls (2.1e4 ± 5.7e3 vs. 1.0e4 ± 4.7e3 activity units; p = 0.013), but 6OHDA did not alter this measure of disease severity in SLE mice (1.8e4 ± 5.2e3 activity units; p = 0.692). Albumin excretion rate (AER) was elevated in SLE mice compared to controls (160.7 ± 28.0 vs. 2.7 ± 2.7 mg/dL; p Conclusions: In summary, 6OHDA aggravated renal inflammation and injury in SLE mice indicated by heightened renal cortical TNF-α and AER. This suggests that chemical splenic denervation may disrupt endogenous, sympathetically-mediated anti-inflammatory mechanisms. Further studies are needed to confirm the role of the splenic nerve in regulating renal inflammation.
A Case of Osteosarcoma in Concurrent Sickle Cell Disease
(2018-03-14) Bowman, William; Berry, Stacey; Hamby, Tyler; MacGregor, Theresa
Background: Osteosarcoma is an aggressive bone cancer with a poor prognosis. When this disease is coupled with a concurrent diagnosis of Sickle Cell Disease (SCD), very careful management of the treatment is necessary, due to complications that may arise. This case study will explore some of the complications that were faced in a patient with these two diseases. Case Information: An 11-year-old male with SCD presented to the hospital with leg pain. He was mistakenly believed to have osteomyelitis, a known complication of SCD. Imaging supported this initial diagnosis but further evaluation was ordered. A biopsy of the proximal tibia showed pleomorphic malignant cells and malignant osteoid, confirming a diagnosis of osteosarcoma. Treatment following the Children’s Oncology Group Protocol: AOST0331 was initiated. This protocol includes 29 weeks of chemotherapy consisting of alternating Methotrexate (MTX) once a week for two weeks, followed by Doxorubicin/Cisplatin one week. This is repeated until week 10, when a surgical resection of the tumor is performed, followed by 17 more weeks of chemotherapy. During treatment, several incidents that are attributable to complications of SCD occurred. Two instances of delayed MTX clearance and the formation of two intra-cardiac thrombi were the most troubling of these complications. The patient remained in the hospital during the prolonged MTX clearance, and was monitored closely until clearance was achieved. The patient also received tPA and Lovenox to dissolve the intra-cardiac thrombus and reduce the likelihood of the formation of another thrombus. Conclusions: SCD with a diagnosis of osteosarcoma presents unique challenges to a physician. SCD induces a hypercoagulable state and often leads to end-organ damage, and osteosarcoma is a cancer that must be dealt with aggressively to achieve remission. A diagnosis of osteosarcoma in a patient who already has SCD has the potential to be masked by the complications of SCD. Osteosarcoma must be considered a differential in someone who presents with bone pain, even if they are already known to have SCD. Once a diagnosis of osteosarcoma is made, the implications of the concurrent diagnosis of SCD requires that physicians very carefully consider the possibilities of severe complications that may arise. Managing physicians must have awareness of the effects chemotherapy can have on an individual that is both in a hypercoagulable state and may also have end-organ damage.
A Case of Ovarian Torsion in the 3rd Trimester of Pregnancy
(2018-03-14) Nguyen, Bao-Quyen; Combs, Shanna
Background Ovarian torsion is a rare occurrence during pregnancy, especially in the third trimester. It is a gynecological emergency and needs to be promptly reversed in order to preserve ovarian function. Unfortunately, ovarian torsion is difficult to diagnose due to non-specific abdominal symptoms. It is especially difficult to diagnose in pregnancy due to the enlarged uterus which leads to trouble visualizing anatomy as well as similar symptom presentation that occurs in pregnancy. Case Information An unusual case of ovarian torsion in the third trimester presented with late onset of abdominal pain and non-reassuring fetal heart tones. The ovarian torsion was unable to be clearly visualized with ultrasound and was found upon emergent Cesarean delivery that was performed due to non-reassuring fetal heart tones. The ovary was found to be necrotic and a right salpingo-oophorectomy was performed. Conclusion It is rare for ovarian torsion to occur in pregnancy and even more rare to have an effect on the fetal status as presented in this case. Upon review of the literature, this case was found to be truly unique in the rarity of occurrence of ovarian torsion late in pregnancy, as well as the effect on the fetal status. Only 2 other case reports of intra-abdominal inflammatory conditions in the third trimester were identified to have caused fetal distress, resulting in an emergent Caesarian delivery.
A Case of Valentino's Syndrome Presenting as Possible Appendicitis
(2018-03-14) Patel, Denish D.O.; Ronaghan, Joseph M.D. FACS; Cherry, Brandon H.
Background: One of the most common causes of right lower quadrant abdominal pain is acute appendicitis. The most frequent symptoms observed are periumbilical pain that radiates to the right lower quadrant, anorexia, nausea and vomiting. Other conditions which mimic acute appendicitis at presentation include ovarian torsion, ruptured ectopic pregnancy, pseudomembranous colitis, and perforated cholecystitis. Here, we present a unique case of Valentino’s syndrome, wherein a perforated duodenal ulcer manifested the same constellation of symptoms as acute appendicitis. Case Information: When computed tomography and ultrasound were not definitive for the diagnosis, the decision was made to perform a laparoscopic appendectomy. The appendix showed no gross signs of inflammation, so intraoperative esophagogastroduodenoscopy was used to examine for a perforated peptic ulcer. When no perforations were found, exploratory laparotomy was performed and revealed purulent fluid in the right colic gutter and a pinhole perforation in the first part of the duodenum. The defect was repaired and the abdominal space was washed thoroughly and closed. The patient recovered well and was discharged from the hospital in good health. Conclusion: Valentino’s syndrome is an uncommon cause of RLQ pain and symptoms mimicking acute appendicitis.
A comparison of treatment acceptance and adherence rates among two populations at high risk to develop tuberculosis in Tarrant County, Texas
(2018-03-14) Miller, Thaddeus; Taskin, Tanjila
Background: After decades of declining incidence rates, progress toward US tuberculosis (TB) elimination goals has begun to stall and perhaps even reverse. In light of this alarming trend, the strategic approach to TB control has begun to place more emphasis on carefully targeted surveillance for and treatment of latent TB infection (LTBI). Approximately 13 million people in the US have LTBI, and both LTBI and active TB are much more prevalent among homeless persons, refugees, and immigrants from high burden settings. Without treatment, 5-10% of persons with LTBI will develop active TB during their lifetime, and most ([greater than] 85%) US patients with recent incident TB have a prior history of LTBI. Still, LTBI is an asymptomatic condition that can be difficult to diagnose, and treatment acceptance and adherence are critical barriers to related prevention efforts. A 2012 report estimated that treatment acceptance and completion rates in the US were only 26% and 53%, respectively, and these vary widely by population.For instance, adherence is 7.2 times higher among the refugee population compared to the homeless population, however, the treatment completion rate is low for both. Local public health departments (PHD) are ultimately responsible for the protection of their catchments through TB surveillance, outpatient treatment, and prevention activities. A complete understanding of how patient characteristics may influence treatment acceptance and adherence is critical to successfully implementing risk targeted TB control strategies at the local level. Purpose: We analyzed acceptance and adherence for refugee and homeless patients offered treatment for diagnosed LTBI in Tarrant County Public Health’s TB and Refugee Clinic. Understanding factors associated with accepting and completing LTBI treatment in these high-risk populations inform public health action at the local level and contributes to individual and community health protections. Methods: We examined LTBI treatment acceptance and adherence among homeless and refugee research subjects in an urban public health clinic in Tarrant County, Texas during January 2013 to December 2016. Our retrospective analysis used deidentified local data collected as part of a larger project by the CDC’s Tuberculosis Epidemiologic Studies Consortium. We used multiple logistic regression and chi-square to compare outcomes while controlling for demographic, clinical, and other factors. Results: To be calculated. Conclusions: Will be complete soon.
A Literature Review of Exercise in the Pediatric Oncology Population
(2018-03-14) Nguyen, Peter; Salem, Yasser; Liu, Howe; Becnel, Kelsey
Title: A Literature Review of Exercise in the Pediatric Oncology Population The advances in treatment of children with cancer have been improved in recent years. This has resulted in an increase in the number of pediatric cancer survivors. Several research studies have shown that the medical condition and its related disorders is associated with impaired growth and development, decreased strength, fatigue, cognitive dysfunction, cardiopulmonary compromise, impaired physical fitness, musculoskeletal complications and decreased quality of life. There is growing evidence that lack of participation in physical activity in children with disability including children with pediatric oncology may result in several negative effects and decrease quality of life. In recent years, several exercise programs have been implemented for pediatric oncology. Purpose The purpose of this literature review is to examine evidence regarding the potential benefits of exercise for children with pediatric oncology. Safety, benefits, and application are addressed. Methods This systematic review identified 18 articles that met our inclusion criteria. Electronic databases used were PubMed, Physiotherapy Evidence Database (PEDro), CINAHL, Rehabilitation Oncology Journal, and Scopus. Key words included pediatric, children, oncology, exercise, and rehabilitation. Our initial search yielded 271 potential articles, which we screened for selection criteria. In total, 751 children with cancer were studied in our final research articles. Results In total, 18 research studies were examined and met our inclusion criteria for aerobic exercise in pediatric oncology patients. Of the included articles, 12 were randomized controlled trials, 2 were quasi-experimental design, 3 were cohort studies, and 1 were clinical trial. Across all 18 studies, 751 children with pediatric oncology were participants. Sample size for each study ranged between 7 and 150 children. All studies showed beneficial effects of exercise training for children with pediatric cancer. Discussion and Conclusion This systematic review adds to the body of literature that supports exercise training for individuals with pediatric oncology. Studies included support the beneficial effects of exercises for children with cancer. Further studies are needed to determine long term effects of any intervention. Available literature on exercise in children with pediatric oncology suggests that there are beneficial effects without adverse outcomes.
A Market-based Approach to Improving Passive Surveillance of Tuberculosis in Tarrant County
(2018-03-14) Stockbridge, Erica L.; Miller, Thaddeus; Moreno, Armando
Purpose: To explore a new method of public health action to further domestic tuberculosis (TB) elimination efforts through cooperation with private healthcare partners in the Tarrant County, Texas public health catchment. U.S. efforts towards TB elimination have recently stalled. Research has shown that these efforts should be expanded to include latent TB infection (LTBI). However, limited resources, a vague mandate, and more make it difficult for public health to maintain consistent surveillance and treatment of LTBI. Therefore, a market-based approach is an attractive method for addressing this new focus. Understanding facilitators and barriers is paramount to developing such an approach. Experience from this limited context, a largely urban population of just over 2 million, will inform if and how a market-based approach can contribute to national TB control efforts. Methods: Interviews and focus group discussions with key individuals from the Tarrant County public health catchment were held beginning 5/19/2017 to explore (1) supporting research, (2) community partners serving at-risk populations, (3) facilitators and (4) barriers. Results: (1) Supportive evidence from epidemiology, economics, public health, private healthcare, etc. potential gross for local providers exceeding $7 million estimated 14.5% of Tarrant’s 2015 population are high risk (2) In Tarrant County, there is one federally qualified healthcare center organization that serves a significant portion of high risk individuals. (3) Facilitators include partner healthcare organizations, CDC support, provider advocates, etc. (4) Barriers include costs (real and perceived), changes to clinical and documentation practices, coding/billing, etc. Conclusions: There is a wealth of evidence to support the feasibility of such a project. Identification of the appropriate at-risk population(s) and their respective healthcare providers highlights community partners likely to be interested in such a project. Through the collection of appropriate resources, use of identified facilitators, and addressing of respective barriers, the project could be implemented at little to no direct cost to the private healthcare organization. Furthermore, the combination of these could yield an effective program that is financially lucrative, thereby meeting the goals of both public health and private healthcare.
A Mechanism study toward understanding the protective effects of glutaredoxin 2 (Grx2) on light-induced retinal damage
(2018-03-14) Liu, Xiaobin; Xavier, Christy; Ananti, Princess; Liu, Yang; Wu, Hongli; Wang, Duen-Shian
Purpose: Glutaredoxin 2 (Grx2), located mainly in the mitochondria, is a glutathione-dependent oxidoreductase which is known to reduce S-glutathionylated proteins. In previous study, we have found that Grx2 could protect the retina from light-induced retinal degeneration. However, the molecular mechanisms that coordinate mitochondrial energy production with thiol-repair processes in the damaged retina remain largely unknown. To better understand the protective effects of Grx2 in the retina, our study was thus extended to analyze the full transcriptome changes of the retinal tissue in light-exposed Grx2 knockout (KO) mice. Methods: Wild type (WT) and Grx2 KO mice were exposed to white light at 12,000 lux for 1 hour after dark adaptation. The retinal damage was confirmed by the electroretinogram (ERG) recording and spectral domain optical coherence tomography (SD-OCT) measurement. Protein glutathionylation level was evaluated by Western Blot. We then compared the full transcriptome of the retinal tissue in WT and Grx2 KO mice by performed the whole transcriptome shotgun sequencing (RNA-seq). The gene network was analyzed using DESeq2 pathway analysis software and the selected genes of interest were further confirmed by real-time PCR and Western Blot. Results: Light-exposed Grx2 KO mice showed compromised visual function as indicated by severe loss of both a- and b-wave amplitudes and the thinning of the outer nuclear layer (ONL). Protein glutathionylation level was elevated in light-exposed Grx2 KO mice. We identified thousands of genes with statistical significant expression changes in light-exposed Grx2 KO mice and classified them into cellular processes and molecular pathways. Among these pathways, many genes that are related to complement activation and inflammation reaction were significantly upregulated. These genes include complement C3, C4a, C4B (C4B), Bcl-3, NF-kappa B, Jak3, and STAT3. Conclusions: Collectively, our results suggest that Grx2 could protect the retina from light-induced retinal degeneration. It plays an important role in regulating light-induced retinal inflammation which may be associated with its ability to reduce S-glutathionylated substrates.
A multi-center retrospective investigation of diagnostic, referral, and early management pathways for pediatric patients with Autism Spectrum Disorder and Developmental Coordination Disorder.
(2018-03-14) Miller, Haylie; Mauk, Joyce; Bowman, W. Paul; Bailey, Laurie; Hamby, Tyler; Kata, Karolina
Background: Autism Spectrum Disorder (ASD) and Developmental Coordination Disorder (DCD) can co-occur, but diagnostic procedures vary widely. Some overlap exists in behavioral, motor, and social problems in ASD and DCD, which adds ambiguity to the diagnostic process. Provider- and patient-centered factors contribute to the differences in pathways to care; understanding these factors may lead to more robust guidelines for assessment of patients with suspected ASD, DCD, and ASD+DCD. Objective: Measure prevalence and describe the diagnostic pathway of ASD+DCD at 3 healthcare sites, and describe the diagnostic pathways reported for ASD, DCD, and ASD+DCD. Identify provider- and patient- centered variables related to diagnostic, early management, and referral patterns. Hypothesis: A combination of patient- and provider-centered variables will contribute to differences in diagnostic and management outcomes for patients with ASD, DCD, and ASD+DCD. Methods: This retrospective study evaluated patients diagnosed with ASD, DCD, and ASD+DCD in the Cook Children’s Medical Center (CCMC) network, UNT Health Science Center (UNTHSC), and the Child Study Center (CSC). Charts included patients ages 0-21 years at the time of first entry, with documented diagnosis of ASD, DCD, or ASD+DCD. We collected primary and co-occurring diagnoses, medications, developmental milestones, test scores, social history, time between first concern visit and diagnosis, and services consulted. Results: At CCMC, the number of patients with ASD was 5520, with DCD was 424, and ASD+DCD was 59. At CSC the number of patients with ASD is 1559, with DCD is 46, and ASD+DCD, 232. UNTHSC data collection will take place in March 2018. We used a stratified random sample of 50 subjects from each diagnostic group (ASD, DCD, ASD+DCD) for initial analyses. Analyses are ongoing, and include correlations and analyses of variance to identify relationships and group differences among patient- and provider-centered variables. Conclusion: The number of patients with ASD, DCD, and ASD+DCD served by CCMC and CSC is significantly lower than anticipated given prevalence estimates. ASD+DCD prevalence was higher at CSC than at CCMC. Assessment and diagnostic procedures at CSC are more extensive, and include developmental motor testing. Higher surveillance at this site may explain the higher observed prevalence of ASD+DCD. Further planned analyses will illuminate patient- and provider-centered differences among the 3 groups.
A Preliminary Look at the Effect of Light Exposure on Blood Glucose Levels of Overweight and Obese Teens
(2018-03-14) Roane, Brandy; Fulda, Kimberly; Fernando, Shane; Shah, Deep; Habiba, Nusrath; Bowman, Paul; Shum, Kathy
Purpose: Teens experience a puberty-driven delay in their circadian clock due to a mismatch in their internal and social clocks that increases their risk of adverse health outcomes. Disruption to the circadian system from ill-timed light exposure before bedtime and reduced melatonin levels produces adverse changes in glucose control and increases Type 2 Diabetes Mellitus (T2DM) risk. As such, teens may be more susceptible to developing T2DM. This study sought to provide better insight into the relationship between light exposure around the sleep period and risk of developing T2DM in this vulnerable and understudied population. We proposed that light levels would be positively associated with HbA1c levels in teens during the two hours before bedtime and during the sleep period. Methods: Current analyses utilized baseline data from a 13-week pilot intervention study (PI: Roane) that examined the impact of a circadian-conscious intervention on T2DM risk. Teens and caregivers provided informed consent/assent. HbA1c levels (mmol/mol) were collected via finger prick. Teens followed a “typical” self-selected sleep schedule for 1-week while wearing a wrist actigraph (AMI MicroMotion Logger) to capture 24-hour sleep and light data. BMI %tile was calculated from in-lab measured height and weight. Mean lux, percent time above 20 lux, minimum lux, and maximum lux were calculated for the two hours pre-bedtime and during the sleep period. Correlation analyses were run to examine the association between light exposure and HbA1c due to small sample size. Results: Teens (n=7) were age 16 years, 57% female, and 57% Hispanic with low to moderate T2DM risk. Mean BMI %tile was 97th, HbA1c was 5.4, and 57% exhibited Acanthosis Nigricans. Mean sleep period duration was 496 minutes (mean sleep duration during this period = 410 minutes). Correlation analyses were not significant; however, visual inspection showed sex-differences in HbA1c levels and different patterns in how light exposure during these two crucial periods may relate to HbA1c. Conclusion: These pilot findings did not confirm an association between light exposure (lux) and HbA1c levels (mmol/mol) in obese and overweight teenagers. Findings were limited by a sample that was small in size and low in T2DM risk. Suggested sex differences in these data combined with documented sex differences in the literature support further examining sex differences in a larger sample with more diverse T2DM risk.
A Rare Case of Superior Vena Cava Syndrome caused by long-term indwelling Hemodialysis Catheter Placement
(2018-03-14) Aftabizadeh, Som; Iyamu, Ikponmwosa; Nguyen, Thao; Madhrira, Machaiah; Reddy, Prashanth; Patel, Aman
Title: A Rare Case of Superior Vena Cava Syndrome caused by long-term indwelling Hemodialysis Catheter Placement First Authors: Dr. Som Aftabizadeh, DO, PGY-1 Co-authors: Dr. Thao Nguyen, DO, PGY-2; Dr. Aman Patel, DO, PGY-3; Dr. Prashanth Reddy, MD, PGY-1 Attendings: Dr. Ikponmwosa Iyamu, MD; Dr. Machaiah Madhrira, MD; Dr. Balamurugan Sankarapandian, MD Name of Institution- Medical City Fort Worth Name of institutional department, division or other administrative unit- Internal Medicine City, State, Zip Code: Fort worth, Texas, 76104 Background/Abstract: End-stage renal disease (ESRD) cases continue to rise at approximately 21,000 cases per year in the US.1 During the past decade there has been a trending increase in use of central venous catheters (CVC) for hemodialysis (HD).2-3 When inserted into the superior vena cava (SVC), these catheters have been shown to be associated with thrombosis. While malignancy is the most common cause of superior vena cava syndrome (SVCS), an increasing incidence of benign causes are appearing. A portion of these benign causes are associated with the increasing use of intravascular catheters.2,4 Case Report: A 51-year-old african american female with past medical history of ESRD on HD, type II diabetes mellitus, coronary artery disease, paroxysmal atrial fibrillation who presented to our emergency department with acute neck swelling associated with hoarseness and headache. She states she woke up on the morning of admission with diffuse bilateral neck swelling that increased in size throughout the day. She denied difficulty with swallowing solids or liquids. She also denied difficulty with respiratory effort, chest pain, or shortness of breath. Her Vitals were stable. Clinical exam showed minimal facial edema but prominent superficial veins of the chest wall and neck region. Chest x-ray showed widening of the mediastinum. Our initial clinical impression was cellulitis, angioedema, or allergic reaction. Chest CT showed a thrombus partially occluding the SVC with severe stenosis at the cavoatrial junction. The patient was diagnosed with SVCS and underwent recanalization with angioplasty and stenting of SVC. The symptoms of superior vena cava syndrome began to improve immediately after the angioplasty and she continued to be free of symptoms and was subsequently discharged home. Of note, the patient had a long history of CVC access with repeated and prolonged placement after failed AVGs. Discussion/Conclusion: SVC syndrome is a medical emergency and can be fatal if resulting in severe cerebral edema and cerebellar herniation. A slower development of SVC is often better tolerated as many patients develop collateralization of vessels.4 It is thought that approximately half of central vein stenosis remain asymptomatic with clinical manifestations presenting due to eventual local upstream hypertension. In addition to risk of thrombosis of all CVCs, hemodialysis related CVCs are believed to have increased risk of thrombosis due to having longer, thicker lumens and longer length of placement.5-6 Therapy is generally endovascular or surgical with the former fairing better in hemodialysis patients with multiple comorbidities.7 This case illustrates the unusual manner in which SVC can present along with the potential for iatrogenic causes of SVC syndrome. Given the increasing frequency of intravascular catheter placement, it’s important to identify iatrogenic causes. Avoiding long term use of hemodialysis catheters and timely creation of AVFs may help prevent these complications. References: Lok CE, Foley R. Vascular access morbidity and mortality: trends of the last decade. Clin J Am Soc Nephrol. 2013;8(7):1213-9. A rare complication of hemodialysis catheters: superior vena cava syndrome. Akoglu H, Yilmaz R, Peynircioglu B, Arici M, Kirkpantur A, Cil B, Altun B, Turgan C Hemodial Int. 2007 Oct; 11(4):385-91. Warren P, Burke C. Endovascular management of chronic upper extremity deep vein thrombosis and superior vena cava syndrome. Semin Intervent Radiol. 2011;28(1):32-8. https://emedicine.medscape.com/article/460865-overview Quaretti P, Galli F, Moramarco LP, et al. Dialysis catheter-related superior vena cava syndrome with patent vena cava: long term efficacy of unilateral Viatorr stent-graft avoiding catheter manipulation. Korean J Radiol. 2014;15(3):364-9. Seelig MH, Oldenburg WA, Klingler PJ, Odell JA. Superior vena cava syndrome caused by chronic hemodialysis catheters: autologous reconstruction with a pericardial tube graft. J Vasc Surg. 1998;28(3):556-60. https://emedicine.medscape.com/article/460865-treatment
A Systematic Review of Physical Therapy Interventions for Parkinson’s Disease
(2018-03-14) Garcia, Stephanie; Kelley, Caitlin; Howe, Liu; Rose, Kendall
Abstract Purpose: The purpose of this systematic review is to identify effective interventions applied by physical therapists to address common impairments in patients with Parkinson’s Disease(PD). Methods: A search of Pubmed, Medline, Scopus, Wiley Online Library, EbscoHost, CINHAHL were used to identify studies published from 2007 to 2017 written in English with the key words: Parkinson’s Disease, posture, balance, gait, rigidity. Results: 25 studies published between 2007 to 2017 that met the inclusion criteria were used. Based on the quality level of evidence, 13 of the studies were qualified as IB, two as IIB, and 10 as III. To address posture, using a hyperextension brace while performing strengthening exercises for 30 minutes a day for four months, strengthening while wearing a weighted backpack twice a day for five weeks, or a multiple intervention approach that incorporates functional strengthening for five days a week in a four week period can be beneficial. Usage of an UpRight device for 21 consecutive days or kinesio tape with postural rehabilitation in 12 visits over four weeks can be incorporated. Use of aquatic rehabilitation can be used to treat abnormal flexion when completing five sessions per week for a total of eight weeks. To address rigidity, Yoga can be beneficial when performed two times a week for 12 weeks. Interval training three times a week for eight weeks can decrease rigidity. Treatments for gait include LVST BIG four times per week for four weeks. A curved walking program for 12 sessions over four to six weeks can increase gait speed. Auditory cueing during the first month of gait training and progressive resistance training can be incorporated two times a week for 10 weeks. Such improvements include decreasing freezing of gait, increased stride length, and speed of movement. To address balance impairments, Tai Chi can be done for two to three times a week for 60 minutes, dance therapy for 75 minutes, Adaptive Tango twice a week, or Argentine Tango can be performed five times a week. Repetitive step training three times a week or HiBalance training three times a week can improve balance. Conclusion: This review indicates that multiple approaches can be used to treat common impairments such as posture abnormalities, rigidity, balance and gait deficits seen in patients with PD. Keywords: Posture, Balance, Parkinson’s Disease, Gait, Rigidity
Acute Effects of Obstructive Sleep Apnea on QT interval
(2018-03-14) Davis, Tyler; Elias, Christopher; Burk, John; Smith, Michael; Burgess, Lauren
Over 20 million people in the United States suffer from Obstructive Sleep Apnea (OSA). Compared to the general population, OSA patients are 2.6 times more likely to experience sudden cardiac death (SCD), and it is suspected that this is due, in part, to QT prolongation leading to fatal dysrhythmias. We recently showed that 20 min of simulated OSA in healthy young individuals caused significant increases in QTc, however, it is not known what effect actual OSA events have on QT interval and what factors influence these responses. Thus, the purpose of this study was to evaluate whether obstructive apneic events in OSA patients leads to QT prolongation compared to baseline. Methods: We determined QTc intervals (determined by Bazett’s formula) from the electrocardiograms of 14 patients undergoing polysomnography for diagnosis of OSA and titration of treatment with positive airway pressure. IRB approval was obtained for our protocol (UNTHSC #2018-019). Patients that were selected had an apnea hypopnea index >20/Hr and had no prior myocardial infarction or heart failure. Each patient’s ECG during their sleep study was analyzed to assess QT interval throughout the night. Baseline QT intervals were compared to QT intervals during obstructive apneas before midnight (Early) and apneas after midnight (Late), thus, representing those in which there were few prior apneas (Early) versus those with numerous prior apneas (Late). The QTc intervals were compared between baseline awake and baseline asleep, and between baseline and Late apneas. Statistical comparisons were made with paired t tests. Results: Baseline QTc intervals were not different between awake and sleep (p > 0.60); however, during apneas (whether Early or Late), the QTc intervals were significantly prolonged (p = 0.008). Conclusions: In conclusion, OSA is often associated with acute QTc prolongation with the magnitude ranging from 5-42 msec in this patient cohort. Further analyses will be performed to determine factors that affect the magnitude of QT prolongation accompanying apneas during the night. In addition, future studies will focus on QTc changes in OSA patients with prior heart disease, as these are the patients at greatest risk for developing serious arrhythmias during the night.
Adenosine Triphosphate (ATP) monitor gauges for testing and validation of biological laboratory disinfection process.
(2018-03-14) Nair, Maya; Moncus, Matthew; Deshmukh, Rashmi
Purpose: Many University of North Texas Health Science Center (UNTHSC) laboratories work with microbiological organisms, which without enough safety precautions or if inappropriately contained, may lead to harmful diseases to the people working in the laboratories. The presence of these organisms on the working stations of the laboratory personnel infers improper disinfection of the surfaces which might lead to a possible exposure and deleterious health effects leading to lawsuits. Therefore, the study aims at detecting these microorganisms using an Adenosine Triphosphate (ATP) monitor. Methods: The study involves the use of the ATP monitor which gauges the presence of a biological agent at any surface and has mostly been used in the food industry for maintaining the quality of food. It has not yet been used in laboratory settings and is going to be tested for its efficacy in such an environment for the first time in UNTHSC labs. As it is an intervention of its kind, the process involves the identification of the labs using biological agents through an annual laboratory inspection and later using the ATP monitor on surfaces coming in frequent contact with people using those particular labs. Results: The results obtained after analysis of the data gathered by the ATP monitor would be used to establish a baseline level of cleanliness and decontamination for laboratories and create a periodic testing protocol to maintain the established levels. Conclusion: The research-oriented laboratories on the UNTHSC campus are of Biosafety Level (BSL) 1 or 2 which implies that they work with several pathogenic organisms which pose a moderate risk to human health. Using an ATP monitor seems to be a promising approach towards enhancing the biosafety on the campus and maintaining a good validation process for laboratory disinfection, thus keeping the environment a safe area to conduct research.
Administration of 5-methoxyindole-2-carboxylic acid that potentially targets mitochondrial dihydrolipoamide dehydrogenase confers cerebral preconditioning against ischemic stroke injury
(2018-03-14) Li, Rongrong; Li, Wenjun; Ren, Ming; Thangthaeng, Nopporn; Sumien, Nathalie; Liu, Ran; Yang, Shaohua; Simpkins, James; Forster, Michael J.; Yan, Liang-Jun; Wu, Jinzi
Purpose: The purpose of this study was to investigate a possible role of mitochondrial dihydrolipoamide dehydrogenase (DLDH) as a chemical preconditioning target for neuroprotection against ischemic injury. Methods: We used 5-methoxyindole-2-carboxylic acid (MICA), a reportedly reversible DLDH inhibitor, as the preconditioning agent and administered MICA to rats mainly via dietary intake. Upon completion of 4 week's MICA treatment, rats underwent 1 h transient ischemia and 24 h reperfusion followed by tissue collection. Results: Our results show that MICA protected the brain against ischemic stroke injury as the infarction volume of the brain from the MICA-treated group was significantly smaller than that from the control group. Data were then collected without or with stroke surgery following MICA feeding. It was found that in the absence of stroke following MICA feeding, DLDH activity was lower in the MICA treated group than in the control group, and this decreased activity could be partly due to DLDH protein sulfenation. Moreover, DLDH inhibition by MICA was also found to upregulate the expression of NAD(P)H-ubiquinone oxidoreductase 1(NQO1) via the Nrf2 signaling pathway. In the presence of stroke following MICA feeding, decreased DLDH activity and increased Nrf2 signaling were also observed along with increased NQO1 activity, decreased oxidative stress, decreased cell death, and increased mitochondrial ATP output. We also found that MICA had a delayed preconditioning effect four weeks post MICA treatment. Conclusion: Our study indicates that administration of MICA confers chemical preconditioning and neuroprotection against ischemic stroke injury.
Age and sex differences in childhood and adulthood obesity association with phthalates: Analyses of NHANES 2011–2014
(2018-03-14) Moore, Jonathan; Huang, Yuhan; Aryal, Subhash; Uche, Uloma I.
Purpose: To examine the relationship between urinary phthalates and obesity in children/adolescents and in adults using data from NHANES 2011-2014. Methods: Using the National Health and Nutrition Examination Surveys (NHANES) 2011-2014, data files on ten urinary phthalates and obesity in children/adolescents (aged 6-19 years old) and in adults (20 years and older) were retrieved. Urinary phthalates were grouped as low molecular weight (LMW) phthalates, High Molecular Weight (HMW) phthalates, Di-2-ethylhexyl phthalates (DEHP) and categorized using weighted quartiles. Children/adolescents were classified as underweight/normal, overweight and obese using the BMI z-score. Adults were classified similarly using BMI measures of29.9, respectively. A multinomial logistic regression was conducted to determine the association of urinary phthalates and obesity while controlling for covariates. Participants with missing covariates, pregnant women and breastfeeding women were excluded. Results: Using multinomial logistic regression, the 3rd quartile for LMW and the 4th quartile for DEHP had statistically significant associations with being overweight in children/adolescents. The 3rd quartile for LMW was associated with being overweight in female children/adolescents and the 4th quartile for DEHP was associated with being overweight in male children/adolescents. The 4th quartile of individual phthalate MECPP was found to result in increased odds of being overweight in the female group and in children overall. The highest quartile for MEHHP was also significantly associated with obesity for children overall and for males. There were no statistically significant associations between urinary LMW, HMW and DEHP concentrations and obesity in adults, even when stratified by gender. Analyses of the individual phthalate components of LMW indicated an association between the 4th quartile of MnBP and overweight among female adults. No association was found in other individual phthalates and prevalence of obesity in adults. Conclusion: Urinary concentrations of LMW and DEHP are associated with increased rates of overweight in children/adolescents and there is a sex difference in this association. There is no apparent association between urinary phthalates and obesity in adults.
Altered gene expression in HIV gp120 transgenic mouse brains: Effects of methamphetamine treatment.
(2018-03-14) Ghorpade, Anuja; Molles, Brian
Purpose: Antiretroviral therapy (ART) has extended lifespans by decades for HIV-infected individuals. However, the prevalence of HIV-associated neurocognitive disorders (HAND) continues to be high despite successful ART therapy. Brain astrocytes can harbor provirus and express neurotoxic HIV proteins such as gp120 and TAT, potentially contributing to HAND. In addition, neurocognitive decline is exacerbated in individuals who use methamphetamine (METH). We hypothesize that METH treatment in gp120+ mice will cause changes in gene expression and damage/death to specific cell populations. Methods: To examine the role of METH in HAND, we used a transgenic mouse line expressing GFAP-controlled HIV gp120 protein (gp120+). Mice were injected intraperitoneally with either 0.9% saline vehicle or successive weekly escalating doses of 1, 5, 10, or 30 mg/kg METH, and their brains were harvested 7 days post-injection for qPCR, immunohistochemistry and protein analyses. Results: In qPCR experiments, gp120+ mice showed dramatically increased levels of GFAP mRNA, suggesting chronic gp120 expression causes astrocyte activation. However, a qPCR probe designed to distinguish the transgene versus the endogenous GFAP transcripts showed lower levels of GFAP activation, suggesting that some of the GFAP mRNA expression is read-through from the transgene construct. GFAP expression in the rostral portion of the brain (anterior to ~0 bregma) was lower than the caudal portion in the gp120- mice, whereas GFAP was higher in the rostral portion in the gp120+ mice, suggesting enhanced astrocyte activation in the rostral portion of the brain encompassing the striatum and frontal cortex. Tissue inhibitor of metalloproteinase-1 (TIMP1) and interleukin 1-beta (IL1b) mRNA levels were increased in gp120+ mice compared to gp120- mice. Gene expression levels of excitatory amino acid transporter-2, tyrosine hydroxylase, and dopamine transporter were not changed in gp120+ mice. None of the METH treatments changed in gene expression in either mouse group at 7 days post-injection. Conclusions: Long-term expression of gp120 in brain leads to altered gene expression of neuroinflammatory mediators. Single-dose METH treatment did not alter gene expression for the targets studied in either the gp120- or gp120+ mouse lines. Future experiments will focus on changes in protein expression and functional properties of specific cell populations in the brain at different times post-METH treatment.
Alzheimer's and Automation: A Match Made in Research?
(2018-03-14) Pierce, Melissa; Hall, James MD; O'Bryant, Sid Ph.D; Conger, Tori
Alzheimer’s and Automation: A Match Made in Research? Presenter: Tori Conger and Melissa Pierce Classification: Staff Authors: Tori Conger, tori.como@unthsc.edu, UNT Health Science Center, Melissa Pierce, melissa.pierce@unthsc.edu, UNT Health Science Center, Dr. James Hall MD, james.hall@unthsc.edu, UNT Health Science Center, Dr. Sid O’Bryant Ph.D, sid.obryant@unthsc.edu , UNT Health Science Center Objective: Alzheimer’s is a disease that destroys memory, alters mental function, disrupts the autonomic nervous system and is detected only after an individual has had the disease for several years. Our research is dedicated to early detection of Alzheimer’s through blood-based biomarkers, clinical testing and MRIs. We are projected to see upwards of 3,000 people over a 5-year period. With one lab, four staff, and minimal sample process time, our research was in need of a system that could increase productivity, reduce human error and allow our samples to be fully processed from blood draw to freezer in under two hours. Our solution: the Hamilton Robotics Easyblood robot combined with a customized LIMS system. Methods: The lab was in need of a system to fully capture the blood collection process. To capture this information, a LIMS system was developed to document each milestone the sample reached such as time of blood draw, time into centrifuge, etc. The Easyblood robot was programmed to aliquot blood fractions (GLP-1 plasma, plasma, buffy coat and serum) to fit our needs based on each project’s protocol. For the LIMS system and Easyblood robot to communicate with each other, an SQL server database was utilized to link the LIMS system to Easyblood through a developed common bond: barcoded collection kits. Each collection kit (EDTA, SST, and p800 tube) has a project barcode and each tube in the collection kit has its own barcode, denoted by sample type. Results: With the implementation of the Easyblood robot and the LIMS system, the lab is able to track the blood collection process from beginning to end. This information enables lab personnel to process multiple samples at one time, easily identify the samples, reduce the amount of time between collection and storage and minimize human error. Conclusion: The two systems working in conjunction with each other allows for increased consistency, simplicity, and reliability in processing blood-based samples. IRB # 2015-171 IBC # 2017-0056
An 11-Year-Old Female with Short Stature, Developmental Delay, and Bilateral Cataracts
(2018-03-14) Swanson, Larry; Hamby, Tyler; Hamilton, Luke; Wilson, Don; Tran, Martin
Pseudohypoparathyroidism (PHP) is a rare, autosomal dominant disorder characterized by an end-organ insensitivity to parathyroid hormone (PTH). 1,2,3 Children with PHP typically present with symptoms of hypocalcemia, such as tetany and seizures. The most common form of PHP is 1A, caused by a loss of function mutation in the GNAS gene, which primarily affects PTH and possibly other hormones that share the same signal transduction. 3,4 In addition to symptoms of hypocalcemia and hormonal resistance, patients with PHP1A present with one or more features of Albright hereditary osteodystrophy (AHO), including short stature, subcutaneous ossifications, obesity, rounded face, mental deficit, and brachydactyly of either the 4th or 5th phalanges of the hands, feet, or both. We report a child who presented with features of PHP1A, discuss the diagnosis, and current recommendation of this rare condition.

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