Abstracts
Permanent URI for this communityhttps://hdl.handle.net/20.500.12503/31249
Browse
Browsing Abstracts by Title
Now showing 1 - 20 of 243
- Results Per Page
- Sort Options
Item A CASE FOR A STANDARDIZED METHOD FOR THE NORMALIZATION OF MUSCLE SYMPATHETIC NERVE ACTIVITY AMPLITUDE(2013-04-12) White, DanielPurpose: MSNA has no agreed upon standard for analysis. For example, mean burst strength (MBS), total activity (TA) and total MSNA (TMSNA) rely on amplitude measurements assigned arbitrary units which are highly dependent on the method of normalization. We investigated the hypothesis that computer algorithms used for automatic normalization of MSNA amplitudes differ from those obtained with manual normalization leading to erroneous interpretations. Methods: MSNA from healthy human subjects (n=8, 2 female) was obtained by microneurography of the peroneal nerve while resting quietly in a 30* semi-recumbent position. Data was analyzed by 3 different normalization methods (Min-Max Auto (MM), Mean Auto (MA), and Rectified Manual (RM)). MSNA is quantified as burst frequency (BF), burst incidence (BI), MBS, TA, and TMSNA. Results: There were no differences in BF or BI between the three analysis methods. However, significant differences were detected between MM and RM in MBS, TA and TMSNA (p=0.002, p=0.009, and p=0.004). Rankings according to activity were not different between MM and RM but were different in MA compared to either MM or RM. Conclusions: There is an overwhelming need to standardize the analysis of MSNA. The current study points out that the variables BF and BI can be compared across studies. However, our data identify that the RM normalization is the only method to quantify MBS, TA and TMSNA for cross-study comparisons.Item A CASE OF HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY WITH NO PREVIOUS CARDIAC HISTORY(2013-04-12) Wardi, MiraiePurpose: This case study will depict the presentation, diagnosis, management and prognosis of hypertrophic obstructive cardiomyopathy (HOCM) in a 64-year-old Caucasian female with no previous cardiac history who presented with dyspnea and an incidental systolic murmur. HOCM is a genetic disease caused by mutations of sarcomere genes that encode components of the contractile apparatus of the heart. We will illustrate an atypical presentation of HOCM in a female with no previous cardiac history and discuss appropriate diagnostic and treatment options. Methods: The patient's medical records, echocardiography reports, and cardiac cauterization reports, were reviewed. Results: A 64-year-old female with a past medical history of hyperlipidemia, tobacco dependence and COPD presented to her pulmonologist with worsening dyspnea on exertion. Upon physical examination, a global III/VI systolic ejection murmur that increased upon standing was heard. Upon evaluation by cardiology and review of echocardiography results, it was found that the patient has severe HOCM with an outflow gradient of 144 mmHg with peak velocities across the left ventricular outflow tract (LVOT) at 8.1 cm/s. There was also severe global left ventricular hypertrophy and asymmetric septal hypertrophy. Left ventricular ejection fraction was preserved at 55%. Systolic anterior motion causing severe mitral regurgitation in an eccentric anterior direction with thickened mitral leaflets was also found. Cardiac catherization revealed mild nonbstructive coronary artery disease, moderate or severe pulmonary hypertension and severe left ventricular to aortic pressure gradient. Holter monitoring revealed sinus rhythm, no NSVT and no significant pauses. The patient was counseled on treatment options which include either myomectomy or alcohol septal ablation. Conclusions: A leading cause of sudden cardiac death in young athletes, HOCM can also present as a sporadic form in older individuals. When performing a cardiac examination, it is important to consider rare cardiac pathologies such as HOCM. Adequate work up of HOCM includes evaluation of the left ventricular and septal size and mitral valve function. It is also important to screen the patient's first degree relatives for HOCM because of the autosomal dominant nature of HOCM gene mutations. Once appropriately diagnosed, treatment options are alcohol ablation or myomectomy of the hypertrophied septum. Prompt treatment is essential to minimize the risk of sudden cardiac death.Item A CASE OF WEST NILE VIRUS MYOCARDITIS PRESENTING AS NON-ST ELEVATION MYOCARDIAL INFARCTION(2013-04-12) Wardi, MiraiePurpose: This case study will present an atypical presentation of West Nile Virus (WNV) myocarditis in a Hispanic male who presented with palpitations, syncope and chest pain consistent with NSTEMI. Typically, WNV infection is asymptomatic; those who are symptomatic present most commonly with WNV and neuroinvasive disease. Myocarditis is an atypical presentation of West Nile Virus infection. We will illustrate the clinical presentation of WNV myocarditis that initially presented as NSTEMI. Methods: The patient's hospital records, including labs, echocardiography findings and cardiac catherization findings, were reviewed. Results: A 38 year old Hispanic male with a previous history of hypertension, hemorrhagic stroke, hyperlipidemia, sleep apnea, metabolic syndrome and gout presented after falling in his home with a chief complaint of elbow, head, neck and chest pain. The patient reported syncope, palpitations, chest pain but no symptoms associated with seizures. Labs showed elevated troponin of 1.385 and a WBC of 21.4. ECG revealed sinus tachycardia, left axis deviation, left atrial enlargement, left anterior fascicular block and nonspecific ST and T wave abnormalities. The patient was admitted on IV antibiotics and serial troponins were monitored. During the course of the admission, cardiac enzymes progressively trended down. Left heart catherization showed minimum irregularities of the left anterior descending less than 20% without evidence of any obstructive coronary artery disease lesions in any of the coronary arteries. Echocardiogram revealed new heart failure with LV ejection fraction of 35-40% due to global cardiomyopathy. Prior to discharge, the patient was tested for West Nile Virus antibodies and viral antigens. He was sent home on maximum medical therapy for coronary artery disease and CHF. West Nile Virus serology was obtained several days after discharge and revealed that the patient was positive for West Nile Virus infection. Conclusions: This case highlights the need for further investigation of cases presenting with increased troponins and suspicion for NSTEMI. Viral myocarditis should be suspected in symptomatic patients who present during mosquito seasons with new onset and persisting headache with chest pain, increased troponins, significant ECG changes, or new onset CHF. Specifically, West Nile Virus has now been implicated in cases with significant cardiac involvement and should be included in any differential diagnosis concerning the etiology of cardiac events.Item A CASE PRESENTATION OF INTESTINAL CANDIDIASIS CAUSING IRRITABLE BOWEL SYNDROME AND PERIPHERAL NEUROPATHY(2013-04-12) Yu, LuPurpose: To demonstrate the role of candidiasis in Irritable Bowel Syndrome (IBS), investigate the possibility of intestinal candidiasis causing periphery neuropathy, and encourage clinicians to consider intestinal candidiasis in patients with symptoms of IBS. Methods: A clinical case of IBS with peripheral neuropathy is investigated. The 35yo man of Mediterranean descent complained of persistent diarrhea, diffuse abdominal pain, generalized myalgia, and parenthesis in extremities. Stools were loose, watery, foul smelling, and yellowish in color. There was no melena. He occasionally had constipation. Dicyclomine provided mild relief during episodes of severe diarrhea. Myalgias were most severe in lower lumbar region, radiating to his extremities. Tramadol provided moderate relief. He also felt weakness, numbness, and tingling in his face, hands and feet Symptoms had been waxing and waning for over 6 years, but worsened over the last year. 6 years ago, he was diagnosed with IBS after a negative EGD and colonoscopy (some evidence of diverticulosis). Results: Labs and imaging tests ruled out celiac disease, diabetes, thyroid disease, mineral deficiency, metal poisoning, autoimmune disorders, Lyme disease, syphilis, and structural abnormalities. The patient was advised keep a food diary. Over a month of carbohydrate and sugar restriction, he had significant relief of his symptoms. His abdominal pain and diarrhea had largely resolved since the diet change. He still experienced occasional parenthesis in extremities. Acquired carbohydrate intolerance due to intestinal candidiasis was suspected. He was treated with Diflucan for 30 days. Along with medication, he was also advised to supplement with probiotics and eat a healthy diet with continued carbohydrate and yeast restriction. The patient has remained symptom-free except for residual peripheral neuropathy since the treatment. Conclusions: Candida albican is a normal gastrointestinal microbial in healthy humans, but during immunosuppression or alteration of bacteria microbiota, such as following broad-spectrum antibiotic treatment or chronic vaginal candidiasis, C. albicans can overgrow and suppress the healthy bacterium of the colon, resulting in abdominal pain and diarrhea. It is also suspected that candidiasis can cause peripheral neuropathy due to overproduction of alcohol. Treatment is anti-fungal medication. A healthy, low-carb diet and probiotic supplements are also essential to maintain intestinal health and prevent recurrence.Item A CROSS SECTIONAL STUDY OF SEXUAL FUNCTIONING, ATTITUDES AND SATISFACTION OF LAPAROSCOPIC BANDING PATIENTS(2013-04-12) Mamawala, MufaddalPurpose: Sexual functioning and sexual satisfaction problems are well known to negatively impact QOL of obese patients. To date little is understood about sexual functioning of patients following WLS. This study is designed to investigate the sexual functioning, attitudes and satisfaction of post-surgical WLS patients, using a cross-sectional design. Methods: Subjects included 44 women who underwent laparoscopic banding surgery (LBS). Subjects had an average age of 44.95 years (20 - 69), and an average post-surgical weight loss of 56.72 pounds (10 - 154). Patients were stratified into (k=3) groups based on time since surgery, 1-6 months, 7-9 months, and e10 months. Subjects completed a self-report medical history checklist to determine current health status (diabetes, osteoarthritis, hypertension, depression, mental disorders). Self-report surveys included Female Sexual Function Index (FSFI), Body Exposure during Sexual Activities Questionnaire (BSEAQ), and Body Image Quality of Life Inventory (BIQLI). Group scores for each survey were compared using repeated measure ANOVAs. Bivariate Correlation was used between BIQLI, BSEAQ, FSFI, and Weight Loss to evaluation relationships between variables. Percent of subjects meeting criteria for Female Sexual Arousal Disorder (FSAD) was calculated based on published normative values. Subjects were then divided into "no sexual dysfunction" and "sexual dysfunction" based on published normative values. Cross-Tabulation and Fischer's-Exact Test was utilized to compare health status between women with and without sexual dysfunction. Results: There was no difference between time since surgery stratified groups for FSFI, BSEAQ, or BIQLI. There was a significant correlation between BSEAQ and FSFI (r= -0.566, p=.000). No other correlations were significant. In comparison to published normal values, 41% of subjects could be classified as having Female Sexual Arousal Disorder. There was no difference in prevalence of self-reported medical conditions between women with and without sexual dysfunction. Conclusions: A high percentage of post-surgical LBS patients are continuing to experience disturbances in sexual functioning despite a wide range of weight loss or time since surgery. Sexual dysfunction appears strongly related to the extent to which they are focused on a negative body image during sexual activity. These results will contribute to the development of targeted interventions to facilitate improvement in QOL in this population.Item A CURIOUS CASE OF PRIMARY SQUAMOUS CELL CARCINOMA OF THE PANCREAS(2013-04-12) William, JosephPurpose: The purpose of this study is to add to the minimal literature regarding diagnosis, treatment and management of squamous cell carcinoma of the pancreas. Furthermore it will provide greater insight on this particular disease process with the goal to improve future patient's morbidity and mortality. Methods: Patient information in the form of imaging studies, pathology reports, history of present illness notes and progress notes were obtained through various medical institutions between November 2012 and January 2013. Results: We present a case of a 60-year-old female with right upper quadrant pain and an abnormal pancreatic head mass consistent across numerous imaging studies, suggestive of a neoplasm. Further confirmatory testing revealed a primary SCC of the pancreas. Conclusions: Due to the rarity of this particular subtype of pancreatic cancer little is known about the cause, treatment and management necessitating the need for additional information about this disease process.Item A DEPRESSIVE SUBGROUP OF MILD COGNITIVE IMPAIRMENT(2013-04-12) Cushing, BlairPurpose: Late life depression is a risk factor for Mild Cognitive Impairment (MCI) and Alzheimer's Disease (AD). MCI represents a transitional period between normal aging and AD and, therefore, represents a potential entry point for preventing AD. Depression is a risk factor for MCI and AD; however, identifying which MCI patients suffer depression-related cognitive impairment remains difficult. The current study sought to identify a clinically-defined depressed sub group among patients with MCI Methods: Data was analyzed from 519 participants (112 MCI) from Project FRONTIER, an ongoing epidemiological study of factors impacting rural aging and health. Depression was assessed with GDS30 and cognition was assessed using the EXIT 25 and RBANS. The sample was randomly split into the training and test sample. Five GDS items were identified in the training sample that were significantly associated with MCI status and were used to create the depressive endophenotype (DepE) of MCI. In the test sample, linear regression was used to examine the impact of depression on neuropsychological tests performance, and logistic regression was conducted to examine the risk of being diagnosed with MCI. Results: In the test sample, DepE was negatively related to RBANS scores of Immediate Memory (B=-2.22, p<0.001), Visuospatial (B=-1.11, p<0.001), Language (B=-1.03, p<0.001), Attention (B=-2.56, p<0.001), and Delayed Memory (B=-1.54, p<0.001), and higher DepE scores were related to poorer executive functioning (EXIT25; B=0.65, p=0.001). DepE scores significantly increased risk for MCI ([OR]= 2.04; 95% CI=l.54-2.69). Conclusions: These findings suggest that a depressed subgroup of MCI exists. Higher DepE scores increased risk for MCI and increased risk for poorer neuropsychological functioning across a range of domains. The DepE may identify those MCI patients who experience depression-related cognitive dysfunction, thereby detecting a selective group that may benefit from depression treatment for prevention of AD.Item A RAPIDLY PROGRESSING CASE OF SCHMIDT SYNDROME IN A MALE(2013-04-12) White, JustinPurpose: The purpose of this case presentation is to describe a very unusual presentation of Schmidt Syndrome, a rare multi-organ autoimmune disease. The case is unusual in that the disease rapidly progressed to multi-organ failure and presented in a male; both of these factors are very rare for Schmidt Syndrome. This is an extremely unique case and reporting the clinical management, findings, and symptoms involved in the case will provide supporting evidence/information for future physicians as this disease is a difficult and often missed diagnosis. Additionally, this case may lead to some new insight into disease process and maybe lead to new management strategies or treatments. Methods: The case presentation was a retrospective chart review of a single patient. The materials included progress notes from primary physicians and consults, lab work, and radiology readings. Results: We discuss diagnosis and clinical management of Schmidt syndrome. Management can be particularly challenging as the effected organs have additional effects on each other. Also discussed is a list of other symptoms that may occur in presentation. Conclusions: This is one of the few cases ever reported of a male with Schmidt syndrome. The rapid progression seen in this case has not previously been linked to affected males. However, this case may indicate that while males are effected less often then females, they may have present with a more severe form of the disease and new management techniques should be investigated to better control such a rampant process.Item A SEMI-AUTOMATED METHODOLOGY FOR THE EXTRACTION OF DNA FROM HUMAN SKELETAL REMAINS(2013-04-12) Mize, MaryPurpose: The conventional method used to extract DNA from skeletal remains is not readily amenable to automation. The numerous steps in the current procedure increase the risk of both sample loss and the potential for contamination with extraneous DNA. An automated DNA extraction procedure will be evaluated and optimized for the quantity and quality of DNA recovered from bone samples on the AutoMate Express™ (Life Technologies). The goal of this project is to determine if this process will yield equivalent amounts of DNA that will produce autosomal STR profiles and mitochondrial DNA sequence data that are comparable to those obtained with the conventional method of organic extraction. Methods: Varying amounts of bone powder, from different age groups of remains, were incubated with BTA Lysis Buffer (Life Technologies) which contains DTT and Proteinase K from two hours to overnight. After the incubation any remaining bone powder was spun down and 230µL of the lysate was loaded onto the AutoMate Express™ columns containing the PrepFiler™ magnetic beads. Total run-time for the instrument is 30 minutes and DNA is eluted in 50µL of buffer. The extracts were quantified and amplifications were performed. Autosomal STR profiles and mitochondrial DNA sequence data generated from samples processed using the AutoMate Express™ were compared to the data generated by the conventional organic extraction method. Results: No significant difference was observed between a 2-hour incubation and overnight incubation when using the AutoMate Express. The overall quantity and quality of the DNA extracted using the AutoMate Express™ was equal to or better than the DNA extracted using the conventional organic method. Conclusions: To this point the DNA obtained using the AutoMate Express, which takes a total of 4 hours, generates genetic data that is comparable or better than the data generated using the conventional methodology which takes 2-3 days.Item ACUTE DISSEMINATED ENCEPHALOMYELITIS IN A PEDIATRIC PATIENT: A CASE STUDY(2013-04-12) Long, AliaPurpose: The purpose of this study is to present a unique case of a pediatric patient with acute disseminated encephalomyelitis (ADEM) who was treated with corticosteroids. Methods: The pathogenesis of ADEM is primarily unknown. The significance of this case study is to present the clinical findings, neurologic changes during the patient's hospital stay, and describe radiological imaging that ultimately led to the diagnosis of ADEM. Results: A case of ADEM in a patient with a past medical history of mental retardation, ADHD, and Bipolar disease was presented. The combination of high-dose methylprednisolone, occupational therapy, and physical therapy resulted in improvement of the patient's level of pain, neurologic findings, and range of motion in her upper and lower extremities. The treatment modalities, possible long-term adverse sequelae as a result of ADEM, review of literature, and discussion and management of ADEM were reviewed. Conclusions: ADEM is an uncommon phenomenon that can be frustrating for patients and physicians as a result of the difficulty in establishing the diagnosis, unknown etiology, and wide variability in morbidity and neurologic deficits that can result. While evidence has shown that ADEM can be the result of a pathological process or may be associated with vaccinations, high-dose steroids combined with physical therapy and occupational therapy may be an effective treatment modality.Item ACUTE GLOBAL AMNESIA WITH HYPERDENSITIES OF BILATERAL TEMPORAL LOBES(2013-04-12) Truong, MelaniePurpose: Case presentation of a 31 year old female with a past medical history of diabetes, hyperlipidemia, and vitiligo who presented with an acute global amnesia and hyper-densities of bilateral temporal lobes. A unique case and the lessons learned. Methods: Medical charts, Diagnostic studies, Imaging studies, Lumbar puncture and Laboratory studies, Consultant notes and referral notes. Results: This case is a journey into the process of elimination as well as trial and error. From laboratory draws for blood; looking for serology, immunologic markers, and complete blood differentials; to imaging studies showing minor arcuate infarcts on CT, and ominous hyper-densities in both temporal lobes of the brain by MRI; we speculate as to the cause. This journey was one of expectant surprise. Acyclovir was prophylactically used to circumvent a herpetic encephalitis. Soon it was found to be unnecessary as the lumbar puncture showed herpes to be an unlikely source. As the days progressed, it became evident that our advanced diagnostic abilities were not satisfactory. The patient did not get better. In the end, after performing lumbar punctures, additional imaging of the blood vessels, and continued laboratory draws in search of an answer; our patient grew weary. A decision to recommend a brain biopsy was presented much too late. The patient decisively declined. Conclusions: As physicians, we want to get to the bottom of any medical problem. Physicians are often prompted to find the answers to patients' problems everyday. In medical texts and in pathology books, it seems so convenient. A case is presented, a trail of diagnostic study often points to the ultimate answer; the case is complete and the book can be closed. Unfortunately, in real life, people live with unsolved issues all the time. So our patient, after over a week in a confined space, decided that she no longer cares enough to find the diagnosis. She knows she cannot remember some things and that it worries her family, but she had had enough. The lesson learned here is that regardless of how severe or esoteric the problem; an expedient management of the case may have been better served. For instance, recognizing the need for a brain biopsy earlier rather than later may have elucidated a possible diagnosis. Second, it isn't the final diagnosis that matters to a patient, but the freedom to explore it if she so chooses to&or not.Item AGING-INDUCED INCREASED SUSCEPTIBILITY TO AUTOIMMUNITY IS DUE TO COMPROMISED NEGATIVE SELECTION IN THE THYMUS RATHER THAN DEFECTS IN REGULATORY T CELLS(2013-04-12) Coder, BrandonPurpose: Immunotolerance generates protection against autoimmunity by deleting self reactive T cells in the thymus through negative selection as well as the generation of natural regulatory T cells (nTregs) that will help suppress autoimmunity in the periphery. Natural aging is associated with a progressive loss of FoxN1 and thymic atrophy, and is also believed to be associated with increased autoimmunity and an increase in suppressive FoxP3+ regulatory T cells (Tregs). Deletion of self-reactive T cells requires self-antigen presentation by medullary thymic epithelial cells (mTECs). We set out to determine if thymic aging, characterized by the progressive loss of FoxN1 and mTEC disruption, alters immunotolerance by influencing negative selection or impacting the generation of suppressive Treg cells. Methods: For thymus population experiments, we induce thymic atrophy in our FoxN1 conditional knockout mice using tamoxifen injections. We then determine expression of CD4+, CD8+, and CD4+8+ double positive, and CD25+FoxP3+ regulatory thymocytes using flow cytometry. The peripheral Treg data is assessed by adoptive transfer of total spleenocytes from young and aged wild type mice into young Rag2-/- mice. Cell populations are determined using flow cytometry. Results: We found that the loss of FoxN1 induced thymic atrophy is associated with an impairment of negative selection, where CD4+ and CD8+ are increased in the thymus while CD4+CD8+ double positive thymocytes are decreased. This indicates that the age atrophied thymus is not able to delete additional single positive thymocytes, and these may be self-reactive thymocytes. Additionally, we found that nTregs in the aged and atrophied thymus are increased in proportion and their suppressor function remains intact. Furthermore, we found that when we transfer aged spleenocytes, in which there are increased Treg and decreased pro-apoptotic Bim protein, and young spleenocytes separately into young Rag2 knockout mice, that the young periphery is able to restore both Bim levels and Treg levels to that of the young mice. Conclusions: We conclude that loss of FoxN1 disrupts thymic mTEC structure and impairs negative selection, which may lead to an increase in self-reactive T cells. However, thymic atrophy does not compromise peripheral Tregs. The function and number of peripheral Tregs is dependent on the micro-environment in which they stay.Item ALTERED EXPRESSION OF IMMUNE RECEPTORS 2B4, CS1 AND LLT1 IN CHILDREN WITH ACUTE LYMPHOBLASTIC LEUKEMIA (ALL)(2013-04-12) Tan, CharissePurpose: Acute lymphoblastic leukemia is the most common type of leukemia found in children with peak prevalence between the ages of 2 and 5. In ALL, there is uncontrolled, exaggerated growth and accumulation of lymphoid progenitor cells, which fail to properly differentiate and function as normal lymphocytes. Despite current treatment protocols that have been successful in the vast majority of ALL patients, serious acute and late complications are frequent and resistance to chemotherapy often develops. Natural Killer (NK) cells, which are components of the lymphocyte population, can recognize and act on target cells under the control of their cell surface receptors. Binding of these receptors to specific ligands on the target cell results in signaling which either activates or inhibits NK cell effector functions. We have previously identified cell surface receptors 2B4, CS1 and LLT1 playing a major role in NK cell activation. Previous studies on these receptors implicate that these receptors may play a role in cancers, however their significance and role in childhood ALL have not been evaluated. We hypothesize that altered expression of these immune receptors play a role in acute lymphoblastic leukemia in children. Methods: ALL subjects and healthy subjects were enrolled at Cook Children's Hospital and UNT Health Science Center, Fort Worth, TX with informed consent/assent according to IRB approval. Peripheral blood mononuclear cells (PBMC) were isolated from whole blood of twelve ALL subjects and three healthy subjects. NK92-MI cell line was used as a positive control. Total RNA was extracted and reverse transcribed (RT-PCR) into complimentary DNA (cDNA). PCR was performed using primers specific to 2B4, CS1, LLT1, and expression was normalized to β-actin. Results: ALL subjects showed altered expression of 2B4 in PBMC as compared to healthy subjects. There was an overall decrease in the expression of CS1 receptor in ALL subjects as compared to healthy subjects. Interestingly, both ALL and healthy subjects showed expression of different isoforms of the LLT1 receptor with variations in their expression level. Conclusions: Results implicate that there are alterations in the expression of immune receptors that may mediate the immune dysregulation in ALL subjects. Expression and functional analysis of these receptors in a larger population of ALL subjects will provide vital knowledge furthering our understanding of the etiology of ALL, progression, and developing potential immunotherapies.Item ALTERED EXPRESSION OF PULMONARY SURFACTANT PROTEIN-A VIA IN-UTERO EXPOSURE TO HIGH CONCENTRATIONS OF FOLIC ACID(2013-04-12) Fraser, PatrickPurpose: Folic acid, a member of the family of B vitamins, is provided in elevated concentrations to pregnant women to prevent congenital birth deformities such as cleft palate and neural tube defects. Previous studies have shown in-utero exposure to high concentrations of folic acid can negatively regulate gene expression via hypermethylation of DNA and/or histones in promoter regions of developmentally regulated genes. Our study aims to show a similar effect on the lung-specific, developmentally regulated gene, surfactant protein-A (SP-A) in the fetal lungs of ICR mice exposed in-utero to high concentrations of dietary folic acid. Appropriate SP-A expression is necessary for the normal development and regulation of multiple aspects of the innate and acquired arms of the immune system. Methods: Outbred ICR mice (n=8) were placed on a diet supplemented with high levels of folic acid (HMD) along with the necessary cofactors for methyl metabolism. A control group (n=8) was placed on a standard diet. Multiple rounds of breeding were conducted until four distinct timepoints were collected. The fetal-lung tissues were harvested at the last four days of gestation: 15, 16, 17, and 18 days post-coitum (dpc), respectively. A significant suppression of SP-A, SP-B, and SP-D at term was revealed in the HMD group when quantitative real-time PCR (qRT-PCR) data were analyzed via the comparative CT method. Results: Increased expression of cyclooxygenase 1 and 2 (COX-1, COX-2), markers of inflammation, was observed in these same mice at 17 dpc. Conclusions: These findings suggest a possible predisposition for pulmonary dysfunction in HMD mice as a result of decreased expression of the anti-inflammatory, SP-A.Item AN INTEGRATED STRATEGY TO PROMOTE HIGHER ORDER THINKING AND REDUCE COGNITIVE DIAGNOSTIC ERRORS THROUGH PHYSICIAN ASSISTANT EDUCATION(2013-04-12) Tshuma, LisaPurpose: Diagnostic errors are more likely to result in patient harm than other types of medical errors and are frequently preventable. The primary causes of diagnostic error are breakdowns in our health care systems, clinical reasoning or both. Although significant effort has been placed in developing health care system solutions, relatively little has been done to mitigate the common causes of breakdown in clinical reasoning such as failed perception, implicit bias and failed heuristics. Our project employed a set of active and reflective learning activities in the MPAS 5242 course designed to provide physician assistant (PA) students with tools to reduce cognitive diagnostic errors in clinical practice. Methods: An integrated teaching approach centered on five strategies to decrease diagnostic cognitive error was employed. These strategies include Cognitive Dispositions to Respond (CDR) awareness, consideration of alternatives, metacognition, simulation and decreased reliance on memory. Students were introduced to CDRs through lectures and assigned readings including the book How Doctors Think. Students completed pre-class online quizzes to prepare them for interactive lectures and small group activities, including small group skits. Students completed weekly online Implicit Associations Tests to help them identify subconscious biases that may contribute to cognitive diagnostic errors. Finally, students wrote a reflection paper to synthesize their learning experience. Fifteen reflection papers were randomly selected and evaluated by 2 raters using a rubric measuring students' ability identify potential cognitive errors, analyze the reason(s) they were likely to commit the errors, and apply strategies to avoid future similar errors. To achieve inter-rater reliability, the two raters independently rated the 15 samples, and then met to resolve any discrepancies. Results: Overall, the results showed that students achieved a satisfactory outcome, which was shown by their mean scores in the three parts of the rubric: 2.8 out of 3.0 in the ability to identify cognitive errors, 3.5 out of 5.0 in the ability to analyze potential errors, and 3.0 out of 5.0 in their ability to formulate strategies to prevent the errors. Conclusions: The integrated teaching strategy was effective promoting higher order thinking by providing PA students with tools to reduce cognitive diagnostic errors in their clinical practicums and future clinical practice.Item ANALYSIS OF IMPACT SCORES OBTAINED AS A FUNCTION OF REVIEW CYCLES (FROM JUNE 2010 TO JUNE 2012 REVIEW CYCLES)(2013-04-12) Tan, DebraPurpose: To examine the trend of scientific quality of research grant applications submitted to AHRQ with time, we assessed the overall impact scores provided by each of 5 standing study sections as a function of times during the past 7 review cycles (from June 2010 to June 2012). Methods: As at the NIH, the Scientific Peer Review Committees at AHRQ use 9 points overall impact score system to evaluate the scientific merit of research grant applications submitted to AHRQ for funding opportunity. This analysis is based upon the enhanced score criterion http://grants.nih.gov/grants/guide/notice-files/NOT-HS-10-002.html using the final impact scores assigned to the applications that were discussed at the review meetings from five study sections and Special Emphasis Panel (SEP) that were reviewed from June 2010 to June 2012 (a total of 7 review cycles). The data used in this analysis was from the National Institutes of Health (NIH) Query View & Report Database (QVR system). Microsoft Excel and SPSS were the tools used for analysis. Results: The means impact scores trend to increase with time in terms of review cycles (from June 2010 to June 2012). The means impact scores trend to increase with time in terms of review cycles (from June 2010 to June 2012). For example, for the HCRT, HQER or HSR study section, the means impact scores decrease to a lowest values of about 31-35 the exception of February 2011 review cycle meeting. The means of overall impact scores gradually increased to higher values at the subsequent review cycles to about 38 to 53 for all 5 study sections. The means for the June 2010 cycle ranged from 36.26 - 40.76 and the means rose to upward trend for the June 2012 cycle at 38.48 - 53.46 range showing an upward trend. Although the mean values of impact scores implicated an upward trend from June 2010 to June 2012, there was no statistical significance among these mean values. Conclusions: Our analysis of impact scores among study sections found no statistically significant differences, indicating that the AHRQ peer review process is consistent in terms of quality of the scientific review among study sections. Our findings could provide useful information to the AHRQ leadership team, as well as the extramural health services research community regarding the scientific peer process for grant applications submitted to AHRQ for funding opportunity.Item ANATOMICAL VARIABILITY OF GLUTEUS MAXIMUS TENDON(2013-04-12) Taylor, VictorPurpose: As part of a series of dissections geared towards an improved anatomical understanding of Greater Trochanteric Pain Syndrome, it was observed that there were multiple tendons from the gluteus maximus inserting on the femur. In this study, the variability of the gluteus maximus tendon insertion was examined. Methods: The experiment was done on 40 partially dissected, embalmed bodies that were donated through the Willed Body Program at the University of North Texas Health Science Center. The gluteus maximus muscle belly was detached from the iliac crest. In addition, the iliotibial band was cut from the origin (ilium) and reflected to gain access to the gluteus maximus tendon. The fat in the area around the greater trochanter was cleaned until the tendon of the gluteus maximus was revealed. Results: 22 hips had only one tendon from the gluteus maximus inserting on the femur (13 on the right and 9 on the left), 19 hips had 2 tendons inserting (10 on the right and 9 on the left), 7 with 3 insertions (5 on the right and 2 on the left), and 1 with 4 insertions on the left side. When sex was separated, women had more insertions with 2 tendons than insertions with 1 tendon. Conclusions: It has been shown that there are multiple tendons from the gluteus maximus inserting into the femur.Item ANATOMICAL VARIATION OF THE LATISSIMUS DORSI AXILLARY ARCH(2013-04-12) Liras, GeorgePurpose: To report an additional anterior attachment of the left latissimus dorsi muscle found in a male cadaver during gross anatomy laboratory dissection of the upper extremity. Methods: During standard dissection of the upper extremity at the UNT Health Science Center Anatomy Cadaver laboratory, we noticed an additional attachment for latissimus dorsi in the left axilla of a male cadaver acquired through the UNT HSC Wiled Body Program. The muscle was thoroughly dissected, described, and photographed for presentation of this case study. Results: The donor possessed the regular attachments for the latissiums dorsi muscle bilaterally. We also observed a group of muscle fibers on the left that appear to have separated from latissimus dorsi to create an anomalous arch of muscular tissue through the axilla. This group of muscle fibers measured 15 cm by 4 cm and attached to latissimus dorsi on the anterior, medial aspect of its humeral insertion. The belly of the anomalous muscle crosses over the brachial plexus and the short head of the biceps brachii muscle and attaches to the long head of the biceps brachii muscle. This muscular arch through the axilla is unusual in that it has no bony attachments, making it more likely that this slip of muscle is a developmental anomaly of latissimus dorsi. Conclusions: Latissimus dorsi is a powerful adductor, extensor, and medial rotator of the arm. Due to the position of the extra attachment of the latissimus dorsi on the left side in this case, we hypothesize that during the donor's lifetime the degree of abduction achieved by the left side may have been greatly constrained compared to the right by the extra muscle's unique attachment closer to the more superior ventral aspect of the body. The more anterior insertion may have also restricted extension to a certain extent, but medial rotation and adduction may have been strengthened. In addition, because of the close proximity of the muscle's belly to the brachial plexus, and especially the median and ulnar nerves, we suspect that when this portion of the latissimus dorsi was activated, the donor may have experienced paresthesia of his anterior hand and/or motor deficits involving the intrinsic hand muscles, thenar muscles and anterior forearm muscles.Item ANATOMICAL VARIATION OF THE SEMITENDINOSUS MUSCLE ORIGIN(2013-04-12) Fraser, PatrickPurpose: During a routine dissection of an 87-year-old female cadaver, an aberrant muscle attachment (AMA) of the right semitendinosus (ST) muscle origin was discovered medial to the primary muscle origin. This attachment originated from the medial portion of the ischial tuberosity and inferior to the sacrotuberous ligament attachment site. It then traveled distally in the long axis of the femur to join the ST muscle, which showed no other variations in structure. Methods: Standard dissection procedures for prosecting human cadavers were followed. Specifically, for the gluteal and posterior thigh region. Results: This study describes a previously undocumented variation of the ST origin that could predispose a patient to the aforementioned thigh pain, as well as pelvic floor pain. Conclusions: Patients presenting with recurrent pain or dysfunction in these areas should prompt an investigation into possible variations of hamstring muscle origins. Future work involving identification of this variation in living subjects could improve chronic pain related to posterior thigh and pelvic floor syndromes.Item ANATOMICAL VARIATION OF THE STERNOCLEIDOMASTOID MUSCLE; A CASE REPORT(2013-04-12) Vice, LaurenPurpose: The sternocleidomastoid (SCM) muscle is a prominent neck muscle. It is the main flexor muscle of the neck and an accessory muscle during deep inspiration. Variations of the SCM have been widely recognized and described in medical literature. Supernumerary clavicular origins separating into individual bellies are a defined variant. However, the existence of a thyrohyoid insertion has not previously been described. Methods: Medical students performed a routine cadaver dissection in the University of North Texas Health Science Center's Gross Anatomy Lab. Results: A sternocleidomastoid muscle with four heads was identified on the left side of a 59 year old male cadaver whose cause of death is liver cancer. A typical SCM has origins on the sternal head and clavicular head, and an insertion on the mastoid process. This male cadaver however has two distinct abnormal findings. The SCM shows three clavicular origins separating into individual bellies. Additionally a unilateral thyrohyoid insertion is present, originating from the distal end of the sterno-mastoid belly. While the supernumerary SCM bellies can be explained by abnormal mesodermal splitting, the thyrohyoid insertion presents as a genetic abnormality not previously reported. Conclusions: Surgical awareness of abnormalities is significant, especially in regards to the existence of supernumerary posterior triangles and the additional thyrohyoid head. Furthermore, the clinical implications suggest possible tension headaches, torticollis and even infringement on the thyroid cartilage during swallowing and speech.