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Appendiceal Mucinous Neoplasm Case Study
No full textAppendiceal Mucinous Neoplasm Case Study Jesse Tamayo, Tyler Patterson, Michael Smith, Jay Patel Appendiceal Mucinous Neoplasms account for less than 1% of all malignancies in the United States. Patients with low grade neoplasms often present with symptoms of an acute appendicitis with right lower quadrant pain due to the distention of the appendix caused by the increasing levels of mucin. These patients may also have perforation of the appendix or appendicitis if the tumor growth is obstructing the orifice of the appendix. An patient with advanced disease may present with similar symptoms as well as distention of the abdomen due to mucinous ascites growing in the peritoneum. Patients may also present with weight loss, abdominal pain, and even intestinal obstruction. A majority of these primary neoplasms have mucin involved in more than 50% of the lesion, arising from low-grade appendiceal neoplasms (LAMN) seen as adenomatous changes in appendiceal mucosa. They can also arise from a polyp forming adenoma similar to those seen in patients who develop colon cancer. Histologically they can be seen with signet ring cells. The patient involved in this case report had presented to the Emergency Department on numerous occasions for right lower quadrant pain. This pain had persisted for years, CT imaging was performed and the tumor was recognized. A procedure for removal was scheduled, however prior to the day of surgery, the patient again presented to the emergency department with excruciating RLQ pain. Surgery was performed the following day. The tumor size was so great that the patient also had a right hemicolectomy performed to remove the tumor in entirety. It was 5.5 cm in greatest dimension. Surgical margins were negative for invasion and twenty six lymph nodes were biopsied and all came negative for cancer. The surgical case was successful for a appendectomy along with a right hemicolectomy to remove a 5.5 by 1.5 low grade appendiceal mucinous tumor confined to the muscularis propria of this patient
Self-assembling peptides induced by eyes absent enzyme to boost the efficacy of doxorubicin therapy in drug-resistant breast cancer cells
No full textEnzyme-induced self-assembly (EISA) is a recently developed nanotechnology technique in which small molecules are induced by cellular enzymes self-assembling into nanostructures inside cancer cells. This technique can boost the efficacy of chemotherapy drugs by avoiding drug efflux, inhibiting the cells' DNA repair mechanisms, and targeting the mitochondria. In this work, we study the self-assembly of a short peptide and its fluorescence analogue induced by Eyes absent (EYA) tyrosine phosphatases to boost the efficacy of doxorubicin (DOX) therapy in drug-resistant types of breast cancer cells, MDA-MB-231 and MCF-7. The peptides Fmoc-FF-YP and NBD-FF-YP were synthesized with the solid-phase peptide synthesis (SPPS) method and analyzed with HPLC and MALDI-TOF. Dynamic light scattering was used to determine the size distribution of peptides exposed to the EYA enzyme in vitro. The presence of EYA enzymes in breast cancer cells was confirmed using the western blotting assay. The intracellular location of the peptide self-assembly was studied by imaging fluorescence NBD-tagged peptides. The efficacy of the peptide alone and with DOX was determined against MCF-7 and MDA-MB-231 using MTT and LIVE-DEAD assays. Nucleus and cytoplasm F-actin (Phalloidin) staining was used to determine cell morphology changes in response to the combination therapy of peptides/DOX. At an optimal concentration, the peptides are not toxic to the cells; however, they boost the efficacy of DOX against drug-resistant breast cancer cells. We used state-of-the-art computer-aided techniques to predict the molecular structure of peptides and their interactions with EYA. This study demonstrates an approach for incorporating non-cytotoxic components into DOX combination therapy, thereby avoiding increased systemic burden or adverse effects.Research reported in this publication was supported by the National Institute of General Medical Science (NIGMS) of the National Institutes of Health (NIH), United States, under award number R16GM150848
Early Life Sex Differences and Alterations in Mitochondrial Function in IUGR Offspring after Weaning may Contribute to Adult Sex Differences in Cerebrovascular Dysfunction and Hypertension in Rodents
No full textBackground: Preeclampsia is a hypertensive pregnancy disorder that usually occurs in the third trimester. Preeclampsia, due to placental ischemia, decreases nutrient and oxygen delivery to the fetus, causing intrauterine growth restriction (IUGR). IUGR increases the risk for chronic conditions such as cerebrovascular dysfunction (CVD) and hypertension (HTN). Human and animal studies show sex differences in CVD and HTN development in IUGR offspring, with males exhibiting a higher prevalence of both. Preliminary data from our lab showed that 17-week-old IUGR male rodents developed CVD, HTN and mitochondrial dysfunction (mtDYS), while IUGR female rodents only developed CVD. The reason for these sex differences is unknown but may be attributed to mtDYS. Although mitochondrial differences appear at 17 weeks, earlier mitochondrial function is unknown. This study investigates changes in mitochondrial function in IUGR offspring after weaning. We hypothesize that mtDYS is elevated in3-week-old IUGR rodent offspring, with greater dysfunction in IUGR males.
Methods: Pregnant Sprague Dawley rats were divided into two groups: normal pregnant (NP) and preeclamptic pregnant rats, which underwent reduced uterine perfusion pressure (RUPP) surgery on gestational day 14. RUPP dams gave birth to IUGR offspring, and NP dams gave birth to control (CON) offspring. After 3 weeks of weaning, offspring were separated by sex and dam pregnancy status. Brains were collected from the following groups: IUGR males (n=6), IUGR females (n=6), CON males (n=4), and CON females (n=6) to measure mitochondrial function via respiration, electron transport chain (ETC) protein amounts, and mitochondrial dynamics of fission (DRP-1) and fusion (MFN-1) proteins. Mitochondrial respiration was assessed using the Oroboros Oxygraph O2K. Protein amounts of ETC complexes (I-V), DRP-1, and MFN-1 were quantified using Western blots.
Results: 3-week-oldIUGR females had increased cerebral mitochondrial respiration suggested by State 3 (490.41 ± 49.85 vs 257.32 ± 69.76pmol O2/sec/mg; p=0.02) and increased protein amounts of ETC Complex I (135.91 ± 9.27 vs 107.77 ± 4.23IU/Protein/CON%; p=0.02) and Complex III (141.76 ± 13.99 vs 110.43 ± 7.73IU/Protein/CON%; p=0.07). MFN-1 protein amounts (133.42 ± 18.75 vs 84.67 ± 6.89IU/Protein/CON%; p=0.03) and DRP-1 protein amounts (111.31 ± 1.89 vs 95.24 ± 2.14IU/Protein/CON%; p<0.0003) were increased in IUGR compared to CON females. Conversely, 3-week-old IUGR males showed decreased cerebral mitochondrial respiration in Basal state (21.48±5.49 vs 55.79 ± 6.96pmol O2/sec/mg; p=0.03) and State 2 (146.22 ± 25.55 vs 224.70 ± 23.13pmol O2/sec/mg; p=0.13). DRP-1 protein amounts were decreased in IUGR males (85.72 ± 3.07 vs 110.18 ± 1.82IU/Protein/CON%; p=0.02), with no changes in mitochondrial ETC complexes or MFN-1 protein amounts compared to CON males.
Conclusion: Early on, IUGR females show mitochondrial function, while IUGR males display mtDYS. Furthermore, the mtDYS in IUGR males at 3 weeks may contribute to HTN development observed in IUGR males and not IUGR females at 17 weeks of age. Future studies are warranted to investigate mtDYS and HTN development in IUGR males and possible protective mechanisms in IUGR females. This study highlights sex differences in cerebral mitochondrial function in prepubescent IUGR offspring, offering insight into the pathophysiology of HTN and CVD development in adulthood, along with suggestions for novel therapeutic targets to prevent HTN and CVD in adult IUGR offspring.This research was supported by start-up funds and the American Heart Association Early Career Development Award [AHA 18CDA34110264 (Cunningham)]. Also, the National Heart Lung and Blood Institute (NHLBI) of the National Institutes of Health Award [5R25HL007786-29(Jones)]
Artificial Intelligence's Prospects and pitfalls in the field of Diagnostic Radiology
No full textOpening:
Artificial Intelligence (AI) is a burgeoning field that is integrating into medicine at an accelerating pace. Its capacity for providing quantitative and qualitative image analysis is becoming an increasingly valuable tool for Diagnostic Radiology. Nowadays, a wide array of AI-based solutions are available, employing diverse approaches like Convolutional Neural Networks (CNNs), Reinforcement Learning, and Image and Texual Generation.
Support:
An area of implementation that is particularly intriguing is in the recent advancements in the interpretation of thoracic imaging. The interpretation of thoracic X-Rays in trauma settings might be delayed due to various hospital processes. Preliminary reads by AI algorithms could identify findings that could lower the workflow burden and allow physicians to focus on more challenging cases (Feng et al.). Additionally, datasets like those collected in these studies have contributed tens of thousands of high-quality, annotated X-Rays in open datasets, which can be used to continually enhance AI tools for the field.
The AI technique of reconstruction can fill in the gaps of lower-quality imaging data, which has the potential to lower the amount of time and resources needed for scans such as Knee MRIs. These techniques could help to democratize advanced imaging to more patients and reduce facility operational costs.
AI has the potential to provide standardization to the subjective nature of image interpretation, with one example being in evaluating metastatic breast lesions. However, Meta-analyses evaluating the efficacy of using AI in diagnosis and staging still display issues with sensitivity, with reported levels being as high as 20%, a figure unusable in a clinical setting.
While approaches such as Deep Learning and Image Reconstruction have a promising future, the truth is that these technologies are still in their infancy. Datasets for Neuroimaging in MRIs might not contain sufficient data to provide the training necessary for certain reconstruction techniques, which could miss crucial artifacts in certain circumstances.
There is a genuine concern as well that AI might exacerbate disparities in healthcare because of the inherent difference in how AI and human doctors arrive at decision-making. Concern arises around the interpretation of data and the potential for AI to propagate biases into the diagnostic image interpretation due to suboptimal AI training. Another example is that AI has been shown to deduce a patient's race without the relevant information as perceived by human clinicians being explicitly provided. The relative absence of understanding of the inner workings of AI algorithms can undermine the trustworthiness of many currently available AI systems. This, in turn, reflects the many potential areas in improving the interpretability of these often what regarded as “blackbox” systems.
Conclusion:
Though AI has many hurdles to overcome, it is likely to gain increasing importance in the Radiologist's toolkit over the coming years. These tools will necessitate the Radiologist to become even more familiar with the technology and data collection. The algorithms that are being developed will undoubtedly benefit from close collaboration between the physician, software developers, and engineers in order to develop effective and clinically relevant software
Acculturation Stress Among Older Indian Americans: Understanding the Challenges of Cultural Transition.
No full textBackground: Acculturation involves the process through which immigrants assimilate the attitudes, values, traditions, beliefs, and practices of a new culture. Acculturation stress, a form of psychological distress stemming from conflicts between an immigrant or ethnic minority group's values and those of the dominant culture, is a prevalent concern among Asian Indians. This study examines acculturation stress among older Asian Indian Americans, a growing subpopulation facing unique challenges in navigating cultural transitions. Methods: The study adopted a mixed-method approach targeting older Asian Indian Americans (aged 55 and above) in the DFW area, combining survey responses with in-depth interviews. Financial incentives were provided to participants. Utilizing a qualitative framework, the research analyzed participant responses to a series of statements to elucidate their experiences of cultural stress, including perceptions of discrimination, feelings of foreignness, identity conflicts, and concerns over cultural assimilation. Data analysis was conducted using descriptive statistics in SAS 9.4, offering insights into the acculturation stress experienced by this demographic. Results: Respondents comprised of 74.19% (n=23) women and 25.81% (n=8) men. Ages range from 12.90 % (n = 4) at 50-54 years, 32.26% (n = 10) at 55-64, 35.48% (n=11) at 65-74 years, and 19.35% (n=6) at 75 and older. Several significant acculturation stress themes were identified. Key issues include identity conflict, leading to feelings of isolation; discrimination, contributing to marginalization; cultural loss, causing grief and anxiety; intergenerational conflict, straining family dynamics; and adverse mental health outcomes like depression. Most participants feel acculturated, except for notable feelings of missing their home country and family. Conclusion: The findings highlight the complexity of acculturation stress among older Asian Indian Americans, revealing a significant impact of identity conflict, discrimination, cultural loss, intergenerational conflict, and mental health issues. While age appears to be a notable factor in acculturation experiences, further research is essential to explore additional variables affecting acculturation, such as immigration status, age at immigration, and geographical location. This study underscores the need for a broader understanding of the multifaceted acculturation process within the Asian Indian American community to inform targeted support and interventions.NIMHD (MD006882-08
Validation of Smart Insoles’ Fatigue Score, a Case Report
No full textBackground: Smart insoles give users valuable insights into their gait patterns, aiming to offer a cost-effective, reliable, accurate, and portable alternative to lab-based gait measurement using motion capture and force plates. Recent advancements have allowed IMU and pressure sensors (FSR) to be integrated directly into insoles, facilitating gait measurements outside of a lab environment. One promising application of smart insoles is to detect biomechanical changes in gait patterns and predict lower-extremity (LE) muscular fatigue. Reliable and accurate measurements of fatigue and recovery could play an essential role in injury prevention strategies and optimizing training intensity in various sports. Prior studies have used validated questionnaires such as the Rating of Fatigue (RoF) and Borg’s Rating of Perceived Exertion (RPE), which showed strong correlations with perceived fatigue and exertion ratings. Heart rate (HR) has also been frequently utilized among the objective measurements of fatigue. This case report aims to validate the fatigue score predicted by the smart insoles (LFS) against subjective and objective measures of fatigue such as RoF, RPE, and HR.
Case Information: A 24-year-old male without existing gait abnormalities participated in a pre-test/post-test design with a progression-to-fatigue protocol consisting of multiple sets of repeated exercises until fatigue. The baseline (pre-evaluation) assessment included a 20m fast-paced walk and 2 static movement jumps (SMJ), followed by 2 countermovement jumps (CMJ). RoF, RPE, and HR measurements were collected at baseline and after each fatiguing set. Each fatigue set consisted of 6x 10m shuttle sprints followed by 5 vertical jumps consecutively without rest. Following each fatigue set, participants underwent post-evaluations that included the same exercises as the pre-evaluation. This approach enabled the insoles to analyze changes in gait from baseline due to the accumulation of fatigue. A 30-minute recovery session was completed after the participant reached a RoF = 10. The recovery session consisted of the RoF, RPE, HR, and post-evaluation measurements every 2 minutes for the first 10 minutes, then every 5 minutes for the remaining 20 minutes.
Conclusion: The participant reached RoF = 10 after 6 repeated fatigue sets. Ground contact time (GCT), measured by the insoles, is one parameter that has been identified to inform the level of fatigue. In the fatiguing session, GCT was very strongly correlated with RoF and RPE (r = 0.971, p=.001); (r=0.986, p<0.001), respectively, but was not strongly correlated with HR (r= 0.543, p = 0.27). In the recovery session, GCT was strongly correlated with both RoF and HR (r =0.689, p=0.04); (r=0.723, p =0.028), respectively. RPE was a poor indicator of fatigue in the recovery session compared to RoF, GCT, and HR.GCT, along with other identified parameters, has the potential to be utilized in the development of the LFS. The LFS score analyzed changes in gait following fatigue and subsequently output a fatigue score for each set. Spearman’s rho and ICC were used to assess correlations and agreement between LFS, RoF, RPE, and HR. Data analysis was done using SPSS v29.0
Deconstructing adaptation in the human nasal airway: An iterative assessment of intranasal airflow and nasal morphology in two and three dimensions.
No full textINTRODUCTION: Nasal geometries have been established as being strongly correlated with climate. In cold-dry climates geometries tend to be tall/narrow, while in hot-humid climates geometries are short/broad. This pattern suggests that taller/narrower nasal airways functionally enhance intranasal air-conditioning (i.e., heat and moisture transfers) by increasing nasal surface area relative to intranasal volume, but this hypothesis has not been empirically tested. METHODS: This study employs 3D models of decongested nasal passages generated from cranial CT scans of individuals of predominantly European (5 males, 6 females) and African (5 males, 5 females) ancestry to directly investigate proposed form-function relationships. Each 3D model then underwent an airflow simulation using computational fluid dynamics to collect measurements of intranasal air temperature, humidity, and airflow velocity across consecutive planes of the 3D models. Morphological measurements of nasal passage area, perimeter, and circularity (i.e., shape) were subsequently collected from the same cross-sectional planes for which airflow measurements were collected. spanning the length of the passage. Multivariate regressions were then performed to assess relationships between morphological and physiological variables at each 2D plane and cumulatively across the entire 3D passage. RESULTS: Regression results indicate that nasal passage morphology, particularly turbinate chamber circularity was significantly associated with intranasal air-conditioning (R2 =0.54, p=0.029). Consistent with proposed hypotheses, individuals with taller/narrower (i.e., less circular) turbinate chamber cross-sectional shapes were found to be associated with higher total inspiratory heat and moisture transfers. CONCLUSIONS: This study provides support for climatic pressures selecting for intranasal air conditioning promoted adaptive changes in nasal morphology during human evolution, likely accounting for the observance of taller/narrower nasal passages in Pleistocene and Holocene Homo sapiens following migrations into colder and/or drier environments.Texas Center for Health Disparities Grant #RF00241 via NIMHD #5U54MD006882-10
The effects of sexual health education programming on health literacy of sexual minority youth
No full textPurpose: Sexual health education programming has always been a politically-charged topic that has once again come under the spotlight with the recent passing of bills in multiple states that restrict classroom education of sexual health. This literature review seeks to understand how these bills could affect the health of young people who go through grade school without proper sexual health education, especially students who identify as LGBTQ. Methods: This study was a literature review. Articles were found on various databases including PubMed, ERIC, and CINHAL using the same key search terms. Articles published within the last 10 years were reviewed and included based on their relevance to the research question. The variety of databases allowed for perspectives from the education, medical, and social stakeholders. Results: A total of 15 articles were included and thoroughly examined. Across the articles, it was found that state requirements widely vary, creating disparity between student who live in different states. Some states were found to require the portrayal of LGBTQ relationships as socially unacceptable or to not include them at all. It was found that these policies did not match public opinion, with many articles finding that states that mandated abstinence-only education (AOE) programs had over 80% of constituents favoring comprehensive sexual education (CSE). Schools that delivered CSE saw lower rates of homophobia and bullying, and dating violence while AOE programs were found to deliver medically inaccurate information. Formal sexual health education during adolescence was also found to create a solid base of sexual health knowledge that persists into adulthood, showing that adolescence is an important time to impart sexual health education as it may be the only such education individuals receive throughout their lifetime. It was also found that exclusion of the LGBTQ population in sexual health education, which many states are now mandating, led them to perceive the content as not relevant to them, leading to decreased use of screening tests for STIs and cancer. Conclusion: Across the articles, it was found that the largest issue facing the quest for effective sexual health education is a lack of standardization across the country. The consensus among existing research is that medically accurate, inclusive, and early sexual health education paves the way for safer school environments and healthier students. Despite this research, the federal government leaves the specifics of sexual health education programming to state and local governments. There is also a glaring lack of research regarding the long-term impact of sexual health programming on students’ health literacy, their ability to understand new health concepts and make the best decisions for their life following graduation
Biopsychosocial Factors Related to Weight Loss for Adults with Acquired Brain Injury Individuals in the Diabetes Prevention Program Group Lifestyle Balance
No full textPurpose: The goal of this study was to combine data from two 12-month Diabetes Prevention Program Group Lifestyle Balance (DPP-GLB) randomized control trials (RCT)s among adult participants with acquired brain injury (ABI; i.e., traumatic brain injury and cerebrovascular accident [CVA; i.e., stroke] ) to identify the profiles of program responders ( ≥ 5% weight-loss at 12 months) and non-responders (< 5% weight-loss at 12 months) at 3, 6, and 12 months across biopsychosocial variables, including demographic, injury-related, self-report, and physiological factors. Hypothesis 1.1: Based on previous findings, we anticipate that age [22], body mass index (BMI) [27], and type of injury [22, 26] will be significantly different between groups. Also, it is anticipated that there will be differences in biological waist circumference, hemoglobin A1C, blood pressure, and 8-year diabetes risk) between responders and nonresponders. Methods: Data was collected from two RCTs examining the effect of the DPP-GLB program on people with ABI. Participants with TBI were 18-64 years of age, had a moderate to severe brain injury, were at least 6 months post-injury, and had a BMI ≥25kg/m2. Participants with CVA/Stroke were 18-85 years of age, had any type of stroke (e.g., hemorrhagic, anoxic), were at least 12 months post-injury, and had a BMI ≥25kg/m2. All participants were recruited from Baylor Scott & White Institute for Rehabilitation (BSWIR) system through flyers, calls, and emails, as well as through outpatient CVA/TBI support groups. Results: Sixty-nine (45 CVA, 24 TBI) participants completed 12-month follow-up in their respective studies with 33 (78%) [18 (38%) CVA, 16 (67%) TBI] classified as responders. There was a greater proportion of responders with a TBI diagnosis (p=0.02), but no additional statistically significant differences were detected (all p>0.05). Conclusion: Results indicate that biopsychosocial variables do not have a significant correlation to weight-loss in participants who responded and didn't respond to the GLB-TBI and GLB-CVA
The Association of Multimorbidity with Whole Health-Centric Provider Communication among Older Adults in the US
No full textResearch Appreciation Day Award Winner - HSC College of Pharmacy, 2024 Clinical/Outcomes/Education Research Award - 1st PlaceThe Association of Multimorbidity with Whole Health-centric Provider Communication among Older Adults in the US
Shawana Shaikh, OMS II, Jahnavi Pinnamraju PharmD, MS, Usha Sambamoorthi, MA, PhD
Background
Whole Health is a person-centered approach diverging from the biomedical focus on diseases and emphasizes nutrition, recharging, spiritual, social support, physical well-being, environmental factors, and mental health. Incorporating the central tenant of “what matters to you” is key in whole health-centric patient-provider communication. This starts with inquiring patients about health goals and life quality. Nearly, 38.0 million (73%) of Americans aged > 65 years have multimorbidity. For individuals with multimorbidity, challenges exist to implementing evidence-based practices for each disease. Therefore, it is necessary to focus on the whole person and incorporate individuals' health goals and life quality for optimal management. The purpose of this study is to examine the prevalence of whole health-centered provider communication among community-dwelling older adults aged > 65 years.
Methods
A cross-sectional study design with data on older adults (age > 65 years) from the publicly available 2020 Medicare Current Beneficiary Survey was used. Whole health variables included how often providers asked about health goals (definitely, somewhat, never) and life quality (never, sometimes, usually, always). Multimorbidity was defined as the presence of two or more chronic conditions. Rao-Scott Chi-square tests and multinomial logistic regression were used to identify the association of multimorbidity with whole health variables while controlling for age, sex, and social determinants of health such as education, poverty, food security, supplemental health insurance, problems paying medical bills, metropolitan area, and marital status. All analyses were conducted with replicate weights using SAS 9.4 survey procedures.
Results
There were 5,516 older adults in our sample representing ~38.71 million older adults in the US. Overall, 43% reported that their healthcare providers 'definitely' inquired about their health goals while 31.1% reported they were 'not' asked. Additionally, only 17.5% reported being inquired ‘always’ about their life quality, while 46.5% reported 'never'. A higher percentage of those with multimorbidity were ‘definitely’ asked about health goals (69.5% vs 65.7%) compared to those without multimorbidity. However, a lower percentage of those with multimorbidity (16.5% vs. 21.6%) were ‘always’ asked about life quality. In adjusted multinomial logistic regressions, older adults with multimorbidity were more likely to 'definitely' be asked about their health goals (aOR = 1.56, 95% CI 1.26, 1.94, p < 0.001) and less likely to ‘always’ be asked about life quality (aOR = 0.65, 95% CI = 0.53, 0.79 p < 0.001) compared to those without multimorbidity.
Conclusion
Overall, whole health-centric communication was poor. Older adults with multimorbidity were more likely to be asked about health goals but less likely to be asked about life quality. Our findings suggest missed opportunities by providers to engage in whole health communication with patients including those with multimorbidity. Health encounters with patients can be an opportunity to empower patients to achieve person-centered health. Integrating health goals and quality-of-life questions into visits can assist providers in developing customized management to empower patients in achieving optimal and whole health