Andrew R. McGill, M.S., Kim C. Tran, Michael N. Teng, Ph.D.
Non-structural protein one (NS1) of RSV is a potent interferon antagonist. Interferon singling is a pivotal moment in the innate antiviral response, and inhibition of this process allows for the virus to proliferate more easily within the host. Diminishing the capacity of NS1 to inhibit this process is an attractive approach for the development of a potentially successful RSV vaccine.
D'souza S MD, FAAP, Lamba V MD, FAAP, Bassel CL, Pharm ,Gutierrez M MD, Fugate K, MSNRNC-NIC, CPHQ, Balakrishnan M, MD, CSSBB
Antibiotic use in the Neonatal Intensive Care Unit (NICU) is required to help treat and prevent infections in neonates. However, unnecessary antibiotic exposure in the NICU can result in direct harm that has consequences for the patient (i.e., increase rate of necrotizing enterocolitis in very low birth weight infants, changes to their microbiome) and for the unit (i.e., changes in local flora and resistance patterns). We developed a multidisciplinary team to monitor and limit antimicrobial usage in our NICU using quality improvement methodology.
Allergy to heparin complicates major surgeries. This case describes a successful desensitization to heparin, which allowed cardiac transplant to proceed.
Tara Vinyette Saco, M.D., Richard F. Lockey, Jennifer W. Leiding, M.D.
This is a case of recurrent sinusitis due to an oroantral communication (OAC). OACs can occur secondary to a root canal and result in recurrent sinusitis. The diagnosis of an OAC is based on clinical symptoms even though a panoramic dental radiograph or computer tomography (CT) scan of the sinuses can help diagnose it. An OAC should be suspected in subjects with recurrent sinusitis following a dental procedure or a sinus culture yielding oral flora. Identification of an anatomical cause for recurrent sinusitis will prevent an unnecessary and costly immunodeficiency evaluation.
Methotrexate is used to treat various malignancies and autoimmune conditions. Although rare, hypersensitivity reactions to methotrexate have been reported. We describe a case of anaphylaxis to methotrexate and successful desensitization.
Non-tuberculous mycobacterial (NTM) infections are increasingly recognized causes of postoperative surgical site infections. NTM pose a significant therapeutic challenge due to their intrinsic resistance to the major classic antituberculous drugs and to several other lines of antibacterial agents. Mycobacterium abscessus and fortuitum are two of the rapidly growing mycobacterium commonly isolated from surgical site infections. We present sensitivity pattern of 19 isolates among breast surgical site infections showing remarkable pattern of sensitivity to the commonly used anti mycobacterial agents
Fatima Khan, MD MBA; Lacey Bernard, MD; Chakrapol Sriaroon MD; Panida Sriaroon MD; Lindsay Rosen; Joie Davis; Steve Holland, MD, Jolan E. Walter MD PhD
Our 43-year-old Thai female patient had recurrent disseminated MAC secondary to immune dysregulation. She presented with a 1 month history of cough, dyspnea, weight loss, and subsequently was diagnosed with disseminated MAC infection. Extensive clinical and laboratory investigations were performed, and antibodies to interferon gamma (IFN-g) were detected. Treatment with rituximab, an anti-CD20 therapy, led to clinical response.
Clostridium difficile is a leading cause of antibiotic-associated diarrhea worldwide and it is the most frequently reported care-associated pathogen in the United States. Oral antibiotics remains the first choice for the treatment of C. difficile infection (CDI), but there are few kinds of effective antibiotics currently available. In this study, we report the use of a novel lysin-human defense fusion protein to inhibit CDI. This protein was designed by combining the catalytic domain of a lysin protein derived from a phage that is widely present in most C. difficile human source and the active terminal of human alpha-defense 5, and expressed in E. coli BL21. Pre-test showed the fusion protein can inhibit the growth of multiple types of C. difficile clinical isolates well in vitro, including the widespread-hypervirulent ribotype 027 and 078 strains.
Clostridium difficile infection has been shown to cause a defective intestinal epithelial tight junction barrier. IL-1beta, IL-6, and TNF-alpha are hypothesized to be the main players in the development of intestinal inflammation and cause an increase in intestinal tight junction permeability.
Duolong Zhu, doctor, Yuanguo Wang, doctor, Laurent Bouillaut, doctor, Ying Cai, doctor, Chunhui Li, doctor, Shaohui Wang, doctor, Abraham L. Sonenshein, doctor, Xingmin Sun, doctor
The symptoms of C. difficile infection (CDI) are attributed largely to two C. difficile toxins, TcdA and TcdB. In addition, C. difficile is an enteric pathogen, and mucosal/oral immunization would be particularly useful to protect the host against CDI considering that the gut is the main site of disease onset and progression. Moreover, vaccines directed only against toxins do not target the cells and spores that transmit the disease. The objective of this project is to develop novel mucosal /parenteral vaccines ( mTcd138) that target both C. difficile toxins and colonization/adhesion factors.
Justin Gibbons, Swamy R. Adapa, Suzzane Li, Vishal Saxena, John H. Adams, Rays H.Y. Jiang
Artemisinins are a key component of the combination therapy used to treat malaria. Plasmodium falciparum, the causative agent of the most deadly from of malaria is evolving resistance to artemisinins. The decreased effectiveness of artemisinins increases the probability of resistance to the partner drugs as well; risking total treatment failure which would result in thousands more deaths a year. The gene shown to have the largest affect in modulating resistance is K13. Here we present an RNA-seq study on an isogenic mutant with a dysregulated K13 gene that provides evidence that K13 is involved in regulating DNA replication and repair.
Afroza Akhtar, PhD student, Dr. Orville Pemberton, Dr. Xiujun Zhang, Dr. Yu Chen
Carbapenemases are the most versatile family of beta lactamase. They can hydrolyze all beta lactam antibiotics used in the clinical settings. Developing inhibitors to target beta lactamses is an urgent need to combat antibiotic resistance. In our study, we are using tetrazole based compounds to develop novel non covalent inhibitors. We are using both Biochemical and X ray crystallographic approach for our research. We hope to design a novel drug candidate that can be used to target multiple classes of carbapenemases.
J. Harrison Collins MS, E. Enriquez-Bruce MD, P. Emmanuel MD
The Ybor Youth Clinic (YYC), a non-profit clinic under the umbrella of the USF Foundation, provides affordable medical services to underinsured, disenfranchised and LGBTQ youth ages 13 to 24, in a non-judgmental, inclusive environment. Here, we describe the characteristics of the population we serve and identify gaps in services.
Cristina A Meehan MS, Anna K. Meyer MD PHD, Bhumika Patel MD, Amre Devandre PHD, Panida Sriaroon MD, Jennifer Leiding MD, Jolan Walter MD PHD
In a retrospective cohort study, we examined the clinical and laboratory features of a cohort of patients with autoimmune cytopenias (AICs). We sought to establish a standard of care for this rare and complex disease. The research cohort included 165 patients diagnosed with AIC with two sub-cohorts, patients with AIC only diagnosis (n= 149, 90%) and patients with both AIC and primary immune deficiency (PIDs) diagnoses (n = 16, 10%). Measures studied included demographics, AIC onset relative to PID diagnosis, clinical features of AIC with and without PID, cytopenias in patients with PID, immune phenotyping, and treatments and outcomes of AIC with and without PID.
Kaposi's sarcoma-associated herpesvirus, one of the major viruses associated with AIDS related cancers, hijacks multiple cellular proteins and pathways to establish lifelong latency in infected hosts. Studies have shown that IFI16 acts as an antiviral restriction factor against a number of DNA viruses, by inhibiting either viral-DNA replication (HCMV and HPV) or transcription (HSV-1, HCMV and HPV) through epigenetic modifications of the viral epigenome. However, till date, no specific epigenetic function of IFI16 has been identified. Here, we have discovered that IFI16 recruits two histone methyltransferases on the KSHV episome leading to altered Histone H3K9 methylation, thus regulating its lifecycle.
Although there are no associations between Turner Syndrome (TS) and immunodeficiency, there are a few case reports detailing subjects with TS and hypogammaglobulinemia.
Cyrus Farazmand, MS; Olga Klinkova, MD, MS; John N. Greene, MD, FACP; Sowmya Nanjappa, MD, MBBS
Actinomyces is a Gram-positive bacterium that causes actinomycosis, an infection that is commonly reported to consist of cervicofacial abscesses but can affect a wide variety of body sites. It can closely mimic malignancy on imaging, especially in its pulmonary form, so we aim to better characterize manifestations of the infection in a cancer center setting.
Warit Jithpratuck MD; Vinny Samuel MD; Panida Sriaroon MD
Chronic eosinophilic pneumonia (CEP) often poses a diagnostic challenge due to its overlapping presentations with other eosinophilic lung diseases. Patients with CEP typically present with progressive respiratory symptoms over several months. Our patient had a 4-month history of productive cough associated with thick cast sputum production. She had peripheral blood and bronchoalveolar lavage eosinophilia and elevated serum IgE. Chest radiographs revealed extensive infiltrations. Her CEP diagnosis was made after other causes of eosinophilic lung disease were excluded. She responded to oral corticosteroids but relapse occurred when treatment was discontinued. Mepolizumab treatment led to excellent clinical response.
Danny T. Nguyen, BA; Stephen J. Malachowski, BS, MS; Roger Gerard, BS; Jacques P. Fontaine, MD; Lary A. Robinson, MD; Robert J. Keenan, MD; Eric M. Toloza, MD, PhD
Using a NIH cancer database on US Medicare patients, we investigated how predictive Lymph Node Ratios (LNRs) are in predicting survival of Stage-2(N1) non-small cell lung cancer after lobectomy without post-operation radiation therapy (PORT).
Obesity increases the risk of heart failure (HF). However, in HF patients, there is a survival advantage in overweight and obese patients compared to normal weight patients, an observation termed the obesity paradox. Evidence for the obesity paradox in HF patients predominantly uses the body mass index to classify obesity, but it cannot accurately distinguish body composition components fat distribution. New studies have explored the use of other, more accurate measures such as dual energy X-ray absorptiometry and waist circumference. This study systematically reviewed the relationship between body composition or fat distribution and mortality in HF patients in primary literature.
Ashley M Perry, Andrew M Brunner, Tao Zou, Donna Neuberg and Amir T Fathi
This study aimed to determine whether insurance status at diagnosis influences CML patient outcomes. The SEER database was used to identify adult patients diagnosed with CML between 2007-2012. Among patients aged 15 to 64 years, insurance status was associated with OS: being uninsured or having Medicaid was associated with worse 5-year OS. Both uninsured and Medicaid patients also had an increased hazard of death in comparison with insured patients. For patients who were 65 years or older, insurance had less of an impact on OS, with similar 5-year OS rates for patients with Medicaid and those with other insurance.
Robert Vander Velde MSc, Viktoriya Marusyk, Olena Balynska, Daria Miroshnychenko, Kenian Liu, Jan Poleszczuk, Andrew Dhawan, Jacob Scott, Andriy Marusyk
Targeted therapies create an effective strategy for decreasing tumor burden. However resistance eventually arises. Most work on resistance has focused on the molecular mechanisms of resistance. Here we explore the evolutionary mechanisms of resistance to ALK tyrosine kinase inhibitors (TKIs) in EML4-ALK positive lung cancer. Specifically we investigate if resistance evolves abruptly or gradually, in a predictable manner and if resistance develops from pre-treatment resistant clones.
James Saller, MD; Sameer Al Diffalha; Kevin Neill; Cecilia Oliveri; Hank Levine; David Boulware and Domenico Coppola, M.D.
This study demonstrates the utility of CDX2 IHC for determining patients with a higher likelihood of harboring intestinal metaplasia undetected by the ABPAS stain at their first biopsy. Our findings show that patients with biopsies that are ABPAS negative and CDX2 positive at their first presentation may later present with frank goblet cell intestinal metaplasia.
Mark Howel, Ryan Green, Elspeth Foran, Rajesh Nair, Stanley Stevens, Jit Banerjee, Shyam Mohapatra, and Subhra Mohapatra
Drug resistance is common in NSCLC patients receiving treatment with epidermal growth factor receptor tyrosine kinase inhibitors (EGFR TKIs). To investigate the development of this drug resistance, our lab has developed EGFR TKI resistant human lung cancer cell lines. Preliminary data has revealed that upregulation of 2 proteins that may be causing enhanced EGFR downstream signaling, possibly outcompeting the effects of the inhibitor and leading to resistance.
Chao Zhang MS, Inna Smalley, Ritin Sharma, Michael F. Emmons, Jane Messina, John M. Koomen, Keiran S. M. Smalley
The majority of melanoma patients treated with inhibitors of BRAF (BRAFi) ultimately develop resistance and fail on therapy. Acquired BRAF inhibitor resistance is often associated with the adoption of a poorly defined, aggressive, and invasive phenotype that can be driven through ligand-independent EphA2 signaling. The main objective of my PhD is focused on elucidating the mechanisms underlying brain metastasis formation in melanoma.
Herman van Besien, BA, Destini Gibbs, BSc, Ari Melnick, MD, Ethel Cesarman, MD-PhD, Lisa G. Roth, MD
The EZH2 histone methyltransferase is a lineage factor for germinal center B cells, and EZH2 inhibitors are toxic to the germinal center B-cell (GCB) subtype of diffuse large B cell lymphoma (GCB-DLBCL). The EZH2 inhibitor EPZ-6438 is undergoing phase I and II trials in GCB-DLBCL with early reports of clinical activity. Since EZH2 inhibition is unlikely to be curative by itself, we performed a drug screening that identified potential synergy between EZH2 and Bcl2 inhibition. We used the selective Bcl-2 inhibitor ABT-199 to perform in-vitro combination experiments with EPZ-6438.
Isaac Raplee MS, Alexei Evsikov Phd, Caralina Marin de Evsikova PhD
Here we used a novel bioinformatics pipeline of publically available RNA sequencing data to elucidate prognostic factors associated with breast cancer progression. Our data supports genomic changes underly malignancy transformation.
Ryan Green MS, Mark Howell MS, Rajesh Nair PhD, Shruti Padhee PhD, Scott Antonia PhD, Eva Samal PhD, Jit Banerjee, Shyam Mohapatra PhD, and Subhra Mohapatra PhD
Alterations to NPRA signaling may lead to inhibition of cancer stem cell (CSC) proliferation; we report the development of a 3D tumor/stroma co-culture model to study and further define the role that NPRA plays in CSC development and drug resistance.
Jamie E. Meegan, Xiaoyuan (Sherry) Yang, Melanie Jannaway, Victor Chatterjee, Sarah Y. Yuan
Circulating extracellular histones are known to contribute to tissue injury in systemic inflammatory responses to infection, trauma, and burns. Citrullination of histone 3, catalyzed by the peptidylarginine deiminase 4 (PAD4) enzyme, is thought to initiate the process of NETosis (the release of neutrophil extracellular traps) in response to infection. NETs are composed of a chromatin web with attached proteases and histones, including citrullinated histone 3 (citH3). This study aimed to identify the effects of citH3 on endothelial barrier dysfunction during inflammation.
Xiaoyuan (Sherry) Yang, PhD, Jamie E. Meegan, BS, Melanie Jannaway, PhD, Danielle C. Coleman, MS, Sarah Y. Yuan, MD, PhD
Disruption of vascular endothelial barrier contributes to multiple organ failure in patients with sepsis. Glycocalyx, a vascular barrier protective matrix covering the apical surface of endothelial cells, has been shown to undergo enzymatic degradation during inflammation. The present study identified a novel role of a disintegrin and metalloproteinase 15 (ADAM15) in inflammation-induced glycocalyx degradation via its ability to cleave glycocalyx component CD44, and demonstrated that ADAM15-mediated glycocalyx shedding contributed to vascular hyperpermeability in sepsis.
Zeinab Y. Motawe, Christopher P. Katnik, Andrea N. Trujillo, Javier Cuevas, Jerome W. Breslin.
Afobazole is a sigma-1 receptor agonist that has been shown to enhance survival in a rat mid-cerebral artery occlusion stroke model. The mechanism has been previously attributed to an inhibition of ischemia-induced calcium dysregulation that lowers glial cell loss and infarct volume.This study shows for the first time a novel mechanism by which afobazole can relax brain arterioles via eNOS-mediated NO production. This mechanism is likely associated with previously reported improvements of outcomes following stroke induced brain injury.
Samuel C. Gidanian, Uddhav K. Chaudhari, Jennifer D. Newcomb, Rahul Mhaskar, Barbara C. Hansen
The existence of an independent association between hypertriglyceridemia and cardiovascular disease remains controversial. The purpose of this study was to characterize the associations between systolic blood pressure and various cardiovascular features under different degrees of naturally-occurring hypertriglyceridemia severity and to determine the independent effect of severe hypertriglyceridemia.
Christine Le, BS, Shaista Malik, M.D., PhD, MPH, Ashwini Erande, MPH, Joseph Tran, BS, Anthony Tran, BS, Alessandra Miranda M.D., Chris Nguyen, BS
During our study, we evaluated audiotapes of medical visits between three different ethnic/racial group of diabetic patients (Non-Hispanic, Hispanic and Vietnamese) and their physicians in order to measure the frequency of cardiovascular risk communication by the physicians during a routine visit and to examine the effect of this communication on the health of these diabetic patients.
Matthew Gliksman, Matthew Schabath PhD, Josephine Emole MD, Frederico Viganego MD, Bijal Shah MD, Julio Chavez MD, Christine Walko PharmD, Howard Mcleod PharmD, Javier Pinilla-Ibarz MD PhD, Michael Fradley MD
Evidence suggests that Ibrutinib, a tyrosine kinase inhibitor, is correlated with increased rates of atrial arrhythmias in those using it to treat B-cell malignancies. There is limited data regarding these rates in clinical practice. Our retrospective case control study compares patients at Moffitt Cancer Center diagnosed with B-cell malignancies who received Ibrutinib to those who received standard chemotherapy, with a focus on atrial arrhythmias and various risk factors.
The proposed research includes study of a single rodent model (Obese Zucker Rat) over time, providing details of the relationship between the accumulation of fat and lymphatic structure and function, along with the extent to which inflammation contributes to lymphatic dysfunction.
Lei Wang, Ph.D.; Jin Wei, Ph.D.; Jie Zhang, Ph.D.; Ruisheng Liu, MD, Ph.D
We have successfully generated a mouse model of dual kidney transplantation (DKT). The hemodynamic responses following DKT are more mimic physiological situations with less kidney injury and better recovery after surgery than traditional single kidney transplantation.
Natascha Alves, B.A., Sarah Yuan, M.D., PhD., Jerome Breslin, PhD
This study investigates how the bioactive lipid sphingosine-1-phosphate (S1P) protects against endothelial barrier dysfunction caused by hemorrhagic shock and resuscitation (HSR). It assesses to what extent S1P can reduce intrinsic apoptosis activation and shedding of the endothelial glycocalyx layer following HSR.
Ezinne Francess Mong, Kemal Marc Akat, John Canfield, John Lockhart , Jeffrey VanWye, Andrew Matar, John Tsibris, June Wu, Thomas Tuschl, Hana Totary-Jain
This work uncovers the role of the LIN28B/let-7 switch in IH pathogenesis and provides a novel mechanism by which propranolol induces IH involution. Furthermore, it provides therapeutic implications for cancers in which the LIN28/let-7 pathway is imbalanced.
Nupur U. Patel, MS; John Denigris, MD; Tania Mendoza, MD; Lubomir Sokol, MD, PhD; and Lucia Seminario-Vidal, MD, PhD
Angioimmunoblastic T-cell lymphoma (AITL) is a common type of peripheral T-cell lymphoma. AITL can be missed until lymphadenopathy develops in patients initially presenting with skin lesions, as skin biopsy may lack conclusive findings. The expression of follicular helper T-cell (THF) markers in the skin can be an important diagnostic clue. We present a case of AITL with skin lesions positive for CD10 and dim PD1 T-cells, with the purpose of highlighting the potential for diagnosing cutaneous AITL via skin biopsy.
Alisha Agrawal, BA, Anna Kim, MD, Erfon Ekhlassi, MD, Lucia Seminario-Vidal, MD, PhD
Patients afflicted with autoimmune thyroiditis, specifically Graves’ disease, can have extrathyroidal manifestations such as exophthalmos, thyroid dermopathy, and acropachy. Thyroid dermopathy usually presents as pretibial myxedema (PTM) due to its predilection for the pretibial area. PTM can also appear in the setting of hypothyroidism following therapy of Graves' disease. In severe forms of PTM, it can present as the elephantiasic form, which is notoriously resistant to conventional treatment. Due to the disease rarity, only a few case reports of elephantiasic PTM exist in the literature. Here we present a patient who was diagnosed with elephantiasic PTM based on the chronicity of the patient’s dermopathy and dramatic clinical presentation.
This case highlights the successful use of methadone in a female patient with Fibromyalgia Syndrome (FMS) who after trying different pharmacological therapies, including the ones recommended by established guidelines, did not reach adequate pain relief. Methadone not only provided a better pain control, but also a significantly better adherence compared to a more traditional approach. The use of methadone to treat FMS pain remains controversial since opioids are not the preferred drugs of choice by established guidelines to treat pain, and in light of a national opioid abuse epidemic.
Chelsea Kesty, B.Sc, Katarina Kesty, M.D. M.B.A, Joseph L. Jorrizzo, M.D.
We present a 36-year-old Caucasian female with a one year history of rash on her chest. Prurigo pigmentosa was diagnosed clinically and treated with doxycylcine. Fewer than 50 cases have been described in non-Japanese patients. In these cases it is often associated with systemic conditions, which will be discussed whether clinicians should work up where hereditary or genetic factors may not predominate.
Parent-Child Interaction Therapy (PCIT) is an empirically supported treatment for children between the ages of 2 to 7 years with emotional and behavioral disorders. This study investigates the implementation of PCIT with a three-year-old boy diagnosed with Oppositional Defiant Disorder, Pica Eating Disorder, and Argininosuccinate Lyase Deficiency.
This case report highlights a female collegiate softball player who suffered an anterior cruciate ligament tear with a nontraditional mechanism. In addition to the unique mechanism of injury, her reconstruction utilized a relatively new surgical technique (quadriceps tendon autograft), and her rehabilitation plan included a novel approach using bloodflow restriction therapy. Initial feedback indicates that these approaches were successful. Future cases to assess long term outcomes would be beneficial.
Castner, N, BS, Weinkle, A, MD, Seminario-Vidal, L, MD, PhD.
Mycosis fungoides (MF) is a form of cutaneous T-cell lymphoma. Clinically, mycosis fungoides presents with a rash, pruritus, and at late stages, tumors. Disease is typically limited to the skin, but is known to occasionally involve visceral organs and the blood. Diagnosing MF can often be challenging because of its ability to mimic other benign dermatologic conditions both clinically and histopathologically. Further complicating this process is the fact that there are multiple histopathological subtypes of MF, including interstitial mycosis fungoides (IMF), a subtype that is scarcely reported in the available literature. Herein, a case of IMF is reported.
Stephen J. Malachowski, MS, Lauren Metterle, Hyunji Choi, MD, Michael Saco, MD, Lucia Seminario-Vidal, MD, PhD, FAAD
Urticaria multiforme is a clinical variant of acute urticaria. It presents as annular/polycyclic plaques with central duskiness, accompanied by fever and acral edema. It commonly presents between 4 months and 4 years of age and its suggested triggers include drugs (i.e. amoxicillin) and infections, especially Streptococcal pharyngitis, otitis media and viral upper respiratory infections. It is frequently misdiagnosed as erythema multiforme or serum sickness-like reaction. Distinguishing urticaria multiforme from similar eruptions is important to minimize unnecessary workup and intervention.
Lillian Tung, Amra Kuc, Angie Zhang, Kathryn S. King MD, Deniz Dayicioglu MD
A 41-year-old female with an adolescent history of flame burns to her neck, chest, abdomen, and upper and lower extremities bilaterally presented to clinic for reconstruction following bilateral mastectomy for breast cancer. She subsequently underwent excision of contractures on her neck and left upper extremity with reconstruction using pre-expanded latissimus dorsi myocutaneous flaps.
Tyler Jones, MD, Diana Braswell, MD and Leslie Turner, MD
Acanthosis nigricans commonly presents as hyperpigmented plaques involving the axillae or nape of the neck in patients with diabetes mellitus. Here, we present a case of acanthosis nigricans at the insulin injection site of a 69 year-old gentleman with diabetes mellitus.
A 33-year old woman underwent a right mastectomy with bilateral deep inferior epigastric perforator (DIEP) flap reconstruction. Intraoperative discovery of a dislocated catheter prevented us from using the internal mammary vein (IMV) for anastomosis. Spontaneous venous port migration is rare, occurring in about 1- 4%, but is a serious complication of long-term venous cannulation and is often asymptomatic. With the aid of the venous congestion algorithm we elected to anastomose the SIEV to the retrograde descending branch of the IMV stump. In normal cases, the anastomoses would occur using SIEV to anterograde IMV.
Adil Malik, Andrew A. Serdiuk, David Thrush, Evan S. Glazer, Puya Alikhani, Arnold B. Etame, Carla C. Moodie, Joseph R. Garrett, Cheryl Goodman, Robert Koss, Livingstone S. Dore, Michael L. Steighner, Eric M. Huss, Philip J. Werner, Keming Yu, Mihaela Druta, and Eric M. Toloza
This is a presentation of a case of acute aortic thromboembolism following right middle and lower bilobectomy for metastatic high-grade sarcoma from the anterior thigh. It discusses significance of arterial thromboembolic events in cancer patients and challenges faced by physicians. Post-operative care is extremely important, and this report highlights one of many complications that are encountered in this patient population. Epidemiology, diagnosis, management, and goals for prevention are discussed in this report.
Maximilian R. Padilla MD, Hershel R Patel MS MD, Shayla Bechtle
Approximately 3% of all Emergency Department (ED) visits in the United States are eye trauma related. Up to one third of these result in blindness. In many of these cases blindness can be avoided by correct diagnosis, stabalization of the eye and prompt treatment. In this case study a patient presented to the ED with a fishook in the eye as a result of a fishing accident. This presentation foccuses on the steps that were taken by the ED and Ophthalmology personel to correctly identify, stabalize, and treat this injury. At the end of this incident the patient had visual acuity only slightly worse than before the accident. Our goal is to present epidemiological data on ocular trauma and provide information to those who may encounter ocular trauma in the beginning stages that will help the healthcare team provide rapid treatment for the best visual outcome.
Pleural effusion lymphoma is a malignancy related to HIV/AIDS, which can present with or without malignant pleural effusions. Treatment is chemotherapy and rarely stem cell transplant.
Venous malformations are low flow vascular anomalies. Doppler ultrasound and MRI may be helpful to determine the size and extent of these lesions. The primary indication for treatment is pain. While several treatment options exist, percutaneous sclerotherapy performed by Interventional Radiologists with agents such as sodium tetradecyl sulphate has been growing in acceptance. Given the success of this minimally invasive therapy, interventional management has replaced many surgical indications at specialized centers. We present a case involving a woman with a low flow venous malformation in the right ankle who was treated with sclerotherapy at Tampa General Hospital.
Garrett Fitzpatrick BS, Tania Mendoza MD, Kun Jiang MD, PhD
Hepatocellular carcinoma (HCC) is the most common primary liver cancer, and the sixth most common human cancer overall. The incidence of HCC is increasing as the prevalence of chronic liver disease increases. Among the major histologic variants of HCC are clear cell, lymphoepithelial, steatohepatic, scirrhous, and fibrolamellar. However, HCC with small cell histology (HCCSC) is extremely rare and remains a challenging diagnosis that can mimic other entities including neuroendocrine tumors, poorly differentiated carcinoma, and others. These cases highlight the importance of astute evaluation of H&E sections and dedicated ancillary investigation in reaching a timely and correct diagnosis of HCCSC.
Ipilimumab is a monoclonal antibody that acts as a checkpoint inhibitory (CPI) therapy targeting cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4). It has been FDA approved for the treatment of stage 3 and late-stage melanoma that is diffuse and unable to be surgically corrected. Immune related adverse events (irAEs) are common adverse events of CPI therapies such as ipilimumab. We report a case of a patient that was initiated on ipilimumab and who subsequently developed an erythema multiforme(EM)-like eruption.
Christina M. Ombres, MD, Kathryn A. Cline, Brooke T. Baldwin, MD, and Stefanie Grewe, MD
A basal cell carcinoma and infundibular cyst in association is a rare phenomenon that is not commonly reported in the literature. Here, we report a case with corresponding clinical and histologic images of a 77-year-old American man with a 10-year history of a cystic lesion in his nasolabial fold that presented to the clinic with new onset pain and drainage.
Norberto Mancera, M.D.; Hershel R. Patel, M.D.; Gina Shetty, M.D.; Swetangi D. Bhaleeya, M.D.
Cytomegalovirus (CMV) retinitis is a serious infection in HIV positive individuals. This condition is rare to diagnose in immunocompetent patients. We present two patients, one who developed CMV retinitis without a diagnosis of HIV and another who developed CMV retinitis in the setting of HIV. Interestingly, both patients had an atypical presentation of occlusive vasculopathy resembling a central retinal artery occlusion.
Kris-Ann Humphrey, M.D., Alex Zabaneh, M.D., David Richards, M.D., Lisa Gamell, M.D.
Tube shunt failure is a significant complication of glaucoma drainage device placement surgery. Traditionally tube revisions include excision of a capsule overlying the tube shunt plate. In this case series, we show a significant IOP reduction maintained up to 1 year, with subconjunctival injection of mitomycin C in addition to capsule excision.
Retrospective study on the use of axillary lymph node dissection in the management of patients with micrometastatic breast cancer as compared with sentinel lymph node dissection
This is a retrospective chart review of patients with spinal cord injury or disease who presented to the SCI center of JAHVAH for annual examination between May 2013-May 2015. Here we investigated the prevalence of skin cancer among veterans with spinal cord injury who presented to Spinal Cord Injury Center in Florida to determine if there was an increase. Secondarily, we evaluated the prevalence of each subtype of skin cancer in veterans with spinal cord injury and the relationship of the skin cancer to the duration, level, and severity of the SCI/D.
Zachary K Christopher BS, Tyag K Patel BS, Jamie Caracciolo MD, Odion Binitie MD, G Douglas Letson MD, David M Joyce MD
A retrospective chart review of patients referred to a cancer center demonstrated that the location of pre-referral biopsies did not delay time to treatment. Rather, it is more likely that the adequacy of the pre-referral MRI impacted time to treatment.
Noura Ayoubi, BS, Mohammad Ayoubi, Sudarshan Krishnamurthy, Abu-Sayeef Mirza, MD
Chart reviews of 4,597 patients managed at free-clinics in 2016 were carried out. Uninsured patients with a history of malignant melanoma were further reviewed to assess care and health outcomes. While patients received recommended full-body skin checks at free-clinics, they were unable to follow through with provider-prescribed referrals for biopsies and excisional treatments due to financial restraints. To improve health outcomes, it is imperative for free-clinics to be educated on dermatologic recommendations for preventing disease recurrence. It is also important for them to be aware of local dermatologists who provide subsidized services so that necessary referrals can be followed through.
Brittany Cozart MS3, Meari Taguchi MS4, Sadaf Aslam MBBS, MS, Michel Murr MD, John Paul Gonzalvo DO, and Amy Weiss MD, MPH
Due to an increase in severe childhood obesity and nonsurgical treatments not yielding significant weight-loss or resolving comorbidities, adolescents are now being considered for bariatric surgeries to aid in weight-loss.The TGH+USF Bariatric Center uses a multi-disciplinary team to help these patients achieve their weight-loss goals in the pursuit of wellness. With the data gathered in this center, the team can appreciate and identify prevalent comorbidities in this population.
500 patient chart review conducted at the James A. Haley VA Dermatology Clinic with a focus on quality improvement of Melanoma, Basal Cell Carcinoma, Squamous Cell Carcinoma and Actinic Keratosis biopsy to excision timelines as well as practitioner to patient communication. Practitioner compliance with regard to current clinic guidelines for patient post-biopsy notification was evaluated and analyzed to determine the effect on patient care.
High risk behaviors threaten the mortality of a population. Uninsured patients have access to less resources, receive less care, and are not a part of the health care system due to financial constraints. Free clinics are underresourced and may not offer preventative education. This project is a retrospective chart review that assessed the prevalence of high risk behaviors seen at free clinics in the Tampa Bay community. Socioeconomic variables were compared with rates of HIV care, STI treatment, HIV/STI testing, obesity, smoking and alcohol use among uninsured patients. More awareness and education on high risk behaviors may prevent future disease.
This retrospective cohort study reviewed all patients who presented to Moffitt Cancer Center between 2001 and 2016 with chrondroblastic osteosarcoma. After exclusion of tumors of the skull, 24 patients were included in analysis.
Adam Turner, BS, Elliot Neal, MS/BSE,Elliot Pressman, BS BA, Alexia Athienitis, PhD, Gautam Rao, BS, Christopher Primiani, BS, Pankaj Agarwalla, MD, Shunchang Ma, MD, Harry van Loveren, MD, Siviero Agazzi, MD
Zygomatic osteotomy, an adjunct to middle cranial fossa (MCF) surgical approaches, improves the superior-inferior angle of approach and minimizes temporal lobe retraction. However, the impact of the zygomatic osteotomy on approach related complications has not been well documented. We analyzed the factors predicting use of a zygomatic osteotomy for middle fossa approaches and evaluated complications associated with a zygomatic osteotomy.
Carson Smith, BA; Jesse Lewis, MD; Thomas Sellers, MD; Brandon Santoni, PhD; Jason Nydick, DO
This study compared radiographic and clinical outcomes between patients who underwent operative treatment with plate-screw vs. intramedullary headless screw fixation for simple fractures of the neck and shaft of metacarpals II-V. We found that fixation with intramedullary headless screw leads to similar radiographic and clinical outcomes as plate-screw fixation. Intramedullary headless screw fixation may offer a less invasive treatment option with a lower rate of complications and hardware removal.
Kyle Sheets, BSE, Mohamed A. Kharfan-Dabaja, MD, Ambuj Kumar, MD MPH, Hemant S. Murthy, MD, Joseph Pidala, MD PhD
This presentation combines two similar studies that look at the prognostic value of serum albumin in patients receiving allogeneic hematopoietic stem cell transplants for various hematologic malignancies. The studies look to prove that a lower serum albumin level at critical time points is an independent predictor of worse outcomes in the context of overall survival, non-relapse mortality, and graft-versus-host disease.
Uncontrolled asthma has been associated with adverse health and economic outcomes, which include impaired quality of life and higher healthcare expenditures due to unscheduled hospitalizations and emergency room visits. The root causes of poor asthma control in children are not well known. This cross sectional descriptive study of asthma care in a pediatric sample in one hospital network will help identify factors associated with poor control of asthma.
Shan He MS, Justin Martin MS, Matt Perez MD, ZhiHua Chen MS, Jane Messina MD
While sentinel lymph node (SLN) biopsy is the standard of care for patients with melanoma >1 mm in depth, the optimal treatment strategy for patients with tumor-involved SLN is unclear. Completion dissection (CLND) of the involved nodal basin(s) is typically employed, but a recent multicenter international trial (MSLT-2) failed to show improvement in overall survival for patients undergoing CLND. This may be explained partially by the low incidence of positive CLND. We utilize our institutional melanoma database to investigate the relationship of clinicopathologic features of primary melanoma and sentinel node metastases to the presence of metastases in the CLND.
Ana Cecilia Belzarena MD, Nicholas Zamith Med student, Nora Watson PA, Odion Binitie MD, John E. Mullinax MD, Ricardo J. Gonzalez MD, Douglas Letson MD, David M Joyce, MD
As part of the Sarcoma Service at Moffitt Cancer Center, we see an elevated number of patients with unplanned resections of soft tissues sarcomas, performed a facilities that do not specialize in this diagnosis and by professionals not trained to do so. Patients have to face many problems result of the unplanned procedure. The idea of our project is to calculate the actual incidence and do a root analysis in an attempt to understand the causes behind this probelm.
Dhyana Sankar, BS, MSIV; Dhyana Sankar; Jude Nawlo, BS, MSIII; Charles Peyton, MD; Wade Sexton, MD; Philippe Spiess, MD
The objective of this study of this study is to evaluate the risk factors in a cohort of high risk, non-metastatic pathologically node negative renal cell carcinoma patients (≥ pT3a RCC) following extirpative surgery at Moffitt Cancer Center. The risk factors can stratify patients for risk of tumor recurrence.
Inflammatory bowel diseases (IBD) often present in adolescence and affect >1.4 million persons in the US. Environmental exposures, notably air pollution and weather, have been suggested to contribute to IBD disease activity. Our goal was to evaluate relationships between environmental exposures and the prevalence and disease activity of pediatric IBD using novel data sources that take into account geographic location.
Dr. Enrico Camporesi, Dr. Hesham Omar, Prachiti Dalvi, Dr. Mehdi Mirsaeidi, Dr. Gerardo Bosco, Dr. Engy Helal, Dr. Devanand Mangar
Drowning is a major worldwide cause of death in children ages 5-14 and accounts for 7% of all injury related deaths worldwide [1]. In 2012 there were 372,000 drowning-related deaths [2]. Though the mechanism of death in drowning is known to be from cardiopulmonary complications, there scant data on the complications that follow in near-drowning incidents. Ventricular arrhythmias can result in cardiac arrest [3]. Hypothermia is also seen if the patient is submerged in cold water. Coronary artery disease has been shown to be a significant prognostic factor in drowning victims [4]. In recent literature, it has been reported that Takotsubo cardiomyopathy is the cause of ischemic changes seen in near-drowning victim’s ECG’s [5,6]. Our study aims to investigate cardiovascular complications and determinants of mortality in near drowning victims.
Julie D. Gibbs, MD; Lucia Seminario, MD, PhD; Elizabeth Sagatys, MD; Jane Messina, MD
Cutaneous T-cell lymphoma (CTCL) accounts for 80-85% of all primary cutaneous lymphoma (PCL), and mycosis fungoides is most common, comprising nearly 50% of PCL. Timely definitive diagnosis is essential for appropriate clinical management of CTCL. Ancillary studies such as T-cell receptor gene rearrangement (TCRGR) and flow cytometry (FC) of tissue and blood can augment histopathologic evaluation in confirming a clonal lymphocytic population, yet the value of these studies in early or suspected CTCL has not been systematically investigated. We performed an IRB-approved retrospective chart review of 30 consecutive patients presenting to a cutaneous lymphoma clinic for evaluation of suspected or recurrent CTCL, to evaluate the sensitivity of TCRGR (beta and gamma genes) and FC (analyzing a 10 marker T cell panel) using clinicopathologic diagnosis of mycosis fungoides as the gold standard.
Bryce Montané, B.S., Frank O. Velez-Cubian, M.D., Kavian Toosi, B.S., Nirav Patel, Carla C. Moodie, P.A.-C., Joseph R. Garrett, M.P.H., A.R.N.P., Jacques P. Fontaine, M.D., and Eric M. Toloza, M.D., Ph.D.
Surgical resection is still the gold standard for early stages of primary lung cancers. More advanced stages, including nodal involvement, are approached with a multimodality therapy. The purpose of our investigation was to determine the surgical outcomes after robotic-assisted video-thoracoscopic (RAVT) surgery for early versus late primary lung cancer stages.
Lynh Nguyen MD, Dhana Balakrishnan MD, Marilyn Bui MD PhD, and Evita Henderson-Jackson MD
Fine needle aspiration biopsies are a valuable diagnostic tool for primary and metastatic bone and soft tissue sarcomas and play a pivotal role in patient management. However, bone and soft tissue cytology can be challenging, as there are limitations such as morphologic tumor heterogeneity and sampling that affect interpretation of histologic typing and grading. In this study, we examine the accuracy and limitations of fine needle aspirations in diagnosis of soft tissue and bone lesions in a tertiary care setting.
An assessment of Lehigh Valley Health Network's current compliance to JACHO's Osteoporosis-Associated Fracture Implementation Guide and exploring how a Fracture Liaison Service care coordinator would help improve future complaince rates.
Jerry Trotter, MS, Dr. Sohee Choi, MD, PhD, Dr. Glenn Currier, MD
This research discusses the differences in performance between patients diagnosed with Social Anxiety Disorder and a control population when encountering a social threat.
Abdullah Abou-Samra B.S., Enrico M. Camporesi M.D.
This study highlights hyperbaric oxygenation's anti-inflammatory abilities and reduction in bone turnover in patients with avascular necrosis of the femoral head.
Traditionally, transplant surgeons prepare corneal grafts in the operating room prior to surgery. This practice leads to widespread variability which may contribute to cornea transplant complications. The purpose of this study is to evaluate the feasibility of preloading corneas at the level eye bank using a commercially available insertion device. We propose that by reducing variability of the tissue preparation process, outcomes can be improved.
Kelsey S. Ryan, Scott McKinley, DO, Jennifer Bartlett, MSN, CPNP, Sorany Son, BS, Michael Wilsey, MD, Thomas Nakagawa, MD, Anthony A. Sochet, MD, MS
The Pediatric Asthma Severity Score (PASS) is a commonly used clinical and research metric for assessing pediatric asthma exacerbation severity. PASS is not validated for practice beyond distinguishing appropriate initial emergency room (ER) disposition. We aimed to determine if PASS predicts a patient's appropriate level of care in the inpatient setting, with special attention to patients who required rapid transfer to another level of care after initial disposition and/or hospital readmission.
Inadequate postnatal nutritional support in very low birth weight (VLBW) infants, particularly protein and energy deficits, may result in growth failure and poor neurodevelopmental outcome. Optimal growth of preterm infants is challenging to achieve. Most preterm infants fail to grow after birth for days, and once they start to grow, they do not sustain normal intrauterine growth rates. This problem is worse in infants who have intrauterine growth restrictions (IUGR), infants with reversed end-diastolic flow (REDF), and infants with serious illnesses and physiological instability. As a result, most preterm infants do not achieve normal anthropometric indices by term gestation. Several reasons are identified for poor postnatal growth and VLBW infants, including: delay in the start of adequate nutrition, providing inadequate rates of macro and micro nutrients, delay in initiation of enteral feeding (due to IUGR or REDF status), use of dilute nutritional mixes (e.g. unfortified human milk (mother’s own or donor), and differences in practices between different neonatal intensive care units and between providers in the same unit. There is a strong evidence in the literature indicating that early aggressive nutritional management for VLBW infants, especially protein and calories, is necessary to achieve normal growth and development during post natal life. To achieve improvement in nutrition and growth outcomes in Tampa general hospital neonatal intensive care unit (NICU), we designed a quality improvement (QI) project that is based on standardize evidence-based NICU feeding guideline with a focus on maximizing protein intake in VLBW infants.
Daniel Lee BS, Evan S. Weitman MD, Matthew C. Perez MD, Vernon K. Sondak MD, Amod A. Sarnaik MD, Ricardo J. Gonzalez MD, Wayne Cruse MD, Jane L Messina MD, Jonathan S. Zager MD
Partially-sampled-melanomas can present quite the dilemma to clinicians. Since the depth of a melanoma dictates its surgical management, it is of utmost importance that the biopsied part of the tumor is representative of its whole. A sample that reads shallower than the true depth can result in additional trips to the operating room, a waste of resources, and all around inefficient care. Conducting a second biopsy on the same lesion can be an option in situations where the depth based on the initial biopsy is in question. However, there is little to no data to either support or refute the usefulness of a re-biopsy. In this study, we sought to assess the impact of additional biopsy of residual pigment and its role in changing surgical management of the primary tumor.
Nicole K. Le, BS, Paul D. Smith, MD, Ambuj Kumar, MD, MPH, Deniz Dayicioglu, MD
We developed a novel, viable, and safe technique of nipple and implant sparing mastectomies for women with breast cancer and a prior breast augmentation.
Ali Wells, BS; George J. Germanos, MD; Jason L Salemi, PhD, MPH; Emad Mikhail, MD
This national online survey was sent to members of the Society of Laparoendoscopic Surgeons in order to assess perspectives on risk factors and prevention for a rare surgical complication. Surgeons were asked to describe the nature of their practice, the number of trocar site hernias (TSH) developed by their patients, and the circumstances of the TSH development. Results were used to describe TSH outcomes and trends in surgical practice based on surgical volume, academic versus private practice, and preferred method of facial closure.
Matthew C Perez MD, John T. Miura MD, Syeda Mahrukh Hussnain Naqvi MD MPH, Youngchul Kim PhD, Amanda Holstein, Daniel Lee, Amod A. Sarnaik MD, Jonathan S. Zager MD FACS
A review of the use of an intralesionally therapy for locoregionally advanced melanoma.
Yumna Ahmad, Amy Weiss, MD, MPH, Sadaf Aslam, MD, MS
The purpose of this study is to develop a measure of readiness for bariatric surgery in severely obese adolescents. The rate of severe or extreme obesity in adolescents is consistently rising. Youth in this classification of weight are at high risk for developing chronic diseases such as hypertension, dyslipidemia, and diabetes. Also, obesity that begins in childhood commonly persists into adulthood increasing the risk of developing type 2 diabetes, cardiovascular disease, stroke, and cancers. However, bariatric surgery has been shown to be very effective in reducing BMI and reversing complications of obesity in adulthood. For this reason, bariatric surgery has begun to be used in adolescents as well and thus far has been shown to be a safe, effective, and viable treatment. This is a relatively new field of study on adolescents; nevertheless a 5-year study conducted in Sweden found that severely obese adolescents who opted for surgical intervention lost more weight than adolescents who chose non-interventional methods. In fact, the study found the adolescents who opted for non-interventional methods saw an increase or stagnant weight. As of now, there has not been much success in determining the best quantitative method to choose a candidate for adolescent bariatric surgery. Much of the research has focused on clinical interviews and psychological analysis. In this study, a questionnaire was created about bariatric surgery, life-style changes it entails, and precautions that adolescent patients need to take in diet, exercise, and management. The patient took the questionnaire during the 1st, 2nd, or 3rd visit with the interdisciplinary team, and then during their 6th visit with the interdisciplinary team. The survey was also administered to sixth visit patients who have not been administered the survey at their first visit. In total, the maximum number of times this questionnaire was taken by each subject is 2. It is hypothesized that their score should increase between the 6 visits. The decision made by the team regarding surgical intervention will also be recorded. Through data analysis, it will be determined whether there is a relationship between the score achieved on this test and the decision made by the clinical team. It is hypothesized that adolescent patients that achieve higher scores on the questionnaires will be more likely to be cleared for surgery. This research was supported by the Scholarly Concentrations Program at USF Health, Morsani College of Medicine.
Gabriela Bou, BS, Michael Wurm, MD, Barbara Hansen, PhD, Karl Schwab, MD
This pilot study analyzes the changes and improvements necessary for further data collection and analysis of the comparison between tissue glucose measurements by the FreeStyle Libre flash glucose monitor and blood glucose measurements in pediatric patients with Type 1 Diabetes on a continuum of pH levels ranging from severely ketoacidotic to non-ketoacidotic stable conditions.
Adarsh Bellur MS, MSIV, Eduardo Rodriguez, Nirmani Karunathilake MS, Peter Nelson MD, MS
This study is aimed at comparing the use of endovascular therapy (vs. bypass) for treatment of peripheral arterial disease among the elderly population (defined as patients 80yrs or older) in the State of Florida from 2000 to 2014.
Navdeep Chahal, Aasha I. Hoogland, Heather S.L. Jim, Joseph A.
Pidala Hematopoietic cell transplant patients with acute versus graft host disease commonly experience depression, fatigue, physical inactivity and poor sleep. These symptoms are thought to be a result of a proinflammatory cytokine disease process. Ustekinumab is a monoclonal antibody that blocks inflammatory Th1 and Th17 cell differentiation and shows promising potential as a treatment option to prevent acute versus graft host disease. The aim of the study was to examine if ustekinumab could be associated with reduced depression, fatigue, poor sleep, and physical inactivity in a randomized trial comparing tacrolimus, sirolimus, and ustekinumab to tacrolimus, sirolimus, and placebo.
Tics are repetitive involuntary movements (e.g. blinking) and vocal sounds (e.g. grunting) that may be simple (involving just a few parts of the body, e.g. sniffing) or complex (involving several parts of the body, often with a pattern, e.g. bobbing the head while jerking an arm, and then jumping). Thirty-three parents of children aged 7-17 years with the presence of tics participated in a survey created to measure parent treatment preferences and related factors. Preliminary data revealed concerns related to use of medication for tics.
Robert Burk, BS, Angel Alsina MD, Alexia Athienitis PhD, John Trendowski BS, Alejandro Delgado BS, Jacentha Buggs MD, Brenna Evans RN, Edson Franco MD, Christopher Albers MD, Nyingi Kemmer MD Long term results of HCC liver transplants (LTx) in the recent era of direct-acting antivirals (DAA) against hepatitis C (HCV) are not available.
India Eaford, BA, MS; Anupam Rishi, Geoffrey G. Zhang, Alexander Viera, Kujtim Latifi, Jessica Frakes, Jose M. Pimiento, Jacques-Pierre Fontaine, Sarah Hoffe
Radiomics involve comprehensive quantification of tumor phenotypes by throughput extraction of imaging data. It may provide complementary information in clinical decision making. We investigated the association between radiomics and clinical outcomes for esophageal cancer following neoadjuvant chemoradiation (NACRT).
Jonathan Littell, M.S., Rachel Semmons, M.D., Jason Wilson, M.D., Andrew Thomas, M.D., Elizabeth Mannion, M.D.
This study aims to characterize the ability of prehospital providers to predict the short-term outcome of patients that they transport to emergency departments. Paramedic ability to accurately predict these outcomes may aid in determining the appropriate destination for patients that they transport. The ability to complete a full evaluation in the field is limited, and we hypothesized that emergency physicians may also have limited ability to predict patient outcome when presented with only prehospital patient history and physical. Management of certain patient chief complaints that are found to be consistently undertriaged (that is, predicted to be discharged when patient actually required admission) may improve as a result of targeted paramedic education or change in prehospital treatment protocols.
Ryan Collier, BS; Jhulianna Vivar, BS, BA; Angela Aungst, MPH; Crystal Dixon, MD; Lise Casady, ARNP-C; Derrick Robertson, MD
Tecfidera was the first FDA approved oral disease-modifying treatment for relapsing forms of MS that requires twice daily dosing. The use of an oral therapy may be more desirable to a patient compared to an injectable therapy, leading to improved adherence. Twice daily dosing for a chronic condition in patients with the potential for additional co-morbidities which may affect adherence should be studied in order to obtain data to assist practitioners and guide clinical practice when this treatment option is selected. This aim of this research was to analyze barriers to adherence for patients treated with Tecfidera.
Casey L. Liveringhouse BA, Kamran A. Ahmed MD, Jacob Purcell BS, Matthew N. Mills BS, G. Daniel Grass MD PhD, Amber G. Orman MD, Javier F. Torres-Roca MD, Roberto Diaz MD PhD
The Radiosensitivity Index (RSI) is a multigene assay that predicts for the intrinsic radiosensitivity of a tumor. In this study, we assessed the RSI of primary and metastatic breast tumor samples from the tissue biorepository at Moffitt Cancer center. We found that primary breast tumors are more radioresistant than metastatic breast tumors. These findings may help inform radiation dose selection in breast cancer patients in both the primary and oligometastatic setting.
Matthias Oawster, sDPT, Genia Gartman, sDPT, Justin Whelchel, sDPT, Charity L. Lane, MS, MA, CPT, FNS, USAW, Nicole Santos, BS, CRA-USF, Thomas Janus, BS, CPT, John M. Mayer, DC, PhD, CCRP, FACSM
This cross-sectional study assesses the impact of dietary habits on wellness, fitness, and injury characteristics of firefighters enrolled in a federally-funded injury prevention trial.
Amanda Holstein, Matthew C. Perez MD, Felipe R. de Pinho MD, Erin Burke MD, Syeda Mahrukh Hussnain Naqvi MD MPH, Youngchul Kim PhD, Jane L. Messina MD, Ricardo J. Gonzalez MD, Amod A. Sarnaik MD, C. Wayne Cruse MD, Louis B. Harrison MD, Vernon K. Sondak MD, Jonathan S. Zager MD
An analysis of local recurrance, disease-specific survival, overall survival and type of wound closure based on surgical margins for treatment of Merkel cell carcinoma.
Latissimus dorsi musculocutaneous flaps are commonly used for post-mastectomy breast reconstruction and greatly enhance aesthetic results. Some reserach supports benefits from denervation of the thoracodorsal nerve while others deem it unnecessary. Therefore, this study seeks to measure patient satisfaction following deep inferior epigastric perforator (DIEP) breast reconstruction surgery at H. Lee Moffitt Cancer Center and Research Institute and Tampa General Hospital.
Lawrence Guan, BS, Justin C Boucher, PhD, Paresh Vishwasrao, PhD, Bishwas Shrestha, PhD, Gongbo Li, PhD, Scott Christley, PhD, Lindsay G Cowell, PhD, Jared Ostmeyer, PhD, William H Rounds, PhD, Inimary T Toby, PhD, Marco L Davila, MD, PhD
We designed a novel chimeric antigen receptor (CAR) T cell therapy targeting Acute Myeloid Leukemia (AML) using next generation sequencing (NGS). NGS allows for direct identification of rearranged immunoglobulin genes, mutation and repertoire analysis, and comparison of multiple immunized mice, bypassing the traditional, time consuming method of hybridoma production, screening, and immunoglobulin sequencing. These novel anti-TIM3 CARs have demonstrated efficacy, persistence, and activation in vitro.
Transplant patients are at high risk for developing skin cancers due to highly immunosuppressive drug regimens. A retrospective survey was sent to the Tampa General Hospital transplant population to better understand if these patients are getting the necessary dermatologic monitoring.
The goal of this project is to complete a safety and efficacy profile on Woven EndoBridge Devices (WEB) in the treatment of complex intra-cranial anuerysms. WEB devices are a type of intrasaccular flow disrupter that have been developed to treat intracranial aneurysms, particularly those with unfavorable anatomy (such as wide-neck and bifurcation anuerysms) in both ruptured and unruptured aneyrusms. These areas are normally difficult to resolve with the original coiling methods. Initial results have shown low complications and morbidity, and may allow for a significant improvement in patient outcome. The device was licensed for use in Summer of 2013, and Hull Royal Infirmary has used over 30 of these devices in their hospital and preliminary data has produced positive results in regards to safety and efficacy. It is essential to quantify this data and provide more insight into the benefit of these devices over using the original "coiling" methodology. This project will identify the impact of these fairly new devices as a more safe and effective treatment for these complex surgical cases, and potentially improve the outcomes of patients with intra-cranial aneurysms significantly. This project will be assessing the new, cutting-edge WEB device that will be used in many future cases of aneurysms, and will provide quantified data about a device that could significantly improve patient safety, effectiveness, and overall outcome.
Following ductus arteriosus ligation hypertension has been infrequently described. This case demonstrates how pathology that increases systemic vascular resistance, such as renal artery stenosis can be masked by the parallel circuit physiology of a patent ductus arteriosus.
Infants born to drug addicted mothers are at risk for developing Neonatal Abstinence Syndrome, which is often associated with difficulty feeding. We organized focus groups with nurses and speech therapists from three regional hospitals to better understand their strategies for feeding. We found that the most helpful strategies for successful feeding included remaining calm, helping keep the infant calm, and recognizing the infants cues.
Atkinson B, Uichanco L, Kattih Z, Perera Y, Angell E, Uhlar C, Martinez V, Roetzheim A, Lopez J, Roetzheim R, MD, Guerra, L, MD, Gonzalez, E, MD
An analysis of hypertension management in patients at the BRIDGE student-run free clinic as compared to national averages and blood pressure at initial visit.
This project is an analysis of medical culture surrounding Advance Care Planning (ACP) and related issues, as seen through various "lenses." This project assessed ACP perceptions, knowledge, and barriers to having discussions about ACP among community members and medical providers and staff. An understanding of medical culture was elucidated through quantitative research, as well as qualitative research methods that include ethnography.
Trust is the foundation for any healthy relationship and yet it is difficult to define. It is multidimensional and can be influenced by one’s experiences, beliefs, and prejudices. In any relationship, trust is bi-directional, and the patient-physician relationship is no exception. Studies have focused on patient trust in the physician, but few have investigated physician trust in the patient. In a relationship defined by risk, uncertainty, and interdependence, building trust between the patient and physician is crucial. Our study aimed to address this paucity in the literature, the healthcare outcomes, and potentially bring awareness to a more mindful medical practice model.
Dr. Douglas Haladay, DPT, PhD, MS, BS; Wells Pierce, BS; Amy Shehadeh, BA; Kristen Smith, BS; Brittany Wert, BS
Shared decision making could be the potential mechanism for opening the door to better treatment outcomes in patients with low back pain. Patients are treated as passive agents rather than participating in their own treatment due therapist neglect in considering their preferences. The lack of patient involvement creates a power asymmetry among the patient and therapist resulting in the patient wanting to be more involved in their treatment. This review of qualitative studies identified the lack of implementation of shared decision making in physical therapy despite the growing necessity to improve treatment outcomes in patients with low back pain.
Bradley Maller, Bachelor of Science, Jordan Karsch, Bachelor of Science, Matthew Lazarra, Bachelor of Science, Kevin Casey, Master of Education
The Pre-health Scholars Program (PSP) is a six-week summer educational program for USF pre-medicine undergraduates who are considered under-represented in medicine. In order to optimize this learning experience for the PSP students, this study saught to evaulate the effectiveness and enjoyment of seven teaching methods used during PSP.
Eric E. Hopkins, B.S.; Danielle Gulick, M. Ed., Ph.D.
This study explores the effects of age and prior career on USMLE Step 1 performance and rates of depression in students for whom medicine constitutes a second career.
Over the past few decades, care of dying patients – including effective communication, compassionate care, use of advanced directives, palliative care options, and physician-assisted dying - has received increasing attention from the medical community and the public. Medical education is central to improvement of physician competency and compassion in end of life (EOL) care. While the importance of educating medical students on EOL care is recognized worldwide, medical students often feel they are not adequately prepared to navigate EOL issues. In response to this need many new EOL educational experiences have been developed, including coursework in Medical Humanities (MH). The purpose of this project was to evaluate the current use of MH in teaching death and dying, investigate perspectives on EOL presented through the humanities, and ultimately create a MH curriculum module on death and dying.
Burnout is a term used to describe a state of mental and physical exhaustion. Medical education is rigorous, and it's design can have detrimental effects on the health of it's trainees. Studies have suggested that students who report higher levels of social support, as well as those who use personal strategies to find meaning in their training, are less likely to have burnout symptoms. To that end, the authors sought to create a podcast devoted to mitigating burnout by increasing student understanding of medicine through a storied exploration of the people, places, and things that inhabit USF health.
Jordan Karsch, B.S., Matthew Lazzara, B.S., Bradley Maller, B.S., Kevin Casey, M.E.D., Shirley Smith, M.A.
The Pre-health Scholars Program (PSP) is a multi-year academic enrichment and career exploration program for pre-health students from groups that are under-represented in medicine that begins as a six-week summer education program. In order to optimize this learning experience for the PSP students in the summer program, this study sought to evaluate the effectiveness and enjoyment of seven teaching methods used during PSP.
The study of medical humanities through visual and verbal representations can shed let on ethical dilemmas that aren’t always presented within the packed medical school curriculum.
Katherine Allen BS, Chelsea Wilson MPAS, LesleAnn Hayward BS, Philip Bowers BS BA, Aleksandra Bacewicz MPH, Danielle Gulick PhD
This study compares burnout rates of medical students at USF Morsani College of Medicine in a pass/fail versus four-tiered grading system using the Maslach Burnout Inventory to determine potential effects of the grading system on student wellness.
This descriptive cross-sectional study investigated the knowledge, attitutdes, and beliefs of professional health students regarding nutrition. We designed a survey after holding focus groups with MD, DPT, and PharmD students. We then administered the survey via email to all enrolled students for the 2016-2017 academic year. We investigated variables such as personal nutrition habits, trusted sources of nutrition information, necessity of nutrition education, and ability to counsel patients on nutrition.
Significant health disparities exist for various pediatric patient populations depending on socioeconomic status and sexual orientation. Addressing medical conditions ranging from infant mortality to obesity and asthma within these populations varies due to the lack of a structured curriculum concerning LGBT adolescents and children living in poverty. The purpose of this study was to demonstrate the importance and effectiveness of teaching these topics to pediatric residents.
Manali Patel, SPT; Kasey Crawford, SPT; Adam Fagan, SPT
The purpose of the study was to survey physical therapist students enrolled in professional physical therapy programs regarding their social media usage, familiarity with social media policies, and to examine how students would judge behaviors of others using social media.
This project aims to review the literature and survey curriculum directors about patient safety education for undergraduate medical students in terms of curricular objectives, methods of program evaluation, teaching formats, student audience (class year), student assessment methods, and barriers to patient safety education implementation.
Haley Frauen, MD Candidate; Bryce Montane, MD Candidate; Dr. Dawn Schocken, PhD, MPH
A seven module health science curriculum with STEM career correlations was was taught to a group of loca high school students who were noted to be at risk for not graduating. A pre and post survey was given to the students before and after the program and the students interest and confidence in a future career in STEM was studied.
Ricardo Rendel B.S, M.S, Shirley Smith M.A, Kevin Casey M.ED
PROJECT STILL ONGOING, EXPECTED COMPLETION JANUARY 2018
Working with the Pre-Health Scholars program, through the Office of Student Diversity and Enrichment, 12 students were enrolled in a 6-week summer course with the goal to provide an educational experience that changes the way these students approach their undergraduate academics. The hope is after the course students will improve GPA, MCAT (or other standardized entry exams). Clinical experiences also made available to the students to supplement their CV and improve competitiveness. Long-term goal is to establish a reproducible model for other health professional programs to adopt and modify to improve disparity of URM and underrepresented populations in medicine.
Healthcare professionals are uniquely positioned for opportunities to identify victims of human trafficking within clinical settings, but often fail to do so as a result of several factors, one of which is inadequate training. If we as a healthcare community can identify gaps in knowledge and appropriately address them in meaningful and effective ways, we can equip healthcare workers with the tools to not only identify patients who may be victims of trafficking, but also engage them and provide sufficient resources to ensure their overall wellbeing.
Chelsea A. Sparks, BS, Summer J. Decker, PhD, Jonathan M. Ford, PhD
The success of a total hip arthroplasty is directly related to the ability of the implant to match original femoral morphology. Given this critical relationship, we characterized normal proximal femoral morphology as it relates to sex, age, and symmetry through measurements obtained from three-dimensional models constructed from computed tomography scans.
We sought to assess the association between type of hospital where primary cytoreductive surgery was performed and survival among women diagnosed with ovarian cancer.
Sharon Chaing, MS; Juan Chipollini, MD; Laura C. Kidd, MD; Anna R. Giuliano, Ph.D.; Peter A.S. Johnstone, M.D.; Philippe E. Spiess, M.D., FACS
Penile cancer has been thought to be a relatively rare malignancy with decreasing incidence in the western world however, concerning recent literature reports have shown increased incidence in the Netherlands, Denmark, and England. Penile squamous cell carcinoma (SCC) accounts for 95% of penile cancers. Thus, this present study analyzed current trends in penile squamous cell carcinoma (SCC) and sought to identify socioeconomic predictors for locally-advanced (pT3/T4) presentation within the United States, between 1998 and 2012, using the National Cancer Data Base, a large, nationwide cancer registry.
Our study describes the indications and utilization of ERCP at Khon Kaen Hospital with the goal of improving risk-stratification and use of resources. Khon Kaen Hospital is a large tertiary referral center located in NE Thailand. This region has the highest incidence of cholangiocarcinoma worldwide and, as a result, a high utilization of ERCP for both diagnostic and therapeutic purposes.
A systematic review to determine which performance-based measures are indicated for clinically meaningful outcomes in patients following unilateral total knee arthroplasty.
Roger L. Gerard, B.S., Frank O. Velez-Cubian, M.D., Danny T. Nguyen, B.S., Marisa Amaral, M.D., Carla C. Moodie, P.A.-C., Joseph R. Garrett, M.P.H., A.R.N.P., Jacques P. Fontaine, M.D., and Eric M. Toloza, M.D., Ph.D.
Lymph node (LN) involvement refers to whether original cancer cells have migrated to regional or distal lymph LNs. In regard to lung cancer, LN status is unequivocally one of the most important factors in determining lung cancer stage, treatment and prognosis. Further, lymph node density (LND) is the ratio between the number of positive lymph nodes excised and the total number of excised lymph nodes. In this study, we sought to determine whether LND serves as a predictor of short- or long-term outcomes after pulmonary lobectomy, and in turn assist in identifying patients whom may benefit from more aggressive management or adjuvant therapy.
Catherine Doyle, Cathyann Feher RN, MSN, Brian Leader, Christopher Lycette MD
Clinical pathways have been shown to reduce risk of adverse events, improve clinical outcomes, and reduce length of stay and associated costs through standardization of care. Considering the lack of established spine pathways and expected increase in spine surgeries performed, development and assessment of spine clinical pathways is critical for future practice.
Human mutagenesis has a large stochastic component. Thus, large coding regions, especially cytoskeletal and extra-cellular matrix protein (CECMP) coding regions are particularly vulnerable to mutations. Recent results have verified a high level of somatic mutations in the CECMP coding regions in the cancer genome atlas (TCGA), and a relatively common occurrence of germline, deleterious mutations in the TCGA breast cancer dataset. Here we report the occurrence of germline, and in some cases, matching somatic, CECMP single nucleotide variations (SNVs) for most of the datasets in the cancer genome atlas (TCGA).
Dhiraj Sikaria MS2, Yaping N. Tu, Diana Fisler, James Mauro, George Blanck
This study dissects and describes specific pathways that are assessed as either pro-proliferative or pro-apoptotic in patient cancers through a framework of the feed-forward apoptosis mechanism
We conducted a retrospective cross-sectional analysis of consecutive adult patients suspected of viral hepatitis infection who presented to Kasturba Hospital for Infectious Disease in Mumbai, India from January to December 2014. We extracted demographic and diagnostic data from an electronic database. We also extracted admission laboratory findings corresponding to each eligible patient from physical log books. We sought to determine the seroprevalence of Hepatitis A, B, C, and E among the study population. We performed descriptive analysis to identify potential demographic risk factors associated with the different types of hepatitis. We evaluated admission laboratory findings among each type of hepatitis.
A method that integrates Epicollect and Google Earth in order to track community health data in an area with limited Internet availability and localizing features.
forwardHEALTH Generation developed a curriculum in the format of a career fair to promote careers in healthcare among students in a rural community in Nicaragua facing a deficit of access to healthcare, as professionals of rural origin are most likely to go into rural practice, and measured the influence of the career fair on participant's career planning through pre-post surveys.
Yohan Perera BS, N Charavanapavan MBBS, H.N. Monze ZOS, Z Kattih BS, L Menezes PhD, Carla Bourne MD
I traveled to Livingstone, Zambia and conducted a cross-sectional study investigating the prevalence of elevated intraocular pressure using rebound tonometry throughout rural villages in Kazungula district, southern Zambia. Elevated intraocular pressure is a major risk factor for developing glaucoma, the second leading cause of blindness in sub-Saharan Africa.
April Darling, Leonid Braydo, Dali Zheng, Jeremy D. Baker, Laura J. Blair, Chad A. Dickey, John Koren III, Vladimir N. Uversky
The major genetic cause of Amyotrophic Lateral Sclerosis and Frontotemporal Dementia is a hexanucleotide expansion mutation in the 5' UTR of the gene C9orf72. Expansion leads to C9orf72 loss of function, RNA foci formation, and six species of dipeptide repeat (DPR) proteins (GA, GP, PG, GR, PA, and PR) of both the sense and antisense varieties. Each sense and antisense DPR species can be simultaneously expressed in a cell of a patient with the mutation. Here, we examined the interplay between the sense species GA and its antisense partner PR and determined that mixing alters the peptides structure and morphology as well as toxicity and localization in cells as compared to when the peptides are expressed individually.
Tumor progression locus 2 (TPL2) is a serine/threonine protein kinase, and is a major inflammatory mediator in immune cells. The predominant inflammatory actions of TPL2 depend on the activation of mitogen-activated protein kinases (MAPK) and the upregulated production of cytokines TNF-α and IL-1β in macrophages and dendritic cells in response to LPS. A significant increase of TNF-α, IL-6 and IL-β in patients with C. difficile infection (CDI) has been reported. Both TNF-α and IL-6 have been postulated to play a key role in the systemic inflammatory response in CDI, and IL-8 is essential in the development of local intestinal inflammatory responses in CDI. The objective of this study is to elucidate the role of TPL2 in the pathogenesis of CDI. We found TPL2 are significantly upregulated and activated in human and mouse intestinal tissues upon C. difficile toxin exposure or CDI. We further demonstrated TPL2 knockout mice were significantly more resistant than wild-type mice to CDI with significantly reduced production of TNF-α, IL-6 and IL-β, KC (a mouse homologue of IL-8) and MPO in the cecum and colon of the TPL2 knockout mice. Finally, we found that TPl2 inhibition by a specific inhibitor or TPL2 gene ablation significantly reduced TcdB-induced production of TNF-α, IL-6 and IL-β, KC by inhibiting activation of p38, Erk, and JNK. Taken together, our data suggest TPL2 represents a potential therapeutic target for CDI treatment.
Helena Hernández-Cuervo B. Sc. M.D., Venkata Narala Ph D., Ramani Soundararajan Ph.D., Jutaro Fukumoto, M.D. Ph.D., Mason Breitzig B.Sc, Matthew Alleyn B.Sc, Sahebgowda Patil M.Sc., Lakshmi Galam Ph.D., Narasaiah Kolliputi Ph.D.
In order to determine if BMI1 expression is related to acute lung injury, we cultured Human epithelial lung cells under conditions of normoxia and hyperoxia. In our experiments, we observed a decrease in BMI1 expression after 48h of hyperoxia. H441 cells lacking BMI1 expression showed changes in their morphology, production of reactive oxygen species, and mitochondrial membrane potential.
Sahebgowda Patil, Venkata R. Narala, Helena Hernández-Cuervo, Byeong Jake Cha, Jutaro Fukumoto, Mason T. Breitzig, Richard F. Lockey, Narasaiah Kolliputi, Lakshmi Galam
The dysfunction of blood supply in lungs can be treated.
There is a discrepancy in the rates of activation of the TRPA1 channel in whole-cell patch clamp and Ca^2+ imaging assays. To determine the cause of this discrepancy, I utilized non-invasive patch clamp techniques to observe if normal TRPA1 activation can be rescued.
Jacob Wilson, Emily Palumbo, Fiona Kearns, Peng Teng, Prerna Malaney, Vladimir Uversky, Jianfeng Cai, H Lee Woodcock, Vrushank Davé
PTEN is a crucial tumor suppressor that is commonly mutated or down-regulated in several diseases, which aberrantly activates oncogenic PI3K/AKT signaling. Chemotherapeutic agents and kinase inhibitors (KIs) have met with off-target effects and chemoresistance. We hypothesize that direct activation of endogenous PTEN will reduce aberrant PI3K signaling and minimize the dose of chemotherapeutic or KIs. We have identified and characterized novel small molecules (γ-AAPeptides), which are the first to directly activate PTEN function. Herein, we have utilized in silico methods to elucidate the interaction between these small molecules and PTEN. Furthermore, we will employ in vitro mutational analysis to corroborate our results of proposed integral residues. In summary, we have used in vitro and in silico analysis to define and characterize the first direct PTEN activators.
Michiko Jo, Andrea N. Trujillo, Naotoshi Shibahara and Jerome W. Breslin
The Kampo medicine Goreisan is a known diuretic and is currently being tested in the clinic to reduce symptoms of surgically induced lymphedema in OB/GYN patients in Japan. The present study was aimed to clarify how Goreisan and its five different components affect lymphatic pump function. The results suggest that Goreisan does not directly affect lymphatic pumping or barrier function, although at its component Alismatis Rhizoma can influence pump activity and Polyporus can enhance barrier function. By extension, in the lymphedema patients treated with Goreisan, its pharmacological action is more likely to be on renal mechanism to reduce excess body fluids.
John Lockhart BS. MS., John Canfield, Ezinne Mong, Jeffrey VanWye, Hana Totary-Jain
mRNA-based therapeutics represent a promising category of biological drugs. Recently, microRNA-regulated in vitro transcribed mRNAs, called miRNA switches, have been used to successfully target the expression of exogenous mRNA in a cell-selective manner. However, the effect of the nucleotide modifications commonly used in miRNA switches on microRNA-dependent silencing has not been examined. Here we show that pseudouridine-modified and unmodified miRNA switches are equally silenced by microRNA, but pseudouridine/5-methylcytosine-modified miRNA switches are affected by microRNA target site sequence. However, both pseudouridine- and pseudouridine/5-methylcytosine-modified miRNA switches are less effectively when using miRNA seed target sites.
Whitney A. Ratliff, Ph.D., David C. Driscoll, and Bruce A. Citron, Ph.D.
Approximately 25-35% of veterans who served in the 1990-1991 Gulf War experience chronic and multi-symptom illnesses that have been collectively termed “Gulf War Illness”. Symptoms include fatigue, musculoskeletal changes, gastrointestinal symptoms and respiratory difficulty, as well as neurological symptoms such as mood and cognitive changes, depression and anxiety. The exact cause of these symptoms is still unknown, however, research suggests that exposure to multiple toxins in the course of military service and deployment to the Persian Gulf may be a contributing factor. Uniquely, these service members were given prophylactic dosing of the acetylcholinesterase inhibitor, pyridostigmine bromide (PB), to protect against the possibility of a nerve gas attack. Additionally, service members were exposed to significant quantities of insecticides, both through personal use of DEET-based repellants and through environmental exposure to organophosphates, such as chlorpyrifos (CPF). We’ve developed a mouse model of Gulf War Illness that recapitulates the multidimensional toxin exposure of Gulf War veterans.
Elliot G. Neal, MS/BSE; Sandra A. Acosta, PhD; Yuji Kaneko, PhD; Cesar V. Borlongan, PhD
In the present study, we investigated BMSCs for the presence T_regs, and found a distinct subpopulation of CD4^+/CD25^+/FoxP3^+ T_regs. We found that the neuroprotective effect of T_regs and BMSCs in co-culture varied in a ratio-dependent manner. We found that T_regs were capable of minimizing stem cell production of IL-6, a pro-inflammatory cytokine and that increasing the concentration of T_regs inhibits BMSC secretion of FGF-b, a cytokine related to BMSC proliferation and differentiation. We showed the ratio of T_regs found natively in BMSCs is optimally adapted to provide the maximum neuroprotective benefit of stem cell treatment after ischemic stroke.
Yan Yan, Liu Tian, JungA woo, Azd, Patrick Lepochat, Azd Al-Mashal, David Kang, PhD
TAR DNA-binding protein 43 KDa (TDP-43) mislocalization is a pathological hallmark of amyotrophic lateral sclerosis and frontotemporal lobar degeneration. TDP-43 is predominantly nuclear, but under “pathological” conditions, it is translocated to the cytosol where it is ubiquitinated and/or phosphorylated and cleaved into smaller fragments. Ubiquitin Specific Peptidase 19 (USP19) is one of the deubiquitinating enzymes (DUBs) involved in regulating the ubiquitination status of substrate proteins. We found that USP19 overexpression can induce tdp-43 cytoplasmic trans-localization. Further USP19 can deubiquitinate TDp-43 in cell model.
Ahsan Habib MS, Darrell Sawmiller, Song Li, Sadia Afrin Munna, David Rongo, Shengnuo Fan, Jun Tian, Huayan Hou, Jin Zeng, Brian Giunta, Adam Smith, Takashi Mori, Glenn Currier, Douglas R Shytle, and Jun Tan
Alzheimer’s disease (AD) is characterized pathologically by the accumulation of neuritic plaques and neurofibrillary tangles in the brain and clinically by a progressive decline in cognitive function. Lithium is used primarily as a mood stabilizer for bipolar disorder and has been used for a long time to treat mania and depression. Furthermore, it has also been shown as preventing cognitive loss which indicated the therapeutic potential of this drug for AD. We hypothesized that an ionic co-crystal of lithium (LISPRO) prevent cognitive decline and associated pathology changes in cell culture and AD mouse models.
Shijie Song MD, Xiaoyuan Kong MD, Sandra Acosta PhD, Vasyl Sava PhD, Cesar V. Borlongan PhD, and Juan Sanchez-Ramos Phd, MD
Administration of the hematopoietic growth factor granulocyte-colony stimulating Factor (G-CSF) has been reported to enhance recovery from traumatic brain injury (TBI) in rodent models. G-CSF exerts actions in both the periphery (stimulation of hematopoiesis) and in the brain, where it serves as a neurotrophic factor, promoting neuronal survival and stimulating neural stem/progenitor cell proliferation in the hippocampus. In order to distinguish the direct CNS actions of G-CSF from its peripheral actions, experiments were designed to block the recruitment of peripheral monocytes to the site of the lesion produced by TBI.
This study evaluates behavior and adult neurogenesis in a novel genetic mouse model of schizophrenia in which two genes, Disrupted-in-schizophrenia-1 (DISC1) and Reelin, have been disrupted. We found deficits in neuronal maturation and multiple behaviors. This mouse model will be used to evaluate gene-environment interactions relevant to schizophrenia susceptibility.
M. Grant Liska, Melissa Gonzalez, Paul R. Sanberg, Sandra A. Acosta, Cesar V. Borlongan
The present study investigates the potential of delayed hyperbaric oxygen therapy – either a single treatment or repeated treatment – to ameliorate motor, neurological, cognitive, and anxiety alterations in a rat model of chronic traumatic brain injury.
Ricardo A. Cordova, MS, Zheying Sun, MS, Niat Gebru, Vincent M. Crowley, Ph. D., Brian S. J. Blagg, Ph. D., Christopher L. Passaglia, Ph. D., Laura J. Blair, Ph. D. , John Koren III, Ph. D.
Study the use of a novel Grp94 inhibitor, 4Br-BnIm, as a potential therapeutic for steroid-induced glaucoma.
Roy Blackburn, John Koren III, PhD., Laura Blair, PhD., April Darling
Alzheimer’s disease (AD) is a progressive disease common in elderly patients that destroys important mental functions including memory largely due to neuronal loss. It is known that accumulation of the protein tau leads to neuronal loss. However, the method of how tau accumulation leads to neurotoxic pathways is highly unexplored. Recent studies show that tau accumulation leads to increased amounts of ubiquiniated proteins in neurons which triggers the activation of the unfolded protein response (UPR). The unfolded protein response is a response caused by the unfolded or misfolded proteins in the endoplasmic reticulum’s (ER) lumen, and leads to ER stress causing cell death. It is thought that in AD, tau is interfering with quality control of the proteins in the ER.
Lisa Kirouac PhD, Krishna Reddy PhD, Monic Amin BS, Laura Pendleton MS, Robert Deschenes PhD
zDHHC9 is a protein acyltransferase (PAT) that adds a palmitate to specific protein substrates. Currently there are two known protein substrates of zDHHC9: H-Ras and N-Ras. In the neuron, there are over 300 potential palmitoylated proteins and it is likely that many of these proteins are post-translationally modified by zDHHC9. Recently, a zDHHC9 nonsense mutation at Arginine 298 (R298*), resulting in a truncation of the last 67 amino acids of the protein, has been associated with X-Linked Intellectual Disability (XLID). Here, we characterize the R298* zDHHC9 mutant in the context of the mature neuron and examine potential altered downstream signaling associated with this loss-of-function mutation.
This study identifies novels substrates of zDHHC9, an enzyme that palmitoylates proteins, and explores the role of this protein modification in X- linked intellectual disability.
Allen Fan, Catherine Wang, Ahsan Habib, Darrell Sawmiller, Huayan Hou, Manasa Kanithi, Dan Zi, Zhi-Xu He, Paul R. Sanberg and Jun Tan
Alzheimer’s disease (AD) is the leading cause of dementia in the elderly. In healthy individual amyloid precursor protein (APP) is cleaved by α-secretase generating sAPPα, which serve neuroprotective functions. However, in the neurodegenerative environment of AD patients, Aß peptides of either 40 or 42 residues are generated by increased beta and gamma secretase activity. These proteins amalgamate in specific regions of the brains causing impairment and dysfunction characteristic of the disease. Human umbilical cord blood cells have proven useful as potential immunomodulatory therapies in various models of neurodegenerative diseases. Our most recent work studied the impact of umbilical cord blood serum (CBS) on modulation of sAPPα production. Heat-activated umbilical cord blood serum, (CBS) has significantly promoted sAPPα production indicating presence of heat sensitive α-secretase in CBS. LC-MS/MS analysis was used to determine the molecular source of a-secretase in purified CBS and AgBS. Of the proteins identified, the subunits of C1 complex (C1q, C1r and C1s) and alpha-2-macroglobulin showed significantly greater levels in aCBSF compared with AgBSF. Specifically, C1 markedly increased sAPPa and aCTF production in a dose-dependent fashion, whereas C1q alone only minimally increased and C3 did not increase sAPPa production in the absence of sera. Furthermore, C1q markedly increased sAPPa and aCTF, while decreasing Ab, in CHO/APPwt cells cultured in the presence of whole sera. These results confirm that APP a-secretase activity in human blood serum is mediated by C1 opening a potential modality of therapeutic for the future of AD.
Yamile Vidal Aguiar,M.S., April Darling, Ph.D. student, Vladimir Uversky, Ph.D., John Koren, Ph.D., Laura Blair,Ph.D.
Tau aggregation is a pathological hallmark in Alzheimer’s disease and other tauopathies. The 22kDa and 27kDa heat shock proteins (Hsp27 and Hsp22) are known to prevent aggregation of unfolded proteins inside the cell. These ATP-independent small heat shock proteins are regulated through phosphorylation. However, the role of phosphorylation on aggregation dynamics and how they regulate tau aggregation is not fully understood.
Niat Gebru, BS, Yamile Vidal Aguiar, MS, Dali Zheng, PhD, April Darling BS , Zheying Sun MS, Laura J Blair PhD, John Koren III PhD
Dopaminergic neurons, found in the Substantia Nigra, are associated with the pathogenesis of Parkinson’s disease. According to recent publications, somatic cells can be converted to other cell types by the combined expression of distinct transcription factors. This study is based on a published paper that involves the generation of functional dopaminergic neurons from human fibroblasts by the expression of Ascl1, Lmx1a and Nurr1. These induced neuronal cells express proteins specific to dopaminergic neurons and generate action potentials. Conversion of these cells can be vital in understanding neuronal development, Parkinson’s disease modelling, and help develop and screen novel therapeutics for these diseases.
Zheying Sun, Master, Dali Zheng, Danilo Polanco, Leia Sullivan, Yan Yan, April Darling, Bryce Nordhues, Jack Webster, Laura Blair, John Koren, Chad Dickey, Robert Deschenes
palmitoylated DNAJC5 can recruit aggregated tau to endosomes and promote tau secretion.
Karina Bach, BA, Konrad Bach, MD, Dr. Jacob Januszewski, DO, Dr. Juan Uribe, MD
The aim of the study was to determine radiographic and clinical outcomes and complication rates of minimally invasive revision surgery for patients with index thoracolumbar fusion.
Andie Dodge, Scott Dindot, David Segal, Edwin Weeber
We have recently created a novel rat model for Angelman syndrome. Here we are demonstrating the behavioral and electrophysiological characterization of this model.
Friday February 23, 2018 8:00am - 12:00pm EST
Ballroom
Suraj Nagaraj, Amara Yunus, Alexandra Portugues, Heather Mahoney, Danielle Gulick
We use mouse models of aging and Alzheimer’s Disease to examine the role of circadian dysfunction in Sundowning Syndrome as well as examining circadian modulation as a potenital axis of treatment.
Within the polyamine biosynthesis pathway, spermine oxidase (SAT1) plays a crucial role in the catabolism and inter-conversion of polyamines. In this study, we set out to determine how inducing SAT1 levels affects the circadian rhythm.
Huimin Liang MS, Chao Ma MS, Andrii Kovalenko BS, Leslie A. Sandusky-Beltran PhD, John Calahatian, Mani Kallupurackal, Miles Nowicki, Emily Lopez, Daniel Lee PhD1
Tau is a microtubule associated protein responsible for stabilizing microtubules in neurons, and remains especially important for neuronal function in the brain. In neurodegenerative disorders, tau often becomes hyperphosphorylated and aggregates to form pathological neurofibrillary tangles(NFTs) inside the neurons and can lead to tauopathies, like Alzheimer’s disease(AD). Tau inclusions remain a central target for drug discovery, however no disease-modifying treatments exist. More recently, signaling involved in mechanistic target of rapamycin complex 1(mTORC1) has become a dominant pathway to signal amino acid abundance and we recently uncovered a role for arginine sensors in tauopathies. We found increased expression of enzymes that promote arginine production and arginine sensors, as well as several putative mTORC1 activation markers in tau transgenic mice. Our data indicates higher mTORC1 signaling and activity in tau transgenic mice compared to non-transgenic mice. The Liquid chromatography-tandem mass spectrometry (LC-MS/MS) data showed that total brain arginine level was increased by 35% in tau transgenic mice. Interstitial fluid from in vivo brain microdialysis showed increased basal levels of extracellular arginine and arginine release following neuronal stimulation in tau transgenic mice compared to non-transgenic littermates.
Friday February 23, 2018 8:00am - 12:00pm EST
Ballroom
Alexander Neifert, Michael Liska, Sandra A. Acosta, Cesar V. Borlongan
The present study evaluates the therapeutic effect of bone marrow stem cells (hBMSC) on the gut-brain axis in stroke pathology, and their potential to ameliorate stroke-associated motor and neurological impairments, inflammation, and aberrant microbiome.
Chao Ma MS, Andrii Kovalenko BS, John Calahatian, Huimin Liang MS, Mani Kallupurackal, Jerry Hunt BS, Kevin Nash PhD, Margaret Fahnestock PhD, Dave Morgan PhD, Paula Bickford PhD, Daniel Lee PhD
Tauopathies including Alzheimer’s disease (AD) consist of age-associated neurodegenerative diseases for which no effective treatments exist. We identified unique interaction between the arginine metabolism and tau metabolism. Normal balance of arginine metabolism is critical for regulating cellular proteostasis and has an influence on tau pathology. We have previously demonstrated that overexpression of arginine metabolizing enzymes arginase1(Arg1) and arginine deiminase(ADI) could significantly reduce different tau phenotypes in tau transgenic mouse models. We posit that arginine depletion can reduce tau pathology through amino acid sensing mechanisms. Several seminal findings identified solute carrier family 38A9 (SLC38A9) as the first arginine sensor. The lysosomal amino acid transporter SLC38A9 interacts with the Rag-Ragulator-v-ATPase complex and is required for arginine to activate the mechanistic target of rapamycin complex 1 (mTORC1). Other key studies revealed that G protein coupled receptor family C, group 6, member A (GPRC6A) binds arginine and may serve as an extracellular arginine sensor.
Meena S. Subbarayan, MS, Aimee N. Winter, PhD, Bethany Grimmig, PhD, Melinda Peters, BS, Edwin J. Weeber, PhD, Kevin Nash, PhD, Paula C. Bickford, PhD
Fractalkine (CX3CL1) is a chemokine expressed predominately by neurons that mediates communication between neurons and microglia. Microglial activity is critical for establishing and refining neural circuits in the both the developing CNS and the adult brain. By regulating microglial activity, CX3CL1 can effectively mitigate the damaging effects of chronic inflammation within the brain, a state that plays a major role in aging. Levels of soluble CX3CL1 decrease with aging, which could lead to enhanced inflammation, and subsequent declines in cognition. Here, we assessed the consequences of treating CX3CL1 knock out mice with soluble fractalkine on the cognitive behavior.
Carla Hasson, MD Candidate; Lisa Veling, MD Candidate; Juan Rico, MD; Rahul Mhaskar, MPH, PhD
A systematic review investigating hydroxyurea's clinical efficacy to prevent stroke and silent stroke in sickle cell disease patients. We evaluated rates of stroke, silent stroke, toxicity, and mortality in sickle cell disease patients being treated with hydroxyurea, compared to standard treatment with chronic blood transfusions.
Alan Roberts, BS, Joseph O. Johnson, PhD, Aleksandra Karolak, PhD, Norma Alcantar, PhD, Katarzyna A. Rejniak, PhD, Marzenna Wiranowska, MS, PhD
This study quantitatively evaluates the tumor cell targeting capabilities and intracellular uptake pattern of Chlorotoxin when delivered intratumorally and intravenously using subcutaneous U87 human glioblastoma mouse model. CTX is a scorpion derived polypeptide that selectively binds to tumor cells of neuroectodermal origin, such as glioma and a wide range of other tumor cells, but not normal cells. We show the specificity of CTX uptake by U87 human glioma cells in vivo.
Rohini Nimbalkar, Vijaykumar Sutariya, Kalyan C. Chapalamadugu, Yashwant Pathak, Todd Daviau, Brain McMillan, Janice Cecace, Srinivas M. Tipparaju
In the present study, our objective was to decrease the volume for oral administration of Acetaminophen (APAP) and to overcome its toxicity, by co-administration with anti-oxidant N-acetyl cysteine (NAC). The objective is to prepare a combination drug nano-formulaton of APAP+NAC. APAP and NAC were incorporated into Eudragit E100 using Methanol as the solvent. APAP+NAC nano-formulation was prepared according to nano-precipitation method with some modifications. This nano-formulation was characterized using different analytical procedures for getting insights in to APAP+NAC combination drug nano-particles for its dimension and drug-release profile and entrapment efficiency. This novel technique allows us to prepare nano-formulation for the combined therapy of APAP with NAC to overcome hepato-toxicity.
Kristina Rosa Bolling, MPH; Thanh Tran, MPH; Rachel Karlnoski, PhD; Loryn Taylor, ARNP-C; Kimberly Brown-Maynell, ARNP-C; Devon Durham; David Smith Jr., MD
Suicide is a major global public health problem. A recent retrospective analysis of data from our burn unit found that while Minorities accounted for a high percentage of self-inflicted burn suicide admissions in the unit, they were found to have lower reported rates of common risk factors for suicide in comparison to Caucasians. Therefore, in this study, we attempted to validate these finding by evaluating all suicide admissions.
Quality improvement project developing a cloud-based directory for case managers at a Los Angeles federally qualified health clinic network and streamlining their EHR documentation.
Sepsis and its associated sequelae rank among the most common causes of death globally. As sepsis is one of the most common reasons for admission of a critically ill patient to an Intensive Care Unit, education of care providers in standard care of sepsis and signs of septic shock can greatly reduce sepsis related morbidity and mortality. In this scope, we employed a quasi-experimental interventional study at Khon Kaen Hospital. The first arm of our study utilized nurses from a variety of different medical departments who participated in a pre-intervention assessment of knowledge, an educational intervention, and a post-intervention assessment of knowledge. The scores before and after the intervention were compared within and between nursing departments at Khon Kaen Hospital. A second arm of our study involved education of visitors of patients at Khon Kaen Hospital about sepsis to spread awareness. A similar style intervention was employed for hospital visitors with a pre-intervention assessment, discussion based educational intervention led by a Thai medical student, and post-intervention assessment. By increasing knowledge regarding sepsis and septic shock, there is potential to increase early identification and therefore reduce sepsis morbidity and mortality.
Eric Hasenkamp MSIII, Gregory Black MSIII, Nicholas Johnson MSIII, Rosanna Ianiro MD, MPH, CPH, DTM&H, CTropMed, Ricardo Izurieta MD, Dr.PH, MPH, Miguel Reina MD, MPH, PhD
This survey was performed in order to assess the population of Jarabacoa, Dominican Republic regarding their knowledge, level of concern, and prevention practices of the Zika virus. In addition, questions about reproductive health were asked in order to determine if and how they protect themselves from sexual spread of the virus.
Attiya Harit MS, LesleAnn Hayward BS, Katherine Allen BS , Virginia Lidell BS, Anna Armstrong PhD, MPH
This poster aims to describe the partnership between Tampa Bay Street Medicine, a Morsani College of Medicine student-led organization focused on providing basic medical care to the local houseless community, and the University of South Florida’s College of Public Health. Medical students along with undergraduate and graduate level College of Public Health students are engaged in an interdisciplinary approach to service-learning and to the creation of a medical needs assessment to evaluate Tampa Bay Street Medicine’s services for the unsheltered population of the Tampa Bay area.
An interdisciplinary team is going to develop a mobile app that aims at improving patient-provider communication by identifying and evaluating key attributes of patient-centered care then providing feedback to patient and provider on how to improve communication.
James D. Denham, MS, Sowmya Nanjappa, MBBS MD, John N. Greene, MD
Bacillus cereus is a Gram-positive rod that is now recognized as a rare cause of frank disease in the neutropenic hematologic malignancy patient. In this report, we describe a case of typhlitis caused by B. cereus and we summarize the available English language literature to draw tentative conclusions regarding the clinical manifestations of this organism.