Proceedings of IMPRS
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2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Sai Kodukula ◽  
Amy Han

Objective:   To examine the impact of the COVID-19 shutdowns on food insecurity and mental health outcomes among low income, minority communities in Northwest Indiana.    Methods:   Surveys were distributed to 160 households during the Northwest Indiana food bank distribution hours to assess food security mental health status. The survey assessed participant food security through questions adapted from the USDA food security survey module. Participant anxiety, depression, and stress scores were aggregated from questions adapted from the PHQ-4. A multiple logit regression model was utilized to estimate the risk associated with food security status and the surveyed variables. Anecdotal evidence was also collected to understand pandemic specific factors impacting participant food security.     Results:   Food insecurity was linked to significantly increased risk of anxiety, depression and stress. Those who identify to be food insecure have an 811 % increased risk of anxiety, 411% increased risk of depression, and 535% increased risk of stress compared to those who are food secure. In addition, a significant correlation exists between median household income and poor mental health. Anecdotal evidence identifies poor job security, food distributions, and support networks as exacerbating factors towards participant’s declining mental health.     Conclusions:   Our findings highlights the exacerbated impact the pandemic has had on the food security and mental health of vulnerable populations. In the light of these results and anecdotal feedback, public health measures must focus on getting increased funding towards local food banks to increase the frequency of mobile distribution markets coupled with direct subsidies to allow for food purchases, especially for those households with children. Given its impact on mental health, food insecurity status should regularly be screened by physicians access to the right resources must be provided for those screening as high risk.   


2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Luci Hulsman ◽  
Mary Ziemba-Davis ◽  
Shelly A. Hicks ◽  
R. Michael Meneghini ◽  
Leonard T. Buller

Background: Surgical reimbursement rates are established by the Centers for Medicare and Medicaid Services (CMS). Studies have indicated that revision hip (rTHA) and knee (rTKA) arthroplasties require significantly more work effort, but are reimbursed less than primary procedures. This study quantified planned and unplanned work performed for revision surgeries by the surgeon and/or the surgeon’s team during the episode of care “reimbursement window.” Quantification of time was performed separately for aseptic and septic (two-stage) revisions and compared to allowed reimbursement amounts.    Methods: All unilateral rTHA and rTKA procedures performed over a 10-year period by a single surgeon at a single institution were retrospectively reviewed. Time dedicated to planned work was calculated over each episode of care, from surgery scheduling to 90 days postoperatively. Impromptu patient inquiries and treatments after discharge, but within the episode of care, involving the surgeon/surgeon team constituted unplanned work. Planned and unplanned work minutes were summed and divided by the number of patients reviewed to obtain average minutes of work per patient.    Results: Calculations demonstrated average per patient work for aseptic rTKA exceeded the reimbursable amount by 31 minutes. Calculated average minutes of work per patient required for aseptic rTHA fell within the number of minutes approved for reimbursement. Average per patient work for septic rTKA and rTHA exceeded the reimbursable amounts by 331 and 166 minutes, respectively, equating to 2.8 to 5.5 hours of uncompensated time.    Conclusion: Revision hip and knee procedures are substantially more complex than primary procedures, with many surgeons referring patients to out-of-network care. Financially dis-incentivizing surgeons to care for these patients reduces patient access to care when high quality care is needed the most, especially infection cases susceptible to high sepsis and mortality rates. Study findings will be applied to advocacy efforts for appropriate legislative reform.


2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Aaron Jones ◽  
Dustin Thomas

CACS may be used to recommend lifestyle changes or other treatment recommendations to reduce the risk of heart disease. The incidence of asymptomatic ischemia in patients with elevated CACS is poorly defined.  Furthermore, the CACS cut-off above which it is clinically important and cost effective to look for and diagnose ischemia is also not well defined. The purpose of this study is to better define the incidence of asymptomatic ischemia in Parkview Heart Institute (PHI) patients with elevated CACS, including an examination of demographic data that may also influence the rate of ischemia. 118 Patients who were screened for CAD, received CACS ≥ 400, and subsequently had stress testing or invasive coronary angiogram within 6 months were admitted into the study. Through statistical analysis it was determined there was no statistical difference in rates of ischemia between patients with CACS of 400-999 and those >1000. However, due to a small sample size this study will be continued to strengthen its results and investigate if demographics play a role in rates of ischemia.


2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Jenna Jones ◽  
Brian Mullis ◽  
Bree Weaver ◽  
Roman Natoli

Objectives: Fracture related infection (FRI) is a severe, potentially limb-threatening complication after fracture fixation. Dilemma exists with regard to removing or retaining implants while treating the infection. The purpose of this study was to compare primary bone union and infection clearance in patients who had an infection following intramedullary nailing of the tibia treated either by retaining the implant or by removing the implant.    Methods: Patients from two level-I trauma centers were identified through billing registries and retrospectively reviewed between January 2013 and December 2020. We identified 44 patients who had a diagnosis of FRI within 90 days of their initial fixation and returned to the OR for operative treatment of the infection. The incidences of both primary union and infection clearance were calculated for both groups and multiple parameters that may be associated with success or failure were assessed.     Results: Four patients did not have complete records and were excluded. Of the remaining patients, 20 (50%) achieved infection clearance. Twenty-three (59%) patients achieved primary union whereas 16 (41%) had a primary outcome of either delayed union, nonunion, or amputation (one additional patient excluded as healing status unknown). Further analysis showed no significant difference (X2 (39) = 1.13, p < .29) in infection clearance between patients treated with nail retention (64%) versus nail removal (68%). No significant difference was seen in primary bone union (X2 (39) = 3.24, p < .07) with 36% of patients treated with nail retention and 68% of patients treated with nail removal reaching primary union; however, this does trend toward an association. Fewer surgeries performed for infection and complication after initial fixation was positively associated with infection clearance (p < .04, M=4.6, SD=2.13, df=39) and primary union (p < .001, M=4, SD=2, df=38).    Conclusion: Infection clearance seems similarly possible with both nail retention and nail removal strategies, with fewer number of surgeries performed for infection and complication improving the likelihood of infection clearance and bone union. This may suggest that more severe FRI’s are less likely to unite and clear infection. Nail removal may play a role in increasing primary bone union; however, a larger sample size is needed for more definitive assessment.  


2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Carsyn Kranz ◽  
Omer Saeed ◽  
Vitalis Osuji ◽  
Evan Fogel ◽  
Nicholas Zyromski ◽  
...  

Background and Hypothesis: Diagnosis of chronic pancreatitis (CP) is challenging and controversial. Magnetic Resonance Imaging (MRI) offers a noninvasive modality to diagnose CP, but its findings have been rarely correlated with histopathology. We aimed to assess the correlation of T1 signal intensity ratio of pancreas to spleen (T1 SIRp/s) and arterio-venous ratio (AVR) of the parenchyma on MRI and Cambridge score on MRCP with surgical histopathology in patients who underwent pancreatic resection.  Methods: We identified 160 pancreatic resections performed in adults between 2017 and 2019 by searching our institution’s surgery database. Seventy-one of them had surgical pathology specimens available and 59 of them had MRI/MRCP within 3 months prior to the surgery. Histologic grading was performed by a gastrointestinal pathologist using Ammann’s fibrosis score. Two image analysts blinded to the clinical information and fibrosis score measured T1 SIRp/s from unenhanced T1-weighted fat-saturated gradient-echo images and arterio-venous ratio (AVR) from post-contrast dynamic phase. Cambridge score was also recorded from MRCP. Statistical analysis included Pearson’s correlation coefficient of the T1 SIRp/s, AVR, and Cambridge score with the fibrosis score and weighted kappa for interobserver agreement.  Results: Correlations between T1 SIRp/s and AVR with the fibrosis score were (r= -0.30, p=0.02, 95%CI: -0.51 to -0.04 and r= -0.36, p=0.01, 95%CI: -0.58 to -0.09, respectively). In comparison, there is less correlation between the Cambridge grade and the fibrosis (r= 0.17, p=0.15, 95% CI for r= -0.07 to 0.39). Interobserver agreement was good (kappa=0.80).  Conclusion: There is moderate correlation between the T1 signal intensity and enhancement ratio of the pancreas with pancreatic fibrosis. This is higher than the correlation between the Cambridge grade and fibrosis. Multi-institutional, prospective studies are needed to verify T1 SIR and AVR as potential imaging biomarkers of pancreatic fibrosis. 


2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Victoria Cook ◽  
Doreen Hunt ◽  
Jacek Kolacz

Background and Hypothesis: The current study evaluated the effect of different medications on a child’s response to the Safe & Sound Protocol (SSP) therapy. Informed by the Polyvagal Theory and the evidenced relationship between state regulation and autonomic imbalance, the therapy aims to improve state dysregulation which can manifest in children as emotional reactivity, sensory processing issues, and auditory sensitivities. Prior studies have shown a reduction in auditory hypersensitivities after the SSP therapy plus evidence shows SSRIs and stimulants have a positive impact on hearing in the presence of background noise. We hypothesized that a) the SSP could improve treatment response in those taking neurotransmitter-altering medication due to synergistic effects or b) it could show reduce treatment response due to sensitivities already being managed by medication. Project Methods: Children in the study underwent a month of the SSP therapy with auditory processing standardized parent reports (Brain Body Center Sensory Scale) taken prior to treatment then approximately 1 week and 4 weeks after treatment. The data was then separated into different medication groups: stimulants (n=4), non-stimulant neurotransmitter altering medications (n=4), and other non-neurotransmitter altering medications (n=9) such as albuterol. Non-medication and medication group outcomes were then compared to identify significant differences between the groups using independent and paired samples t-tests. Results: The results from this study found a significant reduced response to the SSP in children taking non-stimulant neurotransmitter altering medications, which included both sertraline, a selective serotonin reuptake inhibitor, and guanfacine, an a2A-adrenergic agonist. In addition, the non-neurotransmitter altering medication group was the only medication group that showed significant improvement in hypersensitivities while each non-medication group improved in hypersensitivity and hyposensitivity. Potential Impact: Commonly-used guidelines for SSP are to maintain typical medication use during the intervention. This study, the first to systematically assess treatment response to the SSP by medication use, could inform how clinicians implement both SSP and medication treatments concurrently. However, these results are based on very small medication groups, therefore follow-up studies with larger samples are necessary to inform current clinical practices. 


2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Makayla Kirksey ◽  
Brownsyne Tucker Edmonds

Background/Objective: The optimal mode of delivery (MOD) for malpresentation in periviable deliveries (22-24 weeks), remains a source of debate. Neonatal and maternal complications can arise from both vaginal (VD) and cesarean delivery (CD), and the threat of maternal morbidity extends to subsequent pregnancies. It has been difficult to compare these risks while counseling patients about MOD options, so we sought to create a decision tree that maps probable outcomes associated with breech deliveries at 23- and 24-weeks’ gestation, as well as complications posed for subsequent pregnancies.     Methods: An extensive literature review was conducted to identify risk estimates of periviable maternal and neonatal outcomes, along with elective repeat CD (ERCD) and trial of labor after cesarean (TOLAC) for subsequent pregnancies. Probabilities were inputted into TreeAge software, starting with primary maternal health states that may result from CD and VD – “death”, “hysterectomy”, or “no hysterectomy”, followed by the probability of neonatal health states– “death”, “severe morbidity”, or “no severe morbidity”. The likelihood of placenta previa or normal placenta was considered for subsequent pregnancies. We factored in the possibility of ERCD or TOLAC and the associated maternal and neonatal risks for each.      Results: Final design of the tree is complete and risk estimates have been inputted. Primary analysis and sensitivity analyses are planned for August 2021. Ultimately, we will also be able to use measured utility values to calculate quality adjusted life years (QALYs) for each health state.      Conclusion and Clinical Impact: Whether CD or VD is optimal for breech presentation in periviable delivery is influenced by a complex array of factors, including future reproductive plans and maternal values related to potential neonatal and maternal morbidity and mortality. Quantifying risks associated with each MOD will aid providers in their efforts to help families make informed decisions and reduce morbidity across the reproductive lifespan.  


2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Benjamin Obando ◽  
Arthur Cross-Najafi ◽  
Kevin Lopez ◽  
Deepthi Thadasina ◽  
Wenjun Zhang ◽  
...  

Background:   Pig-to-human xenotransplantation (XTx) is a promising solution to the organ shortage. Genetically engineered pigs lacking major xenoantigens have reduced hyperacute rejection and prolonged xenograft survival. Despite these advancements, acute xenograft rejection (AXR) remains a major barrier to clinical XTx. AXR is mediated by multiple immune cells, of which natural killer (NK) cells play a crucial role. Previous studies have shown that human HLA-E suppresses NK cell activation through the inhibitory receptor NKG2A. We seek to improve pig-to-human compatibility by expressing HLA-E in a genetically modified pig endothelial cell (pEC) line. This cell line 5GKO/ HLA-G+ has mutations in five genes encoding for xenoantigens and expresses HLA-G, an inhibitory ligand of the NK cell receptor KIR2DL4. In this study, the 5GKO/HLA-G+/HLA-E+ pEC line was established to examine whether co-expression of inhibitory ligands promotes NK cell tolerance.      Methods:   The HLA-Eα/pCDNA3.1 plasmid containing the HLA-E α-chain (HLA-Eα) cDNA driven by a CMV promoter was linearized and introduced into 106 cells of the 5GKO/HLA-G+ pEC line by electroporation. After 48 hours, HLA-E expression was analyzed by flow cytometry. HLA-E+ pECs were isolated by flow cytometry sort and co-cultured with human peripheral blood mononuclear cells (PBMCs) stimulated by IL-2. NK cell degranulation was compared between the 5GKO/HLA-G+ and 5GKO/HLA-G+/HLA-E+ pEC lines by measuring CD107a expression in the CD3- CD56+ cell population.          Results:   HLA-E molecules were successfully expressed on the pECs surface, indicating the HLA-E a chain can pair with the existing b2-microglobulin (B2M). The transfection efficiency was 38.2%. Three weeks later, the 5GKO/HLA-G+/HLA-E+ pEC was successfully established, confirming via flow cytometric analysis. The analysis of NK cell degranulation (CD107a) is underway.     Conclusion:   We established a 5GKO/HLA-G+/HLA-E+ pEC line, which is a valuable tool to study human-to-pig xenoreactive immune response in vitro, with the goal of improving pig-to-human xenograft immunotolerance. 


2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Aidan Hannon ◽  
Jia-Rong Jheng ◽  
Gunner Halliday ◽  
Yen-Chun Lai

Background: Pulmonary hypertension in heart failure with preserved ejection fraction (PH-HFpEF) is the most common cause of PH worldwide. It is closely linked to risk factors for metabolic syndrome, including obesity and diabetes - factors known to increase proliferation and migration of pulmonary artery smooth muscle cells (PASMCs), leading to pulmonary vascular remodeling. Qualitative studies have shown that patients with progressive vascular abnormalities develop more severe symptoms and suffer frequent hospitalization. However, underlying mechanisms involved in the regulation of pulmonary vascular remodeling in metabolic syndrome-associated PH-HFpEF are still unclear. Aim: We have recently observed decreased levels of the tumor suppressor WW domain-containing oxidoreductase (WWOX), which plays a housekeeping role in repressing cellular proliferation, in PASMCs isolated from rats with experimental PH-HFpEF and human subjects with obesity and diabetes. As microRNAs (miRNAs) have been shown to regulate WWOX expression in cancers, here we aimed at examining the involvement of miRNAs in WWOX-associated pulmonary vasculature regulation in metabolic syndrome-associated PH-HFpEF. Methods and Results: Among miRNAs that have been associated with reduced WWOX expression, including miR -134-5p, -153-3p, -29a-3b, -29b-3p and -187-5p, we found that miR-134-5p was significantly increased in PASMCs of obese and diabetic subjects. To determine the role of miR-134-5p in the regulation of WWOX in the pulmonary vasculature, we applied exogenous miR-134-5p to human PASMCs. Treatment with miR-134-5p decreased WWOX expression, increased PCNA expression (a cell proliferation marker) and enhanced cellular proliferation. Additionally, human PASMCs challenged with high concentration of glucose, palmitic acid and insulin, which mimic hyperglycemic, hyperlipidemic and hyperinsulinemic conditions, exhibited increased miR-134-5p, accompanied by elevated cellular proliferation.  Conclusions: These studies suggest that miR-134-5p may have a potential role in metabolic syndrome-associated PH-HFpEF through regulating WWOX in the pulmonary vasculature. These studies identify miR-134-5p as a potential therapeutic target for the treatment of metabolic syndrome-associated PH-HFpEF. This project was funded, in part, with support from the NIH NHLBI Short-Term Training Program in Biomedical Sciences Grant funded, in part by T35HL110854 from the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.


2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Abduallah Elsayed ◽  
Jeffery Nielsen ◽  
Natalie Taylor ◽  
Mohammed Juboori ◽  
Caio de Andrade Staut ◽  
...  

Non-union bone fracture occurs in 5-10% of fracture injuries. Interventions include surgery with local implantation of autograft, allograft, demineralized bone matrix, and/or bone morphogenetic proteins. These types of fracture injuries are also accompanied by acute and chronic pain states. In most instances, opioids are provided to injured patients during and after surgery. With the opioid crisis, identifying new analgesic therapies that could reduce or eliminate opioid use, while also improving bone healing is important. Here we show the ability of a novel compound, MAK123, to both enhance bone healing and reduce pain behavior in a surgically induced femoral fracture mouse model. Briefly, 20 male C57BL/6 mice underwent a surgically induced femoral fracture and then were treated with 0, 2, 6, or 20 mg/kg, 3X/week for the 3 week study duration. Weekly X-rays were used to examine healing progression. Prior to euthanasia, mice underwent behavioral testing to measure evoked pain behaviors. Upon euthanasia, ex vivo µCT imaging and analysis was completed to assess fracture callus size and composition. While all doses of MAK123 tested resulted in improved healing, the 6mg/kg dose resulted in accelerated bone healing and a significant increase in mineralized callus volume (p<0.05). Similarly, while all doses of MAK123 reduced evoked responses to tactile stimulus as demonstrated by increased paw withdrawal thresholds, 6 mg/kg of MAK123 resulted in a more robust and significant improvement (p<0.05). We postulate that optimization of the dosing schedule/concentration could further improve both bone healing and behavioral measures thought to represent pain in rodents. That said, these promising pre-clinical data warrant further evaluation as MAK123 may prove to be a unique tool for orthopaedic surgery usage whereby it could both improve bone healing and reduce clinical pain, improving overall patient outcomes.  


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