Publications by authors named "Taylor Williams"

26 Publications

  • Page 1 of 1

Utilizing In-Hospital Fabrication to Decrease Simulation Costs.

J Surg Res 2021 Apr 20;265:79-85. Epub 2021 Apr 20.

Department of Surgery, University of Texas Medical Branch, Galveston, Texas. Electronic address:

Background: Two restrictive factors for surgical training through simulation, are the cost of and accessibility to materials and consoles for simulation models. Commercial surgical simulation models continue to maintain high prices with a wide range of fidelity levels. We believe that by utilizing in-house fabrication, these barriers can be decreased while maintaining and even improving the functionality of surgical simulation models as well as increase their individualization and customization.

Methods: By using a combination of digital and manual fabrication techniques such as 3D printing and basic mold making methods, we were able to create models equivalent to current commercial products by utilizing the first of its kind MakerHEALTH space and collaborating with our surgical simulation staff. We then compared our research and development, start-up, materials, operational, and labor costs to buying comparable commercial models with the simulation usage rates of our institution.

Results: We were able to decrease the costs of a 6 model simulation sample set (appendectomy, cholecystectomy, common bile duct exploration, ventral hernia, chest tube insertion, and suture pads) at our institution from $99,646.60 to $13,817.21 for a medical student laborer, $14,500.56 for a surgical resident laborer, $15,321.08 for a simulation staff laborer, and $18,984.48 for an attending physician laborer.

Conclusion: We describe successful approaches for the creation of cost-effective and modular simulation models with the aim of decreasing the barriers to entry and improving surgical training and skills. These techniques make it financially feasible for learners to train during larger faculty-led workshops and on an individual basis, allowing for access to simulation at any time or place.
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http://dx.doi.org/10.1016/j.jss.2021.02.051DOI Listing
April 2021

Value Analysis of Central Line Simulation-Based Education.

Am Surg 2021 Apr 20:31348211011134. Epub 2021 Apr 20.

Department of Surgery, University of Texas Medical Branch, TX, USA.

Background: Central line-associated bloodstream infections (CLABSIs) are preventable complications that pose a significant health risk to patients and place a financial burden on hospitals. Central line simulation-based education (SBE) efforts vary widely in the literature. The aim of this study was to perform a value analysis of published central line SBE and develop a refined method of studying central line SBE.

Methods: A database search of PubMed Central and Cumulative Index to Nursing and Allied Health Literature (CINAHL) was performed for articles mentioning "Cost and CLABSI," "Cost and Central line Associated Bloodstream Infections," and "Cost and Central Line" in their abstract and article body. Articles chosen for qualitative synthesis mentioned "simulation" in their abstract and article body and were analyzed based on the following criteria: infection rate before vs. after SBE, cost of simulation, SBE design including simulator model used, and learner analysis.

Results: Of 215 articles identified, 23 were analyzed, 10 (43.48%) discussed cost of central line simulation with varying criteria for cost reporting, 8 (34.8%) numerically discussed central line complication rates (7 CLABSIs and 1 pneumothorax), and only 3 (13%) discussed both (Figure). Only 1 addressed the true cost of simulation (including space rental, equipment startup costs, and faculty salary) and its longitudinal effect on CLABSIs.

Conclusion: Current literature on central line SBE efforts lacks value propositions. Due to the lack of value-based data in the area of central line SBE, the authors propose a cost reporting standard for use by future studies reporting central line SBE costs.
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http://dx.doi.org/10.1177/00031348211011134DOI Listing
April 2021

Effect of Mitochondrial Antioxidant (Mito-TEMPO) on Burn-Induced Cardiac Dysfunction.

J Am Coll Surg 2021 Apr 7;232(4):642-655. Epub 2021 Jan 7.

Department of Surgery, University of Texas Medical Branch, Galveston, TX; Department of Pediatrics, University of Texas Medical Branch, Galveston, TX. Electronic address:

Background: Imbalance of oxidants/antioxidants results in heart failure, contributing to mortality after burn injury. Cardiac mitochondria are a prime source of reactive oxygen species (ROS), and a mitochondrial-specific antioxidant may improve burn-induced cardiomyopathy. We hypothesize that the mitochondrial-specific antioxidant, Triphenylphosphonium chloride (Mito-TEMPO), could protect cardiac function after burn.

Study Design: Male rats had a 60% total body surface area (TBSA) scald burn injury and were treated with/without Mito-TEMPO (7 mg/kg-1, intraperitoneal) and harvested at 24 hours post-burn. Echocardiography (ECHO) was used for measurement of heart function. Masson Trichrome and hematoxylin and eosin (H & E) staining were used for cardiac fibrosis and immune response. Qualitative polymerase chain reaction (qPCR) was used for mitochondrial DNA replication and gene expression.

Results: Burn-induced cardiac dysfunction, fibrosis, and mitochondrial damage were assessed by measurement of mitochondrial function, DNA replication, and DNA-encoded electron transport chain-related gene expression. Mito-TEMPO partially improved the abnormal parameters. Burn-induced cardiac dysfunction was associated with crosstalk between the NFE2L2-ARE pathway, PDE5A-PKG pathway, PARP1-POLG-mtDNA replication pathway, and mitochondrial SIRT signaling.

Conclusions: Mito-TEMPO reversed burn-induced cardiac dysfunction by rescuing cardiac mitochondrial dysfunction. Mitochondria-targeted antioxidants may be an effective therapy for burn-induced cardiac dysfunction.
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http://dx.doi.org/10.1016/j.jamcollsurg.2020.11.031DOI Listing
April 2021

Learning to Read: Successful Program-Based Remediation Using the Surgical Council on Resident Education (SCORE) Curriculum.

J Am Coll Surg 2021 Apr 29;232(4):397-403. Epub 2020 Dec 29.

Department of Surgery, University of Texas Medical Branch, Galveston, TX. Electronic address:

Background: The Surgical Council on Resident Education (SCORE) curriculum is aligned with the American Board of Surgery (ABS) objectives. Our program adopted the SCORE curriculum in 2015 after poor ABS In-Training Examination (ABSITE) performance and lowest quartile ABS Certifying Exam (CE) and Qualifying Exam (QE) first-time pass rates. We examined the association of SCORE use with ABSITE performance and ABS board exam first-time pass rate.

Study Design: At a single institution, a retrospective review of surgery residents' SCORE metrics and ABSITE percentile was conducted for academic years 2015 to 2019. Metrics analyzed on the SCORE web portal were mean total minutes and total visits per resident for all residents using SCORE that year. First-time pass rates of the ABS QE and CE were examined from 2013 to 2019. Chi-square and linear regression analysis were performed, and a 95% level of confidence was assumed (alpha = 0.05).

Results: Yearly data from categorical general surgery residents showed a significant increase in total minutes, total visits, and ABSITE percentile. Combined first time pass rates for the ABS QE and CE significant increased from 70.8% in 2013 to 2015 to 93.9% in 2016 to 2019 (p = 0.018).

Conclusions: Increased longitudinal use of the SCORE curriculum was associated with programmatic improvements in ABSITE performance and ABS board exam first-time pass rate.
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http://dx.doi.org/10.1016/j.jamcollsurg.2020.11.030DOI Listing
April 2021

The Genetic Evidence of Burn-Induced Cardiac Mitochondrial Metabolism Dysfunction.

Biomedicines 2020 Dec 3;8(12). Epub 2020 Dec 3.

Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA.

Burn-induced cardiac dysfunction is thought to involve mitochondrial dysfunction, although the mechanisms responsible are unclear. In this study, we used our established model of in vivo burn injury to understand the genetic evidence of burn-induced mitochondrial confusion dysfunction by describing cardiac mitochondrial metabolism-related gene expression after burn. Cardiac tissue was collected at 24 hours after burn injury. An O2K respirometer system was utilized to measure the cardiac mitochondrial function. Oxidative phosphorylation complex activities were determined using enzyme activity assays. RT Profiler PCR array was used to identify the differential regulation of genes involved in mitochondrial biogenesis and metabolism. The quantitative qPCR and Western blotting were applied to validate the differentially expressed genes. Burn-induced cardiac mitochondrial dysfunction was supported by the finding of decreased state 3 respiration, decreased mitochondrial electron transport chain activity in complex I, III, IV, and V, and decreased mitochondrial DNA-encoded gene expression as well as decreased levels of the corresponding proteins after burn injury. Eighty-four mitochondrial metabolism-related gene profiles were measured. The mitochondrial gene profile showed that 29 genes related to mitochondrial energy and metabolism was differentially expressed. Of these 29 genes, 16 were more than 2-fold upregulated and 13 were more than 2-fold downregulated. All genes were validated using qPCR and partial genes were correlated with their protein levels. This study provides preliminary evidence that a large percentage of mitochondrial metabolism-related genes in cardiomyocytes were significantly affected by burn injury.
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http://dx.doi.org/10.3390/biomedicines8120566DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7761708PMC
December 2020

Incidence and Complication Rates for Total Hip Arthroplasty in Rheumatoid Arthritis: A Systematic Review and Meta-Analysis Across Four Decades.

Rheumatol Ther 2020 Dec 30;7(4):685-702. Epub 2020 Sep 30.

School of Medicine, The University of Western Australia, Perth, Australia.

Introduction: Over the past several decades, management of rheumatoid arthritis (RA) has evolved significantly, but few studies have examined the real-world impact of these changes on orthopaedic surgery in patients with RA. This systematic review assessed total hip arthroplasty (THA) incidence and postoperative complication rates across the past four decades.

Methods: This is a systematic literature review sourcing data on THA in patients with RA from the electronic databases MEDLINE, EMBASE, Scopus, and Cochrane between January 1, 1980 and December 31, 2019.

Results: The search retrieved 1715 articles of which 44 were included for quantitative synthesis. The rate for THA decreased by almost 40% from 11/1000 patient years (PY) in the 2000s to 7/1000 PY in the 2010s, while the overall complication rate decreased from 9.9% in the 1990s to 5.3% in the 2010s. Throughout the duration of the study, THA incidence and overall complication rate decreased. However, not all individual complication rates decreased. For example, revision and periprosthetic fracture decreased, infection and aseptic loosening remained constant, and dislocation increased.

Conclusion: Medical management of patients with RA has reduced the need for THA, while postoperative medical and surgical management has improved some postoperative outcomes. Nevertheless, there remains room for further improvement to postoperative outcomes through RA-specific management.
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http://dx.doi.org/10.1007/s40744-020-00238-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7695804PMC
December 2020

Surgical Jeopardy: Play to Learn.

J Surg Res 2021 01 17;257:9-14. Epub 2020 Aug 17.

Department of Surgery, University of Texas Medical Branch, Galveston, Texas. Electronic address:

Background: General Surgery residencies use protected education time in various fashions in order to optimize content quality and yield for their learners. This knowledge is tested annually with the American Board for Surgery In-Training Examination (ABSITE) exam and is used to evaluate several aspects of a resident. We hypothesized that using a jeopardy game in educational conference would encourage residents to engage in self-learning and improve ABSITE scores at a single institution.

Materials And Methods: At a single institution, during protected education conference, residents played an hour-long surgical jeopardy game every 7 wk to summarize high yield topics discussed during the previous 6 wk of didactic learning. A 5-point Likert survey was completed by general surgery residents to discern the utility of the game format for learning. The ABSITE category scores were also evaluated from the year before and the year after the game was implemented.

Results: Twenty-four general surgery residents took the survey with >80% agreeing that the jeopardy format was either a fun or an effective way to learn general surgery topics. Additionally, over 80% of residents thought the game format helped with retention of knowledge. ABSITE categories that had a jeopardy session improved from 65.9% to 70.4% correct (P = 0.0003). ABSITE categories that did not have dedicated jeopardy had a non-significant increase in scores (67.7%-69.9%, P = 0.1).

Conclusions: Implementing surgical jeopardy as a component of educational conferences in general surgery resident training is correlated with improvement of ABSITE scores. Surgical jeopardy may be easily adopted and implemented to stimulate self-directed learning for residents.
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http://dx.doi.org/10.1016/j.jss.2020.07.050DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7847244PMC
January 2021

Development of a Low-cost, High-fidelity Skin Model for Suturing.

J Surg Res 2020 12 15;256:618-622. Epub 2020 Aug 15.

Department of Surgery, University of Texas Medical Branch, Galveston, Texas.

Background: In a survey of students at our institution, suturing was the most desired workshop for simulation; however, cost, quality, and availability of skin pads is often prohibitive for suturing workshops. In-hospital fabrication may be utilized to manufacture noncommercial, high-fidelity, and low-cost simulation models. We describe the production, value, and face validation of our simulated skin model.

Materials And Methods: Using an in-hospital fabrication laboratory, we have developed a model for skin and subcutaneous tissue. Our model uses a variety of commercially available materials to simulate the epidermis, dermis, subcutaneous fat, fascia, and muscle. A cost analysis was performed by comparing it with other commonly used commercial skin models. Expert surgeons assessed the material characteristics, durability, and overall quality of our model in comparison with other commercial models.

Results: The materials cost of our novel skin pad model was 30.9% of the mean cost of five different commonly used foam and silicone-based commercial skin models. This low-cost model is more durable than the commercial models, does not require skin pad holders, and is of higher fidelity than the commercial products. In addition to skin closure, our model may be used to simulate fascial closure or fasciotomy.

Conclusions: Model creation using in-hospital workspaces is an effective strategy to decrease cost while improving quality of surgical simulation. Our methods for creation of an inexpensive and high-fidelity skin pad may be purposed for several soft tissue models.
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http://dx.doi.org/10.1016/j.jss.2020.07.051DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8110005PMC
December 2020

Taxonomic determination of the cryptogenic red alga, Chondria tumulosa sp. nov., (Rhodomelaceae, Rhodophyta) from Papahānaumokuākea Marine National Monument, Hawai'i, USA: A new species displaying invasive characteristics.

PLoS One 2020 7;15(7):e0234358. Epub 2020 Jul 7.

Department of Biology, College of Charleston, Charleston, SC, United States of America.

Survey cruises by the National Oceanic and Atmospheric Administration (NOAA) in 2016 and 2019 yielded specimens of an undetermined red alga that rapidly attained alarming levels of benthic coverage at Pearl and Hermes Atoll, Papahānaumokuākea Marine National Monument, Hawai'i. By 2019 the seaweed had covered large expanses on the northeast side of the atoll with mat-like, extensive growth of entangled thalli. Specimens were analyzed using light microscopy and molecular analysis, and were compared to morphological descriptions in the literature for closely related taxa. Light microscopy demonstrated that the specimens likely belonged to the rhodomelacean genus Chondria, yet comparisons to taxonomic literature revealed no morphological match. DNA sequence analyses of the mitochondrial COI barcode marker, the plastidial rbcL gene, and the nuclear SSU gene confirmed its genus-level placement and demonstrated that this alga was unique compared to all other available sequences. Based on these data, this cryptogenic seaweed is here proposed as a new species: Chondria tumulosa A.R.Sherwood & J.M.Huisman sp. nov. Chondria tumulosa is distinct from all other species of Chondria based on its large, robust thalli, a mat-forming tendency, large axial diameter in mature branches (which decreases in diameter with subsequent orders of branching), terete axes, and bluntly rounded apices. Although C. tumulosa does not meet the criteria for the definition of an invasive species given that it has not been confirmed as introduced to Pearl and Hermes Atoll, this seaweed is not closely related to any known Hawaiian native species and is of particular concern given its sudden appearance and rapid increase in abundance in the Papahānaumokuākea Marine National Monument; an uninhabited, remote, and pristine island chain to the northwest of the Main Hawaiian Islands.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0234358PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7340295PMC
September 2020

Adjuvant Therapy is Effective for Melanoma Patients with a Positive Sentinel Lymph Node Biopsy Who Forego Completion Lymphadenectomy.

Ann Surg Oncol 2020 Dec 20;27(13):5121-5125. Epub 2020 Apr 20.

Department of Surgery, Duke University Medical Center, Durham, NC, USA.

Background: Multiple adjuvant therapies for melanoma have been approved since 2015 based on randomized trials demonstrating improvements in recurrence-free survival (RFS) with adjuvant therapy after surgical resection of high-risk disease. Inclusion criteria for these trials required performance of a completion lymph node dissection (CLND) for positive sentinel lymph node (pSLN) disease.

Objective: We aimed to describe current practice for adjuvant therapies in patients with pSLN without CLND (active surveillance [AS]), and to evaluate recurrence in these patients.

Methods: Melanoma patients with pSLN between 2016 and 2019 were identified at two institutions. Demographic information, disease and treatment characteristics, and recurrence details were reviewed retrospectively. Patients were stratified by recurrence and patient-, treatment- and tumor-related characteristics were compared using Fisher's exact test and t test for categorical and continuous variables, respectively.

Results: Overall, 245 SLN biopsies were performed, of which 36 (14.7%) were pSLN. Of 36 pSLN, 4 underwent CLND and 32 underwent AS, of whom 22 (68.8%) received adjuvant therapy with the anti-programmed death-1 (PD1) inhibitor nivolumab (16/22), anti-cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) inhibitor ipilimumab (3/22), or BRAF/MEK inhibitors (3/22). At a median follow up of 13.3 months, 7/32 (21.9%) patients on AS recurred, including 4/22 (18.2%) who received adjuvant therapy and 3/10 (30.0%) who did not. Tumor ulceration was significantly associated with recurrence. While not significant, acral lentiginous subtype appeared more common among those with recurrence.

Conclusion: The majority (68.8%) of patients with pSLN managed without CLND were treated with adjuvant therapy. The 1-year RFS for patients managed with adjuvant therapy without CLND was 82%, which is similar to modern adjuvant therapy trials requiring CLND.
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http://dx.doi.org/10.1245/s10434-020-08478-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7572494PMC
December 2020

General Surgery Resident Use of Electronic Resources: 15 Minutes a Day.

J Am Coll Surg 2020 04 16;230(4):442-448. Epub 2020 Jan 16.

Department of Surgery, University of Texas Medical Branch, Galveston, TX. Electronic address:

Background: General surgery resident performance on the American Board of Surgery In-Service Training Exam (ABSITE) has been used to predict American Board of Surgery (ABS) passage rates, selection for remediation programs, and ranking of fellowship applicants. We sought to identify electronic resource study habits of general surgery residents associated with successful test scores.

Study Design: A single-institution, retrospective review of general surgery resident use of 2 electronic study resources, Surgical Council on Resident Education (SCORE) and TrueLearn (TL), were evaluated for the 7 months before the 2019 ABSITE. Metrics included TL question performance, SCORE use, and a survey about other reading sources. These metrics were evaluated in 3 ABSITE percentile groupings: ≥80, 31 to 79, and ≤30.

Results: The ≥80 and 31 to 79 percentile groups scored higher on TL questions, at 69% and 67.7%, respectively, compared with 61.4% for the ≤30 percentile group (p < 0.03). The ≥80 percentile group spent on average 14.6 minutes/day on SCORE compared with 5.0 minutes/day and 4.7 minutes/day for the 31 to 79 and ≤30 percentile groups, respectively (p < 0.04). The ≥80 percentile group spent 34.8 minutes/session (77 sessions) compared with 19.2 minutes/session (49 sessions) and 20.7 minutes/session (43 sessions) in the 31 to 79 and ≤30 percentile groups, respectively (p = 0.009).

Conclusions: Our nomogram incorporates time spent accessing an electronic content-based resource, SCORE, and performance on an electronic question-based resource as a novel method to provide individualized feedback and predict future ABSITE performance.
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http://dx.doi.org/10.1016/j.jamcollsurg.2019.12.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7212593PMC
April 2020

A Multiplexed Serologic Test for Diagnosis of Lyme Disease for Point-of-Care Use.

J Clin Microbiol 2019 12 22;57(12). Epub 2019 Nov 22.

Immuno Technologies Inc., Memphis, Tennessee, USA

Single multiplexed assays could replace the standard 2-tiered (STT) algorithm recommended for the laboratory diagnosis of Lyme disease if they perform with a specificity and a sensitivity superior or equal to those of the STT algorithm. We used human serum rigorously characterized to be sera from patients with acute- and convalescent-phase early Lyme disease, Lyme arthritis, and posttreatment Lyme disease syndrome, as well as the necessary controls ( = 241 samples), to select the best of 12 proteins to improve our microfluidic assay (mChip-Ld). We then evaluated its serodiagnostic performance in comparison to that of a first-tier enzyme immunoassay and the STT algorithm. We observed that more antigens became positive as Lyme disease progressed from early to late stages. We selected three antigens (3Ag) to include in the mChip-Ld: VlsE and a proprietary synthetic 33-mer peptide (PepVF) to capture sensitivity in all disease stages and OspC for early Lyme disease. With the specificity set at 95%, the sensitivity of the mChip-Ld with 3Ag ranged from 80% (95% confidence interval [CI], 56% to 94%) and 85% (95% CI, 74% to 96%) for two panels of serum from patients with early Lyme disease and was 100% (95% CI, 83% to 100%) for serum from patients with Lyme arthritis; the STT algorithm detected early Lyme disease in the same two panels of serum from patients with early Lyme disease with a sensitivity of 48.5% and 75% and Lyme arthritis in serum from patients with Lyme arthritis with a sensitivity of 100%, and the specificity was 97.5% to 100%. The mChip-Ld platform outperformed the STT algorithm according to sensitivity. These results open the door for the development of a single, rapid, multiplexed diagnostic test for point-of-care use that can be designed to identify the Lyme disease stage.
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http://dx.doi.org/10.1128/JCM.01142-19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6879297PMC
December 2019

GEAMP, a novel gastroesophageal junction carcinoma cell line derived from a malignant pleural effusion.

Lab Invest 2020 01 10;100(1):16-26. Epub 2019 Jul 10.

Esophageal Diseases Center and Division of Hematology-Oncology, Department of Internal Medicine and the Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA.

Gastroesophageal junction (GEJ) cancer remains a clinically significant disease in Western countries due to its increasing incidence, which mirrors that of esophageal cancer, and poor prognosis. To develop novel and effective approaches for prevention, early detection, and treatment of patients with GEJ cancer, a better understanding of the mechanisms driving pathogenesis and malignant progression of this disease is required. These efforts have been limited by the small number of available cell lines and appropriate preclinical animal models for in vitro and in vivo studies. We have established and characterized a novel GEJ cancer cell line, GEAMP, derived from the malignant pleural effusion of a previously treated GEJ cancer patient. Comprehensive genetic analyses confirmed a clonal relationship between GEAMP cells and the primary tumor. Targeted next-generation sequencing identified 56 nonsynonymous alterations in 51 genes including TP53 and APC, which are commonly altered in GEJ cancer. In addition, multiple copy-number alterations were found including EGFR and K-RAS gene amplifications and loss of CDKN2A and CDKN2B. Histological examination of subcutaneous flank xenografts in nude and NOD-SCID mice showed a carcinoma with mixed squamous and glandular differentiation, suggesting GEAMP cells contain a subpopulation with multipotent potential. Finally, pharmacologic inhibition of the EGFR signaling pathway led to downregulation of key downstream kinases and inhibition of cell proliferation in vitro. Thus, GEAMP represents a valuable addition to the limited number of bona fide GEJ cancer cell lines.
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http://dx.doi.org/10.1038/s41374-019-0278-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6920545PMC
January 2020

Comparison of Comorbidity Scores in Predicting Surgical Outcomes.

Med Care 2016 Feb;54(2):180-7

*Department of Surgery, The University of Texas Medical Branch, Galveston, TX †Department of Surgery, The University of South Florida, Tampa, FL ‡Department of Preventive Medicine and Community Health, The University of Texas Medical Branch, Galveston, TX §Department of Surgery, University of Arizona, Tucson, AZ.

Introduction: The optimal methodology for assessing comorbidity to predict various surgical outcomes such as mortality, readmissions, complications, and failure to rescue (FTR) using claims data has not been established.

Objective: Compare diagnosis-based and prescription-based comorbidity scores for predicting surgical outcomes.

Methods: We used 100% Texas Medicare data (2006-2011) and included patients undergoing coronary artery bypass grafting, pulmonary lobectomy, endovascular repair of abdominal aortic aneurysm, open repair of abdominal aortic aneurysm, colectomy, and hip replacement (N=39,616). The ability of diagnosis-based [Charlson comorbidity score, Elixhauser comorbidity score, Combined Comorbidity Score, Centers for Medicare and Medicaid Services-Hierarchical Condition Categories (CMS-HCC)] versus prescription-based Chronic disease score in predicting 30-day mortality, 1-year mortality, 30-day readmission, complications, and FTR were compared using c-statistics (c) and integrated discrimination improvement (IDI).

Results: The overall 30-day mortality was 5.8%, 1-year mortality was 17.7%, 30-day readmission was 14.1%, complication rate was 39.7%, and FTR was 14.5%. CMS-HCC performed the best in predicting surgical outcomes (30-d mortality, c=0.797, IDI=4.59%; 1-y mortality, c=0.798, IDI=9.60%; 30-d readmission, c=0.630, IDI=1.27%; complications, c=0.766, IDI=9.37%; FTR, c=0.811, IDI=5.24%) followed by Elixhauser comorbidity index/disease categories (30-d mortality, c=0.750, IDI=2.37%; 1-y mortality, c=0.755, IDI=5.82%; 30-d readmission, c=0.629, IDI=1.43%; complications, c=0.730, IDI=3.99%; FTR, c=0.749, IDI=2.17%). Addition of prescription-based scores to diagnosis-based scores did not improve performance.

Conclusions: The CMS-HCC had superior performance in predicting surgical outcomes. Prescription-based scores, alone or in addition to diagnosis-based scores, were not better than any diagnosis-based scoring system.
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http://dx.doi.org/10.1097/MLR.0000000000000465DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4713334PMC
February 2016

Hospital readmission after emergency room visit for cholelithiasis.

J Surg Res 2015 Aug 16;197(2):318-23. Epub 2015 Apr 16.

Department of Surgery, The University of Texas Medical Branch, Galveston, Texas. Electronic address:

Background: For patients presenting with symptomatic cholelithiasis, cholecystectomy is the definitive treatment modality. Our goal was to evaluate the surgical follow-up and outcomes in patients seen in the emergency department (ED) for an episode of symptomatic cholelithiasis and discharged home for elective follow-up.

Methods: We performed a retrospective review of consecutive patients seen in the ED for cholelithiasis and discharged without hospital admission between August 2009 and May 2014. All patients were followed for 2 y from the date of the initial ED visit. We evaluated outpatient surgeon visits, elective and emergent cholecystectomy rates, and additional ED visits. Cumulative incidence and Kaplan-Meier curves were used to examine the time from the initial ED visit to outpatient surgeon evaluation and the time from the initial ED visit to ED readmission.

Results: Seventy-one patients were discharged from the ED with a diagnosis of symptomatic gallstones. Patients who had an elective cholecystectomy in the 2 y after the initial visit were 12.6%. In this group, the mean time from the initial ED visit to outpatient surgeon follow-up was 7.7 d, and all elective cholecystectomies occurred within 1 mo of the initial visit. Of the 62 patients who did not have an elective cholecystectomy, only 14.5% of patients in this group had outpatient surgeon follow-up at mean time of 137 d from the initial ED visit for symptomatic gallstones. In addition, 37.1% of patients in this group had additional ED visits for gallstone-related symptoms, with 17.7% of patients having two or more additional ED visits, and 12.9% required emergent and/or urgent cholecystectomy. Additional ED visits (43.5%) occurred within 1 mo and 60.9% within 3 mo of their initial ED visit. In patients with additional ED visits for symptomatic cholelithiasis, 60.9% had more than one abdominal ultrasound or computed tomography scan during the course of multiple visits.

Conclusions: Failure to achieve a timely surgical follow-up leads to multiple ED readmissions and emergent gallstone-related hospitalizations, including emergency cholecystectomy. System-level interventions to ensure outpatient surgical follow-up within 1-2 wk of the initial ED visit has the potential to improve outcomes for patients with symptomatic biliary colic.
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http://dx.doi.org/10.1016/j.jss.2015.04.032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4466203PMC
August 2015

Commentary.

J Neurosci Rural Pract 2013 Jul;4(3):373-4

Department of Psychiatry, University of Tennessee Health Science Center, Memphis, TN 38105, USA.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3821448PMC
July 2013

Illness narrative, depression, and sainthood: an analysis of the writings of Mother Teresa.

J Relig Health 2014 Feb;53(1):290-7

Department of Psychiatry, College of Medicine, University of Tennessee Health Science Center, 920 Madison Avenue, 2nd Floor, Memphis, TN, 38105, USA,

In 2007, the letters of The Blessed Mother Teresa to her confessors were published for the public in a book entitled Come Be My Light. What surprised many readers was that Mother Teresa felt very distant from God and described feeling great "darkness" for many years. This paper draws parallels between the writings of Mother Teresa and those of writers' illness narratives describing the psychiatric condition of Depression. The author provides this textual analysis to explore Mother Teresa's experience within a psychiatric paradigm (Major Depressive Disorder), in comparison with and contrast to the spiritual paradigm of a "Dark Night of the Soul."
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http://dx.doi.org/10.1007/s10943-013-9774-2DOI Listing
February 2014

"Holy PTSD, batman!:" An analysis of the psychiatric symptoms of Bruce Wayne.

Acad Psychiatry 2012 May;36(3):252-5

Dept. of Psychiatry, Univ. of Tennessee, Memphis, TN, USA.

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http://dx.doi.org/10.1176/appi.ap.36.3.252DOI Listing
May 2012

Neural crest and ectodermal cells intermix in the nasal placode to give rise to GnRH-1 neurons, sensory neurons, and olfactory ensheathing cells.

J Neurosci 2011 May;31(18):6915-27

Cellular and Developmental Neurobiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892, USA.

The origin of GnRH-1 cells and olfactory ensheathing cells has been controversial. Genetic Cre-lox lineage tracing of the neural crest (NC) versus ectodermal contribution to the developing nasal placode was performed using two complementary mouse models, the NC-specific Wnt1Cre mouse line and an ectodermal-specific Crect mouse line. Using these lines we prove that the NC give rise to the olfactory ensheathing cells and subpopulations of GnRH-1 neurons, olfactory and vomeronasal cells. These data demonstrate that Schwann cells and olfactory ensheathing cells share a common developmental origin. Furthermore, the results indicate that certain conditions that impact olfaction and sexual development, such as Kallmann syndrome, may be in part neurocristopathies.
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http://dx.doi.org/10.1523/JNEUROSCI.6087-10.2011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3101109PMC
May 2011

Survivors of self-inflicted gunshot wounds: a 20-year chart review.

Psychosomatics 2011 Jan-Feb;52(1):34-40

University of Tennessee Health Science Center, Department of Psychiatry, Memphis, TN 38104, USA.

Objective: Due to the small number of individuals who survive self-inflicted gunshot wounds (SIGSWs), little is known about this population. This study describes a sample of 497 survivors of SIGSWs, and examines patterns of demographics (gender, ethnicity, and age) and circumstances surrounding the incident (location of wound, intoxication, intentionality, and psychiatric diagnosis), which may bear on clinical work with this at-risk population.

Method: We conducted a retrospective chart review of psychiatry consult records over a 20-year period from a community-based medical hospital with a trauma center. Of the 9,226 patients who had psychiatry consults from 1987 to 2007, 5% involved a SIGSW. A number of factors ascertained via clinical interview regarding demographics and circumstances were examined.

Results: Several significant patterns emerged from the sample: (1) there was an overrepresentation of men compared with women; (2) African American survivors were younger and had a greater likelihood of being female compared with Caucasians; (3) male survivors shot themselves in the face/head/neck whereas the women shot themselves in the abdomen with more frequency; and (4) younger persons had a greater likelihood of being intoxicated at the time of the incident, initially claim the SIGSW was an accident, and receive a diagnosis of an adjustment disorder rather than a more serious depressive condition.

Conclusions: This is the most comprehensive examination of SIGSW survivors conducted to date (to our knowledge). Given the usual lethality of SIGSWs, utilizing survivor data can provide critical insights, which may have implications for future research and clinical work with this vulnerable population.
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http://dx.doi.org/10.1016/j.psym.2010.11.019DOI Listing
June 2011

Psychogenic polydipsia: comparison of a community sample with an institutionalized population.

Psychiatry Res 2011 May 30;187(1-2):310-1. Epub 2010 Nov 30.

University of Tennessee Health Science Center, Department of Psychiatry, Memphis, TN, USA.

The prevalence of psychogenic polydipsia, which can cause hyponatremia, is unknown in the outpatient psychiatric community. We report on 42 individuals who were admitted for hyponatremia due to psychogenic polydipsia. No significant differences were found between the community and institutional samples regarding demographics, psychiatric diagnosis, or severity of hyponatremia.
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http://dx.doi.org/10.1016/j.psychres.2010.10.035DOI Listing
May 2011

Anti-obesity and anti-tumor pro-apoptotic peptides are sufficient to cause release of cytochrome c from vesicles.

FEBS Lett 2007 Nov 5;581(28):5464-8. Epub 2007 Nov 5.

Department of Chemistry and Biochemistry, University of San Diego, 5998 Alcala Park, San Diego, CA 92110, USA.

Peptides that target tissue for an apoptotic death have potential as therapeutics in a variety of disease conditions. The class of peptides described herein enters the cell through a specific receptor-mediated interaction. Once inside the cell, the peptide migrates toward the mitochondria, where the membrane barrier is disrupted. These experiments demonstrate that upon treatment with these short peptides large unilamellar vesicles are not lysed, a graded mode of leakage is observed and the transient pores formed by these peptides are large enough to release entrapped cytochrome c from the vesicles.
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http://dx.doi.org/10.1016/j.febslet.2007.10.051DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2173911PMC
November 2007

P21waf1/cip1/sdi1 as a central regulator of inducible smooth muscle actin expression and differentiation of cardiac fibroblasts to myofibroblasts.

Mol Biol Cell 2007 Dec 19;18(12):4837-46. Epub 2007 Sep 19.

Laboratory of Molecular Medicine, Department of Surgery, Davis Heart and Lung Research Institute, The Ohio State University Medical Center, Columbus, OH 43210, USA.

The phenotypic switch of cardiac fibroblasts (CFs) to myofibroblasts is essential for normal and pathological wound healing. Relative hyperoxic challenge during reoxygenation causes myocardial remodeling. Here, we sought to characterize the novel O(2)-sensitive molecular mechanisms responsible for triggering the differentiation of CFs to myofibroblasts. Exposure of CFs to hyperoxic challenge-induced transcription of smooth muscle actin (SMA) and enhanced the stability of both Acta2 transcript as well as of SMA protein. Both p21 deficiency as well as knockdown blunted hyperoxia-induced Acta2 and SMA response. Strikingly, overexpression of p21 alone markedly induced differentiation of CFs under normoxia. Overexpression of p21 alone induced SMA transcription by down-regulating YB1 and independent of TGFbeta1. In vivo, hyperoxic challenge induced p21-dependent differentiation of CFs to myofibroblasts in the infarct boundary region of ischemia-reperfused heart. Tissue elements were laser-captured from infarct boundary and from a noninfarct region 0.5 mm away. Reperfusion caused marked p21 induction in the infarct region. Acta2 as well as SMA expression were markedly up-regulated in CF-rich infarct boundary region. Of note, ischemia-reperfusion-induced up-regulation of Acta2 in the infarct region was completely abrogated in p21-deficient mice. This observation establishes p21 as a central regulator of reperfusion-induced phenotypic switch of CFs to myofibroblasts.
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http://dx.doi.org/10.1091/mbc.e07-03-0270DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2096602PMC
December 2007

Structural evaluation of a novel pro-apoptotic peptide coupled to CNGRC tumor homing sequence by NMR.

Chem Biol Drug Des 2006 Jun;67(6):417-24

Chemistry Department, University of San Diego, San Diego, CA 92110, USA.

Hunter-killer peptides (HKPs) are synthetic peptides that target specific cell types for apoptosis. These studies report functional and structural characteristics of HKP9, an hunter-killer peptide that specifically targets tumor vasculature with a new apoptotic sequence. Vesicle leakage experiments were performed as a model for membrane perturbing activity. Placement of the homing sequence reduces both cell toxicity and vesicle leakage activity. NMR studies elucidate the conformation and orientation of HKP9 in micelles. The positively charged end of the HKP9 killing sequence is solvent exposed; however, the central portion of the peptide is helical and buried in dodecylphosphorylcholine micelles. The homing sequence is less solvent exposed than in a previously reported tumor-homing peptide. The results suggest that solvent accessibility of the homing sequence should be considered in design of future peptides.
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http://dx.doi.org/10.1111/j.1747-0285.2006.00394.xDOI Listing
June 2006

Feasibility to detect severe coronary artery stenoses with upright treadmill exercise magnetic resonance imaging.

Am J Cardiol 2003 Sep;92(5):603-6

Department of Internal Medicine (Cardiology Section), Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA.

We performed treadmill exercise magnetic resonance imaging in 27 patients with exertional chest pain who were referred for contrast coronary angiography to determine the feasibility of this method to identify severe coronary artery stenoses. The sensitivity and specificity for detecting >70% coronary artery luminal diameter narrowings on contrast coronary angiography were 79% and 85%, respectively.
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http://dx.doi.org/10.1016/s0002-9149(03)00734-3DOI Listing
September 2003

Anti-platelet factor 4/heparin antibodies: an independent predictor of 30-day myocardial infarction after acute coronary ischemic syndromes.

Circulation 2003 May 21;107(18):2307-12. Epub 2003 Apr 21.

Section of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1045, USA.

Background: We postulated that antibodies to platelet factor 4/heparin complex might contribute to recurrent ischemic events in patients with acute coronary syndrome.

Methods And Results: We analyzed serum from patients enrolled in the placebo/unfractionated heparin arm of the GUSTO IV-ACS trial who had high likelihood of prior heparin exposure. We selected 109 patients without thrombocytopenia with the 30-day primary end point (death, myocardial infarction [MI], or revascularization) and 109 age-, gender-, and race-matched controls who did not achieve the primary end point. An ELISA for anti-platelet factor 4/heparin antibodies was performed using 48-hour serum samples. The analyses were done by blinded investigators, and the results were correlated with clinical outcomes. Twenty-three of 218 patients (10.6%) had anti-PF4/heparin antibodies. Patients with anti-PF4/heparin antibodies were more likely to have death or MI (30.4% versus 11.3%, P=0.011) or MI (21.7% versus 6.2%, P=0.008) than patients who were negative for the antibody. After multiple logistic regression analysis, anti-PF4/heparin antibodies remained a predictor of 30-day death or MI (odds ratio, 4.0; 95% CI, 1.4 to 11.3; P=0.0093) and MI (odds ratio, 4.6; 95% CI, 1.4 to 15.0; P=0.0108). The antibody was not associated with the composite end point (death, MI, or revascularization) or with death or revascularization alone.

Conclusions: Antibodies to the platelet factor 4/heparin complex are a novel, independent predictor of myocardial infarction at 30 days in patients presenting with acute coronary ischemic syndromes. This finding may explain the previous association between thrombocytopenia and adverse events in patients with acute coronary syndrome and may have important implications for the choice of anticoagulant regimens.
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http://dx.doi.org/10.1161/01.CIR.0000066696.57519.AFDOI Listing
May 2003