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... The Effect of Micro-Learning on Patient Temperatures: Before, During, & After Surgery Jody W. Marksberry DNP Student, BSHS, BSN-RN, AS-ST Felicia Stewart DNP, FNP-C Problem Volume of Information Knowledge Gaps Complacency PICOT What is the effect of a microlearning staff intervention on patient temperatures compared to pre intervention patient temperatures for patients ages 18-65 in an urban outpatient surgical setting? Methods Target Facility: Indiana Level 1 Trauma Center Target Population: Perioperative Staff Unit of Measure: Patient Temperature Pre-Implementation Data: - perioperative patient temperatures Pre-Intervention Staff Knowledge Survey Micro-Learning Educational Intervention: - targeted to increase staff awareness of surgical patient warming Post-Intervention Periop Patient Temperatures Post-Intervention Staff Knowledge Survey Post-Intervention Data Comparison Outcomes - TBD Identify Relationship Between MicroLearning & Patient Outcomes Springboard Future Patient-Centered Efforts Explore Evidence-Based Micro-Learning Conclusion Literature Review Volume learning hinders productivity, strains budgets, yet does not ensure adoption or understanding of the information (Shail, 2019). Micronized learning improves staff self efficacy (Zarshenas., et al 2022). Temperature Change: initial physiological response to health able to be influenced / manipulated. References  ...

... A Comparison of Surgical Procedures (Inspire vs. Genio) for the Treatment of Obstructive Sleep Apnea David C. Lashbrooke, Jr, MS Marian University College of Osteopathic Medicine, Indianapolis, IN Background Treatment The objective of treating OSA is to prevent narrowing or collapsing of the airway, ensuring unobstructed airflow throughout the night Continuous positive airway pressure machine (CPAP) Considered the gold standard treatment Not well tolerated Hypoglossal nerve stimulation (HNS) Facilitates the control of tongue movement to maintain the airway during sleep Inspire is a unilateral HNS system Holds the only current Food and Drug Administration (FDA) approval Generator is surgically implanted in the right chest superficial to the fascia of the pectoralis major muscle and just below the inferior border of the clavicle Respiratory sensing lead is placed between the external and internal intercostal muscles on the lateral thoracic wall Stimulation lead is inserted below the mandible, travels through the neck and connects to the hypoglossal nerve Genio is a bilateral HNS system Not FDA approved and is primarily used in Europe Externally worn on the submental region during sleep Adhesive disposable patch transdermally stimulates the hypoglossal nerve bilaterally STAR Trial and Patient Outcomes (Inspire) In 2014, 126 patients participated in a study that aimed to investigate the effects of HNS on: Apnea hypopnea index (AHI) Oxygen desaturation index (ODI) Epworth Sleepiness Scale (ESS) Functional Outcomes of Sleep Questionnaire (FOSQ) After 12 months of Inspire use, productive changes in all four outcomes listed above were observed compared to the baseline Median ESS scores fell to less than 10.0 indicating a reduction in daytime sleepiness Median FOSQ scores increased at least 2.0 points indicating an improvement of overall quality of life BLAST Trial and Patient Outcomes (Genio) Comparison Inspire stimulates the genioglossus and geniohyoid muscles while Genio only stimulates the protruding genioglossus muscle to keep airway open during sleep Inspire uses a sensing lead which detects the patients breathing to deliver stimulation while Genio delivers stimulation at a fixed rate At this time, no conclusion can be made on the benefits of bilateral versus unilateral stimulation in terms of patient outcomes Additional studies are needed due to small sample sizes In 2017, 27 patients participated in a study nearly identical to that of Inspire Because the Genio device is still relatively new, studies have been limited thus far Similar productive changes in the aforementioned outcomes were observed after 6 months of Genio use Median ESS scores also fell to less than 10.0 indicating a reduction in daytime sleepiness Median FOSQ scores increased by 1.9 points also indicating an improvement of overall quality of life Effect of HNS on AHI and ODI 35 30 25 SCORE Obstructive sleep apnea (OSA) is a prevalent sleep disorder that typically arises when the muscles responsible for regulating the upper airway excessively relax, ultimately causing narrowing or constriction of the throat This muscle relaxation causes the tongue to fall backwards leading to airway blockage Sleep apnea can lead to a variety of serious health issues such as: Hypertension Increased resistance to insulin Increased risk for cancer Cognitive impairment or dementia Neurodegeneration Cardiovascular disease Results 20 15 10 29.3 25.4 23.7 5 9 19.1 12.9 7.4 9.8 0 Baseline Post-Treatment Baseline INSPIRE GENIO AHI Figure 1. Inspire Medical System Remote and Generator Source: Inspire Medical System Figure 2. Genio Submental Patch Source: Genio Sleep Inspire Adverse Events and Complications Following the 12-month STAR Trial, patients experienced a variety of adverse events and complications Postoperative complications due to the procedure are as follows: 26% reported general discomfort around the incision site 18% reported tongue soreness and weakness 12% reported sore throat due to intubation Inspire device related complications are as follows: 40% reported discomfort due to the electrical stimulation 21% reported tongue abrasion 10% reported mouth dryness 6% reported pain associated due the mechanical activity Post-Treatment ODI Figure 3. Effects of HNS on AHI and ODI Source: Eastwood, National Library of Medicine Genio Adverse Events and Complications Postoperative complications due to the procedure are as follows: 19% reported hematomas around the incision site 19% reported general discomfort around the incision site Genio device related complications are as follows: 30% reported impaired or painful swallowing 30% reported skin irritation around the submental region where the disposable patch is worn each night 26% reported trouble speaking due to muscle weakness 11% reported tongue abrasion 11% reported tongue fasciculation 11% reported discomfort due to electrical stimulation  ...

... Confirmation of the Presence of Antibiotic Resistance Gram-Negative Bacteria in the Nina Mason Pulliam EcoLab (NMPE) by Kirby Bauer Assays and Genome Sequencing Jaipal Malhi1, OMS-2, Jake Lex1, OMS-2, Angela Hodges1, OMS-2, Zarah Khan3, Chaina Francois2, and Samina Akbar, PhD 1Marian University College of Osteopathic Medicine, 2 Marian University, 3Purdue University Contact: Samina Akbar., PhD Marian University College of Osteopathic Medicine. 317-955-6608 sakbar@marian.edu INTRODUCTION/ OBJECTIVE Antibiotic resistant (AR) bacteria pose a serious threat to an individuals health, and the presence of AR genes can lead to the development of superbugs that are resistant to currently used antibiotics. Identifying local reservoirs that house AR bacterial strains has become critical. The main objective of our project was to identify the presence and cause of bacterial resistance in gram-negative bacteria collected from Jensen Lake at the Nina Mason Pulliam Ecolab (NMPE). This research was conducted via two protocols. To test for AR, gram-negative bacteria isolated from the NMPE water samples were subjected to Kirby-Bauer assays (Fig. 1). To test for the presence of AR genes, genomic DNA was purified from the bacterial isolates and sent to an outside vendor (ID Genomics) for identification of potential AR genes through PCR amplification and sequencing (Fig. 2). METHODS Kirby Bauer DNA Extraction SUMMARY ENVIRONMENT Nina Mason Pulliam EcoLab RESULTS AminoGlycosides BetaLactams Cephalosporins Class: 62 (18.9%) Class: 126 (77%) 1st: 47 (57%) 2nd: 31 (38%) 3rd: 30 (18%) (1st, 2nd, & 3rd gen) Carbapenems Quinolones Sulfonamides Class: 40 (49%) Class: 62 (38%) Class: 27 (17%) Tetracyclines and Choramphenicol Class: T: 8 (10%) C: 6 (7%) Table 1. Number and Percentage of bacterial isolates with resistance to different antibiotic classes Of the 82 isolates tested, all showed resistance to at least one antibiotic. 80 of the 82 isolates showed multi-drug resistance. Isolates were most resistant to beta-lactam antibiotics (i.e. ampicillin, amox/clav) with 77% of strains having resistance to one of the two. Other notable individual antibiotic resistances were: cephalothin (73%), ciprofloxacin (43%), imipenem (43%), and streptomycin (37%). PCR and sequencing analyses showed antibiotic resistance genes in the 130 isolates tested: CMY (53), CTX-M, TEM & SHV-1 (13 each) were the most common genes seen. Our current data shows that many of the bacterial isolates from the NMPE display resistance to commonly used antibiotics in the medical field, most namely Beta Lactams. Based on the PCR and sequencing analyses of the strains isolated thus far, 108 samples have been identified to have a gene associated with antibiotic resistance. More genetic testing is underway to identify additional antibiotic resistance genes based on the Kirby-Bauer assay data. Further research is needed to locate whether these antibiotic resistance genes are encoded on the genomel, plasmids, or transposons. The long-term focus of our research is to examine the dissemination of AR genes in Indiana waterways and to document the presence of AR throughout different regions of Indiana. We also plan to test the levels of different classes of antibiotics in these water samples to see potential environmental exposures leading to increased rates of resistance. The focus on future research will also be to determine what the routes of dissemination are that lead to antibiotics being found in the waterways of Indiana. ACKNOWLEDGEMENTS Fig. 1. Example of a KirbyBauer assay Fig. 2. An example of PCR amplification of the 16S rRNA gene of the bacterial isolates from Jensen Lake at NMPE. The 894 bp 16S rRNA gene product was amplified using universal primers. The 1kb DNA ladder was run in lanes 1 and 9 of the gel. We would like to thank Marian University for allowing us to use their laboratory facilities and access to the NMPE for research. We would also like to thank Dr. Akbar, for her guidance and assistance throughout this project. This research was funded by an FRD grant and an Indiana Academy of Science grant to Dr. Akbar.  ...

... Disparities in School Supports for Patients with Sickle Cell Disease and Cystic Fibrosis Claryce 1 Gedde , Lia 2 Thibodaux , Ashley 1 Orr , Kristin 3 Wikel , Debra 4 Reisinger , Michelle 1,2 Curtin 1. Marian University College of Osteopathic Medicine, Indianapolis, Indiana; 2. Wake Forest School of Medicine, Winston-Salem, North Carolina; 3. Ball State University Teachers College, Muncie, Indiana; 4. Cincinnati Childrens Hospital, Cincinnati, Ohio Background Methods Sickle cell disease (SCD) and cystic fibrosis (CF) are genetic conditions that present at birth with lifelong needs. SCD Frequency 100,000 people in US Demographics Predominantly Black or Hispanic/Latinx Complications Anemia, pain crises, acute chest syndrome, stroke, asplenia Management Medication (hydroxyurea), annual screening transcranial doppler, pain management Cognitive Overt strokes/silent cerebral Impact infarcts can lead to decline in cognitive function CF 35,000 people in US Predominantly nonHispanic/Latinx whites Frequent lung infections and poor growth/weight gain. Pancreatic enzymes, antibiotic regimens, chest physiotherapy No known direct cognitive effects Children with chronic health care needs may need school supports due to impacts of disease, absenteeism, etc. School supports and services may be provided through an Individualized Education Program (IEP) or Section 504 Accommodation Plan (504 Plan). Multiple disparities exist for minority children vs. white peers: 1. In medical outcomes with increased morbidity/mortality and inequitable treatment access in various diagnoses. 2. In socioeconomic status with black children more often living in poverty. 3. In educational outcomes and access. 4. In expulsion and suspension from school, occurring at much higher rates for black children, higher risk of drop-out/non-completion of high school. This is part of the school-to-prison pipeline. Objective Given disparities in medical and educational services, our study aimed to compare the current school supports in place and recommended supports for students with SCD and CF Data were collected from a hospital-based school program (HBSP) at a large academic medical center. Sample size: 43 unique SCD patients with 78 encounters 104 CF patients with 178 encounters. Data were cleaned by one rater; 30% reviewed for interrater reliability. Discrepancies were resolved with the research team. Data were analyzed through descriptive statistics in Microsoft Excel. Results Conclusions Given the impact of diseases such as SCD and CF, many patients with those diseases would qualify for school supports. However, individuals with SCD are at risk of cognitive impacts secondary to infarct/stroke with need for more extensive supports compared to those with CF. In this study, we found disparities between SCD patients vs. CF patients in percentage of: 1. Patients with an IEP or 504 Plan prior to first HBSP contact 2. Patients recommended to receive school supports after HBSP contact 3. Patients having existing IEP or recommended for an IEP The discrepancies in the recommended school supports for children with CF and SCD are concerning and further contribute to educational disparities. Future Directions: Improving support for children with SCD through HBSP education, material development regarding disease education for teachers/ peers, development of comprehensive recommendations of school support needs for children with SCD, etc. References  ...

... Assessing Patient Perspective of Diet and Exercise in Patients Taking Semaglutide: An Educational Intervention Alexis Young, DNP Candidate, MBA-HCA, BSN, RN Felicia Stewart, DNP, FNP-C & Tara Fox, DNP, CPNP- Faculty Mentors Purpose The DNP project aimed to: assess the effectiveness of an educational intervention focused on improving patient knowledge and receptiveness of making necessary diet and exercise changes during their semaglutide treatment plan. Background Obesity is a public health crisis and poses a global health challenge as it is a multifactorial, complex, and progressive chronic disease with a substantial burden on individuals, society, and the economy (Amaro et al., 2022; Rubino et al., 2021). Obesity is defined as a body mass index (BMI) of 30 kg/m2 in adults (WHO, 2021). Losing 5% of body weight prevents and improves weight-related health complications (Wharton et al., 2022). Lifestyle modifications such as healthy eating and physical activity which are foundational to obesity management may not be enough to achieve long-term health benefits. Inclusion Criteria: 1) adult 18 years or older without diabetes; 2) must be either overweight (BMI to 27) plus at least one comorbidity, or obese (BMI 30); 3) individual is an established patient who has received an initial evaluation and blood work from the DNP-FNP for clearance; and 4) has received at least one semaglutide injection. Up to 90% of individuals with obesity are unable to keep weight off long term, impartially due to difficulties adhering to lifestyle interventions and compensatory changes in appetite-regulating hormones, which act to maintain normal weight homeostasis (also known as metabolic adaptation), thus leading to weight regain (Bray et al., 2017; Garvey et al., 2016; Kaplan et al., 2018; Rubino et al., 2021; Updike, 2021; Wharton et al. 2022). In 2017, the United States Food and Drug Administration (FDA) approved Semaglutide, a subcutaneous injectable glucagon-like-peptide (GLP-1) to combat the obesity and diabetic epidemic. Project: 21 days in length with two data collection periods. GLP-1 prompts the body to produce more insulin, reducing blood sugar (glucose). GLP-1 in higher amounts interacts with parts of the brain to suppress appetite and signal individuals to feel full (satiety). The effectiveness of semaglutide is leading society to the misconception that this pharmacological drug can be used without changing lifestyle behaviors such as diet and exercise. When semaglutide is used in conjunction with diet and exercise, it can cause significant weight loss, reduce side effect profile, lead to an enhanced decreased risk of health conditions and diseases, and lead to long-term weight loss (Amaro et al., 2022; Muller, 2019; Rubino et. al., 2021). Based on current evidence, there is an underrepresentation of diet and exercise educational materials available to healthcare providers to provide patients using semaglutide for weight loss. PICOT For patients 18 years and older who have received at least one semaglutide injection for weight loss, how will an educational handout compared to current verbal education, enhance patient understanding and perspective of lifestyle modifications necessary during and after treatment with semaglutide? Methodology Conducted at an outpatient medical facility in Indianapolis, IN. Days 1-14: Patients were invited to participate in the project via HIPAAcompliant email. An embedded link was used to redirect them to Qualtrics containing the: o Pre-survey o Education intervention o Post-survey o Post intervention email containing educational rack card Days 15- 21: Patients were invited for the second data collection point. o Post-survey: reassessing knowledge, exercise and diet habits, and readiness to change lifestyle behaviors. Surveys: Assess knowledge, diet and lifestyle habits, and readiness to change utilizing the Readiness Ruler tool. Educational intervention: Evidenced-based diet and exercise changes recommended while on semaglutide. Tools used to collect and analyze data: o The Readiness Ruler tool to measure motivation to change o PPT development tool for the educational intervention o YouTube to host educational 6-minute video o Canva development tool for educational rack card o Qualtrics to develop, host, collect, and analyze survey data o DemandForce to send HIPAA-compliant patient email invitation Conclusion Currently in data collection phase. Survey questions and educational intervention available upon request. References Available upon request.  ...

... GNRHR Signaling in Hematologic Cancer Cell Lines Emily Schubach1 and Dr. Catherine E. Steding1,2 1Marian University College of Osteopathic Medicine and 2The Rich and Robin Porter Cancer Research Center, Terre Haute, IN. Rationale and Goals Results and Discussion GnRHR signaling has been demonstrated to affect cancer cell proliferation. The expression of GnRH binding sites in leukemias and lymphomas provides a potential target for chemotherapeutic drugs. Analyzing the effect of GnRHR targeted therapy in non-reproductive cancers is a novel and underexplored project that may contribute to the understanding of directed hormonal signaling in hematologic cancers. The goal of this project is to elucidate the potential effects of targeting the GnRHR pathway in hematologic cell proliferation. Additionally, chemotherapeutic drugs that are not typically used to treat hematological cancers (such as Paclitaxel) may provide useful information about mechanisms of chemoresistance. Because of the demonstrated sensitivity of HL-60 cells to Paclitaxel, gradually increasing the dosage from an initially small dose can provide valuable information in regard to the development of chemoresistance to this particular drug. Treatment with paclitaxel at all timepoints reduced both viability and proliferation with effects increasing as time increased. Short-term treatment (48 hour) with Degarelix and Paclitaxel indicated decreased viability compared to either treatment alone. The combined effects of treatment on viability and proliferation were less clear at the longer 7-day time points. This is likely due to the delayed onset of effect observed for both viability and proliferation following microtubule stabilization. In order to better analyze the combinatorial effects, additional doses of Paclitaxel were applied, and analysis was completed prior to 7 days. At both the 4-day and 7-day timepoints and regardless of Paclitaxel concentration, treatment with both compounds was less effective than treatment with paclitaxel alone. This implies that a reduction in GnRHR signaling could be protective against Paclitaxel treatment but only after Paclitaxel effects build. Background and Introduction Hematologic cancers account for roughly 10% of cancers in the United States. Paclitaxel is a microtubule-stabilizing chemotherapeutic drug that has been used against a variety of malignancies including phase I clinical trials for hematological malignancies Treatment of acute promyelocytic leukemia cell lines with Paclitaxel (Pax) has demonstrated significant microtubule spindle formation and growth suppression via cell-cycle arrest and apoptotic mechanisms. Given the limited information of paclitaxel activity in hematological malignancies, investigations into mechanisms of action and unique signaling pathways remain of critical importance Results Conclusions and Future Directions 2 Day Viability Analysis 7 Day Viability Analysis 80 80 70 % Viability 90 90 % Viability 100 70 60 50 40 30 60 50 40 30 20 20 10 10 0 0 Untreated DMSO Pax Deg + DMSO Deg + Pax Untreated DMSO Treatment 35 6 30 Population Doublings Population Doublings 7 5 4 3 2 1 25 20 15 10 5 0 Untreated DMSO Figure 1. Gonadotropin Releasing Hormone Signaling Cascade Pax Treatment Deg + DMSO Deg + Pax Untreated DMSO Pax Treatment Deg + DMSO Deg + Pax Figure 2. Initial Viability and Proliferation Analysis. Cells were treated with DMSO (control), Deg (500 ng/ml), Pax (500 ng/ml), or a combination of Deg + Pax (500 ng/ml). Trypan Blue Exclusion Assays were performed to determine cell viability and proliferation at two timepoints. Cells were evaluated for viability and population doublings after 48 hours and 7 days, respectively. 4 Day Viability Analysis 100 90 80 70 60 50 40 30 20 10 0 % Viability % Viability 2 Day Viability Analysis 100 90 80 70 60 50 40 30 20 10 0 References Treatment 4 Day Proliferation Analysis 30 16 Population Doublings 14 Population Doublings Special thanks to Marian University Office of Sponsored Programs and Research and the Faculty Research Development Grant program for their support. Additional thanks to Dr. Keeley Cleghorn and past and present Steding Laboratory members. Treatment 2 Day Proliferation Analysis HL-60 Acute Promyelocytic Leukemia cells were cultured in RPMI supplemented with 10% FBS. Trypan Blue Exclusion Assay Deg + Pax 7 Day Proliferation Analysis 0 Materials and Methods Deg + DMSO Treatment 2 Day Proliferation Analysis Gonadotropin releasing hormone (GnRH) plays a role in tumor progression including cell proliferation, angiogenesis, and metastasis. GnRH receptor expression has been demonstrated in transformed lymphocytes and extra pituitary tissues, but the effects of GnRH receptor signaling targeting have not been properly investigated. Degarelix (Deg) is a GnRH receptor antagonist that is commonly used to treat prostate cancer. Pax 12 10 8 6 4 2 0 25 20 DMSO Pax 1 Pax 2 Treatment Deg Deg + Pax 1 Deg + Pax 2 Asik, A., Kayabasi, C., Ozmen Yelken, B., Ylmaz Susluer, S., Dogan Sigva, Z. O., Balc Okcanoglu, T., Saydam, G., Biray Avci, C., & Gunduz, C. (2018).Antileukemic effect of paclitaxel in combination with metformin in HL-60 cell line. Gene, 647, 213220. https://doi.org/10.1016/j.gene.2018.01.017 15 10 5 0 Untreated Although the results of this study are inconclusive, the combinatorial effects of Degarelix and Paclitaxel indicate additional investigations are warranted. Treatment with Degarelix alone demonstrated the possibility for increased cell viability, and therefore could indicate that the GnRHR signaling pathway plays a protective role in suppressing cancer cell proliferation. Further research concerning targeted therapy of GnRHR signaling is needed to confirm the role of GnRHR in cancer cell behaviors. Confirmation of GnRHR effects may have important implications for targeted therapy of resistant hematologic malignancies in patients with low or high levels of GnRHR expression. Additional investigations into the interactions between GnRHR and microtubules or microtubule-associated proteins could help to improve our understanding of the interplay between Paclitaxel effects and GnRHR signaling Untreated DMSO Pax 1 Pax 2 Deg Deg + Pax 1 Deg + Pax 2 Treatment Figure 3. Viability and Proliferation Analysis. Cells were treated with DMSO (control), Deg (500 ng/ml), Pax (500 ng/ml; 100 ng/ml), or a combination of Deg (500 ng/ml) + Pax (500 ng/ml; 100 ng/ml). Cells were evaluated after 48 and 96 hours, respectively. Trypan Blue Exclusion assays were performed to determine cell viability and proliferation. Cheung, L. W., & Wong, A. S. (2008). Gonadotropin-releasing hormone: Gnrh receptor signaling in extrapituitary tissues. FEBS Journal, 275(22), 54795495. https://doi.org/10.1111/j.1742-4658.2008.06677.x Jacobson, J. D., Crofford, L. J., Sun, L., & Wilder, R. L. (1998). Cyclical expression of GnRH and GnRH receptor mrna in lymphoid organs. Neuroendocrinology, 67(1), 117125. https://doi.org/10.1159/000054306  ...

... Analysis of Herbal Extracts for Chemotherapeutic Activity on E. Coli Daniel Jung & Dr. David Strom 1Marian Results Background Antibiotic resistance has remained a topic of concern, and most current treatments prioritize preventing infections from antibiotic resistant pathogens. Hence, finding new antimicrobial compounds to suppress or rid of pathogens is still of importance. To find novel antimicrobial compounds for treating patients, herbal extracts were examined for antimicrobial properties on DH5 Escheria coli. This study focused on examining methanol extracts containing Paeonia lactiflora Pall (radix paeoniae) for its effects on E. coli. DH5 E. coli was studied due to experience working with bacteria and future plans to transform bacteria with resistance genes. University Average Absorbances at 620 nm per Indicated Percentage in Volume of Treatment Using 96-Well Plates. * Significance when compared to no treatment (indicated by 0% treatment). EtOH MeOH H2O Percentage of Treatment Absorbance SD Absorbance SD Absorbance 0.0 0.36* 0.02 2.5 0.34* 0.01 0.33* 0.01 0.36 5.0 0.30* 0.02 0.32* 0.03 0.36 7.5 0.28* 0.01 0.30* 0.02 0.37 10.0 0.19* 0.03 0.25* 0.01 0.37 SD 0.02 0.01 0.01 0.02 Effects of the solvent showed that water did not have a noticeable effect on E. coli growth whereas alcohols did have an effect. Subsequent tests with positive control (Lonicera japonica), which is known to have antimicrobial activity on e. coli, and negative control (Taraxacrum) confirmed that our methods worked in determining activity. Concentration (uL per 2 mL total volume) vs Abs Abs @ 600 nm 2 1.5 1 0.5 0 0 50 (0%) (2.5%) 100 uL Treatment Added MeOH Extract 150 (5.0%) MeOH Extract 2 (7.5%) Abs Ratio @ 600 nm 3 2.5 2 1.5 1 0.5 0 100 200 Series1 300 Time (min) Series2 400 500 600 Time (Min) vs Abs Ratio of 50 uL of Treatment w/ 20 uL E. coli 12 10 8 6 4 2 0 0 120 MeOH Extract 240 Time (min) MeOH Summary Radix paeoniae appears to have a concentration-dependent bacteriostatic inhibition of DH5 E. coli growth. Methanol extracts appear to inhibit E. coli growth more than aqueous extracts and ethanol extracts do. Current methods were examined for optimization. For instance, there was no significant difference between efficacy of methanol extracts boiled for 9 hours and 18 hours (data not presented). Future Considerations Time (min) vs Abs Ratio of Ampicilin & Tetracycline-treated cultures with 60 uL E. coli 0 Inhibition due to radix paeoniae appeared to be bacteriostatic-like since the growth curve is relatively flat compared to methanol and no treatment. MeOH Radix paeoniae extracts demonstrated a concentrationdependent inhibition. Abs Ratio @ 600 nm Methods Absorbance values of vials or wells containing each control or variable were measured using a spectrophotometer after incubation of E. coli to stationary phase. Herbs were ground for 5 to 10 minutes into easily extractable powder. 7.5 g of the herb was dissolved in 20 mL of water or alcohol (methanol or ethanol). Solutions were heated to solvent temperature (100 C for water, 65 C for methanol, and 78 C for ethanol). Solutions were filtered and stored at -20 C for short-term storage and -70 C for long-term storage (greater than two months). Specified amounts of overnight cultures of E. coli were added in triplicates at the start of the experiment. These cultures were grown for seven to eleven hours depending on the well or vial used and starting concentration of the bacteria. Difference in absorbance values of data with and without bacteria were taken before comparison with data of different concentrations. Standard difference was calculated. Significance was indicated based on p-value of 0.05. Decreased absorbance values were taken to indicate decreased populations of E. coli. 2.5 If the inhibition is bacteriostatic, the population will remain constant before eventual elimination. If it is bactericidal, the population will decrease. 360 No Treatment 480 The resulting elution from the HPLC was too dilute to test for antimicrobial effect. Thus, one part of the study will examine various large scale methods for liquid chromatography using a C18 column matrix before isolation and characterization of the efficacious compound(s). Using transformed bacteria with different resistance genes will allow us to quickly determine the mechanism by which these chemicals work. Since the time for incubation is dependent on the initial concentration of bacteria, the total volume, and the doubling time of the bacteria, the experiment set up needs to be optimized to take into account different bacteria.  ...

... ASSESSING THE PSMA-PET CT PREDICTIVE ABILITY OF EXTRAPROSTATIC EXTENSION OF PROSTATE CANCER Ismail Asad 1Department 1 BS , Nicholas of Urology, 1 Tippins , 2Department ABSTRACT Introduction and Objective: Accurate prediction of extraprostatic extension (EPE) can guide surgical treatment planning and maximize quality of life outcomes. We sought to analyze clinical and PSMAPET CT EPE predictability. Methods: Retrospective review of pre-op PSMA-PET CT and clinical parameters compared with histopathologic EPE data. Results: EPE prediction with PSMA-PET CT: sensitivity (0.78), specificity (0.79), PPV (0.61), and NPV (0.90). After including Gleason grade, the ROC curve demonstrated an AUC of 0.82. Conclusion: PSMA-PET CT has strong EPE rule-out accuracy. Gleason grade did not substantially improve predictive capacity. Isamu Tachibana of Radiology, - New advancements in PSMA-PET CT has shown diagnostic utility in the management of prostate cancer. Aim is to investigate clinical and PSMA-PET CT features that predict pathologic EPE. MATERIALS & METHODS - - - 109 patients that underwent 68Ga-PSMA-PET CT prior to robotic radical prostatectomy from 2017 to 2022 at Indiana University were reviewed based on right and left prostate. PSMA-PET variables with cutoffs (contact length>0.5cm, diameter>1.5cm) were compared with whole-mount pathological specimens to identify EPE predictability. Logistic regression models investigated a Gleason grade group threshold of >2 to further increase EPE predictability. Clinton D. Bahler MD, 3Department 1 MS , Mark A. Green Number of patients Median Age at Surgery (IQR) PSA at Surgery Number of Regions (Right and Left Prostate) Gleason Grade Group 7.4 2.1 218 96 (44%) 3 (1%) 35 (16%) 21 (18%) 25 (21%) CT features Largest Lesion Diameter >1.5 cm Curvilinear Contact Length >0.5 cm Figure 1. EPE prediction multivariate logistic models comparing 2 ROC curves - PSMA-PET CT was shown to have reasonable sensitivity and specificity (0.78; 0.79) and a strong negative predictive value (0.90). - A Gleason grade group cutoff of >2 raised the AUC from 0.81 to 0.82. - Curvilinear contact length threshold of 0.5 cm was the primary predictive variable (Sn=0.78, Sp=0.79; AUC=0.79; not shown). 52 (24%) 81 (37%) Whole Mount Pathologic EPE 63 (29%) Table 2. PSMA-PET ability to predict pathologic EPE INDIANA UNIVERSITY SCHOOL OF MEDICINE et al. - PSMA-PET CTs low false negative findings are suggestive of a strong test to rule out EPE (NPV=0.90), thereby increasing surgeon diagnostic confidence when deciding to utilize a nerve-sparing approach. - Evidence of tumor capsular contact on PSMA-PET was shown to be the strongest predictor of EPE. Largest diameter and Gleason grade group made miniscule improvements on the model. - These identified predictive variables on PSMA-PET CT may further refine treatment planning. - 39% of lesions labeled positive by the predictive model did not have pathologic EPE. - To further enhance EPE predictive modelling using PSMA-PET CT, a more precise lesion-based method may be needed. Additional clinical variables should also be explored. 109 62 (57-66) 0 1 2 3 4 PSMA-PET Extraprostatic Extension Mark A. Tann 2 MD , CONCLUSION Table 1. Patient Demographics 68Ga-PSMA-PET 2 PhD , of Pathology, Indiana University School of Medicine, Indianapolis, IN RESULTS INTRODUCTION - 1 MD , Sensitivity Specificity PPV NPV 0.78 0.79 0.61 0.90 - 49/81 (61%) of contact lesions had pathologic EPE; of those 81, excluding diameter 1.5cm and Gleason grade 2 lesions resulted in 29/40 (73%) with pathologic EPE. REFERENCES - KleinJan, G.H., Sikorska, K., Korne, C.M. et al. A prediction model relating the extent of intraoperative fascia preservation to erectile dysfunction after nervesparing robot-assisted radical prostatectomy. J Robotic Surg 13, 455462 (2019). - Moghanaki D, Turkbey B, Vapiwala N, et al: Advances in Prostate Cancer Magnetic Resonance Imaging and Positron Emission Tomography-Computed Tomography for Staging and Radiotherapy Treatment Planning. Semin Radiat Oncol. 2017 Jan;27(1):21-33. - S. Mehralivand, J.H. Shih, S. Harmon, Clayton, et al: A grading system for the Assessment of Risk of Extraprostatic Extension of Prostate Cancer at Multiparametric MRI. Radiology 2019 290:3, 709-719 DEPARTMENT OF UROLOGY  ...

... Papillary glioneuronal tumor presenting with low-pressure hydrocephalus from intraventricular spread: Case Report a BS Authors: Nicholas A Myers, Introduction: , Daniel F Marker, MD, b PhD , Kushal J Shah, c,d MD , Troy D Payner, Charles G Kulwin, c,d MD Extraordinary Care for an Extra-Ordinary Brain Tumor Papillary glioneuronal tumors (PGNTs) are rare, benign neoplasms that are typically solid or solid/cystic, well-circumscribed, parenchymal, solitary, and calcify. While intraventricular location, tumoral hemorrhage, and/or high-pressure obstructive hydrocephalus have been described, presentation with multifocal disease and normal pressure hydrocephalus (NPH)-like symptoms has not. We describe the novel presentation of a glioneuronal tumor distinctly presenting with NPH-like symptoms from intraventricular spread and the associated management. Conclusion: The unusual tumor presented with multifocal disease from presumed intraventricular spread, which has never been described, with remote disease obstructing the cerebral aqueduct. The ventricular system decompressed through the tumor, creating intraparenchymal CSF cavities and thus presenting as a lower-pressure, chronic hydrocephalus while providing surgical access for resection without deficit. This case describes the unique presentation of a multifocal intraventricular tumor and its subsequent management. Case report: Mid-50s male patient presented with unsteady gait for over a year, mild nonspecific visual changes and mild short-term memory impairment initially concerning clinically for NPH. Past medical history was significant for hyperlipidemia and solitary kidney. Neurological exam revealed a shuffling gait; the patient denied any other localizing symptoms. Brain MRI revealed a complex hemorrhagic and calcified lesion in the right atrium of the lateral ventricle, in the setting of mild, triventricular enlargement without transependymal flow, with a separate enhancing lesion at the outflow of the cerebral aqueduct. Surrounding the atrial mass were multiple large intraparenchymal cysts extending to the parietal cortex consistent with CSF (Fig. 1). Systemic workup was negative for metastatic disease. The patient underwent a transcortical resection of the intraventricular tumor through the CSF-filled parenchymal cysts. Intraoperatively the tumor appeared exophytic from the atrial choroid plexus. Histologic examination revealed a neuroepithelial neoplasm composed of atypical ganglion cells and a population of smaller neurocytic cells (Fig. 2). The tumor revealed mineralization; numerous hyalinized vessels and pseudopapillary structures. By immunohistochemistry, the gangliocytic population showed staining for neurofilament and synaptophysin, and was negative for nuclear NeuN. A subset of the gangliocytic cells expressed GFAP. The small neurocytic cell population was weakly/moderately positive for synaptophysin and displayed variable positivity for Olig2 and GFAP. The tumor cells were CD34 and TTF-1 negative. High-grade morphologic features were absent, although cytologic atypia was focally increased. The Ki67 proliferation index was less than 1%. Next-generation sequencing studies identified a classic SLC44A1::PRKCA fusion, confirming diagnosis of PGNT. The tumor failed to classify on DNA methylation array analysis using the Heidelberg central nervous system classifier v12.5; the significance of this is unknown. Initially, his NPHlike symptoms resolved, as the resection corridor acted as a ventriculostomy around the aqueductal obstruction; however, this ultimately closed off and symptoms returned. His residual hydrocephalus was subsequently managed via third ventriculostomy with resolution of gait and cognitive symptoms. c,d MD , Affiliations: Fig. 1 Preoperative MRI. Axial FLAIR and T2 (A and B) images showing CSFconsistency parenchymal cysts extending from the tumor to the subcortical region (asterisk). Contrasted T1 images (C axial and D coronal) show the atrial tumor (asterisk) and the surgical corridor through the parenchymal cysts (red arrow). Figure E shows the satellite lesion (white arrow) in the distal aqueduct causing the clinical hydrocephalic presentation. MRI: magnetic resonance imaging a) College of Osteopathic Medicine, Marian University, 3200 Cold Spring Rd, Indianapolis, IN, 46222, USA b) Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA c) Goodman Campbell Brain and Spine, Carmel, IN, USA d) Ascension St. Vincent Hospital, Indianapolis, IN, USA Fig. 2 Histologic features. (A) Low-power view of hematoxylin and eosin (H&E) stained section. The tumor was heavily fragmented and mineralized. Large areas were hypocellular and showed numerous hyalinized vessels (asterisk) while other areas were more cellular (arrow). The adjacent brain parenchyma showed reactive piloid gliosis (not shown). (B) Higher-power view. The tumor was composed of a gangliocytic component and a smaller neurocytic component. Mitotic activity was not prominent and there was no endothelial proliferation or necrosis. Cytologic atypia was focally increased (not shown). (C and D) Immunohistochemical staining for neurofilament and synaptophysin, respectively. The gangliocytic cells showed variable somal positivity for neurofilament. Synaptophysin highlights a neuropil background and was weakly to moderately positive in both the gangliocytic and smaller neurocytic components. Images from the published report in Radiology Case Reports Volume 18, Issue 10, October 2023, Pages 3632-3635  ...