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Article ; Online: Consensus-based ethical best practices for performing educational point-of-care ultrasonography in the emergency department.

Chao, Samantha K / Liu, Yiju T / Kropf, Charles W / Huang, Robert D / Theyyunni, Nik / Taylor, Lindsay A / Firn, Janice I / Kessler, Ross / Micheller, Daniel R / Battles, Alethia J / Rosculet, Natalja P / Ager, Emily E / Valentyne, Alyssa A / Schellack, Christine J / Hennessy, John P / White, Cameron / Tucker, Ryan V

AEM education and training

2024 Volume 8, Issue 2, Page(s) e10963

Abstract: Objectives: There is no standardized protocol for performing educational point-of-care ultrasonography (POCUS) that addresses patient-centered ethical issues such as obtaining informed consent. This study sought to define principles for ethical ... ...

Abstract	Objectives: There is no standardized protocol for performing educational point-of-care ultrasonography (POCUS) that addresses patient-centered ethical issues such as obtaining informed consent. This study sought to define principles for ethical application of educational POCUS and develop consensus-based best practice guidance. Methods: A questionnaire was developed by a trained ethicist after literature review with the help of a medical librarian. A diverse panel including experts in medical education, law, and bioethics; medical trainees; and individuals with no medical background was convened. The panel voted on their level of agreement with ethical principles and degree of appropriateness of behaviors in three rounds of a modified Delphi process. A high level of agreement was defined as 80% or greater consensus. Results: Panelists voted on 38 total items: 15 related to the patient consent and selection process, eight related to practices while performing educational POCUS, and 15 scenarios involving POCUS application. A high level of agreement was achieved for 13 items related to patient consent and selection, eight items related to performance practices, and 10 scenarios of POCUS application. Conclusions: Based on expert consensus, ethical best practices include obtaining informed consent before performing educational POCUS, allowing patients to decline educational POCUS, informing patients the examination is not intended to be a part of their medical evaluation and is not billed, using appropriate draping techniques, maintaining a professional environment, and disclosing incidental findings in coordination with the primary team caring for the patient. These practices could be implemented at institutions to encourage ethical use of educational POCUS when training physicians, fellows, residents, and medical students.
Language	English
Publishing date	2024-03-21
Publishing country	United States
Document type	Journal Article
ISSN	2472-5390
ISSN (online)	2472-5390
DOI	10.1002/aet2.10963
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Article ; Online: Segmental arterial mediolysis.

Chao, Christine P

Seminars in interventional radiology

2011 Volume 26, Issue 3, Page(s) 224–232

Abstract: Segmental arterial mediolysis (SAM) is a nonatherosclerotic, noninflammatory arteriopathy, which is characterized by dissecting aneurysms resulting from lysis of the outer media of the arterial wall. The most common presentation is abdominal pain and ... ...

Abstract	Segmental arterial mediolysis (SAM) is a nonatherosclerotic, noninflammatory arteriopathy, which is characterized by dissecting aneurysms resulting from lysis of the outer media of the arterial wall. The most common presentation is abdominal pain and hemorrhage in the elderly. Computed tomography (CT) and angiography imaging findings overlap with various vasculitides and include segmental changes of aneurysm and stenosis. A key distinguishing feature is the presence of dissections, the principle morphologic expression of SAM. Differentiation and exclusion of an inflammatory arteritis is crucial in appropriate management, as immunosuppressants generally used for treatment of vasculitis may be ineffective or even worsen the vasculopathy. Although the disease can be self-limiting without treatment or with conservative medical therapy, the acute process carries a 50% mortality rate and may necessitate urgent surgical and/or endovascular therapy. Prompt recognition and diagnosis are therefore of utmost importance in appropriate management of this rare entity.
Language	English
Publishing date	2011-02-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	848341-3
ISSN	1098-8963 ; 0739-9529
ISSN (online)	1098-8963
ISSN	0739-9529
DOI	10.1055/s-0029-1225666
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Article ; Online: Targeted MDM2 Degradation Reveals a New Vulnerability for p53-Inactivated Triple-Negative Breast Cancer.

Adams, Clare M / Mitra, Ramkrishna / Xiao, Youcai / Michener, Peter / Palazzo, Juan / Chao, Allen / Gour, Jitendra / Cassel, Joel / Salvino, Joseph M / Eischen, Christine M

Cancer discovery

2023 Volume 13, Issue 5, Page(s) 1210–1229

Abstract: ... See related commentary by Peuget and Selivanova, p. 1043. This article is highlighted ... in the In This Issue feature, p. 1027. ...

Abstract	Triple-negative breast cancers (TNBC) frequently inactivate p53, increasing their aggressiveness and therapy resistance. We identified an unexpected protein vulnerability in p53-inactivated TNBC and designed a new PROteolysis TArgeting Chimera (PROTAC) to target it. Our PROTAC selectively targets MDM2 for proteasome-mediated degradation with high-affinity binding and VHL recruitment. MDM2 loss in p53 mutant/deleted TNBC cells in two-dimensional/three-dimensional culture and TNBC patient explants, including relapsed tumors, causes apoptosis while sparing normal cells. Our MDM2-PROTAC is stable in vivo, and treatment of TNBC xenograft-bearing mice demonstrates tumor on-target efficacy with no toxicity to normal cells, significantly extending survival. Transcriptomic analyses revealed upregulation of p53 family target genes. Investigations showed activation and a required role for TAp73 to mediate MDM2-PROTAC-induced apoptosis. Our data, challenging the current MDM2/p53 paradigm, show MDM2 is required for p53-inactivated TNBC cell survival, and PROTAC-targeted MDM2 degradation is an innovative potential therapeutic strategy for TNBC and superior to existing MDM2 inhibitors. Significance: p53-inactivated TNBC is an aggressive, therapy-resistant, and lethal breast cancer subtype. We designed a new compound targeting an unexpected vulnerability we identified in TNBC. Our MDM2-targeted degrader kills p53-inactivated TNBC cells, highlighting the requirement for MDM2 in TNBC cell survival and as a new therapeutic target for this disease. See related commentary by Peuget and Selivanova, p. 1043. This article is highlighted in the In This Issue feature, p. 1027.
MeSH term(s)	Humans ; Animals ; Mice ; Cell Line, Tumor ; Proto-Oncogene Proteins c-mdm2/genetics ; Proto-Oncogene Proteins c-mdm2/metabolism ; Tumor Suppressor Protein p53/genetics ; Tumor Suppressor Protein p53/metabolism ; Triple Negative Breast Neoplasms/drug therapy ; Triple Negative Breast Neoplasms/physiopathology ; Antineoplastic Agents/chemistry ; Antineoplastic Agents/pharmacology ; Antineoplastic Agents/therapeutic use ; Proteolysis Targeting Chimera/chemistry ; Proteolysis Targeting Chimera/pharmacology ; Proteolysis Targeting Chimera/therapeutic use ; Up-Regulation/drug effects ; Survival Analysis ; Apoptosis/drug effects ; Tumor Protein p73/metabolism ; Heterografts ; Proteolysis/drug effects ; Female
Chemical Substances	Proto-Oncogene Proteins c-mdm2 (EC 2.3.2.27) ; Tumor Suppressor Protein p53 ; Antineoplastic Agents ; Proteolysis Targeting Chimera ; Tumor Protein p73
Language	English
Publishing date	2023-01-27
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	2625242-9
ISSN	2159-8290 ; 2159-8274
ISSN (online)	2159-8290
ISSN	2159-8274
DOI	10.1158/2159-8290.CD-22-1131
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Article ; Online: Hypothalamic astrocytes control systemic glucose metabolism and energy balance.

Herrera Moro Chao, Daniela / Kirchner, Matthew K / Pham, Cuong / Foppen, Ewout / Denis, Raphael G P / Castel, Julien / Morel, Chloe / Montalban, Enrica / Hassouna, Rim / Bui, Linh-Chi / Renault, Justine / Mouffle, Christine / García-Cáceres, Cristina / Tschöp, Matthias H / Li, Dongdong / Martin, Claire / Stern, Javier E / Luquet, Serge H

Cell metabolism

2023 Volume 34, Issue 10, Page(s) 1532–1547.e6

Abstract: The hypothalamus is key in the control of energy balance. However, strategies targeting hypothalamic neurons have failed to provide viable options to treat most metabolic diseases. Conversely, the role of astrocytes in systemic metabolic control has ... ...

Abstract	The hypothalamus is key in the control of energy balance. However, strategies targeting hypothalamic neurons have failed to provide viable options to treat most metabolic diseases. Conversely, the role of astrocytes in systemic metabolic control has remained largely unexplored. Here, we show that obesity promotes anatomically restricted remodeling of hypothalamic astrocyte activity. In the paraventricular nucleus (PVN) of the hypothalamus, chemogenetic manipulation of astrocytes results in bidirectional control of neighboring neuron activity, autonomic outflow, glucose metabolism, and energy balance. This process recruits a mechanism involving the astrocytic control of ambient glutamate levels, which becomes defective in obesity. Positive or negative chemogenetic manipulation of PVN astrocyte Ca
MeSH term(s)	Animals ; Astrocytes/metabolism ; Energy Metabolism/physiology ; Glucose/metabolism ; Glutamic Acid/metabolism ; Hypothalamus/metabolism ; Mice ; Obesity/metabolism ; Paraventricular Hypothalamic Nucleus/metabolism
Chemical Substances	Glutamic Acid (3KX376GY7L) ; Glucose (IY9XDZ35W2)
Language	English
Publishing date	2023-01-31
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2176834-1
ISSN	1932-7420 ; 1550-4131
ISSN (online)	1932-7420
ISSN	1550-4131
DOI	10.1016/j.cmet.2022.09.002
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Article ; Online: N

Cisar, Justin S / Pietsch, Christine / DeRatt, Lindsey G / Jacoby, Edgar / Kazmi, Faraz / Keohane, Colleen / Legenski, Katie / Matico, Rosalie / Shaffer, Paul / Simonnet, Yvan / Tanner, Alexandra / Wang, Chao-Yuan / Wang, Weixue / Attar, Ricardo / Edwards, James P / Kuduk, Scott D

Journal of medicinal chemistry

2022 Volume 65, Issue 16, Page(s) 11241–11256

Abstract: Acute myelogenous leukemia (AML), a disease of the blood and bone marrow, is characterized by the inability of myeloblasts to differentiate into mature cell types. Dihydroorotate dehydrogenase (DHODH) is an enzyme well-known in the pyrimidine ... ...

Abstract	Acute myelogenous leukemia (AML), a disease of the blood and bone marrow, is characterized by the inability of myeloblasts to differentiate into mature cell types. Dihydroorotate dehydrogenase (DHODH) is an enzyme well-known in the pyrimidine biosynthesis pathway; however, small molecule DHODH inhibitors were recently shown to induce differentiation in multiple AML subtypes. Using virtual screening and structure-based drug design approaches, a new series of N-heterocyclic 3-pyridyl carboxamide DHODH inhibitors were discovered. Two lead compounds,
MeSH term(s)	Dihydroorotate Dehydrogenase/antagonists & inhibitors ; Drug Design ; Enzyme Inhibitors/chemistry ; Enzyme Inhibitors/pharmacology ; Enzyme Inhibitors/therapeutic use ; Humans ; Leukemia, Myeloid, Acute/drug therapy
Chemical Substances	Dihydroorotate Dehydrogenase ; Enzyme Inhibitors
Language	English
Publishing date	2022-08-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	218133-2
ISSN	1520-4804 ; 0022-2623
ISSN (online)	1520-4804
ISSN	0022-2623
DOI	10.1021/acs.jmedchem.2c00788
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Article: Segmental Arterial Mediolysis

Chao, Christine P

Seminars in Interventional Radiology

2009 Volume 26, Issue 03, Page(s) 224–232

Abstract	Segmental arterial mediolysis (SAM) is a nonatherosclerotic, noninflammatory arteriopathy, which is characterized by dissecting aneurysms resulting from lysis of the outer media of the arterial wall. The most common presentation is abdominal pain and hemorrhage in the elderly. Computed tomography (CT) and angiography imaging findings overlap with various vasculitides and include segmental changes of aneurysm and stenosis. A key distinguishing feature is the presence of dissections, the principle morphologic expression of SAM. Differentiation and exclusion of an inflammatory arteritis is crucial in appropriate management, as immunosuppressants generally used for treatment of vasculitis may be ineffective or even worsen the vasculopathy. Although the disease can be self-limiting without treatment or with conservative medical therapy, the acute process carries a 50% mortality rate and may necessitate urgent surgical and/or endovascular therapy. Prompt recognition and diagnosis are therefore of utmost importance in appropriate management of this rare entity.
Keywords	Segmental arterial mediolysis ; imaging findings
Language	English
Publishing date	2009-08-12
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	848341-3
ISSN	1098-8963 ; 0739-9529
ISSN (online)	1098-8963
ISSN	0739-9529
DOI	10.1055/s-0029-1225666
Database	Thieme publisher's database

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Article ; Online: Evaluation of Risk Scores to Predict Pediatric Severe Asthma Exacerbations.

Niu, Chao / Xu, Yuanfang / Schuler, Christine L / Gu, Lijuan / Arora, Kavisha / Huang, Yunjie / Naren, Anjaparavanda P / Durrani, Sandy R / Hossain, Md M / Guilbert, Theresa W

The journal of allergy and clinical immunology. In practice

2021 Volume 9, Issue 12, Page(s) 4393–4401.e8

Abstract: Background: Asthma exacerbations commonly lead to unplanned health care utilization and are costly. Early identification of children at increased risk of asthma exacerbations would allow a proactive management approach.: Objective: We evaluated ... ...

Abstract	Background: Asthma exacerbations commonly lead to unplanned health care utilization and are costly. Early identification of children at increased risk of asthma exacerbations would allow a proactive management approach. Objective: We evaluated common asthma risk factors to predict the probability of exacerbation for individual children aged 0-21 years using data from the electronic medical record (EMR). Methods: We analyzed longitudinal EMR data for over 3000 participants with asthma seen at Cincinnati Children's Hospital Medical Center over a 7-year period. The study population was divided into 3 age groups: 0-4, 5-11, and 12-21 years. Each age group was divided into a derivation cohort and a validation cohort, which were used to build a risk score model. We predicted risk of exacerbation in the next 12 months, validated the scores by risk stratum, and developed a clinical tool to determine the risk level based on this model. Results: Risk model results were confirmed with validation cohorts by calendar year and age groups. Race, allergic sensitization, and smoke exposure were each important risk factors in the 0-4 age group. Abnormal spirometry and obesity were more sensitive predictors of exacerbation in children >12 years. For each age group, a higher expanded score was associated with a higher predicted probability of an asthma exacerbation in the subsequent year. Conclusion: This asthma exacerbation prediction model, and the associated clinical tool, may assist clinicians in identifying children at high risk for exacerbation that may benefit from more aggressive management and targeted risk mitigation.
MeSH term(s)	Asthma/diagnosis ; Asthma/epidemiology ; Child ; Cohort Studies ; Disease Progression ; Humans ; Infant, Newborn ; Risk Assessment ; Risk Factors ; Spirometry
Language	English
Publishing date	2021-09-08
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2843237-X
ISSN	2213-2201 ; 2213-2198
ISSN (online)	2213-2201
ISSN	2213-2198
DOI	10.1016/j.jaip.2021.08.030
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Article ; Online: A Methodology for Remote Microwave Sterilization Applicable to the Coronavirus and Other Pathogens Using Retrodirective Antenna Arrays.

Kossenas, Konstantinos / Podilchak, Symon K / Comite, Davide / Re, Pascual D Hilario / Goussetis, George / Pavuluri, Sumanth K / Griffiths, Samantha J / Chadwick, Robert J / Guo, Chao / Bruns, Nico / Tait-Burkard, Christine / Haas, Jurgen G / Desmulliez, Marc P Y

IEEE journal of electromagnetics, RF and microwaves in medicine and biology

2021 Volume 6, Issue 1, Page(s) 41–51

Abstract: This paper describes an innovative remote surface sterilization approach applicable to the new coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The process is based on the application of a liquid film on the surface or object ... ...

Abstract	This paper describes an innovative remote surface sterilization approach applicable to the new coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The process is based on the application of a liquid film on the surface or object under sterilization (OUS). A beacon signal is used to self-steer the transmitted power from the designed retrodirective antenna array (RDA) towards the OUS using circularly polarized fields; then, the sterilization is completed by raising and maintaining the required temperature for a certain time. Results suggest that the process takes 5 minutes or less for an angular coverage range over 60 degrees whilst abiding by the relevant safety protocols. This paper also models the power incident onto the OUS, providing consistent results with full-wave simulations. A practical RDA system is developed using a 2 × 1 microstrip patch array operating at 2.5 GHz and tested through the positioning of a representative target surface. Measurements, developed by sampling the power transmitted by the heterodyne RDA, are reported for various distances and angles, operating in the near-field of the system. To further validate the methodology, an additional experiment investigating virus deactivation through microwave heating was also developed. Measurements have been performed with an open cavity microwave oven on the Coronavirus (strain 229E) and egg white protein in a cuvette. This demonstrates that the temperature increases of aqueous films up to 70 [Formula: see text]C by remote microwave-induced heat can denature proteins and deactivate viruses. Possible applications of the method include sterilization of ambulances, medical equipment, and internet of things (IoT) devices.
Language	English
Publishing date	2021-05-03
Publishing country	United States
Document type	Journal Article
ISSN	2469-7257
ISSN (online)	2469-7257
DOI	10.1109/JERM.2021.3077110
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Article ; Online: The Sensitivity of Limited-Sequence MRI in Identifying Pediatric Cervical Spine Injury: A Western Pediatric Surgery Research Consortium Multicenter Retrospective Cohort Study.

Melhado, Caroline / Durand, Rachelle / Russell, Katie W / Polukoff, Natalya E / Rampton, John / Iyer, Rajiv R / Acker, Shannon N / Koehler, Richele / Prendergast, Connor / Stence, Nicholas / O'Neill, Brent / Padilla, Benjamin E / Jamshidi, Ramin / Vaughn, Jennifer A / Ronecker, Jennifer S / Selesner, Leigh / Lofberg, Katrine / Regner, Michael / Thiessen, Jaclyn /

The journal of trauma and acute care surgery

2024

Abstract: Introduction: Clinical clearance of a child's cervical spine after trauma is often challenging due to impaired mental status or an unreliable neurologic examination. Magnetic resonance imaging (MRI) is the gold standard for excluding ligamentous injury ... ...

Abstract	Introduction: Clinical clearance of a child's cervical spine after trauma is often challenging due to impaired mental status or an unreliable neurologic examination. Magnetic resonance imaging (MRI) is the gold standard for excluding ligamentous injury in children but is constrained by long image acquisition times and frequent need for anesthesia. Limited-sequence MRI (LSMRI) is used in evaluating the evolution of traumatic brain injury and may also be useful for cervical spine clearance while potentially avoiding the need for anesthesia. The purpose of this study was to assess the sensitivity and negative predictive value of LSMRI as compared to gold standard full-sequence MRI as a screening tool to rule out clinically significant ligamentous cervical spine injury. Methods: We conducted a ten-center, five-year retrospective cohort study (2017-2021) of all children (0-18y) with a cervical spine MRI after blunt trauma. MRI images were re-reviewed by a study pediatric radiologist at each site to determine if the presence of an injury could be identified on limited sequences alone. Unstable cervical spine injury was determined by study neurosurgeon review at each site. Results: We identified 2,663 children less than 18 years of age who underwent an MRI of the cervical spine with 1,008 injuries detected on full-sequence studies. The sensitivity and negative predictive value of LSMRI were both >99% for detecting any injury and 100% for detecting any unstable injury. Young children (age < 5 years) were more likely to be electively intubated or sedated for cervical spine MRI. Conclusion: LSMRI is reliably detects clinically significant ligamentous injury in children after blunt trauma. To decrease anesthesia use and minimize MRI time, trauma centers should develop LSMRI screening protocols for children without a reliable neurologic exam. Level of evidence: 2 (Diagnostic Tests or Criteria).
Language	English
Publishing date	2024-03-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	2651070-4
ISSN	2163-0763 ; 2163-0755
ISSN (online)	2163-0763
ISSN	2163-0755
DOI	10.1097/TA.0000000000004271
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Article ; Online: Endoscopic mucosal incision and muscle interruption (MIMI) for the treatment of Zenker's diverticulum.

Klingler, Michael J / Landreneau, Joshua P / Strong, Andrew T / Barajas-Gamboa, Juan S / Tat, Christine / Tu, Chao / Fathalizadeh, Alisan / Kroh, Matthew / Rodriguez, John / Sanaka, Madhusudhan R / Ponsky, Jeffrey

Surgical endoscopy

2020 Volume 35, Issue 7, Page(s) 3896–3904

Abstract: ... cm in the non-tunneled group (p = 0.03). Clinical success was achieved in 17/19(89.5%) MIMI patients ... and 7/7(100%) of non-tunneled flexible endoscopic patients (p = 0.101). Dysphagia scores improved ... in both groups, although this difference was only significant in the MIMI group (p ≤ 0.001). Recurrence occurred ...

Abstract	Background: In peroral endoscopic myotomy for Zenker's diverticulum (Z-POEM), the cricopharyngeus muscle is divided within a submucosal tunnel started in the hypopharynx. We aimed to evaluate the safety and preliminary outcomes in patients who underwent a modified version of the Z-POEM where the tunnel is made directly overlying the cricopharyngeus, the mucosal incision and muscular interruption (MIMI) approach, and to compare these with patients who underwent a non-tunneled flexible endoscopic approach. Methods: All patients with ZD who were treated by flexible endoscopy at our institution between January 2015 and February 2020 were identified by a retrospective chart review. Dysphagia symptoms were assessed using a validated scoring system. Results: Nineteen patients with ZD underwent MIMI (mean age 76.1 years, 68.1% male) and seven patients underwent non-tunneled flexible endoscopic approach (mean age 64.4 years, 85.7% male) during the study period. Mean ZD size was 2.8 cm in the MIMI group and 1.9 cm in the non-tunneled group (p = 0.03). Clinical success was achieved in 17/19(89.5%) MIMI patients and 7/7(100%) of non-tunneled flexible endoscopic patients (p = 0.101). Dysphagia scores improved in both groups, although this difference was only significant in the MIMI group (p ≤ 0.001). Recurrence occurred in 2/17(11.7%) MIMI patients and 3/7(42.9%) non-tunneled flexible endoscopic patients (p = 0.096). There were 4 complications, including one pharyngeal perforation requiring open surgical repair in a patient with a small ZD with an associated cricopharyngeal bar in the MIMI group. Median length of follow-up was 290 [142; 465] days in the MIMI group and 1056 [258; 1206] days in the non-tunneled group (p = 0.094). Conclusions: MIMI is a technically feasible and effective treatment for ZD. Care should be taken in patients with a cricopharyngeal bar and small ZD, as this may increase the risk of perforation. Larger studies with long-term follow-up are needed to determine if MIMI reduces the risk of symptom recurrence when compared to non-tunneled flexible endoscopic approaches.
MeSH term(s)	Aged ; Deglutition Disorders/etiology ; Endoscopy ; Esophagoscopy ; Female ; Humans ; Male ; Middle Aged ; Muscles ; Retrospective Studies ; Treatment Outcome ; Zenker Diverticulum/surgery
Keywords	covid19
Language	English
Publishing date	2020-08-06
Publishing country	Germany
Document type	Journal Article
ZDB-ID	639039-0
ISSN	1432-2218 ; 0930-2794
ISSN (online)	1432-2218
ISSN	0930-2794
DOI	10.1007/s00464-020-07861-5
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