Texas Medical School Research Articles

Predoctoral US dental school applicants and first-time, first-year enrollees, 2023 Entering Class.

This article aims to provide an overview of the characteristics of applicants and first-time, first-year enrolled predoctoral oral health students in the 2023 Entering Class, while highlighting trends over the past decade. The study employs a descriptive analysis of predoctoral US dental school application data sourced from the ADEA Associated American Dental Schools Application Service (ADEA AADSAS®) and Texas Medical and Dental Schools Application Services (TMDSAS) portals. Between 2013 and 2023, the number of first-time, first-year enrollees increased by 14%. Applicant numbers rebounded post-COVID pandemic and were 0.5% higher in 2023 compared to 2019. The proportion of female predoctoral applicants and first-time, first-year enrollees each increased by 11 percentage points over the last decade. Racial and ethnic diversity among first-time, first-year enrollees improved, particularly among Hispanic or Latino and Black or African American students, with both groups increasing by 51% between 2013 and 2023. There has been a steady increase in first-time, first-year enrollees, reflecting growth in the number of US-trained predoctoral oral health professionals. Applicant numbers have rebounded from the impact of COVID-19 pandemic. The increase in the share of female dental school applicants and first-time, first-year enrollees has brought the gender distribution in predoctoral oral health programs more closely in line with that of postsecondary education. While progress has been made in terms of increased representation of historically underrepresented racial and ethnic (HURE) groups, much work remains to achieve greater representation.

On ‘Evidence for the participation of cytochrome b5 in hepatic microsomal mixed-function oxidation reactions’ by Alfred Hildebrandt and Ronald W. Estabrook

This paper by Alfred G. Hildebrandt and Ronald W. Estabrook at the University of Texas (Southwestern) Medical School, led to the concept of cytochrome b5 (b5) as an auxiliary protein facilitating some cytochrome P450 (P450) reactions in the liver and other tissues. The gist of the paper is that DPNH (now known as NADH) enhanced rates of TPNH (now NADPH)-supported N-demethylation of O-ethylmorphine in rat liver microsomes. The conclusion was that b5 was providing an electron to the ferrous-oxy form of P450 (Fe2+O2), which was supported by some spectral observations on the oxidation state of b5 in the microsomes in the steady state. This observation led to a flurry of activity, which is still in progress. This paper has been cited 678 times in Google (558 in Clarivate), and I have often cited it myself. A PubMed search for the terms P450 andb5 yielded 2244 results.

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A Foot Soldier in Cardiac Metabolism: A Conversation With Heinrich Taegtmeyer, MD, DPhil.

A Foot Soldier in Cardiac Metabolism: A Conversation With Heinrich Taegtmeyer, MD, DPhil.

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Successful treatment with infliximab after adalimumab failure in pediatric noninfectious uveitis

To describe the use of infliximab after adalimumab failure in the treatment of pediatric noninfectious uveitis. A retrospective analysis was performed on the medical records of pediatric patients with noninfectious uveitis treated with infliximab for a minimum of 6months after previously failing to achieve steroid-free remission using adalimumab at the University of Texas Medical School and Children's Medical Center between September 2015 and March 2018. Rates of achieving disease activity quiescence and steroid-free remission as well as incidence of adverse events were calculated. A total of 13 patients with noninfectious uveitis refractory to treatment with adalimumab met inclusion criteria. Three (23%) had anterior uveitis, 4 (31%) had pars planitis, and 6 (46%) had panuveitis. Eleven (85%) patients had preexisting ocular comorbidities. Of these, 4 (31%) had retinal vasculitis, and 1 (7.7%) had cystoid macular edema. There was a 100% response rate to treatment with infliximab following failure to achieve disease quiescence on adalimumab. At mean follow-up time of 21months (range, 8-31) from initiation of infliximab, there was a reduction in steroid dependence from 100% to 15% after transitioning from adalimumab to infliximab (P<0.001). Nine patients (69%) had achieved steroid-free remission on infliximab therapy. The mean time to steroid-free remission was 8.7months. In our study cohort, infliximab was used successfully in all cases of recalcitrant pediatric noninfectious uveitis that previously failed adalimumab therapy.

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I’m Dr. Red Duke by Bryant Boutwell

Reviewed by: I’m Dr. Red Duke by Bryant Boutwell Megan Seaholm I’m Dr. Red Duke. By Bryant Boutwell. (College Station: Texas A&M University Press, 2018. Pp. 284. Photographs, notes, sources, index.) Bryant Boutwell has written an engaging biography of Texas surgeon Dr. Red Duke, a “one-of-a kind made-in-Texas original . . . the Marlboro Man, Albert Schweitzer, and Teddy Roosevelt all in one” (1). His life story is an account of dedication to service, ambition, and adventure that yielded a stunning list of awards. Boutwell provides a list of Duke’s accomplishments in his introduction. Among these are medical missionary to Afghanistan; creator of Memorial Hermann Life Flight, the first air ambulance service in Texas; conservationist; Alaska hunting guide; army [End Page 132] tank commander; and a television personality whose health reports were syndicated worldwide (2). Boutwell organizes his biography around episodes in Duke’s life. Along the way, he provides fascinating histories of developments in trauma medicine and the institutional histories of two of Texas’s finest medical centers, University of Texas Southwestern in Dallas and the University of Texas Medical School in Houston. Boutwell’s publication is the only book-length biography about Duke. Born in 1928 in the small railroad town of Ennis to James Henry Duke and Helen Donegan Duke, devout Baptists, he soon became known as “Red” because of his thick red hair. He spoke with a thick Texas drawl, and his speech was peppered with folksy expressions like “happy as a pig in slop” (101). In 1953, Duke matriculated at the new and growing Southwestern Medical School in Dallas and specialized in surgery. In 1963, he and a fellow resident attended to Texas Governor John Connally, who had been shot in the chest during the assassination of President John F. Kennedy in Dallas and rushed to Parkland Hospital. After serving on the Southwestern faculty, Duke moved to New York City to contribute to research in the Surgical Metabolism Unit at the Columbia University Medical Center. Two years later, he, his wife, and their four children moved to Afghanistan to serve on the faculty of a new medical school. His next and final move was back to Texas, where he joined the inaugural faculty of the University of Texas Medical School at Houston; he served there from 1972 until his death, at age 86, in 2015. Boutwell describes Duke as an inspirational teacher and role model for thousands of medical students, constantly reminding them that the patient was always the most important person in the room. He is remembered by many for his eighteen years presenting the televised program Texas Health Reports, which began as a production of the University of Texas. His signature closing was “from the University of Texas Health Science Center at Houston, I’m Dr. Red Duke” (180). Boutwell is thorough, drawing on more than thirty interviews with Duke and his colleagues, friends, and family as well as diaries, letters and the public record. At times Boutwell’s detail felt a bit tedious, but it is descriptive of Duke’s character. For example, we learn that Red Duke went to seminary to please his father. His time with his wife and family must have been limited, but they were there for him at the end. They all gathered around his hospital bed, saying the Lord’s Prayer. Red provided a final “Amen” (238) before he died. [End Page 133] Megan Seaholm University of Texas at Austin Copyright © 2019 The Texas State Historical Association

In Memoriam: Robert J. Hall, MD (1926–2018)

In Memoriam: Robert J. Hall, MD (1926–2018)

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Invited Commentary: An Interventionist's Guide to Venous Sampling in Endocrinopathies.

HomeRadioGraphicsVol. 37, No. 4 PreviousNext Vascular/Interventional RadiologyInvited Commentary: An Interventionist’s Guide to Venous Sampling in EndocrinopathiesAnil K. Pillai, Alan CohenAnil K. Pillai, Alan CohenAuthor AffiliationsDepartment of Diagnostic and Interventional Imaging, University of Texas Medical School at Houston Houston, TexasAnil K. PillaiAlan CohenPublished Online:Jul 11 2017https://doi.org/10.1148/rg.2017170068MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In

Understanding phospholipid function: Why are there so many lipids?

In the 1970s, phospholipids were still considered mere building blocks of the membrane lipid bilayer, but the subsequent realization that phospholipids could also serve as second messengers brought new interest to the field. My own passion for the unique amphipathic properties of lipids led me to seek other, non-signaling functions for phospholipids, particularly in their interactions with membrane proteins. This seemed to be the last frontier in protein chemistry and enzymology to be conquered. I was fortunate to find my way to Eugene Kennedy's laboratory, where both membrane proteins and phospholipids were the foci of study, thus providing a jumping-off point for advancing our fundamental understanding of lipid synthesis, membrane protein biosynthesis, phospholipid and membrane protein trafficking, and the cellular roles of phospholipids. After purifying and characterizing enzymes of phospholipid biosynthesis in Escherichia coli and cloning of several of the genes encoding these enzymes in E. coli and Saccharomyces cerevisiae, I was in a position to alter phospholipid composition in a systematic manner during the cell cycle in these microorganisms. My group was able to establish, contrary to common assumption (derived from the fact that membrane proteins retain activity in detergent extracts) that phospholipid environment is a strong determining factor in the function of membrane proteins. We showed that molecular genetic alterations in membrane lipid composition result in many phenotypes, and uncovered direct lipid-protein interactions that govern dynamic structural and functional properties of membrane proteins. Here I present my personal "reflections" on how our understanding of phospholipid functions has evolved.

Family Language Barriers and Special-Needs Children.

* Abbreviations: CSHCN — : children with special health care needs ED — : emergency department LEP — : limited English proficiency NEPL — : non-English primary language RCT — : randomized controlled trial Approximately 63 million Americans speak a language other than English at home, and more than 26 million have limited English proficiency (LEP, defined as a self-reported ability to speak English less than very well).1,2 Approximately 12 million school-age children (22%) speak a language other than English at home, a number that has tripled since 1979.2 In the city of Houston, at least 145 languages are spoken at home.3 The marked growth in non–English primary language (NEPL) and LEP families is attributable to the rapid increase in America of the foreign-born population, which grew from 9.6 million in 1970 to 41.3 million in 2013.1,2 Numerous studies document that language barriers affect multiple aspects of health care, including access, health status, use of services, patient-physician communication, satisfaction with care, participation in clinical research, quality, and patient safety.1,2,4–7 The number of children with special health care needs (CSHCN) also has increased substantially. Approximately 16% of children in the United States (18 million) are CSHCN, and the number of CSHCN quadrupled between 1962 and 2005.8 CSHCN comprise almost two-thirds of pediatric hospitalizations, have longer mean hospital lengths of stay, and account for 90% of medical deaths among US children.8 These 2 demographic surges are colliding in America, as 13% of CSHCN reside in NEPL homes. Both populations are at high risk for adverse outcomes and compromised quality … Address correspondence to Ricardo A. Mosquera, MD, University of Texas Medical School at Houston, 6410 Fannin, Ste 510, Houston, TX. E-mail: ricardo.a.mosquera{at}uth.tmc.edu

Lessons learned in andrology: standing on the shoulders of giants.

Lessons learned in andrology: standing on the shoulders of giants.

Preclinical study evaluating a novel trocar site closure system

Preclinical study evaluating a novel trocar site closure system Peter A Walker,1 Shinil K Shah,1,2 Erik B Wilson11Department of Surgery, University of Texas Medical School at Houston, Houston, TX, USA; 2Michael E DeBakey Institute for Comparative Cardiovascular Science and Biomedical Devices, Texas A&amp;M University, College Station, TX, USAIntroduction: Novel trocar closure devices using subperitoneal anchor placement avoid the need for a closed loop suture, and could allow faster trocar site closure with less risk derived from less instrument penetration into the abdominal cavity while decreasing fascial ischemia and tension. We completed a series of animal experiments to compare the Carter-Thomason&reg; suture closure device and neoClose&reg; AnchorGuide device in order to evaluate device safety, efficacy, and ease of utilization.Methods: A porcine model was utilized where 12 mm port sites were closed with either the Carter-Thomason&reg; device or neoClose&reg; AnchorGuide device. Animals were sacrificed at 14 and 56 days after trocar site closure followed by macroscopic and microscopic wound examination. A second group of animals underwent video analysis to evaluate the time required for fascial closure as well as depth of needle passage into the abdomen.Results: All animals survived to the endpoints (14 and 56 days) without mortality or trocar site hernia. A trend towards decreased closure times was identified when using the neoClose&reg; device (t=18.5&plusmn;2.3 seconds) compared to closure with the Carter-Thomason&reg; device (t=32.0&plusmn;8.9 seconds) (P=0.153). A significant decrease in the depth of needle penetration was seen with the neoClose&reg; device (t=31.22&plusmn;1.45 mm) compared to closure with the Carter-Thomason device (t=51.0&plusmn;3.1 mm) (P&lt;0.001). Microscopic analysis showed subperitoneal anchor location at 56 days with minimal fibrosis (neoClose&reg; device) compared to nearly complete suture degradation with deep intramuscular location (Carter-Thomason device).Conclusion: Novel trocar closure devices could offer decreased deployment times while improving closure safety. Initial animal studies have shown that the neoClose&reg; device yields a durable fascial closure that is easy to adopt from a technical standpoint.Keywords: trocal closure, laparoscopy, trocar hernia, closure device

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Effect of Young�s modulus on neural differentiation of human induced pluripotent stem cell derived neural stem cells.

Event Abstract Back to Event Effect of Young’s modulus on neural differentiation of human induced pluripotent stem cell derived neural stem cells. Matthew C. Mosley1, 2, Hyun Ju Lim1, 2, Jing Chen1, 2, Shenglan Li1, 2, Ying Liu1, 2 and Laura Smith Callahan1, 2, 3 1 University of Texas Medical School at Houston, Neurosurgery, United States 2 University of Texas Health Science Center at Houston, Center for Stem Cells & Regenerative Medicine, United States 3 University of Texas Medical School at Houston, Nanomedicine & Biomedical Engineering, United States Introduction: The Young’s modulus of culture substrates has been shown to have a significant effect on the lineage choice and differentiation state of stem cells[1],[2]. Typically, these studies have examined a mechanical range over several orders of magnitude using discrete samples to identify optimal mechanical regions for the differentiation of specific lineages. However, a more detailed examination of the region of interest for a specific lineage, such as neurons, could further improve the optimization of biomaterial mechanics for specific applications. In this study the optimal range for neural differentiation of human induced pluripotent stem cell (hiPSC) derived neural stem cells (NSC) will be examined using poly ethylene glycol dimethacrylate (PEGDM) hydrogels containing a continuous gradient in Young’s Modulus. Material and Methods: 50 mm × 10 mm × 1 mm hydrogel gradients were fabricated by dispensing 10% and 55% 10 kDa PEGDM solutions containing 0.1% Matrigel through two syringe pumps running in inverse linear ramping profiles ranging from 0 mL/h to 52 mL/h, respectively, over 75s into a custom mold, followed by photopolymerization with 2.3 mJ/cm2 for 7 min. After swelling in PBS, one 9.6-mm disc was punched out every 10 mm along each gradient. Discs were then evaluated for swelling ratio, mesh size and mechanical properties. For cellular experiments, the discs were placed in the wells of 48-well plates, seeded with ND2.0 hiPSC derived NCS and cultured with serum-free neural differentiation media for 14 days with medium exchanges every other day. Cell-seeded constructs were stained for neuron-specific β3-tubulin (TUJ1) and length of neurite extension was measured. Cultured cells on constructs were harvested for analyses of gene expression. Statistical significance was determined using one-way or two-way ANOVA in conjunction with the paired t-test with a p-value of < 0.05. Results and Discussion: The Young’s modulus of gradient samples ranged from 0.5 kPA to 3.5 kPA. Gene expression of TUJ1 (immature neuron marker) in cells cultures cultured on hydrogels decreases with increasing hydrogel Young’s modulus (Figure 1). The gene expression of PAX6 (neural stem cell marker), MAP2 (mature neuron marker), GFAP (astrocyte marker) and Oligo2 (oligodendrocyte progenitor marker) were not affected by Young’s modulus changes in this range and oligodendrocyte marker, PDGFRa, was not detected over the time course. Maximal neurite extension was observed in cells cultured on hydrogels with a Young’s modulus of 0.91 kPa (Figure 2). Conclusion: Hydrogel Young’s modulus effects hiPSC derived NSC gene expression of TUJ1 and neurite extension, but does not have a significant effect on the gene expression of other tested neural lineage markers. Modulation of matrix mechanics for neural differentiation is an important matrix property requiring futher optimization and study to fully understand its complex effect on cellular differentiation. Funding from Mission Connect a TIRR Foundation program and William Stamps Farish Fund supported this work.

89: The comparative effectiveness of intravenous acetaminophen versus intravenous morphine for pain relief in early labor: a randomized controlled trial

89 The comparative effectiveness of intravenous acetaminophen versus intravenous morphine for pain relief in early labor: a randomized controlled trial Nana-Ama E. Ankumah, Marissa Tsao, Maria Hutchinson, Claudia Pedroza, Jaideep Mehta, Sean Blackwell, Jerrie Refuerzo UT Health University of Texas Medical School at Houston, Houston, TX OBJECTIVE: Intravenous (IV) opioids are common analgesics in early labor, but are limited by marginal pain relief and adverse maternal/fetal effects. Our objective was to compare the effectiveness of IV acetaminophen to IV morphine in reducing pain in early labor. STUDY DESIGN: We conducted an open-label, randomized controlled trial (RCT) of women 34 weeks gestation with regular uterine contractions and cervical dilation 2-6 cm. Women received either IV acetaminophen 1000 mg or IV morphine 2 mg. Women with contraindications to either study drug were excluded. Effectiveness of analgesics was assessed by monitoring the patient’s need for rescue analgesia and by obtaining visual analog scales (VAS) prior and at 15 minutes, 1 hour, 2 hours and 4 hours. VAS scores, rescue analgesics, maternal side effects (nausea, emesis, drowsiness, pruritus, headache, insomnia) and fetal heart rate tracing changes (accelerations, decelerations, baseline change, variability) were compared between groups. An intent-to-treat analysis was performed with chi-square, t-test and logistic regression as appropriate. RESULTS: Of 40 women randomized, 18 received IV acetaminophen (2 did not receive study drug) and 20 received IV morphine. Within 2 hours of analgesics, over half the women who received IV acetaminophen required rescue analgesic demonstrating its minimal effect in pain control (acetaminophen: 52.9 % vs morphine: 17.6%, p1⁄4 0.02). Within 4 hours, there were no differences in rate of rescue analgesics, (acetaminophen: 73.3% vs morphine: 56.3%, p1⁄40.16). VAS scores were similar at each time point for both groups, p>0.05 (Fig 1). Maternal/fetal adverse effects were similar between groups. CONCLUSION: Although overall VAS were comparable between groups across each time interval, over half of women receiving IV acetaminophen required rescue analgesic within 2 hours of treatment. Our findings suggest that IV acetaminophen is less effective for initial pain relief in early labor compared to IV morphine.