Tulane University School Research Articles

Bascom Headen Palmer, Jr, MD (1889-1954)

PurposeMost ophthalmologists in the US recognize the name “Bascom Palmer” but few are familiar with the individual for whom the Eye Institute is named. This article reviews the biography of Bascom Headen Palmer, Jr., MD (1889-1954). DesignHistorical review. MethodsHistorical documents were reviewed, including the archives of the University of Miami, the Miami Lighthouse for the Blind and Visually Impaired, and other sources. ResultsPalmer, born in Lake City, FL in 1889, was the younger son of a Florida politician. He graduated from what was then called the College of Medicine of the Tulane University of Louisiana (now the Tulane University School of Medicine) in 1914, followed by a two-year internship at Touro Infirmary, service in the army during World War I, and finally a post-graduate course in ophthalmology at the University of Pennsylvania in 1923. He then moved to Miami, where he became influential in two new organizations: the University of Miami, founded in 1925, and the Florida Association of Workers for the Blind (now the Miami Lighthouse for the Blind and Visually Impaired), founded in 1930. He forged collaborations between these two organizations which eventually led to the foundation of the eponymous Eye Institute. ConclusionsThe decades-long collaboration between the Miami Lighthouse and the University of Miami, facilitated by Palmer, ultimately led to the founding of the Eye Institute.

Association Analysis of Demographic Factors and the Likelihood of Self-reporting Mental Illness at Student Run Clinics

Background: Patients in the student-run clinics operated by the Tulane University School of Medicine report higher rates of previous diagnoses of mental illness (45.3%) when compared to the national average (22.8%). The diverse group of patients who utilize these resources have various demographic factors that may influence the likelihood of reporting a mental illness. Our objective is to analyze data from Tulane University School of Medicine’s student-run clinics to identify associations of self-reported psychological diagnoses with demographic and psychosocial factors. Methods: Data collected from surveys filled out by students interviewing patients in student-run clinics (n=1494), chi-square analysis, and multivariate regression analysis were conducted to evaluate associations between self-reported psychiatric illness with demographic and psychosocial factors. Results: In the chi square analysis, patients who were age 18-39, reported using psychiatric medications, identified as White, were female, did not report being homeless, had a previous suicide attempt, had a history of trading drugs for sex or money, were a victim or witness of a violent or traumatic event, and had a history of physical, emotional, and sexual abuse were more likely to report a mental health condition. Patients aged 60-99, who were African American, male, reported homelessness were less likely to report a history of a mental health conditions. Persons who identified as male were the only category statistically associated with decreased odds of reporting a mental health diagnosis. In the regression analysis, patients aged 18-39, aged 40-59, who were female, white, who had a suicide attempt, and had a history of incarceration were likely to report a mental health diagnosis. Conclusions: Patients with specific demographic and psychosocial characteristics were more likely to report a mental health diagnosis.

An anatomical study of the nasal foramina.

The nasal foramen is located in the nasal bone and for vessels passage to supply the nasal area. This project aimed to establish reliable references for the nasal foramina for future clinical applications. The 72 dried skulls, 46 from the Division of Anatomy, University of Phayao, Thailand, and 26 from the Tulane University School of Medicine, USA, were collected and examined. The location, number, and sizes of nasal foramina were noted. The distances from each nasal foramen to the internasal suture, frontonasal suture, nasomaxillary suture, nasion, and rhinion were also recorded and used in the statistical analytical programs. The most common type of nasal foramen in all skulls was type II (one external opening) at 65.97%, followed by type I (no foramen opening) at 20.83%, type III (two external openings) at 11.11% and type IV at 2.08% (three external openings). Nasal foramen subtypes in many of the Thai and American skulls were type IIb and type IIa. The diameter of a connecting nasal foramen was significantly larger than that of a non-connecting. Results from embalmed confirmed the passage of the external nasal artery through the nasal cavity. The study shows no significant difference in nasal foramen morphometry between Thai and American. It illustrates recent data on type and subtype classifications and the location of a vascular passage through the nasal foramen. This is the first study of NF variations and their respective classifications.

MiRNA-221 and -222 increase in exosomes upon insulin stimulation of human vascular smooth muscle cells lacking the insulin-like growth factor 1 receptor

As a result of increased vascular inflammation, patients with Type 2 diabetes experience a near 4-fold increase in their risk for heart attack and stroke. miR-221 and -222 are two microRNAs that are upregulated in the vasculature of Type 2 diabetic patients. miR-221/222 act by downregulating the cyclin-dependent kinase inhibitor, p27Kip1, in vascular smooth muscle cells (VSMCs) and exosome-mediated proinflammatory effects on endothelial cells and macrophages. Loss of the insulin-like growth factor receptor (IGFR) in VSMCs can unmask the insulin receptor (IR) and increase insulin signaling. We have demonstrated that the loss of IGFR, coupled with physiological insulin stimulation, promotes an increased expression of miR-221/-222 in murine VSMCs. Respectively, miR-221/222 content in VSMC-derived exosomes increases and p27Kip1 mRNA expression decreases in VSMCs. We asked whether the effect of loss of IGFR in human coronary artery smooth muscle cells (HCASMCs) would also lead to an increase in miR-221/-222 content of VSMC-derived exosomes. Transfection with a CRISPR-cas9 plasmid targeting IGFR resulted in a 50% decrease in IGFR mRNA in HCASMCs, when compared to transfection with negative control CRISPR plasmids. Droplet digital PCR was used to measure expression of miR-221 and miR-222 in the exosomes derived from both sets of HCASMCs. There was no change in the miR-221/222 content of exosomes derived from HCASMCs transfected with the negative control CRISPR following stimulation with 1nM insulin (7.27± 4.75 vs. 11.33 ± 1.09 copies of miR-221 and 6.43 ± 0.43 vs. 4.68 ± 0.02 copies of miR-222). In contrast, there was a 2 to 3-fold increase in miR-221/222 content in exosomes that were derived from HCASMCs with IGFR knockdown following stimulation with 1nM insulin (14.96 ± 0.3 vs. 35.66 ± 3.08 copies of miR-221 and 9.12 ± 1.19 vs.15.44 ± 5.36 copies of miR-222). We conclude that loss of IGFR coupled with physiological insulin stimulation increases the miR-221/222 content of exosomes of HCASMCs, recapitulating the effects of IGFR loss seen in murine VSMCs as well as the effects of diabetes on VSMCs. This model system will allow additional studies connecting the loss of IGFR to the cardiovascular complications of diabetes. Tulane University School of Medicine, Biomedical Sciences Program. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Editorial introductions.

Editorial introductions.

Injectable cabotegravir for pre-exposure HIV infection prophylaxis

Tulane University School of Medicine, New Orleans, LA The corresponding author is Ronald Slipman, MD; [email protected]. The author declares no conflicts of interest.

Subcutaneous Nodules on the Head and Ankle: Challenge.

*Tulane University School of Medicine, New Orleans, LA; and Departments of †Pathology, and ‡Dermatology, Tulane University School of Medicine, New Orleans, LA. Correspondence: Kezia Surjanto, BS, Tulane University, 1430 Tulane Avenue, New Orleans, LA 70112 (e-mail: [email protected]). C. Bitar received institutional research funding from Amgen. The authors declare no conflicts of interest.

Subcutaneous Nodules on the Head and Ankle: Answer.

*Tulane University School of Medicine, New Orleans, LA; †Department of Pathology, Tulane University School of Medicine, New Orleans, LA; and ‡Department of Dermatology, Tulane University School of Medicine, New Orleans, LA. Correspondence: Kezia Surjanto, BS, Tulane University, 1430 Tulane Avenue, New Orleans, LA 70112 (e-mail: [email protected]). C. Bitar received institutional research funding from Amgen. The remaining authors have no relevant conflicts of interest.

Abstracts from the NIH Office of Research on Women's Health 2022 Annual BIRCWH Meeting:Building Interdisciplinary Research Careers in Women's Health November 2, 2022

Abstracts from the NIH Office of Research on Women's Health 2022 Annual BIRCWH Meeting:Building Interdisciplinary Research Careers in Women's Health November 2, 2022

A Response to: "Quadripolar" Transcranial Electrical Stimulation for Motor-Evoked Potentials.

Department of Neurological Surgery, Tulane University School of Medicine, Mandeville, LA, U.S.A. e-mail: [email protected] The author has no funding or conflicts of interest to disclose.

Correlates of protection for SARS-CoV-2 vaccines

<div class="authors authors-lg"><div class="author"><div class="author-img"><img src="https://bioinsightscdn.blob.core.windows.net/uploads/Bunnell 200x200.png" data-image="1"></div><div class="author-det"> <b>Bruce A Bunnell </b>is a professor and Chair of the Department of Microbiology, Immunology and Genetics at the University of North Texas Health Science Center in Fort Worth, TX. Previously, he served as Director of the Tulane Center for Stem Cell Research and Regenerative Medicine and Professor in the Department of Pharmacology in the Tulane University School of Medicine. Dr. Bunnell obtained his PhD in Microbiology from the University of Alabama at Birmingham School of Medicine. He then pursued Postdoctoral Fellowship research at the Howard Hughes Medical Institute in the School of Medicine at the University of Michigan and the National Human Genome Research Institute at the National Institutes of Health in Bethesda, MD. Dr. Bunnell was an Assistant Professor at the Nationwide Children’s Hospital Research Institute, part of the Ohio State University School of Medicine prior to joining the faculty at Tulane University in 2002. Dr. Bunnell’s research program is focused on both the basic science and translational applications of adult stem cells isolated from the bone marrow and adipose tissue. Dr. Bunnell investigates use of mesenchymal stem cells (MSCs) isolated from the bone marrow or adipose tissue as a therapeutic intervention for both multiple sclerosis (MS) wound repair, lung injury and bone repair. He is particularly interested the interactions of MSC with the immune system and how the cells elicit robust anti-inflammatory effects in vivo. He is currently working towards a human clinical trials for the treatment of osteoarthritis, traumatic brain injury and MS with these cells. He has served as a reviewer of stem cell, regenerative medicine and tissue engineering grants for the National Institutes of Health, Department of Defense and several state funded programs including Maryland, New York, Virginia and Pennsylvania. He has also served on grant review panels for several foreign countries including Denmark, Ireland, Poland, Germany and Spain. Dr. Bunnell serves as an Editorial Board Member for several journals, including Stem Cells, BMC Genomics, and Regenerative Medicine. </div></div></div>

Functional and Molecular Studies of Renal Sphingosine 1 Phosphate Signaling Pathway in IUGR Benjamin Bhunu1 and Suttira Intapad1 Tulane University School of Medicine

Fetal Growth Restriction (FGR) is now regarded as a risk factor for adult renal diseases, however, the precise underlying mechanism that is responsible for this observation remains vague. Sphingosine 1 Phosphate (S1P) is a lysophospholipid with important functions in the regulation of renal physiology and the cardiovascular system. Previously, we demonstrated that in FGR but not control animals, acute activation of Sphingosine 1 Phosphate Receptor 1 (S1PR1) transiently reduces Blood Pressure (BP) in an endothelial nitric oxide synthase dependent manner. We have also shown that both male and female FGR mice have lower nephron number in the kidneys, however, unlike females, male FGR offspring have reduced renal function suggesting sex specific differences in fetal programing of kidney diseases. We have also shown that within 5 minutes of pharmacologically activating S1PR1 with SEW2871, GFR significantly reduces in male control but not IUGR animals. The objective of this study was to test the effect of longer stimulation of S1PR1 agonist on renal function and to determine the distribution of renal S1P signaling molecules. On their 13th day of gestation, pregnant C57BL mice went through a Reduced Uterine Pressure Perfusion (RUPP) or sham surgery to generate FGR and control offspring respectively. At 6 months, measurement of Glomerular Filtration Rate (GFR) and expression of proteins that are involved in S1P signaling was performed using plasma FITC‐Anulin decay, PCR, and immunohistochemistry. For immunohistochemistry, the Integrated Optical Densities (IDO) values from (Diaminobenzidine) DAB‐stained kidney sections were used to statistically quantify protein expression. GFR was lower in male FGR offspring than control (8.85 ±0.55 vs 13.86±1.13 µL/min/kg BW, P˂0.05, FGR vs control males) while in females there was no statistical difference (12.33±0.87 vs 15.92 ±1.94 L/min/kg BW, P˃ 0.05 control females vs FGR). Administration of SEW2871 and measurement of GFR after one hour confirmed that GFR decreases only in control males but not IUGR while in females both FGR and control groups had similar reduction response (6.00±0.46 vs 8.41±0.79 µL/min/kg BW, P˃ 0.05 control males vs FGR) (5. 97±0.48 vs 5.72 ±1.01 µL/min/kg BW, P˃ 0.05 control females vs FGR). Whole kidney transcriptomics showed no statistical differences in the expression profile of S1PR 1‐3 and Sphingosine 1 Phosphate Kinases 1 and 2 (SPHK1‐2) between FGR and control male and female animals. Immunohistochemistry analysis of the kidney medulla and cortex of male animals revealed no difference in the expression profile of S1PR1 in both FGR and control and increased expression of S1PR2 in both the medulla and cortex of FGR animals. S1PR3 was decreased in both the medulla and cortex of FGR mice. SPHK 1 and 2 were not differentially expressed in the medulla of control and FGR animal whereas in the cortex both the two receptors were downregulated in FGR. Our results indicate that acute activation of S1PR1 differentially regulates GFR between male and female FGR. Consequences of the upregulation of S1PR2 and the down regulation of S1PR 3 and SPHK 1‐2 proteins in the kidney of male FGR warrants further investigations.

"I Was Learning Every Step of the Way": Student Perceptions About a New Required Foundational Master of Public Health Program Planning Course.

Tulane University School of Public Health and Tropical Medicine created a program planning course required for all master of public health (MPH) students to address the revised 2016 Council on Education for Public Health (CEPH) foundational competencies. The objective of this study was to examine students' feedback on this new class based on their reflective writing. Students across 3 class sections during 3 semesters (fall 2018, spring 2019, and fall 2019) wrote a reflection paper as a final assignment about their course experience (N = 102). We conducted a conventional qualitative content analysis of deidentified student responses to systematically examine themes in the overarching areas of what students found valuable about the course and what they would want to be improved. We calculated frequency counts of themes to further contextualize the findings. Students found the following aspects of the course valuable: a positive perception shift toward program planning (93.1%), new transferable career skills (87.3%), the course format (77.5%), course content (69.6%), working in teams (52.0%), course assignments (47.1%), and the instructional team (31.4%). Critiques included the following: more support for course assignments (39.2%), challenges of working in teams (27.5%), aspects of the course format (25.5%), gaps in course content (19.6%), and wanting more consultations with the instructional team (5.9%). About 14% of students stated there was nothing or little they would change about the course. Overall, the course received positive feedback from students. They identified several valuable course components and areas that could be enhanced, which we have worked to improve. We offer the course as a potential model for how schools and programs of public health can meet the 2016 CEPH competencies.

Judge rules against former professor

Case name: Saketkoo v. Tulane University School of Medicine, et al., No. 19‐12578 (E.D. La. 12/31/20).

"Incidental Discovery of Dedifferentiated Liposarcoma of the Anterior Mediastinum: A Case Report"

Knauss HM1, Glosser LD1, Shi SX2* and Taleb M3 Author Affiliations 1Department of Medical Education, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA 2Clinical Neuroscience Research Center, Department of Neurosurgery and Neurology, Tulane University School of Medicine, New Orleans, LA, USA 3Department of Pulmonary/Critical Care Medicine, University of Toledo Medical Center, Toledo, OH, USA Received: August 30, 2021 | Published: September 07, 2021 Corresponding author: Shi SX, Clinical Neuroscience Research Center, Department of Neurosurgery and Neurology, Tulane University School of Medicine, New Orleans, LA, USA DOI: 10.26717/BJSTR.2021.38.006178

Does omega-3 supplementation improve dry eye symptoms?

Tulane University School of Medicine, New Orleans, LA The corresponding author is Rebekah Byrne; [email protected]. The author declares no conflicts of interest.

Social media as a tool for engaging medical students interested in orthopaedic surgery.

Instagram and Twitter are two of the most popular social media platforms today. Beyond social communication, these platforms also have the potential to enhance medical education by providing early exposure and mentorship to students and residents in training. The purpose of this study was 1) to investigate orthopaedic surgery related content posted on Instagram and Twitter 2) to analyze who posts orthopaedic surgery related content and 3) to better understand how social media may be used to supplement medical education and exposure for students interested in orthopaedics. Three hashtags, #Orthopedics, #OrthopedicSurgery, and #OrthopedicSurgeon were searched on Instagram and Twitter from March 8 to March 18, 2020. Posts on both platforms were analyzed for the hashtag used, number of likes, source type (e.g.physician, company promoting a product), and type of post (e.g.advertisement, educational). Descriptive statistics were used to analyze the results. This study was performed at the Tulane University School of Medicine, New Orleans, LA, by medical students, with guidance and supervision from faculty in the Tulane University Department of Orthopaedics. Data was collected from 212 (47.2%) Instagram and 237 (52.8%) Twitter posts over a 10-day period. Significantly more Instagram posts used the hashtags #Orthopedicsurgeon and #Orthopedicsurgery (P<.001), while more Twitter posts used the hashtag #Orthopedics (72.0% P<.001). Companies using these hashtags posted more frequently on Twitter than Instagram (P<.001), while a higher number of physicians, orthopaedic practices, and personal accounts utilized Instagram (P<.001). There was significantly more advertising content on Twitter (P<.001), while Instagram included more personal anecdotes, medical imaging and procedures (P<.001). This study demonstrated that content related to orthopaedic surgery is regularly posted on both Instagram and Twitter. Instagram is a visually driven platform that more frequently posted educational and personal content from medical professionals and individuals, while Twitter predominantly published advertisements from companies and orthopaedic practices. The current use of Instagram may make it better suited for providing information and early exposure to medical students interested in the field. III.

Closing the Supply Gap: How a Student Clinic Organization Adapted Their Role During COVID-19 Clinical Suspension to Support Frontline Providers

With the emergence of the COVID-19 pandemic and national personal protective equipment (PPE), the Tulane University School of Medicine (TUSOM) Student Clinic Council (SCC) pivoted their focus from community student-run clinics to organizing a PPE drive to address the urgent needs of local hospitals’ supply shortages. Entitled the TUSOM COVID Response Group, the primary goal was to collect and distribute donated personal protective equipment (PPE) to frontline healthcare providers in New Orleans, Louisiana to temporarily bridge the supply chain gap. In total, from March 20th, 2020 to May 6th, 2020, the group distributed 29,217 N95s, 181,467 surgical masks, 22,747 face shields, 1,100 goggles, 3,382 boxes of gloves, 13,446 gowns and coveralls, 4,525 sleeve, shoe, and head covers, 175 pairs of scrubs, 762 bottles of hand sanitizer, 699 bottles of cleaning supplies, and 38 tablets which were distributed to 17 local hospitals and healthcare faculties. During this time, the five student leaders oversaw 82 student volunteers and coordinated donations from 169 individual and business donors. All facets of medical education and medical student organizations have been forced to adapt to the new era of COVID-19. This PPE drive demonstrates the adaptability of medical student organizations and the ability to enact change in their communities beyond their clinic sites.

Commentary: Virtual Reality Anterior Cervical Discectomy and Fusion Simulation on the Novel Sim-Ortho Platform: Validation Studies.

Correspondence: Aaron Dumont, MD, MBA, Department of Neurological Surgery, Tulane University School of Medicine, 1415 Tulane Ave, New Orleans, LA 70112, USA. Email: [email protected]

“Knowing” your population: who are we caring for at Tulane University School of Medicine’s student-run free clinics?

The purpose of this study is to provide a deeper analysis characterizing the current health status of Tulane University School of Medicine’s student-run free clinic patients. Only one prior study by Rebholz et al. (South Med J 106(3):217–223, https://doi.org/10.1097/SMJ.0b013e318287fe9a , 2013) has explored the demographics in this population. Ultimately, this study will allow for easy interpretation of the demographics of the student clinic system as a whole and for the individual clinics participating in this study. This information will allow clinics to better customize care for their respective populations and ultimately improve health outcomes. Patient demographic data was collected from five preceptor-based clinics from December 2016 to May 2019 and submitted via a REDCap survey. Survey fields included patient age, sex, gender, race, ethnicity, insurance status, chief complaints, past medical history, social history, and medications. Gross data was analyzed in Excel and subsequently stratified by clinic for inter-clinic comparison. A total of 772 patient responses were collected from five different student-run clinics; 56% were male and 44% were female. The three most common reasons for a clinic visit were complaint-free wellness visits (26%), musculoskeletal complaints (16%), and respiratory complaints (11%). The three most common comorbidities included smoking and/or tobacco abuse (28%), psychiatric conditions (19%), and illicit drug abuse (15%). Future applications derived from this study may include redistribution of resources for patient education, social services, medical inventory, and preventative health services based on patient clinical needs.