University Of Texas Medical Branch Research Articles

The Houston Society of Clinical Pathologists 55th Annual Spring Symposium, April 2014.

The Houston Society of Clinical Pathologists educational activity culminates in the Spring Symposium, held every year in April in Houston, Texas. The guest faculty is sponsored by the institutions that form the famed Texas Medical Center and the University of Texas Medical Branch in Galveston. The articles selected for this special section are based on presentations at the symposium and at sponsoring institutions and will appear in 2 parts: part I is in this issue of the ARCHIVES, and part II will be in the July issue. The special section comprises 8 articles written by distinguished, nationally and internationally recognized experts in gastrointestinal (GI) and liver pathology from the United States and Canada. In this issue, part I of the special section will include 4 articles: ‘‘Esophagitis: Old Histologic Concepts and New Thoughts,’’ ‘‘Molecular and Histologic Considerations in the Assessment of Serrated Polyps,’’ ‘‘IgG4-Related Disease of the Gastrointestinal Tract: A 21st Century Chameleon,’’ and ‘‘Neuroendocrine Tumors of the Luminal Gastrointestinal Tract.’’ In the next issue of the ARCHIVES, part II will also include 4 articles: ‘‘Difficult Diagnostic Problems in Pancreatobiliary Neoplasia,’’ ‘‘Pathophysiology and Diseases of the Terminal Pathways of the Biliary System,’’ ‘‘Hepatic Granulomas: A Review With Emphasis on Infectious Causes,’’ and ‘‘DrugInduced Liver Injury.’’ Each of these topics poses certain challenges to the practicing surgical pathologist. Authors are allowed to express their personal opinions and preferences in these articles. Although some readers may disagree with some of the opinions presented in these reviews, I believe most readers (including myself) will benefit from the personal experiences of these highly regarded and respected authors. I hope you enjoy reading this section and find the information presented useful in your daily practice.

Expanded Indications for the Deep Plane Cervicofacial Flap

The deep plane cervicofacial (DPCF) rotation advancement flap has been well described for coverage of cheek and lower eyelid defects. The extension of this flap for coverage of complex combined temporofrontal and brow defects has not been previously described. The primary investigator (E.L.C.) performed a chart review of all 7 DPCF flaps performed for reconstructive purposes at the University of Texas Medical Branch, Galveston, Tex, from November 2011 through August 2012. Three patients with complex combined temporal and brow defects were identified. Three patients underwent coverage of complex combined temporofrontal and brow defects using the DPCF flap. Adequate coverage was provided with good skin color match. No flap loss or tip necrosis was seen, despite immediate excision of the resulting cheek standing cone deformity in 2 of the 3 patients at the time of reconstruction. All patients had suture fixation of the DPCF flap to cheek periosteum. All had none or mild lateral canthal distortion, with less than 1 mm of asymptomatic ectropion at a minimum follow-up of 4 months. The DPCF flap is a safe, effective, and reliable means to provide coverage for complex combined temporofrontal and brow defects. The deep plane elevation and musculocutaneous blood supply may improve flap mobility, viability, and resistance to tension. The standing cone deformity resulting from flap advancement can be primarily excised without risking flap necrosis. With further study, indications for the DPCF flap may include adjacent areas of the face currently being reconstructed using other means.

Trends of the Cost of Hysterectomy

INTRODUCTION: To analyze the effect of changing hysterectomy routes on cost. METHODS: This is a retrospective cohort study (class II-2) performed at a university tertiary care center. We extracted data for women who underwent hysterectomy at the University of Texas Medical Branch from 2010 to 2013, including route of hysterectomy, length of stay (LOS), and hospital costs. Institutional review board approval was obtained. RESULTS: A total of 1,098 hysterectomies were identified. Percentage of laparoscopic, robotic, open, and vaginal cases changed from 17%, 8%, 61%, and 14%, respectively, in 2010 to 14%, 20%, 35%, and 32%, respectively, in 2013. Average LOS changed from 2.58, 1.94, 4.13, and 2.33 days, respectively, in 2010 to 1.11, 0.57, 4.29, and 1.92 days, respectively, in 2013. Average costs for laparoscopic, robotic, open, and vaginal hysterectomy changed from $14,103, $16,795, $13,927, and $9,051, respectively, in 2010 to $11,141, $11,770, $19,663, and $8,218, respectively in 2013. The average cost of hysterectomy per year stayed stable at approximately $13,000. CONCLUSION: Use of the open approach seems to be decreasing, and use of the robotic approach is increasing. The increasing cost of open hysterectomy seems to be offset by a decrease in the cost of robotic hysterectomy. The average cost for hysterectomy per year was relatively stable, because the increasing cost of open hysterectomy was offset by a decreasing cost of robotic hysterectomy.

Interprofessional host perspectives on global health competencies

W. Cherniak, B. Dreifuss, J. Evert, M. Dacso, H.C. Lin, L. Loh; Bridge to Health Medical and Dental, Toronto, ON/CA, University of Arizona College of Medicine Tucson; Global Emergency Care Collaborative, Tucson, AZ/US, University of California San Francisco, San Francisco, CA/US, University of Texas Medical Branch, Galveston, TX/US, University of Pennsylvania School of Medicine, Philadelphia, PA/US, The 53rd Week Ltd., Vancouver, BC/CA

Editorial introductions

Editorial introductions

PartnerSHIPS: Aligning Your Department with Administration for Smooth Sailing

ABSTRACTHealthy partnerships with hospital administration are essential for any neurodiagnostics program to experience growth and development. The differing backgrounds of business-oriented administrators and clinically oriented technologists can result in challenges with various departmental initiatives and lead to ineffective outcomes when seeking to balance high-quality, patient-oriented care with efficient and profitable operations.Over the course of a two-year period, The University of Texas Medical Branch at Galveston (UTMB Health) implemented several changes that have led to better patient care outcomes. These changes were possible because of a remarkably effective collaboration between neurodiagnostic technologists and hospital administration. Proven business principles were combined with evidence-based healthcare and clinical-practice guidelines to facilitate the following initiatives:Combining EEG, electromyogram and nerve conduction studies (EMG/NCV), intraoperative neurophysiological monitoring (IONM), long-term monitoring (LTM), and epilepsy monitoring unit (EMU) into one departmentCross-training of technologistsPolicy and procedure developmentStrategic planning and relationship buildingPartnering with local community college neurodiagnostic programBuilding a per diem nurse (PRN)/float pool for coverageContracting for IONM servicesImplementing these changes has resulted in many improvements within the department, such as an overall increase in procedure volumes, professional development and growth opportunities for staff, and the availability of additional services for improved patient care.

Dr. James w. Fleshman and dr. Warren e. Lichliter.

Dr. James W. Fleshman is the Helen Buchanan and Stanley Joseph Seeger Endowed Professor and Chairman—Department of Surgery, Baylor University Medical Center, and Chief of Surgery at Baylor University Medical Center, Dallas, Texas. James was born in New Orleans, Louisiana, and received an MD degree from Washington University School of Medicine, St. Louis, MO. His general surgery training, which included a year of research, was conducted at The Jewish Hospital of St. Louis, Washington University School of Medicine, St. Louis, MO. He then performed a fellowship in Colon and Rectal Surgery at the University of Toronto, Toronto, Canada. In 1987, he joined the colorectal staff at Washington University School of Medicine, St. Louis, MO, and eventually became professor and section head of the division of colon and rectal surgery. In 2012, he moved to Dallas, TX, to assume his current position. Dr. Fleshman is a major force in colorectal research. In addition to being honored with the American Society of Colon and Rectal Surgeon's Young Researcher's Award in 1992, he served as the President of the American Society of Colon and Rectal Surgeons Research Foundation. He has been involved in most of the major multicenter colorectal trials including the COST (Clinical Outcomes of Surgical Therapy) trial and remains an active researcher. Dr. Fleshman is a member of and held leadership positions in multiple national surgical and colorectal societies. He has served as the president of the ASCRS (American Society of Colon and Rectal Surgeons) and the American Board of Colorectal Surgery, and is a senior member of the American Board of Surgery. Dr. Fleshman has served on the Editorial Board of Diseases of the Colon and Rectum and Annals of Surgery as well as eight other journals. He has had a long interest in cancer and has published over 161 peer-reviewed articles, 34 non–peer-reviewed articles, and 60 book chapters on this and other colorectal subjects. He has edited four textbooks, including the first edition of the ASCRS Textbook of Colon and Rectal Surgery. Dr. Fleshman maintains a very busy clinical practice in which the management of rectal cancer plays a major role. He educates medical students and surgical and colorectal residents on a daily basis. James and his wife, Linda, live in Dallas, Texas. When not working, Jim enjoys golf, reading, and spending time with his family, especially his four grandchildren. In summary, Dr. Fleshman is one of the major leaders and academic surgeons in colorectal surgery. It is an honor to know him and consider him a friend. Dr. Warren E. Lichliter is the Chief of the Department of Colon and Rectal Surgery and Colorectal Surgery Residency Director at Baylor University Medical Center, Dallas, Texas. Warren was born in Murphysbort, Illinois and did his undergraduate training at the University of Tennessee. He attended medical school at the University of Texas Medical Branch at Galveston. His general surgery residency and colorectal surgery training was performed at Baylor University Medical Center, Dallas, Texas. Following his colorectal surgery training, Dr. Lichliter joined the staff at the Baylor University and progressed to the positions listed above. Dr. Lichliter educates medical students and general surgery and colorectal residents on a daily basis and mentors trainees and junior faculty as well as conducting research. His publications include nine peer reviewed articles and he has made multiple presentations at regional and national forums. Dr. Lichliter is a fellow of the American College of Surgeons and the American Society of Colon and Rectal Surgeons (ASCRS). He has served on several important committees and as President of the North Texas Chapter of the American College of Surgeons. He is also Board Certified in General Surgery and Colon and Rectal Surgery and is listed in Best Doctors in America Warren has four children and lives with his wife in Dallas, Texas. On behalf of the readers and staff of Clinics of Colon and Rectal Surgery, I thank Dr. Fleshman and Lichliter for serving as Guest Editors and for providing us with a comprehensive update and state-of-the-art review of rectal cancer management.

Understanding ARDS-associated fibroproliferation.

Received: 10 December 2014 Accepted: 13 December 2014 Published online: 8 January 2015 Springer-Verlag Berlin Heidelberg and ESICM (outside the USA) 2014 G. U. Meduri ()) Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Memphis Veterans Affairs Medical Center, Memphis, TN, USA e-mail: gmeduri@uthsc.edu M. A. Eltorky Surgical Pathology Division, Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA

Decontamination of digital image sensors and assessment of electron microscope performance in a BSL-3 containment

A unique biological safety level (BSL)-3 cryo-electron microscopy facility with a 200 keV high-end cryo-electron microscope has been commissioned at the University of Texas Medical Branch (UTMB) to study the structure of viruses and bacteria classified as select agents. We developed a microscope decontamination protocol based on chlorine dioxide gas with a continuous flow system. In this paper we report on testing digital camera sensors (both CCD and CMOS direct detector) in a BSL-3 environment, and microscope performance after chlorine dioxide (ClO 2 ) decontamination cycles.

Thermally Induced Structural Changes in an Armadillo Repeat Protein Suggest a Novel Thermosensor Mechanism in a Molecular Chaperone

Molecular chaperones are commonly identified by their ability to suppress heat induced protein aggregation. The muscle specific molecular chaperone UNC-45B is known to be critical in folding myosin and is trafficked to the sarcomeres A-band during thermal stress. Here, we identify thermally dependent structural changes in the UCS chaperone domain of UNC-45B that occur in the physiologically relevant heat shock range. We show that distinct changes to the armadillo repeat protein topology result in exposure of hydrophobic patches, and increased flexibility of the molecule. These rearrangements suggest a novel thermosensor within the chaperone domain of UNC-45B. We propose that these changes may be central to the molecular mechanism of UNC-45B chaperone activity. They may function to suppress aggregation under stress by allowing binding to a wide variety of aggregation prone loops on its client. This work was funded by AHA grant 13GRNT17290006 and the Cecil M. Green Endowment at the University of Texas Medical Branch.

Was student dismissed due to having ADD?

A student with attention deficit disorder enrolled in the University of Texas Medical Branch at Galveston's physician assistant program. At the time of her enrollment, she took medication to control the ADD.

Was student dismissed due to having ADD?

A student with attention deficit disorder enrolled in the University of Texas Medical Branch at Galveston's physician assistant program. At the time of her enrollment, she took medication to control the ADD.

Editorial introductions

Editorial introductions

How is arteriovenous fistula longevity best prolonged?: The role of optimal fistula placement.

Seminars in DialysisVolume 28, Issue 1 p. 20-24 Opinion How is Arteriovenous Fistula Longevity Best Prolonged? The Role of Optimal Fistula Placement Gerald A. Beathard, Corresponding Author Gerald A. Beathard University of Texas Medical Branch and Lifeline Vascular Access, Houston, TexasAddress correspondence to: Gerald A. Beathard, M.D., Ph.D., FASN Clinical Professor of Medicine, University of Texas Medical Branch, Lifeline Vascular Access, 5135 Holly Terrace Drive, Houston, TX 77056, or e-mail: [email protected].Search for more papers by this author Gerald A. Beathard, Corresponding Author Gerald A. Beathard University of Texas Medical Branch and Lifeline Vascular Access, Houston, TexasAddress correspondence to: Gerald A. Beathard, M.D., Ph.D., FASN Clinical Professor of Medicine, University of Texas Medical Branch, Lifeline Vascular Access, 5135 Holly Terrace Drive, Houston, TX 77056, or e-mail: [email protected].Search for more papers by this author First published: 25 September 2014 https://doi.org/10.1111/sdi.12304Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume28, Issue1January–February 2015Pages 20-24 RelatedInformation

The Human Challenges of Commercial Spaceflight: An Overview of Medical Research Conducted by the University of Texas Medical Branch Through the Federal Aviation Administration Center of Excellence for Commercial Space Transportation

Abstract In 2010, the Federal Aviation Administration (FAA) announced the institution of a Center of Excellence for Commercial Space Transportation (COE CST), a partnership of multiple academic institutions assembled to address the numerous challenges involved in the commercial spaceflight industry. The University of Texas Medical Branch in Galveston, Texas, was included in this collaboration to provide medical insight into the human challenges of commercial spaceflight. This article will serve to outline the human spaceflight research tasks as designated by the FAA COE CST, and to discuss the research that has been conducted to address many of the risks and challenges involved in human commercial spaceflight.

Acute Bacterial Sinusitis Complicating Viral Upper Respiratory Tract Infection in Young Children

Objectives: (1) Analyze the clinical characteristics of upper respiratory infections (URIs) complicated by acute bacterial sinusitis (ABS) in young children. (2) Describe the bacteria and viruses isolated in nasopharyngeal specimens in children with ABS. Methods: We identified ABS episodes in a prospective, longitudinal cohort study of 294 children (aged 6-35 months at enrollment), who were followed up for one year to capture all URI episodes and complications. At the initial URI visit (median day = 4), nasopharyngeal samples were obtained for bacterial cultures and viral studies. The study was conducted at the University of Texas Medical Branch, Galveston, during 2003-2007. Results: Of 1295 documented URI episodes, 103 (8%) episodes (in 73 children) were complicated by ABS, 32 of which were concurrent with acute otitis media. The majority (72%) of ABS episodes were diagnosed based on persistent symptoms or a biphasic course. The average age was 18.8 ± 7.2 months; white children were more likely to have ABS episodes than blacks ( P = .01). Viruses were detected in 63% during the initial URI visit; rhinovirus detection was positively correlated with ABS ( P = .01). Bacterial cultures were positive in 82/83 (99%) available samples; polymicrobial (56%), Moraxella catarrhalis (20%) and Streptococcus pneumoniae (10%) were the most common cultures. Presence of pathogenic bacteria overall and presence of M. catarrhalis during URI were positively correlated with ABS risk ( P = .04 for both). Conclusions: ABS complicates 8% of URIs in children. Girls have more frequent ABS episodes than boys. Presence of rhinovirus and M catarrhalis during URI are positively correlated with ABS risk.

Utility of a dermatology interest group blog: the impact of medical student interest groups and Web 2.0 tools as educational resources.

The open access University of Texas Dermatology Interest Group blog was established in 2004 for the purposes of increasing communication and collaboration between medical students and dermatology faculty, residents, and alumni, as well as to promote educational opportunities and the missions for which the interest group was created. This blog is unique because of its longevity and continuous postings directed toward the educational and professional needs of medical students and residents. A blog user survey was performed to assess viewers’ thoughts, purpose of viewing, demographic profile, subscriber status, usage of the blog and other Web 2.0 tools (forums, Facebook, blogs, Twitter, podcasts), and perceived usefulness. Sixty-one anonymous online surveys were completed during a 1-month period. Statistical analyses of the responses demonstrated that the utilization of web-based tools and the blog were valuable resources for students, especially for blog subscribers, those more involved in an interest group, and those reading the blog for a longer period of time. The usefulness and impact of this method of communication and dissemination of information in medical education may encourage other student groups, faculty advisors, and educators to implement similar educational tools at their institutions.

Teamwork: an essential for leading and launching innovation.

Teamwork and innovation require a merging of special skills sets to produce the best outcomes. Collaboration and innovation have become core competencies for effectiveness in every industry. The capacity to collaborate and innovate has never been more important, especially in health care, with the regulatory and quality mandates to evaluate every aspect of service to ensure that we add value for patients and families. The examination of teamwork and innovation, which are inextricably linked, are described and discussed. The art of building teams, steps for leading change, and an approach to innovation in health care are described. The University of Texas Medical Branch in Galveston, Texas, shares one approach and experience called Innovation Forerunners-nurses from all levels and areas-to embed the tools and concepts of teamwork and innovation across patient care areas.

Comparison of sentenced inmates’ drug use patterns before and during incarceration

Comparison of sentenced inmates’ drug use patterns before and during incarceration

The effect of the Life Enhancement Treatment for Substance Use (LETS ACT) on cocaine relapse: Results from a randomized control trial

The effect of the Life Enhancement Treatment for Substance Use (LETS ACT) on cocaine relapse: Results from a randomized control trial