Faculty Bibliography

Pretibial traumatic hematomas, a subtype of subcutaneous tension hematomas, are a frequent but understudied injury seen predominantly among the elderly. This patient cohort has a high incidence of comorbidities and frailty. They are frequently taking antiplatelet medications and systemic anticoagulants. The treatment of these injuries can be costly and associated with significant morbidity and even mortality. Early detection and treatment are important when managing pretibial hematomas with the potential for skin necrosis. We report on a case where we performed how early operative debridement, negative pressure wound therapy, and subsequent split-thickness tissue grafting may be an effective management strategy for pretibial hematomas and suggest the importance of establishing standardized institutional approaches for their management.

SARS-CoV-2 infection during pregnancy has severe consequences on maternal and neonatal health. Presently, vaccination stands as a critical preventive measure for mitigating infection-related risks. Although the initial clinical trials for the COVID-19 vaccines excluded pregnant women, subsequent investigations have indicated mRNA vaccinations' effectiveness and short-term safety during pregnancy. However, there is a lack of information regarding the potential biodistribution of the vaccine mRNA during pregnancy and lactation. Recent findings indicate that COVID-19 vaccine mRNA has been detected in breast milk, suggesting that its presence is not confined to the injection site and raises the possibility of similar distribution to the placenta and the fetus. Furthermore, the potential effects and responses of the placenta and fetus to the vaccine mRNA are still unknown. While potential risks might exist with the exposure of the placenta and fetus to the COVID-19 mRNA vaccine, the application of mRNA therapies for maternal and fetal conditions offers a groundbreaking prospect. Future research should leverage the unique opportunity provided by the first-ever application of mRNA vaccines in humans to understand their biodistribution and impact on the placenta and fetus in pregnant women. Such insights could substantially advance the development of safer and more effective future mRNA-based therapies during pregnancy.

Gastrointestinal bleeding is classified as obscure in 5% of patients who remain symptomatic after undergoing upper endoscopy, colonoscopy, and small bowel capsule endoscopy. We present a case of a 45-year-old male who had obscure bleeding for eight years and presented with hemorrhagic shock. He was found to have an ulcerated intra-luminal jejunal lesion on enteroscopy, then had surgical resection that revealed a low-risk gastrointestinal stromal tumor (GIST). If GISTs are bleeding, hemostasis should first be achieved with medical, endoscopic, or radiologic interventions, and then resected because they can have malignancy potential. Furthermore, they should be risk-stratified and either surveilled to monitor for recurrence if low risk or need adjuvant imatinib if high risk. There are currently no screening guidelines for GISTs despite their increasing incidences.

Our comprehension of atrial mechanics, atrial cardiomyopathy and their clinical implications across various cardiovascular conditions has advanced significantly. Atrial interventions can have differing effects on atrial mechanics. With the rapid increase in the use of atrial interventions, it is crucial for investigators and clinicians to acknowledge the potential adverse effects of these interventions on atrial mechanics that might not be clinically significant at the time of interventions. Recognizing the preclinical stage of atrial maladaptation might enable early interventions before the development of irreversible atrial remodeling and clinical manifestation. We review normal atrial function and mechanics, and atrial cardiomyopathy in select cardiovascular conditions. We also summarize and discuss the current evidence of the impact of various atrial interventions on atrial function and mechanics.

Traumatic abdominal wall hernia (TAWH) is a protrusion of contents through a defect in the abdominal wall as a consequence of a blunt injury. The objective of this review was to describe demographic and clinical aspects of this rare pathology, identifying the optimal moment for surgical intervention, evaluating the need to use mesh, and analyzing the effectiveness of surgical treatment. Thus, a systematic review using PubMed, Embase, and Scopus databases was carried out between January 2004 and March 2024. Computed tomography is the gold-standard imaging test for diagnosis. Open surgery is generally the preferred approach, particularly in emergencies. Acute TAWH can be treated by primary suture or mesh repair, depending on local conditions, while late cases usually require mesh.

Treatment of anastomotic ulcers, also known as marginal ulcers, is challenging, especially when established techniques have failed. PuraStat is a biocompatible synthetic peptide gel that is indicated for hemostasis of bleeding in the gastrointestinal tract and vascular anastomoses. We aim to evaluate the feasibility of PuraStat in the setting of nonhealing anastomotic ulcers when used alongside standard therapies. This is a multicenter case series of adult patients who had PuraStat applied with a follow-up repeat endoscopy. Nine out of 10 patients showed clinical improvement. We concluded that PuraStat is an effective agent to aid in healing of anastomotic ulcer.

Nilotinib, a tyrosine kinase inhibitor that targets the Abelson tyrosine kinase (c-Abl) signaling pathway, is FDA-approved to treat chronic myeloid leukemia. Nilotinib has properties indicative of a possible utility in neuroprotection that have prompted exploration of repurposing the drug for the treatment of Alzheimer's disease (AD) and Parkinson's disease (PD). AD is a progressive age-related neurodegenerative disorder characterized by the deposition of extracellular amyloid-β plaques and intracellular neurofibrillary tangles. It is incurable and affects approximately 50 million patients worldwide. Nilotinib reduces c-Abl phosphorylation, amyloid-β levels, and dopaminergic neuron degeneration in preclinical AD models. This study explores the effects of nilotinib on amyloid processing and mitochondrial functioning in the SH-SY5Y human neuroblastoma cell line. SH-SY5Y cells were exposed to nilotinib (1, 5, and 10 µM). Real-time PCR and immunoblot analysis were performed to quantify the expression of genes pertaining to amyloid-β processing and neuronal health. Nilotinib did not significantly change APP, BACE1, or ADAM10 mRNA levels. However, BACE1 protein was significantly increased at 1 µM, and ADAM10 was increased at 10 µM nilotinib without affecting APP protein expression. Further, nilotinib treatment did not affect the expression of genes associated with neuronal health and mitochondrial functioning. Taken together, our findings do not support the efficacy of nilotinib treatment for neuroprotection.

Heart failure (HF) in patients with cancer is associated with high morbidity and mortality. The success of cancer therapy has resulted in an exponential rise in the population of cancer survivors, however cardiovascular disease (CVD) is now a major life limiting condition more than 5 years after cancer diagnosis [Sturgeon, Deng, Bluethmann, et al 40(48):3889-3897, 2019]. Prevention and early detection of CVD, including cardiomyopathy (CM) and HF is of paramount importance. The European Society of Cardiology (ESC) published guidelines on Cardio-Oncology (CO) [Lyon, López-Fernández, Couch, et al 43(41):4229-4361, 2022] detailing cardiovascular (CV) risk stratification, prevention, monitoring, diagnosis, and treatment throughout the course and following completion of cancer therapy. Here we utilize a case to summarize aspects of the ESC guideline relevant to HF clinicians, with a focus on risk stratification, early detection, prevention of CM and HF, and the role for guideline directed medical therapy in patients with cancer.

Plasma lipids are mainly carried in apolipoprotein B (apoB) containing lipoproteins. High levels of these lipoproteins are associated with several metabolic diseases and lowering their plasma levels are associated with reduced incidence of atherosclerotic cardiovascular disease. MicroRNAs (miRs) are small non-coding RNAs that reduce protein expression of their target mRNAs and are potential therapeutic agents. Here, we identified a novel miR-615-3p that interacts with human 3'-UTR of apoB mRNA, induces post-transcriptional mRNA degradation, and reduces cellular and secreted apoB100 in human hepatoma Huh-7 cells. Reducing cellular miR-615-3p levels by CRISPR-sgRNA increased cellular and secreted apoB100 indicating endogenous miR regulates apoB expression. Overexpression of miR-615-3p along with or without palmitic acid treatment decreased cellular and media apoB and increased cellular triglyceride levels without inducing endoplasmic reticulum stress. These studies have identified miR-615-3p as a negative regulator of apoB expression in human liver derived cells. It is likely that there are more miRs that regulate apoB-containing lipoprotein assembly and secretion. Discovery of additional miRs may uncover novel mechanisms that control lipoprotein assembly and secretion.