Faculty Bibliography

OBJECTIVE/UNASSIGNED:Prior clinical findings have demonstrated that maternal laparotomy with trans-amniotic trans-uterine suturing of the fetoscopic port site during in utero myelomeningocele repair reduces the risk of membrane rupture. However, due to laparotomy-associated morbidity, we aimed to explore the feasibility of using a vascular closure device for percutaneous trans-amniotic trans-uterine suturing. METHODS/UNASSIGNED:cannula over the same guidewire. Samples of the sutured uterine wall were sent to pathology and H&E staining was performed to assess uterine hole closure and amnion-to-uterus fixation. RESULTS/UNASSIGNED:device effectively sutured the amnion to the uterus in both the pre- and post-close approach. The pre-close technique achieved better amnion-to-uterus approximation and more appropriate uterine hole closure. H&E staining revealed that without suturing, amnion separation from the chorion layer occurred, and the uterine hole persisted. The post-close technique showed partial connection between the amnion and chorion, but inadequate uterine hole closure with amnion shift into the defect. Optimal closure, with secure amnion-to-chorion fixation and uterine closure, was achieved through the pre-close technique. CONCLUSION/UNASSIGNED:Device seems to be a feasible device for use of uterine port closure in maternal-fetal surgery, larger animal studies with mid-pregnancy application are needed to further validate or refute these findings.

Osteoporosis is a systemic skeletal disease of reduced bone strength that leads to an increased risk of fragility fracture. Osteoporosis epidemiology, diagnosis, and management all are influenced by race and ethnicity. Studies have found approximately 40% to 50% lower fracture rates in Black and Asian as compared to White women. Hispanic women have generally been shown to have lower fracture rates than White women, but the magnitude of difference is uncertain. Studies in men are fewer. Substantial differences in bone density and structure contribute to these differences in fracture rates. The diagnosis of osteoporosis can be made by prior fragility fracture, bone mineral density T-score of less than or equal to -2.5, or by high calculated fracture score using the Fracture Risk Assessment Tool (FRAX). FRAX in the United States incorporates race, which has the effect of lowering calculated risk for Asian, Black, and Hispanic people by 0.43 to 0.64. In regard to pharmacotherapy, while not all trials have reported efficacy by race, there are not major known differences in osteoporosis treatment efficacy by race. Atypical femur fractures, rare subtrochanteric or diaphyseal fractures, are at least 6 times more common in Asian patients with antiresorptive therapies. Finally, there are important disparities in osteoporosis by race, including lower screening rates, lower treatment rates, and worse outcomes after fracture. Our review examines these racial differences in osteoporosis and provides an approach to incorporate race into the osteoporosis treatment algorithm. We advocate for a more aggressive approach to screening, treatment, and inclusion in research for patients of all races at risk of poor outcomes, acknowledging racial disparities in postfracture outcomes.

This pilot study explores the feasibility of large-scale non-fasting triglyceride level screening at blood donation centers. Hypertriglyceridemia is a risk factor for cardiovascular disease and acute pancreatitis. Triglyceride levels were measured in 10,176 blood donors at Carter BloodCare North Texas and found 39.2% with moderate and 2.4% with severe hypertriglyceridemia. Predictors of elevated triglycerides included age, male gender, blood pressure, and body mass index, with increased odds in Hispanic and Asian individuals compared to White individuals. Survey results from 50 donors with severe hypertriglyceridemia showed 69% had positive intent to seek medical care. The study highlights the potential of blood donation centers to serve as platforms for public health screening, and scaling low-cost, non-fasting triglyceride screening is feasible. This approach provides an opportunity for early intervention and disease prevention.

Oral biofilm plays a central role in the development of periodontal and systemic diseases, with growing evidence highlighting significant gender-specific differences. Hormonal fluctuations in women, during puberty, menstruation, pregnancy, menopause, and with oral contraceptive use, may alter the composition and behavior of oral biofilm, increasing susceptibility to gingival inflammation and periodontal disease. Conditions such as polycystic ovary syndrome (PCOS), osteoporosis, and pregnancy-associated gingivitis further demonstrate the influence of endocrine factors on oral health. In men, higher rates of severe periodontitis are observed, potentially linked to testosterone-related immune responses and behavioral factors with associations to lower sperm counts, increased incidence of prostate cancer, and erectile dysfunction. These distinctions underscore the importance of considering sex-specific biology in both the prevention and management of oral and systemic diseases influenced by biofilm. This study reviews the connections between gender-specific health and oral biofilm.

BACKGROUND/OBJECTIVES/UNASSIGNED:Emotional fear memories are increasingly recognized as contributors to the development of specific fears and phobias. Despite this, relatively little dental fear research has specifically focused on patient memories or their potential role in the etiology of dental fear. METHODS/UNASSIGNED:This two-study paper employs qualitative thematic analysis of memories for dental visits among traumatized patients (study 1) and the general patient population (ranging from endorsing no dental fear to severe fear). Recollections were evaluated based on the characteristics (i.e., sensory descriptors, affectively laden, intrusive) of emotional fear memories (studies 1 and 2) and according to a modified cognitive vulnerability model of dental fear (study 2). RESULTS/UNASSIGNED:Characteristics of emotional fear memories were ubiquitous across recollections of individuals who endorsed traumatic dental visits in childhood. Among the general patient population, these characteristics and cognitive vulnerability themes (particularly perceptions of the visit and dentist as dangerous and untrustworthy) were more prevalent in the earliest remembered visits for fearful individuals. When individuals were asked to recall their worst dental visits, emotional fear memory characteristics and vulnerability perceptions were evident across the spectrum of current fear (none to severe). CONCLUSIONS/UNASSIGNED:This study contributes to nascent work examining memory in specific fears and phobias and suggests that worst recollections across a general sample share many of the characteristics that might otherwise imply vulnerability for anxiety. We recommend that dental practices universally screen patients for fear, inquire about past negative experiences, partner with patients to minimize evoking their specific vulnerabilities, and diligently implement these personalized care plans.

PURPOSE/OBJECTIVE:This study sought to investigate the prevalence and sociodemographic determinants related to breast and cervical cancer screening among ever-married women aged 15 to 49 years in Jordan. METHODS:This research employed secondary data from the 2023 Jordan Population and Family Health Survey (JPFHS), which included 12,547 ever-married women aged 15 to 49. Weighted multivariable logistic regression analyses were conducted to quantify screening prevalence and identify related covariates, presented as adjusted odds ratios (AORs) with 95% confidence intervals (CIs). RESULTS:The prevalence of screening for breast and cervical cancer was 15.2% and 16.2%, respectively. Increased screening participation was substantially correlated with advanced age, larger home affluence, higher parity, previous sexually transmitted infections (STIs), and exposure to radio communications. Women aged 35-49 were more likely to receive breast (AOR: 4.0; 95% CI: 2.6-6.0) and cervical cancer screening (AOR: 5.5; 95% CI: 3.3-9.2) compared to those aged 15-24 years. Women in the highest wealth quintile had a greater likelihood of being screened for breast cancer (AOR: 2.1; 95% CI: 1.6-2.8) and cervical cancer (AOR: 2.6; 95% CI: 1.9-3.5). Moreover, breast cancer screening correlated with recent healthcare service consumption (AOR: 1.3; 95% CI: 1.1-1.6), while cervical cancer screening had a favorable association with elevated educational attainment (AOR: 1.6; 95% CI: 1.2-2.3). Living in rural areas was inversely correlated with cervical screening participation (AOR: 0.7; 95% CI: 0.6-1.0).  CONCLUSION: Screening rates for breast and cervical cancer among Jordanian women are inadequate. Interventions that facilitate equitable access-especially aimed at younger, less educated, rural, and low-income women-are crucial for enhancing participation and diminishing inequities in early cancer detection.

AIMS/UNASSIGNED:Myocardial infarction size is associated with mortality in ST-elevation myocardial infarction (STEMI). With advances in primary percutaneous coronary intervention (PPCI) and medical therapy, whether this relationship has changed over time is unclear. METHODS AND RESULTS/UNASSIGNED:= 0.180). CONCLUSION/UNASSIGNED:We observed an independent relationship between infarct size and STEMI mortality, strongest between 2005 and 2009, which reduced over time, becoming non-significant in the 2015-19 period. This association diminished more rapidly for patients with anterior STEMIs. These findings underscore the potential role of contemporary revascularization, systems of care, and guideline-directed medical therapy in reducing STEMI-related mortality.

Hemoglobinopathies and hemolytic anemias (HHA) are genetic blood disorders associated with diverse clinical complications, affecting an estimated 2.1 billion people worldwide. The World Health Organization (WHO) African Region accounts for approximately 425.8 million individuals, or 20% of the global HHA prevalence, yet comprehensive assessments of this burden have been lacking. We present the first systematic analysis of HHA burden in the WHO African Region from 2000-2021 using data from the Global Burden of Disease (GBD) 2021 study. We estimated regional, sex-, and age-specific rates (per 100,000 population) of mortality, incidence at birth, and years lived with disability (YLDs) in five-year intervals. Mortality estimates were generated using the Cause of Death Ensemble model (CODEm), supplemented with spatiotemporal Gaussian process regression. Incidence at birth was estimated using DisMod-MR 2.1, a Bayesian meta-regression tool, while YLDs were calculated by multiplying prevalence by disability weights reflecting severity and duration. Between 2000 and 2021, the WHO African Region experienced persistently higher age-standardized death rates from HHA compared to global levels, although regional mortality declined over the period. Sickle cell disorder (SCD) was the predominant contributor, with the highest mortality [3.68 deaths (95% UI 2.04-6.29) per 100,000] and disability burden [41.08 YLDs (95% UI 26.09-58.61)], while thalassemias contributed the least. Disability-adjusted life years (DALYs) were concentrated in western sub-Saharan Africa, accounting for 71.3% of the regional burden. Age-specific estimates revealed that children under five years faced a disproportionate share of mortality and disability. Despite overall declines in mortality, the WHO African Region continues to bear a disproportionate global burden of HHA, particularly affecting young children. These findings underscore the urgent need for strengthened newborn screening, early treatment, and health system interventions to reduce preventable deaths and disability.

BACKGROUND:Metabolic syndrome is a pressing public health issue and risk factor for the development of type 2 diabetes (T2D) and cardiovascular disease (CVD), yet clinical practice is lacking in biomarkers that represent pre-clinical perturbations of the heterogenous subtypes of risk. This study aimed to characterize the baseline metabolome in relation to known clinical characteristics of risk in a sample of obese adults. METHODS:Untargeted metabolome data from N = 126 plasma samples with baseline data from a previously completed study including obese adults with metabolic syndrome. Metabolites were acquired using validated liquid chromatography mass spectrometry methods with 15-25 internal standards quantified by peak heights. Pearson's correlations were used to determine relationships between baseline metabolites, sample characteristics (e.g., age, body mass index (BMI)), and atherosclerotic clinical characteristics (e.g., high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), triglycerides), adjusting for multiple comparisons using the Benjamini-Hochberg False Discovery Rate (FDR) method. Differences in metabolite levels between clinical classifications of dysglycemia (e.g., normal, prediabetes, diabetes) at baseline were assessed using ANOVA and adjusted for multiple comparisons and adjusted for covariates. RESULTS:The sample consisted primarily of female (74%) participants, predominantly white (70%), with an average age of 56 years. After FDR adjustment, two baseline metabolites were significantly associated with age (xylose, threitol), two with BMI (shikimic acid, propane-1,3-diol), one with LDL (tocopherol-alpha), and 42 with HDL cholesterol. Three metabolites were significantly associated with fasting blood glucose (FBG) levels at baseline (glucose, gluconic acid lactone, pelargonic acid). CONCLUSIONS:This study identified novel metabolite associations with known markers of T2D and CVD risk. Specific metabolites, such as alpha-tocopherol, branched-chain amino acids (BCAAs), and sugar-derived metabolites like mannose and xylose, were significantly associated with age, BMI, lipid profiles, and glucose measures. Although most sample participants had normal HDL cholesterol at baseline, 42 metabolites including branched chain amino acids were significantly associated with HDL, suggesting pre-clinical perturbations in biological pathways associated with both diabetes and cardiovascular comorbidities. Metabolomic signatures specific to prediabetes and metabolic syndrome can enhance risk stratification and enable targeted prevention strategies for T2D. Longitudinal studies are needed to understand how these associations change over time in at-risk individuals compared with controls.