M.S. - Biomedical Sciences
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ItemEffects of the Accessory Infraorbital Nerve and Foramen on the Morphology of the Infraorbital Nerve and Foramen([Honolulu] : [University of Hawaii at Manoa], [December 2016], 2016-12)Title: Effects of the accessory infraorbital nerve on the morphology of the infraorbital nerve and foramen Problem: Anatomical variations of the infraorbital neurovascular bundle are frequently encountered during a host of oral surgical procedures involving the infraorbital region. The accessory infraorbital foramen (AIOF) and its nerve (AION) are variable, but clinical implications are common and include failure of loco-regional anesthesia, risk of neural damage, or hemorrhage following surgical interventions particularly involving the infraorbital nerve (ION) and foramen (IOF). Thus, morphological characterization of the AIOF and AION and relationships to the IOF and ION are essential for optimizing oral surgical procedures. Additionally, predictive features of the AION based on its relationship to ION morphology could facilitate predictive capabilities enabling the surgeon to anticipate its presence and proceed accordingly Purpose: The purpose of this study is to determine whether the presence of an AION affects the size, shape and composition of the infraorbital foramen and nerve. The specific hypothesis tested is that the topography and morphology of the ION and IOF differs between individuals possessing an AION and those lacking this anatomical variant. Data will serve to determine the potential field of innervation of the ION with and without the presence of AION and identify potential morphological correlates between ION and AION features. Procedure: Gross topographic features of IOF (84 hemifaces) were compared between specimens possessing (test) or lacking (control) an AIOF. Nerve fascicle features of ION (60 cadaveric sides) were examined histologically and compared morphometrically between specimen with or without an AION. Results: Occurrence of AIOF was determined as 47.6% of the skulls (20 crania), but only 32.1% of the sides (27 sides). A single AIOF was observed in 24 sides and double AIOF in 3 sides. AIOF occurred bilaterally in seven specimens (16.7%). The majority of AIOF (86.7%) were located superomedial to IOF, but overall a heterogeneous direction of the canal leading to AIOF was noted. A higher frequency of AION was found in left side compared to the right. The number and area of nerve fascicles were determined histologically. The size of the ION without an AION was not significantly different than the ION with AION (1.45x106/1.32x106, p < 0.35). However, the number of ION fascicles was greater in specimens without and AION compared to those with an AION (15.15/12.71, p <0.04) Conclusions: The data indicate that the area of the ION is not affected by an AION, suggesting that the field of innervation of this area will not be modified However the ION appears to divide more proxima in the cases when the AION is present.
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ItemMorphological Study of the Human Hyoid Bone in Cleft Lip and Palate Patients([Honolulu] : [University of Hawaii at Manoa], [August 2016], 2016-08)Qualitative assessment of 3-D reconstructions derived from MRI and CT imaging technologies is critical for the diagnosis and treatment of patients with cleft lip and palate (CLP). However, rapid and reliable quantitative assessment remains elusive. This is particularly true for the analysis of regional deficiencies in morphology of CLP patients. Recent interest has focused on the morphology of the hyoid region of CLP patients since this area is derived from pharyngeal arch 2 and may be indirectly affected by the deficiency in the primary palate derived from pharyngeal arch 1. The objective of this study is to develop and apply novel morphometric methodology to quantitatively assess hyoidal morphology in CLP patients. The hypothesis to be tested is that CLP patients display hyoidal regions that differ quantitatively from patients lacking CLP. Five geometric models with known parameters were designed to simulate size and shape descriptors and used to test the precision and accuracy of ER3D. Cone beam computed tomography (CBCT) images derived from CLP patients as well as patients lacking CLP and these were utilized to generate 3D reconstructions of the hyoidal region in corresponding individuals and compared utilizing affine and non-affine methodologies.. Anatomical landmarks were determined and digitized on the model. Results showed significant accuracy of ER3D morphometric analysis with respect to volumetric and linear measurements and proved the ability of the software to quantitatively record changes in size and shape. For the hyoid models, CLP individuals mostly displayed affine hyoidal changes relative to controls since the defect likely causes size reductions in affected individuals. Non-affine changes were consistent among CLP subjects and were characterized as changes in position with respect to controls rather than shape change. Interestingly, female controls revealed a high degree of diversity compared to both male controls and all CLP groups. These data suggest that the hyoidal region is affected as a result of CLP, but the difference is dominated by size rather than shape change.
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ItemHospitalization Preditcts Functional Decline in Nursing Home Patients([Honolulu] : [University of Hawaii at Manoa], [May 2016], 2016-05)Objectives: According to CMS data, a higher percentage of nursing home (NH) patients in Hawaii demonstrated functional decline than the national average. We examined the effects of hospitalization on functional and cognitive decline in elderly NH patients. Design: Longitudinal observational study. Setting: A 170-bed hospital-affiliated NH in Honolulu, Hawaii. Participants: All patients admitted to the study NH between January 2003 and December 2006 (n=238) and followed from admission until discharge or death through 6/30/2011, using Minimum Data Set (MDS) assessments, NH and hospital medical records. We excluded patients with total Activities of Daily Living (ADL) dependence or severe cognitive impairment (Cognitive Performance Scale CPS=6) at baseline. Measurements: Our primary outcome was change in function, measured by the MDS-ADL scale (range 1-28, higher=more disability) from admission and quarterly assessments. Our secondary outcome was change in cognition, measured with the MDS-CPS (range 0-6, higher=more cognitive impairment). For all patients, functional and cognitive decline over time was analyzed using multivariable linear regression analyses. Subgroup analysis examined those with at least one hospitalization and MDS data before and after hospitalization for within-person pre/post-hospitalization changes in ADL and CPS scores without covariate adjustment. Results: After exclusions, our analytic sample included 147 patients. Mean age was 82.9 years, 36.1% were male and 91.5% were Asian. Mean baseline ADL score was 18.2 (SD 5.4) and mean baseline CPS score was 2.9 (SD 1.4). Mean follow-up time was 1.5 years (SD 1.2). Linear regression adjusting for Charlson Comorbidity Index showed increased ADL disability (2.9 points, 95%CI(2.13, 3.78), p<0.001) after hospitalization, with slight decreased disability by the 2nd MDS after NH readmission (-2.01, 95%CI(-1.35, -2.67), p<0.001). CPS score worsened by 0.47 (95%CI(0.28, 0.65), p<0.001). On within-person comparisons, ADL disability increased by 4.5 points (95%CI(4.3,5.8), p<0.001) after hospitalization, with slight decreased disability by the 2nd MDS assessment after NH readmission (-1.6, 95%CI(-3.2,-0.1), p=0.04). CPS score worsened by 0.7 points (95%CI(0.4,1.1), p<0.0001). Conclusion: Hospitalization was significantly associated with increased functional decline among elderly NH patients, with slight improvement after readmission to the NH. Treatment of acute illness in the NH should be included as an option during goals of care discussions.
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ItemAssociation between Oxytocin Use during Dilation and Evacuation and Estimated Blood Loss([Honolulu] : [University of Hawaii at Manoa], [August 2015], 2015-08)Objectives: Many providers use oxytocin during dilation and evacuation (D&E) to prevent or treat hemorrhage. Evidence to support this practice is scarce. We sought to describe the association between oxytocin use, estimated blood loss (EBL), and surgical outcomes during D&E. Study Design: Women undergoing D&E (≥14 weeks) between 2010 and 2014 were included in this retrospective cohort study to assess the association between oxytocin use and EBL. We also determined whether sociodemographic and health-related factors were associated with higher EBL and whether oxytocin use was associated with a lower complication rate. Mean EBL was compared with a t-test. Excessive blood loss, defined as EBL at or above 250 ml, demographics, and complications were compared with a chi-square and Fisher's Exact tests. Logistic regression was performed. Our database, which included 649 women undergoing D&E, had the ability to detect a 7.5% difference in excessive blood loss. Results: Oxytocin was used in 68.3% of the procedures. Asian (p= 0.02) and Native Hawaiian/Pacific Islander (p=0.03) race, abortion indication (p=0.008) and higher gestational age (p<0.001) were associated with osytocin use. Mean EBL [133.1 (sd=133.9) ml versus 105 ml (73.8), p<0.001] and excessive blood loss (11.1% vs. 4.9%, p=0.01) were higher in the oxytocin group. No significant difference in complication rates emerged (4.7% with oxytocin vs. 4.4% without, p=0.579). The adjusted OR for excessive blood loss was 1.61 (95% Cl 0.77, 3.77) when women received oxytocin. Conclusions: Oxytocin use during D&E did not have a significant association with surgical outcomes including EBL and complications in our population. Implications: Routine use of interventions for bleeding, such as intravenous oxytocin, should be based on scientific evidence or not performed. Findings from our study provide information on how oxytocin use is associated with blood loss during D&E.
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ItemPolymorphisms in Kynurenine Pathway Genes and Psychological Distress in HIV Patients([Honolulu] : [University of Hawaii at Manoa], [August 2015], 2015-08)Background: HIV infection, neuroinflammation and psychopathology are each associated with imbalances in the kynurenic pathway (KP), which includes kynurenine-3-monooxygenase (KMO) and kynurenine aminotransferase II (KATII). Both KMO and KATII enzymes mediate levels of kynurenic acid (KYNA), which increases with HIV infection, and may decrease with psychopathological symptoms such as depression. Since people with HIV are more vulnerable to neuroinflammation and comorbid depression, variations in the genes of these enzymes may influence psychopathological symptoms in HIV. Methods: 72 HIV seronegative (SN) and 72 HIV positive participants were evaluated using the Center for Epidemiologic Studies Depression and Symptom Checklist-90-Revised scales, and were genotyped at KATII rs1480544 at KMO rs1053230. Cerebrospinal fluid kynurenic acid concentration [KYNA] was measured in 51 SN and 49 HIV participants. T-test, and one-way and two-way AN(C)OVA were used to compare effects of genetic variation and HIV status on psychological symptoms or KYNA levels. Pearson or Spearman analyses was used to find correlation between psychopathological symptom scores and KYNA levels. Results: For psychopathological symptoms, overall, HIV participants had higher scores than SN, and SN KATII C-carriers tended to have lower scores than SN TT homozygotes. Older age correlated with higher CSF [KYNA] in KATII C-carriers and KMO CC-homozygotes independently of serostatus. HIV participant psychopathological scores did not differ between KMO genotypes. Conclusions: KATII genotypes and HIV serostatus were associated with psychopathological symptoms. Furthermore, CSF [KYNA] varies with age depending on both KMO and KATII genotypes. Together, this supports a functional role of these variations in the dysregulation of the KP that may moderate psychopathological symptoms in HIV and SN individuals. Understanding the KP mechanisms in HIV may lead to novel treatments for psychopathological symptoms.
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ItemFamily History of Substance Use Problems on Cortical Morphometry in Healthy Children([Honolulu] : [University of Hawaii at Manoa], [August 2015], 2015-08)Background Common structural brain abnormalities reported in substance use related (SUD) related regions were found in children with family history (FH) of SUD. However, the effect of FH-degree of SUD is not well examined. Therefore, the influence of degree of FH of substance use problems (SUP) on cortical morphometry was investigated. Methods 921 typically developing children (ages 3-20 years old; 470 boys/451 girls) had structural MRI and executive functions measures. The influence of first and/or second-degree FH (Any-FH) and the separate effects of first-degree (First-FH) and second-degree FH of SUP (Second-FH) on cortical structures were investigated using FreeSurfer. The relationships between FH related cortical alterations and executive functioning were examined. Sex interactions with FH-degree on cortical morphometry were also investigated. Results Any-FH children had volume alterations mediated by changes in surface areas. FH children have larger left prefrontal and right superior areas and volumes when compared to No-FH children. First-FH and Second-FH show a variable effect on cortical volumes particularly for regions in the posterior frontal and anterior parietal regions as well as the right fusiform gyrus. Sex differences for cortical morphometry between First-FH and Second-FH children were widespread, but strongest in the left frontal regions. The left supramarginal and right fusiform gyri, regions specifically reduced for First-FH children, were also related to differential executive functioning and this same association was found in First-FH girls. Importantly, the majority of results remained even when controlling for confounders such as ADHD. Conclusion The children with FH of SUP have overall differences in prefrontal regions. First-FH and Second-FH children showed different morphometric alterations in parietal and temporal regions, which may contribute to deficits in executive function. Further studies are need to explore the sex-specific influences in cortical morphometry of children with FH of SUP, and the possible consequences on cognition.