500 East Medical Center Drive

Ann Arbor, MI, United States

500 East Medical Center Drive

Ann Arbor, MI, United States
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Bohnen N.I.,University of Michigan | Muller M.L.T.M.,University of Michigan | Frey K.A.,University of Michigan | Frey K.A.,500 East Medical Center Drive
Current Neurology and Neuroscience Reports | Year: 2017

Purpose of Review: The aims of the study were to review recent advances in molecular imaging in the Lewy body dementias (LBD) and determine if these may support the clinical but contested temporal profile distinction between Parkinson disease (PD) with dementia (PDD) versus dementia with Lewy bodies (DLB). Recent Findings: There do not appear to be major regional cerebral metabolic or neurotransmitter distinctions between PDD and DLB. However, recent studies highlight the relative discriminating roles of Alzheimer proteinopathies. PDD patients have lower cortical β-amyloid deposition than DLB. Preliminary tau PET studies suggest a gradient of increasing tau binding from cognitively normal PD (absent to lowest) to cognitively impaired PD (low) to DLB (intermediate) to Alzheimer disease (AD; highest). However, tau binding in DLB, including the medial temporal lobe, is substantially lower than in AD. Summary: Alzheimer-type proteinopathies appear to be more common in DLB compared to PDD with relative but no absolute differences. Given the spectrum of overlapping pathologies, future α-synuclein ligands are expected to have the best potential to distinguish the LBD from pure AD. © 2017, Springer Science+Business Media, LLC.

Mashour G.A.,500 East Medical Center Drive | Moore L.E.,500 East Medical Center Drive | Lele A.V.,University of Kansas | Robicsek S.A.,University of Florida | Gelb A.W.,University of California at San Francisco
Journal of Neurosurgical Anesthesiology | Year: 2014

Perioperative stroke can be a catastrophic outcome for surgical patients and is associated with increased morbidity and mortality. This consensus statement from the Society for Neuroscience in Anesthesiology and Critical Care provides evidencebased recommendations and opinions regarding the preoperative, intraoperative, and postoperative care of patients at high risk for the complication. Copyright © 2014 by Lippincott Williams & Wilkins.

Kalemkerian G.P.,University of Michigan | Kalemkerian G.P.,500 East Medical Center Drive | Gadgeel S.M.,Barbara Ann Karmanos Cancer Institute
JNCCN Journal of the National Comprehensive Cancer Network | Year: 2013

For many years, small cell lung cancer (SCLC) has been staged using the Veterans Affairs classification system, which includes only 2 stages: limited (primary tumor and regional lymph nodes within a tolerable radiation field) and extensive (anything beyond limited stage). The TNM staging system used for non-small cell lung cancer is also prognostic for SCLC and should be integrated into the classification scheme for patients with SCLC. The staging workup for SCLC has traditionally included contrast-enhanced CT scans of the chest and abdomen, bone scan, and MRI or CT scan of the brain. Recent data suggest that PET can improve both staging accuracy and treatment planning in patients with SCLC, although further prospective studies are needed to fully define its role. Copyright © 2013, JNCCN-Journal of the National Comprehensive Cancer Network.

Kung T.A.,500 East Medical Center Drive | Cederna P.S.,500 East Medical Center Drive | Van Der Meulen J.H.,University of Michigan | Urbanchek M.G.,500 East Medical Center Drive | And 2 more authors.
Journals of Gerontology - Series A Biological Sciences and Medical Sciences | Year: 2014

Sarcopenia leads to many changes in skeletal muscle that contribute to atrophy, force deficits, and subsequent frailty. The purpose of this study was to characterize motor unit remodeling related to sarcopenia seen in extreme old age. Whole extensor digitorum longus muscle and motor unit contractile properties were measured in 19 adult (11-13 months) and 12 oldest old (36-37 months) Brown-Norway rats. Compared with adults, oldest old rats had significantly fewer motor units per muscle, smaller muscle cross-sectional area, and lower muscle specific force. However, mean motor unit force generation was similar between the two groups due to an increase in innervation ratio by the oldest old rats. These findings suggest that even in extreme old age both fast-and slow-twitch motor units maintain the ability to undergo motor unit remodeling that offsets some effects of sarcopenia. © 2013 The Author.

Mitsak A.G.,101 Beal Avenue | Dunn A.M.,101 Beal Avenue | Hollister S.J.,101 Beal Avenue | Hollister S.J.,Gg Brown Laboratory | Hollister S.J.,500 East Medical Center Drive
Journal of the Mechanical Behavior of Biomedical Materials | Year: 2012

Scaffold tissue engineering strategies for repairing and replacing soft tissue aim to improve reconstructive and corrective surgical techniques whose limitations include suboptimal mechanical properties, fibrous capsule formation and volume loss due to graft resorption. An effective tissue engineering strategy requires a scaffolding material with low elastic modulus that behaves similarly to soft tissue, which has been characterized as a nonlinear elastic material. The material must also have the ability to be manufactured into specifically designed architectures. Poly(glycerol sebacate) (PGS) is a thermoset elastomer that meets these criteria. We hypothesize that the mechanical properties of PGS can be modulated through curing condition and architecture to produce materials with a range of stiffnesses. To evaluate this hypothesis, we manufactured PGS constructs cured under various conditions and having one of two architectures (solid or porous). Specimens were then tensile tested according to ASTM standards and the data were modeled using a nonlinear elastic Neo-Hookean model. Architecture and testing conditions, including elongation rate and wet versus dry conditions, affected the mechanical properties. Increasing curing time and temperature led to increased tangent modulus and decreased maximum strain for solid constructs. Porous constructs had lower nonlinear elastic properties, as did constructs of both architectures tested under simulated physiological conditions (wetted at 37 °C). Both solid and porous PGS specimens could be modeled well with the Neo-Hookean model. Future studies include comparing PGS properties to other biological tissue types and designing and characterizing PGS scaffolds for regenerating these tissues. © 2012 Elsevier Ltd.

Kerber K.A.,500 East Medical Center Drive
CONTINUUM Lifelong Learning in Neurology | Year: 2012

Purpose of Review: This article describes an approach to the diagnosis and management of acute constant dizziness, one of the most unnerving presentations in medicine. Patients with acute constant dizziness can be completely debilitated by the symptoms. Most cases are caused by a self-limited disorder, typically vestibular neuritis. However, a significant proportion of cases harbor a stroke that could be life threatening. Discriminating a self-limited disorder from a life-threatening disorder can be challenging and often hinges on findings, which may be subtle, from the ocular motor examination.Recent Findings: Early research indicates that bedside ocular motor findings play a critical role in differentiating vestibular neuritis from stroke.Summary: This article describes an approach to the patient with acute constant dizziness. Copyright © American Academy of Neurology. Unauthorized reproduction of this article is prohibited.

Evans A.T.,University of Michigan | Park J.M.,University of Michigan | Chiravuri S.,500 East Medical Center Drive | Gianchandani Y.B.,University of Michigan
Biomedical Microdevices | Year: 2010

This paper describes an actively-controlled architecture for drug delivery systems that offers high performance and volume efficiency through the use of micromachined components. The system uses a controlled valve to regulate dosing by throttling flow from a mechanically pressurized reservoir, thereby eliminating the need for a pump. To this end, the valve is fabricated from a glass wafer and silicon-oninsulator wafer for sensor integration. The valve draws a maximum power of 1.68 μW (averaged over time); with the existing packaging scheme, it has a volume of 2.475 cm3. The reservoirs are assembled by compressing polyethylene terephthalate polymer balloons with metal springs. The metal springs are fabricated from Elgiloy® using photochemical etching. The springs pressurize the contents of 37 mL chambers up to 15 kPa. The system is integrated with batteries and a control circuit board within a 113 cm3 metal casing. This system has been evaluated in different control modes to mimic clinical applications. Bolus deliveries of 1.5 mL have been regulated as well as continuous flows of 0.15 mL/day with accuracies of 3.22%. The results suggest that this device can be used in an implant to regulateintrathecal drug delivery. © 2009. Springer Science + Business Media, LLC.

Evans A.T.,University of Michigan | Chiravuri S.,500 East Medical Center Drive | Gianchandani Y.B.,University of Michigan
Biomedical Microdevices | Year: 2010

This paper describes a system for transferring power across a transdermal needle into a smart refill port for recharging implantable drug delivery systems. The device uses a modified 26 gauge (0.46 mm outer diameter) Huber needle with multiple conductive elements designed to couple with mechanical springs in the septum of the refill port of a drug delivery device to form an electrical connection that can sustain the current required to recharge a battery during a reservoir refill session. The needle is fabricated from stainless steel coated with Parylene, and the refill port septum is made from micromachined stainless steel contact springs and polydimethylsiloxane. The device properties were characterized with dry and wet ambient conditions. The needle and port pair had an average contact resistance of less than 2 Ω when mated in either environment. Electrical isolation between the system, the liquid in the needle lumen, and surrounding material has been demonstrated. The device was used to recharge a NiMH battery with currents up to 500 mA with less than 15°C of resistive heating. The system was punctured 100 times to provide preliminary information with regard to device longevity, and exhibited about 1 Ω variation in contact resistance. The results suggest that this needle and refill port system can be used in an implant to enable battery recharging. This allows for smaller batteries to be used and ultimately increases the volume efficiency of an implantable drug delivery device. © 2009 Springer Science+Business Media, LLC.

Levi B.,University of Michigan | Lisiecki J.,University of Michigan | Rubin P.,University of Michigan | D'Amico R.A.,University of Michigan | And 3 more authors.
Plastic and Reconstructive Surgery | Year: 2014

The U.S. Food and Drug Administration is the government agency responsible for oversight of the safety and efficacy of pharmaceuticals and devices, including biologics and devices that combine biologics with other materials. Within the U.S. Food and Drug Administration, the Center for Biologics Evaluation and Research is specifically responsible for the evaluation and approval of biological products. This department of the U.S. Food and Drug Administration has a series of mechanisms in place to aid researchers in the process of developing new biologics. This article outlines the study phases involved in developing new biologics and how the Center for Biologics Evaluation and Research and investigators can work together to facilitate this process. It also discusses issues specific to biologics that have been encountered in the past and that investigators should consider when developing and obtaining approval for new biologics. The equivalent center within the U.S. Food and Drug Administration for approving medical devices is the Center for Devices and Radiological Health. The equivalent process of development and approval of medical devices is similarly discussed. Finally, essential contacts for investigators within the Center for Biologics Evaluation and Research and the Center for Devices and Radiological Health are provided. Copyright © 2014 by the American Society of Plastic Surgeons.

Chang J.B.,University of Toledo | Kung T.A.,500 East Medical Center Drive | Cederna P.S.,500 East Medical Center Drive
Annals of Plastic Surgery | Year: 2014

Marjolin's ulcers are rare cutaneous malignancies that most commonly present as squamous cell carcinomas in previously injured, chronically inflamed, or scarred skin. Acute and chronic types have been distinguished by the length of latency; by definition, the acute type occurs within 12 months of injury whereas the chronic type appears over 12 months after injury. In this report, 3 cases of acute Marjolin's ulcers are described and questions are raised about the diagnosis of acute Marjolin's ulcer. Other than a discrepancy in lag time, it is unclear if there is any difference in clinical or histological characteristics or even prognosis between acute and chronic Marjolin's ulcers. In fact, the acute type may simply be a preemptive diagnosis that conveniently describes a carcinoma associated with a nonhealing wound and discovered within a short time span. Moreover, the rarity of the diagnosis and the relatively rapid rate of malignant degeneration from the inciting injury lead one to question whether the injury may have simply revealed or accelerated a previously existing occult cutaneous malignancy. With no definitive clinical, histological, or prognostic distinction between acute and chronic Marjolin's ulcers, the use of such terminology may not benefit a clinician's understanding or practice. In fact, it merely supports the clinical guideline that any nonhealing wound, acute or chronic, should be biopsied and sent for pathologic examination to ensure that it does not represent a Marjolin's ulcer. © 2014 Lippincott Williams and Wilkins.

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