Richmond, VA, United States
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Timmons M.K.,Hunter Holmes ire Medical Center | Thigpen C.A.,Proaxis Therapy Innovative Therapy Resource | Seitz A.L.,Northeastern University | Karduna A.R.,University of Oregon | And 2 more authors.
Journal of Sport Rehabilitation | Year: 2012

Context: The literature does not present a consistent pattern of altered scapular kinematics in patients with shoulder-impingement syndrome (SIS). Objectives: To perform meta-analyses of published comparative studies to determine the consistent differences in scapular kinematics between subjects with SIS and controls. In addition, the purpose was to analyze factors of the data-collection methods to explain the inconsistencies in reported kinematics. The results of this study will help guide future research and enable our understanding of the relationship between scapular kinematics and SIS. Evidence Acquisition: A search identified 65 studies; 9 papers met inclusion criteria. Sample sizes, means, and SDs of 5 scapular-kinematic variables were extracted or obtained from each paper's lead author. Standard difference in the mean between SIS and controls was calculated. Moderator variables were plane of arm elevation, level of arm elevation (ARM) and population (POP). Evidence Synthesis: Overall, the SIS group had less scapular upward rotation (UR) and external rotation (ER) and greater clavicular elevation (ELE) and retraction (RET) but no differences in scapular posterior tilt (PT). In the frontal plane, SIS subjects showed greater PT and ER, and in the scapular plane, less UR and ER and greater ELE and RET. There was also greater ELE and RET in the sagittal plane. There was less UR at the low ARM and greater ELE and RET at the high ARM with SIS. Athletes and overhead workers showed less UR, while athletes showed greater PT and workers showed less PT and ER. The general population with SIS had greater ELE and RET only. Conclusions: Subjects with SIS demonstrated altered scapular kinematics, and these differences are influenced by the plane, ARM, and POP. Athletes and overhead workers have a different pattern of scapular kinematics than the general population. The scapular plane is most likely to demonstrate altered kinematics. These factors should be considered when designing futures studies to assess the impact of altered kinematics in patients with SIS. © 2012 Human Kinetics, Inc.


Lamberty G.J.,Minneapolis VA Health Care System | Nakase-Richardson R.,Neuropsychology Section MHBS | Farrell-Carnahan L.,Hunter Holmes ire Medical Center | McGarity S.,James A Haley Veterans Hospital | And 3 more authors.
Journal of Head Trauma Rehabilitation | Year: 2014

Background: In 2008, the Department of Veterans Affairs Polytrauma Rehabilitation Centers partnered with the National Institute on Disability and Rehabilitation Research to establish a Model Systems program of research that would closely emulate the civilian Traumatic Brain Injury (TBI) Model Systems Centers Program established in 1987. Objective: To describe the development of a TBI Model Systems program within the Department of Veterans Affairs Polytrauma System of Care. Methods: Enrollment criteria and data collection/data quality efforts for the newly established Department of Veterans Affairs sites are reviewed. Results: Significant progress has been made in the establishment of a Model Systems program for the Polytrauma System of Care. Data collection has moved forward and program-specific modifications have been implemented. Conclusion: The Veterans Affairs TBI Model System program is established and growing, with many projects underway and a strong working relationship with the civilian TBI Model System programs. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Tang Y.,Virginia Commonwealth University | Suddarth B.,Virginia Commonwealth University | Du X.,Hunter Holmes ire Medical Center | Matsumoto J.A.,University of Virginia
Emergency Radiology | Year: 2014

Acute cerebellitis is a postinfectious or postvaccinal disorder that predominantly affects children. The typical magnetic resonance imaging appearance has been previously described as cerebellar hemispheric cortical edema. Here, we report a rare case of respiratory syncytial virus-related cerebellitis with transient diffusion restriction of cerebellar peduncles and dentate nucleus. Differential diagnoses are also discussed. © 2013 Am Soc Emergency Radiol.


Bose N.,Hunter Holmes ire Medical Center | Bena J.,Cleveland Clinic | Chatterjee S.,Cleveland Clinic
Arthritis Research and Therapy | Year: 2015

Introduction: In patients with systemic sclerosis (SSc), digital ischemia results from an occlusive microvasculopathy that may not respond adequately to conventional vasodilators. Endothelin receptor antagonists can potentially modify the fibroproliferative vascular remodeling in SSc, and hence their use may be justified in the management of digital ischemia. The objective of this clinical trial was to evaluate the effect of ambrisentan, a selective endothelin type A receptor antagonist, on microvascular blood flow in patients with limited systemic sclerosis (SSc) using laser Doppler perfusion imaging (LDPI). Methods: In this randomized, double-blind, placebo controlled study we enrolled 20 patients with limited SSc. Fifteen patients received ambrisentan 5 mg daily for one month and then 10 mg daily for two months, and five received a placebo. There were three visits: weeks 0 (baseline), one and 12. Three patient-oriented questionnaires were completed at each visit: Scleroderma-Health Assessment Questionnaire (S-HAQ), Raynaud Condition Score (RCS), and Pain-Visual Analog Scale (P-VAS). At each visit, LDPI was used to obtain three blood flow readings involving regions of interest in second to fifth fingers of the non-dominant hand at room temperature (25°C) and after cooling (10°C) for two minutes. Results: There were 16 females (80%); mean age was 50 years. None of the differences in blood flow (as measured by LDPI) were significant both at baseline and after cooling. However, patients in the ambrisentan group showed significant improvement in the patient-oriented outcomes: RCS (P = 0.001) and S-HAQ score (P = 0.005). Conclusions: This pilot study did not show evidence of significant increase in digital blood flow over time; however, there was an improvement in RCS and S-HAQ score. We conclude that continuous use of ambrisentan for three months does not seem to significantly improve digital blood flow in SSc patients. Trial registration: Clinicaltrials.gov NCT01072669. Registered 19 February 2010. © Bose et al.


Sell S.A.,Virginia Commonwealth University | Sell S.A.,Hunter Holmes ire Medical Center | McClure M.J.,Virginia Commonwealth University | Ayres C.E.,Virginia Commonwealth University | And 2 more authors.
Journal of Biomaterials Science, Polymer Edition | Year: 2011

The process of electrospinning has proven to be highly beneficial for use in a number of tissue-engineering applications due to its ease of use, flexibility and tailorable properties. There have been many publications on the creation of aligned fibrous structures created through various forms of electrospinning, most involving the use of a metal target rotating at high speeds. This work focuses on the use of a variation known as airgap electrospinning, which does not use a metal collecting target but rather a pair of grounded electrodes equidistant from the charged polymer solution to create highly aligned 3D structures. This study involved a preliminary investigation and comparison of traditionally and airgap electrospun silk-fibroin-based ligament constructs. Structures were characterized with SEM and alignment FFT, and underwent porosity, permeability, and mechanical anisotropy evaluation. Preliminary cell culture with human dermal fibroblasts was performed to determine the degree of cellular orientation and penetration. Results showed airgap electrospun structures to be anisotropic with significantly increased porosity and cellular penetration compared to their traditionally electrospun counterparts. © Koninklijke Brill NV, Leiden, 2011.


Goetz L.L.,Hunter Holmes ire Medical Center | Klausner A.P.,Hunter Holmes ire Medical Center
Physical Medicine and Rehabilitation Clinics of North America | Year: 2014

In this article, the problem of urinary tract infections (UTIs) after spinal cord injury and disorders is defined, the relationship of bladder management to UTIs is discussed, and mechanical and medical strategies for UTI prevention in spinal cord injury and disorders are described. © 2014 .


Gorgey A.S.,Hunter Holmes ire Medical Center | Shepherd C.,Rehabilitation Hospital of Indiana
Journal of Spinal Cord Medicine | Year: 2010

Background: Skeletal muscle atrophy is a common adaptation after spinal cord injury (SCI) that results in numerous health-related complications. Neuromuscular electrical stimulation (NMES) has been recognized as an effective tool, which attenuates atrophy and evokes hypertrophy. Objective: To investigate the effects of NMES resistance training (RT) on individual muscle groups and adipose tissue of the right thigh after stimulation of the knee extensor muscle group in a man with chronic SCI. Participant: A 22-year-old man with a complete SCI sustained in a motorcycle accident 5 years prior to participation in this study. Methods: The participant underwent training twice a week for 12 weeks, including unilateral progressive RT of the right knee extensor muscle group using NMES and ankle weights. The stimulation was applied to knee extensors while the participant was sitting in his wheelchair. A series of T1-weighted magnetic resonance images were acquired for the whole right thigh prior to and after training. Skeletal muscle cross-sectional areas were measured of the whole thigh, knee extensors, hip adductors, hamstrings, and sartorius and gracilis muscle groups. Additionally, intramuscular fat and subcutaneous fat of the thigh were measured. Results: At the end of 12 weeks, the participant was able to lift 17 lbs during full knee extension. Average skeletal muscle cross-sectional areas increased in all of the measured muscle groups (12%-43%). Hypertrophy ranging from 30% to 112% was detected in multiaxial slices after the NMES RT protocol. Intramuscular fat decreased by more than 50% and subcutaneous fat increased by 24%. Conclusion: Unilateral NMES RT protocol evoked hypertrophy in the knee extensor and adjacent skeletal muscle groups and was associated with a reduction in intramuscular fat in a person with a chronic SCI. Additionally, subcutaneous adipose tissue cross-sectional areas increased in response to RT. © 2010 by the American Paraplegia Society.


Sell S.A.,Hunter Holmes ire Medical Center | Sell S.A.,Virginia Commonwealth University | Wolfe P.S.,Virginia Commonwealth University | Ericksen J.J.,Hunter Holmes ire Medical Center | And 3 more authors.
Tissue Engineering - Part A | Year: 2011

Platelet-rich plasma (PRP) therapy has seen a recent spike in clinical interest due to the potential that the highly concentrated platelet solutions hold for stimulating tissue repair and regeneration. The aim of this study was to incorporate PRP into a number of electrospun materials to determine how growth factors are eluted from the structures, and what effect the presence of these factors has on enhancing electrospun scaffold bioactivity. PRP underwent a freeze-thaw-freeze process to lyse platelets, followed by lyophilization to create a powdered preparation rich in growth factors (PRGF), which was subsequently added to the electrospinning process. Release of protein from scaffolds over time was quantified, along with the quantification of human macrophage and adipose-derived stem cell (ADSC) chemotaxis and proliferation. Protein assays demonstrated a sustained release of protein from PRGF-containing scaffolds at up to 35 days in culture. Scaffold bioactivity was enhanced as ADSCs demonstrated increased proliferation in the presence of PRGF, whereas macrophages demonstrated increased chemotaxis to PRGF. In conclusion, the work performed in this study demonstrated that the incorporation of PRGF into electrospun structures has a significant positive influence on the bioactivity of the scaffolds, and may prove beneficial in a number of tissue engineering applications. © Copyright 2011, Mary Ann Liebert, Inc. 2011.


Shankaran S.,Hunter Holmes ire Medical Center | Bearman G.M.L.,North Hospital
Current Infectious Disease Reports | Year: 2012

Oseltamivir and Zanamivir are the two main Neuraminidase inhibitors used for the treatment of Influenza. Oseltamivir resistance has been identified in nonpandemic influenza viruses, as well as H1N1 pandemic Influenza A viruses. Resistance is associated with increased morbidity, and poorer outcomes in severely immunocompromised hosts. Newer neuraminidase inhibitors, increased vaccination and combination therapy may be alternatives for the treatment of Influenza in this setting. © 2012 Springer Science+Business edia, LLC.


Patel N.J.,Hunter Holmes ire Medical Center | Karuturi R.,Virginia Commonwealth University | Al-Horani R.A.,Virginia Commonwealth University | Baranwal S.,Hunter Holmes ire Medical Center | And 4 more authors.
ACS Chemical Biology | Year: 2014

Selective targeting of cancer stem-like cells (CSCs) is a paradigm-shifting approach. We hypothesized that CSCs can be targeted by interfering with functions of sulfated glycosaminoglycans, which play key roles in cancer cell growth, invasion and metastasis. We developed a tandem, dual screen strategy involving (1) assessing inhibition of monolayer versus spheroid growth and (2) assessing inhibition of primary versus secondary spheroid growth to identify G2.2, a unique sulfated nonsaccharide GAG mimetic (NSGM) from a focused library of 53 molecules, as a selective inhibitor of colon CSCs. The NSGM down-regulated several CSC markers through regulation of gene transcription, while closely related, inactive NSGMs G1.4 and G4.1 demonstrated no such changes. G2.2's effects on CSCs were mediated, in part, through induction of apoptosis and inhibition of self-renewal factors. Overall, this work presents the proof-of-principle that CSCs can be selectively targeted through novel NSGMs, which are likely to advance fundamental understanding on CSCs while also aiding development of novel therapeutic agents. © 2014 American Chemical Society.

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