UIC Inc.

By comprehensive utilizing of the geometry structure of 2D Burgers equation and the stochastic noise, we find the decay properties of the solution to the stochastic 2D Burgers equation with Dirichlet boundary conditions. Consequently, the expected ergodicity for this turbulence model is established.

Background: Dance-based exergaming (DBExG) , could potentially facilitate cardiovascular conditioning and functional mobility while enhancing physical activity behavior among people with chronic stroke (PwCS). Albeit, PwCS exhibits limitations (e.g., health care, and travel) in laboratory/outpatient rehabilitation programs, making them inaccessible. The DBExG from the laboratory (phase 1) to a safe and feasible home-based exercise program (phase 2) could effectively improve cardiovascular and functional mobility and address the accessibility limitations. Aim: To evaluate the feasibility, effect, and adherence of DBExG in promoting heart rate variability (HRV) and functional mobility in a laboratory and home-based rehabilitation approach. Design: Pre-post interventional study. Setting: Laboratory (phase 1) and home-based (phase 2) settings. Methods: Community-dwelling PwCS (n=10) participated in the study and received DBExG training using the commercially available Kinect dance gaming “Just Dance 3”. The first 6 weeks of training were provided in the laboratory setting and were delivered in a high-intensity tapering method with the first two weeks consisting of 5 sessions/week, the next two weeks of 3 sessions/week, and the last two weeks of 2 sessions/week, with a total of 20 sessions. Followed by 4 more weeks of DBExG training in the participant’s house (3 days/week), with a total of 12 sessions. Feasibility was addressed by acceptability and retention. Data obtained for HRV analysis pre- and post-intervention consists of HRV for ten minutes in (1) supine resting position; and (2) quiet standing. High-frequency (HF) power measures as indicators of cardiac parasympathetic activity, low-frequency (LF) power of parasympathetic-sympathetic balance, and LF/HF of sympatho-vagal balance were calculated. Six-minute walk test (6-MWT) was used to assess functional mobility. Changes in physical activity during pre- and post-intervention for one week and also during dance training were assessed using Fibit. Results: All participants completed the laboratory and home-based DBExG. All participants reported enjoying the sessions and most felt they were beneficial. Study retention and session adherence was 90% and 96%, in phase 1, and 2 respectively. There were no falls, or adverse safety events reported in either phase of the study. The results showed improvements in HRV HF, LF, and LF/HF. The result findings indicated significant improvement in the 6-MWT. The number of steps during dance intervention increased significantly from 1 st to the 32 nd session. Conclusions: A combination of laboratory, transitioned to home-based maintenance therapy approach appears feasible, safe, and effective thus promising for post-stroke rehabilitation. A larger randomized controlled trial is recommended to further investigate efficacy.

Background Childhood is a period of brain plasticity when environmental influences may have long‐lasting effects. Early socio‐economic position (SEP) may influence brain development at vulnerable stages and set the stage for increased vulnerability to Alzheimer’s Disease and related dementias (ADRD). In this study, we evaluated whether childhood SEP was related to brain structure in adulthood. Methods This analysis included the first 1320 individuals (61% women, age range 50‐85) of diverse Hispanic/Latino background with brain magnetic resonance imaging (MRI) assessments from the HCHS/SOL INCA‐MRI study, conducted at four major urban areas (Bronx, NY; Chicago, IL; Miami, FL, and San Diego, CA). Childhood SEP was assessed by self‐reported maternal educational achievement. We also calculated the difference between attained height and genetically predicted height using height‐associated SNPs, sex, and genetic ancestry as a biomarker of early environmental exposures. Positive values indicate taller attained stature than the expected based on SNPs, suggesting favorable early environmental influence on height; negative values suggest environmental conditions limiting growth. Measures of brain structure [total intracranial volume (TICV), total gray matter volume (TGMV) and hippocampus volume (HV)] were obtained using MRI with standardized procedures. Survey linear regression models were conducted adjusting for potential confounders. Results Low parental educational achievement was common, 55% of mothers completed less than a middle school education. In multivariable linear regression models, higher maternal educational achievement was associated with some measures of brain structure, such as greater TICV (b = 18.6, p<.001 for high school (HS) graduate; b = 26.2, p<.01 for > HS; reference <6 grade), higher TGMV (b = 5.8, p<.02 for HS graduate; b = 5.4, p<.10 for > HS), and higher HV (b = 0.14, p<.01 for HS graduate; b = 0.03, p = NS for greater than HS). Early life factors affecting height were associated with lower TICV (b = ‐18.9, p<.001), lower TGMV (b = ‐6.4, p<.001), and lower HV (b = ‐0.6, p<.01). Conclusion This study showed associations of early childhood socio‐economic position with brain structure assessed in later adulthood. Findings suggest that height residual is a useful predictor of early life environment affecting later life brain volumes.

Photolipids have emerged as attractive tools for the optical control of lipid functions. They often contain an azobenzene photoswitch that imparts a cis double‐bond upon irradiation. Herein, we present the application of photoswitching to a lipidated natural product, the potent proteasome inhibitor cepafungin I. Several azobenzene‐containing lipids were attached to the cyclopeptide core, yielding photoswitchable derivatives. Most notably, PhotoCep4 exhibited a 10‐fold higher cellular potency in its light‐induced cis‐form, matching the potency of natural cepafungin I. The length of the photolipid tail and distal positioning of the azobenzene photoswitch with respect to the macrocycle is critical for this activity. In a proteome‐wide experiment, light‐triggered PhotoCep4 modulation showed high overlap with constitutively active cepafungin I. The mode of action was studied using crystallography and revealed an identical binding of the cyclopeptide in comparison to cepafungin I, suggesting that differences in their cellular activity originate from switching the tail structure. The photopharmacological approach described herein could be applicable to many other natural products as lipid conjugation is common and often necessary for potent activity. Such lipids are often introduced late in synthetic routes, enabling facile chemical modifications.

Introduction/Objective Malakoplakia is a relatively rare inflammatory condition defined by histiocytic infiltration with pathognomonic intracytoplasmic inclusions known as Michaelis-Gutmann bodies. The lesion has been strongly associated with immunosuppressed states. Although the exact mechanism is unknown, an infectious component, such as impaired bactericidal activity in macrophages is highly implicated which leads to deposition of calcium and iron on residual bacterial glycolipid. Although commonly identified in the genitourinary tract, malakoplakia has been found in virtually all organ systems. Methods/Case Report We hereby present a 44-year-old male with a history of renal transplantation, presenting with a history of chronic diarrhea for one year. Colonoscopy was performed which identified diverticulosis in the sigmoid colon and a 5 mm sessile rectal polyp. Histopathological examination of the polyp biopsy demonstrated chronic active colitis, histiocyte aggregates and numerous intracellular, basophilic, concentric, laminated and targetoid calcified structures that were highlighted by Von Kossa and iron stains. These structures are known as Michaelis-Gutmann bodies which are pathognomonic of malakoplakia. A literature review of 45 cases was completed by utilizing the PubMed database. The cases reviewed included involvement of the allograft, host kidney, bladder, colon, prostate, thyroid, submandibular gland, lung, and testicles. Many of the patients were managed with either long term antibiotics, reduction of immunosuppression, or excision of the lesion with improvement in symptoms and/or renal function. Results (if a Case Study enter NA) NA Conclusion Our case highlights the importance of diagnosing this benign entity on histology examination to allow early treatment and improvement in symptoms.

Introduction/Objective Multiple Myeloma (MM) is a plasma cell neoplasm mainly affecting the bone marrow. Common sites of extramedullary dissemination are skin, liver, kidneys, and the central nervous system. Though diffuse plasma cell infiltration of the liver has been described in autopsy literature in about 50% of patients with multiple myeloma, it is usually not associated with focal infiltration. Rare cases of plasma cell infiltration leading to non-obstructive cholestasis and acute hepatic failure have been described. Methods/Case Report We hereby present a case of 54-year-old decedent male with past medical history of obesity, hypertension, and diabetes mellitus who presented to the emergency department with complains of productive cough, dyspnea, vomiting and back discomfort. Labs showed leukocytosis, thrombocytopenia and hypercalcemia. Additionally, there was an increase in lactate and serum monoclonal protein levels and derangements in renal and liver function tests. Skeletal bone survey showed a 1.4 cm well-circumscribed lucent lesion within the distal third of the left clavicle and in the calvarium which raised concern for multiple myeloma and tumor lysis syndrome. During the hospital course, the patient’s overall clinical condition declined rapidly, and he passed away on the third day of admission. During the autopsy examination, the patient’s bone marrow revealed diffuse infiltration of plasma cells confirming multiple myeloma. In addition, the histopathological examination of the liver revealed focal plasmacytoid fibrosis, moderate periportal inflammation with plasma cell infiltration and microsteatosis. Immunohistochemical stains with CD138, MUM-1, ISH kappa and lambda and trichrome highlighted the focal plasma cell infiltration and fibrosis in the liver, respectively. Results (if a Case Study enter NA) NA Conclusion Our case shows the importance of utilizing histopathological and immunohistochemical examination in confirming the diagnosis of multiple myeloma, specifically in the autopsy cases where there is no previous diagnosis of multiple myeloma. In addition, it highlights the awareness of rare focal plasmacytoid fibrosis and infiltration as an extramedullary presentation of multiple myeloma.

Introduction/Objective Outpatient (OP) Red blood cell exchange (RCE) therapy is used to treat patients with severe manifestations of sickle cell disease. Like any blood transfusion, a patient must have an active type and screen, drawn 24 to 72 hours prior to scheduled RCE procedure. UIH Hemapheresis clinic performs several types of apheresis procedures treating sickle cell disease, kidney transplant rejection and autoimmune disorders. Outpatient clinic staff perceived that most RCE procedures are scheduled disproportionately between Wednesday through Friday, which creates an unbalanced schedule that is lighter on Monday and Tuesday, and heavier Wednesday through Friday. The study's objective was to determine if there is a significant difference between the number of outpatient procedures scheduled on the different days of the week. If significant differences are identified, processes may be improved to schedule a more balanced OP clinic week. Potential benefits may include a more balanced patient to nursing staff ratios which can improve patient care and more efficient RBC utilization which can ease workload across multiple cross-functional departments such as nursing staff, reference labs and in-house blood bank staff. Methods/Case Report The UIH Epic Hemapheresis Clinic schedule was searched to identify how many total OP procedures, including RCE, were scheduled each day of the week between 01AUG2021 – 31JUL2022. Only OP procedures occurring in complete five-day weeks were included. Weekends and weeks having clinic closures for holidays were excluded Results (if a Case Study enter NA) Our study show that the lowest number of OP RCE (mean 1.4) and total number of OP procedures (mean 2.6) were on Monday. Wednesday is the busiest day with overall averaging 3.5 total procedures (Standard Deviation: 1.56). However, Friday is the most variable, with the largest SD for both RBCX (SD 1.4) and Total number of procedures (SD 1.7). Conclusion Contributing factors to low procedure volume on Monday are likely multifactorial. Some patients may prefer not to come to the hospital on Saturday for type and screen, while some may forget they need labs. Transportation issues are another factor. One intervention the clinic has implemented is automatic appointment call reminders. Staff encourage patients or caregivers to sign up for the EPIC MyChart app which also notifies patients of upcoming appointments. Future studies need to be conducted to address other bottlenecks within the scheduling workflow and to determine ways to optimize patient appointment adherence.

Background Septic shock causes major morbidity and mortality. Early resuscitation and empiric antimicrobial therapy is the cornerstone of therapy. Mortality can increase up to 5 times in patients with septic shock treated with an empiric regimen that does not cover the primary pathogen. Carbapenems have broad spectrum and are commonly used in sepsis. The balance of empiric use and antimicrobial stewardship can be difficult in low and middle income countries (LMIC) where multi-drug resistance (MDR) is common. Methods This is a prospective observational study from September 1 to November 30, 2020. Patients admitted with urinary tract infection (UTI) and sepsis criteria by SOFA score were included. Patients were categorized by antibiotic into a carbapenem or non-carabpenem cohort. Data was collected prospectively and length of stay, mortality and outcome was compared between groups.Graphic 1.Distribution of antibiotic schemesGraphic 2Distribution of Gram negative bacteria isolation Results We evaluated a total of 44 patients. Most of the cases had length of stay (LOS) > 7 days (72.2%). The antibiotic most frequently used were meropenem (36.4%) and cefepime (31.8%), alone or in combination with other drug (Figure 1). Table 2 shows that there was no increased LOS or death between the two study groups; however, medical complications were more common in the non-carbapenem cohort.Table 2.Outcome of studied population Conclusion Overall, there were no major significant differences between the groups. We did not find an significant increased risk of death or prolonged LOS between the carbapenem and non-carbapenem cohorts, however, the appearance of complication did have an impact depending on the type of antibiotic regimen. This may offer opportunities for empiric treatment guidelines and a target for antimicrobial stewardship. Disclosures All Authors: No reported disclosures

Background Subarachnoid (racemose) neurocysticercosis (SANCC) is an uncommon but severe form of Taenia solium infection. There is limited evidence to guide clinical management of these patients. Methods We performed a multicenter retrospective chart review of 15 U.S. sites. A total of 69 subjects with racemose disease were entered. Results The most common region of exposure was Mexico (67%) followed by Central America (24%). Median age was 43 years (range 15-76) and 71% were male. Common symptoms at the time of index admission were headache (80%), nausea/vomiting (46%), dizziness (44%), and blurry vision (33%). Cysts were intracranial in 64 (93%) subjects and exclusively intraspinal in 4. One patient had meningitis without visible cystic lesions. Incident admission magnetic resonance imaging (MRI) demonstrated ventriculomegaly in 41 (59%) and focal findings in 9 (13%) including ischemic infarct, subarachnoid hemorrhage, and/or arterial aneurysm. For 55 (80%), SANCC was first diagnosed during the index admission. Of these, 23 (42%) had prior medical visits and substantial delay in diagnosis (i.e. previously seen with hydrocephalus [27%], stroke [5.5%], and/or meningitis [11%], missed diagnostic radiologic features [4%], or inadequate imaging [5.5%]). Of the 69 subjects, 54% underwent a neurosurgical procedure during index admission (cyst removal n=16, EVD/shunt/ventriculostomy n=24). At the time of discharge, 6 (8.6%) patients were not given albendazole and/or praziquantel due to cost or availability. Six months following discharge, < 10% of follow up MRIs demonstrated cyst resolution. Planned treatment course of < 4 weeks at discharge compared to >4 weeks was associated with increased risk for new cyst development on follow up imaging at a median of 3.8 years following discharge (range 2.6 months-8 years). Those with a delayed diagnosis received a significantly longer duration of corticosteroids (median 8 weeks) than those without a delay (median 5 weeks, p=0.047). Conclusion The diagnosis of SANCC is often missed, and most patients require neurosurgical intervention. Antiparasitic therapy is suboptimal, especially with regimens developed for parenchymal NCC. Disclosures Jeffrey D. Jenks, MD, MPH, Astellas: Grant/Research Support|F2G: Grant/Research Support|Pfizer: Grant/Research Support

Background Infections (eg. RSV, influenza & Streptococcus pyogenes) have surged following discontinuation of social distancing and masking. Emergency Department (ED) providers feel pressure to prescribe antibiotics for common presentations such as fever for fear of missing a case of Group A Strep, which can lead to antibiotic misuse. Multiplex PCR assays are costly and cultures take 1-2 days to result, and lack sensitivity when antibiotics have already been started. There is a need for a rapid, affordable, and accurate method to distinguish bacterial from viral infections. Some prospective studies have demonstrated that a diagnostic assay that combines CRP with IP-10 and TRAIL can effectively assist ED providers with decisions regarding antibiotic therapy in patients with a febrile illness. Forrest plot of the individual and composite direct odds ratios (DOT) respectively for the nine studies included in the meta-analysis Summary Receiver Operating Characteristic (SROC) analysis of the diagnostic accuracy of the MeMed BV test. The SROC analysis was applied to the data which was pooled from all nine studies included in this meta-analysis Methods The analysis was registered with PROSPERO prior to following PRISMA-DTA framework, which yielded 9 studies with 4X4 tables for sensitivity, specificity, and diagnostic accuracy of the BV test for bacterial vs. viral infection. Articles were searched in PubMed, Medline, Google Scholar and Ovid. Random effects models were used to calculate pooled proportions. The estimated total effect sizes, test for heterogeneity and moderator effect, and ROC curve are reported using R software. Results 9 prospective studies were included with a total of 4084 patients (3271 cases and 813 controls). The proportion of the random effect model was 0.841 (95% CI, 0.788 to 0.882). The total effect sizes of all nine studies are shown. The OR of the random effect model is 124.2 (95% CI, 77.3 to 199.4) and p-value < 0.0001, meaning the OR of a positive BV test result among persons with disease was approximately 124 times higher than the OR for a positive test among persons with no disease. The bivariate diagnostic random-effects meta-analysis for viral vs. bacterial infection AUC = 0.973. Conclusion Across 9 studies performed over 8 years, the combination of TRAIL, IP-10 and C-RP biomarkers (BV test) accurately distinguished between bacterial and viral infections in patients with febrile illness. The test has the potential to be used to facilitate timely diagnosis and antimicrobial treatment decisions. Further large scale studies are needed to establish its role in antimicrobial stewardship. Disclosures All Authors: No reported disclosures

Background: Cardiac arrest continues to pose a significant public health burden, with over 350,000 cases of out-of-hospital cardiac arrests (OHCA) occurring each year in the United States, and nearly 90% of them being fatal. The objective of this work was to develop a deep learning model that can accurately predict the Cerebral Performance Category (CPC) in adult OHCA cases. Methods: Adult OHCA cases at an urban academic emergency department were enrolled between 2018-2023. We evaluated data collected post return of spontaneous circulation (ROSC) at the first hour. Six different groups of data were tested for the prediction of CPC score: (1) Post-Rosc Vitals, (2) Pre-hospital & ED data points, and (3) Hospital Admission data points. The second group of exploratory research variables include: (4) ultrasound variables, (5) biomarkers and (6) Sex steroid hormones. The figure below illustrates the prediction framework for cardiac arrest patients, post ROSC, admitted to the hospital. Results: Of the total of 109 cases that were enrolled, 45% were female and 48% were Black. More than one-third (35%) were discharged alive but only 20% had a CPC of 1-2. While the base model with clinical and demographic variables had an AUC of 0.54, addition of subsequent variables improved the AUC substantially. The AUC improved to 0.59, 0.67 and 0.78 when hormones, ultrasound and biomarker variables were added, respectively, to the base model. However, the optimal model included all variables, resulting in a noteworthy AUC score of 0.861. Conclusion: Our findings emphasize the significance of incorporating novel variables to comprehensively evaluate the outcomes of cardiac arrest patients so that better prediction models can be developed, potentially aiding in modifying procedures and any necessary measures to shift the outcome in favor of preserving patients' lives after OHCA.

Introduction: Obesity is an independent risk factor for atrial fibrillation (AF). While oxidative stress plays an important role in obesity-mediated AF, the specific pathways that cause atrial remodeling remain unclear. NADPH oxidase 2 (NOX2), a major source of cytosolic reactive oxygen species (ROS) production in the heart, is increased in diet-induced obese (DIO) mice and can independently predispose to post-operative AF via atrial remodeling. Hypothesis: We used a Nox2 -knock-out (KO) mouse model and mature human iPSC-derived atrial cardiomyocytes (hiPSC-aCMs) to test the hypothesis that NOX2 increase modulates ion channel remodeling in obesity-mediated AF. Methods: DIO mice and palmitic acid (PA)-treated hiPSC-aCMs were given a NOX blocker (apocynin), and GSK2793059, a NOX2-specific small molecule inhibitor respectively. Trans-esophageal rapid (TE) pacing was used to examine changes to the AF phenotype. Whole-cell patch clamping, qPCR, Western blotting, and electrical mapping were performed to study ion channel remodeling in both models. Results: DIO, DIO-Apocynin, and DIO Nox2 -KO mice displayed increased weight compared to control and Nox2 -KO mice (Figure A). After TE pacing, DIO-Apocynin mice displayed 28.2 ± 25.4 s and DIO Nox2 -KO mice displayed 17.4 ± 31.8 s compared to 167.3 ± 168.9 s in DIO mice (Figure B). Electrophysiological studies show that Nox2 inhibition reverses ion channel remodeling in I Na , I Ks , and I Ca,L (Figure D-F), and atrial fibrosis (Figure H) and prolongs the atrial action potential (AP; Figure C) and increases conduction velocity (CV; Figure G-I) in both DIO mice (Figure C-I) and PA-hiPSC-aCMs (Figure J-L). Conclusions: Collectively, genetic and pharmacological inhibition of NOX2 in DIO mice and PA-treated hiPSC-aCMs abrogate ion channel and structural remodeling and prevents the development of obesity-mediated AF. These findings have important implications for targeted antioxidant therapy for obese patients with AF.

Disclosure: G.J. Mora Calderon: None. R.L. Aguirre: None. D. Preston: None. Introduction: Insulin induced edema is a very rare complication seen after initiation of insulin therapy or after escalation of previous insulin regimen in patients with diabetes. The exact incidence of this condition is unknown. Insulin induced edema seems to have a female predominance and is associated primarily with patients who are underweight. The severity of insulin induced edema can range from mild localized peripheral edema to more severe and generalized complications, including cardiac failure and serosal effusions. There is a higher risk for severe complications in older patients with pre-existing cardiac, hepatic, or renal conditions. Usually, the course is benign and self-resolved without any intervention. Severe and prolonged cases have been reported to need adjuvant therapy (e.g diuretics or sympathomimetic agents) or sodium-restricted dietary regimens. Increasing blood glucose target with a decreased insulin regimen has been proposed as a possible option to prevent insulin induced edema. We present a 14 year-old-male patient with history of poor controlled type 1 diabetes mellitus and recurrent insulin-induced edema after strengthening of his insulin therapy. Case Presentation: A 14-year-old male with poorly controlled type 1 diabetes mellitus presented to the emergency with pitting edema of his face and hands that started a week after intensification of his insulin regimen. His weight increased from 73 kg to 84 kg in about 10 days. His vital signs at presentation were stable and besides the pitting edema, the rest of the physical examination was unremarkable. His mother reported a previous episode of edema that occurred approximately a year before this presentation and about a month after he was first diagnosed with diabetes mellitus. His most recent HbA1c was 14.4%. Patient was admitted for evaluation. Electrocardiogram, transthoracic echocardiogram, chest x-ray, and multiple laboratories (including a comprehensive metabolic panel, complete blood count, B-type natriuretic peptide, urine microalbumin, and thyroid function test ) came back all normal. The edema slowly improved and was eventually discharged. No adjuvant therapy was needed during his hospitalization. Conclusion: The diagnosis of insulin induced edema is primarily based on the exclusion of other etiologies. Most cases reported only one episode after initiation of insulin therapy or after escalation of previous insulin regimen, but it can happen multiple times as noted in our patient. Presentation: Thursday, June 15, 2023

US medical students demonstrate strong interest in receiving global health training. In 2012, the Center for Global Health (CGH) at the University of Illinois College of Medicine (UICOM) developed a Global Medicine (GMED) program to match this interest. From its initiation, mentorship has been a key component of the GMED program. More recently, this has been strengthened by applying additional evidence-informed approaches toward mentoring. These include the “mentor up” approach, a “network of mentors,” and an individualized development plan (IDP). Applying these changes were associated with increases in the number of student abstract presentations and peer-reviewed journal publications. Mentorship based upon evidence-informed approaches should be a key component of global health education in academic medical centers.