Digital Commons Network^™

Point-Of-Care Versus Central Testing Of Hemoglobin During Large Volume Blood Transfusion., Justin Herman, Brian Park, Bharat K. Awsare, Frances Mae West, Denine Crittendon, Lilah Evans, Mary Harach, Julie Karp, Alexis R. Peedin, Marianna Lanoue, Barbara Goldsmith, Eugene P. Warnick, Michael Baram

Division of Pulmonary and Critical Care Medicine Faculty Papers

BACKGROUND: Point-of-care (POC) hemoglobin testing has the potential to revolutionize massive transfusion strategies. No prior studies have compared POC and central laboratory testing of hemoglobin in patients undergoing massive transfusions.

METHODS: We retrospectively compared the results of our point-of-care hemoglobin test (EPOC®) to our core laboratory complete blood count (CBC) hemoglobin test (Sysmex XE-5000™) in patients undergoing massive transfusion protocols (MTP) for hemorrhage. One hundred seventy paired samples from 90 patients for whom MTP was activated were collected at a single, tertiary care hospital between 10/2011 and 10/2017. Patients had both an EPOC® and CBC hemoglobin performed within 30 min …

Comparison Of Three Different Techniques Of Inverted Internal Limiting Membrane Flap In Treatment Of Large Idiopathic Full-Thickness Macular Hole., Fariba Ghassemi, Hassan Khojasteh, Alireza Khodabande, Lauren A. Dalvin, Mehdi Mazloumi, Hamid Riazi-Esfahani, Masoud Mirghorbani

Wills Eye Hospital Papers

Purpose: To evaluate and compare three different techniques of inverted internal limiting membrane (ILM) flap in the treatment of large idiopathic full-thickness macular hole.

Methods: In a comparative interventional case series, 72 eyes from 72 patients with large (> 400 µm) full-thickness macular hole were randomly enrolled into three different groups: group A - hemicircular ILM peel with temporally hinged inverted flap; group B - circular ILM peel with temporally hinged inverted flap; and group C - circular ILM peel with superior inverted flap. Best-corrected visual acuity (BCVA), anatomical closure rate, and ellipsoid zone (EZ) or external limiting membrane (ELM) …

Patient Safety Escape Room: A Graduate Medical Education Simulation For Event Reporting., Gretchen Diemer, Rebecca Jaffe, Dimitrios Papanagnou, Xiao Chi Zhang, Jillian Zavodnick

Department of Emergency Medicine Faculty Papers

Introduction: Although residents are on the front lines of patient care, they enter few formal patient safety reports on the adverse events and near misses they witness. Demonstrating the rationale and mechanics of reporting may improve this.

Methods: We designed and implemented an escape room patient safety simulation to incorporate active learning, gamification, and adult learning theory into intern patient safety onboarding. Interns from all sponsoring institution programs participated, identifying, mitigating, and reporting a range of patient safety hazards. Props and faculty time were the major resources required.

Results: One hundred twenty interns participated in this simulation in June 2018. …

Resistance To Ectromelia Virus Infection Requires Cgas In Bone Marrow-Derived Cells Which Can Be Bypassed With Cgamp Therapy., Eric B. Wong, Brian Montoya, Maria Ferez, Colby Stotesbury, Luis J. Sigal

Department of Microbiology and Immunology Faculty Papers

Cells sensing infection produce Type I interferons (IFN-I) to stimulate Interferon Stimulated Genes (ISGs) that confer resistance to viruses. During lympho-hematogenous spread of the mouse pathogen ectromelia virus (ECTV), the adaptor STING and the transcription factor IRF7 are required for IFN-I and ISG induction and resistance to ECTV. However, it is unknown which cells sense ECTV and which pathogen recognition receptor (PRR) upstream of STING is required for IFN-I and ISG induction. We found that cyclic-GMP-AMP (cGAMP) synthase (cGAS), a DNA-sensing PRR, is required in bone marrow-derived (BMD) but not in other cells for IFN-I and ISG induction and for …

Full Issue: Volume 14, Number 2 - Fall 2019

Jefferson Surgical Solutions

In This Issue

Jefferson Health Offers Smallest-Incision Open-Heart Surgery - Page 1

The Surgeon Speaks

The Surgeon Speaks - Page 1

Overview

The Academic Cycle - Page 2

New Faculty

New Faculty - Page 2

Meet the Interns

Meet the Interns - Page 2

Changing Lives Through Research

Dang Laboratory Explores Novel Approaches to Diagnosing, Treating Liver Cancer - Page 3

Please Welcome

Jefferson Welcomes Four Surgery Residents from Hahnemann - Page 3

Those Who Give

A Wall of Honor, Hope and Healing: Department of Surgery Recognizes Generous Benefactors - Page 4

News in Brief

News in Brief - Page …

News In Brief

Jefferson Surgical Solutions

Effective July 1, Gerald Isenberg, MD, began a two-year term as President of the Medical Staff at Thomas Jefferson University Hospital. Dr. Isenberg is Director of the Surgical Undergraduate Education and Program Director of the Colorectal Fellowship Program.

Benjamin Phillips, MD, was named President of the Pennsylvania Society of Colon and Rectal Surgeons.

In May, Charles J. Yeo, MD, was awarded the 2019 Johns Hopkins School of Medicine Distinguished Alumnus Award in Baltimore. After receiving his medical degree in 1979, Dr. Yeo completed a general surgery residency at The Johns Hopkins Hospital.

Rajesh Aggarwal, MD, has …

A Wall Of Honor, Hope And Healing: Department Of Surgery Recognizes Generous Benefactors

Jefferson Surgical Solutions

Stroll through the sixth-floor halls of Jefferson’s Curtis and College buildings and you will see portraits of the legends who have made an indelible imprint on American medicine and surgery. These portraits include Thomas Mütter (the father of American Plastic Surgery), John Chalmers DaCosta (a master educator) and John H. Gibbon, Jr., inventor of the heart-lung machine.

Now the names of another group of legends adorns the walls: some of the most generous benefactors of the Department of Surgery. Installed in October, the donor wall pays tribute to those whose support has fueled the Department’s compassionate clinical care, rigorous research …

Jefferson Welcomes Four Surgery Residents From Hahnemann

Jefferson Surgical Solutions

When Hahnemann Hospital announced at the end of June that it was closing its doors, 571 residents and fellows were suddenly facing an uncertain future. By July 5, the Thomas Jefferson University Department of Surgery had conducted interviews with 18 soon-to-be-displaced residents and extended invitations to four: William Preston, MD (PGY1), Darshak Thosani, MD (PGY2), Madison Crutcher, MD (PGY3) and Robert Kucejko, MD (PGY4). All four accepted and are now active members of the Jefferson surgery program.

“We had been hearing rumors about Hahnemann for at least 15 years, so the closure wasn’t a complete shock,” explains Residency Program Coordinator …

Dang Laboratory Explores Novel Approaches To Diagnosing, Treating Liver Cancer

Jefferson Surgical Solutions

Since its launch on October 1, 2018, the Dang Laboratory has been dedicated to the study of novel approaches to diagnosing and treating hepatocellular carcinoma (HCC), the most common type of liver cancer. The lab, which is part of the Division of Surgical Research, recently secured two grants and is led by Hien Dang, PhD, with support from Postdoctoral Fellow Kai Zhang, PhD, and Lab Technician Anna Barry, MS.

Before joining the faculty at Jefferson, Dr. Dang worked as a Postdoctoral Fellow supported by a Cancer Research Training Award (CRTA) at the National Cancer Institute, National Institutes of Health in …

Meet The Interns

Jefferson Surgical Solutions

The Department has welcomed an impressive group of categorical interns selected from over 1350 applicants to our program. These doctors, who matched with Jefferson, started on June 20, 2019. Please welcome (from left to right):

Lindsay Weil, MD - Rutgers - New Jersey Medical School

William Preston, MD* - Geisinger Commonwealth School of Medicine

Micaela Collins, MD, MPH - Sidney Kimmel Medical College

James Lee, MD, MS - Tufts University School of Medicine

Kirsten Lung, MD - CA Northstate University College of Medicine

Michael Goodman, MD - Stony Brook University School of Medicine

Sunjay Kumar, MD - Rutgers - Robert …

New Faculty

Jefferson Surgical Solutions

Caitlyn M. Costanzo, MD, has joined the Division of Colorectal Surgery. Dr. Costanzo is a 2011 graduate of Sidney Kimmel Medical College. She remained at Thomas Jefferson University Hospital where she completed the General Surgery Residency Program in 2018 and Colorectal Surgery Fellowship Program in 2019. She also completed a research fellowship program at St. Christopher’s Hospital for Children in 2016. She sees patients at Thomas Jefferson University Hospital and Jefferson Methodist Hospital.

Jaime M. Glorioso, MD, has joined the Division of Transplant Surgery. Dr. Glorioso completed the General Surgery Residency Program at the Mayo Clinic in Minnesota. …

The Academic Cycle, Charles Yeo, Md, Facs

Jefferson Surgical Solutions

Another academic year commenced this summer. Another academic cycle. Jefferson and our Department remain vibrant, successful and agile. We welcomed six terrific interns in June, then added another intern (and three other residents) upon the closure of Hahnemann Hospital. This summer we added eight faculty members to our Department, several new advanced practice providers and many new staff members. Our administrative team has evolved – we have celebrated the promotion of Florence Williams to Department Administrator, and Andrea DelMastro to the position of Director of Clinical Operations.

Enterprise wide – per the Bob Dylan tune “The Times They Are A-Changin’” …

The Surgeon Speaks, T. Sloane Guy, Md, Mba

Jefferson Surgical Solutions

“Robotic surgery is incredibly complex, but I work hard to make it clear and understandable to my patients and their families. I have found online channels, including Twitter and YouTube, to be excellent vehicles for patient education. I have even posted a video of a fully endoscopic mitral valve repair to help people gain a better understanding of how it works and what to expect.

“When a patient is preparing for heart surgery, there can be an overwhelming amount of information to process. I understand that people may not fully absorb all the details during an office visit. By providing …

Jefferson Health Offers Smallest-Incision Open-Heart Surgery

Jefferson Surgical Solutions

As Director of Robotic & Minimally Invasive Cardiac Surgery at Jefferson, T.Sloane Guy, MD, MBA, has a big passion for small incisions. Dr. Guy performs all aspects of adult cardiac surgery, with a focus on mitral valve disease and hypertrophic cardiomyopathy (that is, when part of the heart becomes thickened without an obvious cause). He is particularly well known for his experience in using robotic cardiac surgery to treat these and other conditions. One of the most innovative procedures is totally endoscopic robotic mitral repair. The procedure – the smallest-incision open-heart surgery performed in the world today – relies on …

The Histone Deacetylase Inhibitor Tubacin Mitigates Endothelial Dysfunction By Up-Regulating The Expression Of Endothelial Nitric Oxide Synthase., Jihui Chen, Jian Zhang, Noor F. Shaik, Bing Yi, Xin Wei, Xiao-Feng Yang, Ulhas P. Naik, Ross Summer, Guijun Yan, Xinyun Xu, Jianxin Sun

Center for Translational Medicine Faculty Papers

Endothelial nitric oxide (NO) synthase (eNOS) plays a critical role in the maintenance of blood vessel homeostasis. Recent findings suggest that cytoskeletal dynamics play an essential role in regulating eNOS expression and activation. Here, we sought to test whether modulation of cytoskeletal dynamics through pharmacological regulation of histone deacetylase 6 (HDAC6)-mediated tubulin deacetylation affects eNOS expression and endothelial function in vitro and in vivo.Wefound that tubulin acetylation inducer (tubacin), a compound that appears to selectively inhibit HDAC6 activity, dramatically increased eNOS expression in several different endothelial cell lines, as determined by both immunoblotting and NO production assays. Mechanistically, we found …

Evaluation Of A Technology-Based Survivor Care Plan For Breast Cancer Survivors: Pre-Post Pilot Study., Talya Laufer, Bryan Lerner, Anett Petrich, Anna Quinn, Leah Ernst, Alicin Roop, Janet Knoblauch, Nick C. Leasure, Rebecca J. Jaslow, Sarah Hegarty, Amy Leader, Andrea Barsevick

Department of Medical Oncology Faculty Papers

BACKGROUND: As of 2016, almost 16 million individuals were cancer survivors, including over 3.5 million survivors of breast cancer. Because cancer survivors are living longer and have unique health care needs, the Institute of Medicine proposed a survivor care plan as a way to alleviate the many medical, emotional, and care coordination problems of survivors.

OBJECTIVE: This pilot study for breast cancer survivors was undertaken to: (1) examine self-reported changes in knowledge, confidence, and activation from before receipt to after receipt of a survivor care plan; and (2) describe survivor preferences for, and satisfaction with, a technology-based survivor care plan. …

A Drive To Driven Model Of Mapping Intraspecific Interaction Networks., Libo Jiang, Jian Xu, Mengmeng Sang, Yan Zhang, Meixia Ye, Hanyuan Zhang, Biyin Wu, Youxiu Zhu, Peng Xu, Ruyu Tai, Zixia Zhao, Yanliang Jiang, Chuanju Dong, Lidan Sun, Christopher H. Griffin, Claudia Gragnoli, Rongling Wu

Division of Endocrinology, Diabetes and Metabolic Diseases Faculty Papers

Community ecology theory suggests that an individual's phenotype is determined by the phenotypes of its coexisting members to the extent at which this process can shape community evolution. Here, we develop a mapping theory to identify interaction quantitative trait loci (QTL) governing inter-individual dependence. We mathematically formulate the decision-making strategy of interacting individuals. We integrate these mathematical descriptors into a statistical procedure, enabling the joint characterization of how QTL drive the strengths of ecological interactions and how the genetic architecture of QTL is driven by ecological networks. In three fish full-sib mapping experiments, we identify a set of genome-wide QTL …

Gasdermins In Apoptosis: New Players In An Old Game., Corey Rogers, Emad S. Alnemri

Department of Biochemistry and Molecular Biology Faculty Papers

Apoptosis is a form of programmed cell death (PCD) that plays critical physiological roles in removing superfluous or dangerous cell populations that are unneeded or threatening to the health of the host organism. Although the molecular pathways leading to activation of the apoptotic program have been extensively studied and characterized starting in the 1970s, new evidence suggests that members of the gasdermin superfamily are novel pore-forming proteins that augment apoptosis by permeabilizing the mitochondria and participate in the final stages of the apoptotic program by inducing secondary necrosis/pyroptosis. These findings may explain outstanding questions in the field such as why …

Pbrm1 Acts As A P53 Lysine-Acetylation Reader To Suppress Renal Tumor Growth., Weijia Cai, Liya Su, Lili Liao, Zongzhi Z Liu, Lauren Langbein, Essel Dulaimi, Joseph R Testa, Robert G Uzzo, Zhijiu Zhong, Wei Jiang, Qin Yan, Qing Zhang, Haifeng Yang

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

p53 acetylation is indispensable for its transcriptional activity and tumor suppressive function. However, the identity of reader protein(s) for p53 acetylation remains elusive. PBRM1, the second most highly mutated tumor suppressor gene in kidney cancer, encodes PBRM1. Here, we identify PBRM1 as a reader for p53 acetylation on lysine 382 (K382Ac) through its bromodomain 4 (BD4). Notably, mutations on key residues of BD4 disrupt recognition of p53 K382Ac. The mutation in BD4 also reduces p53 binding to promoters of target genes such as CDKN1A (p21). Consequently, the PBRM1 BD4 mutant fails to fully support p53 transcriptional activity and is defective …

Full Issue: Volume 12, Number 1 - Spring 2017

Jefferson Surgical Solutions

In This Issue

Clinical Integration

Department of Surgery and Philadelphia University Lay Groundwork for Collaboration Prior to Merger - Page 2

Changing Lives Through Research

Clinical Studies Target Fewer Complications, Better Outcomes for Vascular Surgery - Page 3

On the Job

Andrea DelMastro - Page 3

Those Who Give

Patient-Benefactors Support New Kidney Transplant Center - Page 4

Virtual Surgical Planning In Subscapular System Free Flap Reconstruction Of Midface Defects., Brian P. Swendseid, Dylan F. Roden, Swar Vimawala, Tony Richa, Larissa Sweeny, Richard A. Goldman, Adam Luginbuhl, Ryan N. Heffelfinger, Shachika Khanna, Joseph Curry

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

OBJECTIVES: Reconstruction of the midface has many inherent challenges, including orbital support, skull base reconstruction, optimizing midface projection, separation of the nasal cavity and dental rehabilitation. Subscapular system free flaps (SF) have sufficient bone stock to support complex reconstruction and the option of separate soft tissue components. This study analyzes the effect of virtual surgical planning (VSP) in SF for midface on subsite reconstruction, bone segment contact and anatomic position.

MATERIALS AND METHODS: Retrospective cohort of patients with midface defects that underwent SF reconstruction at a single tertiary care institution.

RESULTS: Nine cases with VSP were compared to fourteen cases …

Clinical Significance Of Obstructive Sleep Apnea In Patients With Acute Coronary Syndrome In Relation To Diabetes Status., Xiao Wang, Jingyao Fan, Yunhui Du, Changsheng Ma, Xin-Liang Ma, Shaoping Nie, Yongxiang Wei

Department of Emergency Medicine Faculty Papers

Objective: The prognostic significance of obstructive sleep apnea (OSA) in patients with acute coronary syndrome (ACS) according to diabetes mellitus (DM) status remains unclear. We aimed to elucidate the association of OSA with subsequent cardiovascular events in patients with ACS with or without DM.

Research design and methods: In this prospective cohort study, consecutive eligible patients with ACS underwent cardiorespiratory polygraphy between June 2015 and May 2017. OSA was defined as an Apnea Hypopnea Index ≥15 events/hour. The primary end point was major adverse cardiovascular and cerebrovascular events (MACCEs), including cardiovascular death, myocardial infarction, stroke, ischemia-driven revascularization, or hospitalization for …

Mutation Signature Analysis Identifies Increased Mutation Caused By Tobacco Smoke Associated Dna Adducts In Larynx Squamous Cell Carcinoma Compared With Oral Cavity And Oropharynx., Andrew P. South, Nicoline Y Den Breems, Tony Richa, Uche Nwagu, Tingting Zhan, Shiv Poojan, Ubaldo E. Martinez-Outshoorn, Jennifer M. Johnson, Adam J. Luginbuhl, Joseph Curry

Kimmel Cancer Center Papers, Presentations, and Grand Rounds

Squamous cell carcinomas of the head and neck (HNSCC) arise from mucosal keratinocytes of the upper aero-digestive tract. Despite a common cell of origin and similar driver-gene mutations which divert cell fate from differentiation to proliferation, HNSCC are considered a heterogeneous group of tumors categorized by site of origin within the aero-digestive mucosa, and the presence or absence of HPV infection. Tobacco use is a major driver of carcinogenesis in HNSCC and is a poor prognosticator that has previously been associated with poor immune cell infiltration and higher mutation numbers. Here, we study patterns of mutations in HNSCC that are …

Leadership Doctorates Newsletter: Volume 5, Number 4, Larry Starr, Phd

Leadership Doctorates Newsletter (Formerly Strategic Leadership Newsletter)

In this Issue:

• Program Re-Envisioning
• Faculty Award
• 3rd Annual Applied Research Methods Learning Exchange Conference
• Wilkes-Barre Project
• Annual Meeting and Call for Papers
• Jefferson Digital Commons
• 2019-2020 DSL Dissertation Candidates and Titles
• Horse and Carriage Project
• Community Updates and Scholarship
• At This Holiday Season

Treatment Of Dental Complications In Sickle Cell Disease., Priti Mulimani, Samir K. Ballas, Adinegara Bl Abas, Laxminarayan Karanth

Cardeza Foundation for Hematologic Research

BACKGROUND: Sickle cell disease is the most common single gene disorder and the commonest haemoglobinopathy found with high prevalence in many populations across the world. Management of dental complications in people with sickle cell disease requires special consideration for three main reasons. Firstly, dental and oral tissues are affected by the blood disorder resulting in several oro-facial abnormalities. Secondly, living with a haemoglobinopathy and coping with its associated serious consequences may result in individuals neglecting their oral health care. Finally, the treatment of these oral complications must be adapted to the systemic condition and special needs of these individuals, in …

Role Of Echocardiography In Diagnostic Evaluation Of Patients Admitted To Observation Unit., Muhammad Arslan Cheema, Hafez Mohammad Ammar Abdullah, Waqas Ullah, Yasar Sattar, Shujaul Haq, Khadija Cheema, Asrar Ahmad, Zain Ali, Asoka Balaratna

Abington Jefferson Health Papers

BACKGROUND: Syncope is a transient loss of consciousness due to transient decrease in cerebral perfusion. Syncope accounts for a 3-6% of all emergency department visits. Etiology of syncope can be neural, cardiogenic, or vascular. Previous studies have evaluated the types and management of syncope. Echocardiography is a commonly used test in the evaluation of causes of syncope. Whether the benefit compared to financial burden of this diagnostic study is in all subsets of syncope cases remains unclear.

AIM: To evaluate the impact of echocardiography in the diagnostic evaluation of syncope and to evaluate the subset of patients that would benefit …

Feasibility Of Diffusion And Probabilistic White Matter Analysis In Patients Implanted With A Deep Brain Stimulator., J. Muller, M. Alizadeh, L. Li, S. Thalheimer, C. Matias, M. Tantawi, J. Miao, M. D. Silverman, V. Zhang, G. Yun, V. Romo, F. B. Mohamed, C. Wu

Department of Neurosurgery Faculty Papers

Deep brain stimulation (DBS) for Parkinson's disease (PD) is an established advanced therapy that produces therapeutic effects through high frequency stimulation. Although this therapeutic option leads to improved clinical outcomes, the mechanisms of the underlying efficacy of this treatment are not well understood. Therefore, investigation of DBS and its postoperative effects on brain architecture is of great interest. Diffusion weighted imaging (DWI) is an advanced imaging technique, which has the ability to estimate the structure of white matter fibers; however, clinical application of DWI after DBS implantation is challenging due to the strong susceptibility artifacts caused by implanted devices. This …

Multiple Mitochondrial Thioesterases Have Distinct Tissue And Substrate Specificity And Coa Regulation, Suggesting Unique Functional Roles., Carmen Bekeova, Lauren Anderson-Pullinger, Kevin Boye, Felix Boos, Yana Sharpadskaya, Johannes M Herrmann, Erin L. Seifert

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Acyl-CoA thioesterases (Acots) hydrolyze fatty acyl-CoA esters. Acots in the mitochondrial matrix are poised to mitigate β-oxidation overload and maintain CoA availability. Several Acots associate with mitochondria, but whether they all localize to the matrix, are redundant, or have different roles is unresolved. Here, we compared the suborganellar localization, activity, expression, and regulation among mitochondrial Acots (Acot2, -7, -9, and -13) in mitochondria from multiple mouse tissues and from a model of Acot2 depletion. Acot7, -9, and -13 localized to the matrix, joining Acot2 that was previously shown to localize there. Mitochondria from heart, skeletal muscle, brown adipose tissue, and …

Non-Traditional Anti-Emetic Therapy For Cannabinoid Hyperemesis Syndrome: A Case Report, Sara Groome, Pharmd, Kelly Le, Pharmd, Christina Karalis, Pharmd, Eric Selvage, Pharmd, Brandi Thoma, Pharmd, Bcps, Bccp

Pharmacy Presentations, Posters, and Grand Rounds

• Marijuana is one of the most commonly utilized recreational drugs and is widely known for both its anti-emetic and appetite-stimulating properties
• Medicinal-grade marijuana has been available for patients suffering from various medical conditions, such as chemotherapy-induced nausea and vomiting, for example; it also has been utilized in patients with chronic pain, in addition to a number of other disease states
• While casual, intermittent use elucidates the aforementioned positive effects, chronic use of large quantities of marijuana may precipitate the contrary, such as extensive nausea and vomiting, a hallmark of Cannabinoid Hyperemesis Syndrome (CHS)
• CHS is hypothesized to result from alterations …

Interaction Of The Oncoprotein Transcription Factor Myc With Its Chromatin Cofactor Wdr5 Is Essential For Tumor Maintenance., Lance R. Thomas, Clare M. Adams, Jing Wang, April M. Weissmiller, Joy Creighton, Shelly L. Lorey, Qi Liu, Stephen W. Fesik, Christine M. Eischen, William P. Tansey

Department of Cancer Biology Faculty Papers

The oncoprotein transcription factor MYC is overexpressed in the majority of cancers. Key to its oncogenic activity is the ability of MYC to regulate gene expression patterns that drive and maintain the malignant state. MYC is also considered a validated anticancer target, but efforts to pharmacologically inhibit MYC have failed. The dependence of MYC on cofactors creates opportunities for therapeutic intervention, but for any cofactor this requires structural understanding of how the cofactor interacts with MYC, knowledge of the role it plays in MYC function, and demonstration that disrupting the cofactor interaction will cause existing cancers to regress. One cofactor …