Medicine and Health Sciences Commons^™

Exuberant Arytenoid Edema Following Gore-Tex Thyroplasty, Mopileola Tomi Adewumi, Eli Bress, Robert T Sataloff

Otolaryngology (ENT) Resident Research

Arytenoid edema is not a well-described complication of thyroplasty. We report a case of exuberant arytenoid edema following thyroplasty in a 33-year-old female. The diagnosis was made post-operative day 1, the patient was immediately started on a 6-day course of methylprednisone with voice rest. The arytenoid edema completely resolved within 1 week.

Fusion Versus Fixation In Complex Comminuted C3-Type Tibial Pilon Fractures: A Systematic Review., Yash P Chaudhry, Efstratios Papadelis, Hunter Hayes, Philip F Stahel, Erik A Hasenboehler

Orthopedic Surgery Resident Research

BACKGROUND: Comminuted intra-articular tibial pilon fractures can be challenging to manage, with high revision rates and poor functional outcomes. This study reviewed [1] treatment, complications, and clinical outcomes in studies of complex comminuted tibial pilon fractures (type AO43-C3); and [2] primary ankle arthrodesis as a management option for these types of complex injuries.

METHODS: A systematic literature search was performed on PubMed from 1990 to 2020 to determine complications and outcomes after staged fracture fixation and primary ankle joint arthrodesis for comminuted C3-type tibial pilon fractures. The search was conducted in compliance with the PRISMA guidelines, using the following MeSH …

Neuron-Specific Imp2 Overexpression By Synapsin Promoter-Driven Aav9: A Tool To Study Its Role In Axon Regeneration., Sarah Blizard, Danielle Park, Natalie O'Toole, Sheeva Norooz, Martin Dela Torre, Young Son, Adam Holstein, Scarlett Austin, Joshua Harman, Samantha Haraszti, Daved Fared, Mei Xu

PCOM Scholarly Papers

Insulin-like growth factor II mRNA-binding protein (IMP) 2 is one of the three homologues (IMP1-3) that belong to a conserved family of mRNA-binding proteins. Its alternative splice product is aberrantly expressed in human hepatocellular carcinoma, and it is therefore identified as HCC. Previous works have indicated that IMP1/ZBP1 (zipcode binding protein) is critical in axon guidance and regeneration by regulating localization and translation of specific mRNAs. However, the role of IMP2 in the nervous system is largely unknown. We used the synapsin promoter-driven adeno-associated viral (AAV) 9 constructs for transgene expression both in vitro and in vivo. These viral vectors …

Application Of Single-Cell Rna Sequencing Technology In Liver Diseases: A Narrative Review., Lian He, Anjing Lu, Lin Qin, Qianru Zhang, Hua Ling, Daopeng Tan, Yuqi He

PCOM Scholarly Papers

Objective: This review aimed to summarize the application of single-cell transcriptome sequencing technology in liver diseases.

Background: The increasing application of single-cell ribonucleic acid (RNA) sequencing (scRNA-seq) in life science and biomedical research has greatly improved our understanding of cellular heterogeneity in immunology, oncology, and developmental biology. scRNA-seq has proven to be a powerful tool for identifying and classifying cell subsets, characterizing rare or small cell subsets and tracking cell differentiation along the dynamic cell stages. Globally, liver disease has high rates of morbidity and mortality, and its exact pathological mechanism remains unclear, current treatment options are limited to clearance …

Cartilaginous Choristoma Of The External Auditory Canal., Harleen K Sethi, Melanie Shpigel, Ghiath Alnouri, Jing Zhou, Robert T Sataloff

Otolaryngology (ENT) Resident Research

Cartilaginous choristoma is a rare benign lesion of the external auditory canal, generally found incidentally on physical exam in an asymptomatic patient. Our patient had the largest cartilaginous choristomas described in the literature to date. Additionally, this reviews the nomenclature and differential diagnoses of masses within the external auditory canal.

Mitochondrial Targeted Antioxidants, Mitoquinone And Skq1, Not Vitamin C, Mitigate Doxorubicin-Induced Damage In H9c2 Myoblast: Pretreatment Vs. Co-Treatment, Brian Sacks, Halil Onal, Rose Martorana, Amogh Sehgal, Amanda Harvey, Catherine Wastella, Hafsa Ahmad, Erin Ross, Adona Pjetergjoka, Sachin Prasad, Robert J. Barsotti, Lindon H. Young, Qian Chen

PCOM Scholarly Papers

BACKGROUND: Preconditioning of the heart ameliorates doxorubicin (Dox)-induced cardiotoxicity. We tested whether pretreating cardiomyocytes by mitochondrial-targeted antioxidants, mitoquinone (MitoQ) or SKQ1, would provide better protection against Dox than co-treatment.

METHODS: We investigated the dose-response relationship of MitoQ, SKQ1, and vitamin C on Dox-induced damage on H9c2 cardiomyoblasts when drugs were given concurrently with Dox (e.g., co-treatment) or 24 h prior to Dox (e.g., pretreatment). Moreover, their effects on intracellular and mitochondrial oxidative stress were evaluated by 2,7-dichlorofluorescin diacetate and MitoSOX, respectively.

RESULTS: Dox (0.5-50 μM, n = 6) dose-dependently reduced cell viability. By contrast, co-treatment of MitoQ (0.05-10 μM, n …

Addressing And Inspiring Vaccine Confidence In Black, Indigenous, And People Of Color During The Coronavirus Disease 2019 Pandemic, Jasmine R Marcelin, Talia H Swartz, Fidelia Bernice, Vladimir Berthaud, Robbie Christian, Christopher Da Costa, Nada Fadul, Michelle Floris-Moore, Matifadza Hlatshwayo, Patrik Johansson, Ravina Kullar, Kimberly Manning, Edo-Abasi U. Mcgee, Christopher Medlin, Damani A Piggott, Uzma Syed, Jessica Snowden, Tina Tan, Jacinda C Abdul-Mutakabbir

PCOM Scholarly Papers

During the coronavirus disease 2019 (COVID-19) pandemic, we have witnessed profound health inequities suffered by Black, Indigenous, and People of Color (BIPOC). These manifested as differential access to testing early in the pandemic, rates of severe disease and death 2-3 times higher than white Americans, and, now, significantly lower vaccine uptake compared with their share of the population affected by COVID-19. This article explores the impact of these COVID-19 inequities (and the underlying cause, structural racism) on vaccine acceptance in BIPOC populations, ways to establish trustworthiness of healthcare institutions, increase vaccine access for BIPOC communities, and inspire confidence in COVID-19 …

Hereditary Angioedema., Helen Lesser, Jason E Cohn

Otolaryngology (ENT) Resident Research

A 14-year-old African American female presented to the emergency department with spontaneous, sudden-onset lip swelling for 1 h. On examination, there was significant water-bag edema of the upper lip extending to the philtrum and premaxilla. Nasopharyngeal laryngoscopy revealed a patent airway without edema. She was initiated on intravenous dexamethasone, famotidine, and diphenhydramine, after which her edema improved but did not resolve. She was subsequently transferred to a local pediatric hospital and upon further testing she was found to have a C1 esterase inhibitor de novo gene mutation. Angioedema causes localized, non-pitting edema of the dermis, subcutaneous and submucosal tissue, and …

Reducing Unnecessary Crossmatching For Hip Fracture Patients By Accounting For Preoperative Hemoglobin Concentration, Raj M Amin, Varun Puvanesarajah, Yash P Chaudhry, Matthew J Best, Sandesh S Rao, Steven M Frank, Erik A Hasenboehler

Orthopedic Surgery Resident Research

BACKGROUND: Maximum surgical blood order schedules were designed to eliminate unnecessary preoperative crossmatching prior to surgery in order to conserve blood bank resources. Most protocols recommend type and cross of 2 red blood cell (RBC) units for patients undergoing surgery for treatment of hip fracture. Preoperative hemoglobin has been identified as the strongest predictor of inpatient transfusion, but current maximum surgical blood order schedules do not consider preoperative hemoglobin values to determine the number of RBC units to prepare prior to surgery.

AIM: To determine the preoperative hemoglobin level resulting in the optimal 2:1 crossmatch-to-transfusion (C:T) ratio in hip fracture …

Examining Concurrent Validity Between Comlex-Usa Level 2-Cognitive Evaluation And Comlex-Usa Level 2-Performance Evaluation., Brandon Craig, Xiaolin Wang, Jeanne Sandella, Tsung-Hsun Tsai, David Kuo, Charles Finch

PCOM Scholarly Papers

CONTEXT: The Comprehensive Osteopathic Medical Licensing Examination of the United States of America (COMLEX-USA) is a three level examination used as a pathway to licensure for students in osteopathic medical education programs. COMLEX-USA Level 2 includes a written assessment of Fundamental Clinical Sciences for Osteopathic Medical Practice (Level 2-Cognitive Evaluation [L2-CE]) delivered in a computer based format and separate performance evaluation (Level 2-Performance Evaluation [L2-PE]) administered through live encounters with standardized patients. L2-PE was designed to augment L2-CE. It is expected that the two examinations measure related yet distinct constructs.

OBJECTIVES: To explore the concurrent validity of L2-CE with L2-PE. …

Validation Of A 5-Item Tool To Measure Patient Assessment Of Clinician Compassion In Hospitals, Brian W Roberts, Michael B. Roberts, Anthony Mazzarelli, Stephen Trzeciak

PCOM Scholarly Papers

BACKGROUND: We previously validated a 5-item compassion measure to assess patient experience of clinician compassion in the outpatient setting. However, currently, there is no validated and feasible method for health care systems to measure patient experience of clinician compassion in the inpatient setting across multiple hospitals.

OBJECTIVE: To test if the 5-item compassion measure can validly and distinctly measure patient assessment of physician and nurse compassion in the inpatient setting.

DESIGN: Cross-sectional study between July 1 and July 31, 2020, in a US health care network of 91 community hospitals across 16 states consisting of approximately 15,000 beds.

PATIENTS: Adult …

A Clinical Review Of Robotic Navigation In Total Knee Arthroplasty: Historical Systems To Modern Design., Ahmed Siddiqi, Timothy Horan, Robert M Molloy, Michael R Bloomfield, Preetesh D Patel, Nicolas S Piuzzi

Orthopedic Surgery Resident Research

Robotic-assisted total knee arthroplasty (RA-TKA) has shown improved reproducibility and precision in mechanical alignment restoration, with improvement in early functional outcomes and 90-day episode of care cost savings compared to conventional TKA in some studies. However, its value is still to be determined.Current studies of RA-TKA systems are limited by short-term follow-up and significant heterogeneity of the available systems.In today's paradigm shift towards an increased emphasis on quality of care while curtailing costs, providing value-based care is the primary goal for healthcare systems and clinicians. As robotic technology continues to develop, longer-term studies evaluating implant survivorship and complications will determine …

Return To Play Rates After Ulnar Nerve Transposition And Decompression Surgery: A Retrospective Analysis., Christopher J Hadley, Anant Dixit, John Kunkel, Alex E White, Michael G Ciccotti, Steven B Cohen, Christopher C Dodson

Orthopedic Surgery Resident Research

Background: Medial elbow pain is a common complaint in overhead throwing athletes. The throwing motion places repetitive tensile and compressive forces on the elbow resulting in significant stress across the ulnohumeral joint. This stress can result in soft-tissue, ligamentous, and ulnar nerve injury. The purpose of this study was to retrospectively investigate the clinical findings and outcomes, including return to play rates, of patients who underwent ulnar nerve transposition surgery for isolated ulnar neuritis.

Methods: Throwing athletes who underwent isolated, primary ulnar nerve transposition surgery over an eight-year period, 2009 to 2017, were identified and included in our analysis. Nonthrowing …

Which Motivational Behaviors Impact Success In A Clinical Anatomy Course For Entry Level Doctor Of Physical Therapy Students?, Philip Fabrizio, Anne M.R. Agur, Shannon L. Groff

PCOM Scholarly Papers

Objectives: The motivational behavior of self-efficacy for learning and performance was correlated with academic success in Doctor of Physical Therapy (DPT) students taking clinical anatomy, the first foundational course in the program. Students’ motivation strategies have been reported to be important factors in academic success, however, these strategies have not been investigated in DPT students. Therefore, the purpose of this study was to determine if course grade in clinical anatomy was correlated with the motivation subscales of the Motivated Strategies for Learning Questionnaire (MSLQ).Materials and Methods: The MSLQ was administered to 33first-year DPT students who consented to participate in the …

Effect Of Motivational Behaviors And Race/Ethnicity On Academic Success In Physical Therapy Students: A Preliminary Study, Philip Fabrizio

PCOM Scholarly Papers

Objectives: Doctor of Physical Therapy (DPT) program admissions criteria and markers indicative of academic success appear to be mismatched. Acceptance into a DPT program implies that students have developed self-regulated learning strategies however, motivation behaviors are not typically assessed during the admissions process. The aim of this study was to determine direct effects of motivational behaviors and race/ethnicity on academic success and the moderating effect of race/ethnicity on motivational behaviors. Methods: Thirty-three first-year DPT students participated during their first foundational course, clinical anatomy. Motivation subscales from the motivated strategies for learning questionnaire (MSLQ) were used to assess student motivation behaviors …

The Philadelphia Surgery Conference: A Value Analysis Of A Hands-On Surgical Skill-Building Event., Luke Dipasquale, Robert Libera, Chi Chi Do-Nguyen, Elizabeth Brehman, Vishwant Tatagari, Heather Waring, Denah Appelt, Arthur Sesso

PCOM Scholarly Papers

Context: Limited opportunities exist to practice technical skills and to be exposed to various surgical specialties during preclinical medical education.

Objectives: To assess the value of workshop-based educational opportunities to medical students during preclinical training.

Methods: One hundred and 75 medical and physician assistant students from 10 medical schools attended the 2019 Philadelphia Surgery Conference. All students received STOP THE BLEED® bleeding control training and participated in four workshops, chosen from a list of 23, that demonstrated a variety of surgical skills. Data collection was accomplished using both a pre- and postconference survey to assess changes in confidence of personal …

Repurposing Dextromethorphan And Metformin For Treating Nicotine-Induced Cancer By Directly Targeting Chrna7 To Inhibit Jak2/Stat3/Sox2 Signaling, Lu Wang, Du Liang, Xiao Xiong, Yusheng Lin, Jianlin Zhu, Zhimeng Yao, Shuhong Wang, Yi Guo, Yuping Chen, Kyla Geary, Yunlong Pan, Fuyou Zhou, Shegan Gao, Dianzheng Zhang, Sai-Ching Jim Yeung, Hao Zhang

PCOM Scholarly Papers

Smoking is one of the most impactful lifestyle-related risk factors in many cancer types including esophageal squamous cell carcinoma (ESCC). As the major component of tobacco and e-cigarettes, nicotine is not only responsible for addiction to smoking but also a carcinogen. Here we report that nicotine enhances ESCC cancer malignancy and tumor-initiating capacity by interacting with cholinergic receptor nicotinic alpha 7 subunit (CHRNA7) and subsequently activating the JAK2/STAT3 signaling pathway. We found that aberrant CHRNA7 expression can serve as an independent prognostic factor for ESCC patients. In multiple ESCC mouse models, dextromethorphan and metformin synergistically repressed nicotine-enhanced cancer-initiating cells (CIC) …

The Effects Of Resveratrol On Prostate Cancer Through Targeting The Tumor Microenvironment., Natalie Silk, Jeremy Reich, Rahul Sinha, Shivansh Chawla, Kyla Geary, Dianzheng Zhang

PCOM Scholarly Papers

Prostate cancer is one of the most common cancers diagnosed in men in the United States and the second leading cause of cancer-related deaths worldwide. Since over 60% of prostate cancer cases occur in men over 65 years of age, and this population will increase steadily in the coming years, prostate cancer will be a major cancer-related burden in the foreseeable future. Accumulating data from more recent research suggest that the tumor microenvironment (TME) plays a previously unrecognized role in every stage of cancer development, including initiation, proliferation, and metastasis. Prostate cancer is not only diagnosed in the late stages …

Identification Of 3-Chymotrypsin Like Protease (3clpro) Inhibitors As Potential Anti-Sars-Cov-2 Agents., Vicky Mody, Joanna Ho, Savannah Wills, Ahmed Mawri, Latasha Lawson, Maximilian C C J C Ebert, Guillaume M Fortin, Srujana Rayalam, Shashidharamurthy Taval

PCOM Scholarly Papers

Emerging outbreak of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection is a major threat to public health. The morbidity is increasing due to lack of SARS-CoV-2 specific drugs. Herein, we have identified potential drugs that target the 3-chymotrypsin like protease (3CLpro), the main protease that is pivotal for the replication of SARS-CoV-2. Computational molecular modeling was used to screen 3987 FDA approved drugs, and 47 drugs were selected to study their inhibitory effects on SARS-CoV-2 specific 3CLpro enzyme in vitro. Our results indicate that boceprevir, ombitasvir, paritaprevir, tipranavir, ivermectin, and micafungin exhibited inhibitory effect towards 3CLpro enzymatic activity. The 100 …

A Case Of Diastematomyelia Presenting With Minimal Neurologic Deficits In A Middle-Aged Patient, Gabriella Mamo, Rishu Batra, Jeffrey Steinig

Transitional Year

Diastematomyelia is a rare congenital deformity of the spine in which the spinal cord is split into two hemicords along the sagittal plane. This condition belongs to the group of spinal dysraphisms, is more common in females, and is usually diagnosed prenatally or during childhood; rarely is it diagnosed in adults. We report a male patient in his 50s in which diastematomyelia of the thoracic spine was incidentally encountered after receiving a CT scan of the chest for shortness of breath. Although most patients with this condition are symptomatic, the patient did not display any significant acute neurological complaints at …

The Modern Use Of The Extended Humeral Head (Cuff Tear Arthropathy) Hemiarthroplasty., Tyler J Smith, Sarav S Shah, Justin W Peterson, Glen Ross

Orthopedic Surgery Resident Research

Today, the treatment of osteoarthritis in the rotator cuff-deficient population is largely dominated by reverse shoulder arthroplasty (RSA). Despite the popularity of and increased familiarity with this procedure, the complication rate of RSA remains significant. An extended humeral head hemiarthroplasty may provide a less invasive alternative for select patients with cuff tear arthropathy (CTA) and preserved glenohumeral active elevation. With the indications for reverse arthroplasty expanding to younger patients, there are concerns about the longevity of this implant, as well as the associated revision burden. In the setting of failed RSA, the bone stock available for glenosphere baseplate fixation can …

Evaluation Of Albumin Use In A Community Hospital Setting: A Retrospective Study Looking At Appropriate Use And Prescribing Patterns., Timothy Coyle, Samuel John

PCOM Scholarly Papers

PURPOSE: Albumin has been shown to be safe and effective in clinical practice for a wide variety of indications. The purpose of this medication use evaluation is to quantify the use of albumin in the community hospital setting based on indication and prescribing department.

METHODS: This study is a retrospective, single-center, chart review over a 6-month period of 186 patients aged 18 and older who were treated with IV human albumin 5% or 25% at a single 202-bed community hospital setting from February 1, 2020, to August 1, 2020. A chart review was completed for each patient and the data …

Acute Response And Neuroprotective Role Of Myo/Nog Cells Assessed In A Rat Model Of Focal Brain Injury., Sahlia Joseph-Pauline, Nathan Morrison, Michael Braccia, Alana Payne, Lindsay Gugerty, Jesse Mostoller, Paul Lecker, E-Jine Tsai, Jessica Kim, Mark Martin, Rushil Brahmbhatt, Grzegorz Gorski, Jacquelyn Gerhart, Mindy George-Weinstein, Jonathan Stone, Sivaraman Purushothuman, Arturo Bravo Nuevo

PCOM Scholarly Papers

Focal brain injury in the form of a needlestick (NS) results in cell death and induces a self-protective response flanking the lesion. Myo/Nog cells are identified by their expression of bone morphogenetic protein inhibitor Noggin, brain-specific angiogenesis inhibitor 1 (BAI1) and the skeletal muscle specific transcription factor MyoD. Myo/Nog cells limit cell death in two forms of retinopathy. In this study, we examined the acute response of Myo/Nog cells to a NS lesion that extended from the rat posterior parietal cortex to the hippocampus. Myo/Nog cells were identified with antibodies to Noggin and BAI1. These cells were the primary source …

Bilateral Sensorineural Hearing Loss In The Setting Of Acute Methamphetamine Overdose, Jeremy Reich, Harleen Sethi, Robert Sataloff

Otolaryngology (ENT) Resident Research

Substance abuse is a rare but known cause of sensorineural hearing loss (SNHL). We report a case of acute SNHL in a 28-year-old man following an overdose of methamphetamine and incidental ingestion of fentanyl. On initial encounter, he had moderate-to-severe hearing loss in the right ear and severe-to-profound hearing loss in the left ear in addition to acute kidney injury, liver failure, and lactic acidosis. The patient was treated with a two-week course of high-dose steroids and expressed a subjective improvement in hearing. This case highlights the importance of auditory testing following a drug overdose and is one of the …

A Rare Case Report Of A Corpus Callosal Splenial Lesion In The Context Of Atypical Neuroleptic Malignant Syndrome., Ryan Serdenes, Samuel Orr, Pamela Trio, Seetha Chandrasekhara, Meghan Musselman

Transitional Year

In this report, we describe a case of atypical neuroleptic malignant syndrome (NMS) presenting with an isolated lesion in the splenium of the corpus callosum (ILSCC). There is a paucity of information regarding this topic within the literature and only 7 previous case reports have been published at the time of writing. To our knowledge, this case report is also the first to describe an atypical NMS variant in the context of an ILSCC. In this report, we describe the important considerations in formulating differential diagnosis for ILSCC and are the first report to propose a possible pathophysiological mechanism relating …

Identification And Simultaneous Determination Of The Main Toxical Pyrrolizidine Alkaloids In A Compound Prescription Of Traditional Chinese Medicine: Qianbai Biyan Tablet, Mengting Yang, Daopeng Tan, Anjing Lu, Lin Qin, Changhong Wang, Hua Ling, Yanliu Lu, Yuqi He

PCOM Scholarly Papers

Qianbai biyan tablet (QT) is a compound prescription of traditional Chinese medicine which is used to treat nasal congestion, rhinitis, and nasosinusitis, with Senecio scandens as its main plant material. Several pyrrolizidine alkaloids (PAs) were reported in Senecio scandens and others of Senecio species. Although Senecio scandens is assigned as the legal plant material of QT, whether replaced use of it by other Senecio plants can bring toxicity is unknown because of the lack of quantitative data about toxic PAs between different Senecio species. In the present study, adonifoline, senkirkine, and another PA presumed as emiline have been identified in …

Identification Of Pyrrolizidine Alkaloids In Senecio Plants By Liquid Chromatography-Mass Spectrometry, An-Jing Lu, Yan-Liu Lu, Dao-Peng Tan, Lin Qin, Hua Ling, Chang-Hong Wang, Yu-Qi He

PCOM Scholarly Papers

Pyrrolizidine alkaloids (PAs) are considered as the major constituents that cause hepatoxicity in Senecio plants. PAs can be found in about 3%-5% of the world's flowering plants. Nowadays, the identification method of PAs by separation and preparation was too slow and lacked effective power. A rapid method to identify PAs in plants must be developed. Based on the fragmentation regularity, the hepatoxic PAs and nonhepatoxic PAs were characterized by liquid chromatography-mass spectrometry (LC-MS). The detailed structures of PAs in five Senecio plants were identified based on tandem mass spectrometry (MS/MS) spectrum and chemical research information. In the present study, some …

Primary Dural Lymphoma Mimicking En Plaque Cerebellopontine Angle Meningioma, Mei Xu, Ashish Bains, Yuan Rong

PCOM Scholarly Papers

Primary dural lymphoma (PDL) usually arises from the calvarial dura without the brain parenchyma or systemic involvement and thus may not be considered as a typical form of primary CNS lymphoma (PCNSL). It is exceedingly rare. When it occurs, it might not be suspected as a primary diagnosis on clinical and radiologic findings. We present a PDL case that occurs at the cerebellopontine (CP) angle mimicking en plaque meningioma. The tumor histopathology showed a lymphoproliferative disorder immunophenotypically consistent with a low-grade marginal zone lymphoma. Bone marrow and systemic involvements were not identified, and a diagnosis of PDL was established. As …