Medicine and Health Sciences Commons^™

Nipple Aspirate Cytology And Pathologic Parameters Predict Residual Cancer And Nodal Involvement After Excisional Breast Biopsy., E R Sauter, H Ehya, A Mammen, G Klein

Department of Surgery Faculty Papers

We previously demonstrated that abnormal nipple aspirate fluid (NAF) cytology predicted residual breast cancer (RC) and tumour size after excisional biopsy (EB), although normal NAF cytology did not exclude RC. Tumour size correlates with the risk of lymph node (LN) metastases. LN metastases provide prognostic information allowing medical and radiation oncologists to determine the need for adjuvant therapy. We hypothesized that pathologic factors known after EB, combined with NAF cytology, would predict with a high degree of accuracy the presence of RC and LN spread. NAF cytology and pathologic parameters: tumour distance from biopsy margins, multifocal and multicentric disease, sub-type …

Vdac-Dependent Permeabilization Of The Outer Mitochondrial Membrane By Superoxide Induces Rapid And Massive Cytochrome C Release., M Madesh, György Hajnóczky

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Enhanced formation of reactive oxygen species (ROS), superoxide (O2*-), and hydrogen peroxide (H2O2) may result in either apoptosis or other forms of cell death. Here, we studied the mechanisms underlying activation of the apoptotic machinery by ROS. Exposure of permeabilized HepG2 cells to O2*- elicited rapid and massive cytochrome c release (CCR), whereas H2O2 failed to induce any release. Both O2*- and H2O2 promoted activation of the mitochondrial permeability transition pore by Ca2+, but Ca2+-dependent pore opening was not required for O2*--induced CCR. Furthermore, O2*- alone evoked CCR without damage of the inner mitochondrial membrane barrier, as mitochondrial membrane potential …

Regulation Of Type-Ii Collagen Gene Expression During Human Chondrocyte De-Differentiation And Recovery Of Chondrocyte-Specific Phenotype In Culture Involves Sry-Type High-Mobility-Group Box (Sox) Transcription Factors, David G. Stokes, Gang Liu, Rita Dharmavaram, David Hawkins, Sonsoles Piera-Velazquez, Sergio A. Jimenez

Selected Works of Sergio Jiménez, MD, MACR

During ex vivo growth as monolayer cultures, chondrocytes proliferate and undergo a process of de-differentiation. This process involves a change in morphology and a change from expression of chondrocyte-specific genes to that of genes that are normally expressed in fibroblasts. Transfer of the monolayer chondrocyte culture to three-dimensional culture systems induces the cells to re-acquire a chondrocyte-specific phenotype and produce a cartilaginous-like tissue in vitro. We investigated mechanisms involved in the control of the de-differentiation and re-differentiation process in vitro. De-differentiated chondrocytes re-acquired their chondrocyte-specific phenotype when cultured on poly-(2-hydroxyethyl methacrylate) (polyHEMA) as assayed by morphology, reverse transcriptase PCR of …

A Decentralized, Patient-Centered Approach To Diabetes Disease Management In The Primary Care Setting, Michael Toscani, John P. O'Connor, David B. Nash

College of Population Health Faculty Papers

Although many disease management programs have been developed for diabetes, no single design has proved best for all providers and patient populations. Cost effectiveness is especially relevant to diabetes programs because significant costs of the disease may come from complications that occur later in life, while the costs of the program are incurred immediately. For this reason, diabetes disease management programs with positive outcomes and low implementation costs are of particular importance. We report here on the outcomes of a pilot test of the Steps to Health program developed by Abbott Laboratories. The Steps to Health program was designed to …

From Product Dispensing To Patient Care: The Role Of The Pharmacist In Providing Pharmaceutical Care As Part Of An Integrated Disease Management Approach, Laura T. Pizzi, Jean M. Menz, Geneen R. Graber, Dong-Churl Suh

College of Population Health Faculty Papers

During the past decade, the profession of pharmacy has changed dramatically. The Doctor of Pharmacy degree has replaced the Bachelor of Science degree as the first professional degree offered at most accredited U.S. pharmacy schools. Advanced clinical training is now a mainstay of pharmacy training, and this has enabled pharmacists to contribute to disease management efforts. In addition, technological improvements in prescription processing have afforded pharmacists more time to participate in disease management activities. This paper describes how the role of the pharmacist has changed and reviews the results of programs involving pharmacists as disease management providers in the areas …

Jefferson Alumni Bulletin – Volume 51, Number 1, December 2001

The Bulletin (formerly the Jefferson Medical College Alumni Bulletin)

Jefferson Alumni Bulletin – Volume 51, Number 1, December 2001 Building a dynamic multicultural community at Jefferson, page 4 Farber institute for neurosciences will be headed by Samuel Gandy, page 7 Dean Thomas Nasca’s strategic plan, page 10 Bud Bacharach’56 receives the cornerstone award, page 18

Proteolytic Release Of Cd44 Intracellular Domain And Its Role In The Cd44 Signaling Pathway., I Okamoto, Y Kawano, D Murakami, T Sasayama, N Araki, T Miki, A J Wong, H Saya

Department of Microbiology and Immunology Faculty Papers

CD44 is a widely distributed cell surface adhesion molecule and is implicated in diverse biological processes. However, the nature of intracellular signaling triggered by CD44 remains to be elucidated. Here, we show that CD44 undergoes sequential proteolytic cleavage in the ectodomain and intracellular domain, resulting in the release of a CD44 intracellular domain (ICD) fragment. Consequently, CD44ICD acts as a signal transduction molecule, where it translocates to the nucleus and activates transcription mediated through the 12-O-tetradecanoylphorbol 13-acetate-responsive element, which is found in numerous genes involved in diverse cellular processes. Expression of an uncleavable CD44 mutant as well as metalloprotease inhibitor …

Role Of Protein Kinase C-Delta In The Regulation Of Collagen Gene Expression In Scleroderma Fibroblasts, Sergio A. Jimenez, Svetlana Gaidarova, Biagio Saitta, Nora Sandorfi, David J. Herrich, Joan C. Rosenbloom, Umberto Kucich, William R. Abrams, Joel Rosenbloom

Selected Works of Sergio Jiménez, MD, MACR

Working with cultured dermal fibroblasts derived from control individuals and patients with systemic sclerosis (SSc), we have examined the effects of protein kinase C-delta (PKC-delta) on type I collagen biosynthesis and steady-state levels of COL1A1 and COL3A1 mRNAs. Rottlerin, a specific inhibitor of PKC-delta, exerted a powerful, dose-dependent inhibition of type I and type III collagen gene expression in normal and SSc cells. Optimal rottlerin concentrations caused a 70-90% inhibition of type I collagen production, a >80% reduction in COL1A1 mRNA, and a >70% reduction in COL3A1 mRNA in both cell types. In vitro nuclear transcription assays and transient transfections …

The Importance Of Individualized Pharmaceutical Therapy In The Treatment Of Diabetes Mellitus, David B. Nash, Jennifer B. Koenig, Karen D. Novielli, Renee Liberoni, Miriam Reisman

College of Population Health Faculty Papers

Individualized pharmaceutical care for patients with diabetes is necessary for several reasons. First, diabetes is a highly complex disease caused by the interplay among genetic, physiological, and environmental factors that vary from individual to individual. Second, the profile of patients with diabetes has evolved to include people of all ages and socioeconomic backgrounds, with varying medical histories and health behaviors. Third, diabetes often occurs concurrently with other medical conditions, especially in certain groups, such as the elderly. While the treatment goals for all patients with diabetes are the sameto stabilize and maintain healthy blood glucose levels to prevent serious complicationsthe …

Nurses Alumni Association Bulletin, Fall 2001, Joan Caruso, Paula Levine, Elizabeth K. Prisnock, Marian E. Smith, Sally H. Wagner, John J. Wagner

Nursing Alumni Bulletins

2001 - 2002 Meeting Date Calendar

2002 Annual Luncheon & Meeting Notice

Bulletin Publication Committee, Officers and Committee Chairs

The President's Message

Treasurer's Financial Report

Auditor's Financial Report

Alumni Scholarship Fund

Resume of Minutes

Alumni Office News

Committee Reports

• Nurses Relief Trust Fund
• Clara Melville - Adele Lewis Scholarship Fund
• Nominating
• Social -Annual May Luncheon
• Social - Fall Luncheon of 2000
• Central PA Satellite Committee Report
• Bulletin
• Development

Annual Giving Contributors

News About Our Graduates

Janet C. Hindson Award

Janet C. Hindson Award - Qualifications

Army Nurse Corps Nursing 101

A Loving Aunt's Thoughts

Volunteers In Medicine

Happy Birthday - …

The Review - Fall 2001

Jefferson Review

IN THIS ISSUE

1 - Message From The Dean

2 - A Special Welcome for Alumni Babies

2 - A Very Special Offer for Our Alumni

3 - Farewell to Joann Ludwig

4 - The Admissions-Alumni Partnership

5 - JAVA is Brewing at Jefferson!

6 - What A Year!

8 - Alumni Update

10 - Alumni News Form

11 - Visiting Scholar 2001: A Nurse Alumna Sets the Agenda

12 - Michael Hartman Elected New CHP Alumni President

13 - Commencement 2001

Eliciting The Low-Activity Aldehyde Dehydrogenase Asian Phenotype By An Antisense Mechanism Results In An Aversion To Ethanol., E Garver, Tu Gc, Q N Cao, M Aini, F Zhou, Y Israel

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

A mutation in the gene encoding for the liver mitochondrial aldehyde dehydrogenase (ALDH2-2), present in some Asian populations, lowers or abolishes the activity of this enzyme and results in elevations in blood acetaldehyde upon ethanol consumption, a phenotype that greatly protects against alcohol abuse and alcoholism. We have determined whether the administration of antisense phosphorothioate oligonucleotides (ASOs) can mimic the low-activity ALDH2-2 Asian phenotype. Rat hepatoma cells incubated for 24 h with an antisense oligonucleotide (ASO-9) showed reductions in ALDH2 mRNA levels of 85% and ALDH2 (half-life of 22 h) activity of 55% equivalent to a >90% inhibition in ALDH2 …

Jefferson Alumni Bulletin – Volume 50, Number 4, September 2001

The Bulletin (formerly the Jefferson Medical College Alumni Bulletin)

Jefferson Alumni Bulletin – Volume 50, Number 4, September 2001 Alumni achievement awards: Bacharach and Higgins earn the association’s highest honor, page 4 Underrepresented minority scholarship committee, page 5 Building our resources: innovative new partnerships, page 6 Annual giving raises over $2.3 million, page 12

Pain Control In Healthcare Organizations: Developing Effective Disease Management Programs, C. Richard Chapman, Stephen D. Lande, Bill H. Mccarberg, David B. Nash

College of Population Health Faculty Papers

Although medicine possesses the knowledge and technology for preventing or relieving most pain, poor pain control is still widespread. Unrelieved pain causes unnecessary suffering and increases health care expenditures. Among the barriers to improving pain control are poor provider education in pain management, misguided beliefs about the inevitability of pain and the dangers of pain medication, provider resistance to changing practice patterns, and administrative resistance to implementing improvements that incur short-term costs but lead to long-term savings. In short, poor pain relief in America's health care institutions is a system issue, and improvement requires a system-wide change. An effective program …

Guanylyl Cyclase C Agonists Regulate Progression Through The Cell Cycle Of Human Colon Carcinoma Cells., Giovanni Mario Pitari, M D Di Guglielmo, J Park, S Schulz, Scott A Waldman

Department of Pharmacology and Experimental Therapeutics Faculty Papers

The effects of Escherichia coli heat-stable enterotoxin (ST) and uroguanylin were examined on the proliferation of T84 and Caco2 human colon carcinoma cells that express guanylyl cyclase C (GC-C) and SW480 human colon carcinoma cells that do not express this receptor. ST or uroguanylin inhibited proliferation of T84 and Caco2 cells, but not SW480 cells, in a concentration-dependent fashion, assessed by quantifying cell number, cell protein, and [(3)H]thymidine incorporation into DNA. These agonists did not inhibit proliferation by induction of apoptosis, assessed by TUNEL (terminal deoxynucleotidyl transferase-mediated dNTP-biotin nick end labeling of DNA fragments) assay and DNA laddering, or necrosis, …

Mindfulness-Based Stress Reduction And Health-Related Quality Of Life In A Heterogeneous Patient Population, Diane K. Reibel, Jeffrey M. Greeson, George C. Brainard, Steven Rosenzweig Md

Marcus Institute of Integrative Health Faculty Papers

This study examined the effects of mindfulness-based stress reduction (MBSR) on health-related quality of life and physical and psychological symptomatology in a heterogeneous patient population. Patients (n=136) participated in an 8-week MBSR program and were required to practice 20 min of meditation daily. Pre- and post-intervention data were collected by using the Short-Form Health Survey (SF-36), Medical Symptom Checklist (MSCL) and Symptom Checklist-90 Revised (SCL-90-R). Health-related quality of life was enhanced as demonstrated by improvement on all indices of the SF-36, including vitality, bodily pain, role limitations caused by physical health, and social functioning (all P<.01). Alleviation of physical symptoms was revealed by a 28% reduction on the MSCL (P<.0001). Decreased psychological distress was indicated on the SCL-90-R by a 38% reduction on the Global Severity Index, a 44% reduction on the anxiety subscale, and a 34% reduction on the depression subscale (all P<.0001). One-year follow-up revealed maintenance of initial improvements on several outcome parameters. We conclude that a group mindfulness meditation training program can enhance functional status and well-being and reduce physical symptoms and psychological distress in a heterogeneous patient population and that the intervention may have long-term beneficial effects.

Teaching | Learning | Investigating | Discovering | Treating | Healing, Douglas J. Macmaster Jr., Paul C. Brucker

Thomas Jefferson University Administrative Documents and Reports

2001 Annual report of Thomas Jefferson University.

Quality Improvement Tools In Disease Management, Lisa E. Paddock, Amy L. Phillips, Peter Chodoff

College of Population Health Faculty Papers

Disease management programs require constant monitoring to assure quality and address problems efficiently. To initiate continuous quality improvement in a disease management program, there are several methods available to identify potential problems within the program that may be affecting quality. Some common quality improvement instruments include the Plan-Do-Check-Act model, check sheets, and so forth. Whatever model is used, Statistical Process Control using flow charts, histograms, Pareto diagrams, scatter diagrams, control charts, and cause-and-effect diagrams provides a better understanding about how the organization's processes are functioning. These tools facilitate problem recognition and allow an organization to meet established standards of quality …

The Field Of Disease Management At The Crossroads: An Interview With David B. Nash, Md, Mba, T. J. Basting

College of Population Health Faculty Papers

As David B. Nash, MD, MBA, takes the helm of Disease Management as Editor-in-Chief, the practice of disease management—now a decade old—depends on its practitioners to continue to provide "economic proof of concept." This effort to accrue the credibility needed to design and fund programs will provide further evidence that new technologies can be integrated into care programs across large populations to reduce costs while improving healthcare and access to it.

Jefferson Alumni Bulletin – Volume 50, Number 3, June 2001

The Bulletin (formerly the Jefferson Medical College Alumni Bulletin)

Jefferson Alumni Bulletin – Volume 50, Number 3, June 2001 Parents’ day: a glimpse into students’ lives, page 4 A gift of antique medical instruments, page 6 Interview #8: the rite of applying for residencies, page 8 Hospital appointments for the class of ’01, page 10 Jefferson on the bayou, page 14

Acidification-Induced Sensitization To Thermoradiotherapy In Breast Cancer, Dennis B. Leeper, L T. Komarnicky

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Hyperthermia is an extensively studied cytotoxic agent, with strong radio- and chemosensitizing potential. Recent positive clinical trials combining superficial or deep heating techniques with radiation therapy strongly support a role for hyperthermia as an adjuvant to radiation. Many in vitro and in vivo studies have shown that acute extracellular acidification will compromise fundamental protective cellular responses and enhance tumor response to hyperthermia and chemotherapy.

Breast cancers, like most other tumors, exhibit elevated levels of lactate production that provides a basis for selective acidification. A phase I/II clinical trial is underway to test the hypothesis that hyperglycemia-induced acute acidification will sensitize …

Antioxidant Supplementation In Cancer: Potential Interactions With Conventional Chemotherapy And Radiation Therapy, Clinic Staff

Topics in Integrative Medicine

Several issues are addressed in this discussion of the advantages and disadvantages of supplemental anti-oxidants during cancer treatment with chemotherapy and/or radiation therapy.

Induction Of Beta3-Integrin Gene Expression By Sustained Activation Of The Ras-Regulated Raf-Mek-Extracellular Signal-Regulated Kinase Signaling Pathway., Douglas Woods, Holly Cherwinski, Eleni Venetsanakos, Arun Bhat, Stephan Gysin, Martine Humbert, Paul F. Bray, Vicki L. Saylor, Martin Mcmahon

Cardeza Foundation for Hematologic Research

Alterations in the expression of integrin receptors for extracellular matrix (ECM) proteins are strongly associated with the acquisition of invasive and/or metastatic properties by human cancer cells. Despite this, comparatively little is known of the biochemical mechanisms that regulate the expression of integrin genes in cells. Here we demonstrate that the Ras-activated Raf-MEK-extracellular signal-regulated kinase (ERK) signaling pathway can specifically control the expression of individual integrin subunits in a variety of human and mouse cell lines. Pharmacological inhibition of MEK1 in a number of human melanoma and pancreatic carcinoma cell lines led to reduced cell surface expression of alpha6- and …

Impact Of Smoking On The Outcome Of Anterior Cervical Arthrodesis With Interbody Or Strut-Grafting., Alan Hilibrand, Mark A. Fye, Sanford E. Emery, Mark A. Palumbo, Henry H. Bohlman

Rothman Institute Faculty Papers

BACKGROUND: An increased rate of pseudarthrosis has been documented following posterolateral lumbar spine grafting in patients who smoke. This same relationship has been assumed for anterior cervical interbody grafting, but to our knowledge it has never been proven. This study compared the long-term radiographic and clinical results of smokers and nonsmokers who had undergone arthrodesis with autogenous bone graft following multi-level anterior cervical decompression for the treatment of cervical radiculopathy or myelopathy, or both.

METHODS: One hundred and ninety patients were followed clinically and radiographically for at least two years (range, two to fifteen years). Fifty-nine of the patients had …

Measurement Of The Impact Of Winona Health Online, David B. Nash, David Shulkin, Florence Comite, Ron Loeppke, Bruce Van Cleave, Robert Kane, Jon Christianson, Douglas Pousma

College of Population Health Faculty Papers

The purpose of this article is to present the methodology to study the clinical and financial outcomes associated with the use of Winona Health Online, a novel community-wide interactive healthcare Website in Winona, Minnesota. Outcome methodology was developed by the University of Minnesota School of Public Health and the Carlson School of Management in cooperation with nationally recognized outcomes and disease state management experts, healthcare practitioners in Winona, statisticians, and health economists. The main areas of measurement include health status, satisfaction, cost and utilization of services, and clinical quality.

Chief Medical Officers' Perceptions Of Disease Management Programs, Gang Xu, Lisa E. Paddock, John P. O'Connor, David B. Nash, Mark Zitter

College of Population Health Faculty Papers

The purpose of this article is to examine chief medical officers' (CMOs) perception of disease management programs. Five open-ended questions, each addressing a major issue in the development of disease management programs, were given to 31 CMOs who attended a series of invitation-only conferences on disease management in the fall of 1999. Qualitative data analysis was conducted using the transcripts on each of the issues. Overall, the CMOs viewed the emergence of capitated disease management programs positively. They considered the population of a program to be the contractual patients and/or those at risk for the target disease. On the issue …

Jefferson Alumni Bulletin – Volume 50, Number 2, March 2001

The Bulletin (formerly the Jefferson Medical College Alumni Bulletin)

Jefferson Alumni Bulletin – Volume 50, Number 2, March 2001 Tom Nasca’75 in appointed Dean, page 4 Hospital for neuroscience is created in wills building, page 5 Key molecular pathway in apoptosis, page 8 Swallowing a gene to treat or prevent Cancer? Page 9 “He served Jefferson during difficult times”, page 10 Gardner, Keeley, Slogoff are nominees for trustee, page 21

Association Of Ace Polymorphism And Diabetic Nephropathy In South Indian Patients, Vijay Viswanathan, Yanqing Zhu, Karthik Bala, Stephen Dunn, Chamukuttan Snehalatha, Ambady Ramachandran, Muthu Jayaraman, Kumar Sharma

Department of Medicine Faculty Papers

Objective: To study the association of ACE gene polymorphism and diabetic nephropathy in South Indian subjects.

Setting: Outpatient clinic of a specialized hospital.

Patients: The study included 109 South Indian type 2 diabetic patients (72 males and 37 females; age 56.7±9.0 years, mean±SD). The patients were subdivided into two groups: nephropathic (n=86) and normoalbuminuric patients (n=23).

Interventions: Genomic DNA was isolated from the peripheral blood leukocytes. To determine the ACE genotype, genomic DNA was amplified by PCR initially using a flanking primer pair and, subsequently when necessary, with a primer pair that recognizes the insertion specific sequence for confirmation of …

Teratogen Update: Reproductive Risks Of Leflunomide (Arava); A Pyrimidine Synthesis Inhibitor: Counseling Women Taking Leflunomide Before Or During Pregnancy And Men Taking Leflunomide Who Are Contemplating Fathering A Child, Robert L. Brent

The Selected Works of Robert Brent

Arava™ (leflunomide) is a pyrimidine synthesis inhibitor used in the treatment of active rheumatoid arthritis (RA). The chemical name for leflunomide is N- (4’-trifluoromethylphenyl)-5-methylisoxazole-4-carboxamide. Because the drug has been successful in the treatment of rheumatoid arthritis (RA), it is being widely prescribed. In spite of the clear warning that the drug should not be prescribed for pregnant women, approximately 30 women have become pregnant while taking leflunomide as of December 1999. This commentary was prepared to aid teratology counselors and genetic counselors that might be contacted by physicians or patients about the risk of leflunomide exposure during pregnancy. Before the …

Providing Services To Family Caregivers At Home: Challenges And Recommendations For Health And Human Service Professions, Susan Toth-Cohen, Laura N. Gitlin, Mary Corcoran, Susan Eckhardt, Pamalyn Kearney, Rosalyn Lipsitt

Department of Occupational Therapy Faculty Papers

The home represents a relatively new arena for practice for most service providers, especially those working with families of persons with dementia. This article describes four key factors to consider when working with caregivers of persons with dementia in their homes. The authors also discuss seven common challenges of service provision in the home and recommend strategies for addressing these challenges.