Medicine and Health Sciences Commons^™

Nur77 Mitigates Endothelial Dysfunction Through Activation Of Both Nitric Oxide Production And Anti-Oxidant Pathways, Lin Lu, Soohwa Jang, Jiaqi Zhu, Qing Qin, Lijun Sun, Jianxin Sun

Center for Translational Medicine Faculty Papers

BACKGROUND: Nur77 belongs to the member of orphan nuclear receptor 4A family that plays critical roles in maintaining vascular homeostasis. This study aims to determine whether Nur77 plays a role in attenuating vascular dysfunction, and if so, to determine the molecular mechanisms involved.

METHODS: Both Nur77 knockout (Nur77 KO) and Nur77 endothelial specific transgenic mice (Nur77-Tg) were employed to examine the functional significance of Nur77 in vascular endothelium in vivo. Endothelium-dependent vasodilatation to acetylcholine (Ach) and reactive oxygen species (ROS) production was determined under inflammatory and high glucose conditions. Expression of genes was determined by real-time PCR and western blot …

Effects Of Glp-1 Receptor Agonists On Cardiovascular Outcomes In Patients With Type 2 Diabetes And Chronic Kidney Disease: A Systematic Review And Meta-Analysis, Michael Kelly, Jelena Lewis, Hindu Rao, Jessica Carter, Ivan Portillo, Richard Beuttler

College of Pharmacy Faculty Papers

AIM: To evaluate the cardiovascular outcomes of glucagon-like peptide-1 receptor agonists (GLP1-RA) in patients with type 2 diabetes (T2DM) and chronic kidney disease (CKD).

MATERIALS AND METHODS: We searched PubMed, Ovid MEDLINE, CINAHL, and Web of Science databases for randomized controlled trials reporting event rates for a composite cardiovascular outcome of cardiovascular death, myocardial infarction, and stroke in patients with T2DM and CKD receiving GLP1-RA or placebo. Studies were restricted to those reporting specific event rates for patients with CKD separately from the overall population. We conducted a meta-analysis using a random-effects model. This meta-analysis was registered on PROSPERO (CRD42022320157). …

Smartphone Apps For Diabetes Medication Adherence: Systematic Review, Sheikh Mohammed Shariful Islam, Vinaytosh Mishra, Muhammad U Siddiqui, Jeban Chandir Moses, Sasan Adibi, Lemai Nguyen, Nilmini Wickramasinghe

Division of Internal Medicine Faculty Papers & Presentations

Background: Diabetes is one of the leading noncommunicable chronic diseases globally. In people with diabetes, blood glucose levels need to be monitored regularly and managed adequately through healthy lifestyles and medications. However, various factors contribute to poor medication adherence. Smartphone apps can improve medication adherence in people with diabetes, but it is not clear which app features are most beneficial.

Objective: This study aims to systematically review and evaluate high-quality apps for diabetes medication adherence, which are freely available to the public in Android and Apple app stores and present the technical features of the apps.

Methods: We systematically searched …

Diabetic Care Pathway, Shalini Bansal, Kayla Brockmeyer, Nick Kieran

Physician Executive Leadership-Plus (PEL-Plus)

Presentation Outline

• The Impact of Diabetes
• Problem Statement
• Solution
• Looking to the Future

Case Report: Bilateral Emphysematous Pyelonephritis With Pneumatosis Intestinalis, Maria D'Amico, Joseph Izes, Akhil Das

Department of Urology Faculty Papers

Emphysematous pyelonephritis is a severe and rare gas producing infection in the renal parenchyma or collecting system. Diabetes mellitus is an established risk factor. Treatment options include antibiotics, minimally invasive management such as percutaneous drainage, or nephrectomy. This case report describes a 40-year-old female with newly diagnosed diabetes and cirrhosis who presented with left sided emphysematous pyelonephritis. After initial management with intravenous antibiotics and drainage of the collecting system, this patient's clinical condition worsened, and subsequent repeat imaging revealed bilateral emphysematous pyelonephritis as well as pneumatosis intestinalis.

Racial Disparities In Post-Acute Home Health Care Referral And Utilization Among Older Adults With Diabetes, Jamie Smith, Olga Jarrín, Haiqun Lin, Tina Dharamdasani, Jennifer Tsui, Charlotte Thomas-Hawkins

College of Nursing Faculty Papers & Presentations

Racial and ethnic disparities exist in diabetes prevalence, health services utilization, and outcomes including disabling and life-threatening complications among patients with diabetes. Home health care may especially benefit older adults with diabetes through individualized education, advocacy, care coordination, and psychosocial support for patients and their caregivers. The purpose of this study was to examine the association between race/ethnicity and hospital discharge to home health care and subsequent utilization of home health care among a cohort of adults (age 50 and older) who experienced a diabetes-related hospitalization. The study was limited to patients who were continuously enrolled in Medicare for at …

Preventive Care: Controversies, Challenges And Upcoming Changes In Guidelines, Randa Sifri, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Objectives

• Organizations who make guidelines
• Current guidelines for average-risk adults, with a focus on guidelines with differing recommendations and challenges to implementation/operational issues
• Preview of upcoming changes in guidelines
• Cases to illustrate some of the common questions that come up in delivering office-based preventive care
• Some disclaimers

You Don’T Have To Get Diabetes, Mitch Kaminski, Md, Mba, Nevaneva White, Dnp, Crnp, Cdces

Department of Family & Community Medicine Presentations and Grand Rounds

The goal is to streamline the steps required to make referrals to and enroll in the National Diabeties Prevention Program (DPP).

"I Had No Other Choice But To Catch It Too": The Roles Of Family History And Experiences With Diabetes In Illness Representations., Amy T Cunningham, Alexzandra Gentsch, Lsw, Amanda M B Doty, Geoffrey Mills, Marianna Lanoue, Brendan G. Carr, Judd E Hollander, Kristin L Rising

Department of Family & Community Medicine Faculty Papers

BACKGROUND: A family history of diabetes and family members' experiences with diabetes may influence individuals' beliefs and expectations about their own diabetes. No qualitative studies have explored the relationship between family history and experiences and individuals' diabetes illness representations.

METHODS: Secondary data analysis of 89 exploratory, semi-structured interviews with adults with type 1 or type 2 diabetes seeking care in an urban health system. Participants had a recent diabetes-related ED visit/hospitalization or hemoglobin A1c > 7.5%. Interviews were conducted until thematic saturation was achieved. Demographic data were collected via self-report and electronic medical record review. Interviews were audio-recorded, transcribed, and coded …

Internal Medicine Consultation For Dentists, Nina Mingioni, Md

Clinical Education Teaching Tools

Learning Objectives:

• Recognize ubiquitous nature of common medical condition in general population
• Discuss implications of common medical conditions on dental care of patients
• Identify concerns affecting patients that would necessitate medical consultation prior to dental intervention

Prediction Of Neonatal Birthweight Associated With Maternal Obesity And Diabetes, Laura Gleason, Rebekah Mccurdy, Md, Mph

Phase 1

Introduction: To design a model that will predict neonatal birth weight within obese mothers by diabetic status.

Methods: A secondary data analysis of an RCT (NCT 02909582) was utilized to create a neonatal birth weight prediction model. Women (n=325) with a BMI > 35 kg/m2 from a tertiary academic institution, 2016 – 2019, were included to estimate the risk of large for gestational age (LGA) infants and neonatal birth weight based on maternal prepregnancy BMI and diabetic status. LGA was defined as an infant birth weight > 90th percentile. Analysis included Chi-square, t-test, multivariate logistic and linear regression.

Results: Mean birthweight did …

Nighttime Melatonin Administration And Insulin Sensitivity, Albert Mchugh, Cynthia Cheng, Md, Phd

Phase 1

Introduction: Previous studies have shown melatonin effects on insulin sensitivity, but with conflicting results. The inconsistency between these studies may be due to differences in melatonin dosage and subject age. Low melatonin dosages, generally <5 mg, have been used in prior research. We studied the effect of melatonin 9 mg for 6 weeks on insulin resistance, peripheral microvascular function, and sleep in non-diabetic, non-hypertensive middle-aged and geriatric patients.

Methods: Subjects with a history of hypertension or diabetes were excluded from the study. The geriatric cohort included 5 subjects 60-80 years old while the younger cohort was comprised of 14 subjects age 27-45 years old. Fifteen subjects were randomized to the melatonin treatment group and took 9 mg of controlled-release melatonin by mouth 30 minutes before bedtime for 6 weeks; the four subjects in …

The Effect Of Intrapartum Glycemic Control On The Incidence Of Neonatal Hypoglycemia, Signe Caksa, Amanda Roman, Md

Phase 1

Introduction: 1-2% and 6-9% of pregnancies are complicated by type I/II and gestational diabetes mellitus (DM), respectively, leading to increased risk of adverse neonatal outcomes. Women with DM require glucose monitoring and glycemic control at the time of delivery; however, it remains unclear how variations in intrapartum glucose impact neonatal hypoglycemia.

Methods: This is a retrospective cohort study of women with singleton pregnancies, diagnosed with DM, who delivered >36 weeks gestation after attempting induction of labor at Thomas Jefferson University Hospital between 01/01/2017 and 01/01/2018. Intrapartum DM management included hourly capillary glucose (CG) monitoring until delivery, insulin drip with CG …

Effects Of Medications On Cognitive Function And Falls In Older African Americans With Diabetes, Diana Alnemri, Robin J. Casten

Phase 1

Introduction: Potentially-inappropriate medications (PIMs) are medications that have increased rates of adverse drug events in older adults. Medications with anticholinergic activity are classified as PIMs since they can lead to cognitive dysfunction and increased fall risk. PIM use is higher among African Americans (AA) than Whites.

Methods: This study explored relationships among cognitive function, falls, and PIMs in AAs with diabetes. This study recruited AAs with diabetes (n=99, age ≥60yrs) who were seen in the Emergency Department (ED), and were enrolled in a trial of a behavioral intervention to improve diabetes management. PIMs were based on the Beer’s criteria …

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 …

Shared Learning Meeting Launch – November 8, 2019

Know Diabetes by Heart and Diabetes INSIDE Shared Learning

No abstract provided.

Patient Experience And Challenges In Group Concept Mapping For Clinical Research., Geoffrey D. Mills, Marianna Lanoue, Alexzandra T. Gentsch, Amanda M.B. Doty, Amy Cunningham, Garrison Nord, Kristin L. Rising

Department of Emergency Medicine Faculty Papers

BACKGROUND AND OBJECTIVE: Group concept mapping (GCM) is a research method that engages stakeholders in generating, structuring and representing ideas around a specific topic or question. GCM has been used with patients to answer questions related to health and disease but little is known about the patient experience as a participant in the process. This paper explores the patient experience participating in GCM as assessed with direct observation and surveys of participants.

METHODS: This is a secondary analysis performed within a larger study in which 3 GCM iterations were performed to engage patients in identifying patient-important outcomes for diabetes care. …

Primary Care-Ot For Older African Americans With Diabetes And Mild Cognitive Impairment: Intervention Approaches And Case Stories, Catherine Verrier Piersol, Phd, Otr/L, Faota, Susan Santalucia, Ms, Otr/L, Michele Rifkin, Mhsed, Otr/L, Barry Rovner, Md, Robin Casten, Phd, Neva White, Np, Crnp, Cde

Department of Occupational Therapy Posters and Presentations

Purpose:

To test the efficacy of a collaborative intervention to lower hemoglobin A1c levels (HbA1c) in older African Americans with Type 2 diabetes (DM), Mild Cognitive Impairment (MCI), and suboptimal medication adherence and glycemic control.

Aims:

1. To reduce HbA1c level by 0.5% at 6 and 12 months.
2. To increase MEMS-measured adherence to an oral DM medication at 6 and 12 months.

Hypotheses:

1. Fifty-five percent of intervention participants, compared to 25% of control participants, will have a reduction in HbA1c of 0.5% at 6 months (short term effect) and 12 months (maintenance effect).
2. The Primary Care-Occupational Therapy intervention will increase MEMS-measured …

Pim-1 Kinase Phosphorylates Cardiac Troponin I And Regulates Cardiac Myofilament Function., Ni Zhu, Bing Yi, Zhifu Guo, Guanxin Zhang, Shengdong Huang, Yongwen Qin, Xianxian Zhao, Jianxin Sun

Center for Translational Medicine Faculty Papers

BACKGROUND/AIMS: Pim-1 is a serine/threonine kinase that is highly expressed in the heart, and exerts potent cardiac protective effects through enhancing survival, proliferation, and regeneration of cardiomyocytes. Its myocardial specific substrates, however, remain unknown. In the present study, we aim to investigate whether Pim-1 modulates myofilament activity through phosphorylation of cardiac troponin I (cTnI), a key component in regulating myofilament function in the heart.

METHODS: Coimmunoprecipitation and immunofluorescent assays were employed to investigate the interaction of Pim-1 with cTnI in cardiomyocytes. Biochemical, site directed mutagenesis, and mass spectrometric analyses were utilized to identify the phosphorylation sites of Pim1 in cTnI. …

Sex Differences In Outcomes After Stroke In Patients With Diabetes In Ontario, Canada., Mandip S. Dhamoon, John W. Liang, Limei Zhou, Melissa Stamplecoski, Moira K. Kapral, Baiju R. Shah

Department of Neurology Faculty Papers

BACKGROUND: Outcomes after stroke in those with diabetes are not well characterized, especially by sex and age. We sought to calculate the sex- and age-specific risk of cardiovascular outcomes after ischemic stroke among those with diabetes.

METHODS: Using population-based demographic and administrative health-care databases in Ontario, Canada, all patients with diabetes hospitalized with index ischemic stroke between April 1, 2002, and March 31, 2012, were followed for death, stroke, and myocardial infarction (MI). The Kaplan-Meier survival analysis and Fine-Gray competing risk models estimated hazards of outcomes by sex and age, unadjusted and adjusted for demographics and vascular risk factors.

RESULTS: …

Text Messaging In The Patient-Centered Medical Home To Improve Glucose Control And Retinopathy Screening., Janice M Miller, Ann G. Phalen, Albert Crawford, Anthony Frisby, Barry S. Ziring

College of Nursing Faculty Papers & Presentations

Purpose: To evaluate the effectiveness of a text messaging program (TMP) to improve glucose control, retinopathy screening (RS) rates, and self-care behaviors in patients with uncontrolled type 2 diabetes.

Methods: A single-group design with a quasi-systematic random sample (n=20) received educational/exhortational text messages on their cellular phones for 3 months. Subjects, 12 of whom identified as a minority ethnicity, were mostly male, aged 27-73 years.

Results: Glucose control and RS rates improved significantly. Subjects (>70%) reported changes in self-care behaviors.

Conclusion: Leveraging ubiquitous technology, a TMP for patients with limited access to healthcare education, holds promise

Evaluation Of The Jefferson Family Medicine Associates’ Diabetes Information And Support For Your Health (Dish) Program [Presentation], Amy Cunningham, Phd, Mph

Population Health Science Program Doctoral Dissertations

Type 2 diabetes is increasing in incidence and prevalence, and contributes to significant morbidity, mortality, and costs. Type 2 diabetes management is complex and requires continual patient self-management. However, many physicians lack the time and training to deliver comprehensive diabetes self-management training to their patients, and only 56.8% of individuals with Type 2 diabetes have received formal diabetes education.

Group medical visits (GMVs), which combine one-on-one clinical consultations and group self-management education, have emerged as a promising vehicle for supporting type 2 diabetes management. This dissertation used a quasi-experimental nonequivalent groups design to evaluate the four-session Diabetes Information and Support …

Dielectric Properties Measurements Of Brown And White Adipose Tissue In Rats From 0.5 To 10 Ghz, Dario B. Rodrigues, Paul R. Stauffer, E. Colebeck, A. Z. Hood, S. Salahi, P. F. Maccarini, E. Topsakal

Department of Radiation Oncology Faculty Papers

Brown adipose tissue (BAT) plays an important role in whole body metabolism and with appropriate stimulus could potentially mediate weight gain and insulin sensitivity. Although imaging techniques are available to detect subsurface BAT, there are currently no viable methods for continuous acquisition of BAT energy expenditure. Microwave (MW) radiometry is an emerging technology that allows the quantification of tissue temperature variations at depths of several centimeters. Such temperature differentials may be correlated with variations in metabolic rate, thus providing a quantitative approach to monitor BAT metabolism. In order to optimize MW radiometry, numerical and experimental phantoms with accurate dielectric properties …

Preserving Cognition In Older African Americans With Mild Cognitive Impairment., Barry W. Rovner, Robin J. Casten

Department of Psychiatry and Human Behavior Faculty Papers

No abstract provided.

Variables Prognostic For Delayed Union And Nonunion Following Ulnar Shortening Fixed With A Dedicated Osteotomy Plate., Michael P. Gaspar, Patrick M. Kane, Ralph C Zohn, Taylor Buckley, Sidney M. Jacoby, Eon K. Shin

Department of Orthopaedic Surgery Faculty Papers

PURPOSE: To examine potential risk factors for the development of delayed or nonunion following elective ulnar shortening osteotomy using a dedicated osteotomy plating system.

METHODS: We performed a retrospective review of all patients who underwent elective ulnar shortening using the TriMed single osteotomy dynamic compression plating system by 1 of 2 fellowship-trained hand surgeons over a 5-year period. Demographic data and medical, surgical, and social histories were reviewed. Time to bony union was determined radiographically by a blinded reviewer. Bivariate statistical analysis was performed to examine the effect of explanatory variables on the time to union and the incidence of …

The Emerging Role Of Oxylipins In Thrombosis And Diabetes., Benjamin E Tourdot, Intekhab Ahmed, Michael Holinstat

Division of Endocrinology, Diabetes and Metabolic Diseases Faculty Papers

The prevalence of cardiovascular disease (CVD), the leading cause of death in the US, is predicted to increase due to the shift in age of the general population and increase in CVD risk factors such as obesity and diabetes. New therapies are required to decrease the prevalence of CVD risk factors (obesity and diabetes) as well as reduce atherothrombosis, the major cause of CVD related mortality. Oxylipins, bioactive metabolites derived from the oxygenation of polyunsaturated fatty acids, play a role in the progression of CVD risk factors and thrombosis. Aspirin, a cyclooxygenase-1 inhibitor, decreases atherothrombotic associated mortality by 25%. These …

Regulation Of Lipogenesis By Cyclin-Dependent Kinase 8-Mediated Control Of Srebp-1., Xiaoping Zhao, Daorong Feng, Qun Wang, Arian Abdulla, Xiao-Jun Xie, Jie Zhou, Yan Sun, Ellen S Yang, Lu-Ping Liu, Bhavapriya Vaitheesvaran, Lauren Bridges, Irwin J Kurland, Randy Strich, Jian-Quan Ni, Chenguang Wang, Johan Ericsson, Jeffrey E Pessin, Jun-Yuan Ji, Fajun Yang

Department of Cancer Biology Faculty Papers

Altered lipid metabolism underlies several major human diseases, including obesity and type 2 diabetes. However, lipid metabolism pathophysiology remains poorly understood at the molecular level. Insulin is the primary stimulator of hepatic lipogenesis through activation of the SREBP-1c transcription factor. Here we identified cyclin-dependent kinase 8 (CDK8) and its regulatory partner cyclin C (CycC) as negative regulators of the lipogenic pathway in Drosophila, mammalian hepatocytes, and mouse liver. The inhibitory effect of CDK8 and CycC on de novo lipogenesis was mediated through CDK8 phosphorylation of nuclear SREBP-1c at a conserved threonine residue. Phosphorylation by CDK8 enhanced SREBP-1c ubiquitination and protein …

Community-Based Partnerships For Improving Chronic Disease Management, James Plumb, Laura Carson Weinsten, Rickie Brawer, Kevin Scott

Department of Family & Community Medicine Faculty Papers

With the growing burden of chronic disease, the medical and public health communities are re-examining their roles and opportunities for more effective prevention and clinical interventions. The potential to significantly improve chronic disease prevention and have an impact on morbidity and mortality from chronic conditions is enhanced by adopting strategies that incorporate a social ecology perspective, realigning the patient-physician relationship, integrating population health perspectives into the Chronic Care Model, and effectively engaging communities using established principles of community engagement.

Copyright © 2012 Elsevier Inc. All rights reserved.

Diabetes: It's More Than A Little Sugar

Photonovels

Thomas Jefferson University Hospital – Office to Advance Population Health

Sponsored by Quality Insights of Pennsylvania: Under contract with the Centers for Medicare and Medicaid Services (CMS), protects Medicare patient rights and works collaboratively with health care providers and communities in Pennsylvania to improve the quality of healthcare delivered. To learn more about this non-profit organization, visit www.qipa.org or call 1-800-MEDICARE and ask for information about Quality Insights of Pennsylvania.

Cardiovascular Comorbidities Among Public Health Clinic Patients With Diabetes: The Urban Diabetics Study, Jessica M. Robbins, Chris N. Sciamanna, David A. Webb

College of Population Health Faculty Papers

BACKGROUND:We sought to determine the frequency and distribution of cardiovascular comorbidities in a large cohort of low-income patients with diabetes who had received primary care for diabetes at municipal health clinics.

METHODS:Outpatient data from the Philadelphia Health Care Centers was linked with hospital discharge data from all Pennsylvania hospitals and death certificates.

RESULTS:Among 10,095 primary care patients with diabetes, with a mean observation period of 4.6 years (2.8 after diabetes diagnosis), 2,693 (14.3%) were diagnosed with heart disease, including 270 (1.4%) with myocardial infarction and 912 (4.8%) with congestive heart failure. Cerebrovascular disease was diagnosed in 588 patients (3.1%). Over …