Translational Medical Research Commons^™

Establishing The Relationship Between Mendelian Nafld And Skin Pathology, Anthony Medvedev, Hassan Vahidnezhad, Phd, Leila Youssefian, Phd, Jouni Uitto, Md, Phd

Phase 1

Introduction:

It is estimated that 25% of the world’s population has some form of Nonalcoholic Fatty Liver Disease (NAFLD), a pathology associated with the development of cirrhosis, varices, and hepatocellular carcinoma. The discovery of a biallelic mutation in ABHD5 established the link between NAFLD and Chanarin-Dorfman syndrome. Consequently, it was hypothesized that additional NAFLD-inducing mutations could be associated with dermatologic manifestations.

Methods:

International NAFLD patients from consanguineous families underwent whole exome sequencing. These results were then filtered by frequency and pathogenicity prediction algorithms (e.g. Mutation Taster, Polyphen, CADD) to yield novel mutations. Concurrently, a literature review via PubMed identified …

Expanding The Whipple Accelerated Recovery Pathway (Warp) To All Patients Undergoing Pancreaticoduodenectomy (Pd), Ava Torjani, Clifford Yudkoff, Taylor R. Kavanagh, Wilbur Bowne, Geoffrey Krampitz, Hamza Rshaidat, Cyrus J. Sholevar, Alexandra C. Leto, William Preston, Elwin Tham, Mandeep Shergill, Shawnna Cannaday, Theresa Yeo, Harish Lavu, Charles J. Yeo

Phase 1

Introduction

Enhanced recovery after surgery constitutes a multi-disciplinary approach to reduce length of stay (LOS), post-operative complications (POCs), and readmission rate (RR). This not only improves patient outcomes, but also reduces hospital costs. The Whipple Accelerated Recovery Pathway (WARP) trial successfully reduced LOS without increasing the rate of POCs and RR in patients undergoing pancreaticoduodenectomy (PD). However, the study was limited to a highly selective group of patients. This study aimed to determine if WARP could be expanded to all patients undergoing PD.

Methods

A single-institution retrospective review of 281 patients who underwent PD between 2017-2020 was conducted. Patients were …

Differences In Clinical And Functional Outcomes Between Osteochondral Allograft Transplantation And Autologous Chondrocyte Implantation When Used In The Treatment Of Focal Grade 3 And Grade 4 Articular Cartilage Defects, Daniel Abraham, Joseph Brutico, Kashyap Chauhan, Anant Dixit, Fotios Tjoumakaris, Brad Tucker, Kevin Freedman

Phase 1

Introduction:

Grade 3 and 4 articular cartilage defects involve 50% of cartilage thickness without involvement of the underlying bone. There are several available options for the surgical repair of articular cartilage lesions including osteochondral allograft transplantation (OCA), a well-established procedure, and autologous chondrocyte implantation (ACI), an alternative developed more recently. Although there are studies examining ACI outcomes, there hasn’t been significant comparison of ACI outcomes to other procedures, including OCA. The inquiry question of this study was: how do clinical and functional outcomes differ between patients with focal articular cartilage defects treated with ACI and patients treated with OCA? …

Impact Of Medical Nutrition Therapy On Blood Pressure, Connor Mcelwee, Jessica Vitale, Cynthia Cheng, Md, Phd

Phase 1

Introduction:

We are studying how Jefferson’s Medical Nutrition Therapy (MNT) program has impacted biometric variables in program participants. These variables include body weight, HgA1C, lipids, and blood pressure (BP). My poster will focus on the impact of Jefferson’s MNT on blood pressure. My hypothesis is that participation in MNT will result in reduced blood pressure.

Methods:

The target population is patients who have participated in Jefferson’s MNT program. Study exclusion criteria included history of gastric bypass surgery, medical conditions or medication usage that might impact weight loss and other dependent variables. Data was abstracted from patients’ medical records, as …

Outcomes Following Open Reduction And Internal Fixation For Distal Humerus Fracture: Does Handedness Matter?, Charlotte N. Shields, Joseph R. Johnson, Jack M. Haglin, Sanjit R. Konda, Md, Kenneth A. Egol, Md

Phase 1

Introduction: No studies have assessed the relationship between extremity dominance and distal humerus fractures. This study sought to compare post-operative outcomes between patients with distal humerus fractures treated by open reduction and internal fixation (ORIF) of their non-dominant vs dominant arm.

Methods: A retrospective review of patients who sustained a distal humerus fracture treated with ORIF at one hospital between 2011-2015 was performed. Data collection included demographics, hand dominance, injury information, and surgical management. Post-operative outcomes included complications, time to fracture union, painful hardware, removal of hardware, Mayo Elbow Performance Index (MEPI), and range of motion.

Results: Of the …

The Use Of Imiquimod For The Treatment Of Empd From The Patients’ Perspective, Darren D'Mello, Paul Chung, Md

Phase 1

Introduction:

Imiquimod is a topical medication used to treat many dermatologic conditions, and it has been used to treat patients with Extra-Mammary Paget’s Disease. There have been case reports that described the effects and outcomes of patients who were treated with Imiquimod, but more research on its use for EMPD must be done. There have been no studies that gathered data from the patients themselves; this is what our study hopes to accomplish. We hypothesize that patients with EMPD who were treated with Imiquimod early after their diagnoses or after surgery had better outcomes than those who did not use …

Validation And Accuracy Of Synovial Alpha Defensin In A Suburban Academic Center After Implantation As Part Of The Workup For Periprosthetic Joint Infections, Donald Willier, Iii, Kenneth J. Mcalpine, Md, Anthony F. De Giacomo, Md, John S. Garfi, Ms, Lawrence M. Specht, Md, Michael S. Kain, Md

Phase 1

Introduction

Periprosthetic joint infection (PJI) is a leading cause of total hip and knee arthroplasty failure. The Musculoskeletal Infection Society (MSIS) criteria for PJI has allowed diagnosis standardization. To increase the MSIS criteria accuracy, synovial fluid biomarkers have been tested. Studies evaluating synovial alpha defensin have reported both sensitivity and specificity up to 100%. In this study, we report our analysis on the use of alpha defensin testing in a suburban academic tertiary referral center.

Methods

We performed a retrospective analysis of a prospectively collected database of 133 patients tested for PJI over a 6 year period. From 2014, our …

Effect Of Recipient Diabetes Status On Immune Rejection After Descemet Stripping Endothelial Keratoplasty, Elliot Cherkas, Zeba Syed, Michael Sulewski

Phase 1

This study seeks to determine whether recipient diabetes status relates to incidence of immune rejection following Descemet Stripping Endothelial Keratoplasty (DSEK). We hypothesized that patients with diabetes would have a greater risk of graft immune rejection.

This is a retrospective cohort study to compare recipient diabetes status in 794 DSEK surgeries at Wills Eye Hospital between January 2008 and July 2019. Kaplan-Meier functions of survival time until first immune rejection was compared between groups. Pearson’s chi square test and Wilcoxon test were used to test the null hypothesis.

During the study period, 146 of 794 DSEK recipients had diabetes. At …

Machine Learning By Ultrasonography For Risk Stratification Of Axillary Breast Lymph Nodes, Joshua Yu, John Eisenbrey, Phd, Aylin Tahmasebi, Md

Phase 1

Introduction: Breast cancer is the most common cancer among women worldwide, and ultrasonography has been an essential tool in the management of breast cancer. In order to improve upon ultrasonography efficacy, establishing a machine learning image analysis model would provide additional prognostic and diagnostic factors in the evaluation, monitoring, and treatment of breast cancer.

Methods: This retrospective study utilizes axillary lymph node ultrasound images of patients at Thomas Jefferson University Hospital who have had axillary lymph node biopsies. Automated machine learning of the images was performed on AutoML Vision; Google LLC which generated custom models for classification. About 80% of …

The Impact Of Patient Characteristics On Quality Of Life In Keloid Patients, Jonathan Wang, Romsin Zaya, Rachel Zachian, Mary Metkus, Neda Nikbakht

Phase 1

Introduction: Quality of life (QoL) is an important metric in assessing dermatological diseases such as keloids. This study evaluated the effects of patient characteristics on QoL in keloid patients.

Methods: This was a cross-sectional study. 36 patients presenting to the keloid clinic at TJUH were surveyed. QoL subscale scores for emotion, symptom, and function were calculated in addition to a total score for each patient using a keloid-specific questionnaire. The association between the QoL scores and patient characteristics of sex, ethnicity, as well as keloid location, duration, visibility, size, number, pain score, and pruritis score were evaluated using t-tests. …

Total Knee Arthroplasty In Patients With Prior Meniscus Surgery: A Matched Case Control Study, Lasya Rangavajjula, Steven B. Cohen, Md, Meghan E. Bishop, Md, Shyam Brahmabhatt, Md, Michael G. Ciccotti, Md, Ashley Bassett, Md, Christopher Hadley

Phase 1

Introduction: Meniscus surgery is one of the most commonly performed orthopedic surgical procedures in the United States. However, outcomes following a Total Knee Arthroplasty (TKA) in patients with a history of prior knee arthroscopy are varied with small patient cohorts, warranting further research. The research question investigates how the clinical outcomes of TKA compare between patients with and without prior meniscectomy history. It is hypothesized that there will be no significant difference in clinical outcomes between the two cohorts.

Methods: The study design is a retrospective case-control study. The study population included patients from Rothman Institute with TKA and …

Predictors And Characteristics Of Rib Fracture Following Sbrt For Lung Tumors, Michael P. Carducci, Baskaran Sundaram, Md, Benjamin Greenberger, Md, Maria Werner-Wasik, Md, Gregory C. Kane, Md

Phase 1

See Additional Files section for the abstract.

Predictive Value Of Index Lesion Cross-Sectional Area In Diffuse Large B Cell Lymphoma Patients Treated With Chimeric Antigen Receptor T-Cells, Nicole Winchell, Drew Torigian, Md, Stephen Schuster, Md

Phase 1

No abstract provided.

A Meta-Analysis Of The Effects Of Sglt-2 Inhibitors On Serum Electrolytes, Mark Leibensperger, Jingjing Zhang, Md, Phd, Yonghong Huan, Md

Phase 1

Introduction: Previous studies have reported that sodium-glucose co-transporter 2 (SGLT2) inhibitors affect serum electrolytes levels, especially magnesium. This study aims to integrate direct and indirect trial evidence to evaluate the relative effects of all SGLT2 inhibitors against each other on electrolyte levels in patients with type 2 diabetes (T2D).

Methods: Electronic databases were systematically searched through December 2018 to identify eligible randomized controlled trials (RCTs) that reported mean changes in serum electrolyte levels, including magnesium, sodium, potassium, phosphate, calcium, and urate in patients with T2D. Random-effects pairwise and network meta-analyses were performed to calculate the weighted mean difference (WMD) …

Correlates Of Rem Sleep Without Atonia In Dream Enactment Behavior Associated With Parkinson’S Disease, Nisha Bagchi, Ritu Grewal, Abigail Quintos, Rohin Saroya

Phase 1

Introduction: Parkinson’s Disease (PD), a common neurodegenerative disease worldwide, has few reliable biomarkers. PD has been linked to REM Behavioral Disorder (RBD), a condition where patients abnormally experience REM sleep without atonia (RSWA). We aim to determine whether chin movements, a feature of RSWA, could serve as a PD biomarker. We hypothesize that those with higher RSWA are more likely to have PD.

Methods: Our study examined patients who underwent polysomnograms from 2015 onwards at the Jefferson Sleep Disorders Center. We did a retrospective EPIC chart review and compared 2 groups, those with RBD and PD (n=12) versus RBD …

Coronary Artery Disease And Nonalcoholic Fatty Liver Disease: Clinical Correlation Using Ct Coronary Calcium Scans, Richard S. Kirby, Dina Halegoua-De Marzio

Phase 1

Introduction: Nonalcoholic fatty liver disease (NAFLD) and coronary artery disease (CAD) have been explored with coronary angiography which showed a link between severe NAFLD and CVD risk. This study’s aim is to determine if CT coronary artery calcium (CAC) scores used to determine CAD severity in asymptomatic populations can help predict presence of NAFLD.

Methods: Retrospective cross-sectional study of positive CT CAC scores and liver imaging with either CT, ultrasound, or MRI of the abdomen or CT of the chest. Drinking 7 or 14 drinks per week for a woman or man respectively and chronic viral hepatitis diagnosis …

Patient And Renal Allograft Outcomes Of Anticoagulation Therapy In Kidney Transplantation, Rachel Greene, Goni Katz-Greenberg, Md

Phase 1

Introduction: Kidney transplant recipients are often on anticoagulation or antiplatelet therapy, for a variety of indications. These medications are associated with increased risk of bleeding but may reduce risk of thrombosis and possible complications such as allograft loss. The aim of our study is to evaluate the effect of perioperative anticoagulation or antiplatelet therapy on patient and allograft outcomes.

Methods: Data collection was done by retrospective chart review of all patients who underwent a kidney or kidney/pancreas transplantation at Thomas Jefferson University Hospital (TJUH) from 2012-2019. We recorded perioperative anticoagulation and antiplatelet therapy, risk factors for bleeding and thrombosis, …

Treatment Of Distal Radius Fractures In Patients Over 80 Years Of Age: Functional Outcomes After Open Reduction And Internal Fixation Versus Nonoperative Treatment, Robert Gallivan, Lili E. Schindelar, Md, Mph, Richard Mcentee, Pedro K. Beredjiklian, Md

Phase 1

INTRODUCTION

Distal radius fractures are one of the most common fractures seen in the elderly. With the younger physiological age of patients over 60 years, the expectation of functional outcomes is changing. The management of distal radius fractures in the elderly patient, especially those over the age of 80, has not been well defined. The purpose of this study was to compare operative to nonoperative treatment of distal radius fractures in patients older than 80 years to determine if there is any difference in functional outcomes or complications.

METHODS

A retrospective review was performed to identify patients 80 years or …

Development Of A Method Using Retrograde Neuronal Tracers To Neuroanatomically Characterize Respiratory Neural Circuitry, Samantha Thomas, Angelo Lepore

Phase 1

Introduction:

Loss of respiratory function is one of the leading causes of death following spinal cord injury (SCI). Existing studies have demonstrated that pre-phrenic interneurons (PPIN’s) can be recruited into the phrenic motor neuron (PhMN) pathway following cervical SCI and may contribute to respiratory recovery, but there is still a lack of information detailing the nature of these changes and the extent they may improve diaphragm function. This project aims to validate a method of utilizing neuronal tracers to further characterize the intact respiratory circuitry.

Methods:

This study was carried out using a rat model. A fluorophore-conjugated retrograde neuronal …

Sperm Donor Attitudes And Experiences On Direct-To-Consumer Genetic Testing, Sascha Wodoslawsky, Joy Fatunbi, Md, Andrea Braverman, Md

Phase 1

Introduction: Direct-to-consumer (DTC) genetic testing provides a way for genetically linked persons to connect, threatening the anonymity promised by sperm banks to past sperm donors. This study will assess whether these testing resources have changed attitudes of previous donors on donation and their likelihood to donate again.

Methods: A cross-sectional survey was distributed to sperm donors between 1980 and 2020 at Fairfax Cryobank, measuring variables including demographics and donor attitudes on DTC testing. The Qualtrics survey platform aggregated responses and descriptive statistics were used to report outcomes.

Results: Of the 364 responses, 72.8% of donors had not participated …

Abcd Progression Post Crosslinking For Keratoconus, Sonali Patel, Neil Vadhar, Zeba Syed

Phase 1

Introduction:

Keratoconus is a corneal disease that leads to various ocular illnesses such as scarring and thinning and the most common treatment for this disease at this time is Cross Linking. Previously, post-surgical outcomes of cross linking were analyzed using the AK (Amsler- Krumeich) system which didn’t account for posterior corneal surface and corneal thickness. In order to overcome these shortcomings, a new ABCD classification was developed which accounts for anterior (A) and posterior (B) radius of curvature, thinnest corneal pachymetry (C) and distance for best corrected vision (D).

Methods:

A retrospective study was done using 104 patients who …

Angiogram Negative Subarachnoid Hemorrhage: Incidence, Outcomes, And Predisposition, Victoria Coaxum, Ahmad Sweid, Md, Julie Barbera, Nicolas Nelson, Grace Severance, Angelo D'Antonio-Bertagnolli, Manan Parekh

Phase 1

Introduction: Subarachnoid hemorrhage (SAH) is a medical emergency that may lead to deleterious outcomes unless the underlying cause is determined and managed promptly to prevent further rebleed. Though a significant percentage of cases of SAH have no identifiable pathology, there is a lack of data related to outcomes, predispositions, and whether there has been an increase in the incidence of angiogram negative SAH (anSAH). This study aimed to assess the current incidence of anSAH and factors that are associated with outcomes and predisposition among patients diagnosed with anSAH.

Methods: A retrospective chart review was performed. Medical records of patients …

Cryo Vs Rf P-Wave Characteristics Comparative Analysis, Waleed Khan, Behzad Pavri, John Schanz

Phase 1

Introduction:

Atrial fibrillation is one of the leading causes of heart failure and stroke in the US, meaning that optimizing treatment is essential. There are two catheter based PVI techniques used to treat drug-refractory AF patients: radiofrequency and cryo-balloon ablation. The goal of this study is to determine if there is a difference in efficacy between these two procedures.

Methods:

The study consisted of a retrospective chart review and ECG analysis of approximately 130 patients. The criteria for involvement is patients diagnosed with drug-refractory paroxysmal AF and who have undergone an ablation procedure in the past two years. Baseline characteristics …

Genetic Profiling Of Cell Types In The Pathogenesis Of Nonalcoholic Steatohepatitis (Nash), Yanki Yarman, Raj Vadigepalli

Phase 1

NASH is the progressive form of non-alcoholic fatty liver disease (NAFLD) which affects 25% of adults in the US. We are interested in identifying genetic markers for specific cell populations in the liver and hypothesize that cells undergo genetic reprogramming to handle the molecular stresses of the NASH disease state.

Using previously published single-cell RNA sequencing datasets from mouse liver whole tissue, we identified the top 25 most highly variable genes per cell type in NASH liver tissue. Using R-programming language, datasets from both healthy and diseases livers were deconvoluted, normalized, linearized and dimensionally reduced to create a 3D map …

Expanding The Whipple Accelerated Recovery Pathway (Warp) To All Patients Undergoing Pancreaticoduodenectomy (Pd), Taylor R. Kavanagh, Clifford Yudkoff, Ava Torjani, Geoffrey W. Krampitz, Wilbur Bowne, Hamza Rshaidat, Cyrus J. Sholevar, Alexandra C. Leto, William Preston, Elwin Tham, Mandeep Shergill, Shawnna Cannaday, Theresa Yeo, Harish Lavu, Charles J. Yeo

Phase 1

Introduction:

Pancreaticoduodenectomy (PD) is a complex abdominal procedure with high rates of perioperative morbidity. The Whipple Accelerated Recovery Pathway (WARP) was developed for highly selected patients undergoing PD to reduce hospital length of stay (LOS) and time to adjuvant therapy (TTAT), without increasing post-operative complications (POC) or readmission rates (RR). The purpose of this study was to determine if WARP could be implemented for all-risk patients undergoing PD.

Methods:

A single-institution, retrospective analysis of 281 patients implemented on the WARP between 2017-2020 was performed. 119 patients were categorized as WARP-eligible (WEPs) according to original inclusion criteria, and 162 were …

Likelihood Of Germline Mutation With Solitary Unilateral Retinoblastoma Based On Patient Age At Presentation. A Real-World Analysis Of 482 Consecutive Patients., Martin Calotti, Carol L. Shields, Md, Philip Dockery, Md, Mph, Megan Ruben, Antonio Yaghy, Md, Madalyne A. Sunday, Emily R. Duffner, Hannah J. Levin, Olivia S. Taylor, Sara E. Lally, Md, Jerry A. Shields, Md

Phase 1

Introduction: Retinoblastoma due to germline mutation has a greater risk of bilateral presentation, and multifocal or extraocular involvement. In solitary unilateral retinoblastoma, the inheritance pattern is less understood and assumed to be somatic. We assessed the likelihood of germline inheritance in children with unilateral retinoblastoma and whether it varies based on age at presentation.

Methods: This was a retrospective case study assessing 482 consecutive patients with solitary unilateral retinoblastoma at Wills Eye Hospital between 1972 and 2020 for the likelihood of germline inheritance based on age at presentation (≤1 year vs. >1 year). Germline inheritance was deemed likely if …

Factors Influencing General Surgeons To Involve Urologists In Bladder Trauma Management, Joseph Schultz, Paul Chung, Md

Phase 1

Introduction: Bladder trauma injuries, which are graded by severity, often require immediate care and surgical management by General Surgeons (GS) or Urologists. This study seeks to understand the inconsistencies that exist in collaboration between GS and Urologists in bladder trauma management. We hypothesize that the decision for GS to involve Urologists in bladder trauma management is a multifactorial decision with severity of bladder trauma being the primary determining factor as opposed to other factors like provider experience or hospital setting.

Methods: This cross-sectional descriptive study surveyed GS to determine how likely they were to involve Urologists in bladder trauma …

Effects Of Continuous Positive Airway Pressure On Blood Pressure In Obstructive Sleep Apnea, Amy He, Dani Yellanki, Grace Severance, Peter Zhang, Zachary Feuer, Natali Salinas, Cynthia Cheng, Md, Phd

Phase 1

Introduction:

Obstructive sleep apnea (OSA) has been previously linked to the development of hypertension, possibly through the proposed mechanism of recurrent episodes of intermittent hypoxia leading to endothelial dysfunction, inflammation, and metabolic dysregulation. This study aims to investigate continuous positive airway pressure (CPAP) therapy, a first-line therapy for OSA, and its effects on blood pressure in patients with moderate to severe OSA. We hypothesize that compliance to CPAP leads to a decrease in average annual systolic and diastolic blood pressure, compared to noncompliant and non-CPAP use.

Methods:

Our study is a combined retrospective and prospective EPIC chart review study. Moderate …

Short Term Response To Trigger Finger Injections, Neil Patel, Richard Mcentee, Daniel Seigerman

Phase 1

Introduction: Pain, clicking, and locking are common presentations in patients with hand conditions and more often than not, the cause is a trigger finger. The common practice to treat trigger fingers is a corticosteroid injection. The purpose of this study was to determine how these injections affect patients in the short term.

Methods: Patients who underwent corticosteroid injections from June 2019 to September 2019 was the population of study. Phone interviews were conducted with patients each week for 3 weeks following their injection. Patients were questioned about pain and triggering symptoms. Other demographic data was collected to be reviewed …

Assessment Of Treatment Response Of Keloid Patients, Mary Metkus, Rachel Zachian, John Bruckbauer, Neda Nikbakht, Md, Phd

Phase 1

Introduction: Keloids are benign skin overgrowths, often accompanied by pain and pruritis. Despite many modalities, treatment of keloids is difficult due to variable response and high recurrence rates. This study evaluated the efficacy of surgical excision compared to intralesional triamcinolone in the treatment of keloids.

Methods: This was a retrospective study. Through a medical chart review, patients with keloids treated in the Jefferson Health System from 2018-2020 were identified and included. Participants were surveyed via telephone to assess change in size, pain and pruritis of their keloid in response to treatment. Participants ranked pain and pruritis severity from 1-10 before …