Translational Medical Research Commons^™

The Role Of Toll-Like Receptor 4 In The Progression Of Keloids, Madison Brandes, Nishi Srivastava, Neda Nikbakht

Phase 1

Keloids are highly prevalent in the population and their pathogenesis is largely unknown. T-cell lymphoma research shows that toll like receptor-4 (TLR-4) is highly expressed on CD206+ immunosuppressive macrophages and is implicated in maintaining the tumor microenvironment. Additionally, fibronectin, specifically extra domain A (EDA), is highly expressed and is associated with immunosuppression via the TLR-4 pathway. Assuming that keloids mimic the tumor microenvironment, we hypothesize that TLR-4 is implicated in the pathogenesis of keloids. Using keloid tissue samples and normal breast tissue as a control, immunohistochemistry was performed to observe the presence and co-localization of these markers. Three antibodies were …

Characterizing The Timeline Of Drug Resistant Epilepsy Surgery., Nicole Belliard Martuscelli, Caio Matias, Ashwini Sharan

Phase 1

Introduction: Although early detection and surgery are crucial for positive outcomes in individuals with drug-resistant epilepsy (DRE), a minority of qualifying patients receive it in the US. This retrospective study investigates why some DRE patients who undergo complete pre-surgical assessment end up not receiving surgery.

Methods: We analyzed 211 EPIC charts from all of Jefferson Comprehensive Epilepsy Center's patients who underwent DRE surgical evaluation from 2017 through 2019. To that end, we characterized the DRE surgery timeline and collected data on age, onset of seizures and drug resistance, surgery dates, surgical modalities, and notes that elucidated the reasoning behind …

Evaluation Of Arthroscopic Repair To Pan-Labral Lesions Of The Glenoid: A Retrospective Review Of Patient Outcomes Over A Ten-Year Period And Matched Cohort Analysis, Julien Aoyama, Joseph Schmitz, Christopher Hadley, Meghan Bishop, Md, Brandon Erickson, Md, Sommer Hammoud, Md

Phase 1

Introduction:

Most shoulder labral tears are partial and treated with surgery, but rarely they are “panlabral” around the entire shoulder. Due to infrequency panlabral tears aren’t well understood, and thus this study compares outcomes between panlabral and more common SLAP tears. We hypothesize no difference in outcomes based on surgeon experiences.

Methods:

This is a retrospective cohort study of shoulder labrum repairs at Rothman Institute from 2006-2016. All patients received arthroscopic repair and were categorized to compare panlabral to SLAP tears. The primary outcome is return-to-activity rate at six months post-surgery and secondary outcomes include post-operative range of motion, …

Radiographic Results Of Expandable Interbody Devices, Jonathan Ledesma, Mark Kurd, Md, Kris Radcliff, Md, D. Greg Anderson, Md

Phase 1

Introduction: Minimally invasive surgery for transforaminal lumbar interbody fusion (MIS-TLIF) has become a mainstay procedure in the treatment of degenerative conditions of the lumbar spine. Expandable interbody devices have gained popularity in recent times due to several well-cited advantages including greater correction of disc height and lordosis and decreased intraoperative disruption of neurologic structures. However, the clinical benefits offered by these devices compared to traditional static implants remain unclear. This study seeks to investigate differences in the radiographic and clinical outcomes between traditional static versus expandable interbody devices used in MIS-TLIF.

Methods: Patients who underwent MIS-TLIF performed by three …

Translation Of Ephb2 In Pkcgamma And Calretinin Interneuron Subpopulations After Spinal Cord Injury, David A. Jaffe, Nicolette Heinsinger, Angelo Lepore

Phase 1

Introduction: Neuropathic pain is a common, debilitating occurrence after spinal cord injury (SCI). EphB signaling has been implicated in neuropathic pain, but different populations of neurons that upregulate EphB after SCI must be discovered. Understanding whether EphB2 is upregulated in specific subpopulations of dorsal horn interneurons (e.g. those expressing PKCgamma or calretinin) after injury would increase the understanding of SCI-induced neuropathic pain.

Methods: Mice were either given a contusion-type SCI (n=7) or a laminectomy-only (n=6) at cervical level 5/6. After two weeks of recovery, mRNA was labeled using RNAscope in the sectioned spinal cords. Four different targets were visualized …

The Effect Of Cpap Treatment On T2dm In Moderate To Severe Osa Subjects, Dani Yellanki, Amy He, Grace Severance, Peter Zhang, Zach Feuer, Natali Salinas, Olivia Taylor, Rani Patel, Hannah Kostan, Carl Sun, Catherine Liu, Humaal Khan, Katie Keck, Mikayla Cochrane, Ronak Ahir, Sammy Alfonsi, Will Connolly, Cynthia Cheng, Md, Phd

Phase 1

Introduction: Obstructive sleep apnea (OSA) is a significant risk factor for type 2 diabetes mellitus (T2DM). CPAP treatment can potentially improve glycemic control in such subjects. However, the exact effects of CPAP treatment on diabetes are uncertain. The objective of this study is to examine the effect of CPAP treatment on HbA1c levels in subjects with moderate to severe OSA and T2DM.

Methods: This is a combined retrospective and prospective study collecting data through EPIC medical record reviews. We are collecting HbA1c levels (primary outcome variable) before and after CPAP treatment in subjects with moderate to severe OSA and T2DM. …

Impact Of Covid-19 On Individuals With Opioid Use Disorder’S Access To Services And Substance Use, Camryn Bernheimer, Lara Weinstein, Md

Phase 1

Introduction: The opioid epidemic has already devastated Philadelphia and COVID-19 has the potential to exacerbating this existing crisis. The goal of this study is to investigate how COVID-19 has impacted Medication Assisted Treatment (MAT) service utilization and substance use for individuals with opioid use disorder (OUD).

Methods: 170 participants with OUD in group-based MAT programs in Philadelphia were analyzed three months prior to and after COVID-19. The data provided participant age, gender, race/ethnicity, MAT visits, primary care physician (PCP) visits, behavioral health consult visits (BHC), and urine drug screen (UDS) results from health records. Pre-post COVID-19 relationships were examined …

Assessing The Utilization And Effectiveness Of Pediatric Order Sets In Hpv Vaccine Administration In A Large Urban Family Medicine Practice, Lakshmi Narayanam, Krys Foster, Md, Mph

Phase 1

Introduction: Human papilloma virus (HPV) vaccination remains a controversial topic with low rates of vaccination completion. According to a 2017 National Immunization Survey, only 49% of adolescents were up to date (UTD) on their HPV vaccination, an alarming statistic given its importance in reducing HPV-related cancers. This project seeks to determine the effectiveness of pediatric order sets in affecting rates of HPV vaccine administration in a large urban family medicine practice.

Methods: A retrospective, qualitative chart review was conducted on patients nine years or older seen at Jefferson Family Medicine Associates in Philadelphia, PA from April 2019 to April …

Characterizing The Anesthetic Management Of Patients Undergoing Transradial Cardiac And Cerebrovascular Interventions: A Single-Institution Study, Steven Bieser, Somnath Das, Lohit Velagapudi, Heli Patel, Joshua Weinberg, Lisa Moss, Marguerite Davis, Nicholas Ruggiero, Pascal Jabbour, Victor Romo

Phase 1

Introduction:

Transradial approaches are shown to reduce mortality, morbidity, access-site complications, hospital stay and costs when compared to the transfemoral approach in multiple cardiac trials. Use of the antispasmotic cocktail for these interventions poses challenges for anesthetic management. Differing practices between fields may need to be consolidated. This study aims to characterize the safety profile of cardiac and neuroanesthetic management protocols for transradial interventions, hypothesizing that the cocktail is safe from an anesthetic perspective.

Methods:

We performed a retrospective chart review of patients undergoing transradial diagnostic cardiac and cerebrovascular interventions. Data collected included age, sex, comorbidities, prior antihypertensive medications, dose …

The Use Of Advanced Ultrasound Techniques For The Evaluation Of Uterine Fibroids Pre And Post Uterine Artery Embolization, Kathleen Gillmore, Priscilla Machado, Alison Tan, Carin F Gonsalves, Flemming Forsberg

Phase 1

Introduction: Uterine fibroids are the most common benign tumor in females of reproductive age. Uterine artery embolization (UAE) is a less-invasive alternative to hysterectomy. Our objective is to assess the ability of superb microvascular imaging (SMI) to characterize fibroid microvascularity before and after UAE compared to conventional Doppler modes using contrast-enhanced ultrasound (CEUS) and clinical outcomes as reference standards.

Methods: Participants will be 40 adult females who are scheduled for UAE. Participants receive three transabdominal ultrasounds at day 0, day 14 and day 90 post-UAE using an Aplio i800 scanner. Subjects undergo examination with four non-contrast ultrasound modalities— color doppler …

Celiac Disease: Clinical-Pathological Correlation In 100 Consecutive Patients, Michael J. Dimarino, Sidney Cohen, Md, Stephanie Moleski, Md, Christopher Cao, Md, Michael C. Dimarino, Md, Anthony Dimarino, Md

Phase 1

Introduction: Celiac Disease (CD) is an autoimmune disease that manifests as inflammation in the small intestine that can be measured by both serology (tTG-IgA) and pathology (Marsh scores). Despite having two clear etiologies defining the disease, the relationship between these markers and the clinical presentation is unclear but the age at presentation has thought to be correlated with a worsened pathology.

Methods: This was a retrospective chart review at Thomas Jefferson University Hospital (TJUH). The study consisted of patients diagnosed with Celiac Disease at TJUH with both a Marsh score and a tTG-IgA antibody result. Analysis via correlation statistics …

Prevalence And Risk Factors For Abnormal M-Tics, Maëlys Yepes, Michael Chang, Cynthia Cheng, Md, Phd

Phase 1

Introduction: The lack of effective treatments for Alzheimer’s Disease (AD) underscores the importance of prevention and early detection of amnestic mild cognitive impairment (aMCI), its prodromal state. While studies have proposed a number of potential mechanisms underlying the pathogenesis of AD, such as hypoxia and neuropsychiatric symptoms, little research has been done to evaluate predictive risk factors.

Objective: The objective of this pilot study is to assess the prevalence and risk factors for aMCI.

Methods: This cross-sectional study was performed using data from patients screened for Memories 2, a clinical trial evaluating the effect of CPAP usage in patients with …

Identifying The Roadblocks To Successful Pediatric Imaging Without Sedation Or Anesthesia, Iman Soliman, Ammie M. White, Md, J. Christopher Edgar, Phd, Laura Cadge, Ccls, Margaret Hamel-Daymon, Crnp, Sandra Saade-Lemus, Md, Rochelle Bagatell, Md, Elizabeth T. Drum, Md, Lisa States, Md

Phase 1

Background: Modern imaging modalities allow for assessment of a wide array of medical conditions. Because it is difficult for young children to remain still during lengthy imaging studies, there is a need for sedation and general anesthesia (GA). A growing literature, however, suggests that there may be deleterious neurocognitive effects of sedation/GA in young children. As such, it is in our patients’ best interest to critically evaluate the use of sedation/GA.

Objective: To identify the roadblocks to obtaining clinical pediatric magnetic resonance imaging (MRI) exams without sedation/GA.

Materials and Methods: Participants included 63 parents/guardians of 5- to 9-year-old patients who …

Effectiveness Of A Primary Care Nutrition Education/Vlcd Diet Program, Jessica Vitale, Ayesha Baig, Steven Chang, Hannah Kostan, Connor Mcelwee, Ketav Patel, Cindy Cheng

Phase 1

Introduction: Jefferson currently has a Medical Nutrition Therapy (MNT) program via an educational component delivered via Zoom to assist patients with managing their diet, exercise, medication changes and understanding the physiology of their conditions. We aim to study the effectiveness of the MNT program, along with the impact of duration of program participation, on weight loss, blood pressure, glucose and total cholesterol. In addition, I am focusing on triglycerides, HDL and LDL. We hypothesize that patients in our MNT program will have lower weight, blood pressure, blood glucose and total cholesterol, with a further positive effect of longer participation …

Anatomic Location And Mortality Of Pancreatic Adenocarcinoma: A Single Institution Study, Sophia Lam, Randi Zukas, Ida Micaily, Atrayee Basu Mallick

Phase 1

In pancreatic adenocarcinoma, it is believed that patients with proximal tumors (head) have earlier diagnosis and higher survival due to anatomic location compared to patients with distal tumors (body/tail). We hypothesized that differences in tumor biology would contribute to poorer survival in body/tail tumors compared to head tumors when diagnosed at the same stage.

We performed a retrospective chart review on 324 patients with pancreatic adenocarcinoma (236 head and 88 body/tail) diagnosed from 2011-2017. We gathered electronic health records from a single center with a high volume of pancreatic cancer directed surgery. We compared median patient survival from onset of …

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

Phase 1

Obstructive sleep apnea (OSA) has been shown to significantly promote cardiovascular risk, in part possibly due to activation of the sympathetic nervous system during respiratory events in sleep and its subsequent effects on blood pressure and heart rate. Previous studies have also found associations between long term variability of blood pressure and heart rate with cardiovascular outcomes. We hypothesize that compliance to continuous positive airway pressure (CPAP) therapy will decrease the incidence of cardiovascular events in a dose dependent fashion in patients with moderate to severe OSA.

This retrospective study population consists of patients from the Jefferson Sleep Center with …

Factors Influencing Efficacy And Satisfaction In Prenatal Counseling For Families With Single Ventricle Heart Disease, Taylor Hartzel Houlihan, Jack Rychik, Md

Phase 1

Introduction: The Fetal Heart Program at Children’s Hospital of Philadelphia offers prenatal counseling to families with congenital heart disease diagnoses. This center has yet to examine family satisfaction with counseling, especially those with complicated single ventricle diagnoses. While families may receive sufficient education about their child’s condition, better communication may be needed to prepare them for potential neurological and behavioral complications.

Methods: Through chart review, 355 patient families with single ventricle diagnoses who utilized CHOP prenatal counseling within the past 10 years were identified. Retrospective surveys including Likert scales and open-ended questions were distributed by email. 65 responses were …

Return To Play Criteria Following Operative Management Of Acromioclavicular Joint Separation: A Systematic Review, Richard J. Gawel, Taylor D'Amore, Md, Peters Otlans, Md, Somnath Rao, Steven B. Cohen, Md, Michael G. Ciccotti, Md

Phase 1

Introduction: Acromioclavicular (AC) joint separation is a leading cause of shoulder injury among athletes. High grade injuries may require operative fixation, and comprehensive return to play guidelines have not yet been established. The purpose of this investigation is to summarize return to play criteria following operative management of AC joint separation.

Methods: A systematic review of the literature was performed to evaluate clinical evidence regarding return to play following operative management of isolated AC joint separation. Studies satisfying inclusion criteria were analyzed for return to play timeline and other factors used to guide return to play following surgery.

Results: Sixty-three …

Chronic Kidney Disease Is Associated With Mortality From Covid-19 During Hospitalization In Male Vs. Female Adults, Katherine Senter, Jingjing Zhang

Phase 1

No abstract provided.

Investigation Of Medication Adherence And Rejection In Liver Transplant For Cystic Fibrosis (Cf), Lucia Sanchez, Elizabeth Rand, Md, Phoebe Wood

Phase 1

Introduction: 40% of transplant recipients are non-adherent to medications, causing increased risk of rejection and diminished survival. The relationship between adherence measured as Medication Level Variability Index (MLVI) and graft rejection rates in pediatric liver transplant recipients with CF compared to those without CF will be evaluated. We hypothesize that MLVI is higher and rejection rates are lower in subjects with CF.

Methods: Retrospective chart review of pediatric liver transplants performed at the Children’s Hospital of Philadelphia between 1995-2018 identified 9 CF liver transplant recipients and 9 age matched controls. Medication adherence was assessed using MLVI. An unpaired t-test was …

Effectiveness Of Nutritional Counseling And Vlcd (Very Low Calorie Diet) For Weight Loss And Metabolic Syndromeketav., Ketav Patel, Ayesha Baig, Connor Mcelwee, Jessica Vitale, Cynthia Cheng, Md, Phd

Phase 1

Introduction: Obesity and Diabetes are highly prevalent conditions worldwide. Morbidity and mortality stemming from these conditions has critical implications on the health and day to day lives of patients. A Very Low- Calorie Diet (VLCD) may be an effective tool to aid in lowering weight for both obese and diabetic patients, but has not been well studied. Thus, the efficacy of a VLCD on lowering weight, BMI, blood pressure, HbA1c, Lipid levels, and blood glucose was explored in this pilot study.

Methods: The study’s population is taken from an MNT (medical nutrition therapy) program at Jefferson. Patients who had prior …

Efficacy Of An Appointment Specialist In Reducing Loss To Follow Up In A Retina Practice, Turner D. Wibbelsman, Michael Ammar, Md, Anthony Obeid, Md, Mph, Jason Hsu, Md

Phase 1

Introduction:

Although a new armamentarium has greatly benefitted patients with retinal disease, novel therapeutic approaches require more frequent clinic visits, which may lead to missed treatments and vision loss. This study characterizes patient-reported reasons for missed visits and assesses the efficacy of calling patients for rescheduling missed visits.

Methods:

This retrospective cohort study included patients who missed an appointment for an intravitreal injection between January 2018 and February 2020 at the Retina Service of Wills Eye Hospital. Two calls were made to each patient by an appointment specialist to reschedule the visit and record a reason for the …

Reduced Recovery Times With Total Intravenous Anesthesia In Patients With Obstructive Sleep Apnea, Leonard Estephan, Matthew Stewart, Maurits Boon, Colin Huntley

Phase 1

Introduction: There are currently no specific anesthetic guidelines for patients with obstructive sleep apnea (OSA) undergoing upper airway surgery. Two consistently utilized anesthetic approaches during such procedures include inhalational gas anesthesia and total intravenous anesthesia (TIVA), however whether either is more efficacious remains undefined. We hypothesize that administration of TIVA will lead to reduced post-operative recovery time in patients with comorbid OSA undergoing upper airway surgery.

Methods: A retrospective chart review was performed for patients with comorbid OSA that underwent surgery (upper airway stimulation, nasal surgery, palate surgery) between January 2019 and December 2019. Included patients received either inhaled …

Does Prior Acromioplasty Increase The Incidence Of Acromial Fracture Following Reverse Total Shoulder Arthroplasty? A Retrospective Matched Cohort Analysis, Olivia Blaber, Brandon J. Erickson, Md, Christopher Hadley

Phase 1

Introduction: Reverse total shoulder arthroplasty (RTSA) is an effective treatment option for multiple shoulder pathologies. Arthroscopic acromioplasty is a treatment for subacromial impingement. RTSA can place excess stress on the acromion. No studies have evaluated outcomes following RTSA among patients with prior acromioplasty. The purpose of this study was to report outcomes in patients following RTSA who have had a prior acromioplasty. The authors hypothesized patients with prior acromioplasty who undergo RTSA will have significant improvements in clinical outcomes with no increased risk of acromial fracture.

Methods: Patients from a single institution who underwent RTSA with a history of acromioplasty …

The Prevalence Of Orally Administered Glucocorticoids, Generalized Pustular Psoriasis And Erythrodermic Psoriasis In The Treatment Of Adult Plaque Psoriasis Provided By U.S. Dermatologists, Katherine Awh, Kumar Nasham, Christian Albornoz, Steven Feldman, Anthony Albornoz

Phase 1

Introduction: Orally administered glucocorticoids (OAG) are not recommended for the management of plaque psoriasis (PsO) due to the classically feared outcomes of generalized pustular psoriasis (GPP) and erythrodermic psoriasis (EP). Given their widespread anecdotal use, we hypothesize that the use of OAG is not infrequent among US dermatologists and is rarely complicated by GPP or EP.

Methods: Anonymous electronic survey of 50 US dermatologists. Primary outcomes of interest were the prevalence of OAG in the management of PsO and the prevalence of GPP and EP in the context of OAG tapering.

Results: Overall, 9 out of 50 (18%) respondents …

Effects Of Intravenous Iron Versus Oral Iron For Treatment Of Anemia In Pregnancy On Maternal And Fetal Outcomes: A Systematic Review And Meta-Analysis, Sarah Chen, Julia Burd, Md, Rupsa Boelig, Md

Phase 1

Introduction: Anemia during pregnancy can lead to preterm birth, low fetal birthweight, and poorer neonatal neurological outcomes. The purpose of this study was to compare maternal and fetal outcomes following intravenous (IV) versus oral iron supplementation for iron-deficiency anemia during pregnancy.

Methods: We searched MEDLINE, OVID, Scopus, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials (RCTs) comparing IV versus oral iron supplementation for iron-deficiency anemia during pregnancy. Studies were included in this meta-analysis if they reported maternal and fetal hematologic outcomes. The relative risk (RR) or standard mean difference (SMD) of IV iron supplementation …

Clinical Outcomes Following Lumbar Fusion In Patients With And Without A History Of Spinal Cord Stimulation Therapy, Jake Budlow, Ellina Hattar, Heli Patel, Thiago S. Montenegro, Glenn A. Gonzalez, Garrett Largoza, Christopher Elia, Caio M. Matias, Chengyuan Wu, Ashwini D. Sharan, James S. Harrop

Phase 1

Introduction:

The treatment of chronic back pain is a challenging and costly issue faced by patients across the United States. Spinal cord stimulators (SCS) or lumbar fusion surgery can be utilized in cases of intractable pain. This study aims to determine if a history of a thoracic SCS influences patient recorded outcomes measures (PROMs) of lumbar fusions at six months.

Methods:

This retrospective cohort study includes patients who underwent elective lumbar fusions at Thomas Jefferson University Hospital between January 2018 and December 2019. PROMs were measured, specifically the Oswestry Disability Index (ODI), preoperatively and 6 months postoperatively. Clinical outcomes …

Assessment Of The Diagnostic Accuracy Of Core Needle Biopsy In The Diagnosis Of Lymphoma, Christopher A. Gardner, Xiangyun Ye, Catherine Tucker, Md, Austin Redilla, Guldeep Uppal, Md, Adam F. Binder

Phase 1

Introduction: Excisional biopsy (EB) of lymph nodes is the gold standard for diagnosing lymphoma. Recent literature suggests that diagnostic techniques such as immunohistochemistry, flow cytometry and FISH/Cytogenetics yield similar diagnostic adequacy rates when paired with less invasive procedures, like Core Needle Biopsy (CNB). We were interested in comparing the diagnostic odds ratio and adequacy of patients suspected of lymphoma who underwent CNB to EB at Thomas Jefferson University Hospital (TJUH).

Methods: We performed a retrospective cohort study on biopsies collected from 01/01/2016 and 12/31/2019 at TJUH. Specimens were considered diagnostically inadequate if there was not enough lesional tissue for …

Real-Time Baseline Coagulation Profiles Using Rotem In Patients Undergoing Liver Transplantation, Paul Del Prato, Uzung Yoon, Md

Phase 1

Real-time monitoring of blood coagulation during invasive surgeries is an important component of ensuring patient safety and effective treatment. Rotational thromboelastometry (ROTEM) is a viscoelastic monitoring system of hemostasis in blood that allows for ongoing measurement of global markers of coagulation. This study compares coagulation in a population of hepatocellular carcinoma liver-transplant patients (HCC) with a transplant population of other etiologies (non-HCC). A database of ROTEM measurements acquired peri-operatively during liver transplantation was compiled from over 400 Jefferson patients. A baseline profile was developed comprised of ROTEM measurements of clot initiation/stability that can be used as a methodological standard. Analysis …

Effects Of Continuous Positive Airway Pressure (Cpap) Sleep Apnea Treatment On Mild Cognitive Impairment (Mci) And Cardiovascular Risk, Olivia Taylor, Cynthia Cheng, Md, Phd

Phase 1

There is a documented association between sleep apnea and earlier onset of cognitive impairment later in life. We hypothesize that nightly treatment with CPAP therapy will improve MCI status as estimated by a panel of neuropsychiatry tests in patients >55 with OSA and concomitant memory complaints. With a prospective cohort design, patients compliant with CPAP therapy are being compared to noncompliant patients and a non-OSA control group. My role in this multi-site project was to screen potential patients from Jefferson’s sleep clinic for eligibility for study enrollment. This study is still ongoing. OSA’s high prevalence makes it a worthwhile endeavor …