Digital Commons Network^™

Contrast Enhancement, G-Cimp Subtype, And Cdkn2a/B Homozygous Deletion In Idh-Mutant Astrocytoma, Mehak Majid Khan, Wenyin Shi, Iyad Alnahhas

Department of Neurology Faculty Papers

No abstract provided.

Plane Xanthoma, Connor A. Sheehan, Theresa N. Tran, Jason B. Lee, Jeffrey Y. Liu, Sylvia Hsu

Department of Dermatology and Cutaneous Biology Faculty Papers

No abstract provided.

A Rubric For Assessing Conformance To The Ten Rules For Credible Practice Of Modeling And Simulation In Healthcare, Alexandra Manchel, Ahmet Erdemir, Lealem Mulugeta, Joy Ku, Bruno Rego, Marc Horner, William Lytton, Jerry Myers, Rajanikanth Vadigepalli

Computational Medicine Center Faculty Papers

The power of computational modeling and simulation (M&S) is realized when the results are credible, and the workflow generates evidence that supports credibility for the context of use. The Committee on Credible Practice of Modeling & Simulation in Healthcare was established to help address the need for processes and procedures to support the credible use of M&S in healthcare and biomedical research. Our community efforts have led to the Ten Rules (TR) for Credible Practice of M&S in life sciences and healthcare. This framework is an outcome of a multidisciplinary investigation from a wide range of stakeholders beginning in 2012. …

Full Issue: Volume 20, Number 3 - Spring 2025

Jefferson Surgical Solutions

A publication for friends and colleagues of Jefferson’s Department of Surgery

In This Issue

Cover Story Toll Institute Integrates Cardiac and Vascular Services Across Jefferson Health - Page 1

Overview Surgery: Exciting Times at Jefferson Health - Page 2

On the Job Lauren Meloni, MHA, PTA - Page 2

Education Combating Limb Loss: Coalition Brings Life-Saving Screenings to Underserved Communities - Page 2

Changing Lives Through Research Department Pilot Grants Enable Continued Scientific, Clinical Advances - Page 3

Please Welcome New Faculty - Page 3

Those Who Give Grateful Mother Honors Merli: ‘Great Doctor, Even Better Human Being’ - Page …

News In Brief

Jefferson Surgical Solutions

Our department mourns the recent loss of past faculty member – Herbert E. Cohn, MD. He passed away on March 10, 2025, at the age of 94.

Dr. Cohn was a proud Jeffersonian – he graduated from Jefferson Medical College in 1955 and completed both general surgery and cardiothoracic surgery residencies at Jefferson. He was a devoted, demanding and talented general, thoracic and endocrine surgeon and a dedicated teacher during his many decades at Jefferson. His contributions – too lengthy to cover here – include 20 years’ tenure as Vice Chair of Surgery, service as the President of Medical …

Grateful Mother Honors Merli: ‘Great Doctor, Even Better Human Being’

Jefferson Surgical Solutions

For Peggy Bertorelli, family has always come first. The 77-year-old has devoted her life to loving and caring for her husband, three children and their spouses, and her eight grandchildren. Recent years have brought heartbreaking changes to her family: the loss of her son, Andrew, following a brief illness in 2021 and her husband, David, in 2024.

More than 20 years ago, she nearly lost her daughter, Cristina. Through that ordeal, she met Geno J. Merli, MD. Dr. Merli, who is now celebrating 50 years of service at Jefferson Health, quickly became an honorary member of the Bertorelli clan.

In …

Combating Limb Loss: Coalition Brings Life-Saving Screenings To Underserved Communities

Jefferson Surgical Solutions

Black men in Philadelphia experience amputation at twice the rate compared to other men across Pennsylvania. It’s a stark disparity that medical and community health leaders – including the Frazier Family Coalition – are working to reverse.

At the front lines of this effort are three dedicated clinicians: Jefferson vascular surgeon Paul J. DiMuzio, MD, Jefferson podiatrist Ronald Renzi, DPM, and Neva White, DNP, Executive Director of the Frazier Family Coalition for Stroke Education and Prevention (coordinated through Vickie & Jack Farber Institute for Neuroscience). Through a collaboration among Frazier, Jefferson Health and Temple Health, peripheral artery disease screenings are …

Lauren Meloni, Mha, Pta

Jefferson Surgical Solutions

As Associate Administrator for the Division of Acute Care Surgery, Lauren Meloni supports a team of 22 trauma surgeons who provide care at Thomas Jefferson University Hospital, Jefferson Torresdale Hospital, Lankenau Medical Center and Paoli Hospital. She also oversees operations for the Division’s ambulatory services in Center City.

Every day, she bridges clinical needs and administrative solutions – a role well suited to her professional experience and educational credentials.

Meloni started her career providing direct patient care as a physical therapist assistant (PTA). After five years, she pivoted to the administrative side of health care, joining Jefferson Health in November …

Surgery: Exciting Times At Jefferson Health, Charles Yeo, Md, Facs

Jefferson Surgical Solutions

As we approach the midpoint of 2025, our 201st year, there are multiple accomplishments and developments to celebrate. Some of the highlights include:

• As noted in the cover story – Joseph Bavaria, MD, has joined us to lead the new Department of Cardiac Surgery and Bruce & Robbi Toll Heart and Vascular Institute.
• Our Lung Transplant Program, led by surgeons Charles Hoopes, MD, and Keshava Rajagopal, MD, has successfully launched, with several lung transplants being completed by the team.
• Our department faculty members continue to publish, on average, between a dozen and 20 peer-reviewed papers per month.
• We hosted seven …

Toll Institute Integrates Cardiac And Vascular Services Across Jefferson Health

Jefferson Surgical Solutions

Through a transformational gift from the Bruce and Robbi Toll Foundation, Jefferson Health established the Bruce & Robbi Toll Heart and Vascular Institute in June 2024. This comprehensive program is designed to bring high-quality cardiovascular care directly to patients and communities in Jefferson’s vast and expanding service area. Led by Joseph Bavaria, MD, FACS, FRCS (Edin) ad hom, the Toll Institute is integrating cardiac and vascular services across the Jefferson enterprise – including Cardiology, Cardiac Surgery, Vascular Medicine and Vascular Surgery.

The unified structure will significantly enhance collaboration among care teams, streamline patient experience and increase access to promising clinical …

Macular Thinning And Microvasculature Abnormalities In Children With Sickle Cell Disease: A Longitudinal Analysis, Sally S. Ong, Ann Nampomba, Sara Rahman, Loka Thangamathesvaran, Grace Reilly, Jianqiao Ma, Jay Vaidya, Sophie Lanzkron, Adrienne W. Scott

Cardeza Foundation for Hematologic Research

PURPOSE: To assess longitudinal changes in retinal thickness and vessel density (VD) in pediatric sickle cell disease (SCD).

DESIGN: A prospective cohort study.

PARTICIPANTS: Children (< 18 years old) with HbSS and HbS variant (HbSC and HbS thalassemia) genotypes were enrolled from a university-based retina subspecialty clinic from 2017 to 2019 and followed for ≥2 years.

METHODS: Participants received 3 × 3 and 6 × 6 mm OCT and OCT angiography scans at baseline and at each follow-up visit.

MAIN OUTCOME MEASURES: Retinal thickness, superficial capillary plexus (SCP), and deep capillary plexus (DCP) VD were compared over time.

RESULTS: Children with HbSS (n = 14) and HbS variant (n = 14) genotypes with ≥1 follow-up were included in the study (total 56 eyes). For HbSS, rates of retinal thinning per …

Utility Of Cenegermin For The Management Of Neurotrophic Keratopathy After Penetrating Keratoplasty, Alexandra R. Zaloga, Ashley Khalili, Brandon D. Ayres, Brenton D. Finklea, Beeran B. Meghpara, Christopher J. Rapuano, Zeba A. Syed

Wills Eye Hospital Papers

BACKGROUND: The study aimed to report the outcomes of patients treated with cenegermin 0.002% for neurotrophic keratopathy (NK) following penetrating keratoplasty (PK).

MATERIALS AND METHODS: This retrospective case series included patients evaluated at a tertiary care hospital who completed an 8-week course of cenegermin for NK within 12 months following PK. The primary outcome measure was NK stage, while secondary outcomes included complete epithelial healing, epithelial defect size, and best-corrected visual acuity (BCVA) at baseline and four time points during and following treatment. We also evaluated disease progression.

RESULTS: Fourteen eyes of 14 patients were included and demonstrated significant improvement …

Do Female Patients Experience Worse Outcomes Than Male Patients After Inguinal Hernia Repair? An Analysis Of The Abdominal Core Health Quality Collaborative Database, Amrita Iyer, Sunjay Kumar, Martina Rama, Sourav Podder, Li-Ching Huang, Sami Tannouri, Talar Tatarian, Francesco Palazzo

Department of Surgery Faculty Papers

BACKGROUND: Inguinal hernia repair is one of the most common general surgery operations. Some evidence suggests that female patients are at greater risk of chronic postoperative pain and hernia recurrence. We investigated rates of chronic inguinal pain and recurrence after inguinal hernia repair in both male and female patients using the Abdominal Core Health Quality Collaborative database.

METHODS: The Abdominal Core Health Quality Collaborative database was queried for patients undergoing elective, unilateral inguinal hernia repair who completed 30-day clinical follow-up and baseline and 1-year European Registry for Abdominal Wall Hernias Survey surveys. Both open and minimally invasive cases were included. …

Optimizing Costs In Plastic Surgery: A Systematic Review Of Time-Driven Activity-Based Costing Applications, Emily L. Isch, Gabrielle Kozlowski, D. Mitchell Self, Theodore E. Habarth-Morales, Sydney Somers, Ahilan Sivaganesan, David Kim, Heather A. Mcmahon, Andrew Newsman, Matthew Jenkins

Department of Surgery Faculty Papers

BACKGROUND: The rising complexity and cost of healthcare in plastic surgery, particularly in resource-intensive procedures like free flap and breast reconstruction, pose significant financial challenges. Time-driven activity-based costing (TDABC) offers a method to accurately assess these costs by mapping each step of the care cycle based on time and resources consumed. Although TDABC has been utilized in high-cost fields such as neurosurgery and spine surgery, its application in plastic surgery remains underexplored. This systematic review evaluates the literature on TDABC use in plastic surgery to identify key cost drivers and propose strategies for cost-efficiency.

METHODS: A systematic review was conducted …

Next-Generation Biomaterials For Load-Bearing Tissue Interfaces: Sensor-Integrated Scaffolds And Mechanoadaptive Constructs For Skeletal Regeneration, Rahul Kumar, Kyle Sporn, Pranay Prabhakar, Phani Paladugu, Akshay Khanna, Alex Ngo, Chirag Gowda, Ethan Waisberg, Ram Jagadeesan, Nasif Zaman, Alireza Tavakkoli

SKMC Student Presentations and Publications

Advancements in load-bearing tissue repair increasingly demand biomaterials that not only support structural integrity but also interact dynamically with the physiological environment. This review examines the latest progress in smart biomaterials designed for skeletal reconstruction, with emphasis on mechanoresponsive scaffolds, bioactive composites, and integrated microsensors for real-time monitoring. We explore material formulations that enhance osseointegration, resist micromotion-induced loosening, and modulate inflammatory responses at the bone-implant interface. Additionally, we assess novel fabrication methods-such as additive manufacturing and gradient-based material deposition-for tailoring stiffness, porosity, and degradation profiles to match host biomechanics. Special attention is given to sensor-augmented platforms capable of detecting mechanical …

Detecting Early Changes In Cartilage Collagen And Proteoglycans Distribution Gradients In Mice Harboring The R992c Collagen Ii Mutant Using 2d Correlation Infrared Spectroscopy, Jolanta Fertala, Andrzej Steplewski, Andrzej Fertala

Department of Orthopaedic Surgery Faculty Papers

Collagen II is a vital structural component in developing bones and mature cartilage. Muta- tions in this protein cause spondyloepiphyseal dysplasia, a disease characterized primarily by altered skeletal growth and manifesting with a range of phenotypes, from lethal to mild. This study examined transgenic mice harboring the R992C (p.R1124C) substitution in colla- gen II. Previous research demonstrated significant growth abnormalities and disorganized growth plate structure in these mice, and histological signs of osteoarthritic changes in the knee joints of 9-month-old mice with the R992C mutation. Our study focuses on detecting early structural changes in the articular cartilage that occur before …

Epidemiological Trends Of Facial Fractures In The United States, Gabriel I. Onor, Ugochi T. Aguwa, Nicholas Barksdale, Isaiah X. Hughes, Molly Milano, Camila Cordero, Uche Nwagu, Oluwatomi Akingbola, Chibuzo J. Aguwa, Michael C. Okoronkwo

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Sustaining facial fractures may pose significant challenges to patients' health and quality of life. In the United States (U.S.), facial fractures account for 20 % of all sports-related injuries in pediatrics and many of these injuries are associated with traumatic brain injury. The objective of this study was to identify overall and sports-related incidence rates of facial fractures presenting to U.S. hospital emergency departments from 2014 to 2023 and define demographic risk factors for these injuries.

METHODS: The National Electronic Injury Surveillance System was queried to identify facial fractures from 2014 to 2023 as well as associated demographic data. …

Evidence And Consensus-Based Imaging Guidelines In Birdshot Chorioretinopathy: Multimodal Imaging In Uveitis (Muv) Taskforce Report 8, Jose S. Pulido

Wills Eye Hospital Papers

PURPOSE: To develop consensus-based imaging guidelines for diagnosing and monitoring birdshot chorioretinopathy (BSCR).

DESIGN: Consensus-based approach guided by literature and an expert committee using a nominal group technique (NGT).

METHODS: An expert committee of 5 international uveitis specialists reviewed 15 well-documented representative BSCR cases with comprehensive imaging data. Cases with active and inactive disease were included. Imaging, including color fundus photography (CFP), fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), optical coherence tomography (OCT), fundus autofluorescence (FAF), and OCT angiography (OCTA) were reviewed. Using a structured NGT approach, consensus-based recommendations were developed for specific disease characteristics, biomarkers of activity, and …

Increasing Community Members' Engagement In Cancer Research: The Making Research Clear Program, Rebecca J. Melillo, Christiane J. El Khoury, Joshua Blanding-Godbolt, Q. Greene, Karen M. Bussard, Amy Leader

Kimmel Cancer Center Faculty Papers

BACKGROUND: Despite the importance of engaging community members in research, multiple barriers from the perspective of the investigator and community member exist. The Making Research CLEAR (Community Learning and Experience about Research) Program aims to bridge the gap between research conducted at an NCI-designated cancer center and the community.

METHODS: Community members and a cancer center investigator were paired for a 6-month immersive research experience. Community members had at least one research experience per month with their investigator, while also attending cancer center activities such as Institutional Review Board (IRB) meetings, research lectures, protocol review meetings, and community outreach events. …

Small Gifts, Big Questions: The Ethical Dilemma In Accepting Gifts In Medicine, Meiqi Luo, Md

The Medicine Forum

I remember discussing the topic of gift-giving by patients in a small group session in medical school. When asked whether it’s ethical for medical professionals to accept gifts from patients, I responded, “It depends on the value of the gifts.” If the gifts were of appropriate value and given purely out of appreciation, they serve to strengthen the physician-patient relationship. However, what I failed to realize was the difficulty in determining the value and intention of a gift. My personal experience of receiving gifts from a patient made me aware of such ethical ambiguities.

At the community clinic where I …

Navigating Care And Loss Through Aging, Disease, And Decision-Making In The Covid Era, Michael Predi, Do

The Medicine Forum

There is only one of the loved one you know.
Often it can be hard to let go.
Five years old the world became cold.
Lost my mother to breast cancer.
A cold wound that can’t be answered
Father raised you in a foreign land.
Drove you to school, combed your hair, gave you a life you could have never planned.
Taught me that I would catch a cold from the wind.
No arguing about modern medicine, my dad was thick skinned,
Here comes college, first generation, what an exciting time.
Get to medical school so exciting; here comes the …

Existential Pain, Kian Waddell

The Medicine Forum

A new type of pain
Never covered in a lecture
Not neuropathic, visceral, post-procedural, cancer, phantom pains,
But existential.

She didn’t want pain meds
And she had her reasons -
We didn’t push.

What she wanted was to talk
To be heard
For us to be silent and stop
Asking her every second
If she’d moved bowels, vomited, slept…

What she wanted was to talk.
What other medication is there for pain of the soul?

Eternal Light, Anurag Modak, Md

The Medicine Forum

The microscope is held aloft in a sea of darkness,
Illuminating the gyri and sulci of the exposed brain below.
Its harsh, sterile light creates a veritable barrier
So hot, so intense, it threatens to explode forth at any moment.

The screens scattered across the room provide companionship to this lonely machine
And I, residing amidst the sea of shadows,
Bear witness to its solitude
To the silence of the light.

I have seen vessels tied and aneurysms clipped,
And an eon has gone by…
There’s an air of anticipation,
An expectation of something more.

But, solace and quietude prevail …

Unmasking The Dvt Mimic: A Rare Case Of Diabetic Myonecrosis In A Young Patient, Avish Patel, Md, Paul Endres, Md, Alexander Marchese, Md, Dianna Cheney-Peters, Md

The Medicine Forum

Diabetic myonecrosis is an uncommon complication of diabetes mellitus, often falsely believed to be a deep vein thrombosis (DVT). Patients present with similar presentations of edema and focal tenderness that are most often unilateral in a proximal lower extremity.¹ When venous ultrasound is negative, magnetic resonance imaging (MRI) is the preferred diagnostic modality over muscle biopsy, given the potential complications.^2,3 Treatment includes rest, analgesia, and improved glycemic control.⁴ Given the rise of metabolic disorders and insulin resistance, it is important to be aware of this diagnosis to prevent overutilization of healthcare resources.⁵

Recurrent Post-Viral Rhabdomyolysis In A 36-Year-Old Male: A Case Report, Warda Naqvi, Md, David Walz, Md, Lucy Checchio, Md

The Medicine Forum

Rhabdomyolysis is a syndrome of skeletal muscle breakdown, releasing intracellular contents such as creatine kinase (CK) and myoglobin into the bloodstream, which can precipitate acute kidney injury (AKI).¹ While trauma, extreme exertion, and toxins are frequent culprits, infections, particularly viral illnesses, represent a less common but significant trigger.² Influenza and other respiratory viruses have been implicated in sporadic cases of rhabdomyolysis, often presenting with acute myalgias and elevated CK levels following a viral prodrome.³ In contrast, recurrent rhabdomyolysis is typically associated with inherited metabolic myopathies (e.g., McArdle disease) or autoimmune myositis, conditions often marked by distinct genetic …

Mcconnell’S Sign In The Absence Of Pulmonary Embolism, Alicia Bao, Md, Tendai Marume, Md

The Medicine Forum

McConnell’s sign is an echocardiographic finding characterized by hyperdynamic motion of the right ventricular (RV) apex with akinesis of the RV free wall. It is widely known as an indicator of RV strain in acute pulmonary embolism (PE) but has been described in other conditions such as sepsis-induced RV dysfunction, acute cor pulmonale, and right-sided heart failure. In critically ill patients, RV dysfunction is a major contributor to hemodynamic instability, respiratory failure, and poor outcomes. Given the overlapping signs of various underlying conditions, McConnell’s sign serves as a useful marker for assessing RV involvement but can be challenging to interpret …

A Case Of Streptococcus Pneumoniae Necrotizing Pneumonia With Pneumothorax And Abscess Formation, Susanna Betti, Md

The Medicine Forum

A 63-year-old female with a past medical history of left breast ductal carcinoma in situ, now post-left-sided lumpectomy and radiation in 2005, presented to an outside hospital with chest pain and a cough productive of green sputum. Computed tomography (CT) chest demonstrated patchy ground-glass opacities and dense consolidations in the right middle and lower lobe. Blood cultures and bronchoalveolar lavage culture were positive for Streptococcus pneumoniae, and she was started on antibiotics for community-acquired pneumonia. Her respiratory status rapidly worsened and she required intubation. She developed a large right-sided pneumothorax and had a chest tube placed for a …

A Complex Case Of Multifactorial Hypoxemia From Metastatic Testicular Cancer, Susanna Betti, Md

The Medicine Forum

A 27-year-old male with no known past medical history presented for evaluation of a 14.1 cm testicular mass (Figure A). He was found to have severe anemia (Hgb 2.8 g/dL), and biopsy demonstrated a non-seminomatous mixed germ cell tumor of testicular origin with imaging demonstrating widespread metastases to the brain, lungs, and liver. The patient received multiple blood transfusions and one dose of bleomycin, etoposide, and cisplatin followed by the development of acute respiratory failure. Computed tomography angiography (CTA) chest was negative for pulmonary thromboembolism but demonstrated diffuse ground-glass opacities (Figure B, arrows) and metastatic pulmonary masses containing dilated vessels …

Heart Core: A Framework For Leading With Empathy In Medical Education, Akash Patel, Do, Mark Liotta, Md

The Medicine Forum

In medical training, much of what defines leadership happens outside of clinical decision-making. It happens at 2 a.m. when a resident breaks down from burnout. It happens when a team is navigating interpersonal conflict or when a trainee is overwhelmed by grief, imposter syndrome, or failure. While these moments are deeply impactful, many of us are never taught how to lead through them.

This gap inspired us to create HEART CORE, a framework designed to help residents, faculty, and administrators approach complex, emotional, or high-stakes situations with clarity and compassion. Although it was originally built for chief residents handling difficult …

The Factor Viii Debate: An Auto-Cancelled Lab Near Miss, Avish Patel, Md, Daniel Elchediak, Md, Zachary Pang, Md, Charlotte Shields, Md, Bethanne Venkatesan, Md, Ananya Venkatesh, Md, Michael Alessandro, Bsn, Jeffrey Riggio, Md, Ms, Alexis Wickersham, Md

The Medicine Forum

Near misses, medical errors with no appreciable resultant harm, often go undetected and underreported despite great emphasis on patient safety event reporting over the past two decades.¹ Additionally, near misses are often not triggers for proactive institutional corrective action due to the widespread retroactive safety culture following more harmful or catastrophic safety events.² At Thomas Jefferson University Hospital, all internal medicine first-year residents (PGY1s) participate in an immersive safety event review curriculum of near miss or low-harm safety events, previously described in the literature.³ The following details the event review findings and implemented health-system level changes following …