Digital Commons Network^™

Cell Surface B2m-Free Human Leukocyte Antigen (Hla) Monomers And Dimers: Are They Neo-Hla Class And Proto-Hla?, Mepur H. Ravindranath, Narendranath M. Ravindranath, Senthamil R. Selvan, Fatiha El Hilali, Carly J. Amato-Menker, Edward J. Filippone

Division of Nephrology Faculty Papers

Cell surface HLA-I molecules (Face-1) consist of a polypeptide heavy chain (HC) with two groove domains (G domain) and one constant domain (C-domain) as well as a light chain, B2-microglobulin (B2m). However, HCs can also independently emerge unfolded on the cell surface without peptides as B2m-free HC monomers (Face-2), B2m-free HC homodimers (Face 3), and B2m-free HC heterodimers (Face-4). The transport of these HLA variants from ER to the cell surface was confirmed by antiviral antibiotics that arrest the release of newly synthesized proteins from the ER. Face-2 occurs at low levels on the normal cell surface of the lung, …

Ifit2 Restricts Murine Coronavirus Spread To The Spinal Cord White Matter And Its Associated Myelin Pathology, Madhav Sharma, Debanjana Chakravarty, Afaq Hussain, Ajay Zalavadia, Amy Burrows, Patricia Rayman, Nikhil Sharma, Lawrence C. Kenyon, Cornelia Bergmann, Ganes C. Sen, Jayasri Das Sarma

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Interferon-induced protein with tetratricopeptide repeats 2, Ifit2, is critical in restricting neurotropic murine-β-coronavirus, RSA59 infection. RSA59 intracranial injection of Ifit2-deficient (-/-) compared to wild-type (WT) mice results in impaired acute microglial activation, reduced CX3CR1 expression, limited migration of peripheral lymphocytes into the brain, and impaired virus control followed by severe morbidity and mortality. While the protective role of Ifit2 is established for acute viral encephalitis, less is known about its influence during the chronic demyelinating phase of RSA59 infection. To understand this, RSA59 infected Ifit2-/- and Ifit2+/+ (WT) were observed for neuropathological outcomes at day 5 (acute phase) and 30 …

The Spatiotemporal Variation Characteristics Of Urban Sustainability Based On The Sdgs In Yangtze River Delta, China, Xue Fang, Xinyu Shi, Tyson Keen Phillips, Peng Du, Weijun Gao

College of Architecture and the Built Environment Faculty Papers

At present, most developing countries need to improve the quality of the built environment by means of large-scale infrastructure construction, thereby promoting rapid urbanization. The quality of the built environment ((Formula presented.)) and its environmental pressure ((Formula presented.)) have become our primary focus to achieve a globally acknowledged vision of the Sustainable Development Goals (SDGs). In this study, we proposed an overall workflow by combining the proven urban sustainability ((Formula presented.)) assessment tool with the evaluation process and the analysis of the spatiotemporal dimension to investigate the urban characteristics of the 41 cities in the Yangtze River Delta. Our results …

Genetics Of Functional Seizures; A Scoping Systematic Review, Ali A. Asadi-Pooya, Mark Hallett, Nafiseh Mirzaei Damabi, Khatereh Fazelian Dehkordi

Department of Neurology Faculty Papers

Background: Evidence on the genetics of functional seizures is scarce, and the purpose of the current scoping systematic review is to examine the existing evidence and propose how to advance the field.

Methods: Web of science and MEDLINE were searched, from their initiation until May 2023. The following key words were used: functional neurological disorder(s), psychogenic neurological disorder(s), functional movement disorder(s), psychogenic movement disorder(s), functional seizures(s), psychogenic seizure(s), nonepileptic seizure(s), dissociative seizure(s), or psychogenic nonepileptic seizure(s), AND, gene, genetic(s), polymorphism, genome, epigenetics, copy number variant, copy number variation(s), whole exome sequencing, or next-generation sequencing.

Results: We identified three original studies. …

Tp53 Induced Glycolysis And Apoptosis Regulator And Monocarboxylate Transporter 4 Drive Metabolic Reprogramming With C-Myc And Nfkb Activation In Breast Cancer, Megan E. Roche, Ying-Hui Ko, Marina Domingo-Vidal, Zhao Lin, Diana Whitaker-Menezes, Ruth C. Birbe, Madalina Tuluc, Balázs Győrffy, Jaime Caro, Nancy J. Philp, Ramon Bartrons, Ubaldo Martinez-Outshoorn

Department of Medical Oncology Faculty Papers

Breast cancer is composed of metabolically coupled cellular compartments with upregulation of TP53 Induced Glycolysis and Apoptosis Regulator (TIGAR) in carcinoma cells and loss of caveolin 1 (CAV1) with upregulation of monocarboxylate transporter 4 (MCT4) in fibroblasts. The mechanisms that drive metabolic coupling are poorly characterized. The effects of TIGAR on fibroblast CAV1 and MCT4 expression and breast cancer aggressiveness was studied using coculture and conditioned media systems and in-vivo. Also, the role of cytokines in promoting tumor metabolic coupling via MCT4 on cancer aggressiveness was studied. TIGAR downregulation in breast carcinoma cells reduces tumor growth. TIGAR overexpression in carcinoma …

Editorial: Intervertebral Disc Degeneration And Osteoarthritis: Mechanisms Of Disease And Functional Repair., Graciosa Q Teixeira, Jana Riegger, Raquel M Gonçalves, Makarand V. Risbud

Department of Orthopaedic Surgery Faculty Papers

No abstract provided.

Abaloparatide Maintains Normal Rat Blood Calcium Level In Part Via 1,25-Dihydroxyvitamin D/Osteocalcin Signaling Pathway, Yanmei Yang, Wei-Ju Louis Tseng, Bin Wang

Center for Translational Medicine Faculty Papers

The PTH-related peptide(1-34) analog, abaloparatide (ABL), is the second anabolic drug available for the treatment of osteoporosis. Previous research demonstrated that ABL had a potent anabolic effect but caused hypercalcemia at a significantly lower rate. However, the mechanism by which ABL maintains the stability of blood calcium levels remains poorly understood. Our in vivo data showed that ABL treatment (40 µg/kg/day for 7 days) significantly increased rat blood level of 1,25-dihydroxyvitamin D [1,25-(OH)2D] without raising the blood calcium value. ABL also significantly augmented the carboxylated osteocalcin (Gla-Ocn) in the blood and bone that is synthesized by osteoblasts, and increased noncarboxylated …

A Manual For Ultrasound Guided Intravenous Access: Allay Your Fears, Alleviate With Humor, Approach With Confidence, Michael Dong, Md

The Medicine Forum

“Hey, can you help get IV access on a patient? The nurses have tried many times already.”

If this message fills your heart with trepidation, it may be because you do not have a systematic approach to ultrasound guided intravenous catheter (IV) placement or any prior training in this procedure. At our institution, after failed nursing attempts, the responsibility for obtaining IV access may fall on the physician. Early in the year, this physician may be an intern who has limited experience with IV access, let alone ultrasound guided IV placement. They may have previously undergone a brief training course …

A Guide To Point Of Care Ultrasound Evaluation Of Pneumonia, Michael Dong, Md, Frances Mae West, Md, Rebecca Davis, Md, Jonathan Foster, Md, Jillian Cooper, Md

The Medicine Forum

A patient presenting with fever, hypoxia, productive cough, and leukocytosis can be diagnosed with pneumonia without any imaging findings. However, we often rely on X-ray and computed tomography (CT) imaging to support the clinical diagnosis. Ultrasound is an effective imaging modality for identifying pneumonia without delay and radiation risks.^1,2 A meta-analysis by Ye et al. in 2015 found that ultrasound diagnosis of pneumonia had a pooled sensitivity of 0.95 and a pooled specificity of 0.9, which is superior to X-ray imaging which had a pooled sensitivity of 0.77 and a similar pooled specificity of 0.9.³ This study used …

A Guide To Point Of Care Ultrasound Lung And Ivc Examination Of A Volume Overloaded Patient, Michael Dong, Md, Frances Mae West, Md, Jonathan Foster, Md, Rebecca Davis, Md, Jillian Cooper, Md

The Medicine Forum

A patient presents with dyspnea, hypoxia, and lower extremity edema. Their history is notable for recent high salt intake and non-compliance with diuretics, and their lungs have rales bilaterally. Clinically, we can diagnose a heart failure exacerbation with pulmonary edema. However, we often rely on X-ray and computed tomography (CT) imaging to support the clinical diagnosis and explore the etiology of the hypoxia and dyspnea to narrow the differential. Ultrasound is an effective modality for identifying pulmonary edema and pleural effusions while at the same time ruling out other etiologies such as pneumonia and pneumothorax. With bedside point of care …

A Guide To Point Of Care Ultrasound Examination Of A Pericardial Effusion, Michael Dong, Md, Frances Mae West, Md, Jillian Cooper, Md, Jonathan Foster, Md, Rebecca Davis, Md

The Medicine Forum

A patient presents with pleuritic chest pain, dyspnea, and a recent viral illness. They have no prior cardiac or pulmonary history. Their X-ray on admission demonstrates no pulmonary findings and an enlarged cardiac silhouette, and their EKG is low voltage with electrical alternans. Ultrasound is an effective modality for identifying pericardial effusion and cardiac tamponade while at the same time evaluating for other causes, such as heart failure. Often patients with symptomatic pericardial ef fusion present with non-specific symptoms. While a “formal” transthoracic echocardiogram remains the gold standard for diagnosis, a bedside point of care ultrasound (POCUS) cardiac evaluation can …

A Guide To Point Of Care Ultrasound Examination Of Acute Decompensated Heart Failure, Michael Dong, Md, Rebecca Davis, Md, Jonathan Foster, Md, Jillian Cooper, Md, Frances Mae West, Md

The Medicine Forum

A patient presents with dyspnea on exertion, orthopnea, and lower extremity edema. They have a prior history of coronary artery disease and reported episodes of chest pain three months ago. They did not seek medical evaluation at the time and have had no chest pain recently. In this setting, there is a high clinical suspicion of heart failure with concern for ischemic heart disease. The gold standard for diagnosis of heart failure is a formal transthoracic echocardiogram. Bedside point of care ultrasound (POCUS) is a tool that can provide essential information without delay in diagnosis.

A Case Of Suspected Lisdexamfetamine (Vyvanse) Drug-Induced Liver Injury, Louis Kishfy, Md, Justin Bilello, Md, Monjur Ahmed, Md, Elizaveta Flerova, Md

The Medicine Forum

Amphetamines are a well-established cause of liver injury though the typical presentation is that of illicit drug abuse rather than liver injury occurring in a prescribed setting.¹ Lisdexamfetamine (Vyvanse) is one of the most commonly prescribed stimulant medications used for the treatment of Attention Deficit Hyperactive Disorder (ADHD). The authors were only able to find a single case of lisdexamfetamine-related drug-induced liver injury (DILI) occurring in the pediatric population in their review of the literature. Here we present a case of suspected lisdexamfetamine DILI in an adult patient.

Helpful Or Harmful? A Case Report Of Nutritional Supplements Causing Drug-Induced Liver Injury, Amman Bhasin, Md, Phoebe Chun, Md, Justin Bilello, Md, Manju Ambelil, Md, Dina L. Halegoua-Demarzio, Md

The Medicine Forum

Herbal supplement-induced liver injury represents a growing concern in the body of drug-induced liver injury (DILI) literature, with recent studies in mainland China, Iceland, and the United States reporting estimated rates of herb/dietary supplement-induced liver injury (HILI) between 1.16-6.38 per 100,000 (Björnsson et al., 2013; Shen et al., 2019; Vega et al., 2017). Notably, a recent 2020 study demonstrated an increasing prevalence of hepatotoxicity secondary to herbal and dietary supplements in the US and worldwide (Zheng et al., 2020). Recognizing the hepatotoxicity of various supplements is crucial, given the increasing usage of dietary and herbal supplements and the lack of …

End-Stage Chronic Intestinal Pseudo-Obstruction Resulting In Intestinal Pneumatosis, Justin Bilello, Md, Amman Bhasin, Md, Phoebe Chun, Md, Aaron Martin, Md

The Medicine Forum

Chronic intestinal pseudo-obstruction (CIPO) is a rare gastrointestinal motility disorder that presents with symptoms, physical exam, and imaging findings of mechanical bowel obstruction without an anatomical obstruction. Multiple etiologies, including enteric or extrinsic neuropathic dysfunction, myopathic dysfunction, or dysfunction of the interstitial cells of Cajal, cause CIPO’s pathogenesis. The presentation of CIPO may be idiopathic or caused by underlying diseases. The most common presentation is abdominal pain, bloating, and distension. Here, we present a patient with an end-stage case of CIPO who failed medical therapy. Her distension progressed over a decade, requiring emergency surgery due to intestinal pneumatosis.

A Case Presentation Of Pericarditis Associated With Haemophilus Influenzae Bacteremia, Risa Goldberg, Md, Harrison Bell, Md

The Medicine Forum

Acute pericarditis, or inflammation of the pericardial sac, is a clinical condition which can often be attributed to a variety of underlying etiologies, including infection, autoimmune disease, trauma, and malignancy. While viral infections are commonly implicated in the etiology of pericarditis, bacteria known to be associated with pericarditis include staphylococcus species, streptococcal species, tuberculosis, and in children, Haemophilus influenzae.¹ Here we present a rare case of pericarditis in an adult male patient which occurred in association with Haemophilus influenzae bacteremia.

A Case Of Bartonella Endocarditis And Torrential Aortic Regurgitation Leading To Cardiac Arrest, Brandon Pecchia, Md, Ms, Sawyer Kieffer, Md

The Medicine Forum

Infective endocarditis can be difficult to diagnose, especially when blood culture-negative. We describe a case of a patient who presented with signs and symptoms of new, acute decompensated heart failure who was found to have culture-negative endocarditis, a large, mobile aortic valve mass, and torrential aortic regurgitation. Although the patient remained clinically stable during early admission and was planned for surgical correction of the valvular pathology, he suffered abrupt clinical decompensation which resulted in cardiac arrest. Postmortem serologies were found to be positive for Bartonella henselae and Bartonella quintana.

An Educational Case For Applying The Alveolar- Arterial Gradient In Hypoxemia: An Underutilized And Underappreciated Clinical Tool, Chioma Nwonu, Do, Michael Dong, Md, Daniel Kramer, Md

The Medicine Forum

The Alveolar-arterial gradient, commonly known as the A-a gradient, measures the difference in the oxygen concentration in the alveoli and the arteries across the capillary membrane in the lung. In an ideal system, the A-a gradient would be zero because there would be perfect equilibrium as oxygen diffuses and equalizes across the alveolar and arterial sides of the capillary membrane. However, there is a physiologic A-a gradient because of the differences in perfusion and ventilation in the apical and basilar regions of the lungs. Because this relationship exists, the changes in the A-a gradient have clinical utility in guiding the …

Achenbach Syndrome: A Classic Presentation Of A Not-So-Common Condition, Brandon Pecchia, Md, Ms

The Medicine Forum

Also called “acute idiopathic blue finger” or “paroxysmal finger hematoma,” Achenbach syndrome is a benign collection of findings that is often mistaken for more serious conditions. Characteristically presenting with discrete unexplained bruising or discoloration of the volar aspect of one or two fingers, it is a diagnosis that physicians should include on their differential given its innocuous course and excellent outcomes, without need for invasive testing or intervention. The purpose of this case report therefore is to increase awareness of this rare condition, especially among emergency department physicians and internists, in order to minimize the incidence of unnecessary testing, procedures, …

From The Chief Residents, Tina Boortalary, Md, Justin Robbins, Md, Svenja Schneider, Md

The Medicine Forum

As your Chief Residents, we would like to take a moment to express our heartfelt congratulations to each and every one of you on your incredible scholarly achievements over the past year. We have been impressed by the quality and diversity of your scholarly work. From interdisciplinary clinical research projects that have been submitted to journals across numerous subspecialties, to contributions to the Health Equity and Quality Improvement Summit, you have all demonstrated a passion for excellence and a commitment to advancing the field of medicine. We are grateful for the opportunity to have worked alongside you and to have …

From The Editors, Harrison Bell, Md, Akash Patel, Do, Benjamin Tasevac, Md

The Medicine Forum

We are honored to present the 24th Annual edition of The Medicine Forum to the Jefferson community. Over the years, it has been remarkable to see the quality and diversity of projects submitted to this forum, and this year is no exception. The Medicine Forum aims to celebrate the scholarly activity among physicians in training at our institution. We hope that this year's edition will continue to honor this long standing tradition. Despite the uncertainties and stressors that are inherent to working in a hospital, our authors have found the time to produce scholarly work that will diversify and further …

From The Desk Of The Residency Program Director, Christopher Henry, Md, Facp

The Medicine Forum

It is my pleasure to introduce myself to you for the first time as Program Director, as I also introduce to you our latest edition of The Medicine Forum. Having done my residency training at Jefferson, I am so proud that the tradition of this journal has continued throughout the years despite new residents, new leadership, and new challenges both locally and globally. Our residents’ commitment to not only patient care, but also to scholarship and inquiry remains outstanding and impactful.

Tradition, coming from the Latin word “tradere”, means to transmit, to hand over, or to give for safekeeping; …

Table Of Contents: The Medicine Forum Volume 24, 2022-2023

The Medicine Forum

Table of Contents: The Medicine Forum Volume 24, 2022-2023

The Medicine Forum: Volume 24

The Medicine Forum

The Journal of Thomas Jefferson University Hospital - Department of Internal Medicine, Volume 24, 2022-2023

TABLE OF CONTENTS

• Case Reports
• Ultrasound Education

Arthroscopic Treatment Of Shoulder Stiffness With Rotator Cuff Repair Yields Similar Outcomes To Isolated Rotator Cuff Repair, Parker L. Brush, Adrian Santana, Ruchir Nanavati, Gregory R. Toci, Tariq Z. Issa, Daniel J. Fletcher, Joshua Hornstein

Rothman Institute Papers

Purpose To compare patient-reported and surgical outcome measures in patients with and without secondary shoulder stiffness (SSS) undergoing rotator cuff repair (RCR).

Methods Patients undergoing rotator cuff repair from 2014 to 2020 with complete patient-reported outcome measures (PROMs) by the short-form 12 survey (SF-12) were retrospectively reviewed to identify if operative intervention for SSS was performed alongside the RCR. Those patients with operative intervention for SSS were propensity matched to a group without prior intervention for stiffness by age, sex, laterality, body mass index, diabetes mellitus status, and the presence of a thyroid disorder. The groups were compared by rotator …

Preclinical Evaluation Of Anti-Cd38 Therapy In Mature T-Cell Neoplasms, Colleen Isabelle, William Johnson, Kathleen Mcconnell, Ashley Vogel, Jonathan Brammer, Amy Boles, Robyn Keller, Paola Sindaco, Liam Nisenfeld, Guldeep Uppal, Neda Nikbakht, Bruno Calabretta, Patrizia Porazzi, Jerald Gong, Nitin Chakravarti, Pierluigi Porcu, Anjali Mishra

Kimmel Cancer Center Faculty Papers

No abstract provided.

Editorial: Targeting Dna Damage Response To Enhance Antitumor Innate Immunity In Radiotherapy, Victoria Valvo, Emanuele Vitale, Marco Tigano, Rachel Evans, Meredith A. Morgan, Qiang Zhang

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

No abstract provided.

Gene Signature Reveals Decreased Sox10-Dependent Transcripts In Malignant Cells From Immune Checkpoint Inhibitor-Resistant Cutaneous Melanomas, Timothy J. Purwin, Signe Caksa, Ahmet Sacan, Claudia Capparelli, Andrew E. Aplin

Department of Pharmacology, Physiology, and Cancer Biology Faculty Papers

Evidence is mounting for cross-resistance between immune checkpoint and targeted kinase inhibitor therapies in cutaneous melanoma patients. Since the loss of the transcription factor, SOX10, causes tolerance to MAPK pathway inhibitors, we used bioinformatic techniques to determine if reduced SOX10 expression/activity is associated with immune checkpoint inhibitor resistance. We integrated SOX10 ChIP-seq, knockout RNA-seq, and knockdown ATAC-seq data from melanoma cell models to develop a robust SOX10 gene signature. We used computational methods to validate this signature as a measure of SOX10-dependent activity in independent single-cell and bulk RNA-seq SOX10 knockdown, cell line panel, and MAPK inhibitor drug-resistant datasets. Evaluation …

Republication Of “Open Repair Of Acute Achilles Tendon Ruptures: Is The Incidence Of Clinically Significant Wound Complications Overestimated?”, Meghan E. Bishop, Carly D. Comer, Justin M. Kane, Mitchell G. Maltenfort, Steven M. Raikin

Department of Orthopaedic Surgery Faculty Papers

Background:

Methods:

Corneal Outcomes Following Cataract Surgery Using Ophthalmic Viscosurgical Devices Composed Of Chondroitin Sulfate-Hyaluronic Acid: A Systematic Review And Meta-Analysis, Chia-Wen Hsiao, Hang Cheng, Rana Ghafouri, Nicole C. Ferko, Brandon D. Ayres

Wills Eye Hospital Papers

Background: Ophthalmic viscosurgical devices (OVDs) are commonly used during cataract surgery to protect the corneal endothelium. A systematic literature review and meta-analysis were conducted to assess the clinical evidence of OVDs composed of chondroitin sulfate-hyaluronic acid (CS-HA) versus other OVDs in maintaining endothelial cell density (ECD) and corneal thickness (CT).

Methods: MEDLINE and EMBASE databases were searched from 2000 to 2020. Randomized controlled trials (RCTs, N ≥ 20 per group) comparing an OVD containing CS-HA (ie, VISCOAT®, DuoVisc® or DisCoVisc®) to any other OVD were included. The identified comparators were limited to the OVDs found in the literature, which included …