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The Medicine Forum: Volume 20

The Medicine Forum

The Journal of Thomas Jefferson University Hospital - Department of Internal Medicine, Volume 20, 2018-2019

TABLE OF CONTENTS

Clinical Images

Case Reports

• Cardiology
• Endocrinology
• Gastroenterology and Hepatology
• Hematology and Oncology
• Infectious Disease
• Pulmonary Medicine
• Rheumatology

Original Article

Editorial

Literature Review

Creative Writing

Aspiration Pneumonia After Spine Surgery At Tjuh, Daniel Franco, Md, Jesse Edwards, Md, Kristen Vogl, Pt, Barbara Baskin, Slp, James Harrop, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Problem Definition

Aspiration Pneumonia after Spine Surgery at TJUH has a disproportionately high incidence, compared to other major academic centers When Aspiration Pneumonia is diagnosed in the immediate post operative period, this cascades into increased length of stay, increased overall cost and possibility negative impact for physician and hospital reimbursement At this time, it is unclear which criteria are used by physicians to determine whether an aspiration event has happened.

Reduction Of The Duration Of Contact Precautions In Patients With A Positive Mrsa Swab, Fadi Al-Saiegh, Md, Phyllis Flomenberg, Md, Giuliana Labella, Rn, Kelli Mcrory, James Harrop, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Background

Contact precautions (CP) in hospitals are a method of infection control in the transmission of multi-drug resistant organisms. Unfortunately, even though colonization with nasal methicillin-resistant Staphylococcus aureus (MRSA) is common in asymptomatic patients (3.8-4.5%) (6,7), patients are screened for nasal MRSA since it associated with higher morbidity and mortality. However, those who test positive for nasal MRSA are kept on CP even with a cleared MRSA infection(1). At TJUH, patients were kept on CP for 24 months after a positive swab regardless of location. This, unfortunately, led to unintended negative consequences: delay in patient transfer to other facilities (e. …

An Infection Control Journey In Hospital Based Practice Conversion, Cathleen Strzalka, Mph, Cph, Cic, Kelly Zabriskie, Cic

Division of Infectious Diseases and Environmental Medicine Posters

Objective

• Effectively bring physician based practices (PBPs) under hospital licensure
• Ensure safe delivery of care
• Produce successful regulatory surveys

Physician Based Practices And Instrument Sterilization - How Do You Do It?, Kelly Zabriskie, Cic, Cathleen Strzalka, Mph, Cph, Cic

Division of Infectious Diseases and Environmental Medicine Posters

Objective

To develop a process that allows the PBP to operate efficiently and effectively but still be compliant with proper instrument reprocessing rules and regulations.

Hand Hygiene Observations… Not So Secret Anymore, Mary Ehly, Bsn, Rn, Cic, Courtney Mitchell, Mph, Cic, Charlotte Sacksteder, Ba, Kelly Zabriskie, Bs, Cic

Division of Infectious Diseases and Environmental Medicine Posters

Objective

To create a hand hygiene surveillance program to reduce bias, be more reliable, yield a greater number of observations, and provide real time feedback

Promoting Adherence To Influenza Vaccination Recommendations In Pediatric Practice., Lloyd N. Werk, Maria Carmen Diaz, Adriana Cadilla, James P. Franciosi, Jobayer Hossain

Jefferson Health - Northeast Papers (formerly Aria Health Papers)

OBJECTIVES: In the United States, nonadherence to seasonal influenza vaccination guidelines for children and adolescents is common and results in unnecessary morbidity and mortality. We conducted a quality improvement project to improve vaccination rates and test effects of 2 interventions on vaccination guidelines adherence.

METHODS: We conducted a cluster randomized control trial with 11 primary care practices (PRACTICE) that provided care for 11 293 individual children and adolescents in a children's health care system from September 2015 through April 2016. Practice sites (with their clinicians) were randomly assigned to 4 arms (no intervention [Control], computerized clinical decision support system [CCDSS], …

Grfs And Crfs In Alternative Donor Hematopoietic Cell Transplantation For Pediatric Patients With Acute Leukemia., Rohtesh S. Mehta, Shernan G Holtan, Tao Wang, Michael T. Hemmer, Stephen R. Spellman, Mukta Arora, Daniel R. Couriel, Amin M. Alousi, Joseph Pidala, Hisham Abdel-Azim, Ibrahim Ahmed, Mahmoud Aljurf, Medhat Askar, Jeffery J. Auletta, Vijaya Bhatt, Christopher Bredeson, Saurabh Chhabra, Shahinaz Gadalla, James Gajewski, Robert Peter Gale, Usama Gergis, Peiman Hematti, Gerhard C. Hildebrandt, Yoshihiro Inamoto, Carrie Kitko, Pooja Khandelwal, Margaret L. Macmillan, Navneet Majhail, David I. Marks, Parinda Mehta, Taiga Nishihori, Richard F. Olsson, Attaphol Pawarode, Miguel Angel Diaz, Tim Prestidge, Muna Qayed, Hemalatha Rangarajan, Olle Ringden, Ayman Saad, Bipin N. Savani, Sachiko Seo, Ami Shah, Niketa Shah, Kirk R. Schultz, Melhem Solh, Thomas Spitzer, Jeffrey Szer, Takanori Teshima, Leo F Verdonck, Kirsten M. Williams, Baldeep Wirk, John Wagner, Jean A. Yared, Daniel J. Weisdorf

Department of Medical Oncology Faculty Papers

We report graft-versus-host disease (GVHD)-free relapse-free survival (GRFS) (a composite end point of survival without grade III-IV acute GVHD [aGVHD], systemic therapy-requiring chronic GVHD [cGVHD], or relapse) and cGVHD-free relapse-free survival (CRFS) among pediatric patients with acute leukemia (n = 1613) who underwent transplantation with 1 antigen-mismatched (7/8) bone marrow (BM; n = 172) or umbilical cord blood (UCB; n = 1441). Multivariate analysis was performed using Cox proportional hazards models. To account for multiple testing, P < .01 for the donor/graft variable was considered statistically significant. Clinical characteristics were similar between UCB and 7/8 BM recipients, because most had acute lymphoblastic leukemia (62%), 64% received total body irradiation-based conditioning, and 60% received anti-thymocyte globulin or alemtuzumab. Methotrexate-based GVHD prophylaxis was more common with 7/8 BM (79%) than with UCB (15%), in which mycophenolate mofetil was commonly used. The univariate estimates of GRFS and CRFS were 22% (95% confidence interval [CI], 16-29) and 27% (95% CI, 20-34), respectively, with 7/8 BM and 33% (95% CI, 31-36) and 38% (95% CI, 35-40), respectively, with UCB (P < .001). In multivariate analysis, 7/8 BM vs UCB had similar GRFS (hazard ratio [HR], 1.12; 95% CI, 0.87-1.45; P = .39), CRFS (HR, 1.06; 95% CI, 0.82-1.38; P = .66), overall survival (HR, 1.07; 95% CI, 0.80-1.44; P = .66), and relapse (HR, 1.44; 95% CI, 1.03-2.02; P = .03). However, the 7/8 BM group had a significantly higher risk for grade III-IV aGVHD (HR, 1.70; 95% CI, 1.16-2.48; P = .006) compared with the UCB group. UCB and 7/8 BM groups had similar outcomes, as measured by GRFS and CRFS. However, given the higher risk for grade III-IV aGVHD, UCB might be preferred for patients lacking matched donors. © 2019 American Society of Hematology. All rights reserved.

Rabies-Based Vaccine Induces Potent Immune Responses Against Nipah Virus., Rohan Keshwara, Thomas Shiels, Elena Postnikova, Drishya Kurup, Christoph Wirblich, Reed F. Johnson, Matthias J. Schnell

Department of Microbiology and Immunology Faculty Papers

Nipah Virus (NiV) is a re-emerging zoonotic pathogen in the genus Henipavirus of the Paramyxoviridae family of viruses. NiV is endemic to Bangladesh and Malaysia and is highly fatal to both livestock and humans (human case fatality rate = 74.5%). Currently, there is no approved vaccine against NiV on the market. The goal of this study was to use a recombinant RABV vector expressing NiV glycoprotein (NiV G) to develop a bivalent candidate vaccine against NiV disease and rabies virus (RABV) disease, which is also a significant health burden in the regions where NiV is endemic. The rabies vector is …

Histological Chorioamnionitis Induces Differential Gene Expression In Human Cord Blood Mononuclear Leukocytes From Term Neonates., Suhita Gayen Nee’ Betal, Swati Murthy, Michael Favara, Gina Fong, Joanna Chan, Sankar Addya, Thomas H. Shaffer, Jay S. Greenspan, Vineet Bhandari, Irfan Rahman, Zubair H. Aghai

Department of Pediatrics Faculty Papers

Histological chorioamnionitis (HCA) is an infection of fetal membranes and complicates 5.2% to 28.5% of all live births. HCA is associated with increased mortality and morbidity in both premature and term neonates. Exposure to HCA may have long-term consequences, including an increased risk for allergic disorders and asthma later in childhood, the mechanism(s) of which are still not yet well understood. The objective of this study was to determine the mRNA transcriptome of cord blood mononuclear leukocytes from term neonates to identify key genes and pathways involved in HCA. We found 366 differentially expressed probe IDs with exposure to HCA …

Diagnosis Of B-Cell Lymphoproliferative Disorder Through Concomitant Management Of Medication-Related Osteonecrosis Of The Jaw: A Case Report, Robert Diecidue, Allen F. Champion, Ruifeng Zhou, James G. Buckley

Department of Oral and Maxillofacial Surgery Faculty Papers

No abstract provided.

Survival Probability In Patients With Sickle Cell Anemia Using The Competitive Risk Statistical Model., Emilia Matos Do Nascimento, Clarisse Lopes De Castro Lobo, Basilio De Bragança Pereira, Samir K. Ballas

Cardeza Foundation for Hematologic Research

The clinical picture of patients with sickle cell anemia (SCA) is associated with several complications some of which could be fatal. The objective of this study is to analyze the causes of death and the effect of sex and age on survival of Brazilian patients with SCA. Data of patients with SCA who were seen and followed at HEMORIO for 15 years were retrospectively collected and analyzed. Statistical modeling was performed using survival analysis in the presence of competing risks estimating the covariate effects on a sub-distribution hazard function. Eight models were implemented, one for each cause of death. The …

Probable Donor-Derived Human Adenovirus Type 34 Infection In 2 Kidney Transplant Recipients From The Same Donor., Matthew A. Pettengill, Tara M. Babu, Paritosh Prasad, Sally Chuang, Michael G. Drage, Marilyn Menegus, Daryl M. Lamson, Xiaoyan Lu, Dean Erdman, Nicole Pecora

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Human adenovirus type 34 (HAdV-34) infection is a recognized cause of transplant-associated hemorrhagic cystitis and, in rare cases, tubulointerstitial nephritis. The source of such infections is often difficult to assess, that is, whether acquired as a primary infection, exposure to a pathogen in the transplanted organ, or reactivation of an endogenous latent infection. We present here 2 cases of likely transplant-acquired HAdV-34 infection from the same organ donor, manifesting as tubulointerstitial nephritis in 1.

Finding The 'Qr' To Patient Safety: Applying Gamification To Incorporate Patient Safety Priorities Through A Simulated 'Escape Room' Experience., Xiao Chi Zhang, Gretchen Diemer, Hyunjoo Lee, Rebecca Jaffe, Dimitrios Papanagnou

Department of Emergency Medicine Faculty Papers

Medical errors are the eighth leading cause of mortality in the United States and contribute to over one million preventable injuries. In an effort to prevent medical errors, reporting systems serve as invaluable tools to detect patient safety events and quality problems longitudinally. Historically, trainees (i.e., students and residents) rarely submit incident reports for encountered patient safety threats. The authors propose an immersive learning experience utilizing gamification theory and leveraging the increasingly popular ‘escape room’ to help resident trainees identify reportable patient safety priorities. All 130 incoming intern physicians at the Thomas Jefferson University (Jefferson) were enrolled in the Patient …

Murine Mpdz-Linked Hydrocephalus Is Caused By Hyperpermeability Of The Choroid Plexus., Junning Yang, Claire Simonneau, Robert Kilker, Laura Oakley, Matthew D. Byrne, Zuzana Nichtova, Ioana Stefanescu, Fnu Pardeep-Kumar, Sushil Tripathi, Eric Londin, Pascale Saugier-Veber, Belinda Willard, Mathew Thakur, Stephen Pickup, Hiroshi Ishikawa, Horst Schroten, Richard Smeyne, Arie Horowitz

Cardeza Foundation for Hematologic Research

Though congenital hydrocephalus is heritable, it has been linked only to eight genes, one of which is MPDZ Humans and mice that carry a truncated version of MPDZ incur severe hydrocephalus resulting in acute morbidity and lethality. We show by magnetic resonance imaging that contrast medium penetrates into the brain ventricles of mice carrying a Mpdz loss-of-function mutation, whereas none is detected in the ventricles of normal mice, implying that the permeability of the choroid plexus epithelial cell monolayer is abnormally high. Comparative proteomic analysis of the cerebrospinal fluid of normal and hydrocephalic mice revealed up to a 53-fold increase …

A Systemic Approach To The Development And Improvement Of Trauma Education And Training, Yoon Suh Moh

Counseling and Behavioral Health Faculty Papers

A number of individuals are exposed to adversity (e.g., child abuse and neglect, parental substance abuse, mental illness, incarceration) early in life (Felitti et al., 1998; Centers for Disease Control [CDC] and Prevention, 2019). Moreover, over 70% of individuals worldwide will experience a traumatic event at some point in their lives (Benjet et al., 2016). Mounting research has documented that the effects of trauma exposure in childhood are not only immediate but also enduring, leading to lifelong health problems. At the same time, studies have suggested that there is a lack of systemic trauma education and training. This article will …

Minimal Information For Studies Of Extracellular Vesicles 2018 (Misev2018): A Position Statement Of The International Society For Extracellular Vesicles And Update Of The Misev2014 Guidelines, Clotilde Théry, Kenneth W. Witwer, Elena Aikawa, Maria Jose Alcaraz, Johnathon D. Anderson, Ramaroson Andriantsitohaina, Anna Antoniou, Tanina Arab, Fabienne Archer, Georgia K. Atkiin-Smith, D. Craig Ayre, Jean-Marie Bach, Daniel Bachurski, Hossein Baharvand, Leonora Balaj, Shawn Baldacchino, Natalie N. Bauer, Amy A. Baxter, Mary Bebawy, Carla Beckham, Apolonija Bedina Zavec, Abderrahim Benmoussa, Anna C. Berardi, Paolo Bergese, Ewa Bielska, Cherie Blenkiron, Sylwia Bobis-Wozowicz, Eric Boilard, Wilfrid Boireau, Antonella Bongiovanni, Francesc E. Borràs, Steffi Bosch, Chantal M. Boulanger, Xandra Breakefield, Andrew M. Breglio, Meadhbh Á. Brennan, David R. Brigstock, Alain Brisson, Marike L.D. Broekman, Jacqueline F. Bromberg, Paulina Bryl-Górecka, Shilpa Buch, Amy H. Buck, Dylan Burger, Sara Busatto, Dominik Buschmann, Benedetta Bussolati, Edit I. Buzás, James Bryan Byrd, Giovanni Camussi, David R.F. Carter, Sarah Caruso, Lawrence W. Chamley, Yu-Ting Chang, Chichen Chen, Shuai Chen, Lesley Cheng, Andrew R. Chin, Aled Clayton, Stefano P. Clerici, Alex Cocks, Emanuele Cocucci, Robert J. Coffey, Anabela Cordeiro-Da-Silva, Yvonne Couch, Frank A.W. Coumans, Beth Coyle, Rossella Crescitelli, Miria Ferreira Criado, Crislyn D’ Souza-Schorey, Saumya Das, Amrita Datta Chaudhuri, Paola De Candia, Eliezer F. De Santana Junior, Olivier De Wever, Hernando A. Del Portillo, Tanguy Demaret, Sarah Deville, Andrew Devitt, Bert Dhondt, Dolores Di Vizio, Lothar C. Dieterich, Vincenza Dolo, Ana Paula Dominguez Rubio, Massimo Dominici, Mauricio R. Dourado, Tom A.P Driedonks, Filipe V. Duarte, Heather M. Duncan, Ramon M. Eichenberger, Karin Ekström, Samir El Andaloussi, Celine Elie-Caille, Uta Erdbrügger, Juan M. Falcón-Pérez, Farah Fatima, Jason E. Fish, Miguel Flores-Bellver, András Försönits, Annie Frelet-Barrand, Fabia Fricke, Gregor Fuhrmann, Susanne Gabrielsson, Ana Gámez-Valero, Chris Gardiner, Kathrin Gärtner, Raphael Gaudin, Yong Song Gho, Bernd Giebel, Caroline Gilbert, Mario Gimona, Ilaria Giusti, Deborah C.I. Goberdhan, André Görgens, Sharon M. Gorski, David W. Greening, Julia Christina Gross, Alice Gualerzi, Gopal N. Gupta, Dakota Gustafson, Aase Handberg, Reka A. Haraszti, Paul Harrison, Hargita Hegyesi, An Hendrix, Andrew F. Hill, Fred H. Hochberg, Karl F. Hoffmann, Beth Holder, Harry Holthofer, Baharak Hosseinkhani, Guoku Hu, Yiyao Huang, Veronica Huber, Stuart Hunt, Ahmed Gamal-Eldin Ibrahim, Tsuneya Ikezu, Jameel M. Inal, Mustafa Isin, Alena Ivanova, Hannah K. Jackson, Soren Jacobsen, Steven M. Jay, Muthuvel Jayachandran, Guido Jenster, Lanzhou Jiang, Suzanne M. Johnson, Jennifer C. Jones, Ambrose Jong, Tijana Jovanovic-Talisman, Stephanie Jung, Raghu Kalluri, Shin-Ichi Kano, Sukhbir Kaur, Yumi Kawamura, Evan T. Keller, Delaram Khamari, Elena Khomyakova, Anastasia Khvorova, Peter Kierulf, Kwang Pyo Kim, Thomas Kislinger, Mikael Klingeborn, David J. Klinke Ii, Miroslaw Kornek, Maja M. Kosanović, Árpád Ferenc Kovács, Eva-Maria Krämer-Albers, Susanne Krasemann, Mirja Krause, Igor V. Kurochkin, Gina D. Kusuma, Sören Kuypers, Saara Laitinen, Scott M. Langevin, Lucia R. Languino, Joanne Lannigan, Cecilia Lässer, Louise C. Laurent, Gregory Lavieu, Elisa Lázaro-Ibáñez, Soazig Le Lay, Myung-Shin Lee, Yi Xin Fiona Lee, Debora S. Lemos, Metka Lenassi, Aleksandra Leszczynska, Isaac T.S. Li, Ke Liao, Sten F. Libregts, Erzsebet Ligeti, Rebecca Lim, Sai Kiang Lim, Aija Linē, Karen Linnemannstöns, Alicia Llorente, Catherine A. Lombard, Magdalena J. Lorenowicz, Ákos M. Lörincz, Jan Lötvall, Jason Lovett, Michelle C. Lowry, Xavier Loyer, Quan Lu, Barbara Lukomska, Taral R. Lunavat, Sybren L.N. Maas, Harmeet Malhi, Antonio Marcilla, Jacopo Mariani, Javier Mariscal, Elena S. Martens-Uzunova, Lorena Martin-Jaular, M. Carmen Martinez, Vilma Regina Martins, Mathilde Mathieu, Suresh Mathivanan, Marco Maugeri, Lynda K. Mcginnis, Mark J. Mcvey, David G. Meckes, Jr., Katie L. Meehan, Inge Mertens, Valentina R. Minciacchi, Andreas Möller, Malene Møller Jørgensen, Aizea Morales-Kastresana, Jess Morhayim, François Mullier, Maurizio Muraca, Luca Musante, Veronika Mussack, Dillon C. Muth, Kathryn H. Myburgh, Tanbir Najrana, Muhammad Nawaz, Irina Nazarenko, Peter Nejsum, Christian Neri, Tommaso Neri, Rienk Nieuwland, Leonardo Nimrichter, John P. Nolan, Esther N.M. Nolte-’ T Hoen, Nicole Noren Hooten, Lorraine O’Driscoll, Tina O’Grady, Ana O’Loghlen, Takahiro Ochiya, Martin Olivier, Alberto Ortiz, Luis A. Ortiz, Xabier Osteikoetxea, Ole Ostegaard, Matias Ostrowski, Jaesung Park, D. Michiel Pegtel, Hector Peinado, Francesca Perut, Michael W. Pfaffl, Donald G. Phinney, Bartijn C.H. Pieters, Ryan C. Pink, David S. Pisetsky, Elke Pogge Von Strandmann, Iva Polakovicova, Ivan K.H. Poon, Bonita H. Powell, Ilaria Prada, Lynn Pulliam, Peter Quesenberry, Annalisa Radeghieri, Robert L. Raffai, Stefania Raimondo, Janusz Rak, Marcel I. Ramirez, Graça Raposo, Morsi S. Rayyan, Neta Regev-Rudzki, Fran L. Ricklefs, Paul D. Robbins, David D. Roberts, Silvia C. Rodrigues, Eva Rohde, Sophie Rome, Kasper M.A. Rouschop, Aurelia Rughetti, Ashley E. Russell, Paula Saá, Susmita Sahoo, Edison Salas-Huenuleo, Catherine Sánchez, Julie A. Saugstad, Meike J. Saul, Raymond M. Schiffelers, Raphael Schneider, Tine Hiorth Schøyen, Aaron Scott, Eriomina Shahaj, Shivani Sharma, Olga Shatnyeva, Faezeh Shekari, Ganesh Vilas Shelke, Ashok K. Shetty, Kiyotaka Shiba, Pia R-M Siljander, Andreia M. Silva, Agata Skowronek, Orman L. Snyder Ii, Rodrigo Pedro Soares, Barbara W. Sódar, Carolina Soekmadji, Javier Sotillo, Philip D. Stahl, Willem Stoorvogel, Shannon L. Stott, Erwin F. Strasser, Simon Swift, Hidetoshi Tahara, Muneesh Tewari, Kate Timms, Swasti Tiwari, Rochelle Tixeira, Mercedes Tkach, Wei Seong Toh, Richard Tomasini, Ana Claudia Torrecilhas, Juan Pablo Tosar, Vasilis Toxavidis, Lorena Urbanelli, Pieter Vader, Bas W.M. Van Balkom, Susanne G. Van Der Grein, Jan Van Deun, Martijn J.C. Van Herwijnen, Kendall Van Keuren-Jensen, Guillaume Van Niel, Martin E. Van Royen, Andre J. Van Wijnen, M. Helena Vasconcelos, Ivan J. Vechetti Jr., Tiago D. Veit, Laura J. Vella, Émilie Velot, Frederik J. Verweij, Beate Vestad, Jose L. Viñas, Tamás Visnovitz, Krisztina V. Vukman, Jessica Wahlgren, Dionysios C. Watson, Marca H.M. Wauben, Alissa Weaver, Jason P. Webber, Viktoria Weber, Ann M. Wehman, Daniel J. Weiss, Joshua A. Welsh, Sebastian Wendt, Asa M. Wheelock, Zoltán Wiener, Leonie Witte, Joy Wolfram, Angeliki Xagorari, Patricia Xander, Jing Xu, Xiaomei Yan, María Yáñez-Mó, Hang Yin, Yuana Yuana, Valentina Zappulli, Jana Zarubova, Vytautas Žėkas, Jian-Ye Zhang, Zezhou Zhao, Lei Zheng, Alexander R. Zheutlin, Antje M. Zickler, Pascale Zimmermann, Angela M. Zivkovic, Davide Zocco, Ewa K. Zuba-Surma

Department of Cancer Biology Faculty Papers

The last decade has seen a sharp increase in the number of scientific publications describing physiological and pathological functions of extracellular vesicles (EVs), a collective term covering various subtypes of cell-released, membranous structures, called exosomes, microvesicles, microparticles, ectosomes, oncosomes, apoptotic bodies, and many other names. However, specific issues arise when working with these entities, whose size and amount often make them difficult to obtain as relatively pure preparations, and to characterize properly. The International Society for Extracellular Vesicles (ISEV) proposed Minimal Information for Studies of Extracellular Vesicles (“MISEV”) guidelines for the field in 2014. We now update these “MISEV2014” guidelines …

Checkpoint Inhibitors: What Gastroenterologists Need To Know., Monjur Ahmed

Division of Gastroenterology and Hepatology Faculty Papers

Checkpoint inhibitors are increasingly being used in clinical practice. They can cause various gastrointestinal, hepatic and pancreatic side effects. As these side effects can be serious, appropriate management is essential. The different checkpoint inhibitors with their mechanisms of action and indications, as well as evaluation and management of gastrointestinal, hepatic and pancreatic side effects, are discussed in this article.

Isolated Gonococcal Extensor Tenosynovitis, Cory Lebowitz, Jonas Matzon

Department of Orthopaedic Surgery Faculty Papers

Neisseria gonorrhoeae is a mucosal infection that has the propensity to disseminate, causing symptoms that commonly include arthralgias, skin lesions, fevers, chills, dysuria, genital discharge, septic arthritis, and/or tenosynovitis. Typically, gonococcal tenosynovitis affects the flexor sheath and is associated with arthralgias, skin lesions, or both. To the best of our knowledge, there has not been a documented case of isolated gonococcal extensor tenosynovitis. We report the case of a 16-year-old boy with isolated left upper-extremity gonococcal extensor tenosynovitis who was successfully treated with surgical debridement and antibiotic therapy.

A Comparison Of Screening, Prevention, And Management For Hepatitis B Patients Between The Us And Chinese Healthcare Systems, Thomas Chen, James D. Plumb, Md

Phase 1

Introduction: Hepatitis B (HBV) is a complex disease entity with potentially serious outcomes, including developing hepatocellular carcinoma (HCC). HBV is estimated to be responsible for about 50-80% of HCC cases worldwide, and 75-95% of HCC cases in HBV endemic regions.¹ HBV and HCC are great concerns especially in East Asian countries like China. In China, HCC ranks as the 2^nd most common cancer and 2^nd in cancer mortality, both behind only lung cancer.¹ China is considered an endemic HBV region, with about 100-150 million people infected. In comparison, only an estimated 550,000-2 million people are chronically …

Non-Neutralizing Antibodies Elicited By Recombinant Lassa-Rabies Vaccine Are Critical For Protection Against Lassa Fever., Tiago Abreu-Mota, Katie R. Hagen, Kurt Cooper, Peter B. Jahrling, Gene Tan, Christoph Wirblich, Reed F. Johnson, Matthias J. Schnell

Department of Microbiology and Immunology Faculty Papers

Lassa fever (LF), caused by Lassa virus (LASV), is a viral hemorrhagic fever for which no approved vaccine or potent antiviral treatment is available. LF is a WHO priority disease and, together with rabies, a major health burden in West Africa. Here we present the development and characterization of an inactivated recombinant LASV and rabies vaccine candidate (LASSARAB) that expresses a codon-optimized LASV glycoprotein (coGPC) and is adjuvanted by a TLR-4 agonist (GLA-SE). LASSARAB elicits lasting humoral response against LASV and RABV in both mouse and guinea pig models, and it protects both guinea pigs and mice against LF. We …

Development Of Onchocerca Volvulus In Humanized Nsg Mice And Detection Of Parasite Biomarkers In Urine And Serum., John B. Patton, Sasisekhar Bennuru, Mark L. Eberhard, Jessica A. Hess Ligas, April R. Torigian, Sara Lustigman, Thomas B. Nutman, David Abraham

Department of Microbiology and Immunology Faculty Papers

BACKGROUND: The study of Onchocerca volvulus has been limited by its host range, with only humans and non-human primates shown to be susceptible to the full life cycle infection. Small animal models that support the development of adult parasites have not been identified.

METHODOLOGY/PRINCIPAL FINDINGS: We hypothesized that highly immunodeficient NSG mice would support the survival and maturation of O. volvulus and alteration of the host microenvironment through the addition of various human cells and tissues would further enhance the level of parasite maturation. NSG mice were humanized with: (1) umbilical cord derived CD34+ stem cells, (2) fetal derived liver, …

Presentation And Outcomes After Medical And Surgical Treatment Versus Medical Treatment Alone Of Spontaneous Infectious Spondylodiscitis: A Systematic Literature Review And Meta-Analysis., Davis G Taylor, Avery L Buchholz, Durga R Sure, Thomas J Buell, James H Nguyen, Ching-Jen Chen, Joshua M Diamond, Perry A Washburn, James Harrop, Christopher I Shaffrey, Justin S Smith

Department of Medicine Faculty Papers

Study Design: Systematic literature review.

Objectives: The aims of this study were to (1) describe the clinical features, disabilities, and incidence of neurologic deficits of pyogenic spondylodiscitis prior to treatment and (2) compare the functional outcomes between patients who underwent medical treatment alone or in combination with surgery for pyogenic spondylodiscitis.

Methods: A systematic literature review was performed using PubMed according to PRISMA guidelines. No year restriction was put in place. Statistical analysis of pooled data, when documented in the original report (ie, number of patients with desired variable and number of patients evaluated), was conducted to determine the most …

Potential Role Of Csf Cytokine Profiles In Discriminating Infectious From Non-Infectious Cns Disorders., Danielle Fortuna, D. Craig Hooper, Amity L. Roberts, Larry A. Harshyne, Michelle Nagurney, Mark T. Curtis

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Current laboratory testing of cerebrospinal fluid (CSF) does not consistently discriminate between different central nervous system (CNS) disease states. Rapidly distinguishing CNS infections from other brain and spinal cord disorders that share a similar clinical presentation is critical. New approaches focusing on aspects of disease biology, such as immune response profiles that can have stimulus-specific attributes, may be helpful. We undertook this preliminary proof-of-concept study using multiplex ELISA to measure CSF cytokine levels in various CNS disorders (infections, autoimmune/demyelinating diseases, lymphomas, and gliomas) to determine the potential utility of cytokine patterns in differentiating CNS infections from other CNS diseases. Both …

Role Of The Fractalkine Receptor In Cns Autoimmune Inflammation: New Approach Utilizing A Mouse Model Expressing The Human Cx3cr1, Sandra M. Cardona, Sangwon V. Kim, Kaira A. Church, Vanessa O. Torres, Ian A. Cleary, Andrew S. Mendiola, Stephen P. Saville, Stephanie S. Watowich, Jan Parker-Thornburg, Alejandro Soto-Ospina, Pedronel Araque, Richard M. Ransohoff, Astrid E. Cardona

Department of Microbiology and Immunology Faculty Papers

Multiple sclerosis (MS), an inflammatory demyelinating disease of the central nervous system (CNS) is the leading cause of non-traumatic neurological disability in young adults. Immune mediated destruction of myelin and oligodendrocytes is considered the primary pathology of MS, but progressive axonal loss is the major cause of neurological disability. In an effort to understand microglia function during CNS inflammation, our laboratory focuses on the fractalkine/CX3CR1 signaling as a regulator of microglia neurotoxicity in various models of neurodegeneration. Fractalkine (FKN) is a transmembrane chemokine expressed in the CNS by neurons and signals through its unique receptor CX3CR1 present in microglia. During …

Era Of Direct Acting Anti-Viral Agents For The Treatment Of Hepatitis C., Monjur Ahmed

Division of Gastroenterology and Hepatology Faculty Papers

Hepatitis C infection is universal and the most common indication of liver transplantation in the United States. The period of less effective interferon therapy with intolerable side effects has gone. Now we have stepped into the era of direct acting anti-viral agents (DAAs) against hepatitis C virus. Treatment of hepatitis C is now extremely effective, tolerable and requires a short duration of intake of oral agents. Less monitoring is required with the current therapy and drug-drug interactions are less than the previous regimen. The current treatment options of chronic hepatitis C with various DAAs are discussed in this article.

Balancing Early Antibiotic Administration And Stewardship In Sepsis, Cindy Hou, Do, Ma, Mba, Facoi, Facp

Sepsis Symposium

Presented at the 3rd Annual Sepsis Symposium

The Human Cib1-Ever1-Ever2 Complex Governs Keratinocyte-Intrinsic Immunity To Β-Papillomaviruses., Sarah Jill De Jong, Amandine Créquer, Irina Matos, David Hum, Vignesh Gunasekharan, Lazaro Lorenzo, Fabienne Jabot-Hanin, Elias Imahorn, Andres A. Arias, Hassan Vahidnezhad, Leila Youssefian, Janet G. Markle, Etienne Patin, Aurelia D'Amico, Claire Q.F. Wang, Florian Full, Armin Ensser, Tina M. Leisner, Leslie V. Parise, Matthieu Bouaziz, Nataly Portilla Maya, Xavier Rueda Cadena, Bayaki Saka, Amir Hossein Saeidian, Nessa Aghazadeh, Sirous Zeinali, Peter Itin, James G. Krueger, Lou Laimins, Laurent Abel, Elaine Fuchs, Jouni Uitto, Jose Luis Franco, Bettina Burger, Gérard Orth, Emmanuelle Jouanguy, Jean-Laurent Casanova

Department of Dermatology and Cutaneous Biology Faculty Papers

Patients with epidermodysplasia verruciformis (EV) and biallelic null mutations of TMC6 (encoding EVER1) or TMC8 (EVER2) are selectively prone to disseminated skin lesions due to keratinocyte-tropic human β-papillomaviruses (β-HPVs), which lack E5 and E8. We describe EV patients homozygous for null mutations of the CIB1 gene encoding calcium- and integrin-binding protein-1 (CIB1). CIB1 is strongly expressed in the skin and cultured keratinocytes of controls but not in those of patients. CIB1 forms a complex with EVER1 and EVER2, and CIB1 proteins are not expressed in EVER1- or EVER2-deficient cells. The known functions of EVER1 and EVER2 in human keratinocytes are …

Outcomes Of Shoulder Arthroplasty Performed For Postinfectious Arthritis., Eric M. Padegimas, Thema A. Nicholson, Stephen Silva, Matthew L. Ramsey, Gerald R. Williams, Mark D. Lazarus, Surena Namdari

Rothman Institute Papers

Background: The purpose of this study was to evaluate the functional outcomes, infection rate, and complications associated with shoulder arthroplasty for sequelae of prior septic arthritis.

Methods: This is a retrospective cohort study of 17 patients who underwent shoulder arthroplasty for sequelae of septic arthritis. Patients were analyzed for patient-reported outcomes, complications, and reoperations.

Results: The 17 patients in this cohort were an average age of 65.4 ± 12.2 years old, were 58.8% male, and had an average body mass index of 27.9 ± 4.1 kg/m

Conclusions: Shoulder arthroplasty after septic arthritis had inconsistent functional outcomes and high complication rates …

Lafora Disease Masquerading As Hepatic Dysfunction, Faisal Inayat, Waqas Ullah, Hanan T. Lodhi, Zarak H. Khan, Ghulam Ilyas, Nouman Safdar Ali, Hafez Mohammad A. Abdullah

Abington Jefferson Health Papers

Lafora disease is fatal intractable progressive myoclonic epilepsy. It is frequently characterized by epileptic seizures, difficulty walking, muscle spasms, and dementia in late childhood or adolescence. We chronicle here an unusual case of an asymptomatic young male soccer player who presented with elevated liver enzymes. Neurological examination was unremarkable. The diagnostic workup for hepatitis, infectious etiologies, autoimmune disorders, hemochromatosis, Wilson's disease, alpha-1 antitrypsin deficiency, and other related diseases was inconclusive. He subsequently underwent an uneventful percutaneous liver biopsy. Based on the pathognomonic histopathological findings, Lafora disease was considered the likely etiology. The present study is a unique illustration of this …