Digital Commons Network^™

Intraoperative Vancomycin Use In Spinal Surgery: Single Institution Experience And Microbial Trends., George M. Ghobrial, Md, Vismay Thakkar, Md, Edward Andrews, Md, Michael Lang, Md, Ameet Chitale, Md, Mark E Oppenlander, Md, Christopher M Maulucci, Md, Ashwini D Sharan, Md, Joshua Heller, Md, James Harrop, Md, Jack Jallo, Md, Phd, Facs, Srinivas Prasad, Md

Department of Neurosurgery Faculty Papers

Study Design. Retrospective Case Series.Objective. To demonstrate the microbial trends of spinal surgical site infections(SSI) in patients who had previously received crystallized vancomycin in the operative bed.Summary of Background Data. Prior large, case control series demonstrate the significant decrease in SSI with the administration of vancomycin in the wound bed.Methods. A single institution, electronic database search was conducted for all spinal surgery patients who had received prophylactic crystalline vancomycin powder in the wound bed. Patient's with a prior history of wound infection, intrathecal pumps, or spinal stimulators were excludedResults. 981 consecutive patients (494 male, 487 female, mean age 59.4 years, …

Urgent Global Opportunities To Prevent Birth Defects., Robert L. Brent Dr.

The Selected Works of Robert Brent

No abstract provided.

Achieving High-Value Cardiac Imaging: Challenges And Opportunities., David H Wiener

Division of Cardiology Faculty Papers

Cardiac imaging is under intense scrutiny as a contributor to health care costs, with multiple initiatives under way to reduce and eliminate inappropriate testing. Appropriate use criteria are valuable guides to selecting imaging studies but until recently have focused on the test rather than the patient. Patient-centered means are needed to define the true value of imaging for patients in specific clinical situations. This article provides a definition of high-value cardiac imaging. A paradigm to judge the efficacy of echocardiography in the absence of randomized controlled trials is presented. Candidate clinical scenarios are proposed in which echocardiography constitutes high-value imaging, …

Scitech Book News Reviews, Susan Fingerman

Sci-Tech News

No abstract provided.

Periprosthetic Knee Infection: Ten Strategies That Work., Javad Parvizi, Md, Priscilla Ku Cavanaugh, Claudio Diaz-Ledezma

Department of Orthopaedic Surgery Faculty Papers

Periprosthetic joint infection (PJI) is one of the most serious complications following total knee arthroplasty (TKA). The demand for TKA is rapidly increasing, resulting in a subsequent increase in infections involving knee prosthesis. Despite the existence of common management practices, the best approach for several aspects in the management of periprosthetic knee infection remains controversial. This review examines the current understanding in the management of the following aspects of PJI: preoperative risk stratification, preoperative antibiotics, preoperative skin preparation, outpatient diagnosis, assessing for infection in revision cases, improving culture utility, irrigation and debridement, one and two-stage revision, and patient prognostic information. …

Population Health Matters, Fall 2013, Download Full Text Pdf

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Healthcare-Associated Infections-Is Targeting Zero A Global Reality?, Mary Lou Manning Phd, Crnp, Cic, Faan, Denise Murphy Rn, Mph, Cic, Faan

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Snapin, Positive Regulator Of Stimulation- Induced Ca(2+) Release Through Ryr, Is Necessary For Hiv-1 Replication In T Cells., Shigemi M Kinoshita, Amane Kogure, Shizuka Taguchi, Garry P Nolan

Department of Microbiology and Immunology Faculty Papers

To identify critical host factors necessary for human immunodeficiency virus 1 (HIV-1) replication, large libraries of short-peptide-aptamers were expressed retrovirally. The target of one inhibitor peptide, Pep80, identified in this screen was determined to be Snapin, a protein associated with the soluble N-ethyl maleimide sensitive factor adaptor protein receptor (SNARE) complex that is critical for calcium-dependent exocytosis during neurotransmission. Pep80 inhibited Ca(2+) release from intracellular stores and blocked downstream signaling by direct interruption of the association between Snapin and an intracellular calcium release channel, the ryanodine receptor (RyR). NFAT signaling was preferentially abolished by Pep80. Expression of Snapin overcame Pep80-mediated …

Presence Of Virus Neutralizing Antibodies In Cerebral Spinal Fluid Correlates With Non-Lethal Rabies In Dogs., Clement W Gnanadurai, Ming Zhou, Wenqi He, Christina M Leyson, Chien-Tsun Huang, Gregory Salyards, Stephen B Harvey, Zhenhai Chen, Biao He, Yang Yang, D C Hooper, Berhnard Dietzchold, Zhen F Fu

Department of Cancer Biology Faculty Papers

BACKGROUND: Rabies is traditionally considered a uniformly fatal disease after onset of clinical manifestations. However, increasing evidence indicates that non-lethal infection as well as recovery from flaccid paralysis and encephalitis occurs in laboratory animals as well as humans.

METHODOLOGY/PRINCIPAL FINDINGS: Non-lethal rabies infection in dogs experimentally infected with wild type dog rabies virus (RABV, wt DRV-Mexico) correlates with the presence of high level of virus neutralizing antibodies (VNA) in the cerebral spinal fluid (CSF) and mild immune cell accumulation in the central nervous system (CNS). By contrast, dogs that succumbed to rabies showed only little or no VNA in the …

Occupational Exposure To Hepatitis C Virus: Early T-Cell Responses In The Absence Of Seroconversion In A Longitudinal Cohort Study., Theo Heller, Jens Martin Werner, Fareed Rahman, Eishiro Mizukoshi, Yuji Sobao, Ann Marie Gordon, Arlene Sheets, Averell H. Sherker, Ellen Kessler, Kathleen S. Bean, Steven K. Herrine, M'Lou Stevens, James Schmitt, Barbara Rehermann

Division of Gastroenterology and Hepatology Faculty Papers

BACKGROUND: T-cell responses have been described in seronegative patients who test negative for hepatitis C virus (HCV) RNA despite frequent HCV exposure. However, the cross-sectional design of those studies did not clarify whether T cells were indeed induced by low-level HCV exposure without seroconversion or whether they resulted from regular acute infection with subsequent antibody loss.

METHODS: Over a 10-year period, our longitudinal study recruited 72 healthcare workers with documented HCV exposure. We studied viremia and antibody and T-cell responses longitudinally for 6 months.

RESULTS: All healthcare workers remained negative for HCV RNA and antibodies. However, 48% developed proliferative T-cell …

Aseptically Processed And Chemically Sterilized Btb Allografts For Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Study., Peter A Indelicato, Michael G Ciccotti, Joel Boyd, Laurence D Higgins, Benjamin S Shaffer, C Thomas Vangsness

Department of Orthopaedic Surgery Faculty Papers

PURPOSE: To compare the clinical outcomes of bone-patellar tendon-bone (BTB) allografts processed via a novel sterilization system with the traditional aseptically processed BTB allografts for anterior cruciate ligament (ACL) reconstruction.

METHODS: A total of 67 patients undergoing ACL reconstruction at 6 independent investigation sites were randomized into one of two intervention groups, BioCleanse-sterilized or aseptic BTB allografts. Inclusion criteria included an acute, isolated, unilateral ACL tear, and exclusion criteria included prior ACL injury, multi-ligament reconstruction, and signs of degenerative joint disease. Post-op examiners and patients were blinded to graft type. Patients were evaluated at 6, 12, and 24 months. Clinical …

Spinal Anesthesia: Should Everyone Receive A Urinary Catheter?: A Randomized, Prospective Study Of Patients Undergoing Total Hip Arthroplasty., Adam G Miller, James Mckenzie, Max Greenky, Erica Shaw, Kishor Gandhi, William J Hozack, Javad Parvizi

Rothman Institute Papers

BACKGROUND: The objective of this randomized prospective study was to determine whether a urinary catheter is necessary for all patients undergoing total hip arthroplasty under spinal anesthesia.

METHODS: Consecutive patients undergoing total hip arthroplasty under spinal anesthesia were randomized to treatment with or without insertion of an indwelling urinary catheter. All patients received spinal anesthesia with 15 to 30 mg of 0.5% bupivacaine. The catheter group was subjected to a standard postoperative protocol, with removal of the indwelling catheter within forty-eight hours postoperatively. The experimental group was monitored for urinary retention and, if necessary, had straight catheterization up to two …

Spinal Anesthesia: Should Everyone Receive A Urinary Catheter?: A Randomized, Prospective Study Of Patients Undergoing Total Hip Arthroplasty., Adam G Miller, Md, James Mckenzie, Bs, Max Greenky, Ba, Erica Shaw, Rnp, Kishor Gandhi, Md, William J Hozack, Md, Javad Parvizi, Md, Frcs

Rothman Institute Papers

BACKGROUND: The objective of this randomized prospective study was to determine whether a urinary catheter is necessary for all patients undergoing total hip arthroplasty under spinal anesthesia.

METHODS: Consecutive patients undergoing total hip arthroplasty under spinal anesthesia were randomized to treatment with or without insertion of an indwelling urinary catheter. All patients received spinal anesthesia with 15 to 30 mg of 0.5% bupivacaine. The catheter group was subjected to a standard postoperative protocol, with removal of the indwelling catheter within forty-eight hours postoperatively. The experimental group was monitored for urinary retention and, if necessary, had straight catheterization up to two …

Oncogenes And Inflammation Rewire Host Energy Metabolism In The Tumor Microenvironment: Ras And Nfκb Target Stromal Mct4., Ubaldo E. Martinez-Outshoorn, Md, Joseph Curry, Md, Ying-Hui Ko, Md, Zhao Lin, Md, Madalina Tuluc, Md, David Cognetti, Md, Ruth Birbe, Md, Edmund A. Pribitkin, Md, Alessandro Bombonati, Richard Pestell, Md, Anthony Howell, Federica Sotgia, Michael P. Lisanti, Md

Kimmel Cancer Center Faculty Papers

Here, we developed a model system to evaluate the metabolic effects of oncogene(s) on the host microenvironment. A matched set of "normal" and oncogenically transformed epithelial cell lines were co-cultured with human fibroblasts, to determine the "bystander" effects of oncogenes on stromal cells. ROS production and glucose uptake were measured by FACS analysis. In addition, expression of a panel of metabolic protein biomarkers (Caveolin-1, MCT1, and MCT4) was analyzed in parallel. Interestingly, oncogene activation in cancer cells was sufficient to induce the metabolic reprogramming of cancer-associated fibroblasts toward glycolysis, via oxidative stress. Evidence for "metabolic symbiosis" between oxidative cancer cells …

A Case Study Of Pseudo-Neuropathic Pseudogout, Christina Cress Lindenmeyer, Md, Adam C. Sobel, Md, Levon N. Nazarian, Md, Steven Mandel, Md, Steven M. Raikin, Md, Homyar N. Karanjia, Dpm

The Medicine Forum

Background

This interesting case highlights the clinical progression of a rare disease process and the important role of a multi-disciplinary team in achieving a diagnosis and successful management plan.

Case Presentation

A 76-year-old male with a history of coronary artery disease, hypertension and hyperlipidemia presented as an outpatient with left foot pain and swelling. He had spent a week bicycling in Colorado one month prior to presentation. The pain was initially localized to the plantar surface of his foot and progressed to involve the lateral and dorsal aspects of the foot, as well as his great toe. The pain was …

Palpable Purpura In A Vietnamese Teenage Girl, Akram Mustafa, Md, Edward K. Len, Md, Alan Chiu, Msiii

The Medicine Forum

A 19-year-old Vietnamese female with no significant past medical history presented to the emergency department (ED) with fevers, sore throat, generalized myalgias, arthralgias, and a worsening lower extremity rash for the past two weeks. Approximately one week after the onset of constitutional symptoms, the patient noticed a rash developing on the anterior surface of her legs. Three days prior to hospitalization, her primary care physician prescribed cephalexin for her, but she didn’t recall what it was for. When her symptoms continued to worsen the next few days, she presented to the ED. In the ED, she also complained of abdominal …

Newly Diagnosed Aids With Multiple Opportunistic Infections Despite A Recent Negative Rapid Hiv Test, Soham Vakil, Md, Rene Daniel, Md, Phd, William Short, Md, Mph

The Medicine Forum

Background

Human Immunodeficiency Virus (HIV) is a fairly prevalent disease in the United States, with an estimated 1 million persons infected with HIV-1.1 Despite a decrease in Acquired Immunodeficiency Syndrome (AIDS), the prevalence of HIV is increasing, which has led to recent changes in HIV testing guidelines.2 Newly diagnosed patients should ideally be linked to care and receive intervention and antiretroviral therapy (ART) allowing them to maintain a near normal life expectancy.

Case Presentation

The patient is a 23-year-old African American male with no significant past medical history. He presented to the emergency department (ED) with fevers, weakness, worsening right-sided …

Acute Glomerulonephritis In A Child With Chlamydia Pneumoniae Infection: A Case Report., Giovanna Vitaliti, Raffaele Falsaperla, Leandra Giunta, Giuseppina Spataro, Venerando Rapisarda, Mario Velardita, Giuseppe Nunnari, Piero Pavone

Division of Infectious Diseases and Environmental Medicine Faculty Papers

Background. Infectious diseases seem to be an important and independent risk factor for renal failure, but the underlying mechanism of renal involvement during some kinds of infectious diseases is still unclear, even if the literature data report immunomediated and/or autoimmune mechanisms to explain the pathogenic relationship between the two diseases. In paediatric patients, Chlamydia pneumoniae is a rare cause of renal complications and it may manifest in several ways, mainly involving the respiratory system, even if also renal and glomerulalr complications, have been described. Case Diagnosis/Treatment. Herein we report a case of a 3-year-old child who developed an acute glomerulonephritis …

The Effect Of The Sphere Standards On The Incidence Of Communicable And Infectious Diseases In A Complex Humanitarian Emergency, Masashi Rotte

Master of Public Health Capstone Presentations

The purpose of this study was to determine what effect achieving the Sphere Standards relating to water and sanitation had on the incidence of communicable diseases in a returnee camp in South Sudan during a complex humanitarian emergency. The water and sanitation infrastructure of the returnee camp was tracked over time until it met the Sphere Standards. The total camp population was also tracked over the same period of time and compared to daily counts of diseases diagnosed in a medical clinic at the camp. A daily incidence of disease was then calculated for each communicable disease that was tracked. …

New Jersey Vaccine Mandates: The Confluence Of Regulations, Rights, And Religion, Drew Harris Dpm, Mph

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Population Health Matters, Spring 2013, Vol. 26, No. 2. Download Full Pdf

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Antibody Quality And Protection From Lethal Ebola Virus Challenge In Nonhuman Primates Immunized With Rabies Virus Based Bivalent Vaccine., Joseph E Blaney, Andrea Marzi, Mallory Willet, Amy B Papaneri, Christoph Wirblich, Friederike Feldmann, Michael Holbrook, Peter Jahrling, Heinz Feldmann, Matthias J Schnell

Department of Microbiology and Immunology Faculty Papers

We have previously described the generation of a novel Ebola virus (EBOV) vaccine platform based on (a) replication-competent rabies virus (RABV), (b) replication-deficient RABV, or (c) chemically inactivated RABV expressing EBOV glycoprotein (GP). Mouse studies demonstrated safety, immunogenicity, and protective efficacy of these live or inactivated RABV/EBOV vaccines. Here, we evaluated these vaccines in nonhuman primates. Our results indicate that all three vaccines do induce potent immune responses against both RABV and EBOV, while the protection of immunized animals against EBOV was largely dependent on the quality of humoral immune response against EBOV GP. We also determined if the induced …

Listeria Monocytogenes Cholecystitis: A Possible New Syndrome., Jackrapong Bruminhent, Timothy K Lynch, Jonathan Gefen, Jerome Santoro

Division of Internal Medicine Faculty Papers & Presentations

: The U.S. Food and Drug Administration recently added potentially fatal Listeria monocytogenes infection to the list of opportunistic infections that can occur in patients who receive tumor necrosis factor inhibitor therapy. In this study, the first reported case of L monocytogenes cholecystitis associated with etanercept use is described. It also appears that tumor necrosis factor inhibitor therapy likely increases the risk for Listeria cholecystitis. Clinicians need to be aware of this association when selecting antimicrobial therapy for these patients.

Type Ii Diabetes And Dietary Preferences In A Rapidly Urbanizing Region Of West Africa, Megan Doherty

Master of Public Health Capstone Presentations

This study aims to identify themes in food preferences, knowledge, attitudes and behaviors (KAB) among a mix of rural and urban Ghanaians in the greater Kumasi region; to inform health interventions targeting better patient management of type II diabetes in a rapidly urbanizing region of Ghana; and to inform social marketing strategies by providing insight into consumption patterns. Urban centers in Sub-Saharan Africa have been especially impacted by the persistence of infectious disease and accompanying rise in non-communicable disease prevalence, including type II diabetes. In fact, type II diabetes recently registered as tenth among top causes of death in Kumasi, …

A Global Health Framework Based On Competencies And Learning Opportunities In Graduate Health Education, Robert Simmons, Drph, Mph, Mches, Cph, James D. Plumb, Md, Mph

College of Population Health Lectures, Presentations, Workshops

Poster covers:

• What is Global Health?
• The Changing Global Landscape
• Why Invest in Global Health Education?
• Growth of Global Health Education Programs
• What is Covered in Graduate Education?
• Future Challenges and Opportunities

Inflammatory Biomarker Changes And Their Correlation With Framingham Cardiovascular Risk And Lipid Changes In Antiretroviral-Naive Hiv-Infected Patients Treated For 144 Weeks With Abacavir/Lamivudine/Atazanavir With Or Without Ritonavir In Aries., Benjamin Young, Kathleen E Squires, Lisa L Ross, Lizette Santiago, Louis M Sloan, Henry H Zhao, Brian C Wine, Gary E Pakes, David A Margolis, Mark S Shaefer

Division of Infectious Diseases and Environmental Medicine Faculty Papers

Propensity for developing coronary heart disease (CHD) is linked with Framingham-defined cardiovascular risk factors and elevated inflammatory biomarkers. Cardiovascular risk and inflammatory biomarkers were evaluated in ARIES, a Phase IIIb/IV clinical trial in which 515 antiretroviral-naive HIV-infected subjects initially received abacavir/lamivudine + atazanavir/ritonavir for 36 weeks. Subjects who were virologically suppressed by week 30 were randomized 1:1 at week 36 to either maintain or discontinue ritonavir for an additional 108 weeks. Framingham 10-year CHD risk scores (FRS) and risk category of

Two Coiled-Coil Domains Of Chlamydia Trachomatis Inca Affect Membrane Fusion Events During Infection., Erik Ronzone, Fabienne Paumet

Department of Microbiology and Immunology Faculty Papers

Chlamydia trachomatis replicates in a parasitophorous membrane-bound compartment called an inclusion. The inclusions corrupt host vesicle trafficking networks to avoid the degradative endolysosomal pathway but promote fusion with each other in order to sustain higher bacterial loads in a process known as homotypic fusion. The Chlamydia protein IncA (Inclusion protein A) appears to play central roles in both these processes as it participates to homotypic fusion and inhibits endocytic SNARE-mediated membrane fusion. How IncA selectively inhibits or activates membrane fusion remains poorly understood. In this study, we analyzed the spatial and molecular determinants of IncA's fusogenic and inhibitory functions. Using …

Is The Reporting Timeliness Gap For Avian Flu And H1n1 Outbreaks In Global Health Surveillance Systems Associated With Country Transparency?, Feng-Jen Tsai, Eva Tseng, Chang-Chuan Chan, Hiko Tamashiro, Sandrine Motamed, André C Rougemont

Division of Internal Medicine Faculty Papers & Presentations

BACKGROUND: This study aims to evaluate the length of time elapsed between reports of the same incidents related to avian flu and H1N1 outbreaks published by the WHO and ProMED-mail, the two major global health surveillance systems, before and after the amendment of the International Health Regulations in 2005 (IHR 2005) and to explore the association between country transparency and this timeliness gap.

METHODS: We recorded the initial release dates of each report related to avian flu or H1N1 listed on the WHO Disease Outbreak News site and the matching outbreak report from ProMED-mail, a non-governmental program for monitoring emerging …

Investigating The Role For Il-21 In Rabies Virus Vaccine-Induced Immunity., Corin L Dorfmeier, Evgeni P Tzvetkov, Anthony Gatt, James P Mcgettigan

Department of Microbiology and Immunology Faculty Papers

Over two-thirds of the world's population lives in regions where rabies is endemic, resulting in over 15 million people receiving multi-dose post-exposure prophylaxis (PEP) and over 55,000 deaths per year globally. A major goal in rabies virus (RABV) research is to develop a single-dose PEP that would simplify vaccination protocols, reduce costs associated with RABV prevention, and save lives. Protection against RABV infections requires virus neutralizing antibodies; however, factors influencing the development of protective RABV-specific B cell responses remain to be elucidated. Here we used a mouse model of IL-21 receptor-deficiency (IL-21R-/-) to characterize the role for IL-21 in RABV …

Comparison Of Heterologous Prime-Boost Strategies Against Human Immunodeficiency Virus Type 1 Gag Using Negative Stranded Rna Viruses., Tessa M Lawrence, Celestine N Wanjalla, Emily A Gomme, Christoph Wirblich, Anthony Gatt, Elena Carnero, Adolfo García-Sastre, Douglas S Lyles, James P Mcgettigan, Matthias J Schnell

Department of Microbiology and Immunology Faculty Papers

This study analyzed a heterologous prime-boost vaccine approach against HIV-1 using three different antigenically unrelated negative-stranded viruses (NSV) expressing HIV-1 Gag as vaccine vectors: rabies virus (RABV), vesicular stomatitis virus (VSV) and Newcastle disease virus (NDV). We hypothesized that this approach would result in more robust cellular immune responses than those achieved with the use of any of the vaccines alone in a homologous prime-boost regimen. To this end, we primed BALB/c mice with each of the NSV-based vectors. Primed mice were rested for thirty-five days after which we administered a second immunization with the same or heterologous NSV-Gag viruses. …