Medicine and Health Sciences Commons^™

Botox Injection To Treat Strabismus After Infant Botulism Type B Infection, Sarah G Bonaffini, Victoria Cocozza, Jing Jin

Ophthalmology Resident Research

Purpose: The significance of botulinum toxin to ophthalmologists is twofold. Botulism, a medical emergency, frequently presents with ocular findings including blurred vision, diplopia, ptosis, and photophobia as a result of the neurotoxin produced by Clostridium botulinum. However, botulinum toxins also have therapeutic uses for medical conditions including strabismus. The safety and efficacy of Botulinum toxin A in patients with a history of botulism has not been reported.

Observations: We report a 9-week-old infant, diagnosed with type B toxin positive infant botulism treated with human botulism immune globulin, who developed a large angle exotropia. The infant was treated with intramuscular injections …

Clinical Outcomes Of Superior Capsular Reconstruction For Massive, Irreparable Rotator Cuff Tears: A Systematic Review Comparing Acellular Dermal Allograft And Autograft Fascia Lata, Tyler J. Smith, Anirudh K. Gowd, John Kunkel, Lisa Kaplin, John B. Hubbard, Kevin E. Coates, Benjamin R. Graves, Brian R. Waterman

Orthopedic Surgery Resident Research

Purpose: To investigate clinical outcomes after superior capsular reconstruction (SCR) for the treatment of massive and/or irreparable rotator cuff tears treated with either allograft or autograft. Methods: Using the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines, in April 2020 a systematic review was performed using PubMed, MEDLINE, EMBASE, and Cochrane databases. Clinical studies were assessed for patient-reported outcomes and range of motion, comparing dermal allografts to fascia lata autografts, with a minimum follow-up of 12 months. Results: A total of 16 clinical studies involving 598 patients (606 shoulders) were included for data analysis, with a weighted …

Perichondritis: Inspect The Lobule, Eli Bress, Jason E Cohn

Otolaryngology (ENT) Resident Research

CASE PRESENTATION: This is a brief report of a 57-year-old Caucasian female presented with a 4-day history of worsening left ear pain. Her symptoms began with left otalgia and otorrhea which progressed to helical erythema, prompting a visit to the emergency department. She was noted to have erythema of the left auricle and swelling of the left auditory meatus. Our otolaryngology service observed erythema of the auricle with sparing of the lobule.

DIAGNOSIS: The diagnosis to be otitis externa with perichondritis was established, and we recommended otic ciprofloxacin-hydrocortisone, IV vancomycin, and ciprofloxacin. The patient had marked improvement and was discharged …

Histone Demethylase Phf8 Drives Neuroendocrine Prostate Cancer Progression By Epigenetically Upregulating Foxa2., Qiuli Liu, Jian Pang, Lin-Ang Wang, Zhuowei Huang, Jing Xu, Xingxia Yang, Qiubo Xie, Yiqiang Huang, Tang Tang, Dali Tong, Gaolei Liu, Luofu Wang, Dianzheng Zhang, Qiang Ma, Hualiang Xiao, Weihua Lan, Jun Qin, Jun Jiang

PCOM Scholarly Papers

Neuroendocrine prostate cancer (NEPC) is a more aggressive subtype of castration-resistant prostate cancer (CRPC). Although it is well established that PHF8 can enhance prostate cancer cell proliferation, whether PHF8 is involved in prostate cancer initiation and progression is relatively unclear. By comparing the transgenic adenocarcinoma of the mouse prostate (TRAMP) mice with or without Phf8 knockout, we systemically examined the role of PHF8 in prostate cancer development. We found that PHF8 plays a minimum role in initiation and progression of adenocarcinoma. However, PHF8 is essential for NEPC because not only is PHF8 highly expressed in NEPC but also animals without …

Piwi-Interacting Rnas: Mitochondria-Based Biogenesis And Functions In Cancer, Jin-Fen Su, Anthony Concilla, Dianzheng Zhang, Fang Zhao, Fang-Fang Shen, Hao Zhang, Fu-You Zhou

PCOM Scholarly Papers

PIWI-interacting RNA (piRNAs), once thought to be mainly functioning in germlines, are now known to play an essential role in somatic and cancerous tissues. Ping-pong cycle initiation and mitochondria-based phased production constitute the core of the piRNA biogenesis and these two processes are well conserved in mammals, including humans. By being involved in DNA methylation, histone marker deposition, mRNA degradation, and protein modification, piRNAs also contribute to carcinogenesis partly due to oncogenic stress-induced piRNA dysregulation. Also, piRNAs play important roles in cancer stemness, drug resistance, and tumor immunology. Results from liquid biopsy analysis of piRNA can be used in both …

Pcom Georgia Do Class Of 2025 Composite Sheet, Philadelphia College Of Osteopathic Medicine

Class Composite Sheets

PCOM Georgia DO Class of 2022 student portraits, matriculating Fall 2020.

The Use Of Local Medial Plantar Artery Flap For Heel Reconstruction: A Systematic Review., Jude L Opoku-Agyeman, Amber Allen, Kayla Humenansky

Plastic Surgery Resident Research

BACKGROUND: Soft tissue reconstruction of the heel represents a daunting challenge for reconstructive surgeons, given the weight-bearing role and anatomical properties of the glabrous skin on the plantar surface. For soft tissue defects in this area, the medial plantar artery (MPA) flap has been described as an optimal reconstructive option. Many studies have reported on the use of the medial plantar artery flap for soft tissue coverage of the heel. There currently exists no systematic review on the topic.

AIM: The aim of this article is to review the literature on the use of local medial plantar artery flap for …

A Simple Technique For Intraoperative Scalp Skin Graft Depilation Using Dermabond®, Jude L Opoku-Agyeman, Kayla Humenansky, Brooke Burkey

Plastic Surgery Resident Research

Skin grafting is an essential aspect of burn and wound reconstruction. Split-thickness skin grafts (STSGs) harvested from the scalp are used for wound and burn reconstruction. Skin grafts from the scalp bear hair and hair particles. Residual hair fragments and pieces of hair in the graft have been associated with many complications, including foreign body reaction similar to pseudofolliculitis and chronic inflammation that can lead to infections. It is important to remove the hair and the hair particles from the scalp graft before its application to the donor site. Traditionally, surgeons have employed some techniques including saline agitation and mechanical …

Percutaneous Coil Embolization To Manage Pulmonary Artery Hemorrhage After Distal Endarterectomy, Chirantan Mangukia, Paul Forfia, Anjali Vaidya, Veronica Williams, Dmitry Niman, Parth Rali, Yoshiya Toyoda

Internal Medicine Resident Research

Selective pulmonary artery coil embolization can be a viable treatment option for acute pulmonary hemorrhage after pulmonary thromboendarterectomy.

Obesity And Its Effect On Outcomes In Same-Day Bilateral Total Knee Arthroplasty, Ethan A Remily, Nequesha S Mohamed, Wayne A Wilkie, Tyler Smith, Anthony Judice, Salvador Forte, James Nace, Ronald E Delanois

Orthopedic Surgery Resident Research

Background: The niche surgery of same-day bilateral total knee arthroplasty (sd-BTKA) continues to create debate amongst specialists in arthroplasty. To date, there is a significant lack of literature on obese patients undergoing sd-BTKA, and no study has evaluated outcomes of this procedure when compared to non-obese patients. Therefore, this study will perform a retrospective analysis to compare (I) incidence, (II) demographics, and (III) complications of sd-BTKA in non-obese, obese, and morbidly obese patients in the United States from 2009 to 2016.

Methods: The National Inpatient Sample (NIS) database was queried for all individuals that underwent sd-BTKA from 2009 to 2016. …

Endovascular Treatment Of Cervical Myelopathy From Brachiocephalic Venous Stenosis., Craig Schreiber, Alex Anavim, Mark Kotapka, Paul Brady

Neurosurgery Resident Research

Central venous stenosis is a rare cause of neurologic pathology. Here we present a case of brachiocephalic vein stenosis causing cervical myelopathy through venous engorgement. Our patient was a 51-y/o male who presented with ambulatory dysfunction so he was evaluated for cervical myelopathy. Imaging revealed cord compression from venous engorgement and brachiocephalic vein stenosis. He was treated with angioplasty and vessel stenting which significantly improved flow on postintervention imaging. In conclusion, preoperative vascular imaging should be considered in myelopathic patients as it can detect this rare but dangerous etiology.

Correlation Of Ape1 With Vegfa And Cd163+ Macrophage Infiltration In Bladder Cancer And Their Prognostic Significance, Lin-Ang Wang, Bo Yang, Tang Tang, Yuxin Yang, Dianzheng Zhang, Hualing Xiao, Jing Xu, Luofu Wang, Li Lin, Jun Jiang

PCOM Scholarly Papers

The present study sought to estimate the applicability of apurinic/apyrimidinic endodeoxyribonuclease 1 (APE1), vascular endothelial growth factor A (VEGFA) expression and CD163+ tumor‑associated macrophage (TAM) ratio as prognostic factors in bladder cancer (BCa). A total of 127 patients with bladder urothelial cancer who underwent radical cystectomy at Daping Hospital were recruited between January 2013 and January 2017, including 45 cases of non‑muscle invasive BCa (NMIBC) and 82 of MIBC. Immunohistochemical detection of APE1, VEGFA and CD163, as well as multiple immunofluorescence staining for APE1, VEGFA, CD163 and CD34, were performed on tissue samples. For APE1 and VEGFA, the staining was …

Congenital Pulmonary Airway Malformation (Cpam): An Interesting Ent Consultation., James Ding, Lauren E Melley, Alexander Manteghi

Otolaryngology (ENT) Resident Research

A 13-month-old boy was referred to the emergency department from the pediatrician’s office for increased shortness of breath. A 2-view chest X-ray was ordered revealing right hemithorax hyperlucency, minimal lung markings, and leftward mediastinal shift.

Nasal Bone Fractures: Differences Amongst Sub-Specialty Consultants, Jason E. Cohn, Sammy Othman, Michael Toscano, Tom Shokri, Jason D Bloom, Seth Zwillenberg

Otolaryngology (ENT) Resident Research

BACKGROUND: Nasal fractures constitute the largest proportion of facial trauma each year, however, there is no consensus management. In this study, we investingated the role of the consultant and the functional and aesthetic outcomes of procedures performed to address nasal bone fractures.

METHODS: A retrospective chart review of patients who sustained nasal bone fractures was conducted from 8/1/14 through 1/23/18. Categorical variables were analyzed using chi-squared testing and Fisher's exact test, where appropriate, while continuous variables were compared using Mann-Whitney U testing.

RESULTS: During the study period, 136 patients met inclusion criteria for full analysis. The mean age of this …

To Balloon Or Not To Balloon, The Current State Of Management Of Eustachian Tube Dysfunction., David J. Lafferty, Brian J Mckinnon

Otolaryngology (ENT) Resident Research

While otologic complaints are a common reason for patients to present to an otolaryngologist, Eustachian tube dysfunction (ETD) remains a poorly understood disease whose management is unclear. Among the general population in the United States, ETD has a prevalence of 4.6% among adults and 6.1% among children. Eustachian tube dysfunction is not just a common diagnosis for otolaryngologists, ETD accounted for 2 million visits for patients less than 20 years old to primary care providers and over 2 million visits for patients older than 20 years old between 2005 and 2012. Despite the commonality of ETD, opinions differ wildly among …

Hypogeusia As The Initial Presenting Symptom Of Covid-19, Lauren E Melley, Eli Bress, Erik Polan

PCOM Scholarly Papers

COVID-19 is the disease caused by the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which first arose in Wuhan, China, in December 2019 and has since been declared a pandemic. The clinical sequelae vary from mild, self-limiting upper respiratory infection symptoms to severe respiratory distress, acute cardiopulmonary arrest and death. Otolaryngologists around the globe have reported a significant number of mild or otherwise asymptomatic patients with COVID-19 presenting with olfactory dysfunction. We present a case of COVID-19 resulting in intensive care unit (ICU) admission, presenting with the initial symptom of disrupted taste and flavour perception prior to respiratory …

Exophytic Adiposis Dolorosa (Dercum's Disease) Of The Thigh: A Case Report., Jude L Opoku-Agyeman, Lauren Coffua, Jamee Simone, Terrance Hanley, Amir Behnam

Plastic Surgery Resident Research

Adiposis dolorosa or Dercum's disease is a rare lipomatous disorder characterized by painful lipomas. In this article, we report a case of rather large exophytic adiposis dolorosa causing difficulties with ambulation, and our surgical management of the disorder. To our knowledge, this is the first reported case of a large exophytic adiposis dolorosa of the upper medial thigh causing problems with mobility. This is also the first reported case of the use of a delayed split-thickness skin graft (STSG) after interval use of wound vacuum-assisted closure (VAC) following dermolipectomy. A 77-year-old female presented with a chronic mass on the medial …

Emerging Therapeutic Strategies For Covid-19 Patients, Shudong Zhu, Xialing Guo, Kyla Geary, Dianzheng Zhang

PCOM Scholarly Papers

Over 100,000 cases of COVID-19 patients infected with the novel coronavirus SARS-COV-2 have been reported worldwide in approximately 2 months, resulting in over 3000 deaths. Potential therapeutic strategies, including remdesivir, chloroquine phosphate, abidol, lopinavir/ritonavir, plasma, antibody, vaccine and stem cells are discussed in this review. With the number of patients increasing daily, there is an urgent need for effective therapeutic intervention.

Cost-Effectiveness Model Shows Superiority Of Wireless Spinal Cord Stimulation Implantation Without A Separate Trial., Richard B North, Harish S. Parihar, Shawn D. Spencer, Arthur F Spalding, Jane Shipley

PCOM Scholarly Papers

OBJECTIVE: We evaluated the cost-effectiveness of wireless spinal cord stimulation (Wireless SCS) with single stage "direct to permanent" implantation vs. screening with temporary electrodes and an external pulse generator followed by implantation of a system for long-term use (IPG SCS).

MATERIALS AND METHODS: We created a cost model that takes a 2019 United States (U.S.) payer perspective and is based on IPG SCS cost models for subjects with chronic back and/or leg pain. Our six-month decision tree includes the screening trial period (success ≥50% relief) and leads to various levels of pain relief with or without complications for IPG SCS …

Eagle Syndrome Masquerading As A Chicken Bone, Jason E. Cohn, Sammy Othman, Karima Sajadi-Ernazarova

Otolaryngology (ENT) Resident Research

This is a brief report of a 17-year-old male who presented to the emergency department with odynophagia and a foreign body sensation in the throat after choking on a chicken wing. A soft tissue neck radiograph was performed which revealed a 4.6-cm linear object in the vallecula read by the radiology department as a chicken bone. The otolaryngology team was consulted and performed a nasopharyngeal laryngoscopy which did not reveal a foreign body in the upper aerodigestive tract. On physical examination, the right tonsillar fossa was tender to palpation. Upon further review of the radiograph, the right stylohyoid ligament was …

Pcom Georgia Pharmd Class Of 2024 Composite Sheet, Philadelphia College Of Osteopathic Medicine

Class Composite Sheets

PCOM Georgia DO PharmD Class of 2024 student portraits, matriculating Fall 2020.

Venous Thromboembolism After Penetrating Femoral And Popliteal Artery Injuries: An Opportunity For Increased Prevention, Asanthi Ratnasekera, Odessa Pulido, Sandra Durgin, Sharon Nichols, Alicia Lozano, Danielle Sienko, Alexandra Hanlon, Niels D Martin

General Surgery Resident Research

Background: Trauma patients with penetrating vascular injuries have a higher rate of venous thromboembolism (VTE). The objective of this study was to determine the risk of VTE formation in penetrating femoral and popliteal vascular injuries and the effects of endovascular management of these injuries.

Methods: A retrospective study of Pennsylvania Trauma Outcome Study registry was conducted during a 5-year period (2013-2017). All adult patients with a penetrating mechanism with femoral/popliteal vascular injuries were studied. Primary outcome was incidence of VTE in patients with isolated arterial injuries versus combined arterial/venous injuries. Secondary endpoints were intensive care unit (ICU) length of stay …

Risk Factors For Liposomal Bupivacaine Resistance After Total Hip Or Knee Arthroplasties: A Retrospective Observational Cohort In 237 Patients, Scott Buzin, Arianna L. Gianakos, Deborah Li, Anthony Viola, Sherif Elkattawy, David M. Keller, Richard S. Yoon, Frank A. Liporace

Orthopedic Surgery Resident Research

Purpose: Liposomal bupivacaine demonstrated promise decreasing postoperative pain in total hip and total knee arthroplasty (THA/TKA). Some randomized trials have shown non-superior results; however, confounding variables were not accounted for in such analyses. This study attempts to determine risk factors associated with failure of pain management in patients receiving liposomal bupivacaine.

Methods: Postoperative pain scores were collected following primary or revision arthroplasties between January 2016 and December 2017. Retrospective analysis of institutional total joint quality and outcomes registry was screened and patients undergoing primary or revision arthroplasties who completed a multi-modal pain management including liposomal bupivacaine were included in the …

Isolated Large Glenoid Fracture In Acute Glenohumeral Dislocation In The Elderly: A Novel Indication For Reverse Shoulder Arthroplasty, Tyler Smith, Joseph D'Alonzo, Alfonso Arevalo, Jack Kazanjian

Orthopedic Surgery Resident Research

Case: Two elderly males presented with traumatic shoulder dislocation and bony Bankart fracture consisting of greater than 25% of the glenoid width. Due to several concomitant factors such as polytrauma, activity level, rotator cuff pathology, optimization of comorbidities, risk of complications, and potential for revision surgery, the patients were treated with reverse shoulder arthroplasty (RSA).

Conclusion: RSA may be a satisfactory treatment option for isolated, large glenoid fractures associated with anterior glenohumeral instability in the elderly. These patients are susceptible to rapid deconditioning with prolonged immobilization and may not be medically suited to undergo the prolonged recovery period associated with …

The Vhl/Hif Axis In The Development And Treatment Of Pheochromocytoma/Paraganglioma, Song Peng, Jun Zhang, Xintao Tan, Yiqiang Huang, Jing Xu, Natalie Silk, Dianzheng Zhang, Qiuli Liu, Jun Jiang

PCOM Scholarly Papers

Pheochromocytomas and paragangliomas (PPGLs) are rare neuroendocrine tumors originating from chromaffin cells in the adrenal medulla (PCCs) or extra-adrenal sympathetic or parasympathetic paraganglia (PGLs). About 40% of PPGLs result from germline mutations and therefore they are highly inheritable. Although dysfunction of any one of a panel of more than 20 genes can lead to PPGLs, mutations in genes involved in the VHL/HIF axis including

Digest Of The Philadelphia College Of Osteopathic Medicine, Philadelphia College Of Osteopathic Medicine

PCOM Digest 2020s

The (2020 No. 2) issue of the Digest of the Philadelphia College of Osteopathic Medicine includes the following articles:

• Updates

• Institutional Heritage: Celebrating a Golden Jubilee, Marking a Retirement

• Feature: PCOM Heroes of the Front Lines

• Feature: Exams May Be Cancelled, But Humanity Is Not: A Medical Student Perspective on the COVID-19 Pandemic

• Class Notes

• Obituaries: Lost on the Front Lines

Digest Of The Philadelphia College Of Osteopathic Medicine, Philadelphia College Of Osteopathic Medicine

PCOM Digest 2020s

The (2020 No. 1) issue of the digest of the Philadelphia College of Osteopathic Medicine includes the following articles:

• Updates

• Institutional Heritage: Founders’ Day 2020

• Marking a New Era of Healthcare Education in South Georgia

• Southwest Georgia: A Sense of Place

• Health Care in Rural Georgia

• Class Notes

Myo/Nog Cells Are Nonprofessional Phagocytes, Jacquelyn Gerhart, Lindsay Gugerty, Paul Lecker, Fathma Abdalla, Mark Martin, Olivia Gerhart, Colby Gerhart, Karanveer Johal, Jake Bernstein, John Spikes, Keith Mathers, Arturo Bravo Nuevo, Mindy George-Weinstein

PCOM Scholarly Papers

Myo/Nog cells were discovered in the chick embryo epiblast. Their expression of MyoD reflects a commitment to the skeletal muscle lineage and capacity to differentiate into myofibroblasts. Release of Noggin by Myo/Nog cells is essential for normal morphogenesis. Myo/Nog cells rapidly respond to wounding in the skin and eyes. In this report, we present evidence suggesting that Myo/Nog cells phagocytose tattoo ink in tissue sections of human skin and engulf cell corpses in cultures of anterior human lens tissue and magnetic beads injected into the anterior chamber of mice in vivo. Myo/Nog cells are distinct from macrophages in the skin …

Lsd1 Promotes Bladder Cancer Progression By Upregulating Lef1 And Enhancing Emt., Qiubo Xie, Tang Tang, Jian Pang, Jing Xu, Xingxia Yang, Linang Wang, Yiqiang Huang, Zhuowei Huang, Gaolei Liu, Dali Tong, Yao Zhang, Luofu Wang, Dianzheng Zhang, Weihua Lan, Qiuli Liu, Jun Jiang

PCOM Scholarly Papers

Epithelial-to-mesenchymal transition (EMT) is one of the important underlying molecular mechanisms for most types of cancers including bladder cancer. The precise underlying molecular mechanism in EMT-mediated bladder cancer progression is far from completed. LSD1, a histone lysine-specific demethylase, is known to promote cancer cell proliferation, metastasis, and chemoresistance. We found in this study that LSD1 is highly upregulated in bladder cancer specimens, especially those underwent chemotherapy, and the elevated levels of LSD1 are highly associated with bladder cancer grades, metastasis status, and prognosis. Inhibiting or knockdown LSD1 repressed not only EMT process but also cancer progression. Mechanistically, LSD1 complexes with …

Case Report: Co-Existence Of Brca2 And Palb2 Germline Mutations In Familial Prostate Cancer With Solitary Lung Metastasis., Tang Tang, Lin-Ang Wang, Peng Wang, Dali Tong, Gaolei Liu, Jun Zhang, Nan Dai, Yao Zhang, Gang Yuan, Kyla Geary, Dianzheng Zhang, Qiuli Liu, Jun Jiang

PCOM Scholarly Papers

Background: Mutation-caused loss-of-function of factors involved in DNA damage response (DDR) is responsible for the development and progression of ~20% of prostate cancer (PCa). Some mutations can be used in cancer risk assessment and informed treatment decisions.

Methods: Target capture-based deep sequencing of 11 genes was conducted with total DNA purified from the proband's peripheral blood. Sanger sequencing was conducted to screen potential germline mutations in the proband's family members. Targeted sequencing of a panel of 1,021 genes was done with DNA purified from the tumor tissue.

Results: Two previously unreported germline mutations in the DDR pathway,

Conclusions: The newly …