Medicine and Health Sciences Commons^™

Hyperosmolar Therapy For Raised Intracranial Pressure., Ethan A Benardete

Department of Neurosurgery Faculty Papers

No abstract provided.

Limited Sampling Estimates Of Epigallocatechin Gallate Exposures In Cirrhotic And Noncirrhotic Patients With Hepatitis C After Single Oral Doses Of Green Tea Extract., Dina Halegoua-De Marzio, Walter K. Kraft, Constantine Daskalakis, Xie Ying, Roy L Hawke, Victor J. Navarro

Division of Gastroenterology and Hepatology Faculty Papers

BACKGROUND: Epigallocatechin-3-gallate (EGCG) has antiangiogenic, antioxidant, and antifibrotic properties that may have therapeutic potential for the treatment of cirrhosis induced by hepatitis C virus (HCV). However, cirrhosis might affect EGCG disposition and augment its reported dose-dependent hepatotoxic potential.

OBJECTIVE: The safety, tolerability, and disposition of a single oral dose of EGCG in cirrhotic patients with HCV were examined in an exploratory fashion.

METHODS: Eleven patients with hepatitis C and detectable viremia were enrolled. Four had Child-Pugh (CP) class A cirrhosis, 4 had Child-Pugh class B cirrhosis, and 3 were noncirrhotic. After a single oral dose of green tea extract 400 …

Root Causes Of Intraoperative Hypoglycemia: A Case Series., Eric S. Schwenk, Boris Mraovic, Ryan P. Maxwell, Gina S. Kim, Jesse M. Ehrenfeld, Richard H. Epstein

Department of Anesthesiology Faculty Papers

STUDY OBJECTIVE: To describe the root causes of intraoperative hypoglycemic events.

DESIGN: Retrospective analysis.

SETTING: Large academic teaching hospital.

MEASUREMENTS: Data from 80,379 ASA physical status 1, 2, 3, 4, and 5 surgical patients were reviewed. Blood glucose values, insulin, oral hypoglycemic medication doses, and doses of glucose or other medications for hypoglycemia treatment were recorded.

MAIN RESULTS: Hypoglycemia in many patients had multiple etiologies, with many cases (8 of 17) involving preventable errors. The most common root causes of hypoglycemia were ineffective communication, circulatory shock, failure to monitor, and excessive insulin administration.

CONCLUSION: Intraoperative hypoglycemia was rare, but often …

Influence Of Body Mass Index And Antibiotic Dose On The Risk Of Surgical Site Infections In Pediatric Clean Orthopedic Surgery., Jeffrey J Cies, Shannon Chan, Jobayer Hossain, B Randall Brenn, M Cecilia Di Pentima

Department of Anesthesiology Faculty Papers

OBJECTIVE: To evaluate body mass index (BMI) and antimicrobial dose as risk factors for surgical site infections in pediatric patients.

PATIENTS AND METHODS: Children between 2 and 19 years of age undergoing clean orthopedic procedures and receiving at least one dose of perioperative antibiotics (cefazolin, vancomycin, or clindamycin) were studied. The retrospective case-controlled study was conducted at the Alfred I. duPont Hospital for Children, a 180-bed tertiary-care academic pediatric hospital in Wilmington, DE. Data were collected from January 1, 2002, to December 31, 2005.

RESULTS: Underweight children had a higher risk for SSIs than overweight and normal-weight children. American Society …

Risk Factors For Wound Complications After Ankle Fracture Surgery., Adam G Miller, Andrew Margules, Steven M Raikin

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: The overall rate of complications after ankle fracture fixation varies between 5% and 40% depending on the population investigated, and wound complications have been reported to occur in 1.4% to 18.8% of patients. Large studies have focused on complications in terms of readmission, but few studies have examined risk factors for wound-related issues in the outpatient setting in a large number of patients. A review was performed to identify risk factors for wound complications tracked in the hospital and outpatient setting.

METHODS: Four hundred and seventy-eight patients underwent open reduction and internal fixation of an ankle fracture between 2003 …

Metabolic Syndrome And Migraine., Amit Sachdev, Michael J Marmura

Department of Jefferson Headache Center papers and presentations

Migraine and metabolic syndrome are highly prevalent and costly conditions. The two conditions coexist, but it is unclear what relationship may exist between the two processes. Metabolic syndrome involves a number of findings, including insulin resistance, systemic hypertension, obesity, a proinflammatory state, and a prothrombotic state. Only one study addresses migraine in metabolic syndrome, finding significant differences in the presentation of metabolic syndrome in migraineurs. However, controversy exists regarding the contribution of each individual risk factor to migraine pathogenesis and prevalence. It is unclear what treatment implications, if any, exist as a result of the concomitant diagnosis of migraine and …

Exploring The Depths Of Health Literacy Are We Teaching This And Why Does It Matter?, Susan Toth-Cohen, Phd, Otr/L, Tracey Vause-Earland, Ms, Otr/L

Department of Occupational Therapy Posters and Presentations

Background: Why does Health Literacy Matter?

• Healthcare practitioners often work with older persons with low health literacy without realizing that this issues limiting the success of their interventions. They may also lack awareness of the serious impact that low health literacy can have, since it is associated with lower reported health status, increased hospitalizations, and increased morbidity (Levasseur & Carrier, 2011).
• The current US healthcare system places increase demands on consumers to manage their own health (Smith & Gutman, 2011).
• Educators in the health professions must instill a sense of responsibility in future practitioners to understand the important role they …

Efficacy Of Miniaturized Imacor Trans-Esophageal Echocardiografm (Tee) Prove In Mechanical Circulatory Support., Hitoshi Hirose, Christopher Y. Kang, Joshua K. Wong, Harrison T. Pitcher, Caitlyn M. Johnson, Konrad Sarosiek, Linda J Bogar, Nicholas C. Cavarocchi

Department of Surgery Faculty Papers

Application of the miniaturized ImaCor Trans-Esophageal Echocardiogram (TEE) probe in Heart Transplant/Mechanical Cardiac Support Patients In the surgical cardiac care unit (SCCU), therapeutic interventions often need to be done at the bedside, necessitating the need for a rapidly employable diagnostic tool for the cardiac intensivist. We report the clinical utility of the miniature ImaCor TEE-probe in guiding management of post heart transplant (H-Txp) and mechanical cardiac support patients (MCS) and describe the economic benefit of such a device. This is an IRB approved retrospective review of MCS/H-Txp patients who had ImaCor TEE monitoring in the SCCU of our institution in …

Aplastic Anemia Post Liver Transplant Due To Graft-Versus-Host Disease, Ping Gong, Md, Jerald Z. Gong, Md

Department of Pathology, Anatomy, and Cell Biology Resident's Posters

Poster presented at: American society for clinical pathology (ASCP) conference 2012, Boston MA, USA.

Introduction:

The patient was a 64-year-old male presented with a 2 day history of increasing fevers and altered mental status. He underwent orthotopic liver transplant for cryptogenic cirrhosis, probably secondary to non-alcoholic steatohepatitis, 45 days before. The head and neck imaging showed pancytopenia with WBC 0.6 x 109 /L., hemoglobin 6.8 g/dl and platelet 29 x 109 /L.

Dysregulation Of Mir-31 And Mir-21 Induced By Zinc Deficiency Promotes Esophageal Cancer, Hansjuerg Alder, Cristian Taccioli, Hongping Chen, Yubao Jiang, Karl Smalley, Paolo Fadda, Hatice G. Ozer, Kay Huebner, John Farber, Carlo M. Croce, Louise Fong

Department of Pharmacology and Experimental Therapeutics Faculty Papers

Presented at: Hallmarks and Cancer Conference, October 29-31 in San Francisco.

And AICR Annual Meeting, November 1-2, 2012.

Dietary zinc (Zn) deficiency (ZD) in rats induces an inflammatory gene signature that fuels esophageal squamous cell cancer (ESCC). Using nanoStringTM technology, we show that the inflammation is accompanied by altered expression of specific microRNAs in esophagus, as well as skin, lung, pancreas, liver, prostate, and PBMC, predictive of disease development. Particularly, the ZD esophagus has a microRNA signature resembling human ESCC/tongue SCC miRNAomes with overexpression of miR-31 and miR-21 and downregulation of their respective tumor suppressor targets PPP2R2A and …

Sleep Disturbances And Hypnotic Medication Use In Relation To Risk Of Barrett’S Esophagus And Esophageal Adenocarcinoma, Anastasia Shnitser, Md, Abhik Roy, Md, Sidney Cohen, Md, Anthony J. Dimarino, Md

Division of Gastroenterology and Hepatology Faculty Papers

BACKGROUND

The incidence of esophageal adenocarcinoma (EA) has increased more rapidly than any other cancer (with the exception of malignant melanoma) in the United States over the past 30 years. Gastroesophageal reflux disease (GERD) is the strongest risk factor for the development of Barrett’s esophagus, which in turn leads to the rise of most EA’s. In a large portion of persons with sleep disorders, perhaps as high as 30%, GERD is a major causal or contributing factor. It has been proposed that the use of hypnotics for the treatment of sleep disorders may exacerbate the damaging effects of refluxate on …

Creating A Custom E-Book For Your Course, Jennifer L. Bellot, Phd, Rn, Mhsa, Cne

Tech Talks

Dr. Bellot used AcademicPub to create a custom ebook for her course. Students were able to purchase the ebook edition for use on their iPads or chose to have a print copy made and mailed to them. AcademicPub makes it easy to incorporate your syllabus, presentations, a collection of content from different text books and journal articles into a single book for your course. Dr. Bellot will describe the process, compare it to past practices and report on student satisfaction with this new format for course materials.

12 PowerPoint slides

Possible Steps Of Complete Disassembly Of Post-Termination Complex By Yeast Eef3 Deduced From Inhibition By Translocation Inhibitors., Shinya Kurata, Ben Shen, Jun O Liu, Nono Takeuchi, Akira Kaji, Hideko Kaji

Department of Biochemistry and Molecular Biology Faculty Papers

Ribosomes, after one round of translation, must be recycled so that the next round of translation can occur. Complete disassembly of post-termination ribosomal complex (PoTC) in yeast for the recycling consists of three reactions: release of tRNA, release of mRNA and splitting of ribosomes, catalyzed by eukaryotic elongation factor 3 (eEF3) and ATP. Here, we show that translocation inhibitors cycloheximide and lactimidomycin inhibited all three reactions. Cycloheximide is a non-competitive inhibitor of both eEF3 and ATP. The inhibition was observed regardless of the way PoTC was prepared with either release factors or puromycin. Paromomycin not only inhibited all three reactions …

Neurophysiological Impact And Modeling-Independent Elucidation Of Inactivation Pathways In A-Type K+ Channels, J.D. Fineberg, David Ritter, Manuel Covarrubias

Department of Molecular Physiology and Biophysics Faculty Papers

Poster presented at Society for Neuroscience

Abstract:

A-type voltage-gated K⁺ channels auto-regulate their function by undergoing fast inactivation. Independent of molecular mechanisms, this inactivation can proceed after channel opening (open-state inactivation, OSI) or from a closed state prior to opening (closed-state inactivation, CSI). We hypothesize that the specific neurophysiological roles of A-type Kv channels depend on whether they undergo OSI, CSI or both (CSI+OSI). To explore these possibilities, we introduced Markov kinetic schemes of the A-type Kv4 conductance into a computational model of the hippocamcal CA1 neuron assuming either CSI or CSI+OSI and compared the properties of the somatic …

Acute Heart Transplant Rejection In The Presence Of Apparently Weak, Non-Complement-Fixing Donor-Specific Antibodies Detected At The Time Of Transplant, Anthony Nizio, Paul J. Mather, Beth Colombe

Division of Cardiology Faculty Papers

Poster presented at: American Society for Histocompatibility and Immunogenetics (ASHI) conference.

AIM: A 66 year old female with an end-stage NYHA class IV inotrope-dependent, ischemic cardiomyopathy received a heart transplant on 9-12-09 from a doctor having antigens B13 and DR7. Pre-transplant antibody testing indicated only weakly positive, non-complement fixing donor-specific antibodies. The patient suffered a cardiac arrest on POD#6 and was resuscitated. She was in cardiogenic shock from allograft failure and subsequently expired on POD#9 of multiorgan failure due to "acute humoral rejection". These antibodies were investigated further.

METHODS: Antibodies were evaluated using Labscreen PRA (One Lambda), Labscreen Single Antigen …

Engaging Students In Interprofessional Collaboration: A United States-Japan Exchange, Susan Toth-Cohen, Noriyoshi Asai, Susan Wainwright, Miki Sakamoto, Frances Gilman, Kenneth Covelman, Annalisa Synnestvedt

Department of Occupational Therapy Faculty Papers

Overall Purpose of Exchange

Kitasato University and Thomas Jefferson University, Jefferson School of Health Professions To promote mutual understanding and friendship, to promote cooperation and progression in the education and research of health sciences at Kitasato University and Thomas Jefferson University

Started in 1992 by Dr. Shirley Greening Chair, Department of Bioscience Technology, TJU and Dr. Takeda former medical director of cytotechnologist program and former pathologist at TJUH developed a relationship for faculty exchange with Dr. Hiroyuki Kuramoto, PhD former chair of the OB-GYN dept. at Kitasato School of Medicine

1997: official exchange agreement for Jefferson and Kitasato University students …

Parenthood With Exposure To Mycophenolic Acid Products, Sophia M. Termimi, Megan Clary, Lisa Coscia, Carolyn Mcgrory, Vincent T. Armenti

Department of Surgery Faculty Papers

Successful pregnancy outcomes have been reported in all solid-organ transplant recipients on a variety of immunosuppressive medication regimes. In October 2007, the FDA pregnancy category of mycophenolic acid products (MPA) was changed from category C to D, based on registry and post-marketing data which revealed a higher incidence of spontaneous abortions and structural birth defects. The purpose of this abstract is to describe pregnancy outcomes with exposure to MPA and pregnancies fathered by male transplant recipients conceived while taking MPA. Data were collected by the National Transportation Pregnancy Registry (NTPR) via questionnaires, telephone interview and medical records. There were 152 …

Phase Ii Evaluation Of Dasatinib In The Treatment Of Recurrent Or Persistent Epithelial Ovarian Or Primary Peritoneal Carcinoma: A Gynecologic Oncology Group Study., Russell J Schilder, William E Brady, Heather A Lankes, James V Fiorica, Mark S Shahin, Xun C Zhou, Robert S Mannel, Harsh B Pathak, Wei Hu, R Katherine Alpaugh, Anil K Sood, Andrew K Godwin

Department of Medical Oncology Faculty Papers

OBJECTIVES: Preclinical data suggest an important role for the sarcoma proto-oncogene tyrosine kinase (SRC) in the oncogenesis of epithelial ovarian cancer (EOC) or primary peritoneal carcinoma (PPC). The Gynecologic Oncology Group (GOG) conducted a Phase II trial to evaluate the efficacy and safety of dasatinib, an oral SRC-family inhibitor in EOC/PPC, and explored biomarkers for possible association with clinical outcome.

METHODS: Eligible women had measurable, recurrent or persistent EOC/PPC and had received one or two prior regimens which must have contained a platinum and a taxane. Patients were treated with 100mg orally daily of dasatinib continuously until progression of disease …

Pulmonary Complications In Patients With Severe Brain Injury., Kiwon Lee, Fred Rincon

Department of Neurology Faculty Papers

Pulmonary complications are prevalent in the critically ill neurological population. Respiratory failure, pneumonia, acute lung injury and the acute respiratory distress syndrome (ALI/ARDS), pulmonary edema, pulmonary contusions and pneumo/hemothorax, and pulmonary embolism are frequently encountered in the setting of severe brain injury. Direct brain injury, depressed level of consciousness and inability to protect the airway, disruption of natural defense barriers, decreased mobility, and secondary neurological insults inherent to severe brain injury are the main cause of pulmonary complications in critically ill neurological patients. Prevention strategies and current and future therapies need to be implemented to avoid and treat the development …

Determining The Absolute Requirement Of G Protein-Coupled Receptor Kinase 5 For Pathological Cardiac Hypertrophy: Short Communication., Jessica I Gold, Erhe Gao, Xiying Shang, Richard T Premont, Walter J Koch

Center for Translational Medicine Faculty Papers

RATIONALE: Heart failure (HF) is often the end phase of maladaptive cardiac hypertrophy. A contributing factor is activation of a hypertrophic gene expression program controlled by decreased class II histone deacetylase (HDAC) transcriptional repression via HDAC phosphorylation. Cardiac-specific overexpression of G proteinen-coupled receptor kinase-5 (GRK5) has previously been shown to possess nuclear activity as a HDAC5 kinase, promoting an intolerance to in vivo ventricular pressure overload; however, its endogenous requirement in adaptive and maladaptive hypertrophy remains unknown.

OBJECTIVE: We used mouse models with global or cardiomyocyte-specific GRK5 gene deletion to determine the absolute requirement of endogenous GRK5 for cardiac hypertrophy …

The Effect Of Iliac Crest Autograft On The Outcome Of Fusion In The Setting Of Degenerative Spondylolisthesis: A Subgroup Analysis Of The Spine Patient Outcomes Research Trial (Sport)., Kristen Radcliff, Raymond Hwang, Alan Hilibrand, Harvey E Smith, Jordan Gruskay, Jon D Lurie, Wenyan Zhao, Todd Albert, James Weinstein

Rothman Institute Faculty Papers

BACKGROUND: There is considerable controversy about the long-term morbidity associated with the use of posterior autologous iliac crest bone graft for lumbar spine fusion procedures compared with the use of bone-graft substitutes. The hypothesis of this study was that there is no long-term difference in outcome for patients who had posterior lumbar fusion with or without iliac crest autograft.

METHODS: The study population includes patients enrolled in the degenerative spondylolisthesis cohort of the Spine Patient Outcomes Research Trial who underwent lumbar spinal fusion. Patients were divided according to whether they had or had not received posterior autologous iliac crest bone …

An Autopsy Case Of Alveolar Capillary Dysplasia, Yu Shi, John Farber

Department of Pathology, Anatomy, and Cell Biology Resident's Posters

Poster presented at College of American Pathologist 2012 in San Diego California.

Patient:

Chief Complaint: A full term, newborn girl developed respiratory distress shortly after birth.

Life History Theory And Social Psychology., Donald F Sacco, Karol Osipowicz

Department of Neurology Faculty Papers

No abstract provided.

Global Cellular Regulation Including Cardiac Function By Post-Translational Protein Arginylation., Hideko Kaji, Akira Kaji

Department of Biochemistry and Molecular Biology Faculty Papers

In this issue a very significant contribution to cardiology describing critical roles of ATE1 appears by Kurosaka et al. [1]. In view of this paper, as the discoverers of ATE1, we have been asked to contribute an article (editorial) regarding ATE1 (enzyme which transfers arginine from arginyl tRNA to protein acceptors). This short article consists of three sections: 1) a historical anecdote describing how ATE1 was discovered; 2) its possible role in aging and cellular transformation, and most importantly; 3) its role in the development and maintenance of cardiac activity. The last section has direct bearing to the Kurosaka …

Biosynthetic Pathways And The Role Of The Mas Receptor In The Effects Of Angiotensin-(1-7) In Smooth Muscles., Marcio Augusto Fressatto De Godoy, Larissa Pernomian, Ana Maria De Oliveira, Satish Rattan

Department of Medicine Faculty Papers

Ang-(1-7) is produced via degradation of Ang II by the human angiotensin converting enzyme, also known as ACE2. In the cardiovascular system, Ang-(1-7) has been shown to produce effects that are opposite to those of Ang II. These include smooth muscle relaxation and cardioprotection. While the roles of Ang-(1-7) in other systems are currently topic of intense research, functional data suggest a relaxation action in gastrointestinal smooth muscles in a way that corroborates the results obtained from vascular tissues. However, more studies are necessary to determine a relevant role for Ang-(1-7) in the gastrointestinal system. The Ang-(1-7) actions are mediated …

Increased Susceptibility To Metabolic Syndrome In Adult Offspring Of Angiotensin Type 1 Receptor Autoantibody-Positive Rats., Suli Zhang, Xi Zhang, Lihong Yang, Zi Yan, Li Yan, Jue Tian, Xiaoyu Li, Li Song, Li Wang, Xiaoli Yang, Ronghua Zheng, Wayne Bond Lau, Xinliang Ma, Huirong Liu

Department of Emergency Medicine Faculty Papers

Abstract Aims: Abnormal fetal and early postnatal growth is closely associated with adult-onset metabolic syndrome (MetS). However, the underlying etiological factors remain complex. The presence of the autoantibody against the angiotensin II type 1 receptor (AT1-Ab), a known risk factor for pre-eclampsia, may create a suboptimal intrauterine fetal environment. The current study investigated whether middle-aged offspring of AT1-Ab-positive mothers were prone to metabolic disorder development. Results: The AT1-Abs was detected in placental trophoblastic cells, capillary endothelium, and milk of pregnant rats actively immunized with the second extracellular loop of the AT1 receptor. AT1-Abs in newborn rats induced vasoconstriction, increased intracellular-free …

A Teaching-Learning Initiative With Tablet Computing, Beth Ann Swan, Phd, Crnp, Faan, Kellie Smith, Edd, Rn, Anthony J. Frisby, Phd, Kathryn Shaffer, Msn, Rn, Cne, Mary Hanson-Zalot, Msn, Rn

College of Nursing Faculty Papers & Presentations

Mobile computing and electronic books are the top emerging technologies to impact higher education.¹ The rapid expansion of technology in the health care setting has created a growing recognition that there is a need for adoption of a sound set of innovative teaching-learning strategies related to information management and technology applications in undergraduate nursing curriculum. Success in these technology-related strategies will rest on the degree to which schools comprehensively integrate technology with teaching-learning strategies in the undergraduate nursing curriculum.

Tablet computing has the potential to enhance educational experiences by providing a delivery option for teaching and learning practices that …

The Use Of Interpreters To Improve The Quality And Safety Of Healthcare Through Better Communication In Obstetric Patients: Effect On Primary Cesarean Delivery Rate, Stephen A. Pearlman, Md

Master of Science in Healthcare Quality and Safety Capstone Presentations

Patients with limited English proficiency have poorer healthcare outcomes. An assessment of the cultural and linguistic competency of Christiana Care Health Systems revealed that our language services were not sufficiently robust and this was affecting care. Therefore, the purpose of this quality improvement study was to improve healthcare outcomes, specifically the rate of primary cesarean delivery, through improved language assistance, to patients with limited English proficiency presenting to labor and delivery. The methods employed included use of the TeamSTEPPS program to educate the staff on how to improve safety for patients with limited English proficiency, adding a live Spanish interpreter …

Stubborn, Persistent, Dangerous C.Difficile Infections. Is Improvement Possible?, Sara Townsend

Master of Science in Healthcare Quality and Safety Capstone Presentations

C.difficile also known as C.diff or CDI has developed into a dangerous infection for the United States’ health care system. While much work has been done to improve C.diff rates, health care teams have not been successful in reducing C.difficile infections. Many studies have focused on the mode of transmission of C.difficle, yet there still is not consensus on understanding how this infection is spread. Bryn Mawr Hospital, a community hospital in the suburbs of Philadelphia, Pa, has struggled to improve their C.diff rates like their peers throughout the country. While their infection rates for C.diff are …

Development Of Dna Vaccination Approach For Tumor Immunotargeting, Nathaniel Sangster

Summer Training Program in Cancer Immunotherapy

The emergence of immunotherapy as a prominent modality to treat cancer is a crucial advancement in the fight against this devastating disease. Although DNA vaccines against cancer have not been effective in treating pre-existing tumors, this approach holds much promise particularly for the activation of immune responses to specific mutant antigens responsible for tumorigenesis. Recent studies demonstrated that Q209L point mutation in the GNAQ (and GNA11) is responsible for the development of more than 70% of uveal melanomas and pre-malignant cutaneous blue nevus in humans. Based on the epitope prediction, we hypothesized that DNA vaccination with mutant GNAQ may result …