Medicine and Health Sciences Commons^™

A Diagnostic Dilemma Of Antiglutamic Acid Decarboxylase 65 (Anti-Gad 65) And Mycoplasma Pneumoniae Antibodies In A Girl Presenting With Acute-Onset Obsessive-Compulsive Disorder., Cecilia Freeman, Antanoid J Langeveldt, Robyn R Miller

Department of Pediatrics Faculty Papers

Acute-onset obsessive-compulsive disorder can be challenging, especially when triggered by an underlying disease process. Clinicians often turn to Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS), but it is important to consider a broad differential in these patients. We present a case of a 9-year-old girl with acute-onset obsessive-compulsive behavior likely triggered by a post-infectious phenomenon that ultimately resolved following treatment with plasmapheresis.

Three-Dimensional Structure Of Human Cyclooxygenase (Hcox)-1., Morena Miciaccia, Benny Danilo Belviso, Mariaclara Iaselli, Gino Cingolani, Savina Ferorelli, Marianna Cappellari, Paola Loguercio Polosa, Maria Grazia Perrone, Rocco Caliandro, Antonio Scilimati

Department of Biochemistry and Molecular Biology Faculty Papers

The beneficial effects of Cyclooxygenases (COX) inhibitors on human health have been known for thousands of years. Nevertheless, COXs, particularly COX-1, have been linked to a plethora of human diseases such as cancer, heart failure, neurological and neurodegenerative diseases only recently. COXs catalyze the first step in the biosynthesis of prostaglandins (PGs) and are among the most important mediators of inflammation. All published structural work on COX-1 deals with the ovine isoenzyme, which is easier to produce in milligram-quantities than the human enzyme and crystallizes readily. Here, we report the long-sought structure of the human cyclooxygenase-1 (hCOX-1) that we refined …

Global Point-Of-Care Ultrasound Education And Training In The Age Of Covid-19., Onyinyechi F Eke, Patricia C. Henwood, Grace W Wanjiku, Abiola Fasina, Sigmund J Kharasch, Hamid Shokoohi

Department of Emergency Medicine Faculty Papers

The COVID-19 pandemic has disrupted traditional global point-of-care ultrasound (POCUS) education and training, as a result of travel restrictions. It has also provided an opportunity for innovation using a virtual platform. Tele-ultrasound and video-conferencing are alternative and supportive tools to augment global POCUS education and training. There is a need to support learners and experts to ensure that maximum benefit is gained from the use of these innovative modalities.

Mapping Major Sars-Cov-2 Drug Targets And Assessment Of Druggability Using Computational Fragment Screening: Identification Of An Allosteric Small-Molecule Binding Site On The Nsp13 Helicase., Matthew R Freidel, Roger S Armen

College of Pharmacy Faculty Papers

The 2019 emergence of, SARS-CoV-2 has tragically taken an immense toll on human life and far reaching impacts on society. There is a need to identify effective antivirals with diverse mechanisms of action in order to accelerate preclinical development. This study focused on five of the most established drug target proteins for direct acting small molecule antivirals: Nsp5 Main Protease, Nsp12 RNA-dependent RNA polymerase, Nsp13 Helicase, Nsp16 2'-O methyltransferase and the S2 subunit of the Spike protein. A workflow of solvent mapping and free energy calculations was used to identify and characterize favorable small-molecule binding sites for an aromatic pharmacophore …

Cytokine Storms, Evolution And Covid-19, Joe Alcock, Alix Masters

Department of Medicine Faculty Papers

Since the identification of severe illness caused by the novel coronavirus SARS-CoV-2, the role of the host immune system in causing disease has attracted widespread attention, along with intense interest in medical interventions that target the host immune response. A wide variety of agents have been proposed to treat a cytokine storm in coronavirus disease 2019 (COVID-19), but so far, only one class of medications, corticosteroids, has proved useful. In recent decades, experimental therapies for cytokine storms have been tried and mostly failed to help patients with severe sepsis and other infections. We summarize this history in order to frame …

The Role Of Mirnas, Mirna Clusters, And Isomirs In Development Of Cancer Stem Cell Populations In Colorectal Cancer., Victoria A Stark, Caroline O B Facey, Vignesh Viswanathan, Bruce M Boman

Department of Pharmacology and Experimental Therapeutics Faculty Papers

MicroRNAs (miRNAs or miRs) have a critical role in regulating stem cells (SCs) duringdevelopment and altered expression can cause developmental defects and/or disease. Indeed,aberrant miRNA expression leads to wide-spread transcriptional dysregulation which has beenlinked to many cancers. Mounting evidence also indicates a role for miRNAs in the developmentof the cancer SC (CSC) phenotype. Our goal herein is to provide a review of: (i) current researchon miRNAs and their targets in colorectal cancer (CRC), and (ii) miRNAs that are differentiallyexpressed in colon CSCs. MicroRNAs can work in clusters or alone when targeting different SC genesto influence CSC phenotype. Accordingly, we discuss …

White Paper On Ophthalmic Imaging For Choroidal Nevus Identification And Transformation Into Melanoma, Carol Shields, Sara E. Lally, Lauren Dalvin, Mandeep Sagoo, Marco Pellegrini, Swathi Kaliki, Ahmet Kaan Gündüz, Minoru Furuta, Prithvi Mruthyunjaya, Adrian T. Fung, Jay S. Duker, Sara M. Selig, Antonio Yaghy, Sandor R. Ferenczy, Malvina B. Eydelman, Mark S. Blumenkranz

Wills Eye Hospital Papers

Purpose: To discuss the evolution of noninvasive diagnostic methods in the identification of choroidal nevus and determination of risk factors for malignant transformation as well as introduce the novel role that artificial intelligence (AI) can play in the diagnostic process. Methods: White paper. Results: Longstanding diagnostic methods to stratify benign choroidal nevus from choroidal melanoma and to further determine the risk for nevus transformation into melanoma have been dependent on recognition of key clinical features by ophthalmic examination. These risk factors have been derived from multiple large cohort research studies over the past several decades and have garnered widespread use …

Algorithm For Cavo-Tricuspid Isthmus Flutter On Surface Ecgs: The Actions Study., Daniel Frisch, Eitan Frankel, Deanna Gill, Jad Al Danaf

Division of Cardiology Faculty Papers

OBJECTIVE: Cavo-tricuspid isthmus atrial flutter (CTI-AFL) is an important arrhythmia to recognise because there is a highly effective and relatively low-risk ablation strategy. However, clinical experience has demonstrated that providers often have difficulty distinguishing AFL from atrial fibrillation.

METHODS: We developed a novel ECG-based three-step algorithm to identify CTI-AFL based on established CTI flutter characteristics and verified on consecutive ablation cases of typical flutter, atypical flutter and atrial fibrillation. The algorithm assesses V1/inferior lead F-wave concordance, consistency of P-wave morphology and the presence of isoelectric intervals in the inferior leads. In this observation study, the algorithm was validated on a …

International Evidence-Based Consensus Diagnostic And Treatment Guidelines For Unicentric Castleman Disease., Frits Van Rhee, Eric Oksenhendler, Gordan Srkalovic, Peter Voorhees, Megan Lim, Angela Dispenzieri, Makoto Ide, Sophia Parente, Stephen Schey, Matthew Streetly, Raymond Wong, David Wu, Ivan Maillard, Joshua Brandstadter, Nikhil Munshi, Wilbur Bowne, Kojo S Elenitoba-Johnson, Alexander Fössa, Mary Jo Lechowicz, Shanmuganathan Chandrakasan, Sheila K Pierson, Amy Greenway, Sunita Nasta, Kazuyuki Yoshizaki, Razelle Kurzrock, Thomas S Uldrick, Corey Casper, Amy Chadburn, David C Fajgenbaum

Department of Surgery Faculty Papers

Castleman disease (CD) includes a group of rare and heterogeneous disorders with characteristic lymph node histopathological abnormalities. CD can occur in a single lymph node station, which is referred to as unicentric CD (UCD). CD can also involve multicentric lymphadenopathy and inflammatory symptoms (multicentric CD [MCD]). MCD includes human herpesvirus-8 (HHV-8)-associated MCD, POEMS-associated MCD, and HHV-8-/idiopathic MCD (iMCD). The first-ever diagnostic and treatment guidelines were recently developed for iMCD by an international expert consortium convened by the Castleman Disease Collaborative Network (CDCN). The focus of this report is to establish similar guidelines for the management of UCD. To this purpose, …

Innovator - Spring 2020

Innovator

05 - Message from the President

08 - The Past is a Prologue

15 - Shrinking World/Expanding Horizons

16 - The Nexus: News at Jefferson

20 - Jefferson Hits the Runway at NYFW

22 - A Game Changer

26 - Binge Swatching

30 - Breaking Down the Walls

38 - Coming Full Circle

44 - Question and Innovate

46 - Designer Health

50 - The Site is the Star

54 - Transcend and Include

60 - Reimagine

64 - Ram Roundup

68 - Class Notes

74 - In Memory

78 - Triva

Innovator - Winter 2020

Innovator

8 - A MESSAGE FROM THE PRESIDENT

10 - WHAT’S HAPPENING AT JEFFERSON

16 - DEFINING THE FUTURE OF LEARNING AND WORK
How well are institutions of higher education preparing their graduates for the realities of work in the 21st century?

26 - IT’S IN OUR DNA
Innovative partnership leads to Jefferson Institute for Bioprocessing.

32 - JEFFERSON IS GLOBAL
Jefferson’s study away program provides life-changing experiences for students.

36 - PURSUING KNOWLEDGE AND IMPACT
Provost Mark L. Tykocinski, MD, explores the different research initiatives happening across Jefferson.

38 - LIVING THE DREAM
Jefferson grad orbits among the stars like …

Evanescent - Volume 2, Issue 1

Evanescent

This special issue of the journal focuses on COVID-19 and racism in medicine. It was guest edited by Danielle Snyderman, MD, CMD, a geriatrician and an assistant professor in the department of family and community medicine at Thomas Jefferson University and the medical director of The Hill at Whitemarsh continuing care retirement community, and Nick Safian, a member of the Sidney Kimmel Medical College class of 2022.

CONTENTS

• Introduction from the Guest Editors, page 1
• Note from the Editor-in-Chief, page 5
• Section I: Poetry, page 7
• Section II: Home Life, page 9
• Section III: Entering the Fray, page 15
• Section …

Caring For Aml Patients During The Covid-19 Crisis: An American And Italian Experience., Lindsay Wilde, Md, Alessandro Isidori, Gina Keiffer, Md, Neil D. Palmisiano, Md, Margaret Kasner

Department of Medical Oncology Faculty Papers

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the subsequent pandemic have impacted every aspect of oncology care worldwide. Healthcare systems have been forced to rapidly change practices in order to maximize the safety of patients and healthcare providers and preserve scare resources. Patients with acute myeloid leukemia are at increased risk of complications from SARS-CoV-2 not only due to immune compromise related to the malignancy but also due to the acuity of the disease and intensity of treatment. These issues have created unique challenges during this difficult time. In this article, we present the approaches taken …

Blood-Brain Barrier: Mechanisms Governing Permeability And Interaction With Peripherally Acting Μ-Opioid Receptor Antagonists., Eugene R. Viscusi, Andrew R Viscusi

Department of Anesthesiology Faculty Papers

The blood-brain barrier (BBB) describes the unique properties of endothelial cells (ECs) that line the central nervous system (CNS) microvasculature. The BBB supports CNS homeostasis via EC-associated transport of ions, nutrients, proteins and waste products between the brain and blood. These transport mechanisms also serve as physiological barriers to pathogens, toxins and xenobiotics to prevent them from contacting neural tissue. The mechanisms that govern BBB permeability pose a challenge to drug design for CNS disorders, including pain, but can be exploited to limit the effects of a drug to the periphery, as in the design of the peripherally acting μ-opioid …

Health Design Thinking: An Innovative Approach In Public Health To Defining Problems And Finding Solutions, Sylvie Abookire, Colin Plover, Phd, Rosemary Frasso Phd, Msc, Cph, Bon Ku

College of Population Health Faculty Papers

No abstract provided.

Physiochemical Characteristics Of Hot And Cold Brew Coffee Chemistry: The Effects Of Roast Level And Brewing Temperature On Compound Extraction., Niny Z. Rao, Megan Fuller, Meghan D Grim

College of Life Sciences Faculty Papers

The role of roasting in cold brew coffee chemistry is poorly understood. The brewing temperature influences extraction processes and may have varying effects across the roast spectrum. To understand the relationship between brew temperature and roast temperature, hot and cold brew coffees were prepared from Arabica Columbian coffee beans roasted to light, medium, and dark levels. Chemical and physical parameters were measured to investigate the relationships among degree of roast, water temperature, and key characteristics of resulting coffees. Cold brew coffees showed differential extraction marked by decreased acidity, lower concentration of browned compounds, and fewer TDS indicating that cold water …

Reply: There Are Limits To Autonomy., John W C Entwistle, Kathleen N Fenton

Department of Surgery Faculty Papers

No abstract provided.

A Foldable Nonpenetrating Keratoprosthesis: Medium To Long-Term Clinical Results In Patients With Corneal Blindness Due To Noninflammatory Anterior Cornea Disease., Jose M Vargas, Eric Shiuey

Department of Medicine Faculty Papers

PURPOSE: To report the medium to long-term safety and performance outcomes of the KeraKlear nonpenetrating artificial cornea (KeraKlear) as the primary procedure in patients with corneal blindness due to noninflammatory anterior cornea disease.

METHODS: Fifteen patients with corneal blindness (preoperative visual acuity [VA] of ≥20/200) due to a non-inflammatory anterior corneal condition were included in this prospective, single-center study. Preoperative diagnoses included corneal scars, keratoconus, and corneal dystrophies. Diseased corneas were implanted with the KeraKlear (KeraMed Inc., Irvine, California, USA) by a single surgeon (JMV) using a femtosecond laser to create all incisions. Participants were followed up with for as …

Mobilizing Toxins For Cancer Treatment: Historical Perspectives And Current Strategies., Jessica Kopenhaver, Robert D Carlson, Adam E Snook

Department of Pharmacology and Experimental Therapeutics Faculty Papers

The level of complexity in a disease like cancer presents a number of challenges for effective treatment development, which require significant innovation to overcome [...].

Telemedicine For The Spine Surgeon In The Age Of Covid-19: Multicenter Experiences Of Feasibility And Implementation Strategies., Daniel Franco, Thiago Montenegro, Glenn A Gonzalez, Kevin Hines, Aria Mahtabfar, Melvin D Helgeson, Rakesh Patel, James Harrop

Department of Neurosurgery Faculty Papers

STUDY DESIGN: Multicenter study.

OBJECTIVES: The COVID-19 pandemic has obligated physicians to recur to additional resources and make drastic changes regarding the standard physician-patient encounter. In the last century, there has been a substantial improvement in technology, which over the years has opened the door to a new form of medical practicing known as telemedicine.

METHODS: Healthcare workers from three hospitals involved in the care for COVID-19 patients in the united states were invited to share their experience using telemedicine to deliver clinical care to their patients.

RESULTS: Since the appearance of this worldwide outbreak, social distancing has been a …

The Effect Of Intrapartum Glycemic Control On The Incidence Of Neonatal Hypoglycemia, Signe Caksa, Amanda Roman, Md

Phase 1

Introduction: 1-2% and 6-9% of pregnancies are complicated by type I/II and gestational diabetes mellitus (DM), respectively, leading to increased risk of adverse neonatal outcomes. Women with DM require glucose monitoring and glycemic control at the time of delivery; however, it remains unclear how variations in intrapartum glucose impact neonatal hypoglycemia.

Methods: This is a retrospective cohort study of women with singleton pregnancies, diagnosed with DM, who delivered >36 weeks gestation after attempting induction of labor at Thomas Jefferson University Hospital between 01/01/2017 and 01/01/2018. Intrapartum DM management included hourly capillary glucose (CG) monitoring until delivery, insulin drip with CG …

Narrative Medicine: A Reflective Writing Workshop Series For Interprofessional Healthcare Students At Thomas Jefferson University, Carly S. Slater, Ma, Ms, Brooke Salzman, Md, Rosemary Frasso, Phd, Cph

Phase 1

Introduction: Narrative medicine (NM) teaches reflective writing and close reading to help healthcare professionals think critically about themselves and others in order to offer more effective, empathic care. Few reports of NM methods document its value to facilitating collaboration and communication across students of different professional backgrounds. This study examines the effects of NM workshops on Thomas Jefferson University interprofessional healthcare students, and their utility to achieving these aims: 1) supporting thoughtfulness, mindfulness, and curiosity; 2) supporting the development and use of narrative in understanding the lives/contexts for self and others; 3) improving interactions and communication with others in professional …

Targeting Homologous Recombination Addicted Tumors: Challenges And Opportunities, Talia Golan, Jonathan Brody, Md

Kimmel Cancer Center Faculty Papers

Recent advances in next generation sequencing (NGS) and molecular subtyping of tumors have opened the door to clinically available targeted therapies. Although the treatment of many solid tumors still rely on a steady regimen of non-targeted chemotherapeutic agents, it is becoming increasingly more apparent that certain tumors with defects in DNA damage repair (DDR) genes may be exquisitely sensitive to DNA damaging agents or therapies targeting key elements of this pathway such PARP1, ATR, or ATM. Still, for tumors with DDR defects the challenges are multi-fold including: (I) identifying these tumors in patients in time for a window of opportunity …

Conditions For Combining Gene Therapy With Bone Marrow Transplantation In Murine Krabbe Disease., Mohammad Rafi, Paola Luzi, David A Wenger

Department of Neurology Faculty Papers

No abstract provided.

Inside Out, Spring 2019

Inside Out

Contents:

Spiderweb of Lights, Erica Westlake - Cover

Morning Commute - La Molina, Peru, Sarah Roselli - Inside Cover

Untitled Constellations Kevin Tang - Following Page

Desire, Daisy Zhang - 1

The Cliffs, Kevin Tang - 2

Fish Tails, Sean Considine - 3

Fisherman’s Nook, Boglarka Jordan - 4

Moratorium, Harnoor Kaur - 4

Cain and Abel, Sean Considine - 5

Sunset Outside Philly, Cara Mergner - 5

Abstract Anatomy: Umbilical Cord, Jordyn Tumas - 6

Daughterhood, Danielle Crabtree - 7

Al Kabsa, Sh’Rae Marshall -8

Thinking in Circles, Kerry …

Evanescent - Volume 1, Issue 1

Evanescent

1 - My first 24-hour shift, Marnie Abehouse

3 - Unprepared, Daniel Bahat

5 - #1, Douglas Gouchoe

7 - Harrowing Halloween, Nick Siena

11 - Where do we go from here?, Robert Wilson

15 - Lucky, Marina Heskel

50th Anniversary: Leading The Way In Rehabilitation Medicine (1969-2019), Carol Abbott

Department of Rehabilitation Medicine Posters

No abstract provided.

Structural Basis For The Homotypic Fusion Of Chlamydial Inclusions By The Snare-Like Protein Inca., Gino Cingolani, Michael Mccauley, Anna Lobley, Alexander J Bryer, Jordan Wesolowski, Deanna L Greco, Ravi K Lokareddy, Erik Ronzone, Juan R Perilla, Fabienne Paumet

Department of Biochemistry and Molecular Biology Faculty Papers

Many intracellular bacteria, including Chlamydia, establish a parasitic membrane-bound organelle inside the host cell that is essential for the bacteria's survival. Chlamydia trachomatis forms inclusions that are decorated with poorly characterized membrane proteins known as Incs. The prototypical Inc, called IncA, enhances Chlamydia pathogenicity by promoting the homotypic fusion of inclusions and shares structural and functional similarity to eukaryotic SNAREs. Here, we present the atomic structure of the cytoplasmic domain of IncA, which reveals a non-canonical four-helix bundle. Structure-based mutagenesis, molecular dynamics simulation, and functional cellular assays identify an intramolecular clamp that is essential for IncA-mediated homotypic membrane fusion during …

Single-Cell Gene Expression Analysis Identifies Chronic Alcohol-Mediated Shift In Hepatocyte Molecular States After Partial Hepatectomy., Sirisha Achanta, Aalap Verma, Ankita Srivastava, Harshavardhan Nilakantan, Jan B. Hoek, Rajanikanth Vadigepalli

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

The analysis of molecular states of individual cells, as defined by their mRNA expression profiles and protein composition, has gained widespread interest in studying biological phenomena ranging from embryonic development to homeostatic tissue function and genesis and evolution of cancers. Although the molecular content of individual cells in a tissue can vary widely, their molecular states tend to be constrained within a transcriptional landscape partly described by the canonical archetypes of a population of cells. In this study, we sought to characterize the effects of an acute (partial hepatectomy) and chronic (alcohol consumption) perturbation on the molecular states of individual …

Innovator - Spring 2019

Innovator

8 - A MESSAGE FROM THE PRESIDENT

10 - WHAT’S HAPPENING AT JEFFERSON?

16 - OUR STRATEGIC ACADEMIC FRAMEWORK Jefferson is dedicated to improving lives by redefining humanly possible.

18 - THE BOY FROM BROOKLYN Noted alumnus Harold Ronson leaves his mark on Jefferson.

24 - WE DESIGN THINKING The University has developed a world-class reputation for graduating designers with a demonstrated capacity for developing robust solutions for real-world problems.

30 - UNLEASHING CREATIVITY Provost Mark L. Tykocinski, MD, describes the exciting and productive intersections explored at Jefferson.

32 - AN EVOLUTION ROOTED IN EMPATHY Two industry experts and educators …