Medicine and Health Sciences Commons^™

Roscoe Reid Graham (1890 To 1948): A Canadian Pioneer In General Surgery., Christine C. Piper, Ba, Charles J. Yeo, Md, Scott W. Cowan, Md

Department of Surgery Gibbon Society Historical Profiles

Roscoe Reid Graham, a Canadian surgeon trained at the University of Toronto, was a true pioneer in the field of general surgery. Although he may be best known for his omental patch repair of perforated duodenal ulcers-often referred to as the "Graham patch"-he had a number of other significant accomplishments that decorated his surgical career. Dr. Graham is credited with being the first surgeon to successfully enucleate an insulinoma. He ventured to do an essentially brand new operation based solely on his patient's symptoms and physical findings, a courageous move that even some of the most talented surgeons would shy …

Genomics Into Healthcare: The 5th Pan Arab Human Genetics Conference And 2013 Golden Helix Symposium., Paolo Fortina, Najib Al Khaja, Mahmoud Taleb Al Ali, Abdul Rezzak Hamzeh, Pratibha Nair, Federico Innocenti, George P. Patrinos, Larry J. Kricka

Department of Cancer Biology Faculty Papers

The joint 5th Pan Arab Human Genetics conference and 2013 Golden Helix Symposium, "Genomics into Healthcare" was coorganized by the Center for Arab Genomic Studies (http://www.cags.org.ae) in collaboration with the Golden Helix Foundation (http://www.goldenhelix.org) in Dubai, United Arab Emirates from 17 to 19 November, 2013. The meeting was attended by over 900 participants, doctors and biomedical students from over 50 countries and was organized into a series of nine themed sessions that covered cancer genomics and epigenetics, genomic and epigenetic studies, genomics of blood and metabolic disorders, cytogenetic diagnosis and molecular profiling, next-generation sequencing, consanguinity and hereditary diseases, clinical genomics, …

Depression And Risk Perceptions In Older African Americans With Diabetes, Barry W. Rovner, Md, Julia A. Haller, Md, Robin J. Casten, Phd, Ann P. Murchison, Md, Mph, Lisa A. Hark, Phd, Rd

Department of Psychiatry and Human Behavior Faculty Papers

Introduction: The purpose of this study is to describe the impact of depression on perceptions of risks to health, diabetes self-management practices, and glycemic control in older African Americans with type 2 diabetes.

Methods: The authors analyzed data on depression, risk perceptions, diabetes self-management, and hemoglobin A1C in African Americans with type 2 diabetes.T tests, chi square, and multivariate regression were used to analyze the data.

Results: The sample included 177 African Americans (68% women) whose average age was 72.8 years. Thirty four (19.2%) participants met criteria for depression. Compared to non-depressed participants, depressed participants scored significantly higher on Personal …

Nanotechnology: Current Concepts In Orthopaedic Surgery And Future Directions., M P Sullivan, K J Mchale, Javad Parvizi Md, S Mehta

Rothman Institute Papers

Nanotechnology is the study, production and controlled manipulation of materials with a grain size < 100 nm. At this level, the laws of classical mechanics fall away and those of quantum mechanics take over, resulting in unique behaviour of matter in terms of melting point, conductivity and reactivity. Additionally, and likely more significant, as grain size decreases, the ratio of surface area to volume drastically increases, allowing for greater interaction between implants and the surrounding cellular environment. This favourable increase in surface area plays an important role in mesenchymal cell differentiation and ultimately bone-implant interactions. Basic science and translational research have revealed important potential applications for nanotechnology in orthopaedic surgery, particularly with regard to improving the interaction between implants and host bone. Nanophase materials more closely match the architecture of native trabecular bone, thereby greatly improving the osseo-integration of orthopaedic implants. Nanophase-coated prostheses can also reduce bacterial adhesion more than conventionally surfaced prostheses. Nanophase selenium has shown great promise when used for tumour reconstructions, as has nanophase silver in the management of traumatic wounds. Nanophase silver may significantly improve healing of peripheral nerve injuries, and nanophase gold has powerful anti-inflammatory effects on tendon inflammation. Considerable advances must be made in our understanding of the potential health risks of production, implantation and wear patterns of nanophase devices before they are approved for clinical use. Their potential, however, is considerable, and is likely to benefit us all in the future. Cite this article: Bone Joint J 2014; 96-B: 569-73.

Prostate Cancer: Alcohol, Cancer And 5Α-Reductase Inhibitors-Is There A Link?, Leonard G Gomella

Department of Urology Faculty Papers

Two major trials have been performed to determine the effect of 5α-reductase inhibitors on subsequent diagnoses of prostate cancer. Both trials showed that high alcohol intake significantly increased prostate cancer risk among men allocated to the treatment arms. The recommendation that patients eliminate alcohol when taking 5α-reductase inhibitors seems appropriate.

Characterization Of T-Bet And Eomes In Peripheral Human Immune Cells., James J. Knox, Gabriela L. Cosma, Michael R. Betts, Laura M. Mclane

Department of Microbiology and Immunology Faculty Papers

The T-box transcription factors T-bet and Eomesodermin (Eomes) have been well defined as key drivers of immune cell development and cytolytic function. While the majority of studies have defined the roles of these factors in the context of murine T-cells, recent results have revealed that T-bet, and possibly Eomes, are expressed in other immune cell subsets. To date, the expression patterns of these factors in subsets of human peripheral blood mononuclear cells beyond T-cells remain relatively uncharacterized. In this study, we used multiparametric flow cytometry to characterize T-bet and Eomes expression in major human blood cell subsets, including total CD4(+) …

Cervical Spondylotic Myelopathy In The Young Adult: A Review Of The Literature And Clinical Diagnostic Criteria In An Uncommon Demographic, Peter S Amenta, Md, George M. Ghobrial, Md, Kelly Krespan, Phi Nguyen, Mohammad Ali, Md, James Harrop, Md

Department of Neurosurgery Faculty Papers

Background: Cervical spondylotic myelopathy (CSM) is typically encountered in the elderly population. Significant inconsistencies currently exist regarding the definition of the disorder, the true incidence of CSM in younger populations, and the established diagnostic criteria.

Objective: To highlight the lack of standardization in the definition and diagnosis of CSM.

Methods: A PubMed literature search was conducted spanning the years 2001 to 2011. The search was limited by the following terms: 1) English language, 2) Adults (19-44 years old), and 3) “cervical spondylotic myelopathy.” Each article was reviewed to determine if the presence of the definition of CSM existed in the …

Thermal Dosimetry Characteristics Of Deep Regional Heating Of Non-Muscle Invasive Bladder Cancer., Titania Juang, Paul R. Stauffer, Oana A Craciunescu, Paolo F Maccarini, Yu Yuan, Shiva K Das, Mark W Dewhirst, Brant A Inman, Zeljko Vujaskovic

Department of Radiation Oncology Faculty Papers

PURPOSE: The aim of this paper is to report thermal dosimetry characteristics of external deep regional pelvic hyperthermia combined with intravesical mitomycin C (MMC) for treating bladder cancer following transurethral resection of bladder tumour, and to use thermal data to evaluate reliability of delivering the prescribed hyperthermia dose to bladder tissue.

MATERIALS AND METHODS: A total of 14 patients were treated with MMC and deep regional hyperthermia (BSD-2000, Sigma Ellipse or Sigma 60). The hyperthermia objective was 42° ± 2 °C to bladder tissue for ≥40 min per treatment. Temperatures were monitored with thermistor probes and recorded values were used …

A Pilot Clinical Trial Of Intravesical Mitomycin-C And External Deep Pelvic Hyperthermia For Non-Muscle-Invasive Bladder Cancer., Brant A Inman, Paul R. Stauffer, Oana A Craciunescu, Paolo F Maccarini, Mark W Dewhirst, Zeljko Vujaskovic

Department of Radiation Oncology Faculty Papers

PURPOSE: This paper aims to evaluate the safety and heating efficiency of external deep pelvic hyperthermia combined with intravesical mitomycin C (MMC) as a novel therapy for non-muscle-invasive bladder cancer (NMIBC).

MATERIALS AND METHODS: We enrolled subjects with bacillus Calmette-Guérin (BCG) refractory NMIBC to an early phase clinical trial of external deep pelvic hyperthermia (using a BSD-2000 device) combined with MMC. Bladders were heated to 42 °C for 1 h during intravesical MMC treatment. Treatments were given weekly for 6 weeks, then monthly for 4 months. Heating parameters, treatment toxicity, and clinical outcomes were systematically measured.

RESULTS: Fifteen patients were …

Use Of Antiepileptic Drugs And Lipid-Lowering Agents In The United States., Scott Mintzer, Vittorio Maio, Kathleen Foley

Department of Neurology Faculty Papers

INTRODUCTION: The extent to which enzyme-inducing antiepileptic drugs (EIAEDs) are used as first-line treatment in the United States remains unknown. Studies suggest that EIAEDs produce elevation of serum lipids, which could require additional treatment. We assessed the current use of EIAED in monotherapy for epilepsy in the U.S., as well as the correlation between the use of EIAEDs and subsequent new prescriptions for HMG-CoA reductase inhibitors ("statins") for hyperlipidemia.

METHODS: We queried the MarketScan® databases between July 2009 and January 2013, covering 66million patients with commercial or supplemental Medicare insurance. We identified individuals who had a diagnosis of seizures, continuous …

Pharmacologic Suppression Of Jak1/2 By Jak1/2 Inhibitor Azd1480 Potently Inhibits Il-6-Induced Experimental Prostate Cancer Metastases Formation., Lei Gu, Pooja Talati, Paraskevi Vogiatzi, Ana L Romero-Weaver, Junaid Abdulghani, Zhiyong Liao, Benjamin E. Leiby, David T. Hoang, Tuomas Mirtti, Kalle Alanen, Michael Zinda, Dennis Huszar, Marja T. Nevalainen

Department of Medical Oncology Faculty Papers

Metastatic prostate cancer is lethal and lacks effective strategies for prevention or treatment, requiring novel therapeutic approaches. Interleukin-6 (IL-6) is a cytokine that has been linked with prostate cancer pathogenesis by multiple studies. However, the direct functional roles of IL-6 in prostate cancer growth and progression have been unclear. In the present study, we show that IL-6 is produced in distant metastases of clinical prostate cancers. IL-6-activated signaling pathways in prostate cancer cells induced a robust 7-fold increase in metastases formation in nude mice. We further show that IL-6 promoted migratory prostate cancer cell phenotype, including increased prostate cancer cell …

Partner Support During Pregnancy And Its Influence On Maternal Health Behaviors, Sarah Capponi, Msii, Katelyn Cohen, Msii, Mazvita Nyamukapa, Mph, Jason K. Baxter, Md, Brett Worly, Md

Department of Obstetrics and Gynecology Presentations and Grand Rounds

Abstract

Introduction: Paternal support during pregnancy is considered a predictor of positive birth outcomes. Little research has focused on partner involvement and its impact on maternal health habits such as smoking and alcohol consumption during pregnancy.

Methods:

• This was a cross sectional study

• Pregnant women (n=198) between the ages of 18 – 44 and their partners (n=60)

• Women who identified their partner as their main support

• Norbeck Social Support Questionnaire (scale from 5 - 35)

• ANOVA and Student’s t-test were used to evaluate Norbeck scores and smoking/ drinking status

• Study personnel interviewed subjects to assess reliance on a partner

  Results: …

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Prior Ultrasound-Indicated Cerclage: What Should The Management Be In Next Pregnancy?, Anju Suhag, Md, Jordana Reina, Md, Laura Sanapo, Md, Maria Giraldo, Sushma Potti, Md, Vincenzo Berghella, Md

Department of Obstetrics and Gynecology Presentations and Grand Rounds

Abstract

Objective: To evaluate pregnancy outcomes of women with prior history of ultrasound-indicated cerclage (UIC) for short cervix who in subsequent pregnancy either were followed by transvaginal ultrasound cervical length(TVU CL)screening or received a history-indicated cerclage (HIC).

Materials and Methods: Retrospective cohort study was performed from 1993-2012, involving women with an index singleton pregnancy and history of UIC. Prior UIC was defined as cerclage placed for CLinstitution, women with prior history of UIC were managed in their subsequent pregnancy either by TVU CL screening or by HIC, at the physician's discretion(Figure). In the TVU CL group, if CL became24wks, an …

Detection Of Vascular Endothelial Growth Factor In Colon Cancer Xenografts Using Bevacizumab Based Near Infrared Fluorophore Conjugate., Bishnuhari Paudyal, Pramila Paudyal, Dilip Shah, Hideyuki Tominaga, Yoshito Tsushima, Keigo Endo

Department of Radiology Faculty Papers

BACKGROUND: The aim of this study was to develop the near infrared fluorescence (NIRF)-based imaging agent for the visualization of vascular endothelial growth factor (VEGF) in colon cancer. AlexaFluor 750 conjugating with bevacizumab, and injected intravenously into nude mice bearing VEGF over-expressing HT29 human colorectal cancer. Optical imaging was performed at 15 min, 24 h and 48 h post injection. Immunofluorescences staining of the tumor sections were performed. HT29 colorectal cancer xenografts were clearly visualized with bevacizumab-AlexaFluor 750.

RESULTS: Ex vivo analysis showed 2.1 ± 0.4%, 37.6 ± 6.3% and 38.5 ± 6.2% injected dose/g accumulated in the tumors at …

Limited Brain Metabolism Changes Differentiate Between The Progression And Clearance Of Rabies Virus., Keith Schutsky, Carla Portocarrero, D Craig Hooper, Bernhard Dietzschold, Milosz Faber

Department of Microbiology and Immunology Faculty Papers

Central nervous system (CNS) metabolic profiles were examined from rabies virus (RABV)-infected mice that were either mock-treated or received post-exposure treatment (PET) with a single dose of the live recombinant RABV vaccine TriGAS. CNS tissue harvested from mock-treated mice at middle and late stage infection revealed numerous changes in energy metabolites, neurotransmitters and stress hormones that correlated with replication levels of viral RNA. Although the large majority of these metabolic changes were completely absent in the brains of TriGAS-treated mice most likely due to the strong reduction in virus spread, TriGAS treatment resulted in the up-regulation of the expression of …

New Payment Models: What’S Driving Them, And What Do They Mean For What It Takes To Be A Good Doctor?, Richard Baron, Md

Department of Medicine Presentations and Grand Rounds

Learning Objectives:

1. Describe details of new non-fee for service payment models, including Bundled Payment, Accountable Care Organizations and Advanced Primary Care
2. Explain administrative structures required to implement these kinds of models
3. Articulate the new values-congruent roles physicians will play under new payment models and the skills they will need to play them.

PowerPoint slides only.

Resolving The Titer Of Murine Cytomegalovirus By Plaque Assay Using The M2-10b4 Cell Line And A Low Viscosity Overlay., Katherine A Zurbach, Toktam Moghbeli, Christopher M Snyder

Department of Microbiology and Immunology Faculty Papers

BACKGROUND: Murine cytomegalovirus (MCMV) is increasingly used as an infectious model to investigate host-pathogen interactions in mice. Detailed methods have been published for using primary murine embryonic fibroblasts (MEFs) for preparing stocks and determining viral titers of MCMV. For determining the titer of MCMV by plaque assay, these methods rely on a high viscosity media that restricts viral spreading through the supernatant of the culture, but is also usually too viscous to pipet. Moreover, MEFs must be repeatedly generated and can vary widely from batch-to-batch in purity, proliferation rates, and the development of senescence. In contrast, the M2-10B4 bone marrow …

Critical Role Of Tnf-Α In Cerebral Aneurysm Formation And Progression To Rupture., Robert M Starke, Nohra Chalouhi, Md, Pascal Jabbour Md, Stavropoula Tjoumakaris, L. Fernando Gonzalez, Robert H. Rosenwasswer Md, Kosuke Wada, Kenji Shimada, David M Hasan, Nigel H Greig, Gary K Owens, Aaron Dumont

Department of Neurosurgery Faculty Papers

BACKGROUND: Alterations in TNF-α expression have been associated with cerebral aneurysms, but a direct role in formation, progression, and rupture has not been established.

METHODS: Cerebral aneurysms were induced through hypertension and a single stereotactic injection of elastase into the basal cistern in mice. To test the role of TNF-α in aneurysm formation, aneurysms were induced in TNF-α knockout mice and mice pretreated with the synthesized TNF-α inhibitor 3,6'dithiothalidomide (DTH). To assess the role of TNF-α in aneurysm progression and rupture, DTH was started 6 days after aneurysm induction. TNF-α expression was assessed through real-time PCR and immunofluorescence staining.

RESULTS: …

Primary Care Meets Population Health: 22nd Annual Paul C. Brucker Lecture, Daniel G. Kipnis, Msi

Jefferson Digital Commons News

On April 11, 2014, the 22nd Annual Paul C. Brucker lecture was presented by Kevin Grumbach, MD, Professor and Chair, Department of Family and Community Medicine, University of California, San Francisco.

Ventricular Septal Rupture In The Cardiac Catheterization Laboratory, Loheetha Ragupathi, Md, Xin Zhang, Md, Gregary D. Marhefka, Md, Facp, Facc

Division of Cardiology Faculty Papers

Introduction

• Ventricular septal rupture is a rare but deadly complication of acute myocardial infarction (AMI)

• We describe a case that was recognized at time of occurrence in the cardiac catheterization lab

Cancer Screening 2014, Richard C. Wender, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Presentation celebrating 40th reunion symposium for the Department of Family and Community Medicine at Thomas Jefferson University Hospital.

Presentation outline includes:

Breast, Colon, Lung and Prostate Cancer

Learning objective: Apply new cancer screening guidelines to primary care physicians

A Novel Parp Inhibitor Resistance Mechanism Mediated By The Rna-Binding Protein Hur, Saswati N. Chand, Nicole Meisner-Kober, Shruti Lal, Charles J. Yeo, Md, Jordan M. Winter, Md, Jonathan R. Brody, Md

Department of Surgery Faculty Papers

Abstract

Pancreatic ductal adenocarcinoma (PDA) is the 4th leading cause of cancer-related deaths in the United States, and ranks as the third most common cancer associated with BRCA mutations, not including Fanconi Anemia gene mutations such as PALB2. Current combinations of chemotherapeutics have significant toxicities and only minimally extend overall patient survival. Poly-ADP ribose polymerase (PARP) inhibitors (PARPi), which target the DNA damage repair (DDR) pathway, have delivered promising preclinical and clinical results. Although synthetic lethality conferred by PARPi is a promising approach, still “selected” patients with DNA repair-deficient tumors (e.g., BRCA2 mutated) that initially respond to such molecular-targeted therapies …

Utility Of Pelvic Examination In Lower Abdominal Pain Without Vaginal Complaints, L. Sharan, J. Chien, T. Maiers, Wb Lau

Sigma Xi Student Research Day

Abstract

Abdominal pain is the most common presenting ED complaint. ED texts advocate speculum bimanual pelvic exam to differentiate pathology of abdominal versus pelvic etiology in women of childbearing age. However, the exam is invasive and requires significant ED resources. We hypothesize that routine pelvic exams of females complaining of abdominal pain without vaginal complaints in the ED does not alter clinical management. We performed a retrospective observational study of ED patients in an urban Level 1 trauma center for all non-pregnant women seen from January 2013 to July 2013, aged 18-50, with a chief complaint of isolated lower abdominal …

Preoperative And Operative Factors Associated With Complications Following Radical Nephroureterectomy, A. Arnouk, C. Lallas, E. Trabulsi, J. Raman

Sigma Xi Student Research Day

Abstract

Radical nephroureterectomy (RNU) is the gold standard for managing upper-tract urothelial carcinoma. We review preoperative, operative, and pathologic characteristics of patients undergoing RNU to identify factors associated with perioperative complications. A retrospective review of institutional databases from 8 academic centers identified 732 patients who underwent RNU. Data on preoperative, operative, and pathologic indices were collected. Almost 40% of patients in our cohort experienced a complication within 30 days of RNU. Increasing age, higher Charlson score, and lower baseline renal function were independently associated with patients developing complications. Longer OR duration and intraoperative transfusion requirement were also associated with post-RNU …

Addressing Hindfoot Arthritis With Concomitant Tibial Malunion Or Nonunion With Retrograde Tibiotalocalcaneal Nailing: A Novel Treatment Approach., Justin M Kane, Steven Raikin

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Tibial malunions and nonunions are associated with degenerative changes about the ankle. A comprehensive literature review revealed no articles discussing treatment options for patients with tibial shaft malunion and ipsilateral ankle arthritis. The aim of our study was to evaluate a series of patients in whom tibial osteotomy and retrograde tibiotalocalcaneal nailing were used to treat both tibial deformity and ankle osteoarthritis.

METHODS: Twenty-five patients underwent retrograde tibiotalocalcaneal nailing with concomitant realignment tibial osteotomy with takedown of the nonunion or malunion in a single procedure. All surgical procedures were performed by a single surgeon at a single institution. Baseline …

Revision Total Knee Arthroplasty In The Young Patient: Is There Trouble On The Horizon?, Vinay K Aggarwal, Nitin Goyal, Gregory Deirmengian, Ashwin Rangavajjula, Javad Parvizi Md, Mathew Austin

Rothman Institute Papers

BACKGROUND: The volume of total knee arthroplasties, including revisions, in young patients is expected to rise. The objective of this study was to compare the reasons for revision and re-revision total knee arthroplasties between younger and older patients, to determine the survivorship of revision total knee arthroplasties, and to identify risk factors associated with failure of revision in patients fifty years of age or younger.

METHODS: Perioperative data were collected for all total knee arthroplasty revisions performed from August 1999 to December 2009. A cohort of eighty-four patients who were fifty years of age or younger and a cohort of …

Cortical Injury Modulates The Pain Pathway Partially Through Inducible Nitric Oxide Synthase, Bv Daiutolo, Cm Macolino, Al Tyburski, Mb Elliot

Department of Neurosurgery Faculty Papers

Introduction

Headache is a highly prevalent symptom in all severities of traumatic brain injury (TBI), and it is one of the most common symptoms of post-traumatic headache. Post-traumatic headache (PTH) remains the most common chronic pain syndrome within the TBI patient population¹. Mild and moderate forms of TBI are more prevalent than severe forms, but it is currently believed that PTH occurrence is not related to the severity of TBI¹. Despite being a common symptom following injury, little is known about the pathogenesis of post-traumatic headache. This is partly due to a lack in preclinical animal …

Integrating The Classroom, Clinic, And Use Of Simulation To Prepare Students For Working With Individuals With Sci, Audrey Zapletal, Ms, Otr/L, Rob Hargraves, Ba, Gina Cooke, Ms, Otr/L

Department of Occupational Therapy Posters and Presentations

Background Information

• Students learn best through active engagement. Although experiences vary, practicing skills in clinical situations have proven to be an effective method.
• Practicing skills in a simulated controlled environment provides opportunities for students to receive feedback on their skills.
• Standardized patient experiences provide students a safe environment to practice clinical skills in challenging situations. These experiences have been shown to have a positive impact on learning.

Revisiting Our Roots: Innovative Community-Based Psychosocial Fieldwork Programs: Classroom To Clinic, Susan Santalucia, Ms, Otr/L, Kimberly S. Mollo, Ms, Otr/L, Tina Angelis, Edd, Otr/L

Department of Occupational Therapy Posters and Presentations

Objectives:

1. Understand the core components of a community-based level 1 psychosocial experience that bridge and enhance student classroom learning.

2. Examine strategies to identify, create, and maintain partnerships with community based sites.

3. Explore 2-3 learning activities and/or strategies that facilitate student learning during the Level 1 experience in a community based psychosocial setting.

Bcl2 Expression And Bcl2/Myc Dual Expression Predicts Inferior Survival In Primary Central Nervous System Lymphoma, Guldeep Uppal, Md, Zi-Xuan (Zoe) Wang, Phd, Renu Bajaj, Phd, Mark T. Curtis, Md, Phd, Charalambos C. Solomides, Md, Jon Glass, Md, Peter M. Banks, Stephen C. Peiper, Md, Jerald Z. Gong, Md

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

Background

Primary CNS lymphoma (PCNSL) is a rare type of diffuse large B-cell lymphoma (DLBCL) arising from and usually confined to CNS. Understating of the pathogenesis and prognostic markers is a challenge due to rarity of this neoplasm and paucity of the material available to study. Recent studies have shown that dual expression of MYC and BCL2 in DLBCL contributes to inferior overall survival. The prognostic value of MYC and BCL2 in PCNSL is not well studied.