Medicine and Health Sciences Commons^™

Strategies For Anti-Fibrotic Therapies., Joel Rosenbloom, Fabian A. Mendoza, Md, Sergio A. Jimenez

Jefferson Institute of Molecular Medicine Papers and Presentations

The fibrotic diseases encompass a wide spectrum of entities including such multisystemic diseases as systemic sclerosis, nephrogenic systemic fibrosis and sclerodermatous graft versus host disease, as well as organ-specific disorders such as pulmonary, liver, and kidney fibrosis. Collectively, given the wide variety of affected organs, the chronic nature of the fibrotic processes, and the large number of individuals suffering their devastating effects, these diseases pose one of the most serious health problems in current medicine and a serious economic burden to society. Despite these considerations there is currently no accepted effective treatment. However, remarkable progress has been achieved in the …

Angular Cheilitis: A Maligned Condition., Caren Campbell, Lawrence Parish

Department of Dermatology and Cutaneous Biology Faculty Papers

Why an essay on angular cheilitis, an easily recognized cutaneous entity? One suggestion rests with the observation that angular cheilitis could be one of the most maligned conditions seen in contemporary practice. The fissuring, redness, and soreness at the angles of the mouth may not be catastrophic, but the embarrassment and soreness are disconcerting. Another that is more disturbing concerns the unnecessary testing and treatment often seen in the community.

When a middle aged man presented with angular cheilitis on routine examination, he asked if this was due to a vitamin deficiency. Fig 1 He had been told by a …

Clinical Measurement Of Patellar Tendon: Accuracy And Relationship To Surgical Tendon Dimensions., Chad Zooker, Rajeev Pandarinath, Matthew J Kraeutler, Michael G Ciccotti, Steven B. Cohen, Peter F Deluca

Rothman Institute Papers

Patellar tendon width and length are commonly used for preoperative planning for anterior cruciate ligament reconstruction (ACLR). In the study reported here, we assessed the accuracy of preoperative measurements made by palpation through the skin, and correlated these measurements with the actual dimensions of the tendons at surgery. Before making incisions in 53 patients undergoing ACLR with patellar tendon autograft, we measured patellar tendon length with the knee in full extension and in 90° of flexion, and tendon width with the knee in 90° of flexion. The tendon was then exposed, and its width was measured with the knee in …

Altered Drainage Patterns In Patients With Melanoma And Previous Axillary Dissection., Caitlyn M. Johnson, Charles Intenzo, Michael Mastrangelo, Kendra Feeney, Adam C. Berger

Department of Surgery Faculty Papers

The incidence of melanoma is increasing rapidly in the United States. Sentinel lymph node biopsy is an important diagnostic tool in the treatment and staging of melanoma. However, many patients with melanoma will have had lymph node surgery for previous melanoma or breast cancer. We set out to examine alterations in drainage patterns in patients with previous axillary dissection for breast cancer. We reviewed four patients with truncal and/or extremity melanomas and examined their lymphoscintigraphy and drainage patterns. Three patients with truncal melanoma mapped to cervical lymph nodes and a fourth patient with an arm melanoma mapped to her previously …

Education And Referral Criteria: Impact On Oncology Referrals To Palliative Care., Barbara Reville, Joanne Reifsnyder, Deborah B Mcguire, Karen Kaiser, Abbie Santana

Department of Family & Community Medicine Faculty Papers

OBJECTIVE: To describe a quality improvement project involving education and referral criteria to influence oncology provider referrals to a palliative care service.

METHODS: A single group post-test only quasi-experimental design was used to evaluate palliative care service (PCS) referrals following an intervention consisting of a didactic presentation, education outreach visits (EOV) to key providers, and referral criteria. Data on patient demographics, cancer types, consult volume, reasons for referral, pre-consult length of stay, overall hospital stay, and discharge disposition were collected pre-intervention, then post-intervention for 7.5 months and compared.

SETTING AND SAMPLE: Attending oncologists, nurse practitioner, and house staff from the …

Erosive Arthritis And Hepatic Granuloma Formation Induced By Peptidoglycan Polysaccharide In Rats Is Aggravated By Prasugrel Treatment., Analia E Garcia, Mario C Rico, Elisabetta Liverani, Raul A Dela Cadena, Paul F. Bray, Satya P Kunapuli

Cardeza Foundation for Hematologic Research

Administration of the thienopyridine P2Y12 receptor antagonist, clopidogrel, increased the erosive arthritis induced by peptidoglycan polysaccharide (PG-PS) in rats or by injection of the arthritogenic K/BxN serum in mice. To determine if the detrimental effects are caused exclusively by clopidogrel, we evaluated prasugrel, a third-generation thienopyridine pro-drug, that contrary to clopidogrel is mostly metabolized into its active metabolite in the intestine. Prasugrel effects were examined on the PG-PS-induced arthritis rat model. Erosive arthritis was induced in Lewis rats followed by treatment with prasugrel for 21 days. Prasugrel treated arthritic animals showed a significant increase in the inflammatory response, compared with …

Leadership Considerations For Executive Vice Chairs, New Chairs, And Chairs In The 21st Century., Elisabeth J.S. Kunkel, Jon A. Lehrmann, Michael J. Vergare, Laura Weiss Roberts

Department of Psychiatry and Human Behavior Faculty Papers

The need to fulfill academic goals in the context of significant economic challenges, new regulatory requirements, and ever-changing expectations for leadership requires continuous adaptation. This paper serves as an educational resource for emerging leaders from the literature, national leaders, and other “best practices” in the following domains: 1. Mentorship; 2. Faculty Development; 3. Promotion; 4. Demonstrating value in each of the academic missions; 5. Marketing and communications; and 6. Barriers

An Old Problem With A New Therapy: Gastrointestinal Bleeding In Ventricular Assist Device Patients And Deep Overtube-Assisted Enteroscopy., Konrad Sarosiek, Linda J Bogar, Mitchell I Conn, Brendan O'Hare, Hitoshi Hirose, Md, Phd, Nicholas C. Cavarocchi, Md

Department of Surgery Faculty Papers

Conventional algorithms for diagnosis and treatment of gastrointestinal bleeding (GIB) in patients with nonpulsatile ventricular assist devices (VADs) may take days to perform while patients require transfusions. We developed a new algorithm based on deep overtube-assisted enteroscopy (DOAE) to facilitate a rapid diagnosis and treatment. From 2004 to 2012, 84 patients who underwent VAD placement in our institution, were evaluated for episodes of GIB. Our new algorithm for the management of GIB using DOAE was evaluated by dividing the episodes into three groups: group A (traditional management without enteroscopy), group B (traditional management with enteroscopy performed >24 hours after presentation), …

Department Of Radiology-Annual Executive Summary Report-July 1, 2012 To June 30, 2013, Vijay M. Rao, Md

Department of Radiology Administrative Documents and Reports

86 page Department of Radiology Annual Executive Summary Report, July 1, 2012 to June 30, 2013, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States.

Table of Contents

Chairman, Vice Chairmen 1

Divisions and Directors 1

Committees and Chairmen 1

Radiology Department Faculty Rank 2

Faculty with Secondary Appointments 3

Clinical Divisions 4

Radiology Residents and Fellows 5

Department Organizational Chart 6

Department Administration Chart 7

State of the Department 8

Appendix I: Publications

Journal Articles 24

Books and Book Chapters 30

Abstracts 31

Appendix II: Formal Scientific Presentations 43

Appendix III: Honors, Editorial Activities, Service to Regional or National Organizations …

Smoking Mediates The Relationship Between Adverse Childhood Experiences And Chronic Obstructive Pulmonary Disease In The Brfss Data, Andrew Messersmith

Master of Public Health Capstone Presentations

Associations between adverse childhood experiences (ACEs) and adult health outcomes are well grounded in the empirical literature; such studies generally find both direct and indirect effects of ACE on health outcomes such as liver disease, cancer, and heart disease. In this study, the association between ACEs and chronic obstructive pulmonary disease (COPD) was examined, and smoking was assessed as a partial mediator in the ACE-COPD relationship. Data were collected from five states in which an eight category ACE module was included in the 2011 Behavioral Risk Factor Surveillance System (BRFSS). Logistic regression models were developed to test the mediational hypothesis-that …

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

Master of Public Health Capstone Presentations

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

Knowledge And Attitudes Assessment Of Out-Of-Hospital Emergency Physicians In Yerevan, Armenia, Aline Baghdassarian, Md

Master of Public Health Capstone Presentations

Out-of-hospital emergency care is in an early stage of development in Armenia. While efforts are underway by the Ministry of Health (MOH) and other organizations to reform the emergency medical services (EMS) system, little data exists on the status of pediatric emergency care (PEC). To evaluate the knowledge and attitudes of out-of-hospital emergency physicians (EPs) in pediatric rapid assessment and resuscitation, and to identify areas of improvement to the pediatric EMS system and PEC education in the capital, Yerevan, a cross-sectional, anonymous, self-administered Knowledge and Attitudes survey regarding pediatric rapid assessment and resuscitation was distributed to all out-of-hospital EPs in …

Emergency Department Utilization Among South Philadelphia Residents And Frequent Users In The Jefferson Community Benefit Area, Melissa Mccarey

Master of Public Health Capstone Presentations

Over the past decade, the rate of emergency department (ED) visits increased at almost double the rate that would be expected due to normal population growth. The implications of this increase in ED usage include decreased quality of care, overcrowding, increased wait times, and increased healthcare costs. The purpose of this analysis is to examine health issues, concerns, and underling social determinants of frequent ED users and South Philadelphia Residents who use the Thomas Jefferson University or Methodist Hospital emergency departments. This project is a retrospective data analysis using descriptive statistics, measures of central tendency, and cross-tabulation analysis to analyze …

Emergency Department Utilization: An Analysis Of The Thomas Jefferson Community Benefit Areas In North Philadelphia, Bettina Berman

Master of Public Health Capstone Presentations

The Emergency Department (ED) is a place where disaster preparedness, public health surveillance, and in many cases, ambulatory primary care is provided. The increase in ED visits, combined with expanded services, has led to overcrowding and significant strains on resources. The purpose of this study was to conduct a retrospective data analysis of emergency department utilization in the Thomas Jefferson University Hospital (TJUH) community benefit areas in North Philadelphia and to determine if patients were utilizing the ED for conditions which could have been treated in the outpatient setting. A comprehensive literature review was conducted. The review focused on studies …

Modeling To Assess Value: Is It Ready For Prime Time?, Jaime J. Caro, Mdcm, Frcpc, Facp

Jefferson School of Population Health Fellows’ Day

Jaime Caro is Senior Vice President, Research, at a consulting firm, where he leads development and application of novel techniques in health economics, multi-criteria decision analysis, benefit-risk analysis, comparative effectiveness, and epidemiology. He led the Caro Research Institute for more than a decade, until CRI was acquired in 2007. Dr. Caro trained at McGill University, where he practiced internal medicine and continues as adjunct Professor of Medicine, as well as of Epidemiology and Biostatistics. He is also adjunct professor at the Massachusetts College of Pharmacy and Health Sciences and lecturer at Thomas Jefferson University School of Population Health.

Out-Of-Pocket Costs And Prescription Reversals: The Case Of Oral Linezolid, Margaret K. Pasquale, Anthony M. Louder, Michael C. Deminski, Richard B. Chambers, Seema Haider

Jefferson School of Population Health Fellows’ Day

Kim A. Caldwell, RPh

Employed by Humana Inc., Kim is the Director of Pharmacy Professional Affairs for Humana Pharmacy Solutions. In this role, he and his team serve to liaison between HPS business owners, Humana Public Affairs, and key professional and trade partners. They serve as the pharmacy subject matter experts aligned with key business and regulatory issues, including visits with members of federal and state legislatures as well as the interface with state boards of pharmacy and key trade organizations. Previously, he started and directed Competitive Health Analytics, Inc. (CHA) a business unit within Humana Inc. for the first …

Intermedin Protects Against Myocardial Ischemia-Reperfusion Injury In Diabetic Rats., Hong Li, Yunfei Bian, Nana Zhang, Jia Guo, Cheng Wang, Wayne Bond Lau, Chuanshi Xiao

Department of Emergency Medicine Faculty Papers

BACKGROUND: Diabetic patients, through incompletely understood mechanisms, endure exacerbated ischemic heart injury compared to non-diabetic patients. Intermedin (IMD) is a novel calcitonin gene-related peptide (CGRP) superfamily member with established cardiovascular protective effects. However, whether IMD protects against diabetic myocardial ischemia/reperfusion (MI/R) injury is unknown. METHODS: Diabetes was induced by streptozotocin in Sprague--Dawley rats. Animals were subjected to MI via left circumflex artery ligation for 30 minutes followed by 2 hours R. IMD was administered formally 10 minutes before R. Outcome measures included left ventricular function, oxidative stress, cellular death, infarct size, and inflammation. RESULTS: IMD levels were significantly decreased in …

Caloric Restriction Augments Radiation Efficacy In Breast Cancer., Anthony D Saleh, Brittany A Simone, Juan Palazzo, Jason E Savage, Yuri Sano, Tu Dan, Lianjin Jin, Colin E Champ, Shuping Zhao, Meng Lim, Frederica Sotgia, Kevin Camphausen, Richard G Pestell, James B Mitchell, Michael P Lisanti, Nicole L Simone

Kimmel Cancer Center Faculty Papers

Dietary modification such as caloric restriction (CR) has been shown to decrease tumor initiation and progression. We sought to determine if nutrient restriction could be used as a novel therapeutic intervention to enhance cytotoxic therapies such as radiation (IR) and alter the molecular profile of triple-negative breast cancer (TNBC), which displays a poor prognosis. In two murine models of TNBC, significant tumor regression is noted with IR or diet modification, and a greater regression is observed combining diet modification with IR. Two methods of diet modification were compared, and it was found that a daily 30% reduction in total calories …

A Preliminary Report Of Percutaneous Craniofacial Osteoplasty In A Rat Calvarium, William J. Parkes, Md, Jewel Greywoode, Md, Brian J. O'Hara, Md, Ryan N. Heffelfinger, Md, Howard Krein, Md, Phd

Department of Otolaryngology - Head and Neck Surgery Presentations and Grand Rounds

Objective: To evaluate the potential for injectable, permanent bone augmentation by assessing the biocompatibility and bioactivity of subperiosteal hydroxylapatite (Radiesse) deposition in a rat model.

Methods: Fourteen adult Sprague Dawley rats were injected in the parietal skull with hydroxylapatite (n=10) or a carrier gel control (n=4), using a subperiosteal injection technique on the right and a subcutaneous injection technique on the left. At 1, 3, and 6 months, 3 rats (1 negative control, 2 variables) were sacrificed. At 12 months, the remaining 5 rats were sacrificed. After each harvest, the calvaria were examined under both light and polarized microscopy.

Results: …

Introduction To Ipe: A School-Wide Orientation Initiative, Audrey Zapletal, Ms, Otr/L, Susan Toth-Cohen, Phd, Otr/L, Susan Wainwright, Phd, Pt, Frances Gilman, Dhsc, Rt, R, Ct, Cv, Mr

Department of Occupational Therapy Posters and Presentations

Session Objectives:

Present an innovative approach to orienting new students from various healthcare disciplines on Interprofessional Educa(on (IPE).

Discuss strategies to shape incoming students’ attitudes toward working in teams.

Discuss challenges and opportunities in coordinating a large-­‐scale IPE event.

Synopsis

Interprofessional experiences are a vital part of healthcare education, and early introduction can positively impact students’ attitudes and knowledge about their team members’ roles. While students at academic health centers (AHC’s) have opportunites to engage in IPE, such opportunites can be overwhelming given significant challenges to coordination and implementation. Addressing these challenges, an interprofessional team at Jefferson School of Health …

Management Of Intracranial Bleeding Associated With Dabigatran Use In A Neuroscience Hospital, Alejandro Perez, Md, Lynda Thomson, Geno J. Merli, Md

Department of Pharmacology and Experimental Therapeutics Faculty Papers

Dabigatran, an alternative to warfarin for prevention of stroke with non-valvular atrial fibrillation (AF), offers advantages of a fixed dosage, minimal laboratory monitoring and limited medication interactions. Dabigatran requires dosage adjustment in renal dysfunction and is contraindicated if severe dysfunction. No identified dabigatran reversal agent exists.

Methods: As part of an ongoing quality initiative, novel anticoagulant associated adverse events (AE) are monitored at a dedicated neuroscience hospital.

Results: 5 cases of intracranial bleeding associated with dabigatran occurred from 12/2011-4/2012. All patients were on anticoagulation for AF, the most common dose of dabigatran was 150 mg BID. Mean admission values were …

Insulin Promotes Glucose Consumption Via Regulation Of Mir-99a/Mtor/Pkm2 Pathway., Wei Li, Jing Wang, Qiu-Dan Chen, Xu Qian, Qi Li, Yu Yin, Zhu-Mei Shi, Lin Wang, Jie Lin, Ling-Zhi Liu, Bing-Hua Jiang

Kimmel Cancer Center Faculty Papers

Insulin is known to regulate multiple cellular functions and is used for the treatment of diabetes. MicroRNAs have been demonstrated to be involved in many human diseases, including Type 2 diabetes. In this study, we showed that insulin decreased miR-99a expression levels, but induced glucose consumption and lactate production, and increased the expression of mTOR, HIF-1α and PKM2 in HepG2 and HL7702 cells. Forced expression of miR-99a or rapamycin treatment blocked insulin-induced PKM2 and HIF-1α expression, and glucose consumption and lactate production. Meanwhile, knockdown of HIF-1α inhibited PKM2 expression and insulin-induced glucose consumption. Taken together, these findings will reveal the …

Presumed Familial Late-Onset Medullary Thyroid Cancer In A Patient With A Germline Point Mutation, C. 2304 G->T, In Ret Proto-Oncogene Codon 768: Specific Mutation May Guide Timing Of Prophylactic Total Thyroidectomy In Affected Family Members, Susan Gerber, Md, Madalina Tuluc, Md, Phd, Serge Jabbour, Md, Facp, Face

Department of Medicine Faculty Papers

Medullary thyroid carcinoma (MTC) accounts for 15% of thyroid cancers. It arises in the C-cells of the thyroid, and is often metastatic at presentation. Approximately 75% of MTC cases are sporadic. Heritable MTC is subdivided into three categories: MEN2A, familial medullary thyroid carcinoma (FMTC), and MEN2B. Determination of the particular mutation may guide the timing of prophylactic total thyroidectomy in family members who carry the mutation.

Ectopic Cushing's Syndrome From Acth-Producing Pheochromocytoma, Susan Gerber, Md, Lawrence C. Kenyon, Md, Phd, Mary Kate Mccullen, Serge Jabbour, Md, Facp, Face

Department of Medicine Faculty Papers

ACTH-dependent Cushing’s syndrome results from excessive ACTH secretion from a pituitary gland adenoma (Cushing’s disease) in 80% of cases. Much less commonly, ectopic ACTH production occurs outside the pituitary gland, with the majority of those cases caused by bronchial carcinoids. A small number are due to excessive ACTH secretion by a pheochromocytoma.

Breast Cancer Antiestrogen Resistance 3 (Bcar3) Promotes Cell Motility By Regulating Actin Cytoskeletal And Adhesion Remodeling In Invasive Breast Cancer Cells., Ashley L Wilson, Randy S Schrecengost, Michael S Guerrero, Keena S Thomas, Amy H Bouton

Department of Cancer Biology Faculty Papers

Metastatic breast cancer is incurable. In order to improve patient survival, it is critical to develop a better understanding of the molecular mechanisms that regulate metastasis and the underlying process of cell motility. Here, we focus on the role of the adaptor molecule Breast Cancer Antiestrogen Resistance 3 (BCAR3) in cellular processes that contribute to cell motility, including protrusion, adhesion remodeling, and contractility. Previous work from our group showed that elevated BCAR3 protein levels enhance cell migration, while depletion of BCAR3 reduces the migratory and invasive capacities of breast cancer cells. In the current study, we show that BCAR3 is …

Micu1 Controls Both The Threshold And Cooperative Activation Of The Mitochondrial Ca(2+) Uniporter., György Csordás, Tünde Golenár, Erin L Seifert, Kimberli J Kamer, Yasemin Sancak, Fabiana Perocchi, Cynthia Moffat, David Weaver, Sergio De La Fuente Perez, Roman Bogorad, Victor Koteliansky, Jeffrey Adijanto, Vamsi K Mootha, György Hajnóczky

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Mitochondrial Ca(2+) uptake via the uniporter is central to cell metabolism, signaling, and survival. Recent studies identified MCU as the uniporter's likely pore and MICU1, an EF-hand protein, as its critical regulator. How this complex decodes dynamic cytoplasmic [Ca(2+)] ([Ca(2+)]c) signals, to tune out small [Ca(2+)]c increases yet permit pulse transmission, remains unknown. We report that loss of MICU1 in mouse liver and cultured cells causes mitochondrial Ca(2+) accumulation during small [Ca(2+)]c elevations but an attenuated response to agonist-induced [Ca(2+)]c pulses. The latter reflects loss of positive cooperativity, likely via the EF-hands. MICU1 faces the intermembrane space and responds to …

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

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Preterm Birth And The Controversy Over Universal Cervical Length Screenings, Elizabeth Mearns, Laura Pizzi Pharmd, Mph, Jason K. Baxter Md, Mscp, Vincenzo Berghella Md

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

The Untold Story Of Population Health, Drew Harris Dpm, Mph

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Introduction To Personalized Medicine, Robert D. Lieberthal Phd

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.