Medicine and Health Sciences Commons^™

The Case For Intervention Bias In The Practice Of Medicine., Andrew J Foy, E J Filippone

Department of Medicine Faculty Papers

Bias is an inclination to present or hold a partial perspective at the expense of possibly equal or more valid alternatives. In this paper, we present a series of conditional arguments to prove that intervention bias exists in the practice of medicine. We then explore its potential causes, consequences, and criticisms. We use the term to describe the bias on the part of physicians and the medical community to intervene, whether it is with drugs, diagnostic tests, non-invasive procedures, or surgeries, when not intervening would be a reasonable alternative. The recognition of intervention bias in medicine is critically important given …

Increased Expression Of Pigment Epithelium-Derived Factor In Aged Mesenchymal Stem Cells Impairs Their Therapeutic Efficacy For Attenuating Myocardial Infarction Injury., Hongliang Liang, Huiyuan Hou, Wei Yi, Guodong Yang, Chunhu Gu, Wayne Bond Lau, Erhe Gao, Xinliang Ma, Zifan Lu, Xufeng Wei, Jianming Pei, Dinghua Yi

Department of Emergency Medicine Faculty Papers

AIMS: Mesenchymal stem cells (MSCs) can ameliorate myocardial infarction (MI) injury. However, older-donor MSCs seem less efficacious than those from younger donors, and the contributing underlying mechanisms remain unknown. Here, we determine how age-related expression of pigment epithelium-derived factor (PEDF) affects MSC therapeutic efficacy for MI.

METHODS AND RESULTS: Reverse transcriptase-polymerized chain reaction and enzyme-linked immunosorbent assay analyses revealed dramatically increased PEDF expression in MSCs from old mice compared to young mice. Morphological and functional experiments demonstrated significantly impaired old MSC therapeutic efficacy compared with young MSCs in treatment of mice subjected to MI. Immunofluorescent staining demonstrated that administration of …

Evaluating Tablet Technology In An Undergraduate Nursing Program, Beth Ann Swan, Kellie Smith, Anthony J. Frisby, Kathryn Shaffer, Mary Hanson-Zalot, Julie Becker

College of Nursing Faculty Papers & Presentations

With the introduction of tablet technology, faculty began asking questions about when, where, and how tables might enhance curriculum opportunities for student learning and faculty teaching strategies beyond their use as personal digital devices and smartphones (Swan, Smith, Frisby, Shaffer, & Hason-Zalot). Personal digital devices (PDDs), including smartphones, had been used by nursing students for the past five years. The purpose of this study was to evaluate how tablet technology affected student and faculty teaching-learning processes and outcomes in an accelerated, pre-licensure baccalaureate nursing program.

Thoracolumbar Spine Trauma: Review Of The Evidence., George M. Ghobrial Md, Jack Jallo, Md, Phd

Department of Neurosurgery Faculty Papers

AIM: The aim of this paper was to provide a comprehensive review of literature regarding the classification systems and surgical management of thoracolumbar spine trauma.

METHODS: A Pubmed search of "thoracolumbar", "spine", "fracture" was used on January 05, 2013. Exclusionary criteria included non-Human studies, case reports, and non-clinical papers. RESULTS. One thousand five hundred twenty manuscripts were initially returned for the combined search string; 150 were carefully reviewed, and 48 manuscripts were included in the review.

DISCUSSION: Traumatic spinal cord injury (SCI) has a high prevalence in North America. The thoracolumbar junction is a point of high kinetic energy transfer …

Delayed Appearance Of Aortic Pseudoaneurysm, Melanie Kinkler, Deborah Rodgers, Traci B. Fox, Ms, Rt(R), Rdms, Rvt

Department of Radiologic Sciences Faculty Papers

A pseudoaneurysm off of the abdominal aorta is an extremely rare, yet potentially fatal, diagnosis following trauma to the abdomen. This case describes a delayed complication following spinal surgery.

Carotid Artery Aneurysm: A Case Study, Ashley Ashley Kanefsky, Rdms, Jessica Mcgettigan, Traci B. Fox, Ms, Rt(R), Rdms, Rvt

Department of Radiologic Sciences Faculty Papers

A 60 year old male arrived at the emergency department after losing consciousness. CT showed he demonstrated a right hemispheric embolic stroke with a middle cerebral artery distribution. Upon further investigation, the patient was found to have a right common carotid artery aneurysm that extended about 1 cm from the carotid bifurcation into the internal carotid artery. The patient underwent carotid artery reconstruction with the use of his right great saphenous vein.

This case demonstrates an unusual form of cerebral embolization due to a internal carotid artery aneurysm.

2013 Commencement For Jefferson School Of Health Professions, Jefferson School Of Pharmacy, And Jefferson School Of Nursing

Jefferson College of Nursing Commencements

No abstract provided.

Developmental Dysplasia Of The Hip: Linkage Mapping And Whole Exome Sequencing Identify A Shared Variant In Cx3cr1 In All Affected Members Of A Large Multi-Generation Family., George J Feldman, Javad Parvizi, Mark Levenstien, Kathryn Scott, Jill A Erickson, Paolo Fortina, Marcella Devoto, Christopher L Peters

Department of Orthopaedic Surgery Faculty Papers

Developmental Dysplasia of the Hip (DDH) is a debilitating condition characterized by incomplete formation of the acetabulum leading to dislocation of the femur, suboptimal joint function, and accelerated wear of the articular cartilage resulting in arthritis. DDH affects 1 in 1000 newborns in the United States with well defined "pockets" of high prevalence in Japan, Italy and other Mediterranean countries. Although reasonably accurate for detecting gross forms of hip dysplasia, existing techniques fail to find milder forms of dysplasia. Undetected hip dysplasia is the leading cause of osteoarthritis of the hip in young individuals causing over 40% of cases in …

Peripheral T-Cell Lymphomas: A Review Of Current Approaches And Hopes For The Future., Alan P Skarbnik, Meher Burki, Barbara Pro

Kimmel Cancer Center Faculty Papers

Peripheral T-cell lymphomas (PTCL) are a diverse group of lymphoproliferative disorders, which share a common denominator of overall poor prognosis, with few exceptions. In this article, the authors review current standard of care approaches for the treatment of PTCLs, the role of stem-cell/bone marrow transplantation, and current developments in novel targeted therapies.

Caveolin-1 Is A Negative Regulator Of Tumor Growth In Glioblastoma And Modulates Chemosensitivity To Temozolomide., Kevin Quann, Donna M Gonzales, Isabelle Mercier, Chenguang Wang, Federica Sotgia, Richard G Pestell, Michael P Lisanti, Jean-François Jasmin

Department of Stem Cell Biology and Regenerative Medicine Faculty Papers & Presentations

Caveolin-1 (Cav-1) is a critical regulator of tumor progression in a variety of cancers where it has been shown to act as either a tumor suppressor or tumor promoter. In glioblastoma multiforme, it has been previously demonstrated to function as a putative tumor suppressor. Our studies here, using the human glioblastoma-derived cell line U-87MG, further support the role of Cav-1 as a negative regulator of tumor growth. Using a lentiviral transduction approach, we were able to stably overexpress Cav-1 in U-87MG cells. Gene expression microarray analyses demonstrated significant enrichment in gene signatures corresponding to downregulation of MAPK, PI3K/AKT and mTOR …

Predictors Of Treatment Outcomes In Geriatric Patients With Odontoid Fractures: Aospine North America Multi-Centre Prospective Gof Study., Michael G Fehlings, Ranganathan Arun, Alex R. Vaccaro, Paul M Arnold, Jens R Chapman, Branko Kopjar

Department of Orthopaedic Surgery Faculty Papers

STUDY DESIGN: Multicenter prospective cohort study.

OBJECTIVE: To identify patient and treatment characteristics associated with treatment success or failure in the management of odontoid fractures.

SUMMARY OF BACKGROUND DATA: Odontoid fractures are the most common cervical spine fractures in the elderly and represent a significant management challenge with widely divergent views regarding operative versus nonoperative management.

METHODS: A total of 159 patients 65 years and older with radiographically confirmed type II odontoid fractures were enrolled at 10 sites in the United States and 1 site in Canada between January 2006 and May 2009. Subjects were followed at 6 and 12 …

Analyzing The Health Care Cost Curve: A Case Study, Robert Lieberthal

College of Population Health Faculty Papers

This case study uses data from a self-insured employer plan to perform an analysis into the properties of the health care cost curve. The analysis shows that one statistical property of the health care cost curve is that costs rise continuously, not on an annual or monthly basis. Graphical analysis indicates that managed care techniques used to restrain costs can also smooth utilization, producing the continuously growing cost curve observed. The analysis further illustrates that there is no one ‘‘cost curve’’—analysis must be segmented by population. Finally, the power of predictive models to fit the cost curve varies by population. …

Extracorporeal Membrane Oxygenation For Bridge To Decision And To Recovery., Hitoshi Hirose, Md, Phd, Shingeki Tabaka, Md, James Diehl, Md, Nicholas C. Cavarocchi, Md

Department of Surgery Faculty Papers

Extracorporeal life support has advanced from its humble beginnings over 3 decades ago, with the first description of its success in a patient with Acute Respiratory Distress Syndrome (ARDS), going as far back as 1971. The indications for extracorporeal membrane oxygenation (ECMO) therapy include refractory respiratory and/or cardiac failure, and ECMO is now being increasingly used in adult patients. In this case report, we present a patient who had traveled from India to the United States, where she developed acute decompensated biventricular failure and shock, requiring ECMO placement as a bridge to a decision. During her first few days on …

The Impact Of Community Use Of Novel Oral Anticoagulants On An Academic Medical Center, Luis Eraso, Md, Taki Galanis, Md, Kristina Kipp, Pharm.D., Walter K. Kraft, Md, Michael Palladino, Pharm.D., Cacp, Alejandro Perez, Md, Kimberle Ferebee-Spruill, Crnp, Geno Merli, Md, Brian G. Swift, Pharm.D., Mba, Lynda Thomson, Brittany Vining

Department of Pharmacology and Experimental Therapeutics Faculty Papers

Warfarin has been a mainstay of therapy for treatment and prevention of venous thromboembolic disease (VTED) and prevention of stroke and systemic embolism for over 50 years. Recent FDA approval of several novel oral anticoagulants has offered more extensive treatment options for management of these disease states.

The availability of the novel anticoagulants offers an attractive alternative to warfarin therapy for patients due to their convenience of use. In comparison to warfarin, dabigatran, rivaroxaban and apixaban offer: - a fixed dosage regimen

- a relatively small potential drug interaction profile

- minimal laboratory monitoring

- little to no dietary restrictions. …

Op-Ed: After Hospital Care, The Test Begins. Even For A Healthcare Professional, A Patient's Care Following Discharge Can Be Overwhelming., Beth Ann Swan

College of Nursing Faculty Papers & Presentations

In 2011, my husband, Eric, a trial attorney, was felled by a brain stem stroke just before he was to board a flight at O'Hare in Chicago. He was just 53 years old with no prior health conditions or problems. From the outset, we knew his recovery and rehabilitation would be long and difficult. We didn't know that his transition to post-hospital medical care would be just as challenging.

I'm the dean and a professor at the Jefferson School of Nursing at Thomas Jefferson University in Philadelphia, and I'm a registered nurse. I thought my training and access to resources …

Competition For Antigen Selects T Cell Responses That Undergo Memory Inflation And Maintains Clonal Dominance During Mcmv Infection, Holly Turula, Lila A. Farrington, Corinne Smith, Ann B. Hill, Christopher M Snyder

Department of Microbiology and Immunology Faculty Papers

Cytomegalovirus (CMV) establishes a life-long, persistent/latent infection. Continuous immune surveillance by CMV-specific CD8+ T cells results in their accumulation over time, a process called “memory inflation”. These “inflationary” T cells migrate systemically and comprise the largest T cell populations in humans, making CMV-based vaccines attractive. Why T cells specific for only some CMV-derived epitopes undergo inflation is unclear. We found previously that recombinant murine (M)CMV expressing the SIINFEKL peptide only induced inflation of SIINFEKL-specific T cells, in contrast to wild-type MCMV infection. We show here that:

• Co-infecting mice with viruses expressing and lacking SIINFEKL enabled T cells with multiple specificities …

Chevalier Jackson, M.D. (1865-1958): Il Ne Se Repose Jamais., Phi D Nguyen, B.A., Scott W. Cowan, Md, Charles J. Yeo, Md, Nathaniel R. Evans Iii, M.D.

Department of Surgery Gibbon Society Historical Profiles

In the final year of the American Civil War, 1865, Chevalier Jackson was born on the 4th of November just outside Pittsburgh, Pennsylvania. The eldest of three sons of a poor, livestock-raising family, Jackson was raised in a period of social and political unrest. He was perhaps an even more unrestful boy. The description of his childhood days from his father’s father—Il ne se repose jamais, ‘‘He never rests’’—would ultimately reflect the man, doctor, and evangelist Jackson would later become.1 Indeed, he never did rest, Jackson would tirelessly pave the way for modern bronchoscopy and endoscopy as a whole; bringing …

Antibody Quality And Protection From Lethal Ebola Virus Challenge In Nonhuman Primates Immunized With Rabies Virus Based Bivalent Vaccine., Joseph E Blaney, Andrea Marzi, Mallory Willet, Amy B Papaneri, Christoph Wirblich, Friederike Feldmann, Michael Holbrook, Peter Jahrling, Heinz Feldmann, Matthias J Schnell

Department of Microbiology and Immunology Faculty Papers

We have previously described the generation of a novel Ebola virus (EBOV) vaccine platform based on (a) replication-competent rabies virus (RABV), (b) replication-deficient RABV, or (c) chemically inactivated RABV expressing EBOV glycoprotein (GP). Mouse studies demonstrated safety, immunogenicity, and protective efficacy of these live or inactivated RABV/EBOV vaccines. Here, we evaluated these vaccines in nonhuman primates. Our results indicate that all three vaccines do induce potent immune responses against both RABV and EBOV, while the protection of immunized animals against EBOV was largely dependent on the quality of humoral immune response against EBOV GP. We also determined if the induced …

Prediction Of Advanced Fibrosis In Nonalcoholic Fatty Liver Disease: An Enhanced Model Of Bard Score., Tae Hoon Lee, Seung Hye Han, Ju Dong Yang, Donghee Kim, Monjur Ahmed

Department of Medicine Faculty Papers

UNLABELLED: BACKGROUNDAIMS: The BARD score is a model to detect advanced liver fibrosis in nonalcoholic fatty liver disease (NAFLD) patients. The aims of this study were to identify additional factors and then to build an enhanced version of the BARD score.

METHODS: One hundred seven patients with biopsy-proven NAFLD were enrolled retrospectively. Logistic regressions were performed to identify independent risk factors for advanced liver fibrosis (stage 3 or 4). An enhanced model of the BARD score (BARDI score) was built and evaluated with a receiver operating characteristic (ROC) curve.

RESULTS: In multivariate analysis, age (odds ratio [OR], 0.89; p=0.04), aspartate …

Listeria Monocytogenes Cholecystitis: A Possible New Syndrome., Jackrapong Bruminhent, Timothy K Lynch, Jonathan Gefen, Jerome Santoro

Division of Internal Medicine Faculty Papers & Presentations

: The U.S. Food and Drug Administration recently added potentially fatal Listeria monocytogenes infection to the list of opportunistic infections that can occur in patients who receive tumor necrosis factor inhibitor therapy. In this study, the first reported case of L monocytogenes cholecystitis associated with etanercept use is described. It also appears that tumor necrosis factor inhibitor therapy likely increases the risk for Listeria cholecystitis. Clinicians need to be aware of this association when selecting antimicrobial therapy for these patients.

Common Peroneal Nerve Palsy Following Total Hip Arthroplasty: Prognostic Factors For Recovery., Jai Hyung Park, Bryan Hozack, Peter Kim, Robert Norton, Steven Mandel, Camilo Restrepo, Javad Parvizi

Rothman Institute Papers

BACKGROUND: Common peroneal nerve palsy, although rare, is a serious complication of total hip arthroplasty. Although several publications have dealt with the risk factors for peroneal nerve palsy, there is little literature regarding the time it takes for the nerve to recover and the factors that influence its recovery. The purpose of this study was to elucidate the clinical course of this injury and identify prognostic factors for recovery.

METHODS: From January 2000 to December 2007, 7969 primary and 1601 revision total hip arthroplasties were performed at our institution. Common peroneal nerve palsy developed following thirty-one (0.32%) of these procedures. …

A Public Health Response Against Strongyloides Stercoralis: Time To Look At Soil-Transmitted Helminthiasis In Full., Alejandro J Krolewiecki, Patrick Lammie, Julie Jacobson, Albis-Francesco Gabrielli, Bruno Levecke, Eugenia Socias, Luis M Arias, Nicanor Sosa, David Abraham, Ruben Cimino, Adriana Echazú, Favio Crudo, Jozef Vercruysse, Marco Albonico

Department of Microbiology and Immunology Faculty Papers

Strongyloides stercoralis infections have a worldwide distribution with a global burden in terms of prevalence and morbidity that is largely ignored. A public health response against soil-transmitted helminth (STH) infections should broaden the strategy to include S. stercoralis and overcome the epidemiological, diagnostic, and therapeutic challenges that this parasite poses in comparison to Ascaris lumbricoides, Trichuris trichiura, and hookworms. The relatively poor sensitivity of single stool evaluations, which is further lowered when quantitative techniques aimed at detecting eggs are used, also complicates morbidity evaluations and adequate drug efficacy measurements, since S. stercoralis is eliminated in stools in a larval stage. …

Multimodal Endovascular Management Of Acute Ischemic Stroke In Patients Over 75 Years Old Is Safe And Effective., George M Ghobrial, Nohra Chalouhi, Lana Rivers, Samantha Witte, Justin Davanzo, Richard Dalyai, Michelle L Gardecki, Pascal Jabbour, Fernando Gonzalez, Aaron S Dumont, Robert H Rosenwasser, Stavropoula Tjoumakaris

Department of Neurosurgery Faculty Papers

INTRODUCTION: Greater attention has been directed to endovascular recanalization of acute ischemic stroke in septuagenarians and above.

TECHNIQUE: A retrospective chart review was conducted to include patients treated for acute ischemic stroke from 2006 to 2012. All patients underwent initial neurological assessment and non-contrast head CT. Patients treated from 2009 to 2012 additionally received emergent CT angiogram and CT perfusion. 51 patients met the clinical and radiographic criteria and underwent multimodal endovascular revascularization for acute ischemic events.

RESULTS: All patients underwent cerebral angiography and met angiographic criteria for endovascular thrombolysis. 34 patients (67%) were older than 80 years of age. …

Completely Steroid-Free Immunosuppression In Liver Transplantation: A Randomized Study., Carlo B. Ramirez, Md, Cataldo Doria, Md, Phd, Adam M. Frank, Md, Stephen T. Armenti, Ignazio R. Marino, Md

Department of Surgery Faculty Papers

INTRODUCTION: Corticosteroids (CS) have been standard immunosuppression to prevent and treat rejection. However, CS are associated with increased risk of infection, obesity, hypertension, hyperlipidemia, diabetes, and accelerated hepatitis C virus (HCV) recurrence post-orthotopic liver transplantation (OLT). This study assesses the safety and efficacy of CS-free immunosuppressive regimen in adult OLT.

METHODS: A two-yr, prospective, randomized study of CS with delayed withdrawal (CS) or CS-free regimen with basiliximab, tacrolimus, and enteric-coated mycophenolate sodium (EC-MPS) was performed in 39 patients (CS=20; CS-free=19). CS group received intra-operative methylprednisolone weaned by six months. HCV patients had HCV PCR pre-OLT and 0.5, one, three, and …

The Karabus Affair Speaks To Larger Issues For American Academic And Medical Centers., Leonard A Zwelling, Md, Mba, Razelle Kurzrock, Md, Philip R Cohen, Md, Bernard Levin, Md, Ch, Lawrence Parish, Md

Department of Dermatology and Cutaneous Biology Faculty Papers

Finally, on March 12, 2013, a major American newspaper, The Wall Street Journal, reported on the plight of Dr. Cyril Karabus (1,2). Dr. Karabus is the 78 year old pediatric oncologist from Claremont, Capetown, South Africa who is well known as the retired head of the Oncology and Hematology Unit of the Red Cross Children’s Hospital, University of Cape Town, as well as for his devoted service to poor children in the apartheid era. In 2002, he cared for a three-year old Yemeni girl with acute myelogenous leukemia during a locum tenens in the United Arab Emirates (UAE).

The Line Between Addiction And Medication: Alcohol, Anesthesia, And Analgesia, Priya Joshi, B.S., Emanual Rubin, Md

Department of Pathology Honors Program Student Research Symposium

Alcohol is a particularly dangerous addiction because its consumption is legal even in excess, despite its harmful effects. Because alcohol has a multitude of targets in the central nervous system that are modified during chronic exposure, medications with overlapping targets such as anesthetics and analgesics must be modified when given to alcoholics. Unfortunately, as relatively little is known about the mechanism of addiction, it is difficult to predict how medications will be affected by central adaptation to chronic alcohol exposure. This review summarizes the consequences of alcohol exposure with particular attention to the GABA_Areceptor, and discusses the reasons …

Transfusion Related Acute Lung Injury, Nadia Abidi, Jay Herman, Md, Julie Karp, Md

Department of Pathology Honors Program Student Research Symposium

A 74 year old woman presented with hematemesis. Her medical history was significant for pulmonary embolism treated with warfarin anticoagulation, fibromyalgia treated with NSAIDs/steroids, and a prior bleeding event from a gastric ulcer. On admission she was stable with a hemoglobin of 8.7 g/dL and a therapeutic INR of 3.19. A type and screen determined a blood type of AB positive. In anticipation of endoscopy, the patient received one unit of red blood cells and four units of type AB plasma. Following transfusion, her INR was 1.83. The patient received an additional four units of type AB plasma to further …

Morphologic And Endoscopic Evaluation Of Collagenous Gastritis, Annie Ashok, Ashlie L. Burkart, Md, Cm

Department of Pathology Honors Program Student Research Symposium

Collagenous gastritis (CG) is a rare gastrointestinal condition of unknown etiology and pathogenesis characterized by the presence of a gastric subepithelial collagen band of variable thickness. While little is known about the disease, children and young adults often present with anemia, abdominal pain, and nodular gastric mucosa on endoscopy. In contrast, adults often present with chronic watery diarrhea and normal gastric mucosa on endoscopy. Disease associations (usually in adult cases) include celiac disease, collagenous colitis, collagenous sprue, and lymphocytic colitis. This study aims to further characterize the clinical, endoscopic and morphologic spectrum of CG.

Lumbar Chordoma: A Primary Bone Tumor, Andrew N. Fleischman, Bs, Brian O'Hara, Md

Department of Pathology Honors Program Student Research Symposium

INTRODUCTION

• Primary malignant bone tumor of embryonic notochord remnants
• 1-4% of primary bone tumors, <0.1 per 100,000
• Location: Sacral (50%), Skull base (35%), Vertebral column (15%)
• Classic, chondroid (5-15%), and dedifferentiated (5%) variants
• Most commonly in late middle age (50s to 60s)
• Low-grade, slow growing tumor
• But locally aggressive, high rate of local recurrence (20% in 1^st year)
• Local recurrence is most important predictor of mortality
• Metastasis only occurs very late in disease
• Median survival of about 6 years, less than 12 months with mets
• 5 year survival of 70%, 10 year survival of 40%
• Primary therapy- aggressive surgical resection (if possible) …

An Unexpected Immunohistochemical Profile In An Ovarian Lesion, Kate Fritton, Joanna Chan, Md

Department of Pathology Honors Program Student Research Symposium

A 27 year old female presented with pelvic pain and a palpable pelvic mass. Upon histological examination, the cystic mass contained a multi-cellular lining with nuclear grooves. Negative inhibin staining ruled out a follicular cyst and granulosa cell tumor while pan-cytokeratin positivity suggested an epithelial lesion. The lesion stained positive for thrombomodulin, ultimately suggesting a diagnosis of a Brenner cell tumor, although CD56 positivity in the tumor questions the known immunohistochemical profile of Brenner cell tumors. This unusual result opens the door to future research into the role CD56 in the diagnosis of ovarian neoplasms.