Medicine and Health Sciences Commons^™

Cardiac G-Protein-Coupled Receptor Kinase 2 Ablation Induces A Novel Ca2+ Handling Phenotype Resistant To Adverse Alterations And Remodeling After Myocardial Infarction., Philip W Raake, Xiaoying Zhang, Leif E Vinge, Henriette Brinks, Erhe Gao, Naser Jaleel, Yingxin Li, Mingxin Tang, Patrick Most, Gerald W Dorn, Steven R Houser, Hugo A Katus, Xiongwen Chen, Walter J Koch

Center for Translational Medicine Faculty Papers

BACKGROUND: G-protein-coupled receptor kinase 2 (GRK2) is a primary regulator of β-adrenergic signaling in the heart. G-protein-coupled receptor kinase 2 ablation impedes heart failure development, but elucidation of the cellular mechanisms has not been achieved, and such elucidation is the aim of this study.

METHODS AND RESULTS: Myocyte contractility, Ca(2+) handling and excitation-contraction coupling were studied in isolated cardiomyocytes from wild-type and GRK2 knockout (GRK2KO) mice without (sham) or with myocardial infarction (MI). In cardiac myocytes isolated from unstressed wild-type and GRK2KO hearts, myocyte contractions and Ca(2+) transients were similar, but GRK2KO myocytes had lower sarcoplasmic reticulum (SR) Ca(2+) content …

Management Of Sexual Disorders In Spinal Cord Injured Patients., Vafa Rahimi-Movaghar, Alexander R Vaccaro

Department of Neurosurgery Faculty Papers

Spinal cord injured (SCI) patients have sexual disorders including erectile dysfunction (ED), impotence, priapism, ejaculatory dysfunction and infertility. Treatments for erectile dysfunction include four steps. Step 1 involves smoking cessation, weight loss, and increasing physical activity. Step 2 is phosphodiesterase type 5 inhibitors (PDE5I) such as Sildenafil (Viagra), intracavernous injections of Papaverine or prostaglandins, and vacuum constriction devices. Step 3 is a penile prosthesis, and Step 4 is sacral neuromodulation (SNM). Priapism can be resolved spontaneously if there is no ischemia found on blood gas measurement or by Phenylephrine. For anejaculatory dysfunction, massage, vibrator, electrical stimulation and direct surgical biopsy …

Nitrous Oxide Myelopathy Posing As Spinal Cord Injury., George M. Ghobrial, Md, Richard Dalyai, Md, Adam Flanders, Md, James Harrop, Md

Department of Neurosurgery Faculty Papers

The authors describe a patient who presented with acute tetraparesis and a proposed acute traumatic spinal cord injury that was the result of nitrous oxide myelopathy. This 19-year-old man sustained a traumatic fall off a 6-ft high wall. His examination was consistent with a central cord syndrome with the addition of dorsal column impairment. Cervical MRI demonstrated an isolated dorsal column signal that was suggestive of a nontraumatic etiology. The patient's symptoms resolved entirely over the course of 48 hours. Nitrous oxide abuse is increasing in prevalence. Its toxic side effects can mask vitamin B12 and folate deficiency and central …

Structural Changes In Glaucoma: A Volumetric Mri Study, John Lackey, Alice L. Williams, Srinivas Gatla, Sheryl S. Wizov, Thomas Chia, George Spaeth, Song Lai

Department of Radiology Faculty Papers

Purpose: To investigate brain structural changes in patients with glaucoma.

Methods: High resolution 3D T1-weighted MP-RAGE MRI images were collected in 11 glaucoma patients (5 female, 6 male, 65+/-11 yrs), and 11 age- and gender-matched controls (64+/-12 yrs). The images were first analyzed using an automatic voxel-based morphometry technique which combines a fully automated spatial normalization approach, dubbed HAMMER [1], in conjunction with a tissue mass preserving framework called RAVENS [2]. Four consecutive steps were carried out: removal of non-brain voxels, tissue segmentation, spatial normalization to a standardized template, and generation of a mass-preserving tissue density map (i.e. RAVENS map) …

Predictive Prognosis Value Of Baseline Volumetric Mri, Song Lai, John Lackey

Department of Radiology Faculty Papers

Atrophic changes have been proposed as biomarkers for differential diagnosis of Alzheimer's disease (AD) and amnestic mild cognitive impairment (MCI), and different atrophic rates have been observed in AD, MCI-tp-AD converters (cMRI), stable MCI (sMCI), and normal healthy controls[1]. Measurement of atrophic changes, however, requires longitudinal MRI studies. The purpose of this study was to investigate the following questions: 1. Is it possible to use baseline volumetric MRI to predict MCI conversion to AD, i.e., to tell if a MCI patient is a cMCI or a sMCI? 2. What are the predictive values of APOE genotype, and clinical cognitive …

Adult Ecmo And Gastrointestinal Bleeding From Small Bowel Arteriovenous Malformations: A Novel Treatment Using Spiral Enteroscopy., Konrad Sarosiek, Hitoshi Hirose, Harrison T Pitcher, Nicholas C. Cavarocchi

Department of Surgery Faculty Papers

Hemorrhagic complications on extracorporeal membrane oxygenation (ECMO) are common because of the need for anticoagulation to maintain the oxygenator and circuitry. Gastrointestinal bleeding (GIB) is reported to occur in 3-6% of ECMO patients, ¹ requiring frequent transfusions as well as multiple diagnostic and therapeutic interventions. Multiple transfusions can result in volume overload, coagulopathies and infections leading to significant morbidity and mortality. We present the first published case of GIB from an arteriovenous malformation (AVM) treated with a novel therapy termed spiral enteroscopy while the patient remained on venoarterial (VA) ECMO.

Progesterone And Preterm Birth Prevention: Translating Clinical Trials Data Into Clinical Practice, Vincenzo Berghella

Department of Obstetrics and Gynecology Faculty Papers

OBJECTIVE:

We sought to provide evidence-based guidelines for using progestogens for the prevention of preterm birth (PTB).

METHODS:

Relevant documents, in particular randomized trials, were identified using PubMed (US National Library of Medicine, 1983 through February 2012) publications, written in English, which evaluate the effectiveness of progestogens for prevention of PTB. Progestogens evaluated were, in particular, vaginal progesterone and 17-alpha-hydroxy-progesterone caproate. Additionally, the Cochrane Library, organizational guidelines, and studies identified through review of the above were utilized to identify relevant articles. Data were evaluated according to population studied, with separate analyses for singleton vs multiple gestations, prior PTB, or short …

The Use Of Infliximab In Older Inflammatory Bowel Disease Patients, Stephanie M. Moleski, Christina C. Lindenmeyer, Patricia L. Kozuch

Department of Medicine Faculty Papers

Limited data suggest anti-tumor necrosis factor (TNF) antibodies have equal efficacy but higher morbidity and mortality in older compared to younger inflammatory bowel disease (IBD) patients(1).

Relative Telomere Length: A Novel Non-Invasive Biomarker For The Risk Of Non-Cirrhotic Hepatocellular Carcinoma In Patients With Chronic Hepatitis B Infection., Xiaoying Fu, Shaogui Wan, Hie-Won Hann, Md, Ronald E Myers, Phd, Richard S Hann, Jennifer Au, Bicui Chen, Jinliang Xing, Hushan Yang

Division of Gastroenterology and Hepatology Faculty Papers

BACKGROUND AND AIMS: Telomere length has emerged as a promising risk predictor of various cancers including hepatocellular carcinoma (HCC). However, the majority of studies in this area measured telomere length in hepatocytes and one in lymphocytes with conflicting results. Moreover, no studies have been reported on using circulating DNA telomere length as a non-invasive HCC biomarker.

METHODS: We conducted a nested case-control study to determine the relative telomere length (RTL) in serum DNA from 140 hepatitis B virus (HBV)-related HCC cases and 280 frequency-matched cancer-free HBV controls.

RESULTS: Cases had a significantly longer RTL (median, 0.31; range, 0.02-2.31) than controls …

Library Catalog, Education Services

Academic Commons and Scott Memorial Library Staff Papers and Presentations

2 page handout highlighting library catalog features.

Mitochondrial Lysyl-Trna Synthetase Independent Import Of Trna Lysine Into Yeast Mitochondria., Naresh Babu V Sepuri, Madhavi Gorla, Michael P King

Department of Biochemistry and Molecular Biology Faculty Papers

Aminoacyl tRNA synthetases play a central role in protein synthesis by charging tRNAs with amino acids. Yeast mitochondrial lysyl tRNA synthetase (Msk1), in addition to the aminoacylation of mitochondrial tRNA, also functions as a chaperone to facilitate the import of cytosolic lysyl tRNA. In this report, we show that human mitochondrial Kars (lysyl tRNA synthetase) can complement the growth defect associated with the loss of yeast Msk1 and can additionally facilitate the in vitro import of tRNA into mitochondria. Surprisingly, the import of lysyl tRNA can occur independent of Msk1 in vivo. This suggests that an alternative mechanism is present …

John H. Moore Jr., Md Clinical Professor Of Plastic Surgery And Former Alumni Association President

Jefferson Surgical Solutions

John H. Moore Jr., MD, longtime clinical professor of plastic surgery at Jefferson and former president of the Jefferson Medical College (JMC) Alumni Association, died at home on September 26, 2011.

Born in Pittsburgh in 1953, Moore received his bachelor’s degree from the University of Virginia, where he stayed on for his medical degree. After completing his internship at Thomas Jefferson University Hospital in 1980, he completed a general surgery residency. He then participated in a fellowship in hand surgery and microsurgery at Jefferson and completed a plastic surgery residency at the Eastern Virginia Graduate School of Medicine.

In 1987, …

News In Brief

Jefferson Surgical Solutions

Alejandro Perez, MD, has joined the Jefferson Vascular Center at Methodist Hospital with a dual faculty appointment in the Departments of Medicine and Surgery at Thomas Jefferson University. Dr. Perez completed his residency and fellowship training in vascular medicine at the Cleveland Clinic. He specializes in deep vein thrombosis, pulmonary embolism and hyperbaric oxygen therapy.

Ehyal Shweiki, MD, FACS, has joined the Division of Acute Care Surgery. Dr. Shweiki is fellowship-trained in both cardiothoracic surgery (University of Louisville) and surgical critical care (Washington University/Barnes Jewish Hospital). He also holds an MS in Bioethics. He will serve patients at our …

Zhi Ven Fong, Jmc ’12 Secretary, Gibbon Surgical Society

Jefferson Surgical Solutions

Born and raised in Kuala Lumpur, Malaysia, Zhi Ven Fong spent his first two years of medical school at the International Medical University (IMU) in Malaysia before coming to Philadelphia to study at Jefferson Medical College. And while medical school alone would be enough to keep most students busy, Zhi, 23, has seized every opportunity to build his skills and knowledge as a physician scientist.

“I aspire to be a leader in an academic field like surgery, so I realized I needed experience in research,” Zhi says. “After consulting with senior students, I reached out to Dr. Ernest Rosato, who …

Building A Legacy Of Hope Against Ovarian Cancer

Jefferson Surgical Solutions

Cancer – let alone a rare form of ovarian cancer – wasn’t on Sandy Parvin’s radar when her 11-year-old daughter Sarah was nauseous and vomiting for a few days in the spring of 2005.

“Honestly, we thought she had the flu,” Sandy said. The virus had been going around so Sandy took her daughter to their family physician.

The doctor sent Sarah to the hospital to get some IV fluids. It quickly turned into a parent’s worst nightmare. Sarah was put on a heart monitor and four physicians were there asking questions. Her calcium levels were far too high.

“They …

Gerald A. Isenberg, Md, Facs

Jefferson Surgical Solutions

As Professor of Surgery, Division of Colorectal Surgery; Director, Surgical Undergraduate Education, Jefferson Medical College (JMC); Program Director, Colorectal Residency Program, Thomas Jefferson University Hospital; and Chair, Curriculum Committee, JMC, Gerald A. Isenberg, MD, FACS, is equally focused on – and passionate about – clinical practice and medical education.

Indeed, as he reflects on his career at Jefferson, which spans nearly 25 years, Dr. Isenberg is appreciative of the opportunity to build a busy and vibrant colorectal surgery practice. But he clearly also values his experiences as an educator – particularly the many opportunities to lead and innovate.

In years …

Jefferson Researchers Identify Potential Diagnostic, Prognostic Tools For Pancreatic Cancer

Jefferson Surgical Solutions

When it comes to diagnosing and treating cancer, early detection is important. While other cancers can be identified through routine screenings, pancreatic cancer has been notoriously difficult to diagnose early. After pancreatic cancer is diagnosed, the optimal course of treatment is not always clear.

Hwyda Arafat, MD, PhD, Associate Professor of Surgery at Thomas Jefferson University and co-director of the Jefferson Pancreatic, Biliary and Related Cancers Center, and Jordan M. Winter, MD, Assistant Professor of Surgery, are working to change that.

Together with Mon-Li Chu, PhD, Professor and Vice Chair of the Department of Dermatology and Cutaneous Biology, Dr. Arafat …

Overview

Jefferson Surgical Solutions

Charles J. Yeo, MD, FACS

Samuel D. Gross Professor and

Chair, Department of Surgery

In this issue, Surgical Solutions focuses on our trauma expertise, recent progress in bench research, the contributions of Dr. Gerald Isenberg, insights from medical student Zhi Ven Fong, and pays tribute to Dr. John Moore. A very busy issue!

I was moved by a recent editorial in the New England Journal of Medicine dated February 16, 2012. In the piece entitled “What We Talk About When We Talk About Health Care Costs”, Peter Neumann of Tufts University quotes from the American College of Physicians Ethics Manual, …

Surgeon Speaks

Jefferson Surgical Solutions

Kris Kaulback, MD, FACS

Assistant Professor,

Division of Acute Care Surgery at Jefferson

Medical Director, Trauma Center at Paoli Hospital

Following a major, multisystem trauma, being seen by a trauma center within 60 minutes can mean the difference between life and death. Thanks to Paoli Hospital’s accredited Level II trauma center, which opened on October 1, 2010, more people in Chester County are receiving critical care within the “golden hour.”

As Kris Kaulback, MD, FACS, explains, Paoli earned accreditation by addressing the extensive standards outlined by the Pennsylvania State Trauma Foundation (PSTF). Accreditation reflects the resources available at Paoli around …

Obstructive Sleep Apnea Syndrome And Perioperative Complications: A Systematic Review Of The Literature., Tajender S. Vasu, Md, Ms, Ritu G. Grewal, Md, Karl Doghramji, Md

Department of Sleep Medicine Faculty Papers

Obstructive sleep apnea syndrome (OSAS) is a common sleep related breathing disorder. Its prevalence is estimated to be between 2% and 25% in the general population. However, the prevalence of sleep apnea is much higher in patients undergoing elective surgery. Sedation and anesthesia have been shown to increase the upper airway collapsibility and therefore increasing the risk of having postoperative complications in these patients. Furthermore, the majority of patients with sleep apnea are undiagnosed and therefore are at risk during the perioperative period. It is important to identify these patients so that appropriate actions can be taken in a timely …

Protein Synthesis Factors (Rf1, Rf2, Rf3, Rrf, And Tmrna) And Peptidyl-Trna Hydrolase Rescue Stalled Ribosomes At Sense Codons., Serafín Vivanco-Domínguez, José Bueno-Martínez, Gloria León-Avila, Nobuhiro Iwakura, Akira Kaji, Hideko Kaji, Gabriel Guarneros

Department of Biochemistry and Molecular Biology Faculty Papers

During translation, ribosomes stall on mRNA when the aminoacyl-tRNA to be read is not readily available. The stalled ribosomes are deleterious to the cell and should be rescued to maintain its viability. To investigate the contribution of some of the cellular translation factors on ribosome rescuing, we provoked stalling at AGA codons in mutants that affected the factors and then analyzed the accumulation of oligopeptidyl (peptides of up to 6 amino acid residues, oligopep-)-tRNA or polypeptidyl (peptides of more than 300 amino acids in length, polypep-)-tRNA associated with ribosomes. Stalling was achieved by starvation for aminoacyl-tRNA(Arg4) upon induced expression of …

Improving Empathy Of Physicians Through Guided Reflective Writing, Anita D. Misra-Hebert, J. Harry Isaacson, Martin Kohn, Alan L. Hull, Mohammadreza Hojat, Klara K. Papp, Leonard Calabrese

Department of Psychiatry and Human Behavior Faculty Papers

Objectives: This study was designed to explore how guided reflective writing could evoke empathy and reflection in a group of practicing physicians.

Methods: Total participants recruited included 40 staff physicians at Cleveland Clinic, a tertiary care academic medical center. Twenty physicians (intervention group) were assigned to participate in a 6-session faculty development program introducing narrative medicine and engaging in guided reflective writing. Ten physicians (comparison group 1) received the assigned course reading materials but did not participate in the course sessions. Ten physicians (comparison group 2) neither received the reading materials nor participated in the sessions. Qualitative analysis of the …

Genetic Polymorphism In A Vegf-Independent Angiogenesis Gene Angpt1 And Overall Survival Of Colorectal Cancer Patients After Surgical Resection, Jingyao Dai, Shaogui Wan, Feng Zhou, Ronald E. Myers, Xu Guo, Bingshan Li, Xiaoying Fu, Juan P. Palazzo, Kefeng Dou, Hushan Yang, Jinliang Xing

Kimmel Cancer Center Faculty Papers

Background

The VEGF-independent angiogenic signaling plays an important role in the development of colorectal cancer (CRC). However, its implication in the clinical outcome of CRC has not been reported. This study aimed to investigate the association between genetic variations in several major VEGF-independent signaling pathway genes and the overall survival of CRC patients.

Methods

Seven single nucleotide polymorphisms (SNPs) in four important VEGF-independent angiogenic genes (ANGPT1, AMOT, DLL4 and ENG) were genotyped in a Chinese population with 408 CRC patients.

Results

One SNP, rs1954727 in ANGPT1, was significantly associated with CRC overall survival. Compared to …

Rituximab Induces Sustained Reduction Of Pathogenic B Cells In Patients With Peripheral Nervous System Autoimmunity., Michael A Maurer, Goran Rakocevic, Carol S Leung, Isaak Quast, Martin Lukačišin, Norbert Goebels, Christian Münz, Hedda Wardemann, Marinos Dalakas, Jan D Lünemann

Department of Neurology Faculty Papers

The B cell-depleting IgG1 monoclonal antibody rituximab can persistently suppress disease progression in some patients with autoimmune diseases. However, the mechanism underlying these long-term beneficial effects has remained unclear. Here, we evaluated Ig gene usage in patients with anti-myelin-associated glycoprotein (anti-MAG) neuropathy, an autoimmune disease of the peripheral nervous system that is mediated by IgM autoantibodies binding to MAG antigen. Patients with anti-MAG neuropathy showed substantial clonal expansions of blood IgM memory B cells that recognized MAG antigen. The group of patients showing no clinical improvement after rituximab therapy were distinguished from clinical responders by a higher load of clonal …

Ketamine As An Adjunct For The Long-Term Sedation And Analgesia Of A Patient With A Left Ventricular Assist Device (Lvad) And An Open Chest, Avni Gupta, Charles S. Kato, Eugene R. Viscusi

Department of Anesthesiology Faculty Papers

Conclusion:

A multimodal sedative and analgesic regimen that incorporates ketamine offers important therapeutic advantages in select patients who require very high doses of opioids and benzodiazepines, but warrants futher study.

Library Poster For Quiet Contemplation, Education Services

Library Posters

Library poster for quiet contemplation.

Sir William Osler, M.D., C.M., Jonathan Sarik, B.S., Charles J. Yeo, Md, Pinckney J. Maxwell, Iv, Md

Department of Surgery Gibbon Society Historical Profiles

Sir William Osler impacted medical education and the practice of medicine like few other physicians. As a writer, he authored nearly 1500 publications and lent his name to numerous eponyms. As a teacher he educated vast numbers of students and through his legacy impacted countless more. Sir William Osler (Fig. 1) epitomized what a physician should be throughout his professional life.

The Appropriateness Of Long-Term Opioids To Treat Chronic Back Pain, Thomas Watanabe, Michael Salino, Adam Schreiber

Department of Rehabilitation Medicine Faculty Papers

Point/Counterpoint Case Scenario: A 55-year old man presents to a pain clinic upon referral from his primary care physician. His symptom is axial low back pain. His pain started approximately 1 year earlier without a specific inciting event. He denies radiation of pain into the lower extremities. There is no bowel or bladder involvement. There is no directional preference. He reports pain "all the time," with minimal specific exacerbating or relieving factors. There is no medical-legal involvement. His medical history is significant for hypertension, hypercholesterolemia, obesity, and sleep apnea. He is a divorced father of 2 adult children. He is …

Psychostimulant Drug Abuse And Personality Factors In Medical Students, Joshua T. Buchner, Md, Duc M. Vu, Md, Mohammadreza Hojat

CRMEHC Faculty Papers

Purpose:

This study was designed to examine the prevalence of psychostimulant drug abuse among medical students and to test the hypothesis that medical students who use psychostimulant drugs for non-medical reasons are characterized by a sensation seeking and aggressive-hostility personality and exhibit lower empathy.

Stroke Education In The Chinese Community: A Nurse Resident Project, Laura Beans, Bsn, Rn, Roisin Harvey, Bsn, Rn, Jonathan Lee, Bsn, Rn, David Lincul, Bsn, Rn, Gina Ramos, Bsn, Rn, Jodi Schantz, Bsn, Rn

Department of Nursing papers and presentations

Objectives:

To educate an urban Chinese community by creating a stroke prevention program that increases awareness of the disease.

To educate an urban Chinese community about stroke risk factors, stroke warning signs, and how to reduce modifiable stroke risk factors.