Medicine and Health Sciences Commons^™

Faculty Advisor's Column, Harvey J. Schwartz, Md

Jefferson Journal of Psychiatry

This issue of our Journal marks a new stage in our development. We have started accepting papers from residency programs other than our own. Encouraged by the enthusiastic response our prior issues have elicited from psychiatric educators around the country, we are embarking on a program of expansion. In doing so we hope to provide a unique arena for psychiatric resident thinking. Residents nationwide are invited to share with each other and their faculties, their discoveries, their uncertaintiesand the newness with which they view their work.

Colorectal Cancer (Crc) Vaccine Study: Aim 2 Internship Experience, Selasie Goka

Summer Training Program in Cancer Immunotherapy

Activities:

1. Conducted literature review

2. CRC vaccine study booklet and survey

3. Recruitment survey questionnaire

4. Prepare web-based decision counseling program

38 PowerPoint Slides.

International Evidence On Medical Spending Risk., Robert D. Lieberthal, Phd

College of Population Health Lectures, Presentations, Workshops

Presented for the American Risk and Insurance Association. 2011 ARIA Annual Meeting, San Diego, CA.

20 PowerPoint slides.

Presentation is associated with the paper: http://jdc.jefferson.edu/healthpolicyfaculty/45/

Slob, A Slowpoke Channel Binding Protein, Regulates Insulin Pathway Signaling And Metabolism In Drosophila., Amanda L. Sheldon, Jiaming Zhang, Hong Fei, Irwin B Levitan

Department of Neuroscience Faculty Papers

There is ample evidence that ion channel modulation by accessory proteins within a macromolecular complex can regulate channel activity and thereby impact neuronal excitability. However, the downstream consequences of ion channel modulation remain largely undetermined. The Drosophila melanogaster large conductance calcium-activated potassium channel SLOWPOKE (SLO) undergoes modulation via its binding partner SLO-binding protein (SLOB). Regulation of SLO by SLOB influences the voltage dependence of SLO activation and modulates synaptic transmission. SLO and SLOB are expressed especially prominently in median neurosecretory cells (mNSCs) in the pars intercerebralis (PI) region of the brain; these cells also express and secrete Drosophila insulin like …

Treatment Of Cerebrospinal Fluid Leak During Spinal Cord Stimulator Implantation With Epidural Blood Patches, Farid Kia, Md, Linqiu Zhou, Md, Jason Berk, Md

Department of Rehabilitation Medicine Faculty Papers

Conclusion:

Our data is consistent with prior studies in demonstrating that the incidence of dural puncture and CSF leak with SCS procedures is rare. Based on our experiences, performing an epidural blood patch intra-operatively on the contra-lateral side under fluoroscopy could prevent PDPH. This treatment should especially be considered in patients undergoing SCS trials in order to accurately assess the level of pain reduction. Patients with prior spine surgeries might pose higher risks for dural puncture and more extensive pre-operative assessment could be beneficial.

Primary Provider Beliefs And Practice Patterns Contribute To The Lack Of Hiv/Hcv Coinfected Patients Undergoing Liver Transplantation In The United States, Jonathan M. Fenkel, Md, Victor J. Navarro, Md

Division of Gastroenterology and Hepatology Faculty Papers

Conclusions:

1. The majority of primary providers were ambivalent toward or against LT for HIV/HCV coninfected patients.

2. Half of all respondents were unlikely to refer cirrhotic coinfected patients for LT evaluation.

3. HIV specialists were significantly more likely to believe transplant should be offered, but reported no difference in likelihood of LT referral.

4. These findings suggest that primary provider beliefs and self-reported practice patterns may partially explain the paucity of coinfected US liver transplant recipients.

The Incidence Of Deep Vein Thrombosis Detected By Routine Surveillance Ultrasound In Neurosurgery Patients Receiving Dual Modality Prophylaxis., Patricia C Henwood, Thomas M Kennedy, Lynda Thomson, Taki Galanis, George L Tzanis, Geno J Merli, Walter K. Kraft

Department of Pharmacology and Experimental Therapeutics Faculty Papers

The optimal method of thromboprophylaxis and the value of screening ultrasonography for detection of deep venous thrombosis (DVT) in neurosurgery patients remains unclear. The goal of this study was to determine the incidence of DVT in neurosurgical patients who, by hospital protocol, receive surveillance ultrasonography of the lower extremities twice weekly, in addition to prophylaxis with unfractionated heparin and external pneumatic compression sleeves. A retrospective review of 7,298 ultrasound studies carried out on 2,593 patients over 4 years at a university neurosurgical hospital was conducted. There was a 7.4% incidence of proximal lower extremity DVT and a 9.7% total incidence …

Knowledge And Perceived Barriers About Diabetic Retinopathy And Dilated Eye Exam In Patients With Diabetes, Manisha Verma, Md, Mph, Mona Sarfaty, Robert Simmons, Drph, Mph, Albert G. Crawford

College of Population Health Lectures, Presentations, Workshops

Conclusions:

• The results of this study suggest that 68% of the population from this primary care practice got a dilated eye exam within a year. Facilitators were awareness/knowledge about the DR and DFE, eye problems and information from their doctors.
• Almost 20% of the patients did not get an eye exam as recommended. Various barriers included cost, transportation issues, time constraint issues, lack of symptoms of the disease, and fear of the exam.
• There is a significance difference in getting an eye exam by the type of insurance with a smaller percentage of Medicaid recipients (60%) meeting the guidelines compared …

Novel Irradiated Axial Rotational Flap Model In The Rodent, Adam J. Luginbuhl, Mara Modest, Bs, Kaiguo Yan, Joseph Curry, Ryan N. Heffelfinger

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Abstract

Objectives: To design an easily reproducible rodent rotational skin flap and to evaluate the effects of radiation on flap viability.

Methods: Ten rats received 40 Gy irradiation to the abdominal wall. Following a recovery period of one month, a 3 X 8 cm fasciocutaneous flap based axially on the inferior epigastric vessel, was raised and rotated 60 degrees into a contralateral deficit. Five non-irradiated rats underwent the identical procedure as a control. Animals were sacrificed seven days postoperatively, areas of flap necrosis were documented, and histological specimens were taken to compare flap viability and vessel density.

Results: 60% of …

Growth Inhibition Of Human Hepatocellular Carcinoma Cells By Overexpression Of G Protein-Coupled Receptor Kinase 2, Zhengyu Wei, Reginald Hurtt, Cataldo Doria

Department of Surgery Faculty Papers

Summary:

In this study, we investigated a novel approach for HCC treatment by inducing overexpression of GRK2 in human HCC cells. We found that overexpression of GRK2 through recombinant adenovirus transduction inhibits the growth of human HCC cells. BrdU incorporation assay showed that the growth inhibition caused by elevated GRK2 level was due tot he reduced cell proliferation but not apoptosis. To examine the anti-proliferative function of increased GRK2 level, we performed cell cycle analysis using propidium iodide staining. We found that the proliferation suppression was associated with G2/M phase cell cycle arrest by the wild type GRK2 but not …

Appropriate Medication Prescribing In Elderly Patients: How Knowledgeable Are Primary Care Physicians? A Survey Study In Parma, Italy., Vittorio Maio, Pharmd, Ms, Mph, Eric Jutkowitz, Ba, Karina Herrera Ba, Ms, Safiya Abouzaid Pharmd, Giavanna Negri, Pharmd, Stefano Del Canale, Md, Phd

College of Population Health Faculty Papers

What is known and Objective:  Increasing attention is being paid to inappropriate medication prescribing for the elderly. A growing body of studies have detected a prevalence of inappropriate prescribing ranging from 12% to 40% worldwide, including Regione Emilia-Romagna, Italy. To improve quality of prescribing, a multi-phase pilot project in the Local Health Unit (LHU) of Parma, Regione Emilia-Romagna, was established. This phase aimed to assess primary care physicians' knowledge of appropriate prescribing in elderly patients. Methods:  In total, 155 primary care physicians (51% of the total), convened by the LHU of Parma for an educational session, were asked to complete …

Transplant Glomerulopathy In The Absence Of Donor Specific Antibodies, Mayuri Vijay-Sharma, Md, Pooja Singh, Md, Beth W. Colombe, Phd., Rakesh Gulati, Md, John L. Faber, Md, George Francos, Md

Department of Medicine Faculty Papers

Conclusions:

Half of our 50 patients with TG documented by EM had no DSAs or positive C4d staining in PTCs. Almost 70% of the patients evidenced PTC basement membrane multilayering. These patients were all diagnosed with chronic active CMR independently of the presence of TG. Cellular rejection mechanisms are likely the cause of the TG in this group. Patients with TG and DSAs are at greater risk for episodes of acute AMR and CMR. C4d staining of PTCs was evident in less than 40% and in the glomeruli in less than half. Interestingly, 25 of the 26 DSA+ patients were …

Protein Kinase Cδ And C-Abl Kinase Are Required For Transforming Growth Factor Β Induction Of Endothelial-Mesenchymal Transition In Vitro., Zhaodong Li, Sergio A. Jimenez

Department of Medicine Faculty Papers

OBJECTIVE: The origin of the mesenchymal cells responsible for the intimal fibrosis in systemic sclerosis (SSc) has not been fully identified. The present study was undertaken to investigate whether subendothelial mesenchymal cells may emerge through transdifferentiation of endothelial cells (ECs) into myofibroblasts via endothelial-mesenchymal transition (EndoMT) in vitro and to explore the signaling pathways involved in this process.

METHODS: Primary mouse pulmonary ECs isolated by immunomagnetic methods with sequential anti-CD34 and anti-CD102 antibody selection were cultured in monolayers. Cell morphology and diacetylated low-density lipoprotein uptake assays confirmed their EC characteristics. The induction of EndoMT was assessed by determination of α-smooth …

Assessment Of Adherence To Guidelines For Hepatocellular Carcinoma Screening In Hiv/Hcv Coinfected Patients, Jonathan M. Fenkel, Md, Victor J. Navarro, Md

Division of Gastroenterology and Hepatology Faculty Papers

Conclusions:

1. Self-reported adherence with published guidelines for HCC screening is poor among primary providers for HIV/HCV coinfected patients, including HIV specialists and University-based providers.

2. Unnecessary imaging is also frequently ordered on non-cirrhotics, particularly by University-based providers.

3. Improved adherence to guidelines is needed among primary providers as over 50% of HCC's may be missed, and many patients many not be referred for subspecialty GI or Liver care, where screening practices may differ.

Rip1-Dependent And Independent Effects Of Necrostatin-1 In Necrosis And T Cell Activation., Youngsik Cho, Thomas Mcquade, Haibing Zhang, Jianke Zhang, Francis Ka-Ming Chan

Department of Microbiology and Immunology Faculty Papers

BACKGROUND: Programmed necrosis/necroptosis is an emerging form of cell death that plays important roles in mammalian development and the immune system. The pro-necrotic kinases in the receptor interacting protein (RIP) family are crucial mediators of programmed necrosis. Recent advances in necrosis research have been greatly aided by the identification of chemical inhibitors that block programmed necrosis. Necrostatin-1 (Nec-1) and its derivatives were previously shown to target the pro-necrotic kinase RIP1/RIPK1. The protective effect conferred by Nec-1 and its derivatives in many experimental model systems was often attributed to the inhibition of RIP1 function.

METHODOLOGY/PRINCIPAL FINDINGS: We compared the effect of …

Performance Of Colorectal Cancer Screening Steps In Primary Care, Salini Mohanty, Mph, Mona Sarfaty, Md, Mph, Faafp, Randa Sifri, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Discussion:

This analysis revealed the differences in which physicians in primary care complete CRC screening steps. The approach and completion of screening steps varied greatly among practices.

There was a correlation between the quantitative data and the qualitative data. The analysis from both methodologies produced similar results and supports each other's assessment.

All of the practices analyzed possessed one of the essential elements (a physician recommendation) which is the foundation for increased screening. All of the practices have the potential to expand upon this foundation in order to ensure that all eligible patients are approached and screened for CRC.

The …

Capacity Building For Participatory Health Services Research In Housing First, Lara Carson Weinstein, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Background:

Pathways to Housing ends chronic homelessness for individuals with serious mental illness (SMI) by providing housing first, and then combining that housing with supportive treatment services in the area of mental and physical health, substance abuse, education, and employment. Housing is provided in apartments scattered throughout a community. This "scattered site" model fosters a sense of home and self-determination, and it helps speed client's reintegration into the community. The Pathways model has been remarkable successful in addressing chronic homelessness.

Research Question

What are the chronic physical disease self management support needs of Pathways to Housing clients?

Utilizing Livers From Donors Older Than 65: A Single Center Experience, Krishnaraj Mahendraraj, Jorge H. Castro, Sean Devitt, Chad Gorn, Cataldo Doria, Adam Frank, Warren Maley, Carlo G. Ramirez

Department of Surgery Faculty Papers

Conclusions:

Use of liver grafts from older donors presents similar survival outcomes as grafts from younger donor age. Therefore, it offers a viable option to expand the donor pool and increase number of OLTs.

However, there is higher incidence of retransplantation due to primary graft non-function, and longer hospital length of stay observed in the older donor age group.

Further studies using larger patient populations are needed to validate our results.

Classification And Treatment Of Proximal Humerus Fractures: Inter-Observer Reliability And Agreement Across Imaging Modalities And Experience., Abtin Foroohar, Rick Tosti, John M Richmond, John P Gaughan, Asif M Ilyas

Rothman Institute Papers

SUMMARY: Proximal humerus fractures (PHF) are common injuries, but previous studies have documented poor inter-observer reliability in fracture classification. This disparity has been attributed to multiple variables including poor imaging studies and inadequate surgeon experience. The purpose of this study is to evaluate whether inter-observer agreement can be improved with the application of multiple imaging modalities including X-ray, CT, and 3D CT reconstructions, stratified by physician experience, for both classification and treatment of PHFs.

METHODS: Inter-observer agreement was measured for classification and treatment of PHFs. A total of sixteen fractures were imaged by plain X-ray (scapular AP and lateral), CT …

Letters To The Editor

Jefferson Journal of Psychiatry

We welcome all letters to the editor, and encourage authors to reply. Input from residents and faculty on ideas presented in the Journal create the arena for discussion and dialogue which is the ultimate purpose of this undertaking.

Therapeutic Guitar-An Alternative Approach To The Treatment Of A Difficult Patient, Michael Buxbaum, Md

Jefferson Journal of Psychiatry

The case described in this article is one where an experimental technique was introduced largely because of the therapist's dissatisfaction with the patient's progress. Despite the likelihood of being criticized, I feel compelled to write about this patient. The progress he has made is beyond my expectations, which were admittedly minimal at the outset.

Misuses Of Computers By Adolescents, Henry A. Doenlen, M.D.

Jefferson Journal of Psychiatry

One subject that has been a topic of much recent publicity and concern has been that of computer misuse. Teenage computer programmers gaining entry into the systems of universities, hospitals and businesses have caused the most concern . The duplication of copyrighted programs and information has also been reported to cause loss of considerable money. There seems to be a subpopulation of people who spend considerable time working with computers. These individuals may do so to the exclusion of other aspects of life such as human interaction . This paper will present both my observations of this behavior and my …

The Treatment Of A Borderline Patient Complicated By Involvement With A Charismatic Religious Cult: A Case Report, Mark Miller, Md

Jefferson Journal of Psychiatry

Introduction

Although much has been written about cults in recent years, many questions remain. Do cults recruit subjects by brainw ashing them or do individuals gravitate to cults to fulfill unmet needs? This paper will review some essential points of cult phenomena and discuss the treatment of one patient who was involved in a charismatic religious cult .

Possible Synergistic Action Between Carbamazepine And Lithium Carbonate In The Treatment Of A Manic Patient., John Matt Dorn, M.D.

Jefferson Journal of Psychiatry

Introduction

Carbamazepine has been proven to be efficacious in some patients with affective disorders, notably those who have not responded well to lithium carbonate or neuroleptics (1,2,3) . For those who have responded poorly to either regimen, however, there have been no effective pharmacotherapies until recently, when case reports have suggested a possible synergistic action between lithium carbonate and carbamazepine (4,5,6). The following case report supports this hypothesis.

The Use Of Carbamazepine (Tegretol) In Psychiatry And Its Association To Kindling, Temporal Lobe Epilepsy And Psychopathology, James Stanch, M.D.

Jefferson Journal of Psychiatry

The recent theory of kindling may help to link neurophysiologic, neurotransmitter and neuroanatomic mechanisms important in understanding the neurology of behavior. Limbic kindling is of interest in developing models of epilepsy, psychosis, learning and memory (l -5). Kindling might explain the late development of psychopathology.

This paper will first define kindling and demonstrate how kindling offers a model within which to view more prolonged behavioral deviations as neurophysiological processes. The use of carbamazepine and its association to kindling, temporal lobe dysfunction and psychopathology will be discussed .

Discussion Of The Paper By David A. Scola, M.D. On “The Hemispheric Specialization Of The Human Brain And Its Application To Psychoanalytic Principles”, Howard Field, M.D., Paul J. Fink, M.D., Thomas Swirsky-Sacchetti, Ph.D.

Jefferson Journal of Psychiatry

Dr. Scola proposes a bold and far-reaching synthesis of psychoanalytic theory, developmental neurobiology and neurophysiology of behavior. Freud found this task so frustrating in 1895 that he renounced neurology in favor of a purely psychologic approach (or so Freud claimed; Frank Sulloway sees it differently). Hypotheses that unconscious mental life is situated in the right cerebrum and that defense mechanisms are related to neuroanatomic connections are intriguing. The presentation does not include evidence which contravenes these theories. Sperry presented some evidence that the right hemisphere is self-aware and self-evaluative (I). One great problem in all cross disciplinary studies is the …

The Hemispheric Specialization Of The Human Brain And Its Application To Psychoanalytic Principles, David A. Scola, M.D.

Jefferson Journal of Psychiatry

Volumes of research have been accumulated over the past decade concerning hemispheric specialization of the human brain. Likewise, over the past century, psychoanalysts have painstakingly unraveled through their clinical observation many of the mysteries of intrapsychic functions. Yet little has been written concerning attempts to integrate these seemingly divergent viewpoints.

It was Freud's hope that a neural basis for his clinical observations and psychological explanations of the human mind would eventually be established . This was not possible in his day, however, so this idea was gradually abandoned. With the advent of computers and high technology, perhaps it is time …

Faculty Advisor's Column, Harvey J. Schwartz, Md

Jefferson Journal of Psychiatry

This second issue of our resident journal enlarges our educational effort s in two important ways. The first is obvious . As you can see, we have published this forum in an attractive new form at. This is highlighted by the new cover designed by Dr. Jeffrey Sarnoff. The second piece of progress is our enlarged audience. In addition to our own Jefferson faculty and residents, the Journal is now being distributed to psychiatrists throughout Pennsylvania. For both of these improvements in form we are indebted to the Mead Johnson Pharmaceutical Division for their generous sponsorship.

Table Of Contents: The Jefferson Journal Of Psychiatry, Volume 2, Number 1, January 1984

Jefferson Journal of Psychiatry

Table of Contents: The Jefferson Journal of Psychiatry, Volume 2, Number 1, January 1984.

Dedication

Jefferson Journal of Psychiatry

Dedication to Paul J. Fink, MD.