Medicine and Health Sciences Commons^™

Femoroacetabular Impingement: Saving The Joint, Ronald Huang, Javad Parvizi

Department of Orthopaedic Surgery Faculty Papers

Many factors have been linked to the development of osteoarthritis (OA) of the hip, but often, cases are still considered “idiopathic.” Femoroacetabular impingement (FAI) has been suggested as a possible etiologic factor for the otherwise “idiopathic” cases. It is theorized that the subtle morphologic abnormalities seen at the head-neck junction and acetabulum in FAI may lead to labral tears, chondral damage, and subsequent progression of OA. Prevalence of FAI has been suggested to be as high as 14% in the general population. It often presents in young active patients that subject their hip joint to repetitive micro trauma associated with …

Obesity And Other Predictors Of Absenteeism In Philadelphia School Children., Elizabeth B Rappaport, Constantine Daskalakis, Jocelyn Andrel

Department of Family & Community Medicine Faculty Papers

BACKGROUND: Limited data indicate that obese children are absent from school more than their normal-weight peers. We analyzed administrative data from a large urban school district to investigate the association of obesity and student sociodemographic characteristics with absenteeism.

METHODS: We analyzed 291,040 records, representing 165,056 unique students (grades 1-12). Obesity status was classified according to Centers for Disease Control and Prevention age- and sex-specific percentiles for body mass index (BMI) and analyses were based on negative binomial regression.

RESULTS: Overall rates of overweight and obesity were 17% and 20%, respectively, and the estimated absence rate was 17 absences per 180 …

Transfection Of Human Platelets With Short Interfering Rna., Wei Hong, Altaf A Kondkar, Srikanth Nagalla, Wolfgang Bergmeier, Ying Jin, Jay Herman, Paul Bray

Cardeza Foundation for Hematologic Research

Platelets contain mRNAs and are capable of translating mRNA into protein, and it has been previously demonstrated that platelets increase their levels of integrin β3 overtime while in blood bank storage conditions. We are unaware of prior attempts to introduce nucleic acids into platelets. Considering the potential clinical and research utility of manipulating platelet gene expression, we tested whether small interfering RNAs (siRNAs) could be transfected into normal human platelets. Multiple conditions were tested, including lipofectamine versus electroporation, different amounts of siRNA, the effect of different buffers and the presence of plasma during transfection, and the time for optimal siRNA …

Role And Mechanism Of Arsenic In Regulating Angiogenesis., Ling-Zhi Liu, Yue Jiang, Richard L Carpenter, Yi Jing, Stephen C Peiper, Bing-Hua Jiang

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Arsenic is a wide spread carcinogen associated with several kinds of cancers including skin, lung, bladder, and liver cancers. Lung is one of the major targets of arsenic exposure. Angiogenesis is the pivotal process during carcinogenesis and chronic pulmonary diseases, but the role and mechanism of arsenic in regulating angiogenesis remain to be elucidated. In this study we show that short time exposure of arsenic induces angiogenesis in both human immortalized lung epithelial cells BEAS-2B and adenocarcinoma cells A549. To study the molecular mechanism of arsenic-inducing angiogenesis, we find that arsenic induces reactive oxygen species (ROS) generation, which activates AKT …

Acute Effects Of A Selective Cannabinoid-2 Receptor Agonist On Neuroinflammation In A Model Of Traumatic Brain Injury., Melanie B Elliott, Ronald F Tuma, Peter S Amenta, Mary F Barbe, Jack I Jallo

Department of Neurosurgery Faculty Papers

Proposed therapeutic strategies for attenuating secondary traumatic brain injury (TBI) include modulation of acute neuroimmune responses. The goal of this study was to examine the acute effects of cannabinoid-2 receptor (CB(2)R) modulation on behavioral deficits, cerebral edema, perivascular substance P, and macrophage/microglial activation in a murine model of TBI. Thirty male C57BL/6 mice underwent sham surgery, or cortical contusion impact injury (CCI). CCI mice received vehicle or the CB(2)R agonist 0-1966 at 1 and 24 h after injury. Performance on the rotarod, forelimb cylinder, and open-field tests were evaluated before and at 48 h after sham or CCI surgery. Cerebral …

Evaluation Of The Use Of Patient-Focused Simulation For Student Assessment In A Surgery Clerkship., Gerald A Isenberg, Katherine W Berg, Judith A Veloski, Dale D Berg, J J. Veloski, Charles Yeo

Department of Surgery Faculty Papers

BACKGROUND: The purpose of this study was to evaluate the use of simulated patients in conjunction with anatomic and tissue task-training models to assess skills.

METHODS: Faculty reviewed the objectives of the clerkship to identify skills to be acquired. Three cases were developed related to rectal examination, suturing, and inserting intravenous lines and nasogastric tubes. Student scores were based on their ability to gather data from simulated patients and perform procedures on simulation models.

RESULTS: A total of 670 students were assessed between 2006 and 2009. Alpha reliability coefficients were .97 for Communication/Interpersonal Skills, .71 for Procedures, and .58 for …

Structure Of The Atp Synthase Catalytic Complex (F(1)) From Escherichia Coli In An Autoinhibited Conformation., Gino Cingolani, Thomas M Duncan

Department of Biochemistry and Molecular Biology Faculty Papers

ATP synthase is a membrane-bound rotary motor enzyme that is critical for cellular energy metabolism in all kingdoms of life. Despite conservation of its basic structure and function, autoinhibition by one of its rotary stalk subunits occurs in bacteria and chloroplasts but not in mitochondria. The crystal structure of the ATP synthase catalytic complex (F(1)) from Escherichia coli described here reveals the structural basis for this inhibition. The C-terminal domain of subunit ɛ adopts a heretofore unknown, highly extended conformation that inserts deeply into the central cavity of the enzyme and engages both rotor and stator subunits in extensive contacts …

Chemical Cardiomyopathies: The Negative Effects Of Medications And Nonprescribed Drugs On The Heart., Vincent M Figueredo

Division of Cardiology Faculty Papers

The heart is a target of injury for many chemical compounds, both medically prescribed and not medically prescribed. Pathophysiologic mechanisms underlying the development of chemical-induced cardiomyopathies vary depending on the inciting agent, including direct toxic effects, neurohormonal activation, altered calcium homeostasis, and oxidative stress. Numerous chemicals and drugs are implicated in cardiomyopathy. This article discusses examples of medication and nonprescribed drug-induced cardiomyopathies and reviews their pathophysiologic mechanisms.

Endothelial Differentiation Of Adipose-Derived Stem Cells From Elderly Patients With Cardiovascular Disease., Ping Zhang, Neil Moudgill, Eric Hager, Nicolas Tarola, Christopher Dimatteo, Stephen Mcilhenny, Thomas Tulenko, Paul J Dimuzio

Department of Surgery Faculty Papers

Adipose-derived stem cells (ASCs) possess significant therapeutic potential for tissue engineering and regeneration. This study investigates the endothelial differentiation and functional capacity of ASCs isolated from elderly patients. Isolation of ASCs from 53 patients (50-89 years) revealed that advanced age or comorbidity did not negatively impact stem cell harvest; rather, higher numbers were observed in older donors (>70 years) than in younger. ASCs cultured in endothelial growth medium-2 for up to 3 weeks formed cords upon Matrigel and demonstrated acetylated-low-density lipoprotein and lectin uptake. Further stimulation with vascular endothelial growth factor and shear stress upregulated endothelial cell-specific markers (CD31, …

Religious Experiences Shrink Part Of The Brain, Andrew Newberg, M.D.

Marcus Institute of Integrative Health Faculty Papers

A study links life-changing religious experiences, like being born again, with atrophy in the hippocampus.

The article, “Religious factors and hippocampal atrophy in late life,” by Amy Owen and colleagues at Duke University represents an important advance in our growing understanding of the relationship between the brain and religion. The study showed greater atrophy in the hippocampus in individuals who identify with specific religious groups as well as those with no religious affiliation. It is a surprising result, given that many prior studies have shown religion to have potentially beneficial effects on brain function, anxiety, and depression.

Mitochondrial Oxidative Stress Drives Tumor Progression And Metastasis: Should We Use Antioxidants As A Key Component Of Cancer Treatment And Prevention?, Federica Sotgia, Ubaldo E Martinez-Outschoorn, Michael P Lisanti

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

The functional role of oxidative stress in cancer pathogenesis has long been a hotly debated topic. A study published this month in BMC Cancer by Goh et al., directly addresses this issue by using a molecular genetic approach, via an established mouse animal model of human breast cancer. More specifically, alleviation of mitochondrial oxidative stress, via transgenic over-expression of catalase (an anti-oxidant enzyme) targeted to mitochondria, was sufficient to lower tumor grade (from high-to-low) and to dramatically reduce metastatic tumor burden by >12-fold. Here, we discuss these new findings and place them in the context of several other recent studies …

Download Entire Pdf: The Medicine Forum, Vol 5, Winter 2003

The Medicine Forum

Download entire PDF: The Medine Forum, (The Journal of Thomas Jefferson University Hospital, Department of Internal Medicine), Vol 5, Winter 2003.

Clinical Quiz

The Medicine Forum

5 question clinical quiz. Answers after case presentation: A Man with Dyspnea and Diffuse Abdominal Pain by Dominick Galluzzo MD.

Effect Of Intravenous Pulse Cyclophosphamtoe (Cyc) Therapy On Systemic Sclerosis (Ssc) Inflammatory Lung Disease, Nicole Weinberg, Md, Nora Sandorfi, Md, Sergio A. Jimenez, Md

The Medicine Forum

Deterioration of lung function is the most frequent cause
of death in SSc. Alveolitis is considered the initiating
event of SSc lung fibrosis. Effective therapy of SSc
alveolitis is, therefore, of paramount importance. Here
we assessed the use of intravenous CYC on pulmonary
function testing(PFT) and high resolution computerized
tomography (HRCT) abnormalities in 15 patients with
SSc and alveolitis.

Effects Of Walnut Consumption As Part Of Heart Healthy Diet On Atherogenic Lipoprotein Subclasses, Kimberly L. Dulaney, Md, John M. Morgan, Md, David M. Capuzzi, Md

The Medicine Forum

Nutritional therapy is fundamental in the treatment of
cardiovascular disease. Studies that utilized a low-fat diet
supplemented with 64 grams/day of walnuts have shown
a significant reduction in serum levels of total and LDL
cholesterol, and triglycerides. This study was designed to
see if lipoprotein subclasses varied in patients eating a
low-fat walnut supplemented diet.

A Man With Shortness Of Breath And An Abnormal Ecg: A Short Case, David Defeo, Md

The Medicine Forum

An 80 year-old Chinese male with a history of tobacco
use and asthma presented to the ER complaining of
shortness of breath that was unresponsive to
bronchodilator use. The patient’s ECG on admission was
sinus rhythm at 95 beats per minute with minimal ST
elevations in V2-V4. Laboratory results were significant
for a troponin of 7.7. The patient was started on anticoagulation
with heparin. A transthoracic echocardiogram
revealed an ejection fraction of 25%. The patient
underwent coronary catheterization, which revealed
luminal irregularities of his coronary arteries. Figures 1
and 2 show the end diastolic and end systolic left
ventriculograms from …

An Unresponsive Woman Found Down, Murliya Gowda, Md

The Medicine Forum

A middle-aged unidentified female presented by fire
rescue to the emergency department after being found
unconscious in the snow. Her identity, familiar contacts,
and medical history were not known, but the patient was
presumed to be homeless.

A Woman With Headache And Chest Pain, Theresa Pondok, Md

The Medicine Forum

A 34 y/o woman, with a past medical history significant
for asthma, newly diagnosed hypertension, and migraines,
presented to the emergency department with complaints
of sudden onset chest pain. She was an active young
woman, who up until the day of admission, had been able
to run several miles without chest pain or shortness of
breath. Symptoms began the morning of admission, when
the patient reported that she developed a migraine
heachache, with typical right-sided temporal pain. After
administering an injection of Sumatriptan, her headache
resolved. Soon thereafter, she noted 5/10 substernal chest
pressure occurring suddenly at rest, without radiation …

A Man With Shortness Of Breath And Bloating, Matthew E. Levy,Md

The Medicine Forum

The patient is a 61-year-old male with a past medical
history of hypertension and insulin-dependent diabetes
mellitus presented to the ED with new onset shortness
of breath. He reported a three week progression of
dyspnea after one flight of stairs, from a normal baseline.
The patient also noticed 2 pillow orthopnea and
increased urinary frequency and urgency. He denied
fevers, chills, chest pain, palpitations or productive
cough. Symptoms began when he ran out of his oral
medications three weeks prior to admission (furosemide,
enalapril, digoxin, metoprolol, spironolactone, aspirin).
Family history was positive for alcoholic cirrhosis. Social
history was positive for …

Training Residents In Acls/Code Response Using A Computerized Medical Simulator: Improving Resident Comfort And Preparedness, Elisabeth Dial, Md, Henry Schairer, Md, Steven Silver, Md, Jennifer Claves, Md, David Gardiner, Md, John Caruso Md, Salvatore Mangione, Md, Gregory C. Kane, Md

The Medicine Forum

Internal Medicine residents are responsible for leading the
code response team at most teaching hospitals, yet many
graduating interns (PGY1s) may feel unprepared to run
codes. Currently, the only formal training for house staff
is the two-day American Heart Association’s Advanced
Cardiac Life Support (ACLS) course, generally required at
the beginning of internship, with recertification necessary
every two years. This course does not address leadership
skills or a resident’s self-reported sense of comfort with
leading a code team within a teaching hospital. Prior
investigations have highlighted the deterioration in
knowledge of important ACLS protocols, with knowledge
levels at or near …

A Woman With Extreme Fatigue, Christopher Dimaio Md, Chief Medical Resident

The Medicine Forum

A 23 year old female presented to her primary care
provider’s office complaining of extreme fatigue over the
past few weeks.

Color Photos

The Medicine Forum

10 color photographs.

Isolated Abducens Nerve Palsy Secondary To Varicella Zoster In A Patient With Hiv, Ellen B. Lunenfeld, Md, John A. Walker, Md

The Medicine Forum

17
Varicella Zoster, the recrudescence of the dormant
varicella virus, occurs more often in older patients and
in those who are immunocompromised. Herpes Zoster
ophthalmicus (HZO) is the second most common
manifestation of the disease, second only to thoracic and
lumbar zoster.1 HZO is estimated to account for 10% to
25% of cases.2,3 HZO can lead to a number of ocular
complications, including proptosis, disciform keratitis,
internal ophthalmoplegia, bilateral retinal detachments,
Argyll-Robertson pupil, and progressive outer retinal
neuropathy (PORN).

A Man With Fevers And Chest Pain, Jigar Patel, Md

The Medicine Forum

A 42 y/o Hispanic man without significant medical
history presented to the ED with the complaint of
increasing left-sided chest pain. The patient reported that
symptoms began 4 days prior, when he developed a
severe headache. That night, he noted increasing chills
and sweats, with a fever measured at 103 degrees F. The
following morning, he developed left-sided chest pain
that he described as a pressure exacerbated by movement
and breathing. For the next several days, he reported
feeling worse with continuous chills and fever spikes up
to 105 degrees F, along with increased severity and
duration of his chest …

A Male With Chills And Arthralgias, Lo-Ku Chiang, Md, Ambrish Ojha, Md

The Medicine Forum

A 53-year old man presented to the ED with complaints
of fevers and chills for 5 days. Two days prior, he started
having generalized arthralgias and a painfully numb left
index finger. Similar symptoms had also begun on his
left great toe (See Figures D and E, Color Plates page
19). The patient denied recent trauma, although he was
unsure if he had sustained an insect bite on the dorsal
aspect of his left hand 8 hours prior to the onset of
symptoms. Three sets of blood cultures obtained prior
to admission were positive for methacillin-sensitive
Staphylococcus aureus. The patient …

A Man With Dyspnea And Diffuse Abdominal Pain, Dominick Galluzzo Md

The Medicine Forum

A 50 y/o male with a PMH significant for HIV/HCV
co-infection, and chronic renal insufficiency, presented
to the ED with a one week history of progressive dyspnea
and diffuse abdominal discomfort. He reported resting
shortness of breath without orthopnea, PND, or chest
pain. His abdominal pain was diffuse, and he denied
nausea, vomiting, increased abdominal girth or lower
extremity edema.

Prevention Of Central Venous Catheter-Related Infections, Raghuram Mallya, Md

The Medicine Forum

The central venous catheter is a valuable tool in inpatient
medicine. However, with its use comes the risk of local
and systemic infections. Kluger et al estimated that
250,000 cases of central line-associated blood stream
infections occur annually. Mortality rates range from 12-
25% per infection.1 Therefore, it is essential that health
care providers take all necessary precautionary measures
to avoid infection. Guidelines have been published by the
Centers for Disease Control and Prevention to provide
an evidence-based medicine (EBM) approach for
avoiding central venous catheter-related infections.
Recommendations include proper skin cleansing, the use
of maximal sterile barriers, selection of …

A Man With Diarrhea And Achalasia, Dan Valancius Md

The Medicine Forum

A 78 y/o male with an extensive history of CAD s/p
multiple MIs and CABG surgery, presents with two and
one half weeks of diarrhea. About 9 weeks prior, he had
been diagnosed with achalasia, and was treated with a
botulinum toxin injection, with resolution of his
symptoms of dysphagia. He was also hospitalized a month
ago after experiencing chest pain, and subsequently ruled
in for a small non-ST elevation MI. He underwent
coronary catheterization at that time, and was found to
have severe multivessel disease unamenable to PTCA or
bypass surgery. Now, he presents with progressively
frequent “brown watery” …

A Man With An Elevated Hemoglobin, Paula Sorokanich Md

The Medicine Forum

A 50-year-old male with history of severe gout and
degenerative joint disease presented to his PCP for a
physical. On routine blood work he was found to have
an elevated hemoglobin/hematocrit. This was confirmed
on repeat analysis and work-up was pursued.

A Man With A Soft Tissue Lesion Of The Hand, Susan Masonis Md

The Medicine Forum

A fifty year old male presents with a lesion on his right
hand. Approximately 2 months prior to presentation, the
patient, who is a dentist and avid boater, first noted the
lesion after hitting his hand when working in his boat’s
engine room. Initially he had a 1 cm erythematous
macular lesion on the dorsum of his right hand at the
5th metacarpal. He believed the lesion was present prior
to the time he struck his hand, and the injury brought it
to his attention.