Medicine and Health Sciences Commons^™

Predictive Value Of Index Lesion Cross-Sectional Area In Diffuse Large B Cell Lymphoma Patients Treated With Chimeric Antigen Receptor T-Cells, Nicole Winchell, Drew Torigian, Md, Stephen Schuster, Md

Phase 1

No abstract provided.

Assessment Of Hyperfibrinolysis In Liver Transplantation Surgery As Measured By Rotational Thromboelastometry, Ryan Madsen, Uzung Yoon, Marc Torjman

Phase 1

Hyperfibrinolysis is a significant concern during liver transplantation surgeries. Rotational thromboelastometry (ROTEM) is a point of care device that is capable of intraoperatively measuring the clotting properties of whole blood samples, including the rate of fibrinolysis. The aim of this study was to use ROTEM to determine if improved surgical techniques have lowered rates of hyperfibrinolysis during liver transplantations. Blood samples were taken from 284 patients during liver transplantations that took place over five years from 2014-2019. The blood samples were drawn at various time points during the preanhepatic phase, anhepatic phase, and neohepatic phase of the surgery. Hyperfibrinolysis was …

Usage Of Sleep Domain Of Snot-22 Scores In Screening For Osa In Patients Of Chronic Rhinosinusitis., Patrick Zhu, Mindy Rabinowitz, Md

Phase 1

Introduction: SNOT-22 is a screening tool universally applied in perioperative settings for endoscopic sinus surgery (ESS), typically for chronic rhinosinusitis (CRS). Comorbid obstructive sleep apnea (OSA) increases risk of perioperative complications following ESS, yet pre-ESS OSA screening is not performed. This study sought to determine whether the sleep subdomain SNOT-22 (SD-SNOT) score could be useful for OSA screening.

Methods: A retrospective study was performed by reviewing electronic records of 108 patients that underwent endoscopic sinus surgery between November 2019 – January 2020. Pre-operative and 2 months post-operative SD-SNOT scores were compared with the presence or absence of OSA.

Results: Mean …

Patient And Renal Allograft Outcomes Of Anticoagulation Therapy In Kidney Transplantation, Rachel Greene, Goni Katz-Greenberg, Md

Phase 1

Introduction: Kidney transplant recipients are often on anticoagulation or antiplatelet therapy, for a variety of indications. These medications are associated with increased risk of bleeding but may reduce risk of thrombosis and possible complications such as allograft loss. The aim of our study is to evaluate the effect of perioperative anticoagulation or antiplatelet therapy on patient and allograft outcomes.

Methods: Data collection was done by retrospective chart review of all patients who underwent a kidney or kidney/pancreas transplantation at Thomas Jefferson University Hospital (TJUH) from 2012-2019. We recorded perioperative anticoagulation and antiplatelet therapy, risk factors for bleeding and thrombosis, …

Short Term Response To Trigger Finger Injections, Neil Patel, Richard Mcentee, Daniel Seigerman

Phase 1

Introduction: Pain, clicking, and locking are common presentations in patients with hand conditions and more often than not, the cause is a trigger finger. The common practice to treat trigger fingers is a corticosteroid injection. The purpose of this study was to determine how these injections affect patients in the short term.

Methods: Patients who underwent corticosteroid injections from June 2019 to September 2019 was the population of study. Phone interviews were conducted with patients each week for 3 weeks following their injection. Patients were questioned about pain and triggering symptoms. Other demographic data was collected to be reviewed …

Effects Of Continuous Positive Airway Pressure On Cardiovascular Risk In Obstructive Sleep Apnea, Natali Salinas, Amy He, Dani Yellanki, Peter Zhang, Grace Severance, Zachary Feuer, Cynthia Cheng, Md, Phd

Phase 1

Obstructive sleep apnea (OSA) has been shown to significantly promote cardiovascular risk, in part possibly due to activation of the sympathetic nervous system during respiratory events in sleep and its subsequent effects on blood pressure and heart rate. Previous studies have also found associations between long term variability of blood pressure and heart rate with cardiovascular outcomes. We hypothesize that compliance to continuous positive airway pressure (CPAP) therapy will decrease the incidence of cardiovascular events in a dose dependent fashion in patients with moderate to severe OSA.

This retrospective study population consists of patients from the Jefferson Sleep Center with …

Celiac Disease: Clinical-Pathological Correlation In 100 Consecutive Patients, Michael J. Dimarino, Sidney Cohen, Md, Stephanie Moleski, Md, Christopher Cao, Md, Michael C. Dimarino, Md, Anthony Dimarino, Md

Phase 1

Introduction: Celiac Disease (CD) is an autoimmune disease that manifests as inflammation in the small intestine that can be measured by both serology (tTG-IgA) and pathology (Marsh scores). Despite having two clear etiologies defining the disease, the relationship between these markers and the clinical presentation is unclear but the age at presentation has thought to be correlated with a worsened pathology.

Methods: This was a retrospective chart review at Thomas Jefferson University Hospital (TJUH). The study consisted of patients diagnosed with Celiac Disease at TJUH with both a Marsh score and a tTG-IgA antibody result. Analysis via correlation statistics …

Predictors And Characteristics Of Rib Fracture Following Sbrt For Lung Tumors, Michael P. Carducci, Baskaran Sundaram, Md, Benjamin Greenberger, Md, Maria Werner-Wasik, Md, Gregory C. Kane, Md

Phase 1

See Additional Files section for the abstract.

Likelihood Of Germline Mutation With Solitary Unilateral Retinoblastoma Based On Patient Age At Presentation. A Real-World Analysis Of 482 Consecutive Patients., Martin Calotti, Carol L. Shields, Md, Philip Dockery, Md, Mph, Megan Ruben, Antonio Yaghy, Md, Madalyne A. Sunday, Emily R. Duffner, Hannah J. Levin, Olivia S. Taylor, Sara E. Lally, Md, Jerry A. Shields, Md

Phase 1

Introduction: Retinoblastoma due to germline mutation has a greater risk of bilateral presentation, and multifocal or extraocular involvement. In solitary unilateral retinoblastoma, the inheritance pattern is less understood and assumed to be somatic. We assessed the likelihood of germline inheritance in children with unilateral retinoblastoma and whether it varies based on age at presentation.

Methods: This was a retrospective case study assessing 482 consecutive patients with solitary unilateral retinoblastoma at Wills Eye Hospital between 1972 and 2020 for the likelihood of germline inheritance based on age at presentation (≤1 year vs. >1 year). Germline inheritance was deemed likely if …

Investigation Of Medication Adherence And Rejection In Liver Transplant For Cystic Fibrosis (Cf), Lucia Sanchez, Elizabeth Rand, Md, Phoebe Wood

Phase 1

Introduction: 40% of transplant recipients are non-adherent to medications, causing increased risk of rejection and diminished survival. The relationship between adherence measured as Medication Level Variability Index (MLVI) and graft rejection rates in pediatric liver transplant recipients with CF compared to those without CF will be evaluated. We hypothesize that MLVI is higher and rejection rates are lower in subjects with CF.

Methods: Retrospective chart review of pediatric liver transplants performed at the Children’s Hospital of Philadelphia between 1995-2018 identified 9 CF liver transplant recipients and 9 age matched controls. Medication adherence was assessed using MLVI. An unpaired t-test was …

Machine Learning By Ultrasonography For Risk Stratification Of Axillary Breast Lymph Nodes, Joshua Yu, John Eisenbrey, Phd, Aylin Tahmasebi, Md

Phase 1

Introduction: Breast cancer is the most common cancer among women worldwide, and ultrasonography has been an essential tool in the management of breast cancer. In order to improve upon ultrasonography efficacy, establishing a machine learning image analysis model would provide additional prognostic and diagnostic factors in the evaluation, monitoring, and treatment of breast cancer.

Methods: This retrospective study utilizes axillary lymph node ultrasound images of patients at Thomas Jefferson University Hospital who have had axillary lymph node biopsies. Automated machine learning of the images was performed on AutoML Vision; Google LLC which generated custom models for classification. About 80% of …

Antithrombotic Choice And Timing In Patients Presenting With Symptomatic Hemorrhagic Conversion Of Ischemic Stroke, Joshua Margolis, Robin Dharia, Md, Judy Diep, Md

Phase 1

The primary aim of this research project is to determine the optimal time for antithrombotic agent initiation post ischemic stroke without resulting hemorrhagic conversion. We hypothesize that not only is hemorrhagic conversion risk often inaccurately estimated, but also that antiplatelet agents and anticoagulants may pose similar risk of hemorrhagic conversion, particularly when initiated seven days post ischemic stroke. This risk potentially outweighs their protective effects against recurrent stroke. We are in the process of identifying patients with hemorrhagic conversion of ischemic stroke at Thomas Jefferson University Hospital and will analyze the type and timing of antithrombotic agents. Additional risk factors …

Transradial Approach For Diagnostic Cerebral Angiograms In The Elderly: A Comparative Observational Study, Cannon Greco Hiranaka, Ahmad Sweid, Somnath Das, Joshua H. Weinberg, Kareem El Naamani, Julie Kim, Darcy Curtis, Daniel Joffe, Darshana Vijaywargiya, Chrissa Sioka, Mazen Oneissi, Abdel Hadi El Hajjar, Michael Reid Gooch, Nabeel Herial, Stavropoula I. Tjoumakaris, Robert H. Rosenwasswer, Pascal Jabbour

Phase 1

Introduction: The transradial approach (TRA) reduces mortality, morbidity, access site complications, hospital cost, and length of stay while maximizing patient satisfaction. We aimed to assess the technical success and safety of TRA for elderly patients (aged ≥75 years).

Methods: A retrospective chart review and comparative analysis was performed for elderly patients undergoing a diagnostic cerebral angiogram performed via TRA versus transfemoral approach (TFA). Also, a second comparative analysis was performed among the TRA cohort between elderly patients and their younger counterparts.

Results: Comparative analysis in the elderly (TRA vs TFA) showed no significant differences for contrast dose per vessel, fluoroscopy …

Factors Influencing General Surgeons To Involve Urologists In Bladder Trauma Management, Joseph Schultz, Paul Chung, Md

Phase 1

Introduction: Bladder trauma injuries, which are graded by severity, often require immediate care and surgical management by General Surgeons (GS) or Urologists. This study seeks to understand the inconsistencies that exist in collaboration between GS and Urologists in bladder trauma management. We hypothesize that the decision for GS to involve Urologists in bladder trauma management is a multifactorial decision with severity of bladder trauma being the primary determining factor as opposed to other factors like provider experience or hospital setting.

Methods: This cross-sectional descriptive study surveyed GS to determine how likely they were to involve Urologists in bladder trauma …

A Virtual Educational Intervention Addressing Weight Bias In Medical Students, Gina Goldberg, Joseph Majdan, Md

Phase 1

Introduction:

Individuals with higher body weight experience severe and pervasive discrimination in nearly every walk of life. Stigmatizing treatment from healthcare providers increases anxiety, depression, body dissatisfaction and risk of weight gain while decreasing the likelihood that patients will seek preventative or emergency care. This study assessed whether a virtual session exploring obesity, which included the personal testimony of a Physician Professor with obesity, positively influenced the explicit attitudes and implicit biases of medical students towards people with higher body weight.

Methods:

SKMC medical students completed an Implicit Associations Test (IAT), a Universal Measure of Bias (UMB) and a …

The Use Of Imiquimod For The Treatment Of Empd From The Patients’ Perspective, Darren D'Mello, Paul Chung, Md

Phase 1

Introduction:

Imiquimod is a topical medication used to treat many dermatologic conditions, and it has been used to treat patients with Extra-Mammary Paget’s Disease. There have been case reports that described the effects and outcomes of patients who were treated with Imiquimod, but more research on its use for EMPD must be done. There have been no studies that gathered data from the patients themselves; this is what our study hopes to accomplish. We hypothesize that patients with EMPD who were treated with Imiquimod early after their diagnoses or after surgery had better outcomes than those who did not use …

Using Silac-Based Proteomics To Investigate Pathogenic Mechanisms In Spinal And Bulbar Muscular Atrophy, Debotri Chatterjee

Phase 1

Introduction: Spinal and bulbar muscular atrophy (SBMA) is a neurodegenerative disease caused by a polyglutamine (polyQ) expansion in the androgen receptor (AR). Instead of being exported out and degraded, mutant polyQ-AR remains in the nucleus, forming aggregates. We hypothesize that the cellular toxicity in SBMA is caused by aberrant intra-nuclear interactions (both gained and lost) of polyQ-AR aggregates.

Methods: We utilized SILAC proteomics on a cell model of SBMA to develop an AR interactome and investigate which intra-nuclear proteins and protein networks are affected through interaction with polyQ-AR (population C18) in comparison to wild type AR (C21). A candidate …

Using Rna-Seq To Identify Biomarkers For Guanylyl Cyclase C Activity, Gerard Hoeltzel, Scott Waldman, Md, Phd

Phase 1

Introduction: Deficiencies of guanylyl Cyclase C (GCC), a transmembrane receptor of large intestine epithelial cells, is associated with an increased risk for colorectal cancer (CRC) in mice. Therefore, elucidating the downstream pathways associated with GCC may help inform new therapeutic targets for treating CRC. We performed an RNA-sequencing analysis of GCC^+/+ and GCC^-/- mice and hypothesizes that the two groups would demonstrate significant variations in gene products that may be tied to the GCC signaling pathway.

Methods: Cells from five GCC^+/+ and five GCC^-/- mice were collected and analyzed for mRNA expression levels of over …

Translation Of Ephb2 In Pkcgamma And Calretinin Interneuron Subpopulations After Spinal Cord Injury, David A. Jaffe, Nicolette Heinsinger, Angelo Lepore

Phase 1

Introduction: Neuropathic pain is a common, debilitating occurrence after spinal cord injury (SCI). EphB signaling has been implicated in neuropathic pain, but different populations of neurons that upregulate EphB after SCI must be discovered. Understanding whether EphB2 is upregulated in specific subpopulations of dorsal horn interneurons (e.g. those expressing PKCgamma or calretinin) after injury would increase the understanding of SCI-induced neuropathic pain.

Methods: Mice were either given a contusion-type SCI (n=7) or a laminectomy-only (n=6) at cervical level 5/6. After two weeks of recovery, mRNA was labeled using RNAscope in the sectioned spinal cords. Four different targets were visualized …

Appropriate Ecmo Screening Protocols For Critically Ill Patients During Covid-19, Hudson Carter, Michael Baram, Md

Phase 1

Introduction: The use of Extracorporeal membrane oxygenation (ECMO) for COVID-19 patients has proven to have several advantages that advocate for increased use, but current screening protocols have limited its use and availability. The purpose of this study was to evaluate screening criteria for ECMO patients during COVID-19 and determine their appropriateness based on resource availability.

Methods: The population included patients referred for ECMO screening, and were stratified based upon referral outcome, survival length and patient disposition. The referring physicians were contacted to gather information regarding the referral process, the patient’s status prior to referral, and possible referral to another …

Effectiveness Of A Primary Care Nutrition Education/Vlcd Diet Program, Jessica Vitale, Ayesha Baig, Steven Chang, Hannah Kostan, Connor Mcelwee, Ketav Patel, Cindy Cheng

Phase 1

Introduction: Jefferson currently has a Medical Nutrition Therapy (MNT) program via an educational component delivered via Zoom to assist patients with managing their diet, exercise, medication changes and understanding the physiology of their conditions. We aim to study the effectiveness of the MNT program, along with the impact of duration of program participation, on weight loss, blood pressure, glucose and total cholesterol. In addition, I am focusing on triglycerides, HDL and LDL. We hypothesize that patients in our MNT program will have lower weight, blood pressure, blood glucose and total cholesterol, with a further positive effect of longer participation …

Continuous Positive Airway Pressure Therapy Effects On Lipid And Hepatic Function Test Values, Grace Severance, Cynthia Cheng, Md, Phd, Amy He, Peter Zhang, Dani Yellanki, Zachary Feuer, Olivia Taylor, Natali Salinas

Phase 1

Introduction : Continuous positive airway pressure (CPAP) therapy is an established therapy for patients diagnosed with obstructive sleep apnea (OSA). The following study aims to measure the impact of CPAP therapy on lipid and liver profiles of patients diagnosed with OSA. We hypothesize that CPAP therapy will improve patient serum lipid and liver measures in this patient population compared to patient baseline prior to CPAP therapy. Furthermore, we also will examine differences in hepatic ultrasound results for OSA patients on CPAP therapy.

Methods: The target patient population has moderate-severe OSA, defined as an Apnea-Hypopnea Index greater than 15. The intervention …

Validation And Accuracy Of Synovial Alpha Defensin In A Suburban Academic Center After Implantation As Part Of The Workup For Periprosthetic Joint Infections, Donald Willier, Iii, Kenneth J. Mcalpine, Md, Anthony F. De Giacomo, Md, John S. Garfi, Ms, Lawrence M. Specht, Md, Michael S. Kain, Md

Phase 1

Introduction

Periprosthetic joint infection (PJI) is a leading cause of total hip and knee arthroplasty failure. The Musculoskeletal Infection Society (MSIS) criteria for PJI has allowed diagnosis standardization. To increase the MSIS criteria accuracy, synovial fluid biomarkers have been tested. Studies evaluating synovial alpha defensin have reported both sensitivity and specificity up to 100%. In this study, we report our analysis on the use of alpha defensin testing in a suburban academic tertiary referral center.

Methods

We performed a retrospective analysis of a prospectively collected database of 133 patients tested for PJI over a 6 year period. From 2014, our …

A Meta-Analysis Of The Effects Of Sglt-2 Inhibitors On Serum Electrolytes, Mark Leibensperger, Jingjing Zhang, Md, Phd, Yonghong Huan, Md

Phase 1

Introduction: Previous studies have reported that sodium-glucose co-transporter 2 (SGLT2) inhibitors affect serum electrolytes levels, especially magnesium. This study aims to integrate direct and indirect trial evidence to evaluate the relative effects of all SGLT2 inhibitors against each other on electrolyte levels in patients with type 2 diabetes (T2D).

Methods: Electronic databases were systematically searched through December 2018 to identify eligible randomized controlled trials (RCTs) that reported mean changes in serum electrolyte levels, including magnesium, sodium, potassium, phosphate, calcium, and urate in patients with T2D. Random-effects pairwise and network meta-analyses were performed to calculate the weighted mean difference (WMD) …

Radiographic Results Of Expandable Interbody Devices, Jonathan Ledesma, Mark Kurd, Md, Kris Radcliff, Md, D. Greg Anderson, Md

Phase 1

Introduction: Minimally invasive surgery for transforaminal lumbar interbody fusion (MIS-TLIF) has become a mainstay procedure in the treatment of degenerative conditions of the lumbar spine. Expandable interbody devices have gained popularity in recent times due to several well-cited advantages including greater correction of disc height and lordosis and decreased intraoperative disruption of neurologic structures. However, the clinical benefits offered by these devices compared to traditional static implants remain unclear. This study seeks to investigate differences in the radiographic and clinical outcomes between traditional static versus expandable interbody devices used in MIS-TLIF.

Methods: Patients who underwent MIS-TLIF performed by three …

Effect Of Recipient Diabetes Status On Immune Rejection After Descemet Stripping Endothelial Keratoplasty, Elliot Cherkas, Zeba Syed, Michael Sulewski

Phase 1

This study seeks to determine whether recipient diabetes status relates to incidence of immune rejection following Descemet Stripping Endothelial Keratoplasty (DSEK). We hypothesized that patients with diabetes would have a greater risk of graft immune rejection.

This is a retrospective cohort study to compare recipient diabetes status in 794 DSEK surgeries at Wills Eye Hospital between January 2008 and July 2019. Kaplan-Meier functions of survival time until first immune rejection was compared between groups. Pearson’s chi square test and Wilcoxon test were used to test the null hypothesis.

During the study period, 146 of 794 DSEK recipients had diabetes. At …

Evaluating The Efficacy Of Telestroke Intervention In A Large Community Hospital Network, Daniel Moylan, Daniel Joffe, Charles Morse, Michael Knapp, Ahmad Sweid, Pascal Jabbour

Phase 1

Introduction: Telemedicine for acute ischemic stroke (Telestroke) allows live consultation between patients, remote stroke specialists, and providers to facilitate administration of IV tissue plasminogen activator (IV-tPA) within the 4.5 hour window. Small cohort studies have demonstrated thrombolytic therapy conveys significant benefit to stroke outcomes and yet is underutilized due to difficulties in recognition and delivery of medication. This study proposes that access to telestroke care across the Thomas Jefferson University Hospital network will result in increased thrombolytic reperfusion rates and improved patient outcomes for stroke.

Methods: A retrospective cohort study was designed to utilize a telestroke database collecting information from …

Tumor Doubling Time Of Pulmonary Carcinoid Tumors Measured By Ct, Douglas Russ, Julie Barta, Md, Nathaniel R. Evans, Md, Robert T. Stapp, Do, Gregory C. Kane, Md

Phase 1

Introduction:

Pulmonary carcinoid tumor (PCT) is a rare neuroendocrine lung cancer that is known clinically to be a slow-growing neoplasm. Few studies have established the true growth rate of these tumors when followed over time by radiography. Therefore, we sought to determine PCT tumor doubling time using longitudinal Computed Tomography (CT) scans. Nodule guidelines may misclassify early PCT nodules with a small diameter as benign if tumor growth is too slow to be appreciable on follow up radiographic scans completed between six months and two years after initial detection.

Methods:

We performed a retrospective analysis of available CT imaging …

Evaluation Of Firearm Suicide Among Patients Treated Across The Jefferson Enterprise, Connor Mcpartland, Allegra Bermudez, Stanton B. Miller, Md, Mph, Facs

Phase 1

Introduction and Objective:

Firearm suicide is a leading cause of mortality. This study aims to identify risk factors associated with patients who attempt suicide with a firearm. The hypothesis is that adolescents of non-Hispanic white race/ethnicity are at the highest risk of firearm suicide.

Methods:

Patients treated at Thomas Jefferson University Hospital between 3/1/2017 and 12/1/2020 for a self-inflicted gunshot wound and/or attempted suicide were included in the study. Patients were identified through ICD-10 codes and a clinical research software tool known as TriNetX was used to analyze incidence of suicide as well as potential risk factors such as …

Contrast-Enhanced Endoscopic Ultrasound For Identification Of Sentinel Lymph Nodes In Esophageal Cancer, Bethanne Venkatesan, Ji-Bin Liu, Md, John R. Eisenbrey, Phd, Sriharsha Gummadi, Md, Thomas Kowalski, Md, Robert Coben, Md, Flemming Forsberg, Phd, Corinne Wessner, Priscilla Machado, Md, David Loren, Md

Phase 1

Introduction:

In esophageal carcinoma, lymph node involvement is a crucial aspect of nodal staging and determining treatment strategies. Although grayscale endoscopic ultrasound (EUS) is the standard of care for staging, it is unable to identify lymph node drainage from primary tumors or sentinel lymph nodes (SLN). The goal of this study was to determine if Contrast Enhanced Endoscopic Ultrasound (CE- EUS) is superior to EUS in the identification of SLNs and nodal staging in esophageal carcinoma.

Methods:

In the unblinded pilot study, patients with newly diagnosed esophageal carcinoma were recruited to undergo CE-EUS and standard EUS. EUS was performed …