Medicine and Health Sciences Commons^™

Role Of Il-6 In Uremia-Induced Muscle Dysfunction, Taylor Penzel, Maria P. Martinez Cantarin

Phase 1

Introduction: Defects in mitochondrial function and increased circulating interleukin-6 (IL-6) caused by uremia of chronic kidney disease (CKD) are significant contributors to skeletal muscle atrophy and weakness, and to increased mortality. This study evaluated the effect of abrogation of IL-6 on markers of muscle and mitochondrial dysfunction.

Methods: Adenine supplementation was used to induce uremia in wild-type (WT) and IL-6-knockout (KO) mice, which were compared to control diet WT and IL-6-KO mice, respectively. Body weight, individual muscle weights, quantity and diameter of extensor digitorum longus (EDL) fibers by type (1, 2A, 2B and 2X), optical density of mitochondrial complexes …

The Use Of Advanced Ultrasound Techniques For The Evaluation Of Uterine Fibroids Pre And Post Uterine Artery Embolization, Kathleen Gillmore, Priscilla Machado, Alison Tan, Carin F Gonsalves, Flemming Forsberg

Phase 1

Introduction: Uterine fibroids are the most common benign tumor in females of reproductive age. Uterine artery embolization (UAE) is a less-invasive alternative to hysterectomy. Our objective is to assess the ability of superb microvascular imaging (SMI) to characterize fibroid microvascularity before and after UAE compared to conventional Doppler modes using contrast-enhanced ultrasound (CEUS) and clinical outcomes as reference standards.

Methods: Participants will be 40 adult females who are scheduled for UAE. Participants receive three transabdominal ultrasounds at day 0, day 14 and day 90 post-UAE using an Aplio i800 scanner. Subjects undergo examination with four non-contrast ultrasound modalities— color doppler …

Clinical Outcomes Following Lumbar Fusion In Patients With And Without A History Of Spinal Cord Stimulation Therapy, Jake Budlow, Ellina Hattar, Heli Patel, Thiago S. Montenegro, Glenn A. Gonzalez, Garrett Largoza, Christopher Elia, Caio M. Matias, Chengyuan Wu, Ashwini D. Sharan, James S. Harrop

Phase 1

Introduction:

The treatment of chronic back pain is a challenging and costly issue faced by patients across the United States. Spinal cord stimulators (SCS) or lumbar fusion surgery can be utilized in cases of intractable pain. This study aims to determine if a history of a thoracic SCS influences patient recorded outcomes measures (PROMs) of lumbar fusions at six months.

Methods:

This retrospective cohort study includes patients who underwent elective lumbar fusions at Thomas Jefferson University Hospital between January 2018 and December 2019. PROMs were measured, specifically the Oswestry Disability Index (ODI), preoperatively and 6 months postoperatively. Clinical outcomes …

Evaluating The Effect Of Telestroke Intervention On Patient Treatment And Outcomes, Charles Morse, Daniel Moylan, Daniel Joffe, Michael Knapp, Ahmad Sweid

Phase 1

Acute ischemic strokes (AIS) are a prominent cause of death and have the potential to cause lifelong neurological deficits. We hypothesize that through telestroke intervention, patients will receive treatment more rapidly and therefore have reduced complications as a result of AIS. To analyze the efficacy of telestroke intervention, we completed a retrospective chart review of suspected AIS patients at hospitals in the greater Philadelphia region from 2015-2019. We then assessed whether a patient received a telestroke consultation and any subsequent care. Several variables were then used to determine the effectiveness of this intervention, such as the promptness of treatment, length …

Assessment Of Treatment Response Of Keloid Patients, Mary Metkus, Rachel Zachian, John Bruckbauer, Neda Nikbakht, Md, Phd

Phase 1

Introduction: Keloids are benign skin overgrowths, often accompanied by pain and pruritis. Despite many modalities, treatment of keloids is difficult due to variable response and high recurrence rates. This study evaluated the efficacy of surgical excision compared to intralesional triamcinolone in the treatment of keloids.

Methods: This was a retrospective study. Through a medical chart review, patients with keloids treated in the Jefferson Health System from 2018-2020 were identified and included. Participants were surveyed via telephone to assess change in size, pain and pruritis of their keloid in response to treatment. Participants ranked pain and pruritis severity from 1-10 before …

Assessment Of The Diagnostic Accuracy Of Core Needle Biopsies In The Diagnosis Of Lymphoma, Austin Redilla, George Ye, Catherine Tucker, Md, Christopher Gardner, Guldeep Uppal, Md, Adam F. Binder, Md

Phase 1

Introduction: Excisional biopsy remains the gold standard in the diagnosis of lymphomas. However, recent studies have shown that core needle biopsy (CNB) may have similar accuracy. CNB offers several advantages over excisional biopsy, including reduced cost and morbidity, thus we set out to determine the diagnostic accuracy of CNB at Thomas Jefferson University Hospital (TJUH) to understand if this approach should be utilized more in our system.

Methods: We performed a retrospective chart review of all suspected new diagnosis of lymphoma at TJUH from January 1^st, 2016 to December 31^st, 2019. All CNB and excisional …

Peri-Operative Urodynamic Assessment Has Poor Predictive Value For Developing Post-Operative Urinary Retention, Baylor Wickes, Robert Pivec, Md, Mathew S. Austin, Md

Phase 1

Introduction: Post-operative urinary retention (POUR) following primary total joint arthroplasty (TJA) has a reported prevalence up to 35%. Risk factors for developing POUR have traditionally included surrogate markers such as the presence or absence of urologic disease. However, dynamic measurement of the renal system with post-void residual volumes (PVR) has not been investigated as a tool for assessing POUR risk.

Methods: All male TJA patients underwent an pre-operative screen for POUR, including PVR measurements, patient-derived subjective urinary retention scores, and assessment of urologic disease. This was combined with a post-operative monitoring and catheterization protocol developed in partnership with a …

The Impact Of Patient Characteristics On Quality Of Life In Keloid Patients, Jonathan Wang, Romsin Zaya, Rachel Zachian, Mary Metkus, Neda Nikbakht

Phase 1

Introduction: Quality of life (QoL) is an important metric in assessing dermatological diseases such as keloids. This study evaluated the effects of patient characteristics on QoL in keloid patients.

Methods: This was a cross-sectional study. 36 patients presenting to the keloid clinic at TJUH were surveyed. QoL subscale scores for emotion, symptom, and function were calculated in addition to a total score for each patient using a keloid-specific questionnaire. The association between the QoL scores and patient characteristics of sex, ethnicity, as well as keloid location, duration, visibility, size, number, pain score, and pruritis score were evaluated using t-tests. …

The Psychosocial Impact Of Penile Implant Treatment, Taylor Tidwell, Paul Chung, Md

Phase 1

Introduction: Erectile dysfunction affects nearly 2/3rds of men age 50 or older worldwide and involves multiple hormonal, neurologic, psychological and environmental etiologies. Although contemporary research suggests that ED causes increased anxiety and depressive symptoms, there is relatively little information on how specific treatments impact mental health.

The purpose of this study is to answer the question: How do penile implants influence the psychosocial and emotional wellbeing of patients with ED compared to those without implants?

Methods: Our study uses a free-listing technique to interview via phone 50 patients with erectile dysfunction (25 with implant treatment, 25 without) regarding their emotional, …

The Impact Of Doula-Supported Care On Stress Levels Of Women Receiving Opioid Addiction Treatment, Mariel Becker, Meghan Gannon, Phd, Msph

Phase 1

Introduction: Mothers suffering from opioid addiction are at high risk for experiencing extreme stress levels which prevents them from providing a healthy and nurturing environment for their family. The aim of this project is to explore if a doula-supported care team alleviates the parenting stress of new mothers participating in opioid addiction rehabilitation.

Methods: A total of 35-40 women in treatment at the Montair program for substance use disorder rehabilitation were recruited to participate in the City of Philadelphia’s Community Doula project. The Parenting Stress Index Score (PSI) was recorded and compared to a control group composed of women …

Cns Derived Extracellular Vesicles As Biomarkers In Multiple Sclerosis (Ms), Anshel Kenkare, Abdolmohamad Rostami

Phase 1

This project aims to develop biomarkers for the diagnosis and treatment of multiple sclerosis (MS), a clinically heterogenous disease resulting from demyelination of the central nervous system. Extracellular vesicles (EVs) have shown potential as such a biomarker.

EVs were isolated from the plasma and cerebrospinal fluid (CSF) of patients with suspected MS and patients with headaches. Participants are recruited before starting treatment for their condition and controls were only included if the cause of headache was determined to be non-inflammatory. Proteomic analysis will be conducted on the plasma and CSF before isolating the EVs, as well as the isolated plasma …

Comparative Observational Study For Bifurcating Aneurysm Treatment; Open Versus Endovascular Approaches And Classical Versus New Techniques., Samuel Fallon, Ahmad Sweid, Md, Nikolaos Mouchtouris, Md, Michael Reid Gooch, Md, Pascal Jabbour, Md

Phase 1

Introduction: Aneurysm occur in approximately 3.2% of the population with a mean age of 50 years, a 1:1 gender ratio, and an estimate mortality rate of 70%. Aneurysms develop at branch points with elevated intravascular turbulence and vessel wall shear stress. we aim to compare the efficacy and safety of different surgical treatment modalities for bifurcating intracranial aneurysms.

Methods: A retrospective review of 398 patients who underwent surgical management of a bifurcating aneurysm at Thomas Jefferson University hospital from 2010 to 2020. Aneurysm size, location, modality of treatment, and treatment complications were assessed.

Results: Data analysis is expected to …

Assessing The Utilization And Effectiveness Of Pediatric Order Sets In Hpv Vaccine Administration In A Large Urban Family Medicine Practice, Lakshmi Narayanam, Krys Foster, Md, Mph

Phase 1

Introduction: Human papilloma virus (HPV) vaccination remains a controversial topic with low rates of vaccination completion. According to a 2017 National Immunization Survey, only 49% of adolescents were up to date (UTD) on their HPV vaccination, an alarming statistic given its importance in reducing HPV-related cancers. This project seeks to determine the effectiveness of pediatric order sets in affecting rates of HPV vaccine administration in a large urban family medicine practice.

Methods: A retrospective, qualitative chart review was conducted on patients nine years or older seen at Jefferson Family Medicine Associates in Philadelphia, PA from April 2019 to April …

The Prevalence Of Orally Administered Glucocorticoids, Generalized Pustular Psoriasis And Erythrodermic Psoriasis In The Treatment Of Adult Plaque Psoriasis Provided By U.S. Dermatologists, Katherine Awh, Kumar Nasham, Christian Albornoz, Steven Feldman, Anthony Albornoz

Phase 1

Introduction: Orally administered glucocorticoids (OAG) are not recommended for the management of plaque psoriasis (PsO) due to the classically feared outcomes of generalized pustular psoriasis (GPP) and erythrodermic psoriasis (EP). Given their widespread anecdotal use, we hypothesize that the use of OAG is not infrequent among US dermatologists and is rarely complicated by GPP or EP.

Methods: Anonymous electronic survey of 50 US dermatologists. Primary outcomes of interest were the prevalence of OAG in the management of PsO and the prevalence of GPP and EP in the context of OAG tapering.

Results: Overall, 9 out of 50 (18%) respondents …

Correlates Of Rem Sleep Without Atonia In Dream Enactment Behavior Associated With Parkinson’S Disease, Nisha Bagchi, Ritu Grewal, Abigail Quintos, Rohin Saroya

Phase 1

Introduction: Parkinson’s Disease (PD), a common neurodegenerative disease worldwide, has few reliable biomarkers. PD has been linked to REM Behavioral Disorder (RBD), a condition where patients abnormally experience REM sleep without atonia (RSWA). We aim to determine whether chin movements, a feature of RSWA, could serve as a PD biomarker. We hypothesize that those with higher RSWA are more likely to have PD.

Methods: Our study examined patients who underwent polysomnograms from 2015 onwards at the Jefferson Sleep Disorders Center. We did a retrospective EPIC chart review and compared 2 groups, those with RBD and PD (n=12) versus RBD …

An Assessment Of Quality Improvement Strategies For The Implementation Of Certified Recovery Specialists In Treating Opioid Use Disorder At The Emergency Department At Jefferson, A. Cosmo Annese, Rickie Brawer, Phd, Mph, Ches

Phase 1

Introduction: Opioid overdose mortality rate in the U.S. has seen a staggering upward trend lately, more than tripling between the years 2000-2017. Although the use of Certified Recovery Specialists (CRSs) has been shown to improve overdose rates, relapse rates, and treatment completion rates for people with opioid use disorder (OUD), the optimal specialization of CRSs in healthcare settings has yet to be clearly defined. This project seeks the perspectives of CRSs and healthcare workers to gain insight into how CRSs can be most effectively implemented in the ED at Jefferson to treat OUD.

Methods: The study population includes CRSs and …

Pediatric Group Well Care Within The Maternal Treatment Education & Research (Mater) Program, Elizabeth Franko, Neera Goyal, Vanessa Short, Aditi Kale

Phase 1

Introduction:

This project aims to develop and implement group well care for mothers and infants receiving care for opioid use disorder (OUD). Groups would be composed of 5-7 mothers and infants of similar age with extension of sessions to allow group activities and parenting discussions. To evaluate acceptability and feasibility of this care model, we sought to examine attitudes and beliefs from these mothers, in particular the impacts of the COVID-19 pandemic.

Methods:

A qualitative interview study of women receiving treatment for OUD at Maternal Addiction Treatment Education and Research at Thomas Jefferson University from October – December 2020 was …

Impact Of Long-Term Doula Services On Maternal And Fetal Health Outcomes In Women In Treatment For Opioid Use Disorder, Saloni Parikh, Meghan Gannon, Phd, Msph

Phase 1

This study analyzed the impact of doula services on maternal and fetal health outcomes in pregnant women seeking treatment for opioid use disorder. Understanding the impact of doula services is critical in reducing inequities in health outcomes experienced by this vulnerable population. Retrospective and prospective data was collected from surveys, focus groups, and maternal and infant birth data from 100 women in treatment for opioid use disorder, with fifty utilizing doulas and fifty not utilizing doulas. Standardized data abstraction of quantitative and qualitative measures were collected into an SPSS database and Nvivo, respectively, and analyzed using SPSS. Measures of importance …

Medical Student Interest In Loan Forgiveness Programs, Ricky Burns, Brianna Kunes, Allison Casola, Phd, Mph

Phase 1

Purpose: Student debt from medical school rises every year and there is limited research on how early financial education affects career placement. Our purpose is to investigate the prevalence, demographics and motivations of 3^rd year medical students who intend to enter loan forgiveness programs (LFPs). The question we aim to answer is, what are the demographics of 3^rd-year students who intend to take part in LFPs and how can it be used to create better financial education for future students?

Methods: Data from a 31-item cross-sectional quality improvement and health disparities assessment was given to third year …

The Effect Of 3d Printed Models On Surgical Planning And Outcomes For Partial Nephrectomies, Samuel Morano, E. Reilly Scott, Andrea Quinn, Erica Mann, Adam Schneider, Connor Mcpartland, Kaitlyn Boyd, Alice Karp, Abhay Singh, Md, Thenappan Chandrasekar, Md, Mark Mann, Md, Edouard Trabulsi, Md, Vishal Desai, Md, Costas Lallas, Md

Phase 1

Purpose:

Partial nephrectomies to remove renal masses are kidney-sparing procedures that rely on anatomical comprehension. Prior research demonstrates complex and expensive 3D models (~$1000) increased surgeons’ confidence in selecting their operative plan. We aim to use simpler and cheaper 3D models to improve preoperative surgeon confidence and support operative management.

Methods:

3D printed models (~$35) of the affected kidney, mass, and renal vasculature were created using preoperative CT or MRI imaging of 17 patients presenting for partial nephrectomies at Thomas Jefferson University (TJU) between July and December 2020. The models were created at TJU using Ultimaker technology.

Surgeons filled …

Race And Disordered Eating: A Narrative Review Of Current Literature, Casey Swann, Msed, Lee Pachter, Do, Elizabeth Liveright, Md, Meghan Gannon, Phd, Msph

Phase 1

Research Problem: Eating disorder literature has well-established a correlation between childhood trauma and development of eating disorder symptomology. One type of trauma that is often overlooked in eating disorder research is that of racial stress faced by ethnic minorities. The literature on racism and eating disorders tends to focus on the transdiagnostic construct of disordered eating behavior rather than specific DSM-5 diagnoses. As such, the current literature review examined the findings regarding associations between racial stressors and disordered eating behavior.

Methods: The current literature review between Nov 2007 and August 2020 searched 3 databases, PubMed, CINAHL, and PsycInfo for …

Focal St-Segment Elevation Without Coronary Occlusion: Myocardial Infarction With No Obstructive Coronary Atherosclerosis Associated With Covid-19-A Case Report, Casey Meizinger, Bruce D. Klugherz

Division of Cardiology Faculty Papers

Background: While it is understood that coronavirus disease 2019 (COVID-19) is primarily complicated by respiratory failure, more data are emerging on the cardiovascular complications of this disease. A subset of COVID-19 patients present with ST-elevations on electrocardiogram (ECG) yet normal coronary angiography, a presentation that can fit criteria for myocardial infarction with no obstructive coronary atherosclerosis (MINOCA). There is little known about non-coronary myocardial injury observed in patients with COVID-19, and we present a case that should encourage further conversation and study of this clinical challenge.

Case summary: An 86-year-old man presented to our institution with acute hypoxic respiratory failure …

The Reflection On The Management Of Toxic Epidermal Necrolysis In The Community Setting: An Internist's Perspective, Qian Zhang, Ali Raza Shaikh, Thomas Yoon, Shreeja Shah Shah, James W. Mahoney

Abington Jefferson Health Papers

Toxic epidermal necrolysis (TEN) is a dermatological emergency that is often associated with high mortality. It is differentiated from Stevens-Johnson syndrome (SJS) based on the percentage of the total body surface area affected. There has been an established correlation with certain medications that could trigger the development of such a devastating disease. Despite numerous research studies conducted on aspects of this disease entity, TEN remains foreign to many general Internists situated in a community setting due to the extremely low disease prevalence that leads to a lack of overall experience and medical resources in dealing with this medical condition. Thus, …

Fat Graft For Parotidectomy Defect Reconstruction In The Setting Of Malignant Disease, S. Hamad Sagheer, Bs, Alexander Knops, Ba, Kurren Gill, Md, Vivian Xu, Bs, Howard Krein, Md, Phd, Ryan Heffelfinger, Md

Department of Otolaryngology - Head and Neck Surgery Posters

Objectives: Currently, limited data examines the safety of utilizing fat transfers in the setting of malignant parotid disease. Here we evaluate the safety of fat graft reconstruction of parotidectomy defects in the setting of malignant disease.

Study Design: Retrospective cohort study

Methods: Electronic chart review of patients who underwent parotidectomy from 2012-2020 were reviewed.

Results: Three hundred and sixty-one patients were identified at a single institution who underwent parotidectomy, and 113 (31.3%) were for malignancy. One hundred and thirty-two patients underwent fat graft reconstruction (49.2%, n=65 for umbilical, 50.8%, n=67 for dermal). One-third of patients had malignant pathology (34.8%, n=46). …

Intraoperative Evaluation Of Nasal Valve Repair Interventions: A Prospective Analysis, Kurren Gill, Md, S. Hamad Sagheer, Bs, Cory Bovenzi, Md, Brian Yan, Ba, Howard Krein, Md, Phd, Ryan Heffelfinger, Md

Department of Otolaryngology - Head and Neck Surgery Posters

Objectives: To allow for early identification and treatment of inadequate nasal valve repair interventions in the intraoperative setting, based on degree of nasal valve collapse quantified by suction-assisted pressure readings. Patient outcomes were measured by comparison of pre- and post-operative Nasal Obstruction Symptom Evaluation (NOSE) surveys.

Study Design: Prospective study.

Methods: All enrolled patients undergo suction-assisted evaluation of nasal valve collapse before surgical intervention. Patients randomized into the experimental group underwent repeat assessment after various nasal valve interventions, compared to a control group where adequacy of interventions was assessed by palpation of the nasal ala.

Results: 20 patients who underwent …

Management Of Gliomas In Patients With Lynch Syndrome., Iyad Alnahhas, Appaji Rayi, Shirley Ong, Pierre Giglio, Vinay Puduvalli

Department of Neurology Faculty Papers

No abstract provided.

Printing The Pathway Forward In Bone Metastatic Cancer Research: Applications Of 3d Engineered Models And Bioprinted Scaffolds To Recapitulate The Bone-Tumor Niche., Anne M. Hughes, Alexus D. Kolb, Alison B. Shupp, Kristy M. Shine, Karen M. Bussard

Department of Cancer Biology Faculty Papers

Breast cancer commonly metastasizes to bone, resulting in osteolytic lesions and poor patient quality of life. The bone extracellular matrix (ECM) plays a critical role in cancer cell metastasis by means of the physical and biochemical cues it provides to support cellular crosstalk. Current two-dimensional in-vitro models lack the spatial and biochemical complexities of the native ECM and do not fully recapitulate crosstalk that occurs between the tumor and endogenous stromal cells. Engineered models such as bone-on-a-chip, extramedullary bone, and bioreactors are presently used to model cellular crosstalk and bone-tumor cell interactions, but fall short of providing a bone-biomimetic microenvironment. …

Hematopoietic Cell-Mediated Dissemination Of Murine Cytomegalovirus Is Regulated By Nk Cells And Immune Evasion., Shunchuan Zhang, Lauren E Springer, Han-Zhi Rao, Renee G Espinosa Trethewy, Lindsey M Bishop, Meaghan H Hancock, Finn Grey, Christopher M. Snyder

Department of Microbiology and Immunology Faculty Papers

Cytomegalovirus (CMV) causes clinically important diseases in immune compromised and immune immature individuals. Based largely on work in the mouse model of murine (M)CMV, there is a consensus that myeloid cells are important for disseminating CMV from the site of infection. In theory, such dissemination should expose CMV to cell-mediated immunity and thus necessitate evasion of T cells and NK cells. However, this hypothesis remains untested. We constructed a recombinant MCMV encoding target sites for the hematopoietic specific miRNA miR-142-3p in the essential viral gene IE3. This virus disseminated poorly to the salivary gland following intranasal or footpad infections but …

Early Hemodynamic Assessment Using Nicom In Patients At Risk Of Developing Sepsis Immediately After Emergency Department Triage., Steve B Chukwulebe, David F. Gaieski, Abhishek Bhardwaj, Lakeisha Mulugeta-Gordon, Frances S Shofer, Anthony J Dean

Department of Emergency Medicine Faculty Papers

BACKGROUND: One factor leading to the high mortality rate seen in sepsis is the subtle, dynamic nature of the disease, which can lead to delayed detection and under-resuscitation. This study investigated whether serial hemodynamic parameters obtained from a non-invasive cardiac output monitor (NICOM) predicts disease severity in patients at risk for sepsis.

METHODS: Prospective clinical trial of the NICOM device in a convenience sample of adult ED patients at risk for sepsis who did not have obvious organ dysfunction at the time of triage. Hemodynamic data were collected immediately following triage and 2 hours after initial measurement and compared in …

Algorithm For Cavo-Tricuspid Isthmus Flutter On Surface Ecgs: The Actions Study., Daniel Frisch, Eitan Frankel, Deanna Gill, Jad Al Danaf

Division of Cardiology Faculty Papers

OBJECTIVE: Cavo-tricuspid isthmus atrial flutter (CTI-AFL) is an important arrhythmia to recognise because there is a highly effective and relatively low-risk ablation strategy. However, clinical experience has demonstrated that providers often have difficulty distinguishing AFL from atrial fibrillation.

METHODS: We developed a novel ECG-based three-step algorithm to identify CTI-AFL based on established CTI flutter characteristics and verified on consecutive ablation cases of typical flutter, atypical flutter and atrial fibrillation. The algorithm assesses V1/inferior lead F-wave concordance, consistency of P-wave morphology and the presence of isoelectric intervals in the inferior leads. In this observation study, the algorithm was validated on a …