Medicine and Health Sciences Commons^™

Complete Chemical Structures Of Human Mitochondrial Trnas, Takeo Suzuki, Yuka Yashiro, Ittoku Kikuchi, Yuma Ishigami, Hironori Saito, Ikuya Matsuzawa, Shunpei Okada, Mari Mito, Shintaro Iwasaki, Ding Ma, Xuewei Zhao, Kana Asano, Huan Lin, Yohei Kirino, Yuriko Sakaguchi, Tsutomu Suzuki

Computational Medicine Center Faculty Papers

Mitochondria generate most cellular energy via oxidative phosphorylation. Twenty-two species of mitochondrial (mt-)tRNAs encoded in mtDNA translate essential subunits of the respiratory chain complexes. mt-tRNAs contain post-transcriptional modifications introduced by nuclear-encoded tRNA-modifying enzymes. They are required for deciphering genetic code accurately, as well as stabilizing tRNA. Loss of tRNA modifications frequently results in severe pathological consequences. Here, we perform a comprehensive analysis of post-transcriptional modifications of all human mt-tRNAs, including 14 previously-uncharacterized species. In total, we find 18 kinds of RNA modifications at 137 positions (8.7% in 1575 nucleobases) in 22 species of human mt-tRNAs. An up-to-date list of 34 …

In Reply: May Cooler Heads Prevail During A Pandemic: Stroke In Covid-19 Patients Or Covid-19 In Stroke Patients?, Pascal Jabbour, Ahmad Sweid, Stavropoula Tjoumakaris, Michel Piotin, Waleed Brinjikji, Kimon Bekelis, Eytan Raz, Nader Sourour, Shahid M. Nimjee, Demetrius K. Lopes, Ameer E. Hassan, Aditya S. Pandey, L. Fernando Gonzalez, Ricardo A. Hanel, Adnan H. Siddiqui, David Hasan, Sean D. Lavine, Bernard R. Bendok

Department of Neurosurgery Faculty Papers

No abstract provided.

Core Topic: Anemia, Marisyl De La Cruz, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Agenda

• Diagnosis and evaluation
• Approach to anemia
• Hypoproliferative
• Hyperproliferative
• Management of common anemias
• Cases
• Q & A

• Become familiar with signs and symptoms of anemia
• Use laboratory findings to differentiate anemias
• Review pathophysiology of anemia and recognize anemia as a symptom of other conditions
• Understand management of common anemias seen in primary care

Combination Of A Gellan Gum-Based Hydrogel With Cell Therapy For The Treatment Of Cervical Spinal Cord Injury, Eduardo D Gomes, Biswarup Ghosh, Rui Lima, Miguel Goulão, Tiago Moreira-Gomes, Joana Martins-Macedo, Mark W Urban, Megan C Wright, Jeffrey M Gimble, Nuno Sousa, Nuno A Silva, Angelo C Lepore, António J Salgado

Department of Neuroscience Faculty Papers

Cervical spinal cord trauma represents more than half of the spinal cord injury (SCI) cases worldwide. Respiratory compromise, as well as severe limb motor deficits, are among the main consequences of cervical lesions. In the present work, a Gellan Gum (GG)-based hydrogel modified with GRGDS peptide, together with adipose tissue-derived stem/stromal cells (ASCs) and olfactory ensheathing cells (OECs), was used as a therapeutic strategy after a C2 hemisection SCI in rats. Hydrogel or cells alone, and a group without treatment, were also tested. Four weeks after injury, compound muscle action potentials (CMAPs) were performed to assess functional phrenic motor neuron …

Anticoagulation And Bleeding Risk In Patients With Covid-19, Nancy Musoke, Kevin Bryan Lo, Jeri Albano, Eric Peterson, Ruchika Bhargav, Fahad Gul, Robert Dejoy, Grace Salacup, Jerald Pelayo, Padmavathi Tipparaju, Zurab Azmaiparashvili, Gabriel Patarroyo-Aponte, Janani Rangaswami

Department of Medicine Faculty Papers

BACKGROUND: There is no current standardized approach to anticoagulation in patients with Coronavirus Disease 2019 (COVID-19) while potential bleeding risks remain. Our study characterizes the patterns of anticoagulation use in COVID-19 patients and the risk of related bleeding.

METHODS: This is a single center retrospective analysis of 355 adult patients with confirmed diagnosis of COVID-19 from March 1 to May 31, 2020. Chi-square was used to analyze the relationship between degree of anticoagulant dose and bleeding events by site. Multivariable logistic regression was used to look at factors associated with inpatient death.

RESULTS: 61% of patients were being treated with …

When Limb Surgery Has Become The Only Life-Saving Therapy In Fop: A Case Report And Systematic Review Of The Literature, Esmée Botman, Sanne Treurniet, Wouter D Lubbers, Lothar A Schwarte, Patrick R Schober, Louise Sabelis, Edgar J G Peters, Annelies Van Schie, Ralph De Vries, Zvi Grunwald, Bernard J Smilde, Jakko A Nieuwenhuijzen, Marieke Visser, Dimitra Micha, Nathalie Bravenboer, J Coen Netelenbos, Bernd P Teunissen, Pim De Graaf, Pieter G H M Raijmakers, Jan Maerten Smit, Elisabeth M W Eekhoff

Department of Anesthesiology Faculty Papers

Fibrodysplasia ossificans progressiva (FOP) is a rare disease in which heterotopic ossification (HO) is formed in muscles, tendons and ligaments. Traumatic events, including surgery, are discouraged as this is known to trigger a flare-up with risk of subsequent HO. Anesthetic management for patients with FOP is challenging. Cervical spine fusion, ankylosis of the temporomandibular joints, thoracic insufficiency syndrome, restrictive chest wall disease, and sensitivity to oral trauma complicate airway management and anesthesia and pose life-threatening risks. We report a patient with FOP suffering from life-threatening antibiotic resistant bacterial infected ulcers of the right lower leg and foot. The anesthetic, surgical …

The Role Of Machine Learning In Spine Surgery: The Future Is Now, Michael Chang, Jose A Canseco, Kristen Nicholson, Neil Patel, Alex R. Vaccaro

Department of Orthopaedic Surgery Faculty Papers

The recent influx of machine learning centered investigations in the spine surgery literature has led to increased enthusiasm as to the prospect of using artificial intelligence to create clinical decision support tools, optimize postoperative outcomes, and improve technologies used in the operating room. However, the methodology underlying machine learning in spine research is often overlooked as the subject matter is quite novel and may be foreign to practicing spine surgeons. Improper application of machine learning is a significant bioethics challenge, given the potential consequences of over- or underestimating the results of such studies for clinical decision-making processes. Proper peer review …

Dysregulation Of Ryr Calcium Channel Causes The Onset Of Mitochondrial Retrograde Signaling, Anindya Roy Chowdhury, Satish Srinivasan, György Csordás, György Hajnóczky, Narayan G Avadhani

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

This study shows that multiple modes of mitochondrial stress generated by partial mtDNA depletion or cytochrome c oxidase disruption cause ryanodine receptor channel (RyR) dysregulation, which instigates the release of Ca2+ in the cytoplasm of C2C12 myoblasts and HCT116 carcinoma cells. We also observed a reciprocal downregulation of IP3R channel activity and reduced mitochondrial uptake of Ca2+. Ryanodine, an RyR antagonist, abrogated the mitochondrial stress-mediated increase in [Ca2+]c and the entire downstream signaling cascades of mitochondrial retrograde signaling. Interestingly, ryanodine also inhibited mitochondrial stress-induced invasive behavior in mtDNA-depleted C2C12 cells and HCT116 carcinoma cells. In addition, co-immunoprecipitation shows reduced FKBP12 …

Dosimetric Differences Between Cesium-131 And Iodine-125 Brachytherapy For The Treatment Of Resected Brain Metastases, Menachem Yondorf, Shahdabul Faraz, Andrew Smith, Albert Sabbas, Bhupesh Parashar, Theodore Schwartz, Gabriella Wernicke

Department of Radiation Oncology Faculty Papers

Purpose: To compare treatment plans and evaluate dosimetric characteristics of permanent cesium-131 (131Cs) vs. iodine-125 (125I) implants used in brain brachytherapy. Material and methods: Twenty-four patients with 131Cs implants from a prospective phase I/II trial were re-planned with 125I implants. In order to evaluate the volume of brain tissue exposed to radiation therapy (RT), the dose volume histogram was generated for both radioisotopes. To evaluate the dosimetric differences of the two radioisotopes we compared homogeneity (HI) and conformity indices (CI), and dose covering 100% (D100), 90% (D90), 80% (D80), and 50% (D50) of the clinical target volume (CTV). Results: At …

Covid-19 And Possible Links With Parkinson's Disease And Parkinsonism: From Bench To Bedside, David Sulzer, Angelo Antonini, Valentina Leta, Anna Nordvig, Richard Jay Smeyne, James E Goldman, Osama Al-Dalahmah, Luigi Zecca, Alessandro Sette, Luigi Bubacco, Olimpia Meucci, Elena Moro, Ashley S Harms, Yaqian Xu, Stanley Fahn, K Ray Chaudhuri

Department of Neuroscience Faculty Papers

This Viewpoint discusses insights from basic science and clinical perspectives on coronavirus disease 2019 (COVID-19)/severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection in the brain, with a particular focus on Parkinson's disease. Major points include that neuropathology studies have not answered the central issue of whether the virus enters central nervous system neurons, astrocytes or microglia, and the brain vascular cell types that express virus have not yet been identified. Currently, there is no clear evidence for human neuronal or astrocyte expression of angiotensin-converting enzyme 2 (ACE2), the major receptor for viral entry, but ACE2 expression may be activated by inflammation, and …

Chronic Muscle Pain, Michael Bozzi, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Learning Objectives ●How to approach the patient with chronic muscle pain ●How a complete history and physical can prevent extraneous testing and unnecessary or premature referrals ●Treatment strategies

Evaluation And Management Of Common Anorectal Complaints, Krys Foster, Md, Mph

Department of Family & Community Medicine Presentations and Grand Rounds

Objectives:

• Review the anatomy of the rectum and anus
• Learn skills to perform an appropriate H&P for anorectal complaints
• Appreciate key diagnostic features to common anorectal diagnoses
• Recognize risk factors and red flag signs/symptoms that prompt further evaluation and possible referral

Phosphorylation Of Cyclophilin D At Serine 191 Regulates Mitochondrial Permeability Transition Pore Opening And Cell Death After Ischemia-Reperfusion, Stephen Hurst, Fabrice Gonnot, Maya Dia, Claire Crola Da Silva, Ludovic Gomez, Shey-Shing Sheu

Department of Medicine Faculty Papers

The mitochondrial permeability transition pore (mPTP) plays a critical role in the pathogenesis of cardiovascular diseases, including ischemia/reperfusion injury. Although the pore structure is still unresolved, the mechanism through which cyclophilin D (CypD) regulates mPTP opening is the subject of intensive studies. While post-translational modifications of CypD have been shown to modulate pore opening, specific phosphorylation sites of CypD have not yet been identified. We hypothesized here that phosphorylation of CypD on a serine residue controls mPTP opening and subsequent cell death at reperfusion. We combined in silico analysis with in vitro and genetic manipulations to determine potential CypD phosphorylation …

Description And Reliability Of The Aospine Sacral Classification System, Alex R. Vaccaro, Gregory D. Schroeder, Srikanth N. Divi, Christopher K Kepler, Conor P Kleweno, James C. Krieg, Jefferson R Wilson, Jörg H Holstein, Mark Kurd, Reza Firoozabadi, Luiz R Vialle, F Cumhur Oner, Frank Kandziora, Jens R Chapman, Klaus J Schnake, Lorin M Benneker, Marcel F Dvorak, Shanmuganathan Rajasekaran, Emiliano N Vialle, Andrei F Joaquim, Mohammad Mostafa El-Sharkawi, Gaurav R Dhakal, Eugen C Popescu, Rishi M Kanna, S P J Muijs, Jin W Tee, Carlo Bellabarba

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Several classification systems exist for sacral fractures; however, these systems are primarily descriptive, are not uniformly used, have not been validated, and have not been associated with a treatment algorithm or prognosis. The goal of the present study was to demonstrate the reliability of the AOSpine Sacral Classification System among a group of international spine and trauma surgeons.

METHODS: A total of 38 sacral fractures were reviewed independently by 18 surgeons selected from an expert panel of AOSpine and AOTrauma members. Each case was graded by each surgeon on 2 separate occasions, 4 weeks apart. Intrarater reproducibility and interrater …

Identified Gaps And Opportunities In Perinatal Healthcare Delivery For Women In Treatment For Opioid Use Disorder., Karen Alexander, Vanessa Short, Megan Gannon, Neera Goyal, Madeline Naegle, Diane J Abatemarco

College of Nursing Faculty Papers & Presentations

Pregnancy and the delivery of an infant mark a unique time of engagement in healthcare for women in treatment for opioid use disorder (OUD). The American College of Obstetrics and Gynecology calls for a comprehensive approach to perinatal healthcare delivery for pregnant women with OUD in order to facilitate improved health outcomes and increase patient-provider collaboration. Yet, there is little knowledge regarding the perceptions of women with OUD regarding the current delivery of healthcare which could inform a personalized, tailored approach to perinatal healthcare delivery. Methods: Four focus groups consisting of 22 women with OUD were conducted, transcribed, and analysed …

Is Host Metabolism The Missing Link To Improving Cancer Outcomes?, Christopher M Wright, Anuradha A. Shastri, Emily K Bongiorno, Ajay Palagani, Ulrich Rodeck, Nicole L Simone

Kimmel Cancer Center Faculty Papers

For the past 100 years, oncologists have relentlessly pursued the destruction of tumor cells by surgical, chemotherapeutic or radiation oncological means. Consistent with this focus, treatment plans are typically based on key characteristics of the tumor itself such as disease site, histology and staging based on local, regional and systemic dissemination. Precision medicine is similarly built on the premise that detailed knowledge of molecular alterations of tumor cells themselves enables better and more effective tumor cell destruction. Recently, host factors within the tumor microenvironment including the vasculature and immune systems have been recognized as modifiers of disease progression and are …

Hamman-Rich Syndrome: A Diagnosis Of Exclusion In The Covid-19 Pandemic., Qian Zhang, Ahmad Raza, Vincent Chan, Artem Minalyan, John Madara, Md

Abington Jefferson Health Papers

Hamman-Rich syndrome is a rapidly progressive interstitial lung disease with acute respiratory distress syndrome physiology. It carries a grave prognosis and a high early mortality rate. It is often distinguished from other similar pulmonary pathologies based on the clinical course, laboratory findings, bronchoalveolar lavage testing, and pathology report. We detail a 77-year-old lady with no prior pulmonary disease, smoking history, or occupational and environmental exposures present to the emergency department found to be in acute hypoxic respiratory failure with impressive progressive radiographic findings. The presumptive diagnosis of Hamman-Rich syndrome was made based on a combination of factors after ruling out …

Serum Ammonia And Folate Levels: Opportunities For High Value Care, R. Benson Jones Jr., Md, Sean Dikdan, Md, Bracken Babula, Md

The Medicine Forum

High value care encompasses a variety of principles including ordering tests with high diagnostic yield, while reducing low value practice.

Refusing To Be Labeled, Jennifer Perugini

The Medicine Forum

Refusing to be Labeled

Case Report Of E-Cigarette Associated Lung Injury In A Health Female, Mario Fonseca-Paricio, Md, Alan Gandler, Md, Boyd Hehn, Md

The Medicine Forum

This is a case of a woman presenting with four days of diarrhea and dyspenea found to have E-cigarette or vaping-associated lung injury (EVALI)

A Case Report Of Bullous Subconjunctival Hemorrhag In Adenoviral Conjunctivitis, Sean Haynie, Jesse Johnson, Md

The Medicine Forum

A 78-year-old female with a past medical history of optic neuropathy and atrial fibrillation on warfarin presented with two weeks of progressive bilateral eye redness, swelling, pain, and blurry vision.

A Case Report Of Tragaxofusp Causing Severe Tumor Lysis Syndrome In A Patient With Blastic Plasmacytoid Dendritic Cell Neoplasm, Shuwen Lin, Md, Alice Wang, Md

The Medicine Forum

The patient was an 83-year-old male without significant past medical hsitory who presented to his primary care physician with several days of generalized malaise

Exploring The Adverse Effects Of Car-T Therapy: A Cases Report Of Potential Minoca In Car-T, Danielle Verghese, Pgy-1, Adam Binder, Md, Colin Thomas, Md

The Medicine Forum

A 48-year-old man with a history of Stage IV Diffuse Large B-Cell Lymphoma refractory to R-CHOP alternating with high-dose methotrexate and cytarbine, craniospinal irradiation, and haploidentical stem cell transplant, underwent CD 19-directed CAR-T.

A Case Report Of Hemophagocytic Lymphohistiocytosis Secondary To Disseminated Tuberculosis, Shuwen Lin, Md, Christoher Terry

The Medicine Forum

A 72-year-old woman with past medical history of hypertention and type 2 diabsetes presented to the emergency department for one day history of fevers, poor oral intake, and fatigue.

From The Desk Of The Residency Program Director, Emily Stewart, Md, Facp

The Medicine Forum

It has been a historic year for the Nation, City of Philadelphia and teh Jefferson Internal Medicine Residency Program. We have eperienced many health care crises starting with the closure of the historic Philadelphia hospital, Hahnemann. We welcomed residents form this program as part of the Jefferson Family and integrated many patients into our practices.

From The Editors, Eitan Frankel, Md, Guy Katz, Rachel Redfield, Navdeep Sangha, Michael Weintraub, Randi Zukas

The Medicine Forum

We are delighted to present you with the 21st annual edition of The Medicine Forum.Here in the birthplace of our nation, we like to think of The Medicine Forum as being of the housestaff, by the housestaff and for the housestaff. Undeniably, this publication would not be possible without the countless hours dedicated by our residents, students, fellows and faculty.

Table Of Contents: The Medicine Forum Volume 21, 2019-2020

The Medicine Forum

Table of Contents: The Medicine Forum Volume 21, 2019-2020

An Unusual Treatment For Chronic Myelomonocytic Leukemia, Eric Warner, Msiii, Neil Palmisiano, Md

The Medicine Forum

A 76-year-old female with a past medical history of an extraosseous chondrasrcoma status-post-resection thirty years prior, hypertension, hyperlipidemia, and hypothyroidsimm presented to her primary care physicial with fatigue, two weeks of dyspnea on exertion, lightheadedness, and nausea.

Diagnosing Non-Hfe Hereditary Hemochromatosis, Brian Park, Md, Naman Upadhyay, Md, Dina Halegoua-Demarzio, Md

The Medicine Forum

A 63-year-old Caucasian female presented for evaluation of abnormal bile duct appearance on ERCP after being diagnosed with gallstone pancreatitis, duodenal ulcers and gastritis at another hospital.

Pericardial Effusion With Tamponade Physiology In A Patient With Multiple Myeloma, Sairamya Bodempudi, Md, Rukaiya Bashir-Hamidu, Md, Preya Simlote, Md, Shuwen Lin, Md, Philip Margiotta, Md, Tina Boortalary, Md, Gregary D. Marhefka, Md

The Medicine Forum

A 78-yeaer old African American female with a past medical history of IgA Kappa Multiple Myseloma was transfered to the Cardiovascular Intensive Care Unit (CVICU) at Thomas Jefferson University Hospital (TJUH) after being diagnosed with a pericardial effusion with tamponade physiology at an outside hospital.