Medicine and Health Sciences Commons^™

The Roles Of Grks In Hemostasis And Thrombosis, Xi Chen, Xuefei Zhao, Matthew Cooper, Peisong Ma

Department of Medicine Faculty Papers

Along with cancer, cardiovascular and cerebrovascular diseases remain by far the most common causes of death. Heart attacks and strokes are diseases in which platelets play a role, through activation on ruptured plaques and subsequent thrombus formation. Most platelet agonists activate platelets via G protein-coupled receptors (GPCRs), which make these receptors ideal targets for many antiplatelet drugs. However, little is known about the mechanisms that provide feedback regulation on GPCRs to limit platelet activation. Emerging evidence from our group and others strongly suggests that GPCR kinases (GRKs) are critical negative regulators during platelet activation and thrombus formation. In this review, …

Risk Factors Of Recurrent Falls Among Older Adults Admitted To The Trauma Surgery Department., William Curran-Groome, Gary Klein, Stanton Miller, Azor Hui, Jordan S Wilson, Chol Kuoiloi, Venkata Masarapu, Andre Alabd, Toni Mascaro, Gideon Logan, Jonathan Lubeck

Department of Surgery Faculty Papers

Falls affect more than 29 million American adults ages ≥65 years annually. Many older adults experience recurrent falls requiring medical attention. These recurrent falls may be prevented through screening and intervention. In 2014 to 2015, records for 199 older adult patients admitted from a major urban teaching hospital’s emergency department were queried. Open-ended variables from clinicians’ notes were coded to supplement existing closed-ended variables. Of the 199 patients, 52 (26.1%) experienced one or more recurrent falls within 365 days after their initial fall. Half (50.0%) of all recurrent falls occurred within the first 90 days following discharge. A large proportion …

Percutaneous Intervention Or Bypass Graft For Left Main Coronary Artery Disease? A Systematic Review And Meta-Analysis, Waqas Ullah, Yasar Sattar, Irfan Ullah, Ammu Susheela, Maryam Mukhtar, M Chadi Alraies, Mamas A Mamas, D L Fischman

Abington Jefferson Health Papers

Background: The safety and efficacy of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) for stable left main coronary artery disease (LMCAD) remains controversial.

Methods: Digital databases were searched to compare the major adverse cardiovascular and cerebrovascular events (MACCE) and its components. A random effect model was used to compute an unadjusted odds ratio (OR).

Results: A total of 43 studies (37 observational and 6 RCTs) consisting of 29,187 patients (PCI 13,709 and CABG 15,478) were identified. The 30-day rate of MACCE (OR, 0.56; 95% CI, 0.42-0.76;

Conclusion: PCI might offer early safety advantages, while CABG provides greater …

The Medicine Forum: Volume 21

The Medicine Forum

The Journal of Thomas Jefferson University Hospital - Department of Internal Medicine, Volume 21, 2019-2020

TABLE OF CONTENTS

Clinical Images

Case Reports

• Cardiology
• Gastroenterology and Hepatology
• Hematology and Oncology
• Infectious Disease
• Pulmonary Medicine

Literature Review

Editorial

Denosumab-Induced Hypocalcemia After Billroth Ii Gastric Bypass Surgery., Abigail M Schmucker, Dina E Green, Philip M Montemuro

Student Papers, Posters & Projects

Hypocalcemia is a known risk following bariatric surgery and can contribute to the development of osteoporosis. Osteoporosis is commonly treated with denosumab, though denosumab can exacerbate underlying abnormalities in calcium homeostasis. We present the case of a 59-year-old female with severe hypocalcemia who had been treated with denosumab for osteoporosis three months before and had Billroth II gastric bypass surgery 15 years before, for bariatric purposes. Intravenous calcium supplementation was used to correct the initial electrolyte abnormality, and the patient was able to maintain appropriate calcium levels on high doses of oral calcium before discharge. Denosumab-induced hypocalcemia has been previously …

Deacetylation Of Hsd17b10 By Sirt3 Regulates Cell Growth And Cell Resistance Under Oxidative And Starvation Stresses., Lu Liu, Shuaiyi Chen, Miao Yu, Chenxu Ge, Mengmeng Ren, Boya Liu, Xin Yang, Thomas W Christian, Ya-Ming Hou, Junhua Zou, Wei-Guo Zhu, Jianyuan Luo

Department of Biochemistry and Molecular Biology Faculty Papers

17-beta-hydroxysteroid dehydrogenase 10 (HSD17B10) plays an important role in mitochondrial fatty acid metabolism and is also involved in mitochondrial tRNA maturation. HSD17B10 missense mutations cause HSD10 mitochondrial disease (HSD10MD). HSD17B10 with mutations identified from cases of HSD10MD show loss of function in dehydrogenase activity and mitochondrial tRNA maturation, resulting in mitochondrial dysfunction. It has also been implicated to play roles in the development of Alzheimer disease (AD) and tumorigenesis. Here, we found that HSD17B10 is a new substrate of NAD-dependent deacetylase Sirtuin 3 (SIRT3). HSD17B10 is acetylated at lysine residues K79, K99 and K105 by the acetyltransferase CBP, and the …

Beyond The Waiver Training: Practical Tips You May Not Have Learned, Lara Weinstein, Md, Mph, Drph, Erica Li, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Objectives

• Understand the critical importance of philosophy, structure, and access in MAT
• Share practical tips for starting MAT in your practice
• Discuss lessons learned with developing a MAT program

Journal Club: Emergency Department–Initiated Buprenorphine/Naloxone Treatment For Opioid Dependence, Simon Newsom

Department of Family & Community Medicine Presentations and Grand Rounds

Learning Objectives

• Briefly highlight OUD
• Current ED practices
• Review study
• Future directions

Regional And Experiential Differences In Surgeon Preference For The Treatment Of Cervical Facet Injuries: A Case Study Survey With The Ao Spine Cervical Classification Validation Group, Jose A Canseco, Gregory D Schroeder, Parthik D Patel, Giovanni Grasso, Michael Chang, Frank Kandziora, Emiliano N Vialle, F Cumhur Oner, Klaus J Schnake, Marcel F Dvorak, Jens R Chapman, Lorin M Benneker, Shanmuganathan Rajasekaran, Christopher K Kepler, Alexander R Vaccaro

Department of Neurosurgery Faculty Papers

PURPOSE: The management of cervical facet dislocation injuries remains controversial. The main purpose of this investigation was to identify whether a surgeon's geographic location or years in practice influences their preferred management of traumatic cervical facet dislocation injuries.

METHODS: A survey was sent to 272 AO Spine members across all geographic regions and with a variety of practice experience. The survey included clinical case scenarios of cervical facet dislocation injuries and asked responders to select preferences among various diagnostic and management options.

RESULTS: A total of 189 complete responses were received. Over 50% of responding surgeons in each region elected …

Managing Acute Kidney Injury (Aki) In The Setting Of The Covid-19 Patient Surge, Alan Kliger, Renee Garrick, Leslie Wong, David Chartyan, George Coritsidis, Jeffrey Silberzweig, Savneek Chugh

COVID-19: Spread the Science, not the Virus Seminar Series

Presented by the Greater New York Hospital Association

This panel of nephrologists cared for patients at the height of the spring surge in the Northeast. The aim of the webinar is to share highly technical clinical knowledge and experiences with clinicians across the country who are or will be encountering critically ill patients with Acute Kidney Injury due to COVID-19. Examples of topics include discussion of therapeutic options, use of treatment modalities, and strategies for managing scarce resources.

Featured Speakers:

• Dr. Alan Kliger, Yale School of Medicine
• Dr. Renee Garrick, New York Medical College-Westchester Medical Center
• Dr. Leslie Wong, The …

Can Contrast Enhanced Ultrasound Differentiate Intrahepatic Cholangiocarcinoma From Hepatocellular Carcinoma?, Jia-Yan Huang, Jia-Wu Li, Wen-Wu Ling, Tao Li, Yan Luo, Ji-Bin Liu, Qiang Lu

Department of Radiology Faculty Papers

BACKGROUND: Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) differ in treatment and prognosis, warranting an effective differential diagnosis between them. The LR-M category in the contrast-enhanced ultrasound (CEUS) liver imaging reporting and data system (LI-RADS) was set up for lesions that are malignant but not specific to HCC. However, a substantial number of HCC cases in this category elevated the diagnostic challenge.

AIM: To investigate the possibility and efficacy of differentiating ICC from HCC classified in the LR-M category according to the CEUS LI-RADS.

METHODS: Patients with complete CEUS records together with pathologically confirmed ICC and LR-M HCC (HCC classified …

Lyssavirus Vaccine With A Chimeric Glycoprotein Protects Across Phylogroups, Christine R Fisher, David E Lowe, Todd G Smith, Yong Yang, Christina L Hutson, Christoph Wirblich, Gino Cingolani, Matthias J. Schnell

Department of Biochemistry and Molecular Biology Faculty Papers

Rabies is nearly 100% lethal in the absence of treatment, killing an estimated 59,000 people annually. Vaccines and biologics are highly efficacious when administered properly. Sixteen rabies-related viruses (lyssaviruses) are similarly lethal, but some are divergent enough to evade protection from current vaccines and biologics, which are based only on the classical rabies virus (RABV). Here we present the development and characterization of LyssaVax, a vaccine featuring a structurally designed, functional chimeric glycoprotein (G) containing immunologically important domains from both RABV G and the highly divergent Mokola virus (MOKV) G. LyssaVax elicits high titers of antibodies specific to both RABV …

Variants Of The Human Rad52 Gene Confer Defects In Ionizing Radiation Resistance And Homologous Recombination Repair In Budding Yeast, Alissa D Clear, Glenn M Manthey, Olivia Lewis, Isabelle Y Lopez, Rossana Rico, Shannon Owens, M Cristina Negritto, Elise W Wolf, Jason Xu, Nikola Kenjić, J Jefferson P Perry, Aaron W Adamson, Susan L Neuhausen, Adam M Bailis

College of Health Professions Faculty Papers

RAD52 is a structurally and functionally conserved component of the DNA double-strand break (DSB) repair apparatus from budding yeast to humans. We recently showed that expressing the human gene, HsRAD52 in rad52 mutant budding yeast cells can suppress both their ionizing radiation (IR) sensitivity and homologous recombination repair (HRR) defects. Intriguingly, we observed that HsRAD52 supports DSB repair by a mechanism of HRR that conserves genome structure and is independent of the canonical HR machinery. In this study we report that naturally occurring variants of HsRAD52, one of which suppresses the pathogenicity of BRCA2 mutations, were unable to suppress …

Where There's Smoke, There's Fire: What Current And Future Providers Do And Do Not Know About Electronic Cigarettes., Josephine Hwang, Mdc, Mphc, Crystal Lee, Eric Mastrolonardo, Rosemary Frasso Phd, Msc, Cph

College of Population Health Faculty Papers

BACKGROUND: Health care providers play a pivotal role as educators on health-related matters ranging from vaccination to smoking cessation. With the rising popularity of electronic cigarettes (e-cigarettes), providers face a new challenge. To date, studies have identified a general lack of knowledge among providers regarding e-cigarettes and discomfort with counseling patients on e-cigarette use. This study aims to systematically explore the perspectives of different health care providers on e-cigarettes and their health implications. With a growing availability of research on the health consequences of e-cigarette use, our study also aims to assess the familiarity of our participants with this literature. …

Review Of Treatment Options For Pneumonia In The Inpatient Setting, Shirley B Bonanni

Department of Family & Community Medicine Presentations and Grand Rounds

No abstract provided.

Management Of Neonatal Hyperbilirubinemia, David Schutzman

Department of Family & Community Medicine Presentations and Grand Rounds

No abstract provided.

Refugee Health In Philadelphia, Marc Altshuler

Department of Family & Community Medicine Presentations and Grand Rounds

Objectives

1. Define the U.S. refugee resettlement process
2. Discuss the history of refugee health in Philadelphia and the creation of the Jefferson Center for Refugee Health
3. Review selected data on our patients
4. Learn how to utilize new resources to care for refugees

Diabetes Prevention: Your Role As A Healthcare Professional (July 15, 2020), Alexis Skoufalos, Edd, Mitch Kaminski, Md, Mba, Neha Sachdev, Md, Susanne Trexler, Ches, Gina Trignani, Ms, Rd, Ldn, Neva White, Dnp, Crnp-Bc, Cde

The Philadelphia Diabetes Prevention Collaborative invites you to learn about the latest in screening, testing and how to easily refer your patients to a National Diabetes Prevention (DPP) lifestyle change program within the greater Philadelphia five-county area.

Featuring Health Promotion Council of Southeastern Pennsylvania, the American Medical Association, and the Center for Urban Health and College of Population Health at Jefferson

'It's Common Sense That An Individual Must Eat': Advocating For Food Justice With People With Psychiatric Disabilities Through Photovoice., Lara Carson Weinstein, Mariana Chilton, Renee Turchi, Ann C Klassen, Marianna Lanoue, Alexis Silvero, Leopoldo J Cabassa

Department of Family & Community Medicine Faculty Papers

BACKGROUND: People with SMI have often been excluded in advocacy efforts focused on physical health, health care and health and social policy.

OBJECTIVE: Following a Photovoice project focused on barriers to healthy eating and physical activity in urban neighbourhoods, participant-researchers were invited to present their insights in community advocacy settings. The purpose of this study was to explore the feasibility and participant-researchers' experience of these community advocacy activities.

DESIGN: We held four focus groups with the eight participant-researchers after each community advocacy activity to explore their experience with public speaking, presenting their experiences and advocating.

SETTING AND PARTICIPANTS: People with …

Experience Of Stigma Post Incarceration: A Qualitative Study, Rebecca Sinko, Tina M. Deangelis, Bernadette Alpajora, Josephine Beker, Ilyse Kramer

Department of Occupational Therapy Faculty Papers

Background: Minimal attention has been given to the perspectives and experiences of individuals post incarceration regarding stigma and its impact on reintegration and occupational engagement. This research aimed to understand how stigma is experienced among individuals who were formerly incarcerated and its influence on occupational engagement, specifically social participation, work, and school occupations. This research also examined the role of occupational therapy as an intervention in addressing stigma from the perspectives of individuals who were formerly incarcerated to inform practice and mitigate the influence of stigma. Method: Interviews were conducted with 10 participants of a work rehabilitation program for people …

Integrative Medicine In Health And Well-Being, Andrew Newberg, Madeline Becker

Department of Family & Community Medicine Presentations and Grand Rounds

For integrative approaches to become part of standard care, research is required to understand clinical effects. Clinical data needs to be supplemented by mechanistic studies. Integrative medicine and general medicine have multiple areas of intersection. Studies can evaluate mental and physical disorders such as depression or anxiety or chronic pain and fatigue. Studies can evaluate psychological symptoms associated with other medical and neurological disorders. It is important to establish efficacy and also mechanism. Future collaborations are very welcome!

Drug-Resistant Epilepsy In Children With Juvenile Huntington's Disease: A Challenging Case And Brief Review, Abdulhafeez Khair, Jessica Kabrt, Stephen Falchek

Department of Neurology Faculty Papers

Huntington's Disease (HD) is an autosomal dominant neurodegenerative disorder with a progressive decline in cognitive, motor, and psychological function. Chorea tends to be the most common associated movement disorder, although other variants of several abnormal movements are also seen. Adult-onset HD is the most common subtype. Juvenile Huntington's disease (JHD) accounts for 5%-10% of all HD cases and presents as a rapidly progressive disorder with a multitude of characteristics. We report on a 9-year-old male with JHD who presented with refractory epilepsy. His EEG findings, seizure type, and antiepileptic drug usage are discussed with a brief review of the currently …

Employment And Patient Satisfaction After Liver Transplantation, Christopher Cao, Dina Halegoua-De Marzio, Shady Guirguis, Crystal Chen, Jonathan M. Fenkel, Steven Herrine

Division of Gastroenterology and Hepatology Faculty Papers

Background and Aims: This study serves to revisit the effects of liver transplantation (LT) on employment in an era of improving survival outcomes post-transplant, and to identify areas of improvement in the transplant process to better op-timize post-LT employment and patient satisfaction. Methods: Prospectively, patients who had undergone LT at a single tertiary LT center were surveyed in person and by e-mail. Primary outcomes included employment rate pre-and post-LT, annual salary, weekly hours worked, barriers to re-employment, and patient satisfaction. Results: Responses were collected and analyzed from 121 patients who underwent LT. Pre-LT, 68 (56.1%) reported full-time employ-ment, 13 (10.7%) …

Fruit And Vegetable Consumption Is Associated With Lower Prevalence Of Asymptomatic Diverticulosis: A Cross-Sectional Colonoscopy-Based Study., Benjamin Maxner, Jessica Mcgoldrick, Danielle Bellavance, Po-Hong Liu, Ramnik J Xavier, Joseph C Yarze, Rocco Ricciardi, Kyle Staller, Daniel C Chung, Hamed Khalili

Department of Medicine Faculty Papers

BACKGROUND: Previous studies of the relationship between dietary factors and risk of diverticulosis have yielded inconsistent results. We therefore sought to investigate the association between consumption of fruit and vegetables and prevalent diverticulosis.

METHODS: Our study population included participants in the Gastrointestinal Disease and Endoscopy Registry (GIDER), a colonoscopy-based longitudinal cohort at the Massachusetts General Hospital, who provided comprehensive information on dietary intake and lifestyle factors using validated questionnaires prior to colonoscopy. Information on presence and location of diverticula was obtained from the endoscopist at the end of each procedure. We used Poisson regression modeling to calculate the prevalence ratios …

A Mysterious Paratracheal Mass: Parathyroid Carcinoma., Qian Zhang, Khine S. Shan, Neethu Gopisetti, Md, Thomas Yoon, Iqra Iqbal

Abington Jefferson Health Papers

Parathyroid carcinoma is a rare cause of primary hyperparathyroidism. We detail a 60-years-old gentleman who was otherwise healthy presented to the hospital due to acute encephalopathy. He was subsequently found to have parathyroid carcinoma as the cause of the acute encephalopathy with impressive serum calcium and parathyroid hormone levels. The parathyroid carcinoma was later surgically resected with the diagnosis confirmed via pathology specimen. The patient was safely discharged from the hospital with recommendations of close routine outpatient followup.

Physiochemical Characteristics Of Hot And Cold Brew Coffee Chemistry: The Effects Of Roast Level And Brewing Temperature On Compound Extraction., Niny Z. Rao, Megan Fuller, Meghan D Grim

College of Life Sciences Faculty Papers

The role of roasting in cold brew coffee chemistry is poorly understood. The brewing temperature influences extraction processes and may have varying effects across the roast spectrum. To understand the relationship between brew temperature and roast temperature, hot and cold brew coffees were prepared from Arabica Columbian coffee beans roasted to light, medium, and dark levels. Chemical and physical parameters were measured to investigate the relationships among degree of roast, water temperature, and key characteristics of resulting coffees. Cold brew coffees showed differential extraction marked by decreased acidity, lower concentration of browned compounds, and fewer TDS indicating that cold water …

Perfusion-Guided Sonopermeation Of Neuroblastoma: A Novel Strategy For Monitoring And Predicting Liposomal Doxorubicin Uptake, Aditi Bellary, Arelly Villarreal, Rojin Eslami, Quincy J Undseth, Bianca Lec, Ann M Defnet, Naina Bagrodia, Jessica J Kandel, Mark A Borden, Sumbul Shaikh, Rajiv Chopra, Theodore W Laetsch, Lauren J. Delaney, Colette Shaw, Md, John R. Eisenbrey, Sonia L Hernandez, Shashank R Sirsi

Department of Radiology Faculty Papers

Neuroblastoma (NB) is the most common extracranial solid tumor in infants and children, and imposes significant morbidity and mortality in this population. The aggressive chemoradiotherapy required to treat high-risk NB results in survival of less than 50%, yet is associated with significant long-term adverse effects in survivors. Boosting efficacy and reducing morbidity are therefore key goals of treatment for affected children. We hypothesize that these may be achieved by developing strategies that both focus and limit toxic therapies to the region of the tumor. One such strategy is the use of targeted image-guided drug delivery (IGDD), which is growing in …

Resident Ume Updates, Fred Markham, Marisyl Delacruz

Department of Family & Community Medicine Presentations and Grand Rounds

Agenda

1. Guidelines for Students in Clinical Spaces
2. Grading and feedback
3. RIME scheme
4. Telehealth, QI curriculum
5. Phase 3 Updates and JeffDOT
6. Q&A

Consensus Guidelines For Digital Scholarship In Academic Promotion., Abbas Husain, Zachary Repanshek, Manpreet Singh, Felix Ankel, Jennifer Beck-Esmay, Daniel Cabrera, Teresa M Chan, Robert Cooney, Michael Gisondi, Michael Gottlieb, Jay Khadpe, Jennifer Repanshek, Jessica Mason, Dimitrios Papanagnou, Jeff Riddell, N Seth Trueger, Fareen Zaver, Emily Brumfield

Department of Emergency Medicine Faculty Papers

INTRODUCTION: As scholarship moves into the digital sphere, applicant and promotion and tenure (P&T) committee members lack formal guidance on evaluating the impact of digital scholarly work. The P&T process requires the appraisal of individual scholarly impact in comparison to scholars across institutions and disciplines. As dissemination methods evolve in the digital era, we must adapt traditional P&T processes to include emerging forms of digital scholarship.

METHODS: We conducted a blended, expert consensus procedure using a nominal group process to create a consensus document at the Council of Emergency Medicine Residency Directors Academic Assembly on April 1, 2019.

RESULTS: We …

A Novel Signature Based On Microvascular Invasion Predicts The Recurrence Of Hcc., Binbin Du, Fang Wang, Beers Jarad, Zhihui Wang, Yanzhou Zhang

Department of Medicine Faculty Papers

BACKGROUND AND OBJECTIVES: In hepatocellular carcinoma (HCC) patients, microvascular invasion (MVI) is associated with worse outcomes regardless of treatment. No single reliable preoperative factor exists to predict MVI. The aim of the work described here was to develop a new MVI- based mRNA biomarker to differentiate between high and low risk patients.

METHODS: Using The Cancer Genome Atlas (TCGA) database, we collected data from 315 HCC patients, including mRNA expression and complete clinical data. We generated a seven-mRNA signature to predict patient outcomes. The mRNA signature was validated using the GSE36376 cohort. Finally, we tested the formula in our own …