Medicine and Health Sciences Commons^™

No Double Trouble: How To Reopen The Economy., Larry Hirschhorn, Phd

School of Continuing and Professional Studies Coronavirus Papers

This policy introduces a measure of choice, consonant with our culture. Those younger than 65 can make their own personal tradeoffs between heath and livelihood, while older people, knowing that the virus will be spreading more quickly through the population will be even more cautious, thus preventing their early deaths. We return decisions to people while ensuring that the sum total of decisions does not overwhelm our hospitals. One felicitous result of this policy is that the virus will spread more quickly through the healthier population. This means that when the elderly re-engage in social life they will encounter fewer …

Systems View Of Coronavirus, Sung Won Paek, Larry M. Starr

School of Continuing and Professional Studies Coronavirus Papers

No one envisioned the kinds of problems that emerged from the novel coronavirus nor had anyone considered its interactive scope. Now is the time to begin to redesign our processes and systems so that when confronted again we can cope and navigate better. Everyone needs to be a partner in these redesigns and each of the health, social, educational, and other systems must be integrated because it is their interconnections that coproduce and give meaning to our lives.

Ultra-Low-Dose Estrogen Therapy For Female Hypogonadism., Yukihiro Hasegawa, Tomoyo Itonaga, Kento Ikegawa, Satsuki Nishigaki, Masanobu Kawai, Eri Koga, Hideya Sakakibara, Judith L Ross

Department of Pediatrics Faculty Papers

In females, endogenous estrogen secretion increases gradually before pubertal development. The benefits of low-dose estrogen therapy in patients with Turner syndrome were originally discussed by Ross et al. and Quigley et al. These seminal studies used ethinyl estradiol (EE2), starting at a dose of 25 ng/kg/d. We hypothesized that the initial dosage of estrogen could be titrated to more closely mimic physiological increments of endogenous estrogen. Therefore, our recent study initiated EE2 treatment at a dosage of 1-2 ng/kg/d, an ultra-low-dose estrogen therapy in pediatric patients with Turner syndrome. The ultra-low-dose estrogen therapy in this syndrome produced a good …

Association Of Interleukin 10 Rs1800896 Polymorphism With Susceptibility To Breast Cancer: A Meta-Analysis., Ziyin Zhu, Ji-Bin Liu, Xi Liu, Linxue Qian

Department of Radiology Faculty Papers

Objective: To evaluate the correlation between interleukin 10 (IL-10) -1082A/G polymorphism (rs1800896) and breast cancers by performing a meta-analysis.

Methods: The Embase and Medline databases were searched through 1 September 2018 to identify qualified articles. Odds ratios (OR) and corresponding 95% confidence intervals (CIs) were applied to evaluate associations.

Results: In total, 14 case-control studies, including 5320 cases and 5727 controls, were analyzed. We detected significant associations between the IL10 -1082 G/G genotype and risk of breast cancer (AA + AG vs. GG: OR = 0.88, 95% CI = 0.80-0.97). Subgroup analyses confirmed a significant association in Caucasian populations (OR …

Discrepancies In Written Versus Calculated Durations In Opioid Prescriptions: Pre-Post Study., Benjamin H. Slovis, John Kairys, Bracken Babula, Melanie Girondo, Cara Martino, Lindsey M. Roke, Jeffrey Riggio

Department of Medicine Faculty Papers

BACKGROUND: The United States is in the midst of an opioid epidemic. Long-term use of opioid medications is associated with an increased risk of dependence. The US Centers for Disease Control and Prevention makes specific recommendations regarding opioid prescribing, including that prescription quantities should not exceed the intended duration of treatment.

OBJECTIVE: The purpose of this study was to determine if opioid prescription quantities written at our institution exceed intended duration of treatment and whether enhancements to our electronic health record system improved any discrepancies.

METHODS: We examined the opioid prescriptions written at our institution for a 22-month period. We …

Health Screenings Administered During The Domestic Medical Examination Of Refugees And Other Eligible Immigrants In Nine Us States, 2014-2016: A Cross-Sectional Analysis., Clelia Pezzi, Deborah Lee, Gayathri S. Kumar, Breanna Kawasaki, Lori Kennedy, Jenny Aguirre, Melissa Titus, Rebecca Ford, Blain Mamo, Kailey Urban, Stephen Hughes, Colleen Payton, Kevin Scott, Jessica Montour, Emily S. Jentes

Department of Family & Community Medicine Faculty Papers

BACKGROUND: Refugees and other select visa holders are recommended to receive a domestic medical examination within 90 days after arrival to the United States. Limited data have been published on the coverage of screenings offered during this examination across multiple resettlement states, preventing evaluation of this voluntary program's potential impact on postarrival refugee health. This analysis sought to calculate and compare screening proportions among refugees and other eligible populations to assess the domestic medical examination's impact on screening coverage resulting from this examination.

METHODS AND FINDINGS: We conducted a cross-sectional analysis to summarize and compare domestic medical examination data from …

Use Of Virtual Communication During Level Ii Fieldwork: A Personal Experience, Laronda Lockhart-Keene, Otd, Otr/L, Cla, Emily Spinelli, Cota/L

Department of Occupational Therapy Posters and Presentations

In fieldwork sites where no full time OTP is employed, a fieldwork student requires 8 hours a week of onsite supervision from an OTP. An onsite supervisor of another profession must be available while the OTP is offsite. The other professional is unable to answer questions related directly to occupational therapy (OT) practice. This poster describes virtual communication methods used during a level II fieldwork at a community based wellness program for older adults and how these methods translate to OT/OTA supervision in practice.

Primary & Secondary Prevention Of Cardiovascular Disease In Primary Care, Marshall Miller, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Overview

Review historical perspective and complexity of primary CVD prevention

Discuss primary & secondary prevention of CAD and the 2019 ACC/AHA guidelines

-- Review of the evidence & primary literature

• Focus on CV risk assessment, DM, ASA/DAPT
• Practical guidance and management considerations

-- CASES- let’s practice and discuss

Utilizing Digital Health To Collect Electronic Patient-Reported Outcomes In Prostate Cancer: Single-Arm Pilot Trial, Christine Tran, Ms, Adam Dicker, Md, Phd, Benjamin Leiby, Phd, Eric Gressen, Md, Noelle Williams, Md, Heather Jim, Phd

Kimmel Cancer Center Faculty Papers

Background: Measuring patient-reported outcomes (PROs) requires an individual’s perspective on their symptoms, functional status, and quality of life. Digital health enables remote electronic PRO (ePRO) assessments as a clinical decision support tool to facilitate meaningful provider interactions and personalized treatment.

Objective: This study explored the feasibility and acceptability of collecting ePROs using validated health-related quality of life (HRQoL) questionnaires for prostate cancer.

Methods: Using Apple ResearchKit software, the Strength Through Insight app was created with content from validated HRQoL tools 26-item Expanded Prostate Cancer Index Composite (EPIC) or EPIC for Clinical Practice and 8-item Functional Assessment of Cancer Therapy Advanced …

Associations Between Aquaglyceroporin Gene Polymorphisms And Risk Of Stroke Among Patients With Hypertension, Qingyun Tu, Li Yan, Chun Wang, Aohan Han, Yu Qin, Lan Cui, Quanyong Xiang

Department of Medical Oncology Faculty Papers

Background: Dysregulations ofAQP7andAQP9were found to be related to lipid metabolism abnormality, which had been provento be one of the mechanisms of stroke. However, limited epidemiological studies explore the associations betweenAQP7andAQP9and the risk of stroke among patients with hypertension in China.

Aims: We aimed to investigate the associations between genetic variants in AQP7andAQP9and the risk of stroke among patients with hypertension, as well as to explore gene-gene andgene-environment interactions.

Methods: Baseline blood samples were drawn from 211 cases with stroke and 633 matched controls. Genomic DNA was extracted by a commercially available kit. Genotyping of 5 single nucleotide polymorphisms (SNPs) in …

Molecular Genetics Of Keratinization Disorders - What's New About Ichthyosis, Jouni Uitto, Leila Youssefian, Amir Hossein Saeidian, Hassan Vahidnezhad

Department of Dermatology and Cutaneous Biology Faculty Papers

The heritable forms of keratinization disorders, including various forms of ichthyosis and keratodermas, comprise a phenotypically heterogeneous group of diseases which can be divided into syndromic and non-syndromic forms. In the non-syndromic forms, the clinical manifestations are limited to the cutaneous structures while the syndromic ones are associated with a spectrum of extracutaneous manifestations. The inheritance in different families can be autosomal dominant, autosomal recessive or either X-linked dominant or recessive. Currently at least 67 distinct genes have been associated with different forms of ichthyosis. These genes can be grouped on the basis of their physiological involvement, including genes encoding …

Dietary Alterations Modulate The Microrna 29/30 And Igf-1/Akt Signaling Axis In Breast Cancer Liver Metastasis., Anuradha A. Shastri, Anthony Saleh, Jason E. Savage, Tiziana Deangelis, Kevin Camphausen, Nicole L. Simone

Department of Radiation Oncology Faculty Papers

Background: Metastatic cancer is incurable and understanding the molecular underpinnings is crucial to improving survival for our patients. The IGF-1/Akt signaling pathway is often impaired in cancer leading to its progression and metastases. Diet modification is known to alter the IGF-1/Akt pathway and affect the expression of microRNA involved in tumor initiation, growth and metastases. Liver metastases are one of the most common type of metastases in breast and colon cancer. In the present study, we looked at the effect of diet modification on the expression of microRNA in normal liver and liver with breast cancer metastases using in vivo …

Design And Analysis Of A Novel Long-Distance Double Tendon-Sheath Transmission Device For Breast Intervention Robots Under Mri Field, Xiaohong Jia, Yongde Zhang, Jingang Jiang, Haiyan Du, Yan Yu

Department of Radiation Oncology Faculty Papers

Cancer represents a major threat to human health. Magnetic resonance imaging (MRI) provides superior performance to other imaging-based examination methods in the detection of tumors and offers distinct advantages in biopsy and seed implantation. However, because of the MRI environment, the material requirements for actuating devices for the medical robots used in MRI are incredibly demanding. This paper describes a novel double tendon-sheath transmission device for use in MRI applications. LeBus grooves are used in the original transmission wheels, thus enabling the system to realize long-distance and large-stroke transmission with improved accuracy. The friction model of the transmission system and …

The Incidence And Severity Of Drug Interactions Before And After Switching Antiretroviral Therapy To Bictegravir/Emtricitabine/Tenofovir Alafenamide In Treatment Experienced Patients, Ciara Walshe, Pharmd Candidate, Jason J. Schafer, Pharmd, Mph, Bcps-Aq Id, Bcidp, Aahivp

College of Pharmacy Posters

Objective

• The primary outcome was to measure the proportion of patients experiencing DIs before and after the ART switch.
• The secondary outcome was to measure changes in DI scores before and after the ART switch.

Pediatric Resident Knowledge, Experience, Comfort, And Perceived Competency In Providing Sibling Psychosocial Support., David Buchbinder, Sonam Sidhu, Melissa A. Alderfer, Anne Lown, Russ C. Kolarik, Tommy Wang

Department of Pediatrics Faculty Papers

This article is the author’s final published version in International Journal of Medical Education, Volume 11, March 2020, Pages 73-75.

The published version is available at https://doi.org/10.5116/ijme.5e63.6a46. Copyright © Buchbinder et al.

Osteoblastoma In The Occipital Bone: A Case Report Of A Rare Tumor In The Calvarium, Lukas M. Trunz, Scott H. Faro, Richard J. Gorniak

Department of Radiology Faculty Papers

Osteoblastomas infrequently occur in the calvarium, displaying a preference for temporal and frontal bones when it does. We present an unusual case of a large, expansile osteoblastoma in the occipital bone of a 23-year-old man who presented with a nontender lump at the back of his head. Initial computed tomography scan showed a large occipital bone mass, and after additional imaging, a gross total resection was performed. Histopathological examination revealed an osteoblastoma. Although these tumors are benign, overlapping imaging characteristics of lesions affecting the calvarium often present a diagnostic dilemma. This case emphasizes the importance of imaging in the management …

Functional Blockade Of E-Selectin In Tumor-Associated Vessels Enhances Anti-Tumor Effect Of Doxorubicin In Breast Cancer, Yoshihiro Morita, Macall Leslie, Hiroyasu Kameyama, Ganesh L R Lokesh, Norihisa Ichimura, Rachel Davis, Natalie Hills, Nafis Hasan, Roy Zhang, Yuji Kondo, David G Gorenstein, David E Volk, Inna Chervoneva, Hallgeir Rui, Takemi Tanaka

Department of Pharmacology and Experimental Therapeutics Faculty Papers

Chemotherapy is a mainstay of treatment for solid tumors. However, little is known about how therapy-induced immune cell infiltration may affect therapy response. We found substantial CD45+ immune cell density adjacent to E-selectin expressing inflamed vessels in doxorubicin (DOX)-treated residual human breast tumors. While CD45 level was significantly elevated in DOX-treated wildtype mice, it remained unchanged in DOX-treated tumors from E-selectin null mice. Similarly, intravenous administration of anti-E-selectin aptamer (ESTA) resulted in a significant reduction in CD45+ immune cell density in DOX-treated residual tumors, which coincided with a delay in tumor growth and lung metastasis in MMTV-pyMT mice. Additionally, both …

Male Luts – Introduction And Overview, Thenappan Chandrasekar, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Outline & Goals

• Background – What are “LUTS”?

• Anatomy

• Pathophysiology

• Storage – bladder filling symptoms
• Voiding – urine flow symptoms
• Post-micturition

• Major etiologies and management

• BPH / BOO
• OAB
• Nocturia

• Related to Prostate Cancer?

Proteinuria, Goni Katz-Greenberg, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Outline and Objectives

• Definition
• Screening/Measurement
• Etiology
• Treatment

Modified Glucose-Insulin-Potassium Regimen Provides Cardioprotection With Improved Tissue Perfusion In Patients Undergoing Cardiopulmonary Bypass Surgery, Kun Zhao, Yue Zhang, Jia Li, Qin Cui, Rong Zhao, Wensheng Chen, Jincheng Liu, Bijun Zhao, Yi Wan, Xin-Liang Ma, Shiqiang Yu, Dinghua Yi, Feng Gao

Department of Emergency Medicine Faculty Papers

Background Laboratory studies demonstrate glucose-insulin-potassium (GIK) as a potent cardioprotective intervention, but clinical trials have yielded mixed results, likely because of varying formulas and timing of GIK treatment and different clinical settings. This study sought to evaluate the effects of modified GIK regimen given perioperatively with an insulin-glucose ratio of 1:3 in patients undergoing cardiopulmonary bypass surgery. Methods and Results In this prospective, randomized, double-blinded trial with 930 patients referred for cardiac surgery with cardiopulmonary bypass, GIK (200 g/L glucose, 66.7 U/L insulin, and 80 mmol/L KCl) or placebo treatment was administered intravenously at 1 mL/kg per hour 10 minutes …

Abrogation Of Esophageal Carcinoma Development In Mir-31 Knockout Rats., Louise Y Fong, Cristian Taccioli, Alexey Palamarchuk, Guidantonio Malagoli Tagliazucchi, Ruiyan Jing, Karl J Smalley, Sili Fan, Joseph Altemus, Oliver Fiehn, Kay Huebner, John L Farber, Carlo M Croce

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

MicroRNA-31 (miR-31) is overexpressed in esophageal squamous cell carcinoma (ESCC), a deadly disease associated with dietary Zn deficiency and inflammation. In a Zn deficiency-promoted rat ESCC model with miR-31 up-regulation, cancer-associated inflammation, and a high ESCC burden following N-nitrosomethylbenzylamine (NMBA) exposure, systemic antimiR-31 delivery reduced ESCC incidence from 85 to 45% (P = 0.038) and miR-31 gene knockout abrogated development of ESCC (P = 1 × 10-6). Transcriptomics, genome sequencing, and metabolomics analyses in these Zn-deficient rats revealed the molecular basis of ESCC abrogation by miR-31 knockout. Our identification of EGLN3, a known negative regulator of nuclear …

Meaning-Centered Supervision: A Structured Self-Reflection Model To Reconnect With Personal And Professional Meaning In Palliative Care Work, Rebecca Cammy, Msw, Lcsw

Department of Medical Oncology Posters

Meaning-centered supervision explores participant’s sense of meaning of past, present, and future personal and professional experiences. The series aims to reintegrate selfreflection into clinical practice through experiential exercises, homework journaling, and group discussion. Social workers develop a narrative around themes of professional attitude, living and creating work life, and connections with the social work profession. The goal is to help palliative care social workers create a sense meaning and purpose in their work as they develop their personal and professional identities. Additionally, the hope is to support supervisees through any concerns of burnout and compassion fatigue.

Public Social Media Consultations For Dermatologic Conditions: An Online Survey, Elizabeth Schoenberg, Doaa Shalabi, Jordan Wang, Nazanin Saedi, Matthew Keller

Department of Dermatology and Cutaneous Biology Faculty Papers

The use of social media in medicine has been increasingly studied in recent years, especially concerning its role in patient outreach, education, diagnosis, and management. Dermatology is a unique field in that patients can post photographs of their skin ailments when seeking online medical advice and information. This study examines the role of public social media consultations for dermatologic conditions. A large portion of patients utilize social media for dermatologic consultations and many do not seek care from a dermatologist afterward. Future studies should trend this phenomenon, especially as the use of social media continues to expand.

Flavonoids And Other Polyphenols Act As Epigenetic Modifiers In Breast Cancer., Priyanga Selvakumar, Aja Badgeley, Paige Murphy, Hina Anwar, Urvashi Sharma, Katharine Lawrence, Ashakumary Lakshmikuttyamma

College of Pharmacy Faculty Papers

Breast cancer is a common cancer that occurs due to different epigenetic alterations and genetic mutations. Various epidemiological studies have demonstrated an inverse correlation between breast cancer incidence and flavonoid intake. The anti-cancer action of flavonoids, a class of polyphenolic compounds that are present in plants, as secondary metabolites has been a major topic of research for many years. Our review analysis demonstrates that flavonoids exhibit anti-cancer activity against breast cancer occurring in different ethnic populations. Breast cancer subtype and menopausal status are the key factors in inducing the flavonoid's anti-cancer action in breast cancer. The dose is another key …

Carbidopa-Levadopa Improves Speech Apraxia After Open Traumatic Brain Injury, James J. Bresnahan, Md, Philip J. Koehler Iii, Do, Mithra B. Maneyapanda, Md

Department of Rehabilitation Medicine Posters

Case Description

• A 24-year-old male with open traumatic brain injury (TBI) due to gunshot wound (GSW).
• Initial evaluation revealed a GCS of 3 with GSW to left arm, left abdomen, left flank, and left skull.
• Initial work up with CT-Head showed extensive subarachnoid hemorrhage and cerebral edema with residual bullet fragments in the posterior fossa.
• Thirty days later he was transferred to our rehabilitation hospital.

A Novel Case Based Approach To Icf Education For Pm&R Residents, Nick Freedman, Do, Michael Mallow, Md, Nethra S. Ankam, Md

Department of Rehabilitation Medicine Posters

Little exists in the literature on reliable methods of ICF education. Our goal was to increase knowledge of the ICF and encourage residents to use the ICF framework to inform their clinical thinking through a case-based exercise.

Locked-In Syndrome Due To Neuromyelitis Optica Spectrum Disorder In Acute Rehabilitation: A Case Report, James J. Bresnahan, Md, Summer Schultz, Md, Mithra B. Maneyapanda, Md

Department of Rehabilitation Medicine Posters

Case Description

• 56-year-old female patient with prior questionable diagnoses of brainstem infarct, multiple sclerosis, and systemic lupus erythematosus who presented to the hospital with progressive dysarthria, lethargy, and weakness.
• MRI noted bilateral demyelinating lesions of the midbrain, pons, and middle cerebellar peduncles as well as nonspecific signal abnormality in the spinal cord at T6-T7.
• Her condition further deteriorated to flaccid complete tetraplegia. Communication was limited to extraocular movements and eye blinking.
• Serum aquaporin-4 antibody assay was positive.
• She was diagnosed with NMOSD resulting in transverse myelitis and locked-in syndrome.
• She was treated with IVIG and high-dose steroids and eventually plasma …

An Unusual Cause Of Proximal Thigh Pain: Focal Dystonia Of The Psoas, James J. Bresnahan, Md, Mitchell H. Paulin, Md

Department of Rehabilitation Medicine Posters

Case Description

• 68-year old female presented for evaluation of right groin pain.
• The pain in her groin radiated superiorly to the lower abdomen and inferiorly to the anteromedial aspect of the proximal thigh and was ongoing for >8 years
• Physicians seen: Neurosurgery, Orthopaedics, Pain Management
• Testing: MRI L-Spine showing degenerative changes and no significant neuroforaminal or spinal stenosis.
• Treatments: PT, multiple epidural steroid injections, facet joint injections, medial branch blocks, and a spinal cord stimulator trial

Approaches To Overcome Flow Cytometry Limitations In The Analysis Of Cells From Veterinary Relevant Species, Julia Hunka, John T. Riley, Gudrun F. Debes

Department of Microbiology and Immunology Faculty Papers

BACKGROUND: Flow cytometry is a powerful tool for the multiparameter analysis of leukocyte subsets on the single cell level. Recent advances have greatly increased the number of fluorochrome-labeled antibodies in flow cytometry. In particular, an increase in available fluorochromes with distinct excitation and emission spectra combined with novel multicolor flow cytometers with several lasers have enhanced the generation of multidimensional expression data for leukocytes and other cell types. However, these advances have mainly benefited the analysis of human or mouse cell samples given the lack of reagents for most animal species. The flow cytometric analysis of important veterinary, agricultural, wildlife, …

Levetiracetam Versus Phenytoin For The Treatment Of Established Status Epilepticus: A Systematic Review And Meta-Analysis Of Randomized Controlled Trials., Linjie Li, Yu Zhang, Lu Jia, Desheng Jia, Andrew Faramand, Weelic Chong, Yuan Fang, Lu Ma, Fang Fang

College of Life Sciences Faculty Papers

OBJECTIVES: To compare the efficacy and safety of levetiracetam and phenytoin for the treatment of established status epilepticus.

METHODS: In this systematic review, we searched Medline, Embase, and Cochrane databases from their inception with no language restrictions until May 8, 2019 and updated on February 5, 2020, for randomized controlled trials comparing the efficacy and safety of levetiracetam and phenytoin for the treatment of established status epilepticus. A Meta-analysis was conducted to calculate the risk ratio (RR) using random-effects models.

RESULTS: We identified 7 trials with a total of 1028 participants. Levetiracetam was not associated with an increased rate of …