Medicine and Health Sciences Commons^™

Applications In Molecular Ultrasound Imaging: Present And Future, Vishal Thumar, Md, Ji-Bin Liu, Md, John Eisenbrey, Phd

Department of Radiology Faculty Papers

Molecular ultrasound imaging or targeted contrast-enhanced ultrasound (CEUS) is a relatively new technique that has varied applications to augment both diagnostics and therapeutics. Ultrasound contrast agents are conjugated to ligands that bind with specific biomarkers in the areas of interest which can then be quantified using ultrasound technology. This technique has numerous clinical applications including studying pathophysiology of disease, improving diagnostic sensitivity and specificity, and improving localized drug delivery. This technology, most notably, has proven useful in numerous oncologic and cardiovascular applications. Given ultrasound’s advantages over other radiographic studies including its low cost, lack of ionizing radiation, portability, ability to …

Creating A Virtual Community To Provide Centralized Access To Research Resources And Services, Margeret-Claire Chenault, Ms, Julia Center, Bs, Melissa Mccarey, Mph, Kathleen O'Malley, Bsn, Ccrp, Cce

Jefferson Clinical Research Institute Posters

Purpose

Thomas Jefferson University (TJU) is a rapidly growing, geographically dispersed academic healthcare system. Research personnel must navigate essential resources and services buried within a multitude of siloed platforms and websites. Jefferson Clinical Research Institute (JCRI) provides centralized support to research personnel and investigators and recognizes the need to efficiently connect staff with these resources. TJU launched a new platform that allows employees to access benefits information, payroll, time-off, and mandatory learning. This platform also features virtual “communities” designed for networking and sharing information. JCRI created one such community to link personnel with resources and services (Figure1). We evaluated its …

Gsk3Β-Dependent Phosphorylation Of Cypd And Regulation Of Mptp Opening During Myocardial Infarction, Stephen Hurst, Ludovic Gomez, Shey-Shing Sheu

Center for Translational Medicine Posters

Background

Mitochondrial calcium overload and oxidative stress during ischemia reperfusion (I/R) injury remains a major obstacle during percutaneous coronary intervention after acute myocardial infarction. It often leads to an increased susceptibility for mitochondria permeability transition pore (mPTP) opening leading to cell death. Mitochondrial calcium overload and ROS have been identified as key triggers to open the mPTP for over 30 years, yet the exact mechanism has remained elusive. Additionally, glycogen synthase kinase 3β; (GSK-3β;) is proposed as one of the key molecules that regulate mitochondrial dysfunction and injury during I/R. Indeed inhibition of GSK-3β has been shown to be required …

Pyk2 Expression And Localization In Cardiac Mitochondria And Its Role In Mitochondrial Calcium Regulation, Ariele Baggett, Celia Fernandez-Sanz, Sergio De La Fuente, Johannes Hoek, Shey-Shing Sheu

Center for Translational Medicine Posters

TRPM2 is a non-selective cation channel located in the plasma membrane of the cell. Upon activation, the channel opens, allowing calcium to enter into the cytosol of the cell, leading ultimately to the phosphorylation and activation of the enzyme Pyk2 (proline-rich tyrosine kinase 2). Once phosphorylated, Pyk2 translocates from the cytosol to the mitochondria, where it regulates the formation of the pore component of the mitochondrial calcium uniporter (MCU) complex. Consequently, this interaction is a key factor in mitochondrial calcium uptake and therefore mitochondrial bioenergetics.

Inactivated Rabies Virus-Based Ebola Vaccine Preserved By Vaporization Is Heat-Stable And Immunogenic Against Ebola And Protects Against Rabies Challenge., Drishya Kurup, Christine R. Fisher, Todd G. Smith, Tiago Abreu-Mota, Yong Yang, Felix R. Jackson, Nadia Gallardo-Romero, Richard Franka, Victor Bronshtein, Matthias J. Schnell

Department of Microbiology and Immunology Faculty Papers

BACKGROUND: Ebola virus (EBOV) is a highly lethal member of the Filoviridae family associated with human hemorrhagic disease. Despite being a sporadic disease, it caused a large outbreak in 2014-2016 in West Africa and another outbreak recently in the Democratic Republic of Congo. Several vaccine candidates are currently in preclinical and clinical studies but none are stable without cold chain storage.

METHODS: We used preservation by vaporization (PBV), a novel processing technology to heat-stabilize FiloRab1 (inactivated rabies-based Ebola vaccine), a candidate Ebola vaccine, and stored the vials at temperatures ranging from 4°C to 50°C for 10 days to 12 months. …

Effect On Nurse And Patient Experience: Overnight Use Of Blue-Depleted Illumination, Lorenzo Albala, Timothy Bober, Graham Hale, Benjamin Warfield, Micaela Langille Collins, Zachary Merritt, Eric Steimetz, Shmuel Nadler, Yair Lev, John Hanifin

Department of Neurology Faculty Papers

Background

Typical hospital lighting is rich in blue-wavelength emission, which can create unwanted circadian disruption in patients when exposed at night. Despite a growing body of evidence regarding the effects of poor sleep on health outcomes, physiologically neutral technologies have not been widely implemented in the US healthcare system.

Objective

The authors sought to determine if rechargeable, proximity-sensing, blue-depleted lighting pods that provide wireless task lighting can make overnight hospital care more efficient for providers and less disruptive to patients.

Design

Non-randomised, controlled interventional trial in an intermediate-acuity unit at a large urban medical centre.

Methods

Night-time healthcare providers abstained …

Experiential Learning And Injury Prevention: A Win-Win, Christine Mckeever, Msn, Rn, Julia Ward, Phd, Rn, Anita Fennessey, Drnp, Rn, Cne, Kathryn M. Shaffer, Edd, Rn, Msn, Cne

College of Nursing Posters

Purpose

Experiential learning opportunities help prepare students for patients in crisis management

Harm reduction by ensuring students become certified in the Stop the Bleed Campaign & Opioid Overdose Narcan Prevention

Cervical Assessment By Ultrasound For Preventing Preterm Delivery., Vincenzo Berghella, Gabriele Saccone

Department of Obstetrics and Gynecology Faculty Papers

BACKGROUND: Measurement of cervical length by ultrasound is predictive of preterm birth (PTB). There are three methods of ultrasound cervical assessment: transvaginal (TVU), transabdominal (TAU), and transperineal (TPU, also called translabial). Cervical length measured by TVU is a relatively new screening test, and has been associated with better prediction of PTB than previously available tests. It is unclear if cervical length measured by ultrasound is effective for preventing PTB. This is an update of a review last published in 2013.

OBJECTIVES: To assess the effectiveness of antenatal management based on transvaginal, transabdominal, and transperineal (also called translabial) ultrasound screening of …

High-Fat Diet Fuels Prostate Cancer Progression By Rewiring The Metabolome And Amplifying The Myc Program., David P. Labbé, Giorgia Zadra, Meng Yang, Jaime M Reyes, Charles Y Lin, Stefano Cacciatore, Ericka M. Ebot, Amanda L. Creech, Francesca Giunchi, Michelangelo Fiorentino, Habiba Elfandy, Sudeepa Syamala, Edward D. Karoly, Mohammed Alshalalfa, Nicholas Erho, Ashley Ross, Edward M. Schaeffer, Ewan A. Gibb, Mandeep Takhar, Robert B. Den, Jonathan Lehrer, R. Jeffrey Karnes, Stephen J. Freedland, Elai Davicioni, Daniel E. Spratt, Leigh Ellis, Jacob D. Jaffe, Anthony V. DʼAmico, Philip W. Kantoff, James E. Bradner, Lorelei A. Mucci, Jorge E. Chavarro, Massimo Loda, Myles Brown

Department of Radiation Oncology Faculty Papers

Systemic metabolic alterations associated with increased consumption of saturated fat and obesity are linked with increased risk of prostate cancer progression and mortality, but the molecular underpinnings of this association are poorly understood. Here, we demonstrate in a murine prostate cancer model, that high-fat diet (HFD) enhances the MYC transcriptional program through metabolic alterations that favour histone H4K20 hypomethylation at the promoter regions of MYC regulated genes, leading to increased cellular proliferation and tumour burden. Saturated fat intake (SFI) is also associated with an enhanced MYC transcriptional signature in prostate cancer patients. The SFI-induced MYC signature independently predicts prostate cancer …

Life After Sepsis: Survivorship, Recovery, And Resources, Christa Schorr, Dnp. Msn, Rn, Nea-Bc, Fccm

Sepsis Symposium

This discussion will focus on the challenges that sepsis survivors face. Dr. Schorr will describe short and long term recovery and outcomes of sepsis survivors and their loved ones. She will also identify resources for sepsis survivors and their caregivers.

The Global Crisis Of Antibiotic Resistance, Cindy Hou, Do, Mba

Sepsis Symposium

No abstract provided.

Sepsis & Septic Shock: Deadly Risks And Liabilities, Marshall Schwartz, Jd, Michael Pitt, Jd

Sepsis Symposium

Discuss common sources of negligence identified in medical malpractice cases related to sepsis Discuss the factors that must exist for medical malpractice to exist. Discuss how establishing liability for injuries or death related to sepsis or septic shock can be challenging legally.

Tracking Progress On Preventing And Treating Sepsis: Cdc's Adult Sepsis Event Surveillance Strategy, Chanu Rhee, Md

Sepsis Symposium

This presentation will discuss the differences between diagnostic and surveillance definitions of sepsis and the use and value of each in clinical settings. Specifically, Dr. Rhee will discuss the CDC’s new ‘Adult Sepsis Event’ surveillance tool to help healthcare facilities assess adult sepsis incidence within their facilities.

Early Septic Shock Care – Phenotypes And How We Got Here, Donald Yealy, Md

Sepsis Symposium

Learning Objectives

• List three reasons for the ProCESS and other two non-US trials
• Note two main outcomes
• List two similarities in design and outcome with the more recent trials
• State how different sepsis phenotypes exist and could influence actions and assessments

Comparing Record Linkage Software Programs And Algorithms Using Real-World Data., Alan F. Karr, Matthew T. Taylor, Suzanne L. West, Soko Setoguchi, Tzuyung D. Kou, Tobias Gerhard, Daniel B. Horton

Student Papers, Posters & Projects

Linkage of medical databases, including insurer claims and electronic health records (EHRs), is increasingly common. However, few studies have investigated the behavior and output of linkage software. To determine how linkage quality is affected by different algorithms, blocking variables, methods for string matching and weight determination, and decision rules, we compared the performance of 4 nonproprietary linkage software packages linking patient identifiers from noninteroperable inpatient and outpatient EHRs. We linked datasets using first and last name, gender, and date of birth (DOB). We evaluated DOB and year of birth (YOB) as blocking variables and used exact and inexact matching methods. …

Conceptualization Of A Parasympathetic Endocrine System., Jonathan Gorky, James Schwaber

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

We here propose a parasympathetic endocrine system (PES) comprised of circulating peptides released from secretory cells in the gut, significantly modulated by vagal projections from the dorsal motor nucleus of the vagus (DMV). While most of these gut peptides mediate well-described satiety and digestive effects that increase parasympathetic control of digestion (Lee et al., 1994; Gutzwiller et al., 1999; Klok et al., 2007), they also have actions that are far-reaching and increase parasympathetic signaling broadly throughout the body. The actions beyond satiety that peptides like somatostatin, cholecystokinin, glucagon-like peptide 1, and vasoactive intestinal peptide have been well-examined, but not in …

Silymarin In Non-Cirrhotics With Non-Alcoholic Steatohepatitis: A Randomized, Double-Blind, Placebo Controlled Trial., Victor J. Navarro, Steven H. Belle, Massimo D'Amato, Nezam Adfhal, Elizabeth M. Brunt, Michael W. Fried, K. Rajender Reddy, Abdus S. Wahed, Stephen Harrison

Division of Gastroenterology and Hepatology Faculty Papers

The botanical product silymarin, an extract of milk thistle, is commonly used by patients to treat chronic liver disease and may be a treatment for NASH due to its antioxidant properties. We aimed to assess the safety and efficacy of higher than customary doses of silymarin in non-cirrhotic patients with NASH. This exploratory randomized double-blind placebo controlled multicenter Phase II trial tested a proprietary standardized silymarin preparation (Legalon®, Rottapharm|Madaus, Mylan) and was conducted at 5 medical centers in the United States. Eligible adult patients had liver biopsy within 12 months showing NASH without cirrhosis with NAFLD Activity Score (NAS) ≥4 …

Slc36a1-Mtorc1 Signaling Drives Acquired Resistance To Cdk4/6 Inhibitors., Akihiro Yoshida, Yiwen Bu, Shuo Qie, John Wrangle, E. Ramsay Camp, E. Starr Hazard, Gary Hardiman, Renée De Leeuw, Karen E. Knudsen, J. Alan Diehl

Department of Cancer Biology Faculty Papers

The cyclin-dependent kinase 4/6 (CDK4/6) kinase is dysregulated in melanoma, highlighting it as a potential therapeutic target. CDK4/6 inhibitors are being evaluated in trials for melanoma and additional cancers. While beneficial, resistance to therapy is a concern, and the molecular mechanisms of such resistance remain undefined. We demonstrate that reactivation of mammalian target of rapamycin 1 (mTORC1) signaling through increased expression of the amino acid transporter, solute carrier family 36 member 1 (SLC36A1), drives resistance to CDK4/6 inhibitors. Increased expression of SLC36A1 reflects two distinct mechanisms: (i) Rb loss, which drives SLC36A1 via reduced suppression of E2f; (ii) fragile X …

Heme And Hemoglobin Utilization By Mycobacterium Tuberculosis., Avishek Mitra, Ying-Hui Ko, Gino Cingolani, Michael Niederweis

Department of Biochemistry and Molecular Biology Faculty Papers

Iron is essential for growth of Mycobacterium tuberculosis (Mtb), but most iron in the human body is stored in heme within hemoglobin. Here, we demonstrate that the substrate-binding protein DppA of the inner membrane Dpp transporter is required for heme and hemoglobin utilization by Mtb. The 1.27 Å crystal structure of DppA shows a tetrapeptide bound in the protein core and a large solvent-exposed crevice for heme binding. Mutation of arginine 179 in this cleft eliminates heme binding to DppA and prevents heme utilization by Mtb. The outer membrane proteins PPE36 and PPE62 are also required for heme and hemoglobin …

The Presence Of A Cmv Immunodominant Allele In The Recipient Is Associated With Increased Survival In Cmv Positive Patients Undergoing Haploidentical Hematopoietic Stem Cell Transplantation, Dolores Grosso, Benjamin Leiby, Matthew Carabasi, Joanne Filicko-O'Hara, Sameh Gaballa, William O'Hara, John L Wagner, Neal Flomenberg

Kimmel Cancer Center Papers, Presentations, and Grand Rounds

Specific major histocompatibility (MHC) class I alleles dominate anti-CMV responses in a hierarchal manner. These CMV immunodominant (IMD) alleles are associated with a higher magnitude and frequency of cytotoxic lymphocyte responses as compared to other human leukocyte antigen (HLA) alleles. CMV reactivation has been associated with an increased incidence of graft-vs.-host disease and non-relapse mortality, as well as protection from relapse in HLA-matched HSCT settings. Less is known about the impact of CMV reactivation on these major outcomes after haploidentical (HI) HSCT, an increasingly applied therapeutic option. In HI HSCT, the efficiency of the immune response is decreased due …

Excision Repair Cross-Complementing Group-1 (Ercc1) Induction Kinetics And Polymorphism Are Markers Of Inferior Outcome In Patients With Colorectal Cancer Treated With Oxaliplatin., Devika Rao, Atrayee Basu Mallick, Titto Augustine, Cecilia Daroqui, Jeeshan Jiffry, Amartej Merla, Imran Chaudhary, Raviraja Seetharam, Arjun Sood, Srikanth Gajavelli, Santiago Aparo, Lakshmi Rajdev, Andreas Kaubisch, Jennifer Chuy, Abdissa Negassa, John M. Mariadason, Radhashree Maitra, Sanjay Goel

Department of Medical Oncology Faculty Papers

Background: ERCC1, a component of nucleotide excision repair pathway, is known to repair DNA breaks induced by platinum drugs. We sought to ascertain if ERCC1 expression dynamics and a single nucleotide polymorphism (SNP) rs11615 are biomarkers of sensitivity to oxaliplatin therapy in patients with colorectal cancer (CRC).

Methods: Western blot and qPCR for ERCC1 expression was performed from PBMCs isolated from patients receiving oxaliplatin-based therapy at specified timepoints. DNA was also isolated from 59 biorepository specimens for SNP analysis. Clinical benefit was determined using progression free survival (PFS) for metastatic CRC.

Results: ERCC1 was induced in PBMC in response to …

Endovascular Management And The Risk Of Late Failure In The Treatment Of Ureteroarterial Fistulas, George Titomihelakis, Anthony Feghali, Tuong Nguyen, Dawn Salvatore, Paul Dimuzio, Babak Abai

Department of Medicine Faculty Papers

Ureteroarterial fistula (UAF) is a rare and life-threatening source of hematuria. A high index of suspicion is warranted for early diagnosis and timely intervention. Because of high perioperative risk and comorbidities in UAF patients, the endovascular approach has become preferred for repair. Infection can complicate this mode of therapy, and treatment with antibiotics is important. Herein we present five cases of secondary UAFs treated with stent graft alone or stent graft and embolization.

Continuation Of Angiotensin Converting Enzyme Inhibitors On The Day Of Surgery Is Not Associated With Increased Risk Of Hypotension Upon Induction Of General Anesthesia In Elective Non-Cardiac Surgeries., U. Yoon, A. J. Setren, A. Chen, T. Nguyen, M. C. Torjman, T. L. Kennedy

Department of Anesthesiology Faculty Papers

No abstract provided.

Pharmacokinetics Of Intraperitoneal Vancomycin In Patients On Automated Peritoneal Dialysis, Edwin Lam, Yi Ting Kayla Lien, Valvanera Vozmediano, Stephan Schmidt, Walter K. Kraft, Jingjing Zhang

Department of Pharmacology and Experimental Therapeutics Posters

Primary Objective

• Characterize the pharmacokinetics of vancomycin in plasma, dialysate, and urine following a single intraperitoneal dose

Secondary Objective

• Explore the safety, tolerability, and feasibility in administering vancomycin during the long dwell period in patients on APD

Perioperative Use Of Renin-Angiotensin System Inhibitors And Outcomes In Patients Undergoing Cardiac Surgery., Qian Ding, Zugui Zhang, Hong Liu, Huang Nie, Mark Berguson, Jordan E. Goldhammer, Nilas Young, Douglas Boyd, Rohinton Morris, Jianzhong Sun

Department of Anesthesiology Faculty Papers

It remains disputable about perioperative use of renin-angiotensin system inhibitors (RASi) and their outcome effects. This multicenter retrospective cohort study examines association between use of perioperative RASi and outcomes in patients undergoing coronary artery bypass graft and/or valve surgery. After the exclusion, the patients are divided into 2 groups with or without preoperative RASi (PreRASi, n = 8581), or 2 groups with or without postoperative RASi (PostRASi, n = 8130). With using of propensity scores matching to reduce treatment selection bias, the study shows that PreRASi is associated with a significant reduction in postoperative 30-day mortality compared with without one …

Neurological Conditions Associated With Spinal Cord Injury, Man Amanat, Alexander R. Vaccaro, Mona Salehi, Vafa Rahimi-Movaghar

Rothman Institute Papers

Background: Comorbid neurological conditions associated with spinal cord injury (SCI) significantly affect an individual’s quality of life, yet they are often under-rated. Recent reports suggest that SCI may predispose patients to develop other neurological disorders. We aim at providing an overview of the evidence of neurological conditions which are or seem resultant of SCI.

Methods: We conducted a literature review using PUBMED and GOOGLE SCHOLAR to evaluate the occurrence of different neurological disorders in people with SCI.

Results: Individuals with SCI seem at an increased risk of stroke, cognitive impairment, dementia, multiple sclerosis, Parkinson’s disease, restless leg syndrome, and seizures. …

Comparison Of Two Commercial Matrix-Assisted Laser Desorption/Ionization-Time Of Flight Mass Spectrometry (Maldi-Tof Ms) Systems For Identification Of Nontuberculous Mycobacteria., Barbara A. Brown-Elliott, Thomas R. Fritsche, Brooke J. Olson, Sruthi Vasireddy, Ravikiran Vasireddy, Elena Iakhiaeva, Diana Alame, Richard J. Wallace, John A. Branda

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Objectives: This multi-center study’s aim was to assess the performance of two commercially-available matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) systems in identifying a challenge collection of clinically-relevant nontuberculous mycobacteria (NTM).

Methods: NTM clinical isolates (N=244) belonging to 23 species/subspecies were identified by gene sequencing and analyzed using the Bruker Biotyper with Mycobacterial Library v5.0.0 and the bioMérieux VITEK MS with v3.0 database.

Results: Using the Bruker or bioMérieux systems, 92% or 95% of NTM strains, respectively, were identified at least to the complex/group level; 62% and 57%, respectively, were identified to the highest taxonomic level. Differentiation between members …

Impact Of Palliative Care Consultation On End Of Life Care Measures: A Retrospective Analysis Of Patients In The Oncology Care Model, Alison Greidinger, Md, Maria Vershvovsky, Md, Evan Lapinsky, Md, Alison Rhoades, Md, Amy Leader, Drph, Vittorio Maio, Pharmd, Jared Minetola, Karen Walsh, Ms, Mba, Valerie Csik, Mph, Cpps, Ruben Rhoades, Md

Department of Medical Oncology Posters

Introduction

• In 2016 ASCO recommended that patients with advanced cancer receive dedicated palliative care (PC) services1. Early PC involvement is associated with lower spending, fewer 30-day readmission rates, decreased chemotherapy administration at the end of life (EOL) and increased hospice referrals2.
• Many patients are not referred and continue to receive chemotherapy and utilize high-acuity services near the EOL.
• The Oncology Care Model (OCM) is a CMS episode-based alternative payment model promoting high-value care.
• We evaluated the effect of PC visits on EOL outcomes including code status (CS) and spending in the last 30 days of life.

Commentary: Using Directional Deep Brain Stimulation To Co-Activate The Subthalamic Nucleus And Zona Incerta For Overlapping Essential Tremor/Parkinson's Disease Symptoms., Chengyuan Wu, Caio Matias

Department of Radiology Faculty Papers

We have read with interest the article titled “Using Directional Deep Brain Stimulation to Co-activate the Subthalamic Nucleus and Zona Incerta for Overlapping Essential Tremor/Parkinson's Disease Symptoms” by Falconer et al. (1). In this case report, the authors present a patient treated with unilateral left-sided deep brain stimulation (DBS) after medical management alone proved to be ineffective. The stereotactic target was described as being “3 mm lateral to the most lateral point of the red nucleus” at the Bejjani line (2); and implantation of the electrode at this target was confirmed with microelectrode recordings, intraoperative macrostimulation …

Characterizing Smoking-Related Litter In Public Parks In Philadelphia, Russell K. Mcintire, Phd, Mph, Ashley Lipshaw, Mph

College of Population Health Posters

Background

• Cigarettes are the most littered item in the country.
• Since 1980 cigarette butts have represented 30-40% of all litter collected from coastal waterways and urban areas among major surveys in the U.S.
• Communities have established smoke free public spaces, including parks, in part to mitigate this source of litter and pollution.
• In 2014, Philadelphia prohibited smoking on all lands and facilities under the jurisdiction of the Philadelphia Department of Parks and Recreation
• However, not all parks in Philadelphia have the same environment to deter smoking, as “Smoke-Free” signs are not posted in all parks

Objectives

This study reports the …