Medicine and Health Sciences Commons^™

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

The Medicine Forum

It has been another wonderful year in the Jefferson Internal Medicine Residency Program. Our program continues to train the best and brightest residents in the country. This publication is just one example of the passion, dedication and creativity our residents continue to provide to the Jefferson Community. The residents are not just outstanding clinicians but excel in all aspects of medicine including: research, humanities and medical education.

The Medicine Forum: Volume 19

The Medicine Forum

The Medicine Forum: Volume 19

Enzyme Replacement Therapies: What Is The Best Option?, Azam Safary, Mostafa Akbarzadeh Khiavi, Rahimeh Mousavi, Jaleh Barar, Mohammad Rafi

Department of Neurology Faculty Papers

Despite many beneficial outcomes of the conventional enzyme replacement therapy (ERT), several limitations such as the high-cost of the treatment and various inadvertent side effects including the occurrence of an immunological response against the infused enzyme and development of resistance to enzymes persist. These issues may limit the desired therapeutic outcomes of a majority of the lysosomal storage diseases (LSDs). Furthermore, the biodistribution of the recombinant enzymes into the target cells within the central nervous system (CNS), bone, cartilage, cornea, and heart still remain unresolved. All these shortcomings necessitate the development of more effective diagnosis and treatment modalities against LSDs. …

Psoriasiform Sarcoidosis Presenting In Pregnancy And Treatment Considerations, Christian A. Albornoz, Jordan Wang, Matthew Keller

Department of Dermatology and Cutaneous Biology Faculty Papers

Cutaneous sarcoidosis is a common presentation for patients with sarcoidosis. Rarely, patients can present with psoriasiform lesions mimicking chronic plaque psoriasis. Here, we present a case of psoriasiform sarcoidosis in a pregnant patient. Pregnancy represents a unique challenge to systemic treatments if topical management fails. Tumor necrosis factor alpha inhibitors warrant special consideration during pregnancy.

Jefferson Digital Commons Quarterly Report: April-June 2018, Kelsey Duinkerken, Msi, James Copeland, Libt

Jefferson Digital Commons Reports

This quarterly report includes:

• New Feature: PlumX Metrics
• New Feature: CrossRef DOIs
• College Restructuring
• Articles
• CREATE Day Presentations
• Department of Surgery Resident Research Day
• Dissertations
• From the Archives
• Grand Rounds and Lectures
• Master of Public Health Capstones
• Newsletters
• Pathology Honors Program Student Research Symposium
• Posters
• What People are Saying About the JDC

With Some Risk-Taking And Luck: A Veterinarian's Adventures In Viral Immunology., Luis J. Sigal

Department of Microbiology and Immunology Faculty Papers

No abstract provided.

Drug-Induced Dermatomyositis After Lacosamide: A Case Report., Rebecca G. Gaffney, Meera Tarazi, Victoria P. Werth

Student Papers, Posters & Projects

Here we describe a caseof a woman who had DM after treatment withlacosamide. To our knowledge, drug-induced DMfrom lacosamide has not been reported previously.

Comparison Of Osteoporosis Pharmacotherapy Fracture Rates: Analysis Of A Marketscan® Claims Database Cohort, Alan W. Reynolds, Guodong Liu, Paul T. Kocis, Jenna N. Skowronski, Douglas L. Leslie, Edward J. Fox

Student Papers, Posters & Projects

Background: Several different classes of medications have been shown to be efficacious at preventing fractures in patients with osteoporosis. No study has compared real world efficacy at preventing fractures between all currently approved medications.

Objectives: To directly compare the efficacy of all currently available osteoporosis medications by using a large population claims database.

Methods: The Truven Health Analytics MarketScan® database from 2008 - 2012 was used to identify all patients who started a new osteoporosis medication. Patients who experienced a fracture after at least 12 months of treatment were identified and risk factors for fracture for all patients were recorded. …

Pregnancies Complicated By Maternal Osteogenesis Imperfecta Type Iii: A Case Report And Review Of Literature., Tetsuya Kawakita, Melissa Fries, Jasbir Singh, Huda B. Al-Kouatly

Department of Obstetrics and Gynecology Faculty Papers

The restrictive lung disease can be exacerbated by growing fundus in women with osteogenesis imperfecta type III. Regional anesthesia can be performed in these women. Mode of delivery for women with osteogenesis imperfecta type III is generally cesarean delivery. Neonatal outcomes are complicated due to indicated preterm deliveries.

Retrograde Axonal Transport Of Rabies Virus Is Unaffected By Interferon Treatment But Blocked By Emetine Locally In Axons., Margaret A. Macgibeny, Orkide O. Koyuncu, Christoph Wirblich, Matthias J. Schnell, Lynn W. Enquist

Department of Microbiology and Immunology Faculty Papers

Neuroinvasive viruses, such as alpha herpesviruses (αHV) and rabies virus (RABV), initially infect peripheral tissues, followed by invasion of the innervating axon termini. Virus particles must undergo long distance retrograde axonal transport to reach the neuron cell bodies in the peripheral or central nervous system (PNS/CNS). How virus particles hijack the axonal transport machinery and how PNS axons respond to and regulate infection are questions of significant interest. To track individual virus particles, we constructed a recombinant RABV expressing a P-mCherry fusion protein, derived from the virulent CVS-N2c strain. We studied retrograde RABV transport in the presence or absence of …

Trametinib Prevents Mesothelial-Mesenchymal Transition And Ameliorates Abdominal Adhesion Formation, Edward J. Macarak, Christine Lotto, Deepika Koganti, Xiaoling Jin, Pete J. Wermuth, Anna-Karin Olsson, Matthew Montgomery, Joel Rosenbloom

Department of Dermatology and Cutaneous Biology Faculty Papers

Background

Intra-abdominal adhesions are a major cause of morbidity after abdominal or gynecologic surgery. However, knowledge about the pathogenic mechanism(s) is limited, and there are no effective treatments. Here, we investigated a mouse model of bowel adhesion formation and the effect(s) of an Federal Drug Administration-approved drug (trametinib) in preventing adhesion formation.

Materials and methods

C57BL/6 mice were used to develop a consistent model of intra-abdominal adhesion formation by gentle cecal abrasion with mortality rates ofEDA) which arises from alternative splicing of the fibronectin messenger RNA resulting in different protein isoforms. Trichrome staining assessed collagen deposition. Quantitative polymerase chain reaction …

Subdermal Ultrasound Contrast Agent Injection For Sentinel Lymph Node Identification: An Analysis Of Safety And Contrast Agent Dose In Healthy Volunteers., Priscilla Machado, Maria Stanczak, Ji-Bin Liu, Jason N. Moore, John R. Eisenbrey, Laurence Needleman, Walter K. Kraft, Flemming Forsberg

Department of Radiology Faculty Papers

Objectives—Mapping of the lymphatic chain for identification of the sentinel lymph node (SLN) is an important aspect of predicting outcomes for breast cancer patients, and it is usually performed as an intraoperative procedure using blue dye and/or radiopharmaceuticals agents. Recently the use of contrast-enhanced ultrasound (CEUS) has been proposed as an alternative imaging technique for this mapping. The objective of this study was to evaluate the use of subdermal administration of the ultrasound contrast agent Sonazoid (GE Healthcare) in terms of patient safety and to select the dose to be used for lymphatic applications in humans.

Methods—This study …

The Bulletin: Sidney Kimmel Medical College At Thomas Jefferson University, Volume 67, Issue 2, Spring/Summer 2018

The Bulletin (formerly the Jefferson Medical College Alumni Bulletin)

This issue includes:

• Exposure: Michael Weinstein, MD '94, had a plan to take his own life; now he is back to living it
• Medical School 2.0: JeffMD - A New Way to Train Physicians
• 25 Years of JeffHOPE Clinics: Student Volunteers Shape Patients' Lives - and Their Own
• Caring for the Most Vulnerable a "Moral, Ethical, Medical Responsibility": Jefferson's Latina Women's Clinic Dispenses Care and Compassion
• The Dean's Column
• Findings: New Look at Eye's Immune Status
• Home at Last: A message from Elizabeth Dale
• Endowed Professorships
• Time Capsule
• On Campus
• Feeling all the Bumps: Jefferson Oncologist Looks at the World …

Obinutuzumab, A Potent Anti-B-Cell Agent, For Rituximab-Unresponsive Igm Anti-Mag Neuropathy., Goran Rakocevic, Ubaldo E. Martinez-Outshoorn, Marinos C. Dalakas

Department of Medical Oncology Faculty Papers

Anti-MAG demyelinating neuropathy is difficult to treat. All immunotherapies have failed except for rituximab, a chimeric B-cell–depleting monoclonal antibody against CD20, that helps up to 40% of patients based on 2 controlled and several uncontrolled series.^1,–,3 Because the majority of these patients are left disabled, stronger anti–B-cell agents might be promising.

We describe clinical response and autoantibody changes after treatment with obinutuzumab (Gazyva), a new generation of humanized anti-CD20 monoclonal antibodies, in 2 patients with anti-MAG neuropathy who continued to worsen despite multiple courses of rituximab. Obinutuzumab, approved for chronic lymphocytic leukemia (CLL), exerts greater peripheral and lymphoid B-cell …

A Word From The Writing Team (July 2018), Jennifer Wilson, Ms, Els, Pam Walter, Mfa

A Word From the Writing Team (Newsletter)

This issue includes:

• From Thesis to Journal Article
• Open All Summer
• Sign Up for Our Fall Writing Retreat
• Writing Café

Cardiac-Derived Ctrp9 Protects Against Myocardial Ischemia/Reperfusion Injury Via Calreticulin-Dependent Inhibition Of Apoptosis., Dajun Zhao, Pan Feng, Yang Sun, Zhigang Qin, Zhengbin Zhang, Yanzhen Tan, Erhe Gao, Wayne Bond Lau, Xin-Liang Ma, Jian Yang, Shiqiang Yu, Xuezeng Xu, Dinghua Yi, Wei Yi

Department of Emergency Medicine Faculty Papers

Cardiokines play an essential role in maintaining normal cardiac functions and responding to acute myocardial injury. Studies have demonstrated the heart itself is a significant source of C1q/TNF-related protein 9 (CTRP9). However, the biological role of cardiac-derived CTRP9 remains unclear. We hypothesize cardiac-derived CTRP9 responds to acute myocardial ischemia/reperfusion (MI/R) injury as a cardiokine. We explored the role of cardiac-derived CTRP9 in MI/R injury via genetic manipulation and a CTRP9-knockout (CTRP9-KO) animal model. Inhibition of cardiac CTRP9 exacerbated, whereas its overexpression ameliorated, left ventricular dysfunction and myocardial apoptosis. Endothelial CTRP9 expression was unchanged while cardiomyocyte CTRP9 levels decreased after simulated …

Systemwide Clinical Ultrasound Program Development: An Expert Consensus Model., Robert Strony, Jennifer R. Marin, John Bailitz, Anthony J. Dean, Mike Blaivas, Vivek Tayal, Chris Raio, Rachel Liu, Aimee Woods, Michael Zwank, Matthew Fields, Alyssa Abo, Stan Wu, Tarina Kang, Teresa Liu, Megan Leo, Courtney Smalley, Jerry Chiricolo, Mikaela Chilstrom, Resa E. Lewiss

Department of Emergency Medicine Faculty Papers

Clinical ultrasound (CUS) is integral to the practice of an increasing number of medical specialties. Guidelines are needed to ensure effective CUS utilization across health systems. Such guidelines should address all aspects of CUS within a hospital or health system. These include leadership, training, competency, credentialing, quality assurance and improvement, documentation, archiving, workflow, equipment, and infrastructure issues relating to communication and information technology. To meet this need, a group of CUS subject matter experts, who have been involved in institution- and/or systemwide clinical ultrasound (SWCUS) program development convened. The purpose of this paper was to create a model for SWCUS …

In Wound Repair Vimentin Mediates The Transition Of Mesenchymal Leader Cells To A Myofibroblast Phenotype., J. L. Walker, B. M. Bleaken, A. R. Romisher, A. A. Alnwibit, A. S. Menko

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Following injury, mesenchymal repair cells are activated to function as leader cells that modulate wound healing. These cells have the potential to differentiate to myofibroblasts, resulting in fibrosis and scarring. The signals underlying these differing pathways are complex and incompletely understood. The ex vivo mock cataract surgery cultures are an attractive model with which to address this question. With this model we study, concurrently, the mechanisms that control mesenchymal leader cell function in injury repair within their native microenvironment and the signals that induce this same cell population to acquire a myofibroblast phenotype when these cells encounter the environment of …

Local Bdnf Delivery To The Injured Cervical Spinal Cord Using An Engineered Hydrogel Enhances Diaphragmatic Respiratory Function., Biswarup Ghosh, Zhicheng Wang, Jia Nong, Mark W. Urban, Zhiling Zhang, Victoria A. Trovillion, Megan C. Wright, Yinghui Zhong, Angelo C. Lepore

Farber Institute for Neuroscience Faculty Papers

We developed an innovative biomaterial-based approach to repair the critical neural circuitry that controls diaphragm activation by locally delivering brain-derived neurotrophic factor (BDNF) to injured cervical spinal cord. BDNF can be used to restore respiratory function via a number of potential repair mechanisms; however, widespread BDNF biodistribution resulting from delivery methods such as systemic injection or lumbar puncture can lead to inefficient drug delivery and adverse side effects. As a viable alternative, we developed a novel hydrogel-based system loaded with polysaccharide-BDNF particles self-assembled by electrostatic interactions that can be safely implanted in the intrathecal space for achieving local BDNF delivery …

Early Gestational Mesenchymal Stem Cell Secretome Attenuates Experimental Bronchopulmonary Dysplasia In Part Via Exosome-Associated Factor Tsg-6., Sushma Chaubey, Sam Thueson, Devasena Ponnalagu, Mohammad Afaque Alam, Ciprian P. Gheorghe, Zubair Aghai, Harpreet Singh, Vineet Bhandari

Department of Pediatrics Faculty Papers

BACKGROUND: Mesenchymal stem cells (MSCs) are promising tools for the treatment of human lung disease and other pathologies relevant to newborn medicine. Recent studies have established MSC exosomes (EXO), as one of the main therapeutic vectors of MSCs in mouse models of multifactorial chronic lung disease of preterm infants, bronchopulmonary dysplasia (BPD). However, the mechanisms underlying MSC-EXO therapeutic action are not completely understood. Using a neonatal mouse model of human BPD, we evaluated the therapeutic efficiency of early gestational age (GA) human umbilical cord (hUC)-derived MSC EXO fraction and its exosomal factor, tumor necrosis factor alpha-stimulated gene-6 (TSG-6).

METHODS: Conditioned …

Preferred Criterion For Deciding Laparoscopic Cholecystectomy For Patients With Chronic Cholecystitis Using Radio-Nuclide Tc99m Hepatobiliary Mebrofenin, Duy Tran, R.T(N), Cnmt, Nmtcb(Ct), Cheryl Rickley, Cnmt, Charles Intenzo, Md, Sung Kim, Md

Department of Radiology Posters

Objective

To determine what gastroenterologist prefer for laparoscopic cholecystectomy when using Tc99m hepatobiliary scintigraphy.

Spontaneous Lung Herniation Leading To Extensive Subcutaneous Emphysema, Pneumothorax, Pneumomediastinum, And Pneumopericardium., Mohsin Hamid, Ali R. Ghani, Waqas Ullah, Usman Sarwar, Rajesh Patel

Abington Jefferson Health Papers

Spontaneous lung herniation is a rare phenomenon in which the lung parenchyma along with the pleural membranes protrudes outside their usual boundaries and can lead to a wide variety of complications. We are reporting a case of a middle-aged male who presented with chronic obstructive pulmonary disease (COPD) exacerbation with severe bouts of cough. Initial computed tomography (CT) chest was unrevealing, but two days later, he developed spontaneous lung herniation, which was initially managed conservatively, but later it progressed to pneumothorax, pneumomediastinum, with striking CT scan images showing extensive subcutaneous emphysema. Blowhole incisions were done on the anterior chest wall …

Availability And Use Of Magnesium Sulphate At Health Care Facilities In Two Selected Districts Of North Karnataka, India., Geetanjali Katageri, Umesh Charantimath, Anjali Joshi, Marianne Vidler, Umesh Ramadurg, Sumedha Sharma, Sheshidhar Bannale, Beth A. Payne, Sangamesh Rakaraddi, Chandrashekhar Karadiguddi, Geetanjali Mungarwadi, Avinash Kavi, Diane Sawchuck, Richard Derman, Shivaprasad Goudar, Ashalata Mallapur, Mrutyunjaya Bellad, Laura A. Magee, Rahat Qureshi, Peter Von Dadelszen

Global Health Articles

BACKGROUND: Pre-eclampsia and eclampsia are major causes of maternal morbidity and mortality. Magnesium sulphate is accepted as the anticonvulsant of choice in these conditions and is present on the WHO essential medicines list and the Indian National List of Essential Medicines, 2015. Despite this, magnesium sulphate is not widely used in India for pre-eclampsia and eclampsia. In addition to other factors, lack of availability may be a reason for sub-optimal usage. This study was undertaken to assess the availability and use of magnesium sulphate at public and private health care facilities in two districts of North Karnataka, India.

METHODS: A …

Trends And Determinants Of Stillbirth In Developing Countries: Results From The Global Network's Population-Based Birth Registry., Sarah Saleem, Shiyam Sunder Tikmani, Elizabeth M. Mcclure, Janet L. Moore, Syed Iqbal Azam, Sangappa M. Dhaded, Shivaprasad S. Goudar, Ana Garces, Lester Figueroa, Irene Marete, Constance Tenge, Fabian Esamai, Archana B. Patel, Sumera Aziz Ali, Farnaz Naqvi, Musaku Mwenchanya, Elwyn Chomba, Waldemar A. Carlo, Richard Derman, Patricia L. Hibberd, Sherri Bucher, Edward A. Liechty, Nancy Krebs, K. Michael Hambidge, Dennis D. Wallace, Marion Koso-Thomas, Menachem Miodovnik, Robert L. Goldenberg

Global Health Articles

BACKGROUND: Stillbirth rates remain high, especially in low and middle-income countries, where rates are 25 per 1000, ten-fold higher than in high-income countries. The United Nations' Every Newborn Action Plan has set a goal of 12 stillbirths per 1000 births by 2030 for all countries.

METHODS: From a population-based pregnancy outcome registry, including data from 2010 to 2016 from two sites each in Africa (Zambia and Kenya) and India (Nagpur and Belagavi), as well as sites in Pakistan and Guatemala, we evaluated the stillbirth rates and rates of annual decline as well as risk factors for 427,111 births of which …

The Feasibility Of Task-Sharing The Identification, Emergency Treatment, And Referral For Women With Pre-Eclampsia By Community Health Workers In India., Umesh Charanthimath, Marianne Vidler, Geetanjali Katageri, Umesh Ramadurg, Chandrashekhar Karadiguddi, Avinash Kavi, Anjali Joshi, Geetanjali Mungarwadi, Sheshidhar Bannale, Sangamesh Rakaraddi, Diane Sawchuck, Rahat Qureshi, Sumedha Sharma, Beth A. Payne, Peter Von Dadelszen, Richard Derman, Laura A. Magee, Shivaprasad Goudar, Ashalata Mallapur, Mrutyunjaya Bellad, Zulfiqar Bhutta, Sheela Naik, Anis Mulla, Namdev Kamle, Vaibhav Dhamanekar, Sharla K. Drebit, Chirag Kariya, Tang Lee, Jing Li, Mansun Lui, Asif R Khowaja, Domena K. Tu, Amit Revankar

Department of Obstetrics and Gynecology Faculty Papers

BACKGROUND: Hypertensive disorders are the second highest direct obstetric cause of maternal death after haemorrhage, accounting for 14% of maternal deaths globally. Pregnancy hypertension contributes to maternal deaths, particularly in low- and middle-income countries, due to a scarcity of doctors providing evidence-based emergency obstetric care. Task-sharing some obstetric responsibilities may help to reduce the mortality rates. This study was conducted to assess acceptability by the community and other healthcare providers, for task-sharing by community health workers (CHW) in the identification and initial care in hypertensive disorders in pregnancy.

METHODS: This study was conducted in two districts of Karnataka state in …

Early Pregnancy Loss In Belagavi, Karnataka, India 2014-2017: A Prospective Population-Based Observational Study In A Low-Resource Setting., Sangappa M. Dhaded, Manjunath S. Somannavar, Jane P. Jacob, Elizabeth M. Mcclure, Sunil S. Vernekar, S. Yogesh Kumar, Avinash Kavi, Umesh Y. Ramadurg, Janet L. Moore, Dennis P. Wallace, Richard J. Derman, Robert L Goldenberg, Shivaprasad S. Goudar

Global Health Articles

BACKGROUND: The prevalence of early pregnancy loss through miscarriage and medically terminated pregnancy (MTP) is largely unknown due to lack of early registration of pregnancies in most regions, and especially in low- and middle-income countries. Understanding the rates of early pregnancy loss as well as the characteristics of pregnant women who experience miscarriage or MTP can assist in better planning of reproductive health needs of women.

METHODS: A prospective, population-based study was conducted in Belagavi District, south India. Using an active surveillance system of women of childbearing age, all women were enrolled as soon as possible during pregnancy. We evaluated …

Lateralized Hippocampal Oscillations Underlie Distinct Aspects Of Human Spatial Memory And Navigation., Jonathan Miller, Andrew J. Watrous, Melina Tsitsiklis, Sang Ah Lee, Sameer A. Sheth, Catherine A. Schevon, Elliot H. Smith, Michael R. Sperling, Ashwini Sharan, Ali Akbar Asadi-Pooya, Gregory A. Worrell, Stephen Meisenhelter, Cory S. Inman, Kathryn A. Davis, Bradley Lega, Paul A. Wanda, Sandhitsu R. Das, Joel M. Stein, Richard Gorniak, Joshua Jacobs

Department of Neurology Faculty Papers

The hippocampus plays a vital role in various aspects of cognition including both memory and spatial navigation. To understand electrophysiologically how the hippocampus supports these processes, we recorded intracranial electroencephalographic activity from 46 neurosurgical patients as they performed a spatial memory task. We measure signals from multiple brain regions, including both left and right hippocampi, and we use spectral analysis to identify oscillatory patterns related to memory encoding and navigation. We show that in the left but not right hippocampus, the amplitude of oscillations in the 1-3-Hz "low theta" band increases when viewing subsequently remembered object-location pairs. In contrast, in …

Concurrent Regulation Of Lkb1 And Camkk2 In The Activation Of Ampk In Castrate-Resistant Prostate Cancer By A Well-Defined Polyherbal Mixture With Anticancer Properties., Amber F. Macdonald, Ahmed Bettaieb, Dallas R. Donohoe, Dina S. Alani, Anna Han, Yi Zhao, Jay Whelan

Department of Cancer Biology Faculty Papers

BACKGROUND: Zyflamend, a blend of herbal extracts, effectively inhibits tumor growth using preclinical models of castrate-resistant prostate cancer mediated in part by 5'-adenosine monophosphate-activated protein kinase (AMPK), a master energy sensor of the cell. Clinically, treatment with Zyflamend and/or metformin (activators of AMPK) had benefits in castrate-resistant prostate cancer patients who no longer responded to treatment. Two predominant upstream kinases are known to activate AMPK: liver kinase B1 (LKB1), a tumor suppressor, and calcium-calmodulin kinase kinase-2 (CaMKK2), a tumor promotor over-expressed in many cancers. The objective was to interrogate how Zyflamend activates AMPK by determining the roles of LKB1 and …

Cadaveric Simulation For Improving Surgical Training In Dermatology., Ezra Hazan, Richard Torbeck, Deirdre Connolly, Jordan V. Wang, Thomas Griffin, Matthew Keller, Joshua Trufant

Department of Dermatology and Cutaneous Biology Faculty Papers

Simulation models are rapidly changing medical education, especially the training of dermatology residents. Various models are available, including cadaveric simulations. Our study evaluates the impact of a cadaveric simulation on the training of dermatology residents. Over a period of three years, cadaveric simulation was shown to increase the surgical knowledge of residents. Residents were more confident in their knowledge of surgical anatomy and also surgical skills. Cadaveric simulation may offer a positive impact on resident training in dermatology.

Altered Expression Of Genes Involved In Ganglioside Biosynthesis In Substantia Nigra Neurons In Parkinson's Disease., Jay S. Schneider

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Reduced expression of GM1 and other major brain gangliosides GD1a, GD1b and GT1b have been reported in Parkinson's disease (PD) brain. Mechanisms underlying these changes are unclear but may be due to a deficit in the ganglioside biosynthetic process. The present study examined the extent to which deficits in gene expression of key biosynthetic enzymes involved in synthesis of GM1 and GD1b (B3galt4) and GD1a and GT1b (St3gal2) exist in neuromelanin-containing neurons in the PD substantia nigra (SN). In situ hybridization histochemistry was used to examine gene expression of B3GALT4 and ST3GAL2 in neuromelanin-containing neurons in the SN in 8 …