Medicine and Health Sciences Commons^™

Induction Of Peripheral Tolerance In Ongoing Autoimmune Inflammation Requires Interleukin 27 Signaling In Dendritic Cells, Rodolfo Thome, Jason N. Moore, Elisabeth R. Mari, Javad Rasouli

Department of Neurology Faculty Papers

Peripheral tolerance to autoantigens is induced via suppression of self-reactive lymphocytes, stimulation of tolerogenic dendritic cells (DCs) and regulatory T (Treg) cells. Interleukin (IL)-27 induces tolerogenic DCs and Treg cells; however, it is not known whether IL-27 is important for tolerance induction. We immunized wild-type (WT) and IL-27 receptor (WSX-1) knockout mice with MOG_35-55 for induction of experimental autoimmune encephalomyelitis and intravenously (i.v.) injected them with MOG_35-55 after onset of disease to induce i.v. tolerance. i.v. administration of MOG^35-55 reduced disease severity in WT mice, but was ineffective in Wsx^-/- mice. IL-27 signaling in DCs was …

Hyperoxia Causes Mir-34a-Mediated Injury Via Angiopoietin-1 In Neonatal Lungs., Mansoor Syed, Pragnya Das, Aishwarya Pawar, Zubair H. Aghai, Anu Kaskinen, Zhen W. Zhuang, Namasivayam Ambalavanan, Gloria Pryhuber, Sture Andersson, Vineet Bhandari

Department of Pediatrics Faculty Papers

Hyperoxia-induced acute lung injury (HALI) is a key contributor to the pathogenesis of bronchopulmonary dysplasia (BPD) in neonates, for which no specific preventive or therapeutic agent is available. Here we show that lung micro-RNA (miR)-34a levels are significantly increased in lungs of neonatal mice exposed to hyperoxia. Deletion or inhibition of miR-34a improves the pulmonary phenotype and BPD-associated pulmonary arterial hypertension (PAH) in BPD mouse models, which, conversely, is worsened by miR-34a overexpression. Administration of angiopoietin-1, which is one of the downstream targets of miR34a, is able to ameliorate the BPD pulmonary and PAH phenotypes. Using three independent cohorts of …

Gucy2c Maintains Intestinal Lgr5+ Stem Cells By Opposing Er Stress, Crystal Kraft, Jeff A. Rappaport, Adam E. Snook, Amanda M. Pattison, John P. Lynch, Scott A. Waldman

Department of Pharmacology and Experimental Therapeutics Faculty Papers

Long-lived multipotent stem cells (ISCs) at the base of intestinal crypts adjust their phenotypes to accommodate normal maintenance and post-injury regeneration of the epithelium. Their long life, lineage plasticity, and proliferative potential underlie the necessity for tight homeostatic regulation of the ISC compartment. In that context, the guanylate cyclase C (GUCY2C) receptor and its paracrine ligands regulate intestinal epithelial homeostasis, including proliferation, lineage commitment, and DNA damage repair. However, a role for this axis in maintaining ISCs remains unknown. Transgenic mice enabling analysis of ISCs (Lgr5-GFP) in the context of GUCY2C elimination (Gucy2c^-/-) were combined with immunodetection techniques …

Dabigatran Reversal With Idarucizumab., Charles V. Pollack, Paul A Reilly, Jeffrey I Weitz

Department of Medicine Faculty Papers

No abstract provided.

Initiating C.H.E.W. At Maternity Care Coalition, Haley Wicklum, Rickie Brawer, Mph, Phd

CwiC Posters

The purpose of this project is to provide access to healthy and affordable foods to the families involved in Maternity Care Coalition’s Early Head Start program as means to reduce obesity in the 0-3 year old children. Implementing the C.H.E.W. (Cultivating Healthy Eating and Wellness) program, which includes a new food buying club where families can access healthy food at whole sale prices as well as nutrition education workshops throughout the year, will provide access to the healthy and affordable foods needed. The program is focused on pregnant women and young families with children 0-3 years of age to attempt …

Depression, Cognition, & Social Determinants Of Health: Assessing Associations In Older African Americans With Diabetes, Jeremiah Davis, Robin Casten, Phd, Barry W. Rovner, Md

CwiC Posters

Social determinants of health have been widely identified as characteristics of one’s social and economic climate that affect one’s health outcomes1. (see Graphic 1)

The Alzheimer’s Association indicates that rates of Alzheimer’s disease (AD) and other forms of dementia are two times higher in older African Americans than their white counterparts2. People who have diabetes are also at an increased risk.

The prevalence and co-morbidity of depression among older Americans with diabetes (both with and without cognitive impairment) has been well established3.

Understanding the effect that social determinants of health have on the onset and progression of dementia and depression …

A Pilot Study For Enhancing Postpartum Discharge Instructions For Incision Care: Assessment Of Comprehension, Rebekah Jo Mccurdy, Md, Rebecca Lawrence, Bs, Sarah Cohen, Bs, Jason K. Baxter, Md, Mscp

CwiC Posters

Literacy and Health Care

• 14.5% of United States is illiterate 1

• Reading level of most medical forms is 10th grade 2

Improving Outcomes with a Visual Aid

• Cesarean Surgical Site Infection (SSI) rate is 5% 3

• A patient with a SSI can be 2 times as expensive 4

• Visual aids improve information recall 8 and confidence in wound care 5

Study Objectives

1. To evaluate the readability of the cesarean wound care discharge instructions relative to the patient population’s reading level

2. To conduct a pilot Randomized Control Trial (RCT) to evaluate the effectiveness of …

Examining The Role Of Diagnosis In The Emergency Department Experience, Danielle Kovalsky, Bs, Angela Gerolamo, Phd, Aprn, Bcps, Amanda Doty, Ms, Alexzandra Gentsch, Lsw, Annemarie Jutel, Rn, Bphed (Hons), Phd, Kristin L. Rising, Md, Ms

CwiC Posters

Study Objective:

To explore the social, functional, and emotional needs that patients want addressed when seeking a diagnosis at their ED visit.

Leading Causes Of Death In Vietnam, Lindsey Roth

CwiC Posters

Vietnam is currently facing a public health crisis. Rates of chronic and preventable diseases are climbing, in addition to mortality rates from these diseases. If nothing is done to halt these rising rates, the health of the Vietnamese people will only continue to decline. Although there may be many factors contributing to these high death rates due to chronic diseases, risky health behaviors, such as smoking, and the state of the healthcare system can be considered two main contributors to the leading causes of death in Vietnam. The high smoking rates and high costs of healthcare are hindering the health …

Baseline Assessment Of Providers' Perspectives On Integrating Community Health Workers Into Primary Care Teams To Improve Diabetes Prevention, Ariel Brown, Garseng Wong, Radhika Gore, Mark Schwartz, Md

CwiC Posters

• Type 2 Diabetes Mellitus (T2DM) affects 11% of U.S. adults

• Additional 35% considered pre-diabetic, at-risk for developing T2DM1

• Bellevue Hospital and the VA NY Harbor Hospital disproportionately affected: 2x the prevalence in the general population, and increasing2

• Only 55% of adults receive recommended preventive services3

• Panel management: each care team is responsible for preventive care, disease management, and acute care of a patient panel

• Community health worker (CHW): non-clinical frontline public health professional trained in behavioral counseling, care follow-up, program referrals, and health education4-8

• Come from the community that they serve, so they …

Assessing Variability In End-Of-Life Intensity Of Care After Out-Of-Hospital Cardiac Arrest, Polina Ferd, Md Candidate, David Karp, Musa, Alexis Zebrowski, Phd Candidate, Brendan G. Carr, Md, Ma, Ms

CwiC Posters

Out of hospital cardiac arrest (OHCA) affects over 300,000 Americans per year.1 Many factors affect the outcomes and overall OHCA survival in a community; some of these include an individual’s characteristics such as age, co-morbid conditions, availability of an AED on scene, time to CPR, and the characteristics of the hospital they are treated at.1,2 Directly following resuscitation from cardiac arrest, the individual is at risk of developing numerous problems caused by sequelae of ischemic injury sustained during the arrest. The national average rate of survival to discharge is only 10%.2,3 Many of these factors are modifiable and provide an …

Association Of Metabolic Syndrome And Change In Unified Parkinson's Disease Rating Scale Scores., Maureen Leehey, Sheng Luo, Saloni Sharma, Anne-Marie A. Wills, Jacquelyn L. Bainbridge, Pei Shieen Wong, David K. Simon, Jay S Schneider, Yunxi Zhang, Adriana Pérez, Rohit Dhall, Chadwick W. Christine, Carlos Singer, Franca Cambi, James T Boyd

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

OBJECTIVE: To explore the association between metabolic syndrome and the Unified Parkinson's Disease Rating Scale (UPDRS) scores and, secondarily, the Symbol Digit Modalities Test (SDMT).

METHODS: This is a secondary analysis of data from 1,022 of 1,741 participants of the National Institute of Neurological Disorders and Stroke Exploratory Clinical Trials in Parkinson Disease Long-Term Study 1, a randomized, placebo-controlled trial of creatine. Participants were categorized as having or not having metabolic syndrome on the basis of modified criteria from the National Cholesterol Education Program Adult Treatment Panel III. Those who had the same metabolic syndrome status at consecutive annual visits …

All Limbs Lead To The Trunk, Daniel E. Graves, Phd, Darryn Atkinson, Phd, Pt

Department of Rehabilitation Medicine Posters

This poster describes the development of and the psychometric properties of the trunk scale that measures the voluntary motor ability in the thoracic and upper lumbar regions. The function of the trunk musculature has far reaching implications, particularly in persons with SCI, where postural control and voluntary movement are compromised to varying degrees. Precisely coordinated muscle actions must occur in the appropriate sequence, duration, and combination for the optimal movement function and maintenance of balance and posture during dynamic activities. Trunk mobility is required for nearly all mobility tasks, particularly transitional movements such as rolling, supine to sit, and sit …

Metastatic Deaths In Retinoblastoma Patients Treated With Intraarterial Chemotherapy (Ophthalmic Artery Chemosurgery) Worldwide., David H. Abramson, Carol L. Shields, Pascal Jabbour, Luiz Fernando Teixeira, José Roberto Falco Fonseca, Marcio Chaves Pedro Marques, Francis L. Munier, Francesco Puccinelli, Theodora Hadjistilianou, Sandra Bracco, Guillermo Chantada, Alejandro Ceciliano, Y. Pierre Gobin

Department of Neurosurgery Faculty Papers

BACKGROUND: Ophthalmic artery chemosurgery [OAC, intra-arterial chemotherapy (IAC)] was introduced in 2006 as treatment modality for intraocular retinoblastoma. The purpose of this commentary is to retrospectively review the incidence of metastatic deaths in retinoblastoma patients treated with OAC worldwide over a 10 year period. Retrospective data regarding metastatic deaths was collected from six international retinoblastoma centers (New York City USA, Philadelphia USA, Sao Paulo Brazil, Siena Italy, Lausanne Switzerland and Buenos Aires Argentina). All retinoblastoma patients from these centers (naive and recurrent, unilateral and bilateral) treated with OAC/IAC since 2006 have been included in this study. Data regarding number of …

The Handoff Culture: Can We Change How An Icu To Floor Transfer Works?, Kristin Lohr, Md, Grant Turner, Md, Allison Greco, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Handoffs between providers have increased following the implementation of the 2011 Accreditation Council for Graduate Medical Education (ACGME) work hour restrictions. Properly structured and timed handoffs are essential to patient safety.1 Despite this, studies have shown that errors in code status, medication allergies, and important updates to the problem list are common, all of which can lead to adverse outcomes to patients.2

At Thomas Jefferson University Hospital (TJUH) the 2016 Safety Culture Survey revealed that across all specialties, 37% of residents felt that things “fall through the cracks” when transferring patients from one unit to another.

Our interdepartmental Housestaff Quality …

Tnf-Α Promotes Nuclear Enrichment Of The Transcription Factor Tonebp/Nfat5 To Selectively Control Inflammatory But Not Osmoregulatory Responses In Nucleus Pulposus Cells., Zariel I. Johnson, Alexandra C. Doolittle, Joseph W. Snuggs, Irving M. Shapiro, Christine L. Le Maitre, Makarand V. Risbud

Department of Orthopaedic Surgery Faculty Papers

Intervertebral disc degeneration (IDD) causes chronic back pain and is linked to production of proinflammatory molecules by nucleus pulposus (NP) and other disc cells. Activation of tonicity-responsive enhancer-binding protein (TonEBP)/NFAT5 by non-osmotic stimuli, including proinflammatory molecules, occurs in cells involved in immune response. However, whether inflammatory stimuli activate TonEBP in NP cells and whether TonEBP controls inflammation during IDD is unknown. We show that TNF-α, but not IL-1β or LPS, promoted nuclear enrichment of TonEBP protein. However, TNF-α-mediated activation of TonEBP did not cause induction of osmoregulatory genes. RNA sequencing showed that 8.5% of TNF-α transcriptional responses were TonEBP-dependent and …

Characterization Of Pulmonary Metastases In Children With Hepatoblastoma Treated On Children's Oncology Group Protocol Ahep0731 (The Treatment Of Children With All Stages Of Hepatoblastoma): A Report From The Children's Oncology Group., Allison F. O'Neill, Alexander J. Towbin, Mark D. Krailo, Caihong Xia, Yun Gao, M. Beth Mccarville, Rebecka L. Meyers, Eugene D. Mcgahren, Greg M. Tiao, Stephen P. Dunn, Max R. Langham, Christopher B. Weldon, Milton J. Finegold, Sarangarajan Ranganathan, Wayne L. Furman, Marcio Malogolowkin, Carlos Rodriguez-Galindo, Howard M. Katzenstein

Department of Pediatrics Faculty Papers

Purpose To determine whether the pattern of lung nodules in children with metastatic hepatoblastoma (HB) correlates with outcome. Methods Thirty-two patients with metastatic HB were enrolled on Children's Oncology Group Protocol AHEP0731 and treated with vincristine and irinotecan (VI). Responders to VI received two additional cycles of VI intermixed with six cycles of cisplatin/fluorouracil/vincristine/doxorubicin (C5VD), and nonresponders received six cycles of C5VD alone. Patients were imaged after every two cycles and at the conclusion of therapy. All computed tomography scans and pathology reports were centrally reviewed, and information was collected regarding lung nodule number, size, laterality, timing of resolution, and …

Intravesical Rad-Ifnα/Syn3 For Patients With High-Grade, Bacillus Calmette-Guerin-Refractory Or Relapsed Non-Muscle-Invasive Bladder Cancer: A Phase Ii Randomized Study., Neal D Shore, Stephen A Boorjian, Daniel J Canter, Kenneth Ogan, Lawrence I Karsh, Tracy M Downs, Leonard G Gomella, Ashish M Kamat, Yair Lotan, Robert S Svatek, Trinity J Bivalacqua, Robert L Grubb, Tracey L Krupski, Seth P Lerner, Michael E Woods, Brant A Inman, Matthew I Milowsky, Alan Boyd, F Peter Treasure, Gillian Gregory, David G Sawutz, Seppo Yla-Herttuala, Nigel R Parker, Colin P N Dinney

Department of Medicine Faculty Papers

Purpose Many patients with high-risk non-muscle-invasive bladder cancer (NMIBC) are either refractory to bacillus Calmette-Guerin (BCG) treatment or may experience disease relapse. We assessed the efficacy and safety of recombinant adenovirus interferon alfa with Syn3 (rAd-IFNα/Syn3), a replication-deficient recombinant adenovirus gene transfer vector, for patients with high-grade (HG) BCG-refractory or relapsed NMIBC. Methods In this open-label, multicenter (n = 13), parallel-arm, phase II study ( ClinicalTrials.gov identifier: NCT01687244), 43 patients with HG BCG-refractory or relapsed NMIBC received intravesical rAd-IFNα/Syn3 (randomly assigned 1:1 to 1 × 10(11) viral particles (vp)/mL or 3 × 10(11) vp/mL). Patients who responded at months 3, …

Jefferson Conference Sponsorship

Office of Diversity & Inclusion Initiatives Newsletter

Featuring:

• National Medical Association
• Gay and Lesbian Medical Association

Graduate Medical Education

Office of Diversity & Inclusion Initiatives Newsletter

To expand and enhance diversity and inclusion for our resident physicians, three initiatives targeting GME have been implemented.

Faculty Initiatives

Office of Diversity & Inclusion Initiatives Newsletter

New URM faculty welcome meeting

SKMC is committed to the career development of all faculty at Jefferson but recognize that those from a racial or ethnic group that is underrepresented in medicine, a woman in a specialty in which women are underrepresented and/or those who self-identify as lesbian, bisexual, gay, transgender, or questioning sexual identity may have unique concerns such as reducing isolation or finding a mentor with a similar background. Dr. Karen Novielli, Vice Dean for Faculty Affairs and Professional Development, along with Dr. Bernie Lopez, Associate Dean for Diversity and Community Engagement, meet individually with new faculty from …

Pipeline Programs

Office of Diversity & Inclusion Initiatives Newsletter

Pipeline programs are designed to prepare and inspire students to pursue careers in medicine and medical research. SKMC is committed to providing experiences and education to middle school, high school, college, and graduate students from groups underrepresented in the health care fields to increase the pool of qualified candidates applying to careers related to medicine and medical research.

Our programs:

• The Jefferson STEP-UP Medicine Program
• Future Health Professions Program (FHPP)

Diversity And Inclusion Education

Office of Diversity & Inclusion Initiatives Newsletter

In the 2016-2017 academic year, two then-second year SKMC students. Linda Magana and Kevin Guttierez, created and conducted a “Race and Medicine” course that first year SKMC students could receive credits for their Humanities Course. The Office of the Dean at SKMC has created a new lecture series called, “Confronting Racism, Bias, and Social Injustice in Healthcare.” This first-of-akind at Jefferson educational series is meant to educate on this important topic and to allow us to begin the discussions needed to move us forward in our quest to provide the best patient care. The content was developed by Drs. John …

Skmc Council On Diversity And Inclusion

Office of Diversity & Inclusion Initiatives Newsletter

The SKMC Council for Diversity and Inclusion (D & I) is charged with reviewing and assessing the status and effectiveness of diversity and inclusion initiatives at SKMC and makes recommendations regarding initiatives, policies, and resources needed to achieve desired outcomes. Headed by Mark L. Tykocinski, MD, the Anthony F. and Gertrude M. DePalma Dean of SKMC, and cochaired by Dr. Bernie Lopez, the Council determines the course of diversity and inclusion at SKMC with input from members who are deans, department chairs, faculty, administrators, residents and students.

Odii Student Organizations

Office of Diversity & Inclusion Initiatives Newsletter

Featuring:

• Student National Medical Association (SNMA)
• The Asian Pacific American Medical Student Association (APAMSA)
• JeffLGBTQ
• Veterans Health Initiative
• Jewish Student Association (JSA)
• Refugee Health Partners (RHP)
• Student Advisory Board
• Latino Medical Student Association (LMSA)
• Medical Spanish Translator Program

A Message From The Associate Dean For Diversity And Community Engagement, Bernard Lopez, Md

Office of Diversity & Inclusion Initiatives Newsletter

Diversity: the richness in human differences. Why is diversity important? A wide variety of experiences and points of view mean that we get to look at issues from all angles rather than just one. Inclusion: the active, intentional, and ongoing engagement with diversity. Why is inclusion important? It is not enough to have diversity - inclusion means that we value and cherish the wide variety of experiences and viewpoints. Creating and enhancing this environment is important as we set the stage to provide service to our most important customer - our patients.

Since September 2013 when I was appointed as …

Symptomatic Choledocholithiasis After Cholecystectomy, Joseph Spataro, Mazen Tolaymat, Charles Kistler, Michael Jacobs, Jeffrey Fitch, Monjur Ahmed

Department of Medicine Posters

Background

• Clinical manifestations of choledocholithiasis include biliary colic, obstructive jaundice, pancreatitis, and acute cholangitis
• Secondary common bile duct (CBD) stones are common when the gallbladder is intact or after recent cholecystectomy (CCY) whereas recurrent stones develop >3 years after surgery1,2
• Patients with retained CBD stones after CCY may be asymptomatic for years and there is limited data on their pattern of presentation
• Despite known predisposing conditions and risk factors for recurrent biliary disease, the role of intraoperative cholangiography (IOC) during CCY remains controversial

Poster presented at: World Congress of Gastroenterology at ACG 2017 in Orlando Florida, United States.

Differentiation And Protective Capacity Of Virus-Specific Cd8, Vesselin T. Tomov, Olesya Palko, Chi Wai Lau, Ajinkya Pattekar, Yuhang Sun, Ralitza Tacheva, Bertram Bengsch, Sasikanth Manne, Gabriela L. Cosma, Laurence C. Eisenlohr, Timothy J. Nice, Herbert W. Virgin, E. John Wherry

Department of Microbiology and Immunology Faculty Papers

Noroviruses can establish chronic infections with active viral shedding in healthy humans but whether persistence is associated with adaptive immune dysfunction is unknown. We used genetically engineered strains of mouse norovirus (MNV) to investigate CD8⁺ T cell differentiation during chronic infection. We found that chronic infection drove MNV-specific tissue-resident memory (Trm) CD8⁺ T cells to a differentiation state resembling inflationary effector responses against latent cytomegalovirus with only limited evidence of exhaustion. These MNV-specific Trm cells remained highly functional yet appeared ignorant of ongoing viral replication. Pre-existing MNV-specific Trm cells provided partial protection against chronic infection but largely ceased …

The Role Of B Cell Targeting In Chronic Graft-Versus-Host Disease., Ruben Rhoades, Md, Sameh Gaballa, Md

Department of Medical Oncology Faculty Papers

Chronic graft-versus-host disease (cGVHD) is a leading cause of late morbidity and mortality following allogeneic stem cell transplantation. Current therapies, including corticosteroids and calcineurin inhibitors, are only effective in roughly 50% of cases; therefore, new treatment strategies are under investigation. What was previously felt to be a T cell disease has more recently been shown to involve activation of both T and B cells, as well as a number of cytokines. With a better understanding of its pathophysiology have come more expansive preclinical and clinical trials, many focused on B cell signaling. This report briefly reviews our current understanding of …

Sex Differential In 15-Hydroxyprostaglandin Dehydrogenase Levels In The Lumen Of Human Intracranial Aneurysms., Nohra Chalouhi, Pascal Jabbour, Mario Zanaty, Robert M. Starke, James Torner, Daichi Nakagawa, David M. Hasan

Department of Neurosurgery Faculty Papers

BACKGROUND: Aspirin is a promising medical therapy for the prevention of intracranial aneurysm (IA) rupture. Recently, we found that men have a better response to aspirin than women. The purpose of this study was to determine whether a sex differential exists in the level of 15-hydroxyprostaglandin dehydrogenase (15-PGDH) in the lumen of human IAs.

METHODS AND RESULTS: Consecutive patients undergoing coiling or stent-assisted coiling for a saccular IA at our institution were enrolled. Two samples (A and B) were collected from IA lumens, and the plasma level of 15-PGDH was measured using an ELISA-based method. The study included 38 patients, …