Medicine and Health Sciences Commons^™

Hormone-Induced Calcium Oscillations Depend On Cross-Coupling With Inositol 1,4,5-Trisphosphate Oscillations., Lawrence D Gaspers, Paula J Bartlett, Antonio Politi, Paul Burnett, Walson Metzger, Jane Johnston, Suresh K Joseph, Thomas Höfer, Andrew P Thomas

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Receptor-mediated oscillations in cytosolic Ca(2+) concentration ([Ca(2+)]i) could originate either directly from an autonomous Ca(2+) feedback oscillator at the inositol 1,4,5-trisphosphate (IP3) receptor or as a secondary consequence of IP3 oscillations driven by Ca(2+) feedback on IP3 metabolism. It is challenging to discriminate these alternatives, because IP3 fluctuations could drive Ca(2+) oscillations or could just be a secondary response to the [Ca(2+)]i spikes. To investigate this problem, we constructed a recombinant IP3 buffer using type-I IP3 receptor ligand-binding domain fused to GFP (GFP-LBD), which buffers IP3 in the physiological range. This IP3 buffer slows hormone-induced [IP3] dynamics without changing steady-state …

Predicting Invasiveness In Early Stage Lung Cancer, Julie Linek, Md

Division of Pulmonary, Allergy, and Critical Care Medicine Presentations and Grand Rounds

Objectives:

To discuss characteristic pathologic and radiologic correlates of tumor invasiveness in lung adenocarcinoma and their associated clinical implications.

To describe current advances in cancer biology related to the acquisition of tumor invasion and metastasis.

To identify areas for further research which have clinical impact for prognostication and treatment of early stage lung cancer.

Overall Goals and Objectives:

Following this activity, a participant should be able to:

1. Recognize recent advances and developments in Pulmonary Medicine & Critical Care and translate into clinical practice

2. Integrate perspectives of multiple disciplines into decision-making on behalf of patients through structured plans …

Leukocyte Esterase Strip Test: Matched For Musculoskeletal Infection Society Criteria., Eric H Tischler, Priscilla K Cavanaugh, Javad Parvizi Md

Rothman Institute Papers

BACKGROUND: The presence of leukocyte esterase in the synovial fluid has recently been proposed as a marker for periprosthetic joint infection. However, the sensitivity and specificity of leukocyte esterase has not been determined when matched for the current, most inclusive Musculoskeletal Infection Society (MSIS) criteria for periprosthetic joint infection.

METHODS: The presence of leukocyte esterase was prospectively evaluated in synovial joint aspirates from hips and knees from May 2009 to May 2013. The cohort consisted of 189 hip and knee aspirations (fifty-two positive and 137 negative for infection). If the aspirate was bloody, a centrifuge was used to precipitate red …

Surgical Suturing Training With Virtual Reality Simulation Versus Dry Lab Practice: An Evaluation Of Performance Improvement, Content, And Face Validity, Michael J. Amirian, Samuel M. Lindner, Edouard J. Trabulsi, Costas D. Lallas

Department of Urology Faculty Papers

The purpose of this study is to evaluate the effectiveness of virtual reality (VR) simulation versus dry lab suturing practice at improving suturing performance in robotic surgery. Nineteen novice participants with no prior robotic suturing experience were randomized to two groups, VR simulation and dry lab, which consisted of inanimate training on a da Vinci Si surgical system. Each group underwent baseline suturing evaluation, then trained on the Simbionix™ Suturing Module (SSM) or undertook suturing practice using the da Vinci Surgical System in a dry lab. Final suturing performance was evaluated using the objective suture scoring method. Participants in the …

Camk2n1 Inhibits Prostate Cancer Progression Through Androgen Receptor-Dependent Signaling., Tao Wang, Shuiming Guo, Zhuo Liu, Licheng Wu, Mingchao Li, Jun Yang, Ruibao Chen, Xiaming Liu, Hua Xu, Shaoxin Cai, Hui Chen, Weiyong Li, Shaohua Xu, Liang Wang, Zhiquan Hu, Qianyuan Zhuang, Liping Wang, Kongming Wu, Jihong Liu, Zhangqun Ye, Jun-Yuan Ji, Chenguang Wang, Ke Chen

Department of Cancer Biology Faculty Papers

Castration resistance is a major obstacle to hormonal therapy for prostate cancer patients. Although androgen independence of prostate cancer growth is a known contributing factor to endocrine resistance, the mechanism of androgen receptor deregulation in endocrine resistance is still poorly understood. Herein, the CAMK2N1 was shown to contribute to the human prostate cancer cell growth and survival through AR-dependent signaling. Reduced expression of CAMK2N1 was correlated to recurrence-free survival of prostate cancer patients with high levels of AR expression in their tumor. CAMK2N1 and AR signaling form an auto-regulatory negative feedback loop: CAMK2N1 expression was down-regulated by AR activation; while …

The Induction Of The P53 Tumor Suppressor Protein Bridges The Apoptotic And Autophagic Signaling Pathways To Regulate Cell Death In Prostate Cancer Cells., Lymor Ringer, Paul Sirajuddin, Lucas Tricoli, Sarah Waye, Muhammad Umer Choudhry, Erika Parasido, Angiela Sivakumar, Mary Heckler, Aisha Naeem, Iman Abdelgawad, Xuefeng Liu, Adam S Feldman, Richard J Lee, Chin-Lee Wu, Venkata Yenugonda, Bhaskar Kallakury, Anatoly Dritschilo, John Lynch, Richard Schlegel, Olga Rodriguez, Richard Pestell, Maria Laura Avantaggiati, Chris Albanese

Kimmel Cancer Center Faculty Papers

The p53 tumor suppressor protein plays a crucial role in influencing cell fate decisions in response to cellular stress. As p53 elicits cell cycle arrest, senescence or apoptosis, the integrity of the p53 pathway is considered a key determinant of anti-tumor responses. p53 can also promote autophagy, however the role of p53-dependent autophagy in chemosensitivity is poorly understood. VMY-1-103 (VMY), a dansylated analog of purvalanol B, displays rapid and potent anti-tumor activities, however the pathways by which VMY works are not fully defined. Using established prostate cancer cell lines and novel conditionally reprogrammed cells (CRCs) derived from prostate cancer patients; …

The Future Of Population-Based Reimbursement, David Chin, Md, Mba

College of Population Health Forum

David C. Chin, MD, MBA is a Distinguished Scholar at the Johns Hopkins Bloomberg School of Public Health and Johns Hopkins School of Medicine, where he focuses on novel industry/academic research partnerships and preparing health systems and academic medical centers for success under accountable care.

Dr. Chin will describe the Maryland-All payer system as a model of innovative population-based reimbursement. He will discuss early adaptive strategies, including ways in which health care systems will need to change. Dr. Chin will also provide a comparison of the new incentives in the model vs. fee-for-service.

Prior to joining Hopkins Dr. Chin has …

Measuring The Effectiveness Of Interactive Patient Education In Reducing Hospital Readmission Rates Of Patients Diagnosed With Congestive Heart Failure, Melanie Colace, Carly Bongart, Kayla Walker, Alisha Droxler, Yuehhsia Chen, Mary Bouchaud

College of Nursing Posters

Introduction •The leading cause of hospitalization in the United States is heart failure among adults 65 years of age. •One million patients are hospitalized every year with a primary diagnosis of heart failure, resulting in a Medicare expenditure exceeding $17 billion. •For every five patients admitted to a hospital with congestive heart failure (CHF), one patient will be readmitted within 30 days of discharge . •75 percent of early heart failure readmissions are preventable. •Medicare introduced the Hospital Readmission Reduction Program that became effective in 2012. • This program established financial penalties for greater than expected readmissions for primary diagnoses …

The Effects Of A Smart Phone App On Hospital Readmission Rates For Patients Diagnosed With Diabetes, Kevin Abercrombie, Mary Bouchaud

College of Nursing Posters

Abstract

Diabetes has been a growing concern in the United States due to the rapidly increasing incidence of this disease over the past decade. In their 2014 report, the CDC reported there were 29.1 million people diagnosed with diabetes in 2012, comprising 9.3% of the total US population. In addition, according to the CDC, 1.7 million people were newly diagnosed with type I and type II diabetes in 2012 with health care costs at an estimated $245 billion. Moving forward, the most effective approach is to empower and educate these patients to self-manage their own disease to decrease or prevent …

A Plausible Mechanism, Based Upon Short-Root Movement, For Regulating The Number Of Cortex Cell Layers In Roots., Shuang Wu, Chin-Mei Lee, Tomomi Hayashi, Simara Price, Fanchon Divol, Sophia Henry, Germain Pauluzzi, Christophe Perin, Kimberly L Gallagher

Department of Medical Laboratory Sciences & Biotechnology Faculty Papers

Formation of specialized cells and tissues at defined times and in specific positions is essential for the development of multicellular organisms. Often this developmental precision is achieved through intercellular signaling networks, which establish patterns of differential gene expression and ultimately the specification of distinct cell fates. Here we address the question of how the SHORT-ROOT (SHR) proteins from Arabidopsis thaliana (AtSHR), Brachypodium distachyon (BdSHR), and Oryza sativa (OsSHR1 and OsSHR2) function in patterning the root ground tissue. We find that all of the SHR proteins function as mobile signals in A. thaliana and all of the SHR homologs physically interact …

Olfactory Acuity In Chronic Migraine: A Cross-Sectional Study., Alexander C Whiting, Michael J. Marmura, Sarah E Hegarty, Scott W. Keith

Department of Neurology Faculty Papers

OBJECTIVE/BACKGROUND: This study aims to measure olfactory acuity in chronic migraine subjects, at baseline and on migraine days, and compare to age- and sex-matched controls. Olfactory impairment is common in neurological disorders. While smell hypersensitivity has been established with chronic migraine, olfactory acuity has not been well studied.

METHODS: We recruited 50 subjects with chronic migraine from the Jefferson Headache Center and 50 age- and sex-matched controls. Using the University of Pennsylvania Smell Identification Test (UPSIT), a validated test of olfaction, olfactory acuity was measured at baseline and during a migraine for subjects, and compared to controls at baseline and …

Comfort Care And Symptom Management, Shawnna Cannaday, Rn, Msn, Fnp-Bc, Theresa P. Yeo, Phd, Mph, Acnp

Pancreatic Cancer & Related Diseases Patient Symposium

Discuss Common Concerns in Supportive Care

•Grief

•Pain

•Nausea / Constipation / Diarrhea

•Anxiety / Depression

•Fatigue / Tiredness

•Decision making

Obstructive Sleep Apnea And Metabolic Syndrome: Where Is The Chicken? Where Is The Egg?, Vsevolod Y. Polotsky, Md, Phd

Division of Pulmonary, Allergy, and Critical Care Medicine Presentations and Grand Rounds

Objectives:

• Discuss the prevalence of obstructive sleep apnea and its outcomes
• Review clinical evidence on the relationships between obstructive sleep apnea and the metabolic syndrome
• Discuss potential mechanisms linking sleep apnea and the metabolic syndrome

Overall Goals and Objectives:

Following this activity, a participant should be able to:

1. Recognize recent advances and developments in Pulmonary Medicine & Critical Care and translate into clinical practice

2. Integrate perspectives of multiple disciplines into decision-making on behalf of patients through structured plans for patient care.

3. Develop areas for future research and discuss appropriate methods to address these needs.

4. Summarize and …

What's Good For The Heart Is Good For The Shoulder? Commentary On An Article By Chang-Meen Sung, Md, Et Al.: "Are Serum Lipids Involved In Primary Frozen Shoulder? A Case-Control Study"., Mark D Lazarus

Rothman Institute Papers

No abstract provided.

Robert Edward Gross (1905-1988): Ligation Of A Patent Ductus Arteriosus And The Birth Of A Specialty., Alexander V. Chalphin, Bs, Charles J. Yeo, Md, Scott W. Cowan, Md, Stacey Milan, Md

Department of Surgery Gibbon Society Historical Profiles

The early 20th century saw an explosion in surgical expertise. Specialties dedicated to delicate organs such as the heart and vulnerable populations, like children, were in their infancy. Dr. William E. Ladd, the father of pediatric surgery, founded the first dedicated department of pediatric surgery at Boston Children’s Hospital in 1910. At the time, attempts at cardiac surgery almost universally ended in death of the patient. The first successful surgical treatment of the cardiac valves would not occur for another 15 years, and the great vessels would remain out of reach for decades more. Dr. Robert E. Gross, the shy …

Hormone Whodunit: Clues For Solving The Case Of Intratumor Androgen Production., Karen E Knudsen

Department of Cancer Biology Faculty Papers

One of the key mechanisms by which prostate cancer cells evade hormone therapy is through intratumor testosterone production. New evidence points toward androstenedione as a potential precursor of intratumor androgen production and furthers nomination of AKR1C3 as a therapeutic target in advanced disease. Clin Cancer Res; 20(21); 5343-5. ©2014 AACR.

Ido2 In Immunomodulation And Autoimmune Disease., George C Prendergast, Richard Metz, Alexander J Muller, Lauren M F Merlo, Laura Mandik-Nayak

Department of Microbiology and Immunology Faculty Papers

IDO2 is a relative of IDO1 implicated in tryptophan catabolism and immune modulation but its specific contributions to normal physiology and pathophysiology are not known. Evolutionary genetic studies suggest that IDO2 has a unique function ancestral to IDO1. In mice, IDO2 gene deletion does not appreciably affect embryonic development or hematopoiesis, but it leads to defects in allergic or autoimmune responses and in the ability of IDO1 to influence the generation of T regulatory cells. Gene expression studies indicate that IDO2 is a basally and more narrowly expressed gene than IDO1 and that IDO2 is uniquely regulated by AhR, which …

Low Vision Depression Prevention Trial In Age-Related Macular Degeneration: A Randomized Clinical Trial., Barry W. Rovner, Robin J Casten, Mark T Hegel, Robert W Massof, Benjamin E Leiby, Allen C Ho, William S Tasman

Department of Psychiatry and Human Behavior Faculty Papers

PURPOSE: To compare the efficacy of behavior activation (BA) + low vision rehabilitation (LVR) with supportive therapy (ST) + LVR to prevent depressive disorders in patients with age-related macular degeneration (AMD).

DESIGN: Single-masked, attention-controlled, randomized, clinical trial with outcome assessment at 4 months.

PARTICIPANTS: Patients with AMD and subsyndromal depressive symptoms attending retina practices (n = 188).

INTERVENTIONS: Before randomization, all subjects had 2 outpatient LVR visits, and were then randomized to in-home BA+LVR or ST+LVR. Behavior activation is a structured behavioral treatment that aims to increase adaptive behaviors and achieve valued goals. Supportive therapy is a nondirective, psychological treatment …

The Significance Of Functional Renal Obstruction In Predicting Pathologic Stage Of Upper Tract Urothelial Carcinoma., Michael J. Amirian, Kushan Radadia, Hadley Narins, Kelly A. Healy, Scott G. Hubosky, Demetrius H. Bagley, Edouard J. Trabulsi, Costas D. Lallas

Department of Urology Faculty Papers

BACKGROUND AND PURPOSE: Assessing the severity of upper tract urothelial carcinoma (UTUC) has been difficult because of inadequate biopsy specimens. Additional predictive parameters of disease stage would be useful when deciding a treatment plan; it has been suggested that preoperative hydronephrosis can be a surrogate. We examined the relationship between preoperative ipsilateral renal obstruction identified by imaging with final pathologic stage after nephroureterectomy (NU) for UTUC. We then analyzed those patients with ipsilateral renal obstruction and examined if tumor location is associated with an advanced pathologic stage.

METHODS: Patients who underwent NU for UTUC between the years 2001 to 2013 …

Teaching Health Advocacy To Medical Students: A Comparison Study., Julia Belkowitz, Lee M Sanders, Chi Zhang, Gauri Agarwal, Daniel Lichtstein, Alex J Mechaber, Esther K Chung

Department of Pediatrics Faculty Papers

CONTEXT: Many encourage service learning and health advocacy training in medical student education, but related evaluation is limited.

OBJECTIVES: To assess (1) impact of a required community health advocacy training for medical students on student attitudes, knowledge, and skills; (2) student characteristics associated with higher advocacy knowledge and skills; and (3) perspectives of community-based organizations (CBOs).

DESIGN: Cross-sectional surveys.

SETTING: University of Miami Miller School of Medicine (UMMSM) Regional Medical Campus and main campus.

PARTICIPANTS: Medical students at both UMMSM campuses.

INTERVENTION: Required community health advocacy training for first- and second-year students including classroom experiences and hands-on project in partnership …

Jewish Dermatologists In Nazi Germany., Walter H.C. Burgdorf, Lawrence Charles Parish

Department of Dermatology and Cutaneous Biology Faculty Papers

With the development of medical specialties beginning in the 1860’s, physicians could devote their time to the study of specific organ systems or surgical approaches. Although Jews had been given full rights in the new Germany by 1871, prejudice and other restrictions often precluded hospital and university appointments. Major specialities like internal medicine and surgery were almost closed to Jews, as were obstetrics and gynecology. Dermatology with its heavy emphasis on sexually transmitted diseases evolved into a suitable domain for Jewish physicians almost by default. Even those Jews who converted to Christianity were not spared from discrimination. Paul Gerson Unna …

New Posters Added To The Jefferson Digital Commons, Daniel G. Kipnis, Msi

Jefferson Digital Commons News

15 new posters have been deposited in the Jefferson Digital Commons

Screen Time Overtime: Should A “Screen Time Diet” Be Part Of Healthy Everyday Activities And Routines For Families And Their Young Children?, Sarah Jamieson, Ots, Mary Muhlenhaupt, Otd, Otr/L, Faota

Department of Occupational Therapy Posters and Presentations

Introduction:

Though television is still the primary form of media for children, almost one-third of TV programming is accessed through smart phones, tablets, and computers (Strasburger et al., 2013).

•Families do not adhere to AAP’s guidelines (Brown, 2011)

•Research suggests detrimental effect on young children

OT’s are an integral resource to help families design healthy recreational “screen time diets.”

Mouse Hepatitis Virus Infection Upregulates Genes Involved In Innate Immune Responses., Dhriti Chatterjee, Sankar Addya, Reas S Khan, Lawrence C. Kenyon, Alexander Choe, Randall J Cohrs, Kenneth S Shindler, Jayasri Das Sarma

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Neurotropic recombinant strain of Mouse Hepatitis Virus, RSA59, induces meningo-encephalitis, myelitis and demyelination following intracranial inoculation. RSA59 induced neuropathology is partially caused by activation of CNS resident microglia, as demonstrated by changes in cellular morphology and increased expression of a microglia/macrophage specific calcium ion binding factor, Iba1. Affymetrix Microarray analysis for mRNA expression data reveals expression of inflammatory mediators that are known to be released by activated microglia. Microglia-specific cell surface molecules, including CD11b, CD74, CD52 and CD68, are significantly upregulated in contrast to CD4, CD8 and CD19. Protein analysis of spinal cord extracts taken from mice 6 days post-inoculation, …

Bronchial Thermoplasty – Principles And Controversies, David Manoff, Md

Division of Pulmonary, Allergy, and Critical Care Medicine Presentations and Grand Rounds

Objectives:

1) Learn the indications and contraindications to bronchial thermoplasty.

2) Develop a basic understanding of the controversies about, and the barriers to, the use of thermoplasty.

3) Understand the peri-procedural care and follow-up of patients who receive bronchial thermoplasty.

No Audio. PowerPoint slides only.

Dipstick Proteinuria Is An Independent Predictor Of High On Treatment Platelet Reactivity In Patients On Clopidogrel, But Not Aspirin, Admitted For Major Adverse Cardiovascular Events., Carlos D. Davila, Fernando Vargas, Kuan-Hsiang Gary Huang, Thomas Monaco, Anastasios Dimou, Janani Rangaswami, Vincent M. Figueredo, M.D.

Division of Cardiology Faculty Papers

Abstract The effectiveness of aspirin and clopidogrel in patients with chronic kidney disease (CKD) suffering from acute cardiovascular events is unclear. High on treatment platelet reactivity (HTPR) has been associated with worse outcomes. Here, we assessed the association of dipstick proteinuria (DP) and renal function on HTPR and clinical outcomes. Retrospective cohort analysis of 261 consecutive, non-dialysis patients admitted for Major Adverse Cardiovascular Events (MACE) that had VerifyNow P2Y12 and VerifyNow Aspirin assays performed. HTPR was defined as P2Y12 reactivity unit (PRU) > 208 for clopidogrel and aspirin reaction units (ARU) > 550 for aspirin. Renal function was classified based on the …

Management Of Head And Neck Pseudoaneurysms: A Review Of 33 Consecutive Cases., Eliza Anderson, Nohra Chalouhi, Md, Aaron Dumont, Stavropoula Tjoumakaris, Mario Zanaty, Robert H. Rosenwasswer Md, Robert M Starke, Pascal Jabbour Md

Department of Neurosurgery Faculty Papers

Background. Endosaccular coiling, vessel occlusion, stenting, stent-assisted coiling, and flow diversion are all endovascular treatment options for pseudoaneurysms (PAs) of the head and neck. We explore different clinical situations in which these were selected for PA management at a single institution. Methods. Over a period of ten years, 33 patients presented to our hospital with PAs of the head and neck. Their outcomes and procedural complications are discussed. Results. We observed a complication rate of 18.2% (6 of 33), consisting predominantly of infarcts following vessel occlusion. As measured by the modified Rankin Scale, 25 (75.8%) patients had achieved favorable outcomes …

Olfactory Function In Migraine Both During And Between Attacks., Michael J. Marmura, Teshamae S Monteith, Waseem Anjum, Richard L Doty, Sarah E Hegarty, Scott W Keith

Department of Neurology Faculty Papers

INTRODUCTION: People with migraine often report being osmophobic, both during and between acute migraine attacks. It is not clear, however, whether such reports are associated with changes in olfaction such as hyperosmia, as measured by psychophysical testing. In this case-control study we quantitatively assessed olfactory identification ability, which correlates with threshold tests of olfactory acuity, in patients with migraine at baseline (no headache), during migraine episodes, and after a treated attack and compared the test scores to those of matched control subjects.

METHODS: Fifty episodic migraine subjects and 50 and sex- and age-matched controls without headache were tested. All completed …

Impact Of Preadmission Beta-Blocker Use On Cardiac Abnormalities And In-Hospital Mortality In Patients With Aneurysmal Subarachnoid Hemorrhage, Toshimasa Okabe, Md, Anushya Jeyabalan, Md, Benjamin E. Leiby, Phd, Fred Rincon, Md, Walter K. Kraft, Md

Department of Pharmacology and Experimental Therapeutics Faculty Papers

Introduction:

Various cardiac abnormalities, including dysrhythmias, left ventricular (LV) dysfunction, and myocardial injury, are commonly seen after subarachnoid hemorrhage (SAH). In patients taking a beta-blocker (BB) chronically, the medication is generally discontinued after hospitalization due to the concern of compromising cerebral perfusion. We hypothesized that sudden BB discontinuation might inadvertently lead to an increased incidence of composite cardiac abnormalities and higher in-hospital mortality in patients presenting with nontraumatic SAH.

Overview And Impact Of Implementation Of A Pharmacy Concierge Service, William Balas, Phd, Christine H. Delash, Pharm.D, Brian G. Swift, Pharm.D., Mba, Lynda Thomson, Pharm D., Cacp

Pharmacy Presentations, Posters, and Grand Rounds

Problem / Issue:

Patients are at risk for adverse events and re-admissions due to outpatient medication errors and non-adherence to prescribed medication regimens. Patients are especially at risk for medication errors and misunderstanding of prescribed medication regimens during the transition of care process from the inpatient to outpatient setting.