Medicine and Health Sciences Commons^™

Analytical “Bake-Off” Of Whole Genome Sequencing Quality For The Genome Russia Project Using A Small Cohort For Autoimmune Hepatitis, Daria V. Zhernakova, Sergei Kliver, Nikolay Cherkasov, Gaik Tamazian, Mikhail Rotkevich, Ksenia Krasheninnikova, Igor Evsyukov, Sviatoslav Sidorov, Pavel Dobrynin, Andrey A. Yurchenko, Valentin Shimansky, Irina V. Shcherbakova, Andrey S. Glotov, David L. Valle, Minzhong Tang, Emilia Shin, Kathleen B. Schwarz, Stephen James O'Brien

Biology Faculty Articles

A comparative analysis of whole genome sequencing (WGS) and genotype calling was initiated for ten human genome samples sequenced by St. Petersburg State University Peterhof Sequencing Center and by three commercial sequencing centers outside of Russia. The sequence quality, efficiency of DNA variant and genotype calling were compared with each other and with DNA microarrays for each of ten study subjects. We assessed calling of SNPs, indels, copy number variation, and the speed of WGS throughput promised. Twenty separate QC analyses showed high similarities among the sequence quality and called genotypes. The ten genomes tested by the centers included eight …

Clinicopathologic Features And Prognostic Grouping Of Gastrointestinal Stromal Tumors (Gists) In Pakistani Patients: An Institutional Perspective, Atif Ali Hashmi, Mahrukh Faraz, Zareeha Nauman, Mohammad Usman Qureshi, Shumaila Kanwal Hashmi, Hira Fatima Waseem, Muhammad Muzzammil Edh, Naveen Faridi, Amir Khan

Department of Pathology and Laboratory Medicine

Objectives: Gastrointestinal stromal tumors (GISTs) are rare tumors of gastrointestinal tract, prognosis of which largely depends upon histopathologic characteristics of resection specimens, which were not widely studied in our population. Therefore we aimed to evaluate the histopathologic characteristics of GISTs in our population and their prognostic grouping according to college of American pathologist’s guidelines.
Results: Mean age of patients was 53.4 years (18–71 years). 92% of cases were of primary GISTs and stomach was the most common site (57.7%). 75% of cases were of spindle cell morphology and 53.8% belonged to high risk prognostic group. Comparison of stomach and intestinal …

Stable Isotope-Resolved Metabolomics Shows Metabolic Resistance To Anti-Cancer Selenite In 3d Spheroids Versus 2d Cell Cultures, Teresa W. -M. Fan, Salim S. El-Amouri, Jessica K. A. Macedo, Qing Jun Wang, Huan Song, Teresa Cassel, Andrew N. Lane

Center for Environmental and Systems Biochemistry Faculty Publications

Conventional two-dimensional (2D) cell cultures are grown on rigid plastic substrates with unrealistic concentration gradients of O₂, nutrients, and treatment agents. More importantly, 2D cultures lack cell–cell and cell–extracellular matrix (ECM) interactions, which are critical for regulating cell behavior and functions. There are several three-dimensional (3D) cell culture systems such as Matrigel, hydrogels, micropatterned plates, and hanging drop that overcome these drawbacks but they suffer from technical challenges including long spheroid formation times, difficult handling for high throughput assays, and/or matrix contamination for metabolic studies. Magnetic 3D bioprinting (M3DB) can circumvent these issues by utilizing nanoparticles that enable …

2018 July 10 - Medical Student Education Committee Minutes, Medical Student Education Committee, East Tennessee State University

Medical Student Education Committee Minutes

No abstract provided.

Opposing Tumor-Promoting And -Suppressive Functions Of Rictor/Mtorc2 Signaling In Adult Glioma And Pediatric Shh Medulloblastoma., Seçkin Akgül, Yinghua Li, Siyuan Zheng, Marcel Kool, Daniel M Treisman, Chaoyang Li, Yuan Wang, Susanne Gröbner, Tsuneo Ikenoue, Yiping Shen, Sandra Camelo-Piragua, Gerald Tomasek, Sebastian Stark, Vinay Guduguntla, James F Gusella, Kun-Liang Guan, Stefan M Pfister, Roel G W Verhaak, Yuan Zhu

Faculty Research 2018

Most human cancers arise from stem and progenitor cells by the sequential accumulation of genetic and epigenetic alterations, while cancer modeling typically requires simultaneous multiple oncogenic events. Here, we show that a single p53 mutation, despite causing no defect in the mouse brain, promoted neural stem and progenitor cells to spontaneously accumulate oncogenic alterations, including loss of multiple chromosomal (chr) regions syntenic to human chr10 containing Pten, forming malignant gliomas with PI3K/Akt activation. Rictor/mTORC2 loss inhibited Akt signaling, greatly delaying and reducing glioma formation by suppressing glioma precursors within the subventricular zone stem cell niche. Rictor/mTORC2 loss delayed timely differentiation …

Brain Herniation Through The Cribriform Plate: Review And Comparison To Encephaloceles In The Same Region., Rabjot Rai, Joe Iwanaga, Marios Loukas, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

Herniations of the brain and/or meninges through an opening of the skull often occur through the foramen magnum, e.g., Chiari malformations and encephaloceles. The herniation of brain matter through the cribriform plate is a rare incident and has not been reported frequently. The presence of such an occurrence still requires attention and anatomical understanding. This review will examine the potential causes of cribriform plate herniation and its distinguishability to nasal encephaloceles. The sloping of brain tissue toward potential space/opening in response to elevated pressures in the cranium to accommodate for the added pressure are features seen in herniation. The presence …

Malignant Hyperthermia, Ryan Vincent

Nursing Student Class Projects (Formerly MSN)

No abstract provided.

Exposition Des Travailleurs Aux Substances Chimiques Et Aux Agents Biologiques Dans Les Usines De Biométhanisation Des Matières Organiques Putrescibles : Évaluation Exploratoire, Bouchra Bakhiyi, Geneviève Marchand, Yves Cloutier, Yves Beaudet, Marc Veillette, Marie-Ève Dubuis, Hamza Mbareche, Joseph Zayed, Caroline Duchaine, Jacques Lavoie

Rapports de recherche scientifique

La biométhanisation est un procédé de transformation anaérobie des matières organiques putrescibles (MOP) en biogaz et en digestat destiné à l'épandage en milieu agricole. Ce procédé est en forte croissance en raison de la Politique québécoise de gestion des matières résiduelles qui prévoit le bannissement de l'enfouissement des MOP, et ce, dès 2020. L'exposition des travailleurs affectés aux activités de biométhanisation a fait l’objet de peu de publications scientifiques. L'objectif général de cette recherche est donc d'évaluer de manière exploratoire l’exposition de ces travailleurs. Plus spécifiquement, cette étude vise à 1) détecter et à mesurer la présence et les concentrations …

Anesthesia Considerations For Spinal Anesthesia In Infants, Cody Grassel

Nursing Capstones

No abstract provided.

Radio-Fluorogenic Gel Dosimetry With Coumarin., Peter A Sandwall, Brandt P Bastow, Henry B Spitz, Howard R Elson, Michael Lamba, William B Connick, Henry Fenichel

Oncology Articles

Gel dosimeters are attractive detectors for radiation therapy, with properties similar to biological tissue and the potential to visualize volumetric dose distributions. Radio-fluorogenesis is the yield of fluorescent chemical products in response to energy deposition from ionizing radiation. This report shares the development of a novel radio-fluorogenic gel (RFG) dosimeter, gelatin infused with coumarin-3-carboxlyic acid (C3CA), for the quantification of imparted energy. Aqueous solutions exposed to ionizing radiation result in the production of hydroxyl free radicals through water radiolysis. Interactions between hydroxyl free radicals and coumarin-3-carboxylic acid produce a fluorescent product. 7-hydroxy-coumarin-3-carboxylic acid has a blue (445 nm) emission following …

Cross Jurisdictional Boundaries To Build A Health Coalition: A Kentucky Case Study, Angela L. Carman, Margaret L. Mcgladrey

Health, Behavior & Society Faculty Publications

Cross-jurisdictional sharing is accomplished through collaboration across jurisdictional boundaries to deliver essential public health services and solve problems that cannot be easily addressed by single organizations or jurisdictions. Partners across 10 counties and three public health jurisdictions of the Barren River Area Development District (BRADD) convened as Barren River Initiative to Get Healthy Together (BRIGHT), a community health improvement coalition. Focus groups and interviews with BRIGHT members indicate that the use of effective strategies to focus collaborative health improvement efforts fosters a cohesive coalition even when the group is populated by individuals from across public health jurisdictional boundaries. Focusing strategies …

Developing Droplet Based 3d Cell Culture Methods To Enable Investigations Of The Chemical Tumor Microenvironment, Jacqueline Alexandria De Lora

Biomedical Sciences ETDs

Adaptation of cancer cells to changes in the biochemical microenvironment in an expanding tumor mass is a crucial aspect of malignant progression, tumor metabolism, and drug efficacy. In vitro, it is challenging to mimic the evolution of biochemical gradients and the cellular heterogeneity that characterizes cancer tissues found in vivo. It is well accepted that more realistic and controllable in vitro 3D model systems are required to improve the overall cancer research paradigm and thus improve on the translation of results, but multidisciplinary approaches are needed for these advances. This work develops such approaches and demonstrates that new droplet-based cell-encapsulation …

Metabolic Acidosis After Sodium Thiosulfate Infusion And The Role Of Hydrogen Sulfide, Guenola M. Hunt, Hilary F. Ryder

Dartmouth Scholarship

Sodium thiosulfate (STS), first-line treatment for calcific uremic arteriolopathy, causes a mild asymptomatic acidosis in many patients. However, severe, life-threatening acidosis out of proportion with the expected acid load of STS may occur, potentially due to metabolism of STS to hydrogen sulfide.

Aerosol Microdroplets Exhibit A Stable Ph Gradient, Haoran Wei, Eric P. Vejerano, Weinan Leng, Qishen Haung, Marjorie R. Willner, Linsey C. Marr, Peter J. Vikesland

Faculty Publications

Suspended aqueous aerosol droplets (<50 μm) are microreactors for many important atmospheric reactions. In droplets and other aquatic environments, pH is arguably the key parameter dictating chemical and biological processes. The nature of the droplet air/ water interface has the potential to significantly alter droplet pH relative to bulk water. Historically, it has been challenging to measure the pH of individual droplets because of their inaccessibility to conventional pH probes. In this study, we scanned droplets containing 4-mercaptobenzoic acid–functionalized gold nanoparticle pH nanoprobes by 2D and 3D laser confocal Raman microscopy. Using surface-enhanced Raman scattering, we acquired the pH distribution inside approximately 20-μm-diameter phosphate-buffered aerosol droplets and found that the pH in the core of a droplet is higher than that of bulk solution by up to 3.6 pH units. This finding suggests the accumulation of protons at the air/water interface and is consistent with recent thermodynamic model results. The existence of this pH shift was corroborated by the observation that a catalytic reaction that occurs only under basic conditions (i.e., dimerization of 4-aminothiophenol to produce dimercaptoazobenzene) occurs within the high pH core of a droplet, but not in bulk solution. Our nanoparticle probe enables pH quantification through the cross-section of an aerosol droplet, revealing a spatial gradient that has implications for acid-base–catalyzed atmospheric chemistry.

Hypnoparenting Effects Towards Fatigue As An Impact Of Chemotherapy Among Pediatric Patients With Acute Lymphoblastic Leukemia, Sapariah Anggraini

Jurnal Keperawatan Indonesia

The management of fatigue among pediatric patients with lymphoblastic leukemia does not become a priority apart from the cancer management itself. Hence, it is necessary to put an attention towards this issue by giving another complementary therapy for the patient called hypnoparenting. By implementing hypnoparenting will decrease the level of fatigue because of the chemotherapy process. Therefore the purpose of study was to investigate the effect of hypnoparenting towards fatigue prevalence as an impact of chemotherapy among pediatric patients with Acute Lymphoblastic Leukemia. This research utilized quasi experiment before after study. The population of the study was pediatric patients (5-12 …

Evidence Of Chikungunya Virus Disease In Pakistan Since 2015 With Patients Demonstrating Involvement Of The Central Nervous System, Kelli L. Barr, Erum Khan, Joveria Farooqi, Kehkashan Imtiaz, Dhani Prakoso, Faisal Malik, John A. Lednicky, Maureen T. Long

Department of Pathology and Laboratory Medicine

Several arboviruses are endemic to and co-circulate in Pakistan. In recent years, Pakistan has observed a rise in arboviral infections. A cross-sectional study for arboviral diseases, which included screening for Chikungunya virus (CHIKV), was initiated in 2015 to determine which pathogens were causing disease in patients presenting to health care services. Exposure to CHIKV was verified via detection of viral nucleic acids or virus-specific IgM with virus-specific neutralizing antibodies. Out of 997 enrolled patients presenting with clinical features suggestive of arboviral disease, 102 patients were positive for CHIKV IgM antibodies and 60 patients were positive for CHIKV nucleic acids or …

Perspectives Of Older Blacks And Whites Living With Serious Mental Illness About Outpatient Mental Health Services, Rosalyn Roker

USF Tampa Graduate Theses and Dissertations

In the United States, over three million adults, age 50 and older, reported a diagnosis of serious mental illness (SMI) in the past year. Most of them live in community-settings and are less likely than younger adults to utilize mental health treatment. Lack of and insufficient treatment for SMI places them at increased risk of morbidity, earlier mortality, cognitive decline, and diminished quality of life. The current study aimed to: (1) examine the factors that influence Black and White older adults, who live with SMI, to seek and engage in outpatient mental health treatment; (2) identify the perspectives of Black …

Peningkatan Kualitas Hidup Lanjut Usia (Lansia) Di Kota Depok Dengan Latihan Keseimbangan, Stefanus Mendes Kiik, Junaiti Sahar, Henny Permatasari

Jurnal Keperawatan Indonesia

Quality Improvement of Elderly Life in Depok City with Balance Exercise. The quality of life (QOL) of the older adult is affected by various factors such as physical health, psychological health, social relationships and environment. This study aimed to investigate the effect of balance exercise on quality of life among older adults. This quasi-experimental design included two groups; 30 subjects as intervention groups and 30 subjects as control groups. The sample was taken by multistage random sampling. There were significant improvements in quality of life among older adults (p<0,001). Balance exercise can improve physical health, psychological health, social relationships, and environment. Balance exercise can be utilized as one of the preventive efforts to increase the quality of life among older adults in the community. Further research may consider a variety of age to know the effectiveness of balance exercise.

Resident Reflection: A Missed Date, Timothy Kuchera, Md

The Medicine Forum

Resident Reflection: A Missed Date

The Opioid Epidemic – Addressing Provider Roles And Responsibilities, Anita Modi, Md, Debbie Chen, Md, Neha Bansal Etherington, Md, Brianna Shinn, Md, Colin Thomas, Md

The Medicine Forum

INTRODUCTION

This year marks the 19th volume of Jefferson’s annual publication spearheaded by Internal Medicine residents and supported by its fellows. Our Editorial Board includes Neha, Debbie, Anita, Brianna, and myself. Our mission is to further medical knowledge by sharing each other’s observations and studies both through our publication, which you can find online, as well as through annual discussion at Grand Rounds.

This year, we’ve chosen to focus on our roles as providers in the midst of the National Opioid Epidemic. The National Institute on Drug Abuse has reported that the number of opioid-related overdose deaths from both illegal …

White Paper: Improving Handoff Culture In Intensive Care Unit To Floor Handoffs, Grant Turner, Md, Kristin Lohr, Md, Andrew Brown, Md, Allison Greco, Md, Rebecca C. Jaffe, Md

The Medicine Forum

The frequency of handoffs between providers has increased since the 2011 Accreditation Council for Graduate Medical Education (ACGME) work hour restrictions, generating concerns over the quality of these handoffs and their impact on patient safety. At Thomas Jefferson University Hospital (TJUH), the 2016 Safety Culture Survey revealed that across all specialties, many residents felt that “things fall through the cracks” when transferring patients from one unit to another. The interdepartmental Housestaff Quality and Safety Leadership Council (HQSLC) at TJUH sought to improve handoffs at our institution and identified two areas of focus: (1) standardizing the language of handoffs with a …

Syncope Diagnosed By Inducible Sustained Ventricular Tachycardia, Amit Vira, Md

The Medicine Forum

INTRODUCTION

Syncope is a common complaint in the emergency department (ED), accounting for approximately 3% of all ED visits.1 Although most causes of syncope are benign and self-limited, others are associated with significant morbidity and mortality.

Sclerosing Mesenteritis: Clinical Presentation, Imaging Findings, And Treatment, Jennifer Nauheim, Bsc, Rose Onyeali, Md

The Medicine Forum

CASE PRESENTATION

A 67-year old male with a history of myocardial infarction status post percutaneous coronary intervention and stage IV bladder cancer status post radical cystoprostatectomy with ileal neobladder reconstruction and chemotherapy (cisplatin and gemcitabine) presented with progressive, severe epigastric and lower abdominal pain associated with nausea. The pain had intensified over the previous week and was associated with a recent fifteen pound weight loss in the setting of poor oral intake. He denied nausea or diarrhea. His physical exam was notable for abdominal tympany and tenderness. His labs were notable for mild hyperkalemia (potassium 5.0 mmol/L), normal white blood …

Adverse Effects Of Checkpoint Inhibitor Immunotherapy In Medical Oncology, Michael Brister, Md, Colin Thomas, Md

The Medicine Forum

No abstract provided.

Amyotrophic Lateral Sclerosis Presenting As Chronic Cough, Marjorie Friedman, Md

The Medicine Forum

INTRODUCTION

Amyotrophic Lateral Sclerosis (ALS) is a debilitating, uniformly fatal disease. While it most commonly presents with limb weakness, patients may also present with neurocognitive, respiratory, or bulbar symptoms. Despite its poor prognosis, an early diagnosis can save patients from unnecessary and expensive testing, lead to interventions that improve quality of life, and give patients and family time for advanced planning.1 This case highlights an unusual presentation of ALS.

KEY POINTS

• Our patient presented with chronic cough and restrictive lung disease and after extensive workup was diagnosed with ALS.
• Bulbar and respiratory symptoms are uncommon initial presentations of ALS.
• Early …

A Case Of Cryptogenic Organizing Pneumonia Managed Without A Diagnostic Biopsy, Kamal Amer, Md, Mckensie Walker, Bsc, Vincent Yeung, Md

The Medicine Forum

INTRODUCTION

Organizing pneumonia (OP) is a type of diffuse interstitial lung disease characterized by a specific histopathologic pattern of response to lung injury. When the etiology of the injury is unknown and in the absence of inflammatory or connective tissue disease, this entity is termed cryptogenic organizing pneumonia (COP) or primary organizing pneumonia (POP). Disease states in which the etiology of underlying injury is known is termed secondary organizing pneumonia (SOP). Causes of SOP include drug toxicity, chronic heart or renal failure, rheumatic disease, collagen vascular disease, infection, immunodeficiency, autoimmune disease, and interstitial lung disease.

OP is characterized by the …

Fifty Shades Of Sarcoidosis: A Case Report Of Löfgren Syndrome, Arpana Parachuri, Md

The Medicine Forum

INTRODUCTION

Sarcoidosis is a multi-organ disorder that is characterized by the presence of noncaseating granulomas in involved organs. It commonly affects young and middle-aged individuals of all races, but is 3-4 times more common in African Americans and typically presents earlier with more severe symptoms.1 The lungs are affected in 90% of patients and pulmonary disease accounts for the majority of the morbidity and mortality associated with this disease. However, approximately 30% of patients can present with extrapulmonary findings and can have involvement of other organs such as the skin and eyes.1 The various presentations of sarcoidosis can make it …

Use Of Venovenous Extracorporeal Membranous Oxygenation Following Iatrogenic Tracheal Rupture, Rajiv Kabadi, Md

The Medicine Forum

INTRODUCTION

Iatrogenic tracheal rupture is a rare complication of endotracheal intubation and has a high risk of morbidity and mortality. Risk factors include female gender, short stature (height less than 160-cm), difficult airway anatomy, underlying connective tissue disorder, chronic obstructive pulmonary disease, use of a rigid stylet, inadequate intubation tube size, cuff over-inflation, emergent intubation and intubation performed by non-anesthesiologists. 1 Early recognition is important and diagnosis requires bronchoscopic confirmation.2,3 We describe a case where emergent venovenous extra-corporeal membrane oxygenation (VV-ECMO) was utilized in the management of tracheal rupture.

KEY POINTS

• Tracheal rupture is an uncommon but severe complication of …

A Case Of Eosinophilic Granulomatosis With Polyangiitis, Anita Modi, Md, Lily Ackermann, Md

The Medicine Forum

INTRODUCTION

Eosinophilic granulomatosis with polyangiitis (eGPA) is a small- and medium-sized-vessel vasculitis with multi-organ manifestations. Given the rarity of eGPA, patients are often misdiagnosed for decades and may initially present with life-threatening manifestations of late-stage disease. Therefore, it is important to raise awareness of this condition and its associated signs and symptoms. This case report serves to describe a classic presentation of a patient with eGPA, as well as to delineate the diagnostic workup, acute management, and early outpatient follow-up required.

KEY POINTS

Given the life-threatening complications of this rare condition, it is important to raise awareness about eGPA. This …

Tenofovir Cons The Kidneys: A Case Of Acquired Fanconi, Ritu Nahar, Md, Emma Lundsmith, Md

The Medicine Forum

INTRODUCTION

Proximal (Type 2) renal tubular acidosis (RTA) is a relatively rare diagnosis, especially in adults. It is characterized by a reduction in proximal bicarbonate reabsorption resulting in urinary bicarbonate wasting. Proximal RTA can also be associated with additional defects in proximal tubular function including impaired reabsorption of phosphate, glucose, uric acid, and amino acids. Generalized proximal tubular dysfunction is termed Fanconi syndrome. While there are primary causes of Fanconi syndrome including sporadic and familial sources, this syndrome can also be acquired. Two major culprits include monoclonal gammopathies resulting in increased excretion of immunoglobulin light chains and drug-induced nephrotoxicity to …