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Commencement, Georgia (2020), Philadelphia College Of Osteopathic Medicine

Commencements

Georgia Campus Commencement program, Class of 2020. Degrees include Doctorate in Osteopathic Medicine.

Commencement, Philadelphia (2020), Philadelphia College Of Osteopathic Medicine

Commencements

Philadelphia Campus Commencement program, Class of 2020. Degrees include Doctorate in Osteopathic Medicine.

Hypogeusia As The Initial Presenting Symptom Of Covid-19, Lauren E Melley, Eli Bress, Erik Polan

PCOM Scholarly Works

COVID-19 is the disease caused by the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which first arose in Wuhan, China, in December 2019 and has since been declared a pandemic. The clinical sequelae vary from mild, self-limiting upper respiratory infection symptoms to severe respiratory distress, acute cardiopulmonary arrest and death. Otolaryngologists around the globe have reported a significant number of mild or otherwise asymptomatic patients with COVID-19 presenting with olfactory dysfunction. We present a case of COVID-19 resulting in intensive care unit (ICU) admission, presenting with the initial symptom of disrupted taste and flavour perception prior to respiratory …

Exophytic Adiposis Dolorosa (Dercum's Disease) Of The Thigh: A Case Report., Jude L Opoku-Agyeman, Lauren Coffua, Jamee Simone, Terrance Hanley, Amir Behnam

Plastic Surgery Resident Research

Adiposis dolorosa or Dercum's disease is a rare lipomatous disorder characterized by painful lipomas. In this article, we report a case of rather large exophytic adiposis dolorosa causing difficulties with ambulation, and our surgical management of the disorder. To our knowledge, this is the first reported case of a large exophytic adiposis dolorosa of the upper medial thigh causing problems with mobility. This is also the first reported case of the use of a delayed split-thickness skin graft (STSG) after interval use of wound vacuum-assisted closure (VAC) following dermolipectomy. A 77-year-old female presented with a chronic mass on the medial …

Emerging Therapeutic Strategies For Covid-19 Patients, Shudong Zhu, Xialing Guo, Kyla Geary, Dianzheng Zhang

PCOM Scholarly Works

Over 100,000 cases of COVID-19 patients infected with the novel coronavirus SARS-COV-2 have been reported worldwide in approximately 2 months, resulting in over 3000 deaths. Potential therapeutic strategies, including remdesivir, chloroquine phosphate, abidol, lopinavir/ritonavir, plasma, antibody, vaccine and stem cells are discussed in this review. With the number of patients increasing daily, there is an urgent need for effective therapeutic intervention.

Cost-Effectiveness Model Shows Superiority Of Wireless Spinal Cord Stimulation Implantation Without A Separate Trial., Richard B North, Harish S. Parihar, Shawn D. Spencer, Arthur F Spalding, Jane Shipley

PCOM Scholarly Works

OBJECTIVE: We evaluated the cost-effectiveness of wireless spinal cord stimulation (Wireless SCS) with single stage "direct to permanent" implantation vs. screening with temporary electrodes and an external pulse generator followed by implantation of a system for long-term use (IPG SCS).

MATERIALS AND METHODS: We created a cost model that takes a 2019 United States (U.S.) payer perspective and is based on IPG SCS cost models for subjects with chronic back and/or leg pain. Our six-month decision tree includes the screening trial period (success ≥50% relief) and leads to various levels of pain relief with or without complications for IPG SCS …

Risk Factors For Liposomal Bupivacaine Resistance After Total Hip Or Knee Arthroplasties: A Retrospective Observational Cohort In 237 Patients, Scott Buzin, Arianna L. Gianakos, Deborah Li, Anthony Viola, Sherif Elkattawy, David M. Keller, Richard S. Yoon, Frank A. Liporace

Orthopedic Surgery Resident Research

Purpose: Liposomal bupivacaine demonstrated promise decreasing postoperative pain in total hip and total knee arthroplasty (THA/TKA). Some randomized trials have shown non-superior results; however, confounding variables were not accounted for in such analyses. This study attempts to determine risk factors associated with failure of pain management in patients receiving liposomal bupivacaine.

Methods: Postoperative pain scores were collected following primary or revision arthroplasties between January 2016 and December 2017. Retrospective analysis of institutional total joint quality and outcomes registry was screened and patients undergoing primary or revision arthroplasties who completed a multi-modal pain management including liposomal bupivacaine were included in the …

Case Report: Co-Existence Of Brca2 And Palb2 Germline Mutations In Familial Prostate Cancer With Solitary Lung Metastasis., Tang Tang, Lin-Ang Wang, Peng Wang, Dali Tong, Gaolei Liu, Jun Zhang, Nan Dai, Yao Zhang, Gang Yuan, Kyla Geary, Dianzheng Zhang, Qiuli Liu, Jun Jiang

PCOM Scholarly Works

Background: Mutation-caused loss-of-function of factors involved in DNA damage response (DDR) is responsible for the development and progression of ~20% of prostate cancer (PCa). Some mutations can be used in cancer risk assessment and informed treatment decisions.

Methods: Target capture-based deep sequencing of 11 genes was conducted with total DNA purified from the proband's peripheral blood. Sanger sequencing was conducted to screen potential germline mutations in the proband's family members. Targeted sequencing of a panel of 1,021 genes was done with DNA purified from the tumor tissue.

Results: Two previously unreported germline mutations in the DDR pathway,

Conclusions: The newly …

Isolated Large Glenoid Fracture In Acute Glenohumeral Dislocation In The Elderly: A Novel Indication For Reverse Shoulder Arthroplasty, Tyler Smith, Joseph D'Alonzo, Alfonso Arevalo, Jack Kazanjian

Orthopedic Surgery Resident Research

Case: Two elderly males presented with traumatic shoulder dislocation and bony Bankart fracture consisting of greater than 25% of the glenoid width. Due to several concomitant factors such as polytrauma, activity level, rotator cuff pathology, optimization of comorbidities, risk of complications, and potential for revision surgery, the patients were treated with reverse shoulder arthroplasty (RSA).

Conclusion: RSA may be a satisfactory treatment option for isolated, large glenoid fractures associated with anterior glenohumeral instability in the elderly. These patients are susceptible to rapid deconditioning with prolonged immobilization and may not be medically suited to undergo the prolonged recovery period associated with …

Venous Thromboembolism After Penetrating Femoral And Popliteal Artery Injuries: An Opportunity For Increased Prevention, Asanthi Ratnasekera, Odessa Pulido, Sandra Durgin, Sharon Nichols, Alicia Lozano, Danielle Sienko, Alexandra Hanlon, Niels D Martin

General Surgery Resident Research

Background: Trauma patients with penetrating vascular injuries have a higher rate of venous thromboembolism (VTE). The objective of this study was to determine the risk of VTE formation in penetrating femoral and popliteal vascular injuries and the effects of endovascular management of these injuries.

Methods: A retrospective study of Pennsylvania Trauma Outcome Study registry was conducted during a 5-year period (2013-2017). All adult patients with a penetrating mechanism with femoral/popliteal vascular injuries were studied. Primary outcome was incidence of VTE in patients with isolated arterial injuries versus combined arterial/venous injuries. Secondary endpoints were intensive care unit (ICU) length of stay …

Eagle Syndrome Masquerading As A Chicken Bone, Jason E. Cohn, Sammy Othman, Karima Sajadi-Ernazarova

Otolaryngology (ENT) Resident Research

This is a brief report of a 17-year-old male who presented to the emergency department with odynophagia and a foreign body sensation in the throat after choking on a chicken wing. A soft tissue neck radiograph was performed which revealed a 4.6-cm linear object in the vallecula read by the radiology department as a chicken bone. The otolaryngology team was consulted and performed a nasopharyngeal laryngoscopy which did not reveal a foreign body in the upper aerodigestive tract. On physical examination, the right tonsillar fossa was tender to palpation. Upon further review of the radiograph, the right stylohyoid ligament was …

Lsd1 Promotes Bladder Cancer Progression By Upregulating Lef1 And Enhancing Emt., Qiubo Xie, Tang Tang, Jian Pang, Jing Xu, Xingxia Yang, Linang Wang, Yiqiang Huang, Zhuowei Huang, Gaolei Liu, Dali Tong, Yao Zhang, Luofu Wang, Dianzheng Zhang, Weihua Lan, Qiuli Liu, Jun Jiang

PCOM Scholarly Works

Epithelial-to-mesenchymal transition (EMT) is one of the important underlying molecular mechanisms for most types of cancers including bladder cancer. The precise underlying molecular mechanism in EMT-mediated bladder cancer progression is far from completed. LSD1, a histone lysine-specific demethylase, is known to promote cancer cell proliferation, metastasis, and chemoresistance. We found in this study that LSD1 is highly upregulated in bladder cancer specimens, especially those underwent chemotherapy, and the elevated levels of LSD1 are highly associated with bladder cancer grades, metastasis status, and prognosis. Inhibiting or knockdown LSD1 repressed not only EMT process but also cancer progression. Mechanistically, LSD1 complexes with …

The Vhl/Hif Axis In The Development And Treatment Of Pheochromocytoma/Paraganglioma, Song Peng, Jun Zhang, Xintao Tan, Yiqiang Huang, Jing Xu, Natalie Silk, Dianzheng Zhang, Qiuli Liu, Jun Jiang

PCOM Scholarly Works

Pheochromocytomas and paragangliomas (PPGLs) are rare neuroendocrine tumors originating from chromaffin cells in the adrenal medulla (PCCs) or extra-adrenal sympathetic or parasympathetic paraganglia (PGLs). About 40% of PPGLs result from germline mutations and therefore they are highly inheritable. Although dysfunction of any one of a panel of more than 20 genes can lead to PPGLs, mutations in genes involved in the VHL/HIF axis including

Myo/Nog Cells Are Nonprofessional Phagocytes, Jacquelyn Gerhart, Lindsay Gugerty, Paul Lecker, Fathma Abdalla, Mark Martin, Olivia Gerhart, Colby Gerhart, Karanveer Johal, Jake Bernstein, John Spikes, Keith Mathers, Arturo Bravo Nuevo, Mindy George-Weinstein

PCOM Scholarly Works

Myo/Nog cells were discovered in the chick embryo epiblast. Their expression of MyoD reflects a commitment to the skeletal muscle lineage and capacity to differentiate into myofibroblasts. Release of Noggin by Myo/Nog cells is essential for normal morphogenesis. Myo/Nog cells rapidly respond to wounding in the skin and eyes. In this report, we present evidence suggesting that Myo/Nog cells phagocytose tattoo ink in tissue sections of human skin and engulf cell corpses in cultures of anterior human lens tissue and magnetic beads injected into the anterior chamber of mice in vivo. Myo/Nog cells are distinct from macrophages in the skin …

Digest Of The Philadelphia College Of Osteopathic Medicine, Philadelphia College Of Osteopathic Medicine

PCOM Digest 2020s

The (2020 No. 2) issue of the Digest of the Philadelphia College of Osteopathic Medicine includes the following articles:

• Updates

• Institutional Heritage: Celebrating a Golden Jubilee, Marking a Retirement

• Feature: PCOM Heroes of the Front Lines

• Feature: Exams May Be Cancelled, But Humanity Is Not: A Medical Student Perspective on the COVID-19 Pandemic

• Class Notes

• Obituaries: Lost on the Front Lines

Digest Of The Philadelphia College Of Osteopathic Medicine, Philadelphia College Of Osteopathic Medicine

PCOM Digest 2020s

The (2020 No. 1) issue of the digest of the Philadelphia College of Osteopathic Medicine includes the following articles:

• Updates

• Institutional Heritage: Founders’ Day 2020

• Marking a New Era of Healthcare Education in South Georgia

• Southwest Georgia: A Sense of Place

• Health Care in Rural Georgia

• Class Notes

Collagen Fibrils And Proteoglycans Of Peripheral And Central Stroma Of The Keratoconus Cornea - Ultrastructure And 3d Transmission Electron Tomography, Aljoharah Alkanaan, Robert J. Barsotti, Omar Kirat, Adnan Khan, Turki Almubrad, Saeed Akhtar

PCOM Scholarly Works

Keratoconus (KC) is a progressive corneal disorder in which vision gradually deteriorates as a result of continuous conical protrusion and the consequent altered corneal curvature. While the majority of the literature focus on assessing the center of this diseased cornea, there is growing evidence of peripheral involvement in the disease process. Thus, we investigated the organization of collagen fibrils (CFs) and proteoglycans (PGs) in the periphery and center of KC corneal stroma. Three-dimensional transmission electron tomography on four KC corneas showed the degeneration of microfibrils within the CFs and disturbance in the attachment of the PGs. Within the KC corneas, …

Mta3 Represses Cancer Stemness By Targeting The Sox2ot/Sox2 Axis, Liang Du, Lu Wang, Jinfeng Gan, Zhimeng Yao, Wan Lin, Junkuo Li, Yi Guo, Yuping Chen, Fuyou Zhou, Sai-Ching Jim Yeung, Robert P Coppes, Dianzheng Zhang, Hao Zhang

PCOM Scholarly Works

Cancer cell stemness (CCS) plays critical roles in both malignancy maintenance and metastasis, yet the underlying molecular mechanisms are far from complete. Although the importance of SOX2 in cancer development and CCS are well recognized, the role of MTA3 in these processes is unknown. In this study, we used esophageal squamous cell carcinoma (ESCC) as a model system to demonstrate that MTA3 can repress both CCS and metastasis in vitro and in vivo. Mechanistically, by forming a repressive complex with GATA3, MTA3 downregulates SOX2OT, subsequently suppresses the SOX2OT/SOX2 axis, and ultimately represses CCS and metastasis. More importantly, MTA3

Validation Of A 5-Item Tool To Measure Patient Assessment Of Clinician Compassion In The Emergency Department., Praveen Sabapathi, Michael B. Roberts, Brian M Fuller, Michael A Puskarich, Christopher W Jones, J Hope Kilgannon, Valerie Braz, Christina Creel-Bulos, Nathaniel Scott, Kristina L Tester, Anthony Mazzarelli, Stephen Trzeciak, Brian W Roberts

PCOM Scholarly Works

BACKGROUND: To test if the 5-item compassion measure (a tool previously validated in the outpatient setting to measure patient assessment of clinician compassion) is a valid and reliable tool to quantify a distinct construct (i.e. clinical compassion) among patients evaluated in the emergency department (ED).

METHODS: Cross-sectional study conducted in three academic emergency departments in the U.S. between November 2018 and April 2019. We enrolled adult patients who were evaluated in the EDs of the participating institutions and administered the 5-item compassion measure after completion of care in the ED. Validity testing was performed using confirmatory factor analysis. Cronbach's alpha …

Use Of Integra For Reconstruction After Nevi Resection: A Systematic Review And Pooled Analysis Of Reported Cases, Jude Opoku-Agyeman, Kayla Humenansky, Wellington Davis Iii, Paul Glat

Plastic Surgery Resident Research

BACKGROUND:

The use of Integra Dermal Reconstruction Template has emerged as an option for wound reconstruction, after resection of congenital nevi, especially giant congenital nevi. There have been many reports on Integra use in the literature for this purpose. This systematic review with pooled analysis examines the current literature regarding Integra use after resection of congenital nevi, including patient characteristics and reported outcomes.

METHODS:

Systematic electronic searches were performed using PubMed, Ovid, Embase, and Cochrane library databases for studies reporting the use of Integra to reconstruct defects after nevi resection. Studies were analyzed if they met the inclusion criteria. Pooled …

Revisiting The Expanded Use Of Hyperbaric Oxygen Therapy For Treatment Of Resistant Migraines, David V Matera, Brian Smith, Benjamin Lam

PCOM Scholarly Works

There are currently 13 indications approved by the U.S. Food and Drug Administration for use of hyperbaric oxygen therapy. The European Consensus Conference on Hyperbaric Medicine has 28 indications approved for its use. However, neither includes the use of hyperbaric oxygen therapy for neurological conditions such as migraines with aura. Recent research has made the attempt to fully understand the use of hyperbaric therapy in treatment of neurological conditions, but results have so far been inconclusive. We report a 23-year-old female with an 11-year history of migraines with aura who has received inadequate pharmacological treatment for her migraines since she …

Surgical Configurations Of The Pectoralis Major Flap For Reconstruction Of Sternoclavicular Defects: A Systematic Review And New Classification Of Described Techniques, Jude Opoku-Agyeman, David Matera, Jamee Simone

Plastic Surgery Resident Research

The pectoralis major flap has been considered the workhorse flap for chest and sternoclavicular defect reconstruction. There have been many configurations of the pectoralis major flap reported in the literature for use in reconstruction sternoclavicular defects either involving bone, soft tissue elements, or both. This study reviews the different configurations of the pectoralis major flap for sternoclavicular defect reconstruction and provides the first ever classification for these techniques. We also provide an algorithm for the selection of these flap variants for sternoclavicular defect reconstruction.

METHODS:

EMBASE, Cochrane library, Ovid medicine and PubMed databases were searched from its inception to August …

An Unusual Presentation Of Subglottic Stenosis Necessitating Urgent Tracheostomy, Jacob Burdett, Alexander Manteghi

Otolaryngology (ENT) Resident Research

By definition, the subglottis is the area of the larynx immediately below the vocal folds extending to the level of the inferior border of the cricoid cartilage. This area represents the narrowest portion of the pediatric airway and is the most common site of iatrogenic stenosis. This stenosis is generally secondary to increased rates of intubation in infants of prematurity. Evaluation and treatment for subglottic stenosis represents one of the most common airway consultations within pediatric otolaryngology. Goals of therapy include securing a safe airway and restoring subglottic patency. In this clinical case, we present a unique pattern and presentation …

An Interesting Secondary Airway Lesion In An Infant With Laryngomalacia, William L. Valentino, David Lafferty, Alexander Manteghi

Otolaryngology (ENT) Resident Research

A 2-month-old male with a prior diagnosis of laryngomalacia (LM) presented to the emergency department in respiratory distress with worsening inspiratory stridor, suprasternal retractions, and a dry cough. A chest X-ray and lateral neck radiograph were performed and demonstrated no abnormalities. Flexible laryngoscopy revealed the same, previously observed moderately prolapsed arytenoids and an omega-shaped epiglottis with shortened aryepiglottic (AE) folds. He also had a right lower neck mass. He was scheduled for a direct laryngoscopy and bronchoscopy (DLB) and supraglottoplasty. During the DLB, LM and anterior compression of the midtrachea was noted. Lysis of the AE folds was performed in …

A Renal Cell Carcinoma With Biallelic Somatic Tsc2 Mutation: Clinical Study And Literature Review., Jian Pang, Linang Wang, Jing Xu, Qiubo Xie, Qiuli Liu, Dali Tong, Gaolei Liu, Yiqiang Huang, Xingxia Yang, Jinhong Pan, Xiaochu Yan, Qiang Ma, Dianzheng Zhang, Jun Jiang

PCOM Scholarly Works

OBJECTIVES: To elucidate the effect of the biallelic somatic TSC2 mutations, identified in one adolescent patient, in renal cell carcinoma (RCC).

METHODS: Mutation analyses, immunohistochemistry and real-time polymerase chain reaction (PCR) were conducted.

RESULTS: Two novel somatic mutations of TSC2 in unilateral and solitary RCC samples from a 14-year-old female were identified. The pathological features suggest the tumor as a clear-cell renal cell carcinoma. In addition, immunohistochemistry revealed elevated levels of phosphorylated S6K1. Results from in vitro cellular experiments suggest that the mutant TSC2 proteins were quickly degraded and they failed to repress the phosphorylation of S6K1 and STAT3, which …

Commencement, Philadelphia (2019), Philadelphia College Of Osteopathic Medicine

Commencements

Philadelphia Campus Graduate Program Commencement program, Class of 2019. Degrees include Doctor of Osteopathic Medicine.

Depletion Of Myo/Nog Cells In The Lens Mitigates Posterior Capsule Opacification In Rabbits., Jacquelyn Gerhart, Liliana Werner, Nick Mamalis, Joseph Infanti, Colleen Withers, Fathma Abdalla, Colby Gerhart, Arturo Bravo Nuevo, Olivia Gerhart, Lori Getts, Kelly Rhodes, Jessica Bowers, Robert Getts, Mindy George-Weinstein

PCOM Scholarly Works

Purpose: Posterior capsule opacification (PCO) is a vision-impairing disease that occurs in some adults and most children after cataract surgery. Contractile myofibroblasts contribute to PCO by producing wrinkles in the lens capsule that scatter light. Myofibroblasts in the lens originate from Myo/Nog cells named for their expression of the MyoD transcription factor and bone morphogenetic protein inhibitor noggin. In this study we tested the effects of depleting Myo/Nog cells on development of PCO.

Methods: Myo/Nog cells were eliminated by injecting the G8 antibody conjugated to 3DNA nanocarriers for the cytotoxin doxorubicin (G8:3DNA:Dox) during cataract surgery in rabbits. The severity of …

Multilevel Sleep Surgery Including The Palate In Nonsyndromic, Neurologically Intact Children With Obstructive Sleep Apnea, Jason E. Cohn, George E. Relyea, Srihari Daggumati, Brian J. Mckinnon

Otolaryngology (ENT) Resident Research

OBJECTIVE:

To examine the effects of multilevel sleep surgery, including palate procedures, on obstructive sleep apnea parameters in the pediatric population.

STUDY DESIGN:

A case series with chart review was conducted to identify nonsyndromic, neurologically intact pediatric patients who underwent either uvulectomy or uvulopalatopharyngoplasty as part of multilevel sleep surgery from 2011 through 2017.

SETTING:

A tertiary care, university children's hospital.

SUBJECTS AND METHODS:

Unpaired Student t test was used to compare average pre- and postsurgical apnea-hypopnea index (AHI) and oxygen saturation nadir (OSN). Paired Student t test was used to compare the mean pre- and postsurgical AHI and OSN …

Reconstruction Of Sternoclavicular Defect With Completely Detached Pectoralis Major Flap, Jude Opoku-Agyeman, Sergio Perez, Amir Behnam, David Matera

Plastic Surgery Resident Research

Sternoclavicular joint infection is very rare. Osteomyelitis is a known complication of septic sternoclavicular joint. Once this condition is diagnosed, aggressive management including antibiotic and surgical debridement is warranted. Patients are often left with sizeable sternoclavicular defects that may need surgical reconstruction. In this report, we describe the use of a completely detached pectoralis major flap for the reconstruction of a large sternoclavicular defect after resection for osteomyelitis. Briefly, after the debridement of the infected sternoclavicular joint, the pectoralis major was detached from its sternoclavicular attachments and further detached from the humeral attachments rendering it completely detached on a vascular …

Epithelioid Glioblastoma Presenting As Aphasia In A Young Adult With Ovarian Cancer: A Case Report, Megan M. Finneran, Joseph Georges, Michael Kakareka, Ryan Moncman, Miriam Enriquez, Todd Siegal, Gregory Kubicek, Alan Turtz, Steven S. Yocom, H Warren Goldman

PCOM Scholarly Works

Our patient's clinical history and preoperative radiographic evaluation suggested central nervous system (CNS) metastatic disease. Ultimately, final pathology revealed epithelioid glioblastoma (eGBM), a newly classified CNS primary tumor. This reinforces the importance of direct tissue sampling and including eGBM on the differential for young patients with histories of systemic cancer presenting with new CNS lesions.