Medical Specialties Commons^™

Nbtxr3 Radiotherapy-Activated Functionalized Hafnium Oxide Nanoparticles Show Efficient Antitumor Effects Across A Large Panel Of Human Cancer Models., Ping Zhang, Julie Marill, Audrey Darmon, Naeemunnisa Mohamed Anesary, Bo Lu, Md, Sébastien Paris

Department of Radiation Oncology Faculty Papers

Purpose: The side effects of radiotherapy induced on healthy tissue limit its use. To overcome this issue and fully exploit the potential of radiotherapy to treat cancers, the first-in-class radioenhancer NBTXR3 (functionalized hafnium oxide nanoparticles) has been designed to amplify the effects of radiotherapy.

Patients and Methods: Thanks to its physical mode of action, NBTXR3 has the potential to be used to treat any type of solid tumor. Here we demonstrate that NBTXR3 can be used to treat a wide variety of solid cancers. For this, we evaluated different parameters on a large panel of human cancer models, such as …

Safety And Improved Efficacy Signals Following Gene Therapy In Childhood Blindness Caused By Gucy2d Mutations, Samuel G. Jacobson, Artur V. Cideciyan, Allen Ho, Igor V. Peshenko, Alexandra V. Garafalo, Alejandro J. Roman, Alexander Sumaroka, Vivian Wu, Arun Krishnan, Rebecca Sheplock, Sanford Boye, Alexander Dizhoor, Shannon Boye

Wills Eye Hospital Papers

A first-in-human clinical trial of gene therapy in Leber congenital amaurosis due to mutations in the GUCY2D gene is underway, and early results are summarized. A recombinant adeno-associated virus serotype 5 (rAAV5) vector carrying the human GUCY2D gene was delivered by subretinal injection to one eye in three adult patients with severe visual loss, nystagmus, but preserved retinal structure. Safety and efficacy parameters were monitored for 9 months post-operatively. No systemic toxicity was detected; there were no serious adverse events, and ocular adverse events resolved. P1 and P2 showed statistically significant rod photoreceptor vision improvement by full-field stimulus testing in …

Patellofemoral Disfunction, Chris Mulholland, Md

Department of Family & Community Medicine Presentations and Grand Rounds

No abstract provided.

Suicide Assessment, Angelo Rannazzisi, Psyd

Department of Family & Community Medicine Presentations and Grand Rounds

Agenda

● Risk & Protective Factors of Suicide

• Demographic, Diagnostic, Psychological Variables

● Suicide Risk Assessment

• C-SSRS (Columbia-Suicide Severity Rating Scale)
• BDI-II (Beck Depression Inventory 2nd Edition)
• Reasons for Living Inventory (RFL)

● Creating a Safety Plan

The Protective Effect Of Traditional Chinese Medicine On Liver Ischemia-Reperfusion Injury., Wen Ma, Songling Tang, Dina Xie, Guoqiang Gu, Lu Gan

Department of Emergency Medicine Faculty Papers

Liver ischemia-reperfusion (I/R) injury occurs during transplantation and major hepatic surgery, which may lead to postoperative liver dysfunction. More and more traditional Chinese medicines (TCMs) have been used to treat liver ischemia-reperfusion injury. The purpose of this review is to evaluate the different protective effects of TCMs in the treatment of liver ischemia-reperfusion injury and to summarize its possible mechanisms. The results indicate that TCMs attenuate liver I/R injury via multiple mechanisms, including antioxidation stress, anti-inflammatory response, antiapoptosis, and inhibiting endoplasmic reticulum stress. However, the in-depth mechanism of the protective effects of these traditional Chinese medicines still remains unknown.

Analysis Of An Obstetrics Point-Of-Care Ultrasound Training Program For Healthcare Practitioners In Zanzibar, Tanzania., Elizabeth A Hall, Danielle Matilsky, Rachel Zang, Naomasa Hase, Ali Habibu Ali, Patricia C Henwood, Anthony J Dean

Department of Emergency Medicine Faculty Papers

BACKGROUND: A point-of-care ultrasound education program in obstetrics was developed to train antenatal healthcare practitioners in rural Zanzibar. The study group consisted of 13 practitioners with different training backgrounds: physicians, clinical officers, and nurse/midwives. Trainees received an intensive 2-week antenatal ultrasound course consisting of lectures and hands-on practice followed by 6 months of direct supervision of hands-on scanning and bedside education in their clinical practice environments. Trainees were given a pre-course written exam, a final exam at course completion, and practical exams at 19 and 27 weeks. Trainees were expected to complete written documentation and record ultrasound images of at …

Redefining Cancer Of Unknown Primary: Is Precision Medicine Really Shifting The Paradigm?, Timothée Olivier, Eugenio Fernandez, Intidhar Labidi-Galy, Pierre-Yves Dietrich, Veronica Rodriguez-Bravo, Giulia Baciarello, Karim Fizazi, Anna Patrikidou

Department of Cancer Biology Faculty Papers

The concept of Cancer of Unknown Primary (CUP) has evolved with the advent of medical oncology. CUP can be difficult to diagnose and represents 2 to 5% of new cancers, therefore not exceptionally rare. Within CUPs can be identified a subset of favourable prognosis tumours, however the vast majority of CUP patients belongs to a poor prognosis group. CUP features significant oncological challenges, such as unravelling biological and transversal issues, and most importantly, improving patient's outcomes. In that regard, CUP patients’ outcomes regrettably showed minimal improvement for decades and CUP remains a cancer group of very poor prognosis. The biology …

Narrative Medicine In Ophthalmology, Martina Rama

inSIGHT

While technological and medical advancements have made it possible to diagnose and treat previously deadly conditions, modern day medicine comes with a new set of challenges around the doctor-patient relationship. Scientifically competent medicine cannot always help patients cope emotionally with their health issues. For physicians, understanding patients’ experience with illness in order to comfort and accompany them through their challenges is just as important as meeting their physical health needs. Dr. Rita Charon, the founder of narrative medicine, highlights how physicians today sometimes lack the ability to connect with, empathize with, and support their patients through difficult diagnoses.¹ When …

An Inside Look: Oculoplastics And “Droopy Eyelids”, Payton Boere

inSIGHT

In writing this article, I had the pleasure of speaking with Dr. Alison Watson, an oculoplastic attending surgeon at Wills Eye Hospital, all about this exciting and innovative specialty. During our discussion, she said that one of the things she loves most about this field is its diversity, including the range of procedures she gets to perform and patients she is able to treat. While there are procedures common to all oculoplastic surgeons, such as cosmetic and functional eyelid surgery to address both upper and lower eyelid malposition, reconstruction following periocular cancer resection, along with nasolacrimal surgery, Dr. Watson explained …

The Present And Future Of Artificial Intelligence In Ophthalmology, Robert Abishek, Elliot Cherkas

inSIGHT

Dr. Ravi Goel is a comprehensive ophthalmologist and cataract surgeon at Wills Eye Hospital, with a specific interest in finding ways that AI can help ophthalmologists improve their clinical care and treat more patients. Dr. Goel also publishes a daily blog, Protecting Sight, where he discusses a variety of topics ranging from advances in cataract surgery to medical education. One common thread throughout his blog is the burgeoning impact of AI on the field of ophthalmology, such as the utility of deep learning algorithms for diagnosing various diseases and the impact that improved intra-ocular lens (IOL) power calculations will have …

Off Label Innovation: Discovering New Uses For Glaucoma Drops, Glenn Oh

inSIGHT

Dr. Jason Hsu and his team (Ophthalmic Consultants of Boston, Boston, Massachusetts; Retinal Consultants of Houston, Houston, Texas; Retina Service of Wills Eye Hospital and Mid Atlantic Retina, Philadelphia, Pennsylvania; Associated Retinal Consultants, Royal Oak, Michigan) performed a multicenter randomized placebo-controlled clinical trial in which patients with nAMD who were suboptimal responders despite frequent anti-VEGF injections were randomized to use either dorzolamide-timolol drops or artificial tears.16 Eligible patients were 45 years or older with nAMD who were receiving ranibizumab or aflibercept injections at 4 - 6 week intervals (i.e., at least four injections within six months prior to enrollment) and …

A Career Of Honor And Humility: Interview With A Pioneer In Ophthalmology, Eli Cehelyk

inSIGHT

Imagine being a first-time parent in your early 30s, and you have just learned that your three-month old infant has retinoblastoma. Thanksgiving is right around the corner and you have no idea what the future holds. How would you feel? What thoughts would be racing through your head? With both hope and anxiety, you make an appointment at Wills Eye to see Dr. Carol Shields, a world-renowned expert on ocular oncology. With confidence and compassion, she walks into the room with her entire team and says, “Don’t worry, we will get everything under control for you. We will take your …

An Experience In The Wills Academic Global Ophthalmology Fellowship And Beyond, Crystal Lee, Mph

inSIGHT

Even before medical school, Dr. John Anhalt knew he wanted to serve communities all over the globe—after college, he joined the Peace Corps for two years, teaching math and science in the Kingdom of Lesotho. After seeing the vast differences between the health care in Lesotho and in the United States, Dr. Anhalt was inspired to apply to medical school with the intention of pursing a specialty in infectious disease before launching a career in global medicine. It was not until his ophthalmology rotation in University of Texas San Antonio, that he realized that ophthalmology, with its mix of medical …

Insight, Volume 1, Issue 1, 2021

inSIGHT

Contents

10 - An Experience in the Wills Academic Global Ophthalmology Fellowship and Beyond
By Crystal Lee

14 - A Career of Honor and Humility: Interview with a Pioneer in Ophthalmology
By Eli Cehelyk

19 - Off Label Innovation: Discovering New Uses for Glaucoma Drops
By Glenn Oh

22 - The Present and Future of Artificial Intelligence in Ophthalmology
By Robert Abishek & Elliot Cherkas

26 - An Inside Look: Oculoplastics and “Droopy Eyelids”
By Payton Boere

31 - Narrative Medicine in Ophthalmology
By Martina Rama

The Impact Of 2020 And The Future Of Cardiology Training: How Do We Innovate?, Prasanti Alekhya Kotta, Brittany Corso, Yevgeniy Brailovsky, Estefania Oliveros

Division of Cardiology Faculty Papers

No abstract provided.

Collaboration Therapy: Telehealth Principles And Case Studies, Elliot Cole, Phd, Larry M. Starr, Phd

School of Continuing and Professional Studies Faculty Papers

While conventional in-clinic Traumatic Brain Injury (TBI) rehabilitation serves the needs of the vast majority of patients many of whom go on to resume their lives a significant percentage of patients continue to have enduring cognitive disabilities despite long-term and skilled therapy. However, these patients can rapidly achieve gains which typically continue to increase toward substantial self-sufficiency when engaged in Collaboration Therapy (CT). CT is directed toward patient populations appropriate for a telehealth service who meet the following criteria: 1) patients have plateaued in conventional in-clinic therapy; 2) in-patients are too distant from an appropriate outpatient facility; and 3) individuals …

Social Isolation: Impact On Physical And Mental Health, Alexa Waters, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Learning Objectives

• Review the impact of social isolation and loneliness on important aspects of health and well-being, with a focus on older adults
• Review risk and protective factors for social isolation and loneliness
• Discuss how the health care system and primary care physicians can better identify and address social isolation
• Briefly highlight interventions to enhance social connectedness and reduce loneliness

Outline

• Background
• Impacts of social isolation and loneliness on health and well-being
• Risk and protective factors for social isolation and loneliness
• Role of the health system and primary care in addressing social isolation and loneliness
• Cases throughout

The Limping Child, Bob Wiley, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Learning Objectives

• Review the definition of limp
• Describe the approach to initial evaluation of a limping child, including key items in the history and physical exam
• Appreciate the broad differential that one must keep when evaluating a limping child
• Understand the different types of limp and how they can be used to formulate a differential
• Recognize red flag signs and symptoms which require more urgent evaluation
• Use cases to demonstrate some of the common presentations that are seen by the GP

Sex And Age Comparisons In Neuromuscular And Biomechanical Characteristics Of The Knee In Young Athletes, Erin R Pletcher, Travis J Dekker, Scott M Lephart, Tim C Sell

Department of Exercise Science Faculty Papers

Background: The identification of risk factors for injury is a key step for musculoskeletal injury prevention in youth sports. Not identifying and correcting for injury risk factors may result in lost opportunity for athletic development. Physical maturation and sex affect these characteristics, which may indicate the need for both age and sex-based injury prevention programs.

Hypothesis/purpose: This study examined age and sex differences in knee strength, static balance, jump height, and lower extremity landing biomechanics in school- and high school-age athletes.

Study design: Cross-sectional.

Methods: Forty healthy school aged (10.8±0.8 yrs) and forty high school (16.8±0.8 yrs) athletes completed isokinetic …

Achieving Value In Spine Surgery: 10 Major Cost Contributors., Lucas R. Philipp, Adam Leibold, Aria Mahtabfar, Thiago Montenegro, Glenn Gonzalez, James Harrop

Department of Neurosurgery Faculty Papers

STUDY DESIGN: Narrative Review.

OBJECTIVES: The increasing cost of healthcare overall and for spine surgery, coupled with the growing burden of spine-related disease and rising demand have necessitated a shift in practice standards with a new emphasis on value-based care. Despite multiple attempts to reconcile the discrepancy between national recommendations for appropriate use and the patterns of use employed in clinical practice, resources continue to be overused-often in the absence of any demonstrable clinical benefit. The following discussion illustrates 10 areas for further research and quality improvement.

METHODS: We present a narrative review of the literature regarding 10 features in …

Bundled Payment Models In Spine Surgery., Kevin Hines, Nikolaos Mouchtouris, Charles Getz, Glenn Gonzalez, Thiago Montenegro, Adam Leibold, James Harrop

Department of Neurosurgery Faculty Papers

STUDY DESIGN: The following is a narrative discussion of bundled payments in spine surgery.

OBJECTIVE: The cost of healthcare in the United States has continued to increase. To lower the cost of healthcare, reimbursement models are being investigated as potential cost saving interventions by driving incentives and quality improvement in fields such a spine surgery.

METHODS: Narrative overview of literature pertaining to bundled payments in spine surgery synthesizing findings from computerized databases and authoritative texts.

RESULTS: Spine surgery is challenging to define payment modes because of high cost variability and surgical decision-making nuances. While implementing bundled care payments in spine …

A Diverse Nation Calls For A Diverse Healthcare Force., Autumn L Saizan, Annyella Douglas, Nada Elbuluk, Susan Taylor

Department of Dermatology and Cutaneous Biology Faculty Papers

No abstract provided.

Association Of Race With Lung Cancer Risk Among Adults Undergoing Lung Cancer Screening., Christine S Shusted, Nathaniel R Evans, Hee-Soon Juon, Gregory C Kane, Julie A Barta

Division of Pulmonary, Allergy, and Critical Care Medicine Faculty Papers

No abstract provided.

Targeting Resistance To Radiation-Immunotherapy In Cold Hnsccs By Modulating The Treg-Dendritic Cell Axis., Michael W. Knitz, Thomas E. Bickett, Laurel B. Darragh, Ayman J. Oweida, Shilpa Bhatia, Benjamin Van Court, Shiv Bhuvane, Miles Piper, Jacob Gadwa, Adam C. Mueller, Diemmy Nguyen, Varuna Nangia, Douglas G. Osborne, Xiyuan Bai, Sarah E. Ferrara, Mary-Keara Boss, Andrew Goodspeed, Matthew A. Burchill, Beth A. Jirón Tamburini, Edward D. Chan, Curtis R. Pickering, Eric T. Clambey, Sana D. Karam

Department of Radiation Oncology Faculty Papers

BACKGROUND: Numerous trials combining radiation therapy (RT) and immunotherapy in head and neck squamous cell carcinoma (HNSCC) are failing. Using preclinical immune cold models of HNSCC resistant to RT-immune checkpoint inhibitors, we investigate therapeutic approaches of overcoming such resistance by examining the differential microenvironmental response to RT.

METHODS: We subjected two HPV-negative orthotopic mouse models of HNSCC to combination RT, regulatory T cells (Treg) depletion, and/or CD137 agonism. Tumor growth was measured and intratumorous and lymph node immune populations were compared among treatment groups. Human gene sets, genetically engineered mouse models DEREG and BATF3-/-, flow and time-of-flight cytometry, RNA-Seq, …

Preparticipation Evaluation Of The Special Olympics Athlete, Mary M. Stephens, Md, Mph

Department of Family & Community Medicine Presentations and Grand Rounds

Objectives

• By the end of this module the student will be able to describe the components of a pre-participation sports evaluation.
• By the end of this module the student will be able to articulate an assessment for atlantoaxial instability.
• By the end of this module the student will be able to apply the learned knowledge from the module to a case study.
• By the end of this module the student will be able to recommend appropriate anticipatory guidance to the athlete.

Impact Of Body Mass Index On Covid-19-Related In-Hospital Outcomes And Mortality., Waqas Ullah, Sohaib Roomi, Nayab Nadeem, Rehan Saeed, Shafaq Tariq, Moataz Ellithi, Shujaul Haq, Ahmad Arslan, John Madara, Margot Boigon, Donald C. Haas, David L. Fischman

Abington Jefferson Health Papers

Background: Given the high prevalence of obesity around the globe, patients with coronavirus disease 2019 (COVID-19) are at an increased risk of devastating complications.

Methods: A retrospective cohort study was performed to determine the association of basal metabolic index (body mass index (BMI)) with the need for invasive mechanical ventilation (IMV), dialysis, upgrade to an intensive care unit (ICU) and mortality. Independent t-test and multivariate logistic regression analysis were performed to calculate mean differences and adjusted odds ratios (aORs) with its 95% confidence interval (CI), respectively.

Results: A total of 176 consecutive patients with confirmed COVID-19 diagnosis were included. …

Resident Immune Cells Of The Avascular Lens: Mediators Of The Injury And Fibrotic Response Of The Lens., A. Menko, Jodirae Dedreu, Caitlin M. Logan, Heather Paulson, Alex V Levin, Janice L Walker

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Tissues typically harbor subpopulations of resident immune cells that function as rapid responders to injury and whose activation leads to induction of an adaptive immune response, playing important roles in repair and protection. Since the lens is an avascular tissue, it was presumed that it was absent of resident immune cells. Our studies now show that resident immune cells are a shared feature of the human, mouse, and chicken lens epithelium. These resident immune cells function as immediate responders to injury and rapidly populate the wound edge following mock cataract surgery to function as leader cells. Many of these resident …

Commentary On "A Prospective, Single-Blinded, Bicentric Study, And Literature Review To Assess The Need Of C2-Ganglion Preservation - Saviour's Criteria"., James Harrop

Department of Orthopaedic Surgery Faculty Papers

No abstract provided.

Gad Antibody-Spectrum Disorders: Progress In Clinical Phenotypes, Immunopathogenesis And Therapeutic Interventions., Popianna Tsiortou, Harry Alexopoulos, Marinos Dalakas

Department of Neurology Faculty Papers

Antibodies against glutamic acid decarboxylase (GAD), originally linked to stiff person syndrome (SPS), now denote the “GAD antibody-spectrum disorders” (GAD-SD) that also include autoimmune epilepsy, limbic encephalitis, cerebellar ataxia and nystagmus with overlapping symptomatology highlighting autoimmune neuronal excitability disorders. The reasons for the clinical heterogeneity among GAD-antibody associated syndromes remain still unsettled, implicating variable susceptibility of GABAergic neurons to anti-GAD or other still unidentified autoantibodies. Although anti-GAD antibody titers do not correlate with clinical severity, very high serum titers, often associated with intrathecal synthesis of anti-GAD-specific IgG, point to in-situ effects of GAD or related autoantibodies within the central nervous …

Angiotensin Converting Enzyme Inhibitors And Angiotensin Receptor Blockers In Acute Heart Failure: Invasive Hemodynamic Parameters And Clinical Outcomes., Kevin Bryan Lo, Hesam Mostafavi Toroghi, Grace Salacup, Jiahui Jiang, Ruchika Bhargav, Eduardo Quintero, Kira Balestrini, Anum Shahzad, Roy O Mathew, Peter A Mccullough, Janani Rangaswami

Department of Medicine Faculty Papers

There are limited data regarding the use of angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARBs) in acute heart failure (AHF). The purpose is to determine the patterns of ACEi/ARB use at the time of admission and discharge in relation to invasive hemodynamic data, mortality, and heart failure (HF) readmissions. This is a retrospective single-center study in patients with AHF who underwent right heart catheterization between January 2010 and December 2016. Patients on dialysis, evidence of shock, or incomplete follow up were excluded. Multivariate logistic regression analysis was used to analyze the factors associated with continuation of ACEi/ARB use on discharge …