Medical Specialties Commons^™

Long-Term Effects Of Very Low Dose Particle Radiation On Gene Expression In The Heart: Degenerative Disease Risks, Venkata Naga Srikanth Garikipati, Arsen Arakelyan, Eleanor A Blakely, Polly Y Chang, May M Truongcao, Maria Cimini, Vandana Malaredy, Anamika Bajpai, Sankar Addya, Malik Bisserier, Agnieszka Brojakowska, Abrisham Eskandari, Mary K Khlgatian, Lahouaria Hadri, Kenneth M Fish, Raj Kishore, David A Goukassian

Kimmel Cancer Center Faculty Papers

Compared to low doses of gamma irradiation (γ-IR), high-charge-and-energy (HZE) particle IR may have different biological response thresholds in cardiac tissue at lower doses, and these effects may be IR type and dose dependent. Three- to four-month-old female CB6F1/Hsd mice were exposed once to one of four different doses of the following types of radiation: γ-IR 137Cs (40-160 cGy, 0.662 MeV), 14Si-IR (4-32 cGy, 260 MeV/n), or 22Ti-IR (3-26 cGy, 1 GeV/n). At 16 months post-exposure, animals were sacrificed and hearts were harvested and archived as part of the NASA Space Radiation Tissue Sharing Forum. These heart tissue samples were …

Combined High-Dose Lattice Radiation Therapy And Immune Checkpoint Blockade For Advanced Bulky Tumors: The Concept And A Case Report, Liuqing Jiang, Xiaobo Li, Jianping Zhang, Wenyao Li, Fangfen Dong, Cheng Chen, Qingliang Lin, Chonglin Zhang, Fen Zheng, Weisi Yan, Yi Zheng, Xiaodong Wu, Benhua Xu

Department of Radiation Oncology Faculty Papers

Although the combination of immune checkpoint blockades with high dose of radiation has indicated the potential of co-stimulatory effects, consistent clinical outcome has been yet to be demonstrated. Bulky tumors present challenges for radiation treatment to achieve high rate of tumor control due to large tumor sizes and normal tissue toxicities. As an alternative, spatially fractionated radiotherapy (SFRT) technique has been applied, in the forms of GRID or LATTICE radiation therapy (LRT), to safely treat bulky tumors. When used alone in a single or a few fractions, GRID or LRT can be best classified as palliative or tumor de-bulking treatments. …

Seizure Clusters, Seizure Severity Markers, And Sudep Risk., Manuela Ochoa-Urrea, Nuria Lacuey, Laura Vilella, Liang Zhu, Shirin Jamal-Omidi, M R Sandhya Rani, Johnson P Hampson, Mojtaba Dayyani, Jaison Hampson, Norma J Hupp, Shiqiang Tao, Rup K Sainju, Daniel Friedman, Maromi Nei, Catherine Scott, Luke Allen, Brian K Gehlbach, Victoria Reick-Mitrisin, Stephan Schuele, Jennifer Ogren, Ronald M Harper, Beate Diehl, Lisa M Bateman, Orrin Devinsky, George B Richerson, Guo-Qiang Zhang, Samden D Lhatoo

Department of Neurology Faculty Papers

Rationale: Seizure clusters may be related to Sudden Unexpected Death in Epilepsy (SUDEP). Two or more generalized convulsive seizures (GCS) were captured during video electroencephalography in 7/11 (64%) patients with monitored SUDEP in the MORTEMUS study. It follows that seizure clusters may be associated with epilepsy severity and possibly with SUDEP risk. We aimed to determine if electroclinical seizure features worsen from seizure to seizure within a cluster and possible associations between GCS clusters, markers of seizure severity, and SUDEP risk. Methods: Patients were consecutive, prospectively consented participants with drug-resistant epilepsy from a multi-center study. Seizure clusters were defined as …

Preventive Care: Controversies, Challenges And Upcoming Changes In Guidelines, Randa Sifri, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Objectives

• Organizations who make guidelines
• Current guidelines for average-risk adults, with a focus on guidelines with differing recommendations and challenges to implementation/operational issues
• Preview of upcoming changes in guidelines
• Cases to illustrate some of the common questions that come up in delivering office-based preventive care
• Some disclaimers

Return To Play Rates After Ulnar Nerve Transposition And Decompression Surgery: A Retrospective Analysis., Christopher J Hadley, Anant Dixit, John Kunkel, Alex E White, Michael G. Ciccotti, Steven B. Cohen, Christopher C Dodson

Rothman Institute Papers

Background: Medial elbow pain is a common complaint in overhead throwing athletes. The throwing motion places repetitive tensile and compressive forces on the elbow resulting in significant stress across the ulnohumeral joint. This stress can result in soft-tissue, ligamentous, and ulnar nerve injury. The purpose of this study was to retrospectively investigate the clinical findings and outcomes, including return to play rates, of patients who underwent ulnar nerve transposition surgery for isolated ulnar neuritis.

Methods: Throwing athletes who underwent isolated, primary ulnar nerve transposition surgery over an eight-year period, 2009 to 2017, were identified and included in our analysis. Nonthrowing …

Collaborative Review: Factors Influencing Treatment Decisions For Patients With A Localized Solid Renal Mass., Thenappan Chandrasekar, Stephen A. Boorjian, Umberto Capitanio, Boris Gershman, Maria Carmen Mir, Alexander Kutikov

Department of Urology Faculty Papers

CONTEXT: With the addition of active surveillance and thermal ablation (TA) to the urologist's established repertoire of partial (PN) and radical nephrectomy (RN) as first-line management options for localized renal cell carcinoma (RCC), appropriate treatment decision-making has become increasingly nuanced.

OBJECTIVE: To critically review the treatment options for localized, nonrecurrent RCC; to highlight the patient, renal function, tumor, and provider factors that influence treatment decisions; and to provide a framework to conceptualize that decision-making process.

EVIDENCE ACQUISITION: A collaborative critical review of the medical literature was conducted.

EVIDENCE SYNTHESIS: We identify three key decision points when managing localized RCC: (1) …

Safety And Efficacy Of Hypofractionated Stereotactic Radiosurgery For High-Grade Gliomas At First Recurrence: A Single-Center Experience., Yun Guan, Ji Xiong, Mingyuan Pan, Wenyin Shi, Jing Li, Huaguang Zhu, Xiu Gong, Chao Li, Guanghai Mei, Xiaoxia Liu, Li Pan, Jiazhong Dai, Yang Wang, Enmin Wang, Xin Wang

Department of Radiation Oncology Faculty Papers

BACKGROUND: The optimal treatment for recurrent high-grade gliomas (rHGGs) remains uncertain. This study aimed to investigate the efficacy and safety of hypofractionated stereotactic radiosurgery (HSRS) as a first-line salvage treatment for in-field recurrence of high-grade gliomas.

METHODS: Between January 2016 and October 2019, 70 patients with rHGG who underwent HSRS were retrospectively analysed. The primary endpoint was overall survival (OS), and secondary endpoints included both progression-free survival (PFS) and adverse events, which were assessed according to Common Toxicity Criteria Adverse Events (CTCAE) version 5. The prognostic value of key clinical features (age, performance status, planning target volume, dose, use of …

Tonebp Regulates The Hyperosmotic Expression Of Aquaporin 1 And 5 In The Intervertebral Disc., Joseph Snuggs, Steven Tessier, R A B Bunning, Irving Shapiro, Makarand V Risbud, Christine Lyn Le Maitre

Department of Orthopaedic Surgery Faculty Papers

The central region of the intervertebral disc (IVD) is rich in proteoglycans, leading to a hyperosmotic environment, which fluctuates with daily loading. The cells of the nucleus pulposus (NP cells) have adapted to this environment via the function of tonicity enhancer binding protein (TonEBP), and NP cells have been shown to express several water channels known as aquaporins (AQP). We have previously shown that AQP1 and 5 decrease during IVD degeneration. Here, the regulation of AQP1 and 5 by hyperosmotic conditions and the role of TonEBP in this regulation was investigated. AQP1 and 5 gene expression was upregulated by hyperosmotic …

Cytokine Storms, Evolution And Covid-19, Joe Alcock, Alix Masters

Department of Medicine Faculty Papers

Since the identification of severe illness caused by the novel coronavirus SARS-CoV-2, the role of the host immune system in causing disease has attracted widespread attention, along with intense interest in medical interventions that target the host immune response. A wide variety of agents have been proposed to treat a cytokine storm in coronavirus disease 2019 (COVID-19), but so far, only one class of medications, corticosteroids, has proved useful. In recent decades, experimental therapies for cytokine storms have been tried and mostly failed to help patients with severe sepsis and other infections. We summarize this history in order to frame …

Cardiac Stress Testing, Michael Bozzi, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Outline and Learning Objectives

-- Questions to be answered:
• What is a stress test?
• Who should I send for a stress test?
• Which kind of stress test should I order?
• How do I interpret these results?

-- 4 Cases

Female Sexual Dysfunction In Older Adults, Madeline Taskier, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Learning Objectives

1. Review female sexual response and anatomy/physiology of the older female adult
2. Define different types of sexual dysfunction and risk factors
3. Review approaches to screening for sexual dysfunction in the primary care setting
4. Discuss practical approaches to treatment or referral in the primary care setting

Chloroquine: Autophagy Inhibitor, Antimalarial, Bitter Taste Receptor Agonist In Fight Against Covid-19, A Reality Check?, Pawan Sharma, Kielan D. Mcalinden, Saeid Ghavami, Deepak A. Deshpande

Center for Translational Medicine Faculty Papers

The recent SARS-CoV-2 pandemic poses one of the greatest challenges to modern medicine. Therefore, identification of new therapeutic strategies seems essential either based on novel vaccines or drugs or simply repurposing existing drugs. Notably, due to their known safety profile, repurposing of existing drugs is the fastest and highly efficient approach to bring a therapeutic to a clinic for any new indication. One such drug that has been used extensively for decades is chloroquine (CQ, with its derivatives) either for malaria, lupus and rheumatoid arthritis. Accumulating body of evidence from experimental pharmacology suggests that CQ and related analogues also activate …

Macrophage And Adipocyte Interaction As A Source Of Inflammation In Kidney Disease, Cristina Martos-Rus, Goni Katz-Greenberg, Zhao Lin, Eurico Serrano, Diana Whitaker Menezes, Marina Domingo-Vidal, Megan Roche, Kavitha Ramaswamy, D. Craig Hooper, Bonita Falkner, Maria P Martinez Cantarin

Kimmel Cancer Center Faculty Papers

In obesity, adipose tissue derived inflammation is associated with unfavorable metabolic consequences. Uremic inflammation is prevalent and contributes to detrimental outcomes. However, the contribution of adipose tissue inflammation in uremia has not been characterized. We studied the contribution of adipose tissue to uremic inflammation in-vitro, in-vivo and in human samples. Exposure to uremic serum resulted in activation of inflammatory pathways including NFκB and HIF1, upregulation of inflammatory cytokines/chemokines and catabolism with lipolysis, and lactate production. Also, co-culture of adipocytes with macrophages primed by uremic serum resulted in higher inflammatory cytokine expression than adipocytes exposed only to uremic serum. Adipose tissue …

Pandemic Makes Chronic Disease Prevention A Priority., Karen S. Kmetik, Alexis Skoufalos, David B. Nash

College of Population Health Faculty Papers

This article is the authors' final version prior to publication in Population Health Management, Volume 24, Issue 1, February 2021, Pages 1-2

Final publication is available from Mary Ann Liebert, Inc., publishers https://doi.org/10.1089/pop.2020.0126

Reduced Recovery Times With Total Intravenous Anesthesia In Patients With Obstructive Sleep Apnea, Leonard Estephan, Matthew Stewart, Maurits Boon, Colin Huntley

Phase 1

Introduction: There are currently no specific anesthetic guidelines for patients with obstructive sleep apnea (OSA) undergoing upper airway surgery. Two consistently utilized anesthetic approaches during such procedures include inhalational gas anesthesia and total intravenous anesthesia (TIVA), however whether either is more efficacious remains undefined. We hypothesize that administration of TIVA will lead to reduced post-operative recovery time in patients with comorbid OSA undergoing upper airway surgery.

Methods: A retrospective chart review was performed for patients with comorbid OSA that underwent surgery (upper airway stimulation, nasal surgery, palate surgery) between January 2019 and December 2019. Included patients received either inhaled …

Comparison Of Endovascular Therapy Versus Medical Therapy In The Management Of Descending Thoracic Aortic Dissection, Eli Cehelyk, Babak Abai, Md

Phase 1

Introduction: This retrospective review aimed to compare clinical outcomes between patients with descending aortic dissections, with and without organ malperfusion, who were managed with thoracic endovascular aortic repair (TEVAR) or best medical therapy (BMT).

Methods: Thirty-eight patients diagnosed with descending aortic dissections between 2013 and 2020 were identified for analysis. Patients with dissection secondary to trauma and death unrelated to cardiothoracic pathology were excluded. Participants were divided into three groups based on their management: TEVAR (without side branch stenting), TEVAR+ (with additional branch stenting) and BMT. The primary outcome measure was length of hospital stay (LOS) and statistics were analyzed …

Otologic Opioid Usage And Pain Control In The Postoperative Period, Matthew Stewart, Eric Mastrolonardo, Joann Butkus, Raphael Banoub, Md, Tingting Zhan, Phd, Sophia Dang, Md, David Cognetti, Md, Rebecca Chiffer, Md, Thomas Wilcox, Md

Phase 1

Introduction: Patients’ unused prescription opioids can be diverted and increase the overall opioid burden on society. Therefore, otolaryngologists can reduce opioid influx by minimizing excess tablets in opioid prescriptions. We hypothesize that otology patients at TJUH receive more opioid tablets than needed to effectively manage postoperative pain.

Methods: Patients ages ≥18 years old who received otologic surgery at TJUH were included in this prospective observational study between November 2019 and August 2020. Patients were provided a survey for recording pain on postoperative days 0, 1, 3, and 7 and the amount of remaining opioids from their prescription. Opioid amounts were …

Postoperative Opioid-Prescribing Practices In Nasal Surgery: A Prospective Study, Brian M. Yan, S. Hamad Sagheer, Cory D. Bovenzi, Uche Nwagu, David Cognetti, Howard Krein, Ryan Heffelfinger

Phase 1

Introduction: Within facial plastic and reconstructive surgery (FPRS), prescription practices have trended toward prescribing larger amounts of perioperative opioids. However, there is limited literature regarding the postoperative pain experience and opioid consumption for FPRS. The purpose of our study was to investigate opioid prescription and consumption following procedures of the nose, with the aim of developing evidence-based guidelines for postoperative pain management.

Methods: In this prospective single center study, morphine milligram equivalents (MME) consumption and pain scores were collected in 72 patients who underwent nasal surgery. Patient demographics, MME use, and pain scores were examined. MME use was compared …

Total Knee Arthroplasty In Patients With Prior Meniscus Surgery: A Matched Case Control Study, Lasya Rangavajjula, Steven B. Cohen, Md, Meghan E. Bishop, Md, Shyam Brahmabhatt, Md, Michael G. Ciccotti, Md, Ashley Bassett, Md, Christopher Hadley

Phase 1

Introduction: Meniscus surgery is one of the most commonly performed orthopedic surgical procedures in the United States. However, outcomes following a Total Knee Arthroplasty (TKA) in patients with a history of prior knee arthroscopy are varied with small patient cohorts, warranting further research. The research question investigates how the clinical outcomes of TKA compare between patients with and without prior meniscectomy history. It is hypothesized that there will be no significant difference in clinical outcomes between the two cohorts.

Methods: The study design is a retrospective case-control study. The study population included patients from Rothman Institute with TKA and …

Establishing The Relationship Between Mendelian Nafld And Skin Pathology, Anthony Medvedev, Hassan Vahidnezhad, Phd, Leila Youssefian, Phd, Jouni Uitto, Md, Phd

Phase 1

Introduction:

It is estimated that 25% of the world’s population has some form of Nonalcoholic Fatty Liver Disease (NAFLD), a pathology associated with the development of cirrhosis, varices, and hepatocellular carcinoma. The discovery of a biallelic mutation in ABHD5 established the link between NAFLD and Chanarin-Dorfman syndrome. Consequently, it was hypothesized that additional NAFLD-inducing mutations could be associated with dermatologic manifestations.

Methods:

International NAFLD patients from consanguineous families underwent whole exome sequencing. These results were then filtered by frequency and pathogenicity prediction algorithms (e.g. Mutation Taster, Polyphen, CADD) to yield novel mutations. Concurrently, a literature review via PubMed identified …

Evaluation Of Arthroscopic Repair To Pan-Labral Lesions Of The Glenoid: A Retrospective Review Of Patient Outcomes Over A Ten-Year Period And Matched Cohort Analysis, Julien Aoyama, Joseph Schmitz, Christopher Hadley, Meghan Bishop, Md, Brandon Erickson, Md, Sommer Hammoud, Md

Phase 1

Introduction:

Most shoulder labral tears are partial and treated with surgery, but rarely they are “panlabral” around the entire shoulder. Due to infrequency panlabral tears aren’t well understood, and thus this study compares outcomes between panlabral and more common SLAP tears. We hypothesize no difference in outcomes based on surgeon experiences.

Methods:

This is a retrospective cohort study of shoulder labrum repairs at Rothman Institute from 2006-2016. All patients received arthroscopic repair and were categorized to compare panlabral to SLAP tears. The primary outcome is return-to-activity rate at six months post-surgery and secondary outcomes include post-operative range of motion, …

Callicore, Cole Miller, Galen Ogg, Jasmine Phun, Yajnesh Vedanaparti, Morgan Hutchinson, Md

Phase 1

Transporting children in SPICA casts in a safe, comfortable, and convenient manner so that the parents can feel more at ease.

Effects Of Intravenous Iron Versus Oral Iron For Treatment Of Anemia In Pregnancy On Maternal And Fetal Outcomes: A Systematic Review And Meta-Analysis, Sarah Chen, Julia Burd, Md, Rupsa Boelig, Md

Phase 1

Introduction: Anemia during pregnancy can lead to preterm birth, low fetal birthweight, and poorer neonatal neurological outcomes. The purpose of this study was to compare maternal and fetal outcomes following intravenous (IV) versus oral iron supplementation for iron-deficiency anemia during pregnancy.

Methods: We searched MEDLINE, OVID, Scopus, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials (RCTs) comparing IV versus oral iron supplementation for iron-deficiency anemia during pregnancy. Studies were included in this meta-analysis if they reported maternal and fetal hematologic outcomes. The relative risk (RR) or standard mean difference (SMD) of IV iron supplementation …

Effects Of Continuous Positive Airway Pressure (Cpap) Sleep Apnea Treatment On Mild Cognitive Impairment (Mci) And Cardiovascular Risk, Olivia Taylor, Cynthia Cheng, Md, Phd

Phase 1

There is a documented association between sleep apnea and earlier onset of cognitive impairment later in life. We hypothesize that nightly treatment with CPAP therapy will improve MCI status as estimated by a panel of neuropsychiatry tests in patients >55 with OSA and concomitant memory complaints. With a prospective cohort design, patients compliant with CPAP therapy are being compared to noncompliant patients and a non-OSA control group. My role in this multi-site project was to screen potential patients from Jefferson’s sleep clinic for eligibility for study enrollment. This study is still ongoing. OSA’s high prevalence makes it a worthwhile endeavor …

Reliability Of Surgical Margin Labels Using 3d Radiographic Software, Heather Ross, Raphael Banoub, Md, Brian Swendseid, Md, Joseph Curry, Md

Phase 1

Introduction: Surgical resection is a primary treatment for head and neck cancers that improves prognosis and quality of life for patients. Margin assessment is a critical component in this process as positive margins are associated with poor clinical outcomes. However, there is a lack of consensus on how surgical margins should be labeled for accurate origin identification. The objective of this project is to determine the difference in interpretation of surgical margin labels between and within Thomas Jefferson otolaryngologists and pathologists.

Methods: Adults with head and neck cancer who underwent surgical resection were identified. Pre-operative head and neck CT DICOM …

Timing Of Preoperative Surgical Antibiotic Prophylaxis Prior To One-To-Three Level Elective Lumbar Fusion, Akash Singh, Gregory Schroeder, Md, Jose Canseco, Md, Alexander Vaccaro, Md, Parthik Patel, Md, Ariana Reyes, Md

Phase 1

Introduction: Surgical site infections (SSIs) in patients who have undergone lumbar fusion surgery can be a devastating complication. The aim of this study was to examine the relationship between timing of preoperative antibiotic prophylaxis and adverse outcomes such as SSIs with subgroup analysis stratified by antibiotic type.

Methods: This retrospective cohort included patients having undergone a 1-3 level lumbar fusion who were allocated into 5 groups based on the time from antibiotic administration to incision (Group A = 0-15 min, Group B = 16-30 min, Group C = 31-45 min, Group D = 46 – 60 min, and Group …

Needs Analysis For Breastfeeding Education At Thomas Jefferson University Hospital, Michal Norry, Julia Switzer, Md

Phase 1

Purpose: There are currently gaps in breastfeeding education for OB/GYN and Family Medicine residents, consequently affecting their confidence in this area of patient care. To address this issue, we are conducting an analysis of the efficacy of the current curriculum to highlight areas for future improvement.

Methods: PGY1-4 residents in the departments of Family Medicine (FM) and Obstetrics and Gynecology (OB/GYN) completed a pre-test before their required annual breastfeeding education on August 6, 2020. We used a validated pre-test from the American Academy of Pediatrics (AAP) which included items assessing the training. Learners self-selected one of two didactic sessions: in …

Urosim, Robert Abishek, Bryan Nardone, Jasmine Wang, Christopher Wetzel, Rob Pugliese

Phase 1

Designing a more cost-efficient method for ureteroscopy simulation training that involves 3D printing an anatomically-accurate model of a patient’s renal pelvicalyceal system.

Strategic Design Development For Malawian Public Health Center Labor & Delivery Suites, Kayla Holston, Mph, Meghan Gannon, Phd, Msph, Christopher Harnish, March, Zayithwa Fabiano, Mbbs, Luis Gadama, Mbbs, Mmed

Phase 1

Introduction: Maternity ward pre-, peri-, and postnatal room sharing creates concerns regarding maternal privacy (particularly confidentiality and dignity), paternal involvement in birthing process, and staff workflow efficiency. This study aimed to understand the current state of the aforementioned concerns and their impact on maternal child bonding and maternal mental health at Queen Elizabeth Central Hospital (QECH).

Methods: At discharge, mothers of birth (MOBs) were surveyed on pre-, peri-, and postnatal experience with regard to privacy and paternal involvement in the birthing process, and then assessed using the Mother to Infant Bonding Scale and Edinburg Depression Scale. Father of births (FOBs) …

Rapid Decline In Telestroke Consults In The Setting Of Covid-19., Syed O. Shah., Robin Dharia, Jaime Stazi, Maureen Deprince, Robert H. Rosenwasswer

Farber Institute for Neuroscience Faculty Papers

Background and Purpose: As coronavirus disease 2019 (COVID-19) continues to be a global pandemic, there is a growing body of evidence suggesting that incidence of diseases that require emergent care, particularly myocardial infarction and ischemic stroke, has declined rapidly. The objective of this study is to quantify our experience of telestroke (TS) consults at a large tertiary comprehensive stroke center during the COVID-19 pandemic.

Methods: We retrospectively reviewed TS consults of patients presenting to our neuroscience network. Those with a confirmed diagnosis of acute ischemic stroke or transient ischemia attack were included. Data were compared from April 1, 2019, to …