Medical Specialties Commons^™

James Mann, M.D. (1759-1832): Military Surgeon For The "Second War Of Independence"., Eliza C. Anderson, Md, Scott W. Cowan, Md, Charles J. Yeo, Md

Department of Surgery Gibbon Society Historical Profiles

The War of 1812 is remembered for the Burning of Washington, and Francis Scott Key’s “The Star Spangled Banner,” but little else. It was a poorly funded war of relatively short duration and nebulous resolution. Under such circumstances, it is understandable that the “Second War of Independence” failed to produce many notable military or medical advancements. However, one surgeon took it upon himself to recount his experiences in the field. For his dedication to the art and science of medicine, James Mann deserves recognition.

Postoperative Intussusception In 10-Year-Old Presenting As Decreased Intestinal Motility, Arielle Spellun, Loren Berman, Stephen Murphy

Department of Medicine Faculty Papers

No abstract provided.

Bh3 Mimetic Abt-737 Sensitizes Colorectal Cancer Cells To Ixazomib Through Mcl-1 Downregulation And Autophagy Inhibition., Lifeng Yang, Juefeng Wan, Sheng Xiao, Darryll Barkhouse, Ji Zhu, Guichao Li, Bo Lu, Zhen Zhang

Department of Radiation Oncology Faculty Papers

The proteasome inhibitor MLN9708 is an orally administered drug that is hydrolyzed into its active form, MLN2238 (ixazomib). Compared with Bortezomib, MLN2238 has a shorter proteasome dissociation half-life and a lower incidence and severity of peripheral neuropathy, which makes it an attractive candidate for colorectal cancer treatment. In the present study, we observed that MLN2238 induced autophagy, as evidenced by conversion of the autophagosomal marker LC3 from LC3I to LC3II, in colorectal cancer cell lines. Mcl-1, an anti-apoptotic Bcl-2 family protein, was markedly elevated after treating a colorectal cancer cell line with MLN2238. We proved that inhibiting Mcl-1 expression enhances …

Illness Cognitions And Coping Self-Efficacy In Depression Among Persons With Low Vision., Bonnie A Sturrock, Jing Xie, Edith E Holloway, Mark Hegel, Robin J. Casten, David Mellor, Eva Fenwick, Gwyneth Rees

Department of Psychiatry and Human Behavior Faculty Papers

PURPOSE: To investigate the mediating role of coping self-efficacy (CSE) between two types of illness cognitions (i.e., acceptance and helplessness) and depressive symptoms in persons with low vision.

METHODS: This was a single-group, cross-sectional study. Patients with visual acuity < 6/12 in the better eye and at least minimal depressive symptoms (≥5 on the Patient Health Questionnaire-9 [PHQ-9]) were recruited from vision rehabilitation services and participated in telephone-administered structured interviews at one time point. Measures were the PHQ-9, CSE Scale, and Illness Cognition Questionnaire. Structural equation modeling (SEM) devised the causal flow of illness cognitions and their observed indirect effects on depressive symptoms via the CSE mediators: problem focused, emotion focused, and social support.

RESULTS: The study comprised 163 patients (mean age 62 years; 61% female), most with age-related macular degeneration (26%) and moderate vision impairment (44%, <6/18-6/60). Structural equation modeling indices indicated a perfect fit (χ2 < 0.001, P = 1.00), accounting for 55% of the variance in depressive symptoms. Lower levels of acceptance and higher levels of helplessness illness cognitions were associated with lower self-efficacy in problem-focused coping (β = 0.38, P < 0.001, β = -0.28, P < 0.01, respectively), which in turn was associated with greater depressive symptom severity (β = -0.54, P < 0.001).

CONCLUSIONS: Lack of acceptance and greater helplessness relating to low vision led to a lack of perceived capability to engage in problem-focused coping, which in turn promoted depressive symptoms. Third-wave cognitive-behavioral treatments that focus on acceptance may be …

Radiotherapy For Iris Metastasis From Esophageal Carcinoma: A Series Of Three Cases., Chandana Das, Carol L Shields

Wills Eye Hospital Papers

BACKGROUND: Description of three cases of metastatic esophageal carcinoma to the iris and focus on management strategies.

METHODS: A 48-year-old man (Case 1) with previously treated stage IV esophageal carcinoma presented with blurred vision in the left eye (OS) for 3 weeks. Initial fine needle aspiration biopsy (FNAB) was negative for malignant cells, so incisional biopsy was performed and confirmed metastatic carcinoma. A 53-year-old man (Case 2) with previously treated stage III esophageal cancer experienced 2 months of pain and 1 month of blurred vision OS. Documented tumor growth suggested esophageal carcinoma metastasis. A 65-year-old man (Case 3) with previously …

An Atrophic Plaque On The Breast Six Years After Breast Reconstruction Surgery, Michelle Khurana, Richard Torbeck, Young C. Kauh

Department of Dermatology and Cutaneous Biology Faculty Papers

No abstract provided.

Managing Opioid-Tolerant Patients In The Perioperative Surgical Home., John T. Wenzel, Eric S. Schwenk, Jaime L. Baratta, Eugene R. Viscusi

Department of Anesthesiology Faculty Papers

Management of acute postoperative pain is important to decrease perioperative morbidity and improve patient satisfaction. Opioids are associated with potential adverse events that may lead to significant risk. Uncontrolled pain is a risk factor in the transformation of acute pain to chronic pain. Balancing these issues can be especially challenging in opioid-tolerant patients undergoing surgery, for whom rapidly escalating opioid doses in an effort to control pain can be associated with increased complications. In the perioperative surgical home model, anesthesiologists are positioned to coordinate a comprehensive perioperative analgesic plan that begins with the preoperative assessment and continues through discharge.

Thermal Dosimetry For Bladder Hyperthermia Treatment. An Overview., Gerben Schooneveldt, Akke Bakker, Edmond Balidemaj, Rajiv Chopra, Johannes Crezee, Elisabeth D. Geijsen, Josefin Hartmann, Maarten C.C.M. Hulshof, H. Petra Kok, Margarethus M. Paulides, Alejandro Sousa-Escandon, Paul R. Stauffer, Paolo F. Maccarini

Department of Radiation Oncology Faculty Papers

The urinary bladder is a fluid-filled organ. This makes, on the one hand, the internal surface of the bladder wall relatively easy to heat and ensures in most cases a relatively homogeneous temperature distribution; on the other hand the variable volume, organ motion, and moving fluid cause artefacts for most non-invasive thermometry methods, and require additional efforts in planning accurate thermal treatment of bladder cancer. We give an overview of the thermometry methods currently used and investigated for hyperthermia treatments of bladder cancer, and discuss their advantages and disadvantages within the context of the specific disease (muscle-invasive or non-muscle-invasive bladder …

Ictal Crying, Ali Akbar Asadi-Pooya, Dale Wyeth, Michael R. Sperling

Department of Neurology Faculty Papers

PURPOSE: The purpose of this study was to describe a series of patients with ictal crying to estimate its occurrence and characterize the clinical features and the underlying etiology.

METHODS: We retrospectively reviewed all the long-term video-EEG reports from Jefferson Comprehensive Epilepsy Center over a 12-year period (2004-2015) for the occurrence of the terms "cry" or "sob" or "weep" in the text body. All the extracted reports were reviewed, and patients with at least one episode of documented ictal crying at the epilepsy monitoring unit (EMU) were included in the study.

RESULTS: During the study period, 5133 patients were investigated …

Surgical Apgar Score (Sas) Predicts Perioperative Morbidity And Length Of Stay In Patients Undergoing Esophagectomy At A High-Volume Center, Danica Giugliano, Md, Andrew Morgan, Francesco Palazzo, Md, Nathaniel R. Evans Iii, M.D., Ernest L Rosato, Md, Adam C. Berger, Md, Benjamin E Leiby, Phd

Department of Surgery Posters

Background:

Esophagectomy is a procedure that carries considerable morbidity. Many studies have evaluated factors to predict patients at risk and improve clinical outcomes. The aim of this study was to determine whether the SAS predicts complications, length of stay, and anastomotic leak for patients undergoing esophagectomy at a high-volume institution.

Rare Case Of Metastatic Pituitary Disease, Anitha Somasundaram, Md, Kevin D. Judy, Md, Kevin Furlong, Do

Department of Neurosurgery Posters

Background:

Metastatic involvement of the pituitary gland is extremely rare. We present a case of metastatic pituitary disease with panhypopituitarism and diabetes insipidus.

Management Considerations Of Massive Hemoptysis While On Extracorporeal Membrane Oxygenation., Harrsion T. Pitcher, Meredith A. Harrison, Colette Shaw, Scott W. Cowan, Hitoshi Hirose, Nicholas C. Cavarocchi

Department of Surgery Faculty Papers

BACKGROUND: Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is a life-saving procedure in patients with both respiratory and cardiac failure. Bleeding complications are common since patients must be maintained on anticoagulation. Massive hemoptysis is a rare complication of ECMO; however, it may result in death if not managed thoughtfully and expeditiously.

METHODS: A retrospective chart review was performed of consecutive ECMO patients from 7/2010-8/2014 to identify episodes of massive hemoptysis. The management of and the outcomes in these patients were studied. Massive hemoptysis was defined as an inability to control bleeding (>300 mL/day) from the endotracheal tube with conventional maneuvers, …

Dual Kidney Allocation Score: A Novel Algorithm Utilizing Expanded Donor Criteria For The Allocation Of Dual Kidneys In Adults, Jill N. D'Souza, Md, Katherine Mckee-Cole, Md, Abigail Strang, Md, Patrick Barth, Md, Aaron Chidekel, Md, Udayan Shah, Md

Department of Otolaryngology - Head and Neck Surgery Posters

Abstract:

Objective The recognition of wound-related complications following pediatric tracheotomy is on the rise. These complications can have a significant impact on clinical course as well as on hospital healthcare costs to the tracheotomy dependent child and family

Methods A tracheotomy database was created in 2000 and reviewed for incidence of major and minor complications.

Setting Tertiary Care Pediatric Referral Center

Results We identified a post-tracheotomy complication rate of 19.9%, of which the most common complication was wound breakdown (65% of complications).

Conclusion Rate of post-tracheotomy wound-care complications is 12.9%. Wound description is subjective and prone to inter-observer variability. A …

Cancer Stem Cell Metabolism., Maria Peiris-Pagès, Ubaldo E. Martinez-Outshoorn, Richard G. Pestell, Federica Sotgia, Michael P Lisanti

Kimmel Cancer Center Papers, Presentations, and Grand Rounds

Cancer is now viewed as a stem cell disease. There is still no consensus on the metabolic characteristics of cancer stem cells, with several studies indicating that they are mainly glycolytic and others pointing instead to mitochondrial metabolism as their principal source of energy. Cancer stem cells also seem to adapt their metabolism to microenvironmental changes by conveniently shifting energy production from one pathway to another, or by acquiring intermediate metabolic phenotypes. Determining the role of cancer stem cell metabolism in carcinogenesis has become a major focus in cancer research, and substantial efforts are conducted towards discovering clinical targets.

Adiponectin Ameliorates The Apoptotic Effects Of Paraquat On Alveolar Type Ⅱ Cells Via Improvements In Mitochondrial Function., Yarong He, Liqun Zou, Yaxiong Zhou, Hai Hu, Rong Yao, Yaowen Jiang, Wayne Bond Lau, Tun Yuan, Wen Huang, Zhi Zeng, Yu Cao

Department of Emergency Medicine Faculty Papers

Previous studies have demonstrated that excessive reactive oxygen/nitrogen species (ROS/RNS)‑induced apoptosis is an important feature of the injury to the lung epithelium in paraquat (PQ) poisoning. However the precise mechanisms of PQ‑induced dysfunction of the mitochondria, where ROS/RNS are predominantly produced, remain to be fully elucidated. Whether globular adiponectin (gAd), a potent molecule protective to mitochondria, regulates the mitochondrial function of alveolar type II cells to reduce PQ‑induced ROS/RNS production remains to be investigated. The current study aimed to investigate the precise mechanisms of PQ poisoning in the mitochondria of alveolar type II cells, and to elucidate the role of …

Suppression Of Progranulin Expression Inhibits Bladder Cancer Growth And Sensitizes Cancer Cells To Cisplatin., Simone Buraschi, Shi-Qiong Xu, Manuela Stefanello, Igor Moskalev, Alaide Morcavallo, Marco Genua, Ryuta Tanimoto, Ruth Birbe, Stephen C. Peiper, Leonard G. Gomella, Antonino Belfiore, Peter C. Black, Renato V. Iozzo, Andrea Morrione

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

We have recently demonstrated a critical role for progranulin in bladder cancer. Progranulin contributes, as an autocrine growth factor, to the transformed phenotype by modulating Akt-and MAPK-driven motility, invasion and anchorage-independent growth. Progranulin also induces F-actin remodeling by interacting with the F-actin binding protein drebrin. In addition, progranulin is overexpressed in invasive bladder cancer compared to normal tissue controls, suggesting that progranulin might play a key role in driving the transition to the invasive phenotype of urothelial cancer. However, it is not established whether targeting progranulin could have therapeutic effects on bladder cancer. In this study, we stably depleted urothelial …

Utilization Of Exercise Prescriptions For Older Adults, David Jeong, Md, Caqsm, Cep, Rmsk, Brooke Salzman, Md, Jeremy Close, Md

Department of Family & Community Medicine Posters

Objective

This study was conducted to investigate

1) Providers` knowledge and physician attitude about Exercise and Physical activity (PA) recommendations for Older Adults (OA)

2) Frequency of utilizing written exercise prescriptions

3) Barriers to using exercise prescriptions in primary care practice

4) Providers’ interest in learning about and utilizing exercise prescriptions

Recurrent Siadh After Switching Citalopram To Very Low Dose Duloxetine In The Elderly, David Jeong, Md, Caqsm, Cep, Rmsk, Patrick Doggett, Md, Kristine Swartz, Md, Lauren Hersh, Md, Brooke Salzman, Md

Department of Family & Community Medicine Posters

Objective

• Duloxetine-induced SIADH has been seldom reported
• This case study emphasizes the importance of suspecting rare adverse effects of recurrent SIADH after switching an SSRI to duloxetine in older adults

The Pennsylvania Emergency Department Geriatric Readiness Project, Adam Perry, Md, Alyssa Sipes, Bs

College of Population Health Posters

BE THE ED DOC – Illustrating Geriatric Readiness

An independent, right handed 81 year old who lives alone trips and falls while walking with her walker. A thorough evaluation at her local ED reveals only a nonoperative right proximal humeral fracture. Her pain is well controlled with immobilization and oral analgesics.

What is her disposition?

• Discharge home with shoulder immobilizer and instructions to call orthopedics in the morning.
• Admit to Telemetry Bed for “Syncope” with orthopedics and cardiology consultations, with subsequent SubAcute Rehabilitation stay.
• Admit to Observation Status for “Ambulatory Dysfunction”.
• Discharge home with her daughter, who lives locally, with …

The Retinal Determination Gene Network: From Developmental Regulator To Cancer Therapeutic Target., Deguang Kong, Yu Liu, Qian Liu, Na Han, Cuntai Zhang, Richard G. Pestell, Kongming Wu, Gaosong Wu

Department of Medical Oncology Faculty Papers

Although originally identified for its function in Drosophila melanogaster eye specification, the Retinal Determination Gene Network (RDGN) is essential for the development of multiple organs in mammals. The RDGN regulates proliferation, differentiation and autocrine signaling, and interacts with other key signaling pathways. Aberrant expression of RDGN members such as DACH, EYA and SIX contributes to tumor initiation and progression; indeed, the levels of RDGN members are clinically prognostic factors in various cancer types. Stimulation or suppression of the activities of these crucial components can block cancer cell proliferation, prevent cancer stem cell expansion and even reverse the EMT process, thereby …

The Transcription Factor Runx2 Regulates Receptor Tyrosine Kinase Expression In Melanoma., Rajeev K Boregowda, Daniel J Medina, Elke Markert, Michael A Bryan, Wenjin Chen, Suzie Chen, Anna Rabkin, Michael J Vido, Samuel I Gunderson, Marina Chekmareva, David J Foran, Ahmed Lasfar, James S Goydos, Karine A Cohen-Solal

Department of Cancer Biology Faculty Papers

Receptor tyrosine kinases-based autocrine loops largely contribute to activate the MAPK and PI3K/AKT pathways in melanoma. However, the molecular mechanisms involved in generating these autocrine loops are still largely unknown. In the present study, we examine the role of the transcription factor RUNX2 in the regulation of receptor tyrosine kinase (RTK) expression in melanoma. We have demonstrated that RUNX2-deficient melanoma cells display a significant decrease in three receptor tyrosine kinases, EGFR, IGF-1R and PDGFRβ. In addition, we found co-expression of RUNX2 and another RTK, AXL, in both melanoma cells and melanoma patient samples. We observed a decrease in phosphoAKT2 (S474) …

Spike Voltage Topography In Temporal Lobe Epilepsy, Ali Akbar Asadi-Pooya, Marjan Asadollahi, Shoichi Shimamoto, Matthew Lorenzo, Michael R. Sperling

Department of Neurology Faculty Papers

We investigated the voltage topography of interictal spikes in patients with temporal lobe epilepsy (TLE) to see whether topography was related to etiology for TLE. Adults with TLE, who had epilepsy surgery for drug-resistant seizures from 2011 until 2014 at Jefferson Comprehensive Epilepsy Center were selected. Two groups of patients were studied: patients with mesial temporal sclerosis (MTS) on MRI and those with other MRI findings. The voltage topography maps of the interictal spikes at the peak were created using BESA software. We classified the interictal spikes as polar, basal, lateral, or others. Thirty-four patients were studied, from which the …

Role Of Target Specific Oral Anticoagulation After Operative Management Of Venous Thoracic Outlet Syndrome, Jeontaik Kwon, Md, Paul J. Dimuzio, Md, Babak Abai, Md, Dawn Salvatore, Md, Taki Galanis, Md, Geno J. Merli, Md, Luis H. Eraso, Md

Department of Surgery Posters

Background:

The purpose of this study is to review the efficacy of Target Specific Oral Anticoagulants (TSOAC) versus vitamin K antagonist (VKA) for post-surgical anticoagulation in patient with primary subclavian vein thrombosis. Rivaroxaban, a factor Xa inhibitor, was the first TSOAC approved by the FDA in 2012 for the treatment and prevention of deep vein thrombosis. However, the efficacy and safety of TSOAC for prevention of recurrent deep vein thrombosis after revascularization of upper extremity compression syndromes is largely unknown.

Intraoperative Neurophysiological Monitoring For Endoscopic Endonasal Approaches To The Skull Base: A Technical Guide., Harminder Singh, Richard W. Vogel, Robert M. Lober, Adam T. Doan, Craig I. Matsumoto, Tyler J. Kenning, James J. Evans

Department of Neurosurgery Faculty Papers

Intraoperative neurophysiological monitoring during endoscopic, endonasal approaches to the skull base is both feasible and safe. Numerous reports have recently emerged from the literature evaluating the efficacy of different neuromonitoring tests during endonasal procedures, making them relatively well-studied. The authors report on a comprehensive, multimodality approach to monitoring the functional integrity of at risk nervous system structures, including the cerebral cortex, brainstem, cranial nerves, corticospinal tract, corticobulbar tract, and the thalamocortical somatosensory system during endonasal surgery of the skull base. The modalities employed include electroencephalography, somatosensory evoked potentials, free-running and electrically triggered electromyography, transcranial electric motor evoked potentials, and auditory …

Auras In Patients With Temporal Lobe Epilepsy And Mesial Temporal Sclerosis., Ali Akbar Asadi-Pooya, Maromi Nei, Ashwini Sharan, Michael R. Sperling

Department of Neurology Faculty Papers

We investigated auras in patients with drug-resistant temporal lobe epilepsy (TLE) and mesial temporal sclerosis (MTS). We also investigated the clinical differences between patients with MTS and abdominal auras and those with MTS and non-mesial temporal auras. All patients with drug-resistant TLE and unilateral MTS who underwent epilepsy surgery at Jefferson Comprehensive Epilepsy Center from 1986 through 2014 were evaluated. Patients with good postoperative seizure outcome were investigated. One hundred forty-nine patients (71 males and 78 females) were studied. Thirty-one patients (20.8%) reported no auras, while 29 patients (19.5%) reported abdominal aura, and 30 patients (20.1%) reported non-mesial temporal auras; …

Effects Of Preoperative Aspirin On Major Outcomes In Graded High-Risk Patients Undergoing Cardiac Surgery, Qian Ding, Eric Yuen, Mark Berguson, Hong Liu, Linong Yao, Jordan E. Goldhammer, Jianzhong Sun

Department of Anesthesiology Posters

Introduction:

• Among patients with cardiovascular disease, nearly 70% take preventive aspirin.¹
• The benefits of aspirin are greater as a patient’s risk of cardiovascular events increases; patients with a lower risk of cardiovascular events derive less of a benefit from aspirin.²
• The effect of aspirin in surgical patients has not yet been investigated, in particular if there is an optimal effect based on operative risk when undergoing cardiac surgery.

Objective:

To determine the effects of preoperative aspirin on major outcomes after cardiac surgery in patients with low, medium, and high predicted operative mortality as determined by the EuroSCORE risk …

Effects Of Diabetes Mellitus And Chronic Kidney Disease On Major Outcomes In Patients Undergoing Cardiac Surgery, Mark W. Berguson, Jordan E. Goldhammer, Hong Liu, Rohinton Morris, Jianzhong Sun

Department of Anesthesiology Posters

Introduction:

• Diabetes mellitus (DM) is the leading cause of chronic kidney disease (CKD). CKD typically manifests in late stages of DM.

• DM and CKD are prevalent in patients with cardiovascular disease.

• The impact of concurrent DM and CKD on major adverse cardiocerebral events (MACE) in patients undergoing cardiac surgery remains unclear.^1,2

Objective:

To determine the effect of DM and CKD on major outcomes in patients undergoing cardiac surgery.

Preoperative Aspirin And Major Perioperative Outcomes In Patients With Hypertension Undergoing Cardiac Surgery, Qian Ding, Eric Yuen, Mark Berguson, Hong Liu, Linong Yao, Rohinton Morris, Jianzhong Sun

Department of Anesthesiology Posters

Introduction:

• Hypertension is prevalent in patients undergoing cardiac surgery and associated with a higher incidence of cardiovascular complications.
• Aspirin has been shown to prevent cardiovascular events in patients with a high risk of cardiovascular disease.
• Very few studies have investigated aspirin and hypertension, particularly its effects on major outcomes in hypertensive patients undergoing cardiac surgery.^1,2

Objective

To determine the effects of preoperative aspirin on postoperative outcomes for patients with hypertension undergoing cardiac surgery.

To examine the impact of chronic kidney disease and heart failure superimposed with hypertension on outcomes after cardiac surgery.

Benefits Of Wireless Telephone Technologies For Bilaterally Implanted Adults, Louisa Liang, Au.D., Paula Marcinkevich, Au.D.

Department of Otolaryngology - Head and Neck Surgery Posters

Introduction

Cochlear implant (CI) recipients often have difficulty conversing on the telephone, particularly in noise. Successful use of landline and cellular telephones also can be limited because of less-than-optimal phone placement with respect to the sound processor microphone. One solution for recipients of Advanced Bionics cochlear implants may be the use of new streaming technologies from Phonak to improve the ability to talk on the phone. In addition to reducing interference caused by noise, use of these technologies is not strictly placement-dependent and also allows bilateral/bimodal recipients to take advantage of hearing with two ears.

The primary objective of this …

Patient Perception Of Telehealth Primary Care Video Visits, Rhea E. Powell, Md, Mph, Jeffrey Henstenburg, Bs, Grace Cooper, Ba, Judd Hollander, Md, Kristin L. Rising, Md, Ms

Department of Medicine Posters

Introduction

• Telehealth (TH) is an innovative model of care delivery with potential to provide more patient-centered healthcare, allowing patients to receive care when and where is most convenient.
• To date, little is known about patient perceptions of receiving care with the use of TH video visits.