Medical Specialties Commons^™

Central Line-Associated Blood Stream Infections In Pediatric Intensive Care Units: Longitudinal Trends And Compliance With Bundle Strategies., Jeffrey D. Edwards, Carolyn T. Herzig, Hangsheng Liu, Monika Pogorzelska-Maziarz, Philip Zachariah, Andrew W. Dick, Lisa Saiman, Patricia W. Stone, E. Yoko Furuya

College of Nursing Faculty Papers & Presentations

BACKGROUND: Knowing the temporal trend central line-associated bloodstream infection (CLABSI) rates among U.S. pediatric intensive care units (PICUs), the current extent of central line bundle compliance, and the impact of compliance on rates is necessary to understand what has been accomplished and can be improved in CLABSI prevention.

METHODS: This is a longitudinal study of PICUs in National Healthcare Safety Network hospitals and a cross-sectional survey of directors and managers of infection prevention and control departments regarding PICU CLABSI prevention practices, including self-reported compliance with elements of central line bundles. Associations between 2011-2012 PICU CLABSI rates and infection prevention practices …

Management Of Complications Of Wrist Arthroplasty And Wrist Fusion., Michael P. Gaspar, Patrick M Kane, Eon K. Shin

Department of Orthopaedic Surgery Faculty Papers

The human wrist joint is unique from functional and anatomic standpoints. Numerous articulations exist within the wrist that allow for many options for partial wrist fusion and arthroplasty. In cases of pancarpal disease, fusion or arthroplasty of the entire wrist joint can be performed. Because of the high functional demand of the wrist, many of these surgical options can fail, leading to devastating complications. This article addresses the types of fusions and arthroplasties available for the wrist and discusses the potential complications associated with each. Methods to prevent these complications are presented and those to treat them once they have …

A Special Report Of Current State Of The Medical Physicist Workforce - Results Of The 2012 Astro Comprehensive Workforce Study, Erli Chen, Anna Arnone, Jussi K. Sillanpää, Yan Yu, Michael D. Mills

Department of Radiation Oncology Faculty Papers

No abstract provided.

Flattening Filter-Free Accelerators: A Report From The Aapm Therapy Emerging Technology Assessment Work Group, Ying Xiao, Stephen F. Kry, Richard A. Poppel, Ellen D. Yorke, Niko Papanikolaou, Sotirios Stathakis, Ping Xia, Saiful Huq, John E. Bayouth, James Galvin Phd, Fang-Fang Yin

Department of Radiation Oncology Faculty Papers

No abstract provided.

Compensatory Fetal Membrane Mechanisms Between Biglycan And Decorin In Inflammation., Luciana Batalha De Miranda De Araujo, Casie E Horgan, Abraham Aron, Renato V. Iozzo, Beatrice E Lechner

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Preterm premature rupture of fetal membranes (PPROM) is associated with infection, and is one of the most common causes of preterm birth. Abnormal expression of biglycan and decorin, two extracellular matrix proteoglycans, leads to preterm birth and aberrant fetal membrane morphology and signaling in the mouse. In humans and mice, decorin dysregulation is associated with inflammation in PPROM. We therefore investigated the link between biglycan and decorin and inflammation in fetal membranes using mouse models of intraperitoneal Escherichia coli injections superimposed on genetic biglycan and decorin deficiencies. We assessed outcomes in vivo as well as in vitro using quantitative PCR, …

Inflammatory Muscle Diseases., Marinos C Dalakas

Department of Neurology Faculty Papers

No abstract provided.

Kinase-Independent Role Of Cyclin D1 In Chromosomal Instability And Mammary Tumorigenesis., Mathew C Casimiro, Gabriele Disante, Marco Crosariol, Emanuele Loro, William Dampier, Adam Ertel, Zuoren Yu, Elizabeth A Saria, Alexandros Papanikolaou, Z Li, Chenguang Wang, Sankar Addya, Michael P. Lisanti, Paolo Fortina, Robert D Cardiff, Aydin Tozeren, Erik S Knudsen, Andrew Arnold, Richard Pestell

Department of Cancer Biology Faculty Papers

Cyclin D1 is an important molecular driver of human breast cancer but better understanding of its oncogenic mechanisms is needed, especially to enhance efforts in targeted therapeutics. Currently, pharmaceutical initiatives to inhibit cyclin D1 are focused on the catalytic component since the transforming capacity is thought to reside in the cyclin D1/CDK activity. We initiated the following study to directly test the oncogenic potential of catalytically inactive cyclin D1 in an in vivo mouse model that is relevant to breast cancer. Herein, transduction of cyclin D1-/- mouse embryonic fibroblasts (MEFs) with the kinase dead KE mutant of cyclin D1 led …

Phylogenetic Tree Construction And “Truncal Loss” Analysis Reveal Hidden Associations Between Loss Of Protein Expression In Swi/Snf Complex Components And Tumor Stage And Survival In Clear Cell Renal Cell Carcinoma (Ccrcc), Wei Jiang, Md, Phd, Essel Dulaimi, Karthik Devarajan, Qiong Wang, Raymond O'Neill, Charalambos C. Solomides, Md, Stephen C Peiper, Phd, Robert Uzzo, Joseph R. Testa, Haifeng Yang, Phd

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Background

Polybromo-1 (PBRM1), a targeting subunit of the SWI/SNF chromatin remodeling complex, is mutated at a rate of ~40% in clear cell Renal Cell Carcinoma (ccRCC), second only to VHL. Whether its mutation is correlated with tumor stage is controversial. As other components of the SWI/SNF complex were also reported to be mutated in ccRCC, we aim to examine the protein expression patterns of PBRM1, ARID1A, BRG1, and BRM in ccRCC, and to investigate possible association between their loss of expression and tumor stage, as well as survival. We also included a histone modifier, SETD2, which is recently discovered to …

Polymorphisms In Genes Of Tricarboxylic Acid Cycle Key Enzymes Are Associated With Early Recurrence Of Hepatocellular Carcinoma., Shaogui Wan, Yousheng Wu, Xingchun Zhou, Yibing Chen, Jiaze An, Xiaohe Yu, Huiqing Zhang, Hushan Yang, Jinliang Xing

Department of Medical Oncology Faculty Papers

Alterations of activity and expression in tricarboxylic acid (TCA) cycle key enzymes have been indicated in several malignancies, including hepatocellular carcinoma (HCC). They play an important role in the progression of cancer. However, the impact of single nucleotide polymorphisms (SNPs) in genes encoding these key enzymes on the recurrence of HCC has not been investigated. In this study, we genotyped 17 SNPs in genes encoding TCA cycle key enzymes and analyzed their association with recurrence-free survival (RFS) in a cohort of 492 Chinese HCC patients by Cox proportional hazard model and survival tree analysis. We identified 7 SNPs in SDHC, …

Crosstalk Between Desmoglein 2 And Patched 1 Accelerates Chemical-Induced Skin Tumorigenesis., Donna M Brennan-Crispi, Claudia Hossain, Joya Sahu, Mary Brady, Natalia A Riobo, M G Mahoney

Department of Biochemistry and Molecular Biology Faculty Papers

Aberrant activation of Hedgehog (Hh) signaling is causative of BCCs and has been associated with a fraction of SCCs. Desmoglein 2 (Dsg2) is an adhesion protein that is upregulated in many cancers and overexpression of Dsg2 in the epidermis renders mice more susceptible to squamous-derived neoplasia. Here we examined a potential crosstalk between Dsg2 and Hh signaling in skin tumorigenesis. Our findings show that Dsg2 modulates Gli1 expression, in vitro and in vivo. Ectopic expression of Dsg2 on Ptc1+/lacZ background enhanced epidermal proliferation and interfollicular activation of the Hh pathway. Furthermore, in response to DMBA/TPA, the Dsg2/Ptc1+/lacZ mice developed squamous …

Assessment For Risk Factors Associated With Local Recurrence In Chordoma, John A. Abraham, Md, Wei Jiang, Md, Phd

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Background

Chordoma is a rare but locally aggressive malignant neoplasm showing notochordal differentiation. The clinical differential diagnoses can be extensive, and definitive diagnosis often relies on histopathologic evaluation. Histologically, chordoma shows dual epithelial and mesenchymal differentiation, with various morphologies. Despite surgical resection and use of adjuvant radiation therapy, the local recurrence rate of chordoma remains high. We aim to establish factors associated with the increased risk of recurrence and help guide treatment decisions.

Routine Surveillance Of Patients With Hypertensive Disorders In Pregnancy, Johanna Quist-Nelson, Md, Lauren Cooper, Md, Abigail Wolf, Md

Department of Obstetrics and Gynecology Presentations and Grand Rounds

BACKGROUND

• Hypertensive disorders in pregnancy carry morbidity and mortality for mothers and infants
• Hypertensive disorders include a full spectrum from gestational hypertension and preeclampsia to eclampsia.
• In 2013 the American College of Obstetricians and Gynecologists released an executive summary with new task force recommendations for closer monitoring of patients with hypertensive disorders including:

Twice weekly blood pressure monitoring

Weekly office visits

Ultrasound surveillance of fetal growth

Weekly laboratory surveillance

Delivery at 37 weeks for patients with gestational hypertension and preeclampsia without severe features

Surgical Outcomes Of Sequential Versus Concomitant Glaucoma Drainage Implant And Boston Keratoprosthesis Type 1, Varum Patel, Marlene R. Moster, Louis J. Kishfy, Julian Barkan, Tingting Zhan, Irving M. Raber, Brandon D. Ayers, Michael J. Pro, Michael Waisbourd

Wills Eye Hospital Papers

BACKGROUND

The Boston Keratoprosthesis Type 1 (KPro) is a surgical device used in patients who have failed traditional corneal transplant treatment or are poor candidates for it.¹ Candidates for KPro often have advanced anterior segment disease that predisposes them to developing glaucoma.² As a result, these patients may require both a KPro, to treat their corneal pathology, and a glaucoma drainage implant (GDI), to treat their glaucoma. To date, there have been no long-term studies comparing the order of GDI placement with KPro surgery and how it affects surgical outcomes.

Practical Management Of Anticoagulation In Patients With Atrial Fibrillation., Richard J Kovacs, Greg C Flaker, Sherry J Saxonhouse, John U. Doherty, Kim K Birtcher, Adam Cuker, Bruce L Davidson, Robert P Giugliano, Christopher B Granger, Amir K Jaffer, Bella H Mehta, Edith Nutescu, Kim A Williams

Department of Medicine Faculty Papers

Anticoagulation for atrial fibrillation has become more complex due to the introduction of new anticoagulant agents, the number and kinds of patients requiring therapy, and the interactions of those patients in the matrix of care. The management of anticoagulation has become a "team sport" involving multiple specialties in multiple sites of care. The American College of Cardiology, through the College's Anticoagulation Initiative, convened a roundtable of experts from multiple specialties to discuss topics important to the management of patients requiring anticoagulation and to make expert recommendations on issues such as the initiation and interruption of anticoagulation, quality of anticoagulation care, …

Utility Of The Qt Interval In Predicting Outcomes In Patients Presenting To The Emergency Department With Chest Pain., Toni A De Venecia, Marvin Y Lu, Chinualumogu C Nwakile, Vincent M. Figueredo, M.D.

Division of Cardiology Faculty Papers

OBJECTIVES: The aim of this study was to investigate whether prolongation of the heart rate-corrected QT interval (QTc) is an independent risk factor for predicting future acute coronary syndrome (ACS) occurrence or mortality in patients with at least one cardiac risk factor presenting with chest pain to the emergency department (ED).

METHODS: This is a single-center, retrospective study of patients presenting with chest pain to the ED of Einstein Medical Center, Philadelphia, between 2011 and 2012. Proportional hazards models were used to calculate hazard ratios (HRs) for occurrence of ACS or death within 1 year. Kaplan-Meier curves were used to …

Successful Isolation Of Viable Adipose-Derived Stem Cells From Human Adipose Tissue Subject To Long-Term Cryopreservation: Positive Implications For Adult Stem Cell-Based Therapeutics In Patients Of Advanced Age., Sean Devitt, Md, Cynthia M Carter, Raia Dierov, Scott Weiss, Robert P Gersch, Ivona Percec

Jefferson Hospital Staff Papers and Presentations

We examined cell isolation, viability, and growth in adipose-derived stem cells harvested from whole adipose tissue subject to different cryopreservation lengths (2-1159 days) from patients of varying ages (26-62 years). Subcutaneous abdominal adipose tissue was excised during abdominoplasties and was cryopreserved. The viability and number of adipose-derived stem cells isolated were measured after initial isolation and after 9, 18, and 28 days of growth. Data were analyzed with respect to cryopreservation duration and patient age. Significantly more viable cells were initially isolated from tissue cryopreserved2 years, irrespective of patient age. However, this difference did not persist with continued growth and …

Evaluation Of The American-English Quality Of Life In Short Stature Youth (Qolissy) Questionnaire In The United States., Monika Bullinger, Rachel Sommer, Andreas Pleil, Nelly Mauras, Judith L. Ross, Ron Newfield, Lawrence Silverman, Anja Rohenkohl, Janet Fox, Julia Quitmann

Department of Medical Genetics Faculty Papers

BACKGROUND: The European Quality of Life in Short Stature Youth (QoLISSY) is a novel condition-specific instrument developed to assess health related quality of life (HrQoL) in children/adolescents with short stature from patient and parent perspectives. Study objective was to linguistically validate and psychometrically test the American-English version of the QoLISSY instrument.

METHODS: Upon conversion of the British-English version to American-English, content validity and acceptance of the questionnaire were examined through focus group discussions with cognitive debriefing in 28 children/adolescents with growth hormone deficiency (GHD) or idiopathic short stature (ISS) and their parents. In the subsequent field test with 51 families …

Evaluation And Nonsurgical Management Of Rotator Cuff Calcific Tendinopathy., Ari C. Greis, Stephen M. Derrington, Matthew Mcauliffe

Rothman Institute Papers

Rotator cuff calcific tendinopathy is a common finding that accounts for about 7% of patients with shoulder pain. There are numerous theories on the pathogenesis of rotator cuff calcific tendinopathy. The diagnosis is confirmed with radiography, MRI or ultrasound. There are numerous conservative treatment options available and most patients can be managed successfully without surgical intervention. Nonsteroidal anti-inflammatory drugs and multiple modalities are often used to manage pain and inflammation; physical therapy can help improve scapular mechanics and decrease dynamic impingement; ultrasound-guided needle aspiration and lavage techniques can provide long-term improvement in pain and function in these patients.

Technology And Simulation To Improve Patient Safety., George M. Ghobrial Md, Youssef J. Hamade, Bernard R. Bendok, James Harrop

Department of Neurosurgery Faculty Papers

Improving the quality and efficiency of surgical techniques, reducing technical errors in the operating suite, and ultimately improving patient safety and outcomes through education are common goals in all surgical specialties. Current surgical simulation programs represent an effort to enhance and optimize the training experience, to overcome the training limitations of a mandated 80-hour work week, and have the overall goal of providing a well-balanced resident education in a society with a decreasing level of tolerance for medical errors.

Complementary And Alternative Medicine In Cancer Prevention And Therapy., Peng Cao, Senthamil R Selvan, Esra Küpeli Akkol, Ning Wang, Hongjun Yang, Xiaolan Cheng

Department of Medical Oncology Faculty Papers

No abstract provided.

Short-Wavelength Enrichment Of Polychromatic Light Enhances Human Melatonin Suppression Potency., George Brainard, John P. Hanifin, Benjamin Warfield, Marielle K. Stone, Mary E. James, Melissa Ayers, Alan Kubey, Brenda Byrne, Mark Rollag

Department of Neurology Faculty Papers

The basic goal of this research is to determine the best combination of light wavelengths for use as a lighting countermeasure for circadian and sleep disruption during space exploration, as well as for individuals living on Earth. Action spectra employing monochromatic light and selected monochromatic wavelength comparisons have shown that short-wavelength visible light in the blue-appearing portion of the spectrum is most potent for neuroendocrine, circadian, and neurobehavioral regulation. The studies presented here tested the hypothesis that broad spectrum, polychromatic fluorescent light enriched in the short-wavelength portion of the visible spectrum is more potent for pineal melatonin suppression in healthy …

Focused Ultrasound For Treatment Of Bone Tumours., Dario B. Rodrigues, Paul R. Stauffer, David Vrba, Mark Hurwitz, Md

Department of Radiation Oncology Faculty Papers

PURPOSE: Focused ultrasound (FUS) is a modality with rapidly expanding applications across the field of medicine. Treatment of bone lesions with FUS including both benign and malignant tumours has been an active area of investigation. Recently, as a result of a successful phase III trial, magnetic resonance-guided FUS is now a standardised option for treatment of painful bone metastases. This report reviews the clinical applications amenable to treatment with FUS and provides background on FUS and image guidance techniques, results of clinical studies, and future directions.

METHODS: A comprehensive literature search and review of abstracts presented at the recently completed …

Burden Of Periprosthetic Joint Infection And Its Treatment On Kidney Function

Rothman Institute Conference Posters

Introduction:

Patients with periprosthetic joint infection (PJI) are subjected to several potentially nephrotoxic conditions such as acute and chronic systemic inflammatory reactions, multiple surgical procedures and noxious antibiotics. This study aims to investigate 1) the incidence and severity of kidney injury in patients undergoing surgical treatment for PJI, 2) whether the number of surgeries affects renal function in PJI patients and 3) the potential risk factors for kidney injury.

Low Dose Aspirin: An Effective Chemoprophylaxis For Preventing Venous Thromboembolic Events, Javad Parvizi, Md, Frcs, Antonia F. Chen, Md, Mba, Camilo Restrepo, Md, Ronald Huang, Md, Jenny Cal, Bs, William J. Hozack, Md, Jess H. Lonner, Md

Rothman Institute Conference Posters

The available guidelines, endorsed by Surgical Care Improvement Project (SCIP), have advocated that aspirin (ASA) is a safe and eff­ective strategy for venous thromboembolic events (VTE) prophylaxis following total joint arthroplasty (TJA). The optimal dose of aspirin for this purpose is not known. The first guidelines for prevention of VTE that were issued by the American Academy of Orthopedic Surgeons recommended 325 mg Bis in die (twice a day) (bid) for this purpose with the recommendation having a 1C grade (little evidence to support the recommendation). It is known that platelet aggregation inhibition occurs at lower doses. Traditionally, ASA 81mg …

Red Cell Distribution Width: An Unacknowledged Predictor Of Mortality And Length Of Stay Following Revision Arthroplasty, Pouya Alijanipour, Md, Snir Heller, Md, Fatih Kucukdurmaz, Md, Benjamin Zmistowski, Md, Maryam Rezapoor, Ms, Javad Parvizi, Md, Frcs

Rothman Institute Conference Posters

Introduction

Red blood cell distribution width (RDW), a measure of variability in size of circulating erythrocytes, is routinely reported in complete blood cell analysis, and together with mean cell volume (MCV) has conventionally been used to distinguish the cause of anemia. It is calculated by (Standard deviation of MCV÷ mean MCV) x 100, with normal range being 11.5%-14.5%. Several recent publications have described RDW as an independent predictor of adverse outcome and mortality in patients with different underlying medical conditions such as acute and chronic heart failure, peripheral artery disease, chronic pulmonary disease and acute kidney injury1. The purposes of …

Radiation Exposure To The Eye With Mini C-Arm Use During Hand Surgery, Mark L. Wang, Md, Phd, C. Edward Hoffler, Md, Phd, Frederick E. Liss, Md, Asif Ilyas, Md, Charles Leinberry, Md, Pedro Beredjiklian, Md

Rothman Institute Conference Posters

Introduction:

Fluoroscopic radiation exposure is a potential occupational health risk to the Hand Surgeon, given operator proximity and the relative lack of eye shielding. The association of eye radiation exposure and the early development of cataracts have been previously reported. Mini C-arm fluoroscopy is commonly utilized during routine Hand Surgery. At present, the amount of radiation exposure to the eye, associated with the routine use of mini C-arm fluoroscopy, is unknown, thus warranting further investigation. The purpose of this study is to test the hypothesis that eye radiation exposure, sustained during routine mini C-arm use, does not exceed that of …

Rotational Alignment In Medial Unicompartmental Knee Arthroplasty: Comparison Of Anatomic Landmarks, Glenn J. Kerr, Md, Patrick O'Toole, Md, Eddie Wu, Do, Jess H. Lonner, Md

Rothman Institute Conference Posters

Introduction:

The landmarks used for tibial component rotation in total knee arthroplasty (TKA) and medial unicompartmental knee arthroplasty (UKA) may differ, utilizing the medial edge of the tibial tubercle and the medial edge of the tibial spine, respectively. However, some surgeons reference from the medial edge of the tibial tubercle in UKA. Use of the tibial tubercle to determine orientation of the sagittal cut in medial UKA can result in external rotation of the tibial component, leading to rotational mismatch between the femoral and tibial components, potential disruption of the ACL and tibial component undersizing. The purpose of this study …

The Patellar Tendon Can Cause External Tibial Component Malrotation In Lateral Unicondylar Knee Arthroplasty, Glenn J. Kerr, Md, Patrick O'Toole, Md, Eddie Wu, Do, Jess H. Lonner, Md

Rothman Institute Conference Posters

Introduction:

The optimal rotational axis of the tibial component in lateral unicompartmental knee arthroplasty (UKA) should be aligned parallel to the lateral tibial spine. However, the relatively lateral positions of the tibial tubercle and patellar tendon make the sagittal tibial cut in lateral UKA difficult and commonly predisposes to inadvertent external rotation of the tibial component. The purpose of this study was to quantify the potential rotational impact that occurs when aligning the anterior edge of the sagittal tibial cut with the lateral edge of the patellar tendon in lateral UKA.

Trigger Finger Release Performed Wide Awake: Prospective Comparison Of Local Anesthetics, Constantinos Ketonis, Md, Phd, Nayoung Kim, Bs, Frederic Liss, Md, Benjamin Zmistowski, Md, Jonas L. Matzon, Md, Charles Leinberry, Md, Mark L. Wang, Md, Phd, Christopher Jones, Md, William Kirkpatrick, Md, Asif M Ilyas, Md

Rothman Institute Conference Posters

Introduction:

Trigger fi­nger (TF) is one of the most common conditions treated by hand surgeons with a lifetime risk up to 10% in patients with diabetes. If conservative management fails, surgical treatment is undertaken, with or without sedation and a tourniquet, via a small incision to release the A1 pulley. A number of local anesthetics are readily available including Lidocaine, Ropivacaine and Marcaine as well as encapsulated formulations thereof such as Exparel. Since it’s approval in 2011, there have been numerous reports of successfully achieving prolonged pain relief with locally injected Exparel after various procedures, but to the best of …

When Is It Safe For Patients To Drive After Right Total Hip Arthroplasty?, Victor H. Hernandez, Md, Alvin C. Ong, Md, Fabio Orozco, Md, Anne Marie Madden, Zachary D. Post, Md

Rothman Institute Conference Posters

Introduction:

• Driving restrictions after total hip arthroplasty (THA) can be inconvenient and burdensome for patients.
• When patients may safely be allowed to drive remains controversial.
• Most studies recommend 6 weeks but recent advances in surgical approach, pain management and rapid recovery may have changed this time frame.
• The purpose of this study was to prospectively evaluate driving safety after THA through brake reaction time.