Medical Specialties Commons^™

Aspirin May Be Adequate For Venous Thromboembolic Event Prophylaxis After Revision Hip And Knee Arthroplasty, Greg K. Deirmengian, Md, Snir Heller, Md, Eric B. Smith, Md, Mitchell Maltenfort, Phd, Javad Parvizi, Md, Frcs

Rothman Institute Conference Posters

Introduction:

The optimal prophylaxis for prevention of venous thromboembolic events (VTE) after total hip arthroplasty (THA) and total knee arthroplasty (TKA) remains unknown.(1) Current studies focus on primary arthroplasty and there are little to no data on the ideal prophylaxis for VTE following revision arthroplasty.(2) Revision surgery, due to its complexity, longer operative time, higher risk of bleeding and infection diff­ers from primary arthroplasty.(3) The objective of this study was to evaluate whether aspirin, known to be e­ffective for prevention of VTE after primary arthroplasty, is also e­ffective against such events following revision THA and TKA.

Anterior Cruciate Ligament Reconstruction With Bone-Patellar Tendon-Bone Autograft Versus Allograft In Young Patients, Alfred W. Atanda, Daniel F. O'Brien, Matthew J. Kraeutler, Russell R. Flato, Matthew R. Salminen, Kevin Henrichsen, Patrick Kane, Christopher Dodson, Steven B. Cohen, Michael G. Ciccotti

Rothman Institute Papers

Objectives: Traditionally, bone-patella tendon-bone (BTB) autograft has been the gold standard graft choice for younger, athletic patients requiring ACL reconstruction. However, donor site morbidity, post-operative patella fracture, and increased operative time have led many surgeons to choose BTB allograft for their reconstructions. Opponents of allografts feel that slower healing time, higher rate of graft failure, and potential for disease transmission makes them undesirable graft choices in athletic patients. The purpose of this study is to evaluate the clinical outcomes, both subjective and objective, of young patients that who have undergone either BTB autograft or allograft reconstructions with a minimum of …

Biological Response To Prosthetic Debris., Diana Bitar, Javad Parvizi

Rothman Institute Papers

Joint arthroplasty had revolutionized the outcome of orthopaedic surgery. Extensive and collaborative work of many innovator surgeons had led to the development of durable bearing surfaces, yet no single material is considered absolutely perfect. Generation of wear debris from any part of the prosthesis is unavoidable. Implant loosening secondary to osteolysis is the most common mode of failure of arthroplasty. Osteolysis is the resultant of complex contribution of the generated wear debris and the mechanical instability of the prosthetic components. Roughly speaking, all orthopedic biomaterials may induce a universal biologic host response to generated wear débris with little specific characteristics …

Targeting Tumor-Initiating Cells: Eliminating Anabolic Cancer Stem Cells With Inhibitors Of Protein Synthesis Or By Mimicking Caloric Restriction., Rebecca Lamb, Hannah Harrison, Duncan L Smith, Paul A Townsend, Thomas Jackson, Bela Ozsvari, Ubaldo E. Martinez-Outshoorn, Md, Richard Pestell, Anthony Howell, Michael P. Lisanti, Federica Sotgia

Kimmel Cancer Center Faculty Papers

We have used an unbiased proteomic profiling strategy to identify new potential therapeutic targets in tumor-initiating cells (TICs), a.k.a., cancer stem cells (CSCs). Towards this end, the proteomes of mammospheres from two breast cancer cell lines were directly compared to attached monolayer cells. This allowed us to identify proteins that were highly over-expressed in CSCs and/or progenitor cells. We focused on ribosomal proteins and protein folding chaperones, since they were markedly over-expressed in mammospheres. Overall, we identified >80 molecules specifically associated with protein synthesis that were commonly upregulated in mammospheres. Most of these proteins were also transcriptionally upregulated in human …

Posterior Surgical Approach Procedures For Cervical Myelopathy, Pedro H.I. Pohl, Marcel Jun Tamaoki, Luciano M. Rodrigues, Kristen Radcliff, Takashi Yurube, James D. Kang, João Carlos Belloti

Department of Orthopaedic Surgery Faculty Papers

This is the protocol for a review and there is no abstract. The objectives are as follows: The main objective of this review is to assess the effects of laminectomy and fusion versus laminoplasty for multilevel cervical stenosis with myelopathy, on treatment outcomes such as pain, quality of life, functional and neurological improvement, and complication rates. © 2015 The Cochrane Collaboration.

State Law Mandates For Reporting Of Healthcare-Associated Clostridium Difficile Infections In Hospitals., Julie Reagan, Carolyn T A Herzig, Monika Pogorzelska-Maziarz, Andrew W Dick, Patricia W Stone, Jd Divya Srinath

Department of Nursing papers and presentations

US state and territorial laws were reviewed to identify Clostridium difficile infection reporting mandates. Twenty states require reporting either under state law or by incorporating federal Centers for Medicare & Medicaid Services' reporting requirements. Although state law mandates are more common, the incorporation of federal reporting requirements has been increasing.

Emerging Drugs For Sickle Cell Anemia., Priya C Singh, Samir K. Ballas

Cardeza Foundation for Hematologic Research

INTRODUCTION: The search for effective therapeutic interventions for sickle cell disease (SCD) has been an ongoing endeavor for over 50 years. During this period, only hydroxyurea (HU), which received US FDA approval in February 1998, was identified as an effective therapeutic agent in preventing or ameliorating the frequency of vaso-occlusive crises, acute chest syndrome and the need for blood transfusion. Approximately 25% of patients with sickle cell anemia (SCA), however, do not respond to HU and some patients experiencing serious side effects of this chemotherapeutic agent. Nevertheless, the success of HU opened the sluice gates to identify other effective drug …

A Resource Planning Analysis Of District Hospital Surgical Services In The Democratic Republic Of The Congo., Melanie K. Sion, Md, Dheepa Rajan, Hyppolite Kalambay, Jean-Pierre Lokonga, Joseph Bulakali, Mathias Mossoko, Dieudonne Kwete, Gerard Schmets, Edward Kelley, Tarcisse Elongo, Luis Sambo, Meena Cherian

Department of Surgery Faculty Papers

BACKGROUND: The impact of surgical conditions on global health, particularly on vulnerable populations, is gaining recognition. However, only 3.5% of the 234.2 million cases per year of major surgery are performed in countries where the world's poorest third reside, such as the Democratic Republic of the Congo (DRC).

METHODS: Data on the availability of anesthesia and surgical services were gathered from 12 DRC district hospitals using the World Health Organization's (WHO's) Emergency and Essential Surgical Care Situation Analysis Tool. We complemented these data with an analysis of the costs of surgical services in a Congolese norms-based district hospital as well …

Implementation Of Antimicrobial Stewardship Policies In U.S. Hospitals: Findings From A National Survey., Monika Pogorzelska-Maziarz, Carolyn T A Herzig, Elaine L Larson, E Yoko Furuya, Eli N Perencevich, Patricia W Stone

Department of Obstetrics and Gynecology Faculty Papers

OBJECTIVE: To describe the use of antimicrobial stewardship policies and to investigate factors associated with implementation in a national sample of acute care hospitals.

DESIGN: Cross-sectional survey.

PARTICIPANTS: Infection Control Directors from acute care hospitals participating in the National Healthcare Safety Network (NHSN).

METHODS: An online survey was conducted in the Fall of 2011. A subset of hospitals also provided access to their 2011 NHSN annual survey data.

RESULTS: Responses were received from 1,015 hospitals (30% response rate). The majority of hospitals (64%) reported the presence of a policy; use of antibiograms and antimicrobial restriction policies were most frequently utilized …

Radiation Therapy After Radical Prostatectomy For Prostate Cancer: Evaluation Of Complications And Influence Of Radiation Timing On Outcomes In A Large, Population-Based Cohort., Sarah E Hegarty, Terry Hyslop, Adam Dicker Md, Phd, Timothy Showalter Md

Department of Radiation Oncology Faculty Papers

PURPOSE: To evaluate the influence of timing of salvage and adjuvant radiation therapy on outcomes after prostatectomy for prostate cancer.

METHODS: Using the Surveillance, Epidemiology, and End Results-Medicare linked database, we identified prostate cancer patients diagnosed during 1995-2007 who had one or more adverse pathological features after prostatectomy. The final cohort of 6,137 eligible patients included men who received prostatectomy alone (n = 4,509) or with adjuvant (n = 894) or salvage (n = 734) radiation therapy. Primary outcomes were genitourinary, gastrointestinal, and erectile dysfunction events and survival after treatment(s).

RESULTS: Radiation therapy after prostatectomy was associated with higher rates …

Antibiotics For Cancer Therapy., Richard Pestell, Albert A Rizvanov

Department of Cancer Biology Faculty Papers

No abstract provided.

Bilayer Button Graft For Endoscopic Repair Of High-Flow Cranial Base Defects, Chris Luminais, M. L. Otten, A. A. Farag, P. Soni, W. Mohiuddin, N. Ziegler, G. G. Nyquist, C. Farrell, M. R. Rosen, J. J. Evans

Department of Otolaryngology - Head and Neck Surgery Presentations and Grand Rounds

Closure of dural defects in trans-nasal, extended, endoscopic techniques remains a challenge, and published cerebrospinal fluid (CSF) leak rates are higher than rates for trans-cranial approaches. Development of a technique that used a vascularized, nasoseptal flap (NSF) significantly reduced the rate of CSF leak, and several groups have developed ways to buttress the NSF. A closure technique developed at our institution uses a bilayer “button” of fascia lata. The initial series of twenty patients repaired with this method from 2007 to July 1, 2009 were presented, with a CSF leak rate of 10% (Luginbuhl et al 2010).

The Effects Of Test-Enhanced Learning On Long-Term Retention In Aan Annual Meeting Courses., Douglas P Larsen, Andrew C Butler, Wint Y Aung, John R Corboy, Deborah I Friedman, Michael R Sperling

Department of Neurology Faculty Papers

OBJECTIVE: We measured the long-term retention of knowledge gained through selected American Academy of Neurology annual meeting courses and compared the effects of repeated quizzing (known as test-enhanced learning) and repeated studying on that retention.

METHODS: Participants were recruited from 4 annual meeting courses. All participants took a pretest. This randomized, controlled trial utilized a within-subjects design in which each participant experienced 3 different postcourse activities with each activity performed on different material. Each key information point from the course was randomized in a counterbalanced fashion among participants to one of the 3 activities: repeated short-answer quizzing, repeated studying, and …

Novel Actions Of Next-Generation Taxanes Benefit Advanced Stages Of Prostate Cancer., Renée De Leeuw, Lisa D. Berman-Booty, Matthew J. Schiewer, Stephen J Ciment, Robert Den, Adam P. Dicker, William Kelly, Edouard J. Trabulsi, Costas D. Lallas, Leonard G. Gomella, Karen E. Knudsen

Department of Cancer Biology Faculty Papers

PURPOSE: To improve the outcomes of patients with castration-resistant prostate cancer (CRPC), there is an urgent need for more effective therapies and approaches that individualize specific treatments for patients with CRPC. These studies compared the novel taxane cabazitaxel with the previous generation docetaxel, and aimed to determine which tumors are most likely to respond.

EXPERIMENTAL DESIGN: Cabazitaxel and docetaxel were compared via in vitro modeling to determine the molecular mechanism, biochemical and cell biologic impact, and cell proliferation, which was further assessed ex vivo in human tumor explants. Isogenic pairs of RB knockdown and control cells were interrogated in vitro …

Effectiveness Of Surgery For Lumbar Stenosis And Degenerative Spondylolisthesis In The Octogenarian Population: Analysis Of The Spine Patient Outcomes Research Trial (Sport) Data., Jeffrey A Rihn, Alan S Hilibrand, Wenyan Zhao, Jon D Lurie, Alexander Vaccaro, Md, Phd, Todd Albert, James Weinstein

Rothman Institute Papers

BACKGROUND: The purpose of this study was to determine whether surgery is an effective option for the treatment of stenosis of the lumbar spine and degenerative spondylolisthesis in the octogenarian population.

METHODS: An as-treated analysis of patients with lumbar stenosis and degenerative spondylolisthesis enrolled in the Spine Patient Outcomes Research Trial (SPORT) was performed. Patients who were at least eighty years of age (n = 105) were compared with those younger than eighty years (n = 1130). Baseline patient and clinical characteristics were noted, and the difference in improvement from baseline between operative and nonoperative treatment was determined for each …

Francis Daniels Moore: One Of The Brightest Minds In The Surgical Field., Sara L. Low, Bs, Charles J. Yeo, Md, Scott W. Cowan, Md, Ashesh P. Shah, Md

Department of Surgery Gibbon Society Historical Profiles

Francis Daniels Moore was a pioneer ahead of his time who made numerous landmark contributions to the field of surgery, including the understanding of metabolic physiology during surgery, liver and kidney transplant, and the famous Study on Surgical Services of the United States (SOSSUS) report of 1975 that served for decades as a guideline for development of surgical residencies. He was the epitome of what a physician should be, a compassionate and dedicated surgeon, innovative scientist, and a medical professional dedicated to quality medical education across all specialties.

Vivien Thomas: Master Craftsman, Gifted Teacher, And Unsung Hero., Alisha Joyner, B.S., Charles J. Yeo, Md, Pinckney J. Maxwell, Iv, Md

Department of Surgery Gibbon Society Historical Profiles

The field of pediatric cardiovascular surgery gained international recognition in 1944 with the first successful correction of a tetralogy of Fallot congenital anomaly in a 15-month-old patient. Dr. Helen Taussig (1898 to 1986), a pediatrician at Johns Hopkins Hospital, recognized the need for the procedure. Dr. Alfred Blalock (1899 to 1964), Chief of Surgery at Johns Hopkins Hospital, is credited with performing the surgery. However, there is an unsung hero who for many years did not receive a single mention in the medical literature. Vivien Thomas (1910 to 1985) was Dr. Blalock’s research assistant who is said to have stood …

African American Men With Low-Grade Prostate Cancer Have Increased Disease Recurrence After Prostatectomy Compared With Caucasian Men., Kosj Yamoah, Curtiland Deville, Neha Vapiwala, Elaine Spangler, Charnita M. Zeigler-Johnson, Bruce Malkowicz, David I Lee, Michael Kattan, Adam P. Dicker, Timothy R. Rebbeck

Department of Radiation Oncology Faculty Papers

PURPOSE: To explore whether disparities in outcomes exist between African American (AA) and Caucasian (CS) men with low-grade prostate cancer and similar cancer of the prostate risk assessment-postsurgery (CAPRA-S) features following prostatectomy (RP).

METHODS: The overall cohort consisted of 1,265 men (234 AA and 1,031 CS) who met the National comprehensive cancer network criteria for low- to intermediate-risk prostate cancer and underwent RP between 1990 and 2012. We first evaluated whether clinical factors were associated with adverse pathologic outcomes and freedom from biochemical failure (FFbF) using the entire cohort. Next, we studied a subset of 705 men (112 AA and …

Population Health: Where's The Beef?, David B. Nash

College of Population Health Faculty Papers

No abstract provided.

On Voxel-By-Voxel Accumulated Dose For Prostate Radiation Therapy Using Deformable Image Registration., Jialu Yu, Nicholas Hardcastle, Kyoungkeun Jeong, Edward T. Bender, Mark A. Ritter, Wolfgang A. Tomé

Department of Radiation Oncology Faculty Papers

Since delivered dose is rarely the same with planned, we calculated the delivered total dose to ten prostate radiotherapy patients treated with rectal balloons using deformable dose accumulation (DDA) and compared it with the planned dose. The patients were treated with TomoTherapy using two rectal balloon designs: five patients had the Radiadyne balloon (balloon A), and five patients had the EZ-EM balloon (balloon B). Prostate and rectal wall contours were outlined on each pre-treatment MVCT for all patients. Delivered fractional doses were calculated using the MVCT taken immediately prior to delivery. Dose grids were accumulated to the last MVCT using …

Dysregulation Of Kv3.4 Channels In Dorsal Root Ganglia Following Spinal Cord Injury., David Ritter, Benjamin M Zemel, Tamara J Hala, Michael E O'Leary, Angelo C Lepore, Manuel Covarrubias

Farber Institute for Neuroscience Faculty Papers

Spinal cord injury (SCI) patients develop chronic pain involving poorly understood central and peripheral mechanisms. Because dysregulation of the voltage-gated Kv3.4 channel has been implicated in the hyperexcitable state of dorsal root ganglion (DRG) neurons following direct injury of sensory nerves, we asked whether such a dysregulation also plays a role in SCI. Kv3.4 channels are expressed in DRG neurons, where they help regulate action potential (AP) repolarization in a manner that depends on the modulation of inactivation by protein kinase C (PKC)-dependent phosphorylation of the channel's inactivation domain. Here, we report that, 2 weeks after cervical hemicontusion SCI, injured …

Morphine For The Treatment Of Pain In Sickle Cell Disease., Mihir Gupta, Lilian Msambichaka, Samir K. Ballas, Kalpna Gupta

Cardeza Foundation for Hematologic Research

Pain is a hallmark of sickle cell disease (SCD) and its treatment remains challenging. Opioids are the major family of analgesics that are commonly used for treating severe pain. However, these are not always effective and are associated with the liabilities of their own. The pharmacology and multiorgan side effects of opioids are rapidly emerging areas of investigation, but there remains a scarcity of clinical studies. Due to opioid-induced endothelial-, mast cell-, renal mesangial-, and epithelial-cell-specific effects and proinflammatory as well as growth influencing signaling, it is likely that when used for analgesia, opioids may have organ specific pathological effects. …

Low-Density Lipoprotein Cholesterol Lowering Therapies: What Is On The Horizon?, Ramprasad Gadi, Vincent M. Figueredo, M.D.

Division of Cardiology Faculty Papers

Elevated low-density lipoprotein cholesterol (LDL-C) levels are associated with an increased risk for cardiovascular disease (CVD). Statins have been the cornerstone of lipid therapy to lower LDL-C for the past two decades, but despite significant clinical efficacy in a majority of patients, a large residual risk remains for the development of initial or recurrent atherosclerotic CVD. In addition, owing to the side-effects, a significant percentage of patients cannot tolerate any statin dose or a high enough statin dose. Thus, novel therapeutic agents are currently being developed to lower LDL-C levels further. This review will highlight these novel therapeutic agents including …

Endovascular Stroke Therapy Results Improve Over Time: The ‘Learning Curve’ At A New Comprehensive Stoke Center, Ethan A. Benardete, Anil K. Nair

Department of Neurosurgery Faculty Papers

Background: The requirements for a comprehensive stroke center (CSC) include the capability to perform endovascular stroke therapy (EST). EST is a complex process requiring early identification of appropriate patients and effective delivery of intervention. In order to provide prompt intervention for stroke, CSCs have been established away from large academic centers in community-based hospitals. We hypothesized that quantifiable improvements would occur during the first 2 years of a community-based CSC as the processes and personnel evolved. We report the results over time of EST at a new community-based CSC. Methods: We have retrospectively analyzed demographic data and outcome metrics of …

Adult Tracheal Stenosis Causes And Therapies, Colin Huntley, Md

Department of Otolaryngology - Head and Neck Surgery Presentations and Grand Rounds

Outline:

• History of Tracheotomy
• Tracheal Stenosis-Etiology, Signs/Symptoms, Workup, Treatment Modalities

Note: No audio, only PowerPoint slides.

Dr. Mary Edwards Walker: Years Ahead Of Her Time., Dre M. Irizarry, Bs, Nicole Salomone, As, Karen A. Chojnacki, Md, Charles J. Yeo, Md, Scott W. Cowan, Md, Linda J. Bogar, Md

Department of Surgery Gibbon Society Historical Profiles

Women phsycians in the United States were virtually nonexistent in the early to mid-1800s. Traditional medical schools still did not accept women, and few secretarian or eclectic medical schools were beginning to open their doors to female students. In 1849 at Geneva College, Elizabeth Blackwell became the first woman to achieve a medical degree in the United States.1 At the time of the Civil War, the few women who had managed to obtain medical degrees mainly served as nurses in the war, because society was not yet ready to accept the female physician.2 Dr. Mary Edwards Walker would help change …

Treatment Of Exophytic Renal Cancer Smaller Than 3 Cm: Surgery Versus Active Surveillance., Costas D. Lallas, Edouard J. Trabulsi, Samuel D. Kaffenberger, Karim A Touijer

Department of Urology Faculty Papers

No abstract provided.

What Is Translational Bioinformatics?, Eric R. Londin, Carol I. Barash

Computational Medicine Center Faculty Papers

No abstract provided.

Role Of Cellular Senescence And Nox4-Mediated Oxidative Stress In Systemic Sclerosis Pathogenesis., Sonsoles Piera-Velazquez, Sergio A. Jimenez

Department of Dermatology and Cutaneous Biology Faculty Papers

Systemic sclerosis (SSc) is a systemic autoimmune disease characterized by progressive fibrosis of skin and numerous internal organs and a severe fibroproliferative vasculopathy resulting frequently in severe disability and high mortality. Although the etiology of SSc is unknown and the detailed mechanisms responsible for the fibrotic process have not been fully elucidated, one important observation from a large US population study was the demonstration of a late onset of SSc with a peak incidence between 45 and 54 years of age in African-American females and between 65 and 74 years of age in white females. Although it is not appropriate …

Adiponectin Protects Against Paraquat-Induced Lung Injury By Attenuating Oxidative/Nitrative Stress., Rong Yao, Yaxiong Zhou, Yarong He, Yaowen Jiang, Peng Liu, Lei Ye, Zhijie Zheng, Wayne Bond Lau, Yu Cao, Zhi Zeng

Department of Emergency Medicine Faculty Papers

The specific mechanisms underlying paraquat (PQ)-induced lung injury remain unknown, which limits understanding of its cytotoxic potential. Although oxidative stress has been established as an important mechanism underlying PQ toxicity, multiple antioxidants have proven ineffective in attenuating the deleterious effects of PQ. Adiponectin, which shows anti-oxidative and antinitrative effects, may have the potential to reduce PQ-mediated injury. The present study determined the protective action of globular domain adiponectin (gAd) on PQ-induced lung injury, and attempted to elucidate the underlying mechanism or mechanisms of action. BALB/c mice were administered PQ, with and without 12 or 36 h of gAd pre-treatment. The …