Medical Specialties Commons^™

Definition Of Periprosthetic Joint Infection, Javad Parvizi, Md, Frcs, Thorsten Gehrke, Md

Rothman Institute Papers

Diagnosis of periprosthetic joint infection (PJI) remains challenging as no “gold standard” for diagnosis exists [3]. The challenge is then what test(s) or criterion (ia) can be used to define PJI. In an effort to standardize the definition of PJI, Musculoskeletal Infection Society (MSIS) convened a workgroup in 2011 to issue diagnostic criteria for PJI [1]. The MSIS definition of PJI consists of two major criteria, when the presence of either criterion would indicate PJI, and six minor criteria, when the presence of four or more would indicate PJI.

Unique Interdisciplinary Public Health Model Doubles Latent Tuberculosis Infection Treatment Completion Of Refugee Patients In A Large Metropolitan Area, Christine O'Leary, Pharmd, Kevin Scott, Md, Marc Altshuler, Md, Karen Kitagawa-James, Rn, Bsn, Maria Hervada-Paige, Mss

Department of Family & Community Medicine Presentations and Grand Rounds

Background and Purpose:

The Jefferson Center for Refugee Health (JCRH), a component of Jefferson Family Medicine Associates (JFMA), is the first and largest single provider of refugee health in Philadelphia; over 1,000 refugee primary care visits are provided annually. Refugee patients are disproportionately affected by latent tuberculosis infection (LTBI) compared to the general population of the United States; and though treatment of LTBI is highly effective at reducing conversion to active tuberculosis (TB), completion rates among the foreign-born are reported to be less than 50%. To establish baseline LTBI incidence and treatment completion rates for our refugee population, the JCRH …

What's New In Spine Surgery., Keith H Bridwell, Paul A Anderson, Scott D Boden, Han Jo Kim, Alexander Vaccaro, Md, Phd, Jeffrey C Wang

Rothman Institute Papers

No abstract provided.

The Tumor Suppressive Role Of Camk2n1 In Castration-Resistant Prostate Cancer., Tao Wang, Zhuo Liu, Shuiming Guo, Licheng Wu, Mingchao Li, Jun Yang, Ruibao Chen, Hua Xu, Shaoxin Cai, Hui Chen, Weiyong Li, Liang Wang, Zhiquan Hu, Qianyuan Zhuang, Shaohua Xu, Liping Wang, Jihong Liu, Zhangqun Ye, Jun-Yuan Ji, Chenguang Wang, Ke Chen

Department of Cancer Biology Faculty Papers

Prostate cancer at advanced stages including metastatic and castration-resistant cancer remains incurable due to the lack of effective therapies. The CAMK2N1 gene, cloned and characterized as an inhibitor of CaMKII (calcium/calmodulin-dependent protein kinase II), has been shown to affect tumorigenesis and tumor growth. However, it is still unknown whether CAMK2N1 plays a role in prostate cancer development. We first examined the protein and mRNA levels of CAMK2N1 and observed a significant decrease in human prostate cancers comparing to normal prostate tissues. Re-expression of CAMK2N1 in prostate cancer cells reduced cellular proliferation, arrested cells in G0/G1 phases, and induced apoptotic cell …

Multisite Phosphorylation Of The Sum1 Transcriptional Repressor By S-Phase Kinases Controls Exit From Meiotic Prophase In Yeast., Daniel Corbi, Sham Sunder, Michael Weinreich, Aikaterini Skokotas, Erica S Johnson, Edward Winter

Department of Biochemistry and Molecular Biology Faculty Papers

Activation of the meiotic transcription factor Ndt80 is a key regulatory transition in the life cycle of Saccharomyces cerevisiae because it triggers exit from pachytene and entry into meiosis. The NDT80 promoter is held inactive by a complex containing the DNA-binding protein Sum1 and the histone deacetylase Hst1. Meiosis-specific phosphorylation of Sum1 by the protein kinases Cdk1, Ime2, and Cdc7 is required for NDT80 expression. Here, we show that the S-phase-promoting cyclin Clb5 activates Cdk1 to phosphorylate most, and perhaps all, of the 11 minimal cyclin-dependent kinase (CDK) phospho-consensus sites (S/T-P) in Sum1. Nine of these sites can individually promote …

Advances In Neurovascular Treatments., Robert M Starke, Stephen J Monteith, Nohra Chalouhi, Dale Ding, Ricky Medel, David Hasan, Aaron S Dumont

Department of Neurosurgery Faculty Papers

No abstract provided.

Micrornas: The Short Link Between Cancer And Rt-Induced Dna Damage Response., Christopher M Wright, Tu Dan, Adam Dicker Md, Phd, Nicole L Simone

Department of Radiation Oncology Faculty Papers

No abstract provided.

Sphingosine-1-Phosphate Promotes The Differentiation Of Adipose-Derived Stem Cells Into Endothelial Nitric Oxide Synthase (Enos) Expressing Endothelial-Like Cells., Divya Arya, Shaohua Chang, Paul J Dimuzio, Jeffrey Carpenter, Thomas N Tulenko

Department of Surgery Faculty Papers

BACKGROUND: Adipose tissue provides a readily available source of autologous stem cells. Adipose-derived stem cells (ASCs) have been proposed as a source for endothelial cell substitutes for lining the luminal surface of tissue engineered bypass grafts. Endothelial nitric oxide synthase (eNOS) is a key protein in endothelial cell function. Currently, endothelial differentiation from ASCs is limited by poor eNOS expression. The goal of this study was to investigate the role of three molecules, sphingosine-1-phosphate (S1P), bradykinin, and prostaglandin-E1 (PGE1) in ASC endothelial differentiation. Endothelial differentiation markers (CD31, vWF and eNOS) were used to evaluate the level of ASCs differentiation capability. …

Results Of A Phase I Study Of Bendamustine In Combination With Ofatumumab, Carboplatin And Etoposide (Boce) For Refractory Of Relapsed Aggressive B-Cell Non Hodgkin's Lymphomas (Nhl), Sameh Gaballa, Md, Neil D. Palmisiano, Md, Aakanksha Asija, Md, Andrew Chapman, Do, Jennifer K. Cloud, Bs, Joanne Filicko-O'Hara, Md, Lewis Rose, Md, Michael Ramirez, Md, Onder Alpdogan, Md, Neal Flomenberg, Md, Barbara Pro, Md, Elena Gitelson, Md, Phd, Mark Weiss, Md

Department of Medical Oncology Faculty Papers

Introduction:

• There are a number of regimens used to treat relapsed/refractory aggressive lymphomas and little consensus exists on the best salvage treatment.
• No regimen has shown clear superiority but uniformly there was an inferior outcome among patients who had relapsed after a prior rituximab containing regimen.
• Ofatumumab is a fully human IgG1k monoclonal anti-CD20 antibody. It recognizes a distinct epitope on the human CD20 molecule. In vitro studies with ofatumumab have shown more complement dependent cytotoxicity than rituximab.
• Bendamustine has single agent activity in relapsed aggressive lymphomas and has a favorable safety profile.

Objectives:

• We conducted a phase I trial …

Utility Of The Stop-Bang Questionnaire For Identifying Obstructive Sleep Apnea In Patients Undergoing Bariatric Surgery, Karen Jablonski, Md, Ritu G. Grewal, Md, Ramya Punati,, Shivam Saxena, Karl Doghramji, Md, Alec Beekley, Md, David S. Tichansky, Md

Department of Surgery Faculty Papers

Introduction

Patients undergoing bariatric surgery are at high risk for obstructive sleep apnea (OSA).

OSA has been associated with an increased risk of perioperative complications, but is under-recognized and underdiagnosed in the bariatric population.

It is currently recommended that all patients considering bariatric surgery for obesity should be evaluated for OSA.

In the general pre-surgical population, the STOP-BANG questionnaire is a validated screening tool for identifying OSA.

We hypothesize that in bariatric patients the STOP-BANG questionnaire plus other clinical variables can predict OSA.

Francis F. Maury, M.D. (1840 To 1879): An Often Forgotten Pioneer In Early American Surgery., Guillaume S. Chevrollier, B.S., Scott W. Cowan, Md, Charles J. Yeo, Md, John C. Kairys, Md

Department of Surgery Gibbon Society Historical Profiles

Francis F. Maury (Fig. 1) was born on August 9, 1840, in Danville, Kentucky, where he was raised on a farm by his mother and father. His father was an Episcopal clergyman of Huguenot descent, whose forefathers had fled from France to escape religious persecution. After receiving a Bachelor of Arts degree from Center College in the summer of 1860, he entered medical school at the University of Virginia. After one full term, he matriculated to Philadelphia’s Jefferson Medical College and completed his medical education as a private student under the direction of Dr. Samuel D. Gross.1, 2 He obtained …

Ambroise Paré (1510 To 1590): A Surgeon Centuries Ahead Of His Time., James T. Shen, B.S., Michael Weinstein, Md, Alec C. Beekley, Md, Charles J. Yeo, Md, Scott W. Cowan, Md

Department of Surgery Gibbon Society Historical Profiles

In their extensive writings, Hippocrates and Celsus counseled physicians to be knowledgeable in both the medical and surgical management of patient recovery. However, their words fell by the wayside because cutting of the body was forbidden by the Roman Catholic Church. Furthermore, the contemporaneous Arabic medical teachings emphasized tradition and authority over observation and personal experience. This created an ever-growing rift between the schools of surgical and pharmacologic medicine with both groups denying their involvement in the other domain. Surgeons had been plagued by postoperative complications including infection, malnutrition, and muscular wasting for centuries. Surgeons were forced to re-examine how …

Mir-221/222 Promotes S-Phase Entry And Cellular Migration In Control Of Basal-Like Breast Cancer., Yuan Li, Chunli Liang, Haizhong Ma, Qian Zhao, Ying Lu, Zhendong Xiang, Li Li, Jie Qin, Yihan Chen, William C Cho, Richard G Pestell, Li Liang, Zuoren Yu

Department of Cancer Biology Faculty Papers

The miR-221/222 cluster has been demonstrated to function as oncomiR in human cancers. miR-221/222 promotes epithelial-to-mesenchymal transition (EMT) and confers tamoxifen resistance in breast cancer. However, the effects and mechanisms by which miR-221/222 regulates breast cancer aggressiveness remain unclear. Here we detected a much higher expression of miR-221/222 in highly invasive basal-like breast cancer (BLBC) cells than that in non-invasive luminal cells. A microRNA dataset from breast cancer patients indicated an elevated expression of miR-221/222 in BLBC subtype. S-phase entry of the cell cycle was associated with the induction of miR-221/222 expression. miRNA inhibitors specially targeting miR-221 or miR-222 both …

Who's Your Expert? Use Of An Expert Opinion Survey To Inform Development Of American Psychiatric Association Practice Guidelines., Joel Yager, Robert Kunkle, Laura J. Fochtmann, Sara M. Reid, Robert Plovnick, James E. Nininger, Joel J. Silverman, Michael J. Vergare

Department of Psychiatry and Human Behavior Faculty Papers

OBJECTIVE: For many clinical questions in psychiatry, high-quality evidence is lacking. Credible practice guidelines for such questions depend on transparent, reproducible, and valid methods for assessing expert opinion. The objective of this study was to develop and demonstrate the feasibility of a method for assessing expert opinion to aid in the development of practice guidelines by the American Psychiatric Association (APA).

METHODS: A "snowball" process initially soliciting nominees from three sets of professional leaders was used to identify experts on a guideline topic (psychiatric evaluation). In a Web-based survey, the experts were asked to rate their level of agreement that …

Understanding The Power Of Perinatal Events And Metabolic Status In Childhood., Bonita Falkner, Julie Ingelfinger

Department of Medicine Faculty Papers

No abstract provided.

An Update On Breast Cancer Screening And Prevention., Maria Syl D. De La Cruz, Mona Sarfaty, Richard C Wender

Department of Family & Community Medicine Faculty Papers

The goal of this article is to provide clinical guidance on breast cancer screening and prevention in primary care. The discussion highlights the importance of risk assessment, including screening options and risk-reduction strategies, for women at average and high risk. We review recommendations for breast cancer screening, evaluate current evidence on primary prevention, examine current practice patterns, and consider the impact of recent changes within health care.

Personality And Functional Vision In Older Adults With Age-Related Macular Degeneration, Barry W. Rovner, R. J. Casten, Mark T. Hegel, Robert W. Massof, Benjamin E. Leiby, Allen C. Ho, William S. Tasman

Department of Psychiatry and Human Behavior Faculty Papers

Introduction: The purpose of the study was to determine whether personality traits influence self-reported functional vision in patients with age-related macular degeneration (AMD). Methods: This is a prospective cross-sectional analysis of baseline data from the Low Vision Depression Prevention Trial. Participants (N = 182) over age 65 with bilateral AMD, visual acuity worse than 20/70 in the better-seeing eye, and subthreshold depression were recruited from the Wills Eye Hospital retina practice. Assessments included visual acuity, contrast sensitivity, National Eye Institute Visual Function Questionnaire-25 plus Supplement (NEI VFQ-25) near and distance subscales, depression, and personality testing. Structural equation models were used …

Ovarian Leydig Cell Hyperplasia: An Unusual Case Of Virilization In A Postmenopausal Woman., Jaya M Mehta, Jeffery L. Miller, Anthony J. Cannon, Stacey K. Mardekian, Lawrence C. Kenyon, Serge A. Jabbour

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Objective. To report an unusual case of ovarian Leydig cell hyperplasia resulting in virilization in a postmenopausal woman. Methods. Patient's medical history and pertinent literature were reviewed. Results. A 64-year-old woman presented with virilization with worsening hirsutism, deepening of her voice, male musculature, and male pattern alopecia. Her pertinent past medical history included type 1 diabetes, hyperlipidemia, and hypertension. Her pertinent past surgical history included hysterectomy due to fibroids. On further work-up, her serum total testosterone was 506 ng/dL (nl range: 2-45) and free testosterone was 40 pg/mL (nl range: 0.1-6.4). After ruling out adrenal causes, the patient underwent an …

Responding To Change In Reproductive Endocrinology Fellowships, William Schlaff, Md

Department of Obstetrics and Gynecology Faculty Papers

Thirty years ago, in the days when I was a reproductive endocrinology fellow, the field looked far different than it does today. Reproductive endocrinologists at that time were most assuredly the experts in diagnosing and treating infertility, but were often, if not usually the go-to doctors for patients with congenital uterovaginal anomalies, endometriosis, and those in need of complicated endoscopic procedures. The REI was not only the authority on polycystic ovary syndrome and other hormonal problems, but often the leader in addressing clinical issues in contraception, abnormal uterine bleeding, and menopause. In the early to mid-1980’s infertility treatment, such as …

Aquacel Surgical Dressing Reduces The Rate Of Acute Pji Following Total Joint Arthroplasty: A Case-Control Study., Jenny Cai, Joseph A Karam, Javad Parvizi, Eric B Smith, Peter F. Sharkey

Rothman Institute Papers

An effort to prevent PJI has led to the development of antimicrobial dressings that support wound healing. We sought to determine whether Aquacel Surgical dressing independently reduces the rate of acute PJI following TJA. A single institution retrospective chart review of 903 consecutive cases who received the Aquacel Surgical dressing and 875 consecutive cases who received standard gauze dressing was conducted to determine the incidence of acute PJI (within 3months). The incidence of acute PJI is 0.44% in the Aquacel dressing group compared to 1.7% in the standard gauze dressing group (P=0.005). Multivariate analysis revealed that use of Aquacel dressing …

Azd8931, An Equipotent, Reversible Inhibitor Of Signaling By Epidermal Growth Factor Receptor (Egfr), Her2, And Her3: Preclinical Activity In Her2 Non-Amplified Inflammatory Breast Cancer Models., Zhaomei Mu, Teresa Klinowska, Xiaoshen Dong, Emily Foster, Chris Womack, Sandra V Fernandez, Massimo Cristofanilli

Department of Medical Oncology Faculty Papers

INTRODUCTION: Epidermal growth factor receptor (EGFR) overexpression has been associated with prognostic and predictive value in inflammatory breast cancer (IBC). Epidermal growth factor receptor 2 (HER2) overexpression is observed at a higher rate in IBC compared with noninflammatory breast cancer. Current clinically available anti-HER2 therapies are effective only in patients with HER2 amplified breast cancer, including IBC. AZD8931 is a novel small-molecule equipotent inhibitor of EGFR, HER2, and HER3 signaling. In this study, we investigated the antitumor activity of AZD8931 alone or in combination with paclitaxel using preclinical models of EGFR-overexpressed and HER2 non-amplified IBC cells.

METHODS: Two IBC cell …

Overexpression Of The Astrocyte Glutamate Transporter Glt1 Exacerbates Phrenic Motor Neuron Degeneration, Diaphragm Compromise, And Forelimb Motor Dysfunction Following Cervical Contusion Spinal Cord Injury., Ke Li, Charles Nicaise, Daniel Sannie, Tamara J Hala, Elham Javed, Jessica L Parker, Rajarshi Putatunda, Kathleen A Regan, Valérie Suain, Jean-Pierre Brion, Fred Rhoderick, Megan C Wright, David J Poulsen, Angelo C Lepore

Farber Institute for Neuroscience Faculty Papers

A major portion of spinal cord injury (SCI) cases affect midcervical levels, the location of the phrenic motor neuron (PhMN) pool that innervates the diaphragm. While initial trauma is uncontrollable, a valuable opportunity exists in the hours to days following SCI for preventing PhMN loss and consequent respiratory dysfunction that occurs during secondary degeneration. One of the primary causes of secondary injury is excitotoxic cell death due to dysregulation of extracellular glutamate homeostasis. GLT1, mainly expressed by astrocytes, is responsible for the vast majority of functional uptake of extracellular glutamate in the CNS, particularly in spinal cord. We found that, …

The Relative Efficacy Of Antifibrinolytics In Adolescent Idiopathic Scoliosis: A Prospective Randomized Trial., Kushagra Verma, Md, Thomas Errico, Chris Diefenbach, Christian Hoelscher, Austin Peters, Joseph Dryer, Tessa Huncke, Kirstin Boenigk, Baron S Lonner

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Antifibrinolytics can reduce intraoperative blood loss. The primary aim of this study was to determine the efficacy of intraoperative tranexamic acid, epsilon-aminocaproic acid, and placebo at reducing perioperative blood loss and the transfusion rate in patients with adolescent idiopathic scoliosis undergoing posterior spinal arthrodesis.

METHODS: This is a prospective, randomized, double-blind comparison of tranexamic acid, epsilon-aminocaproic acid, and placebo used intraoperatively in patients with adolescent idiopathic scoliosis. One hundred and twenty-five patients with adolescent idiopathic scoliosis were randomly assigned to the tranexamic acid, epsilon-aminocaproic acid, or control groups. Parameters recorded included estimated blood loss, hematocrit, blood product usage, drain …

Letter To Alliance For Headache Disorders Advocacy, William B. Young, Md

Department of Jefferson Headache Center Papers and Presentations

Several years ago the Centers for Medicare and Medicare Services (CMS) decided it would not pay for oxygen for the treatment of cluster headache. This is a serious hardship for many people with cluster headache. The American Headache Society and the Alliance for Headache Disorders Advocacy appealed to CMS to reverse this decision but they refused.

In February, we went to Congress, asking them to encourage CMS to reconsider this appeal. As a result of these efforts, Nebraska Senator Johanns and Delaware Senator Coons are circulating a letter for all Senators to sign urging CMS to re-evaluate this situation. To …

Cesarean Sections, Buprenorphine, Intrathecal Opioids & Pain Control – What To Do?, Madeel A. Abdullah, Md, Michelle Beam, D.O., H. Jane Huffnagle, D.O., Suzanne Huffnagle, D.O., Michelle Mele, Md, Eugene R. Viscusi, Md

Department of Anesthesiology Faculty Papers

Introduction

Suboxone^® is becoming a popular alternative to methadone maintenance in opioid abstinence. This population will likely expand in the future presenting a challenge for perioperative analgesia. Conventional pharmacology suggests that buprenorphine has a high binding affinity for the mu-opioid receptor (MOR), displacing any other opioid; and, only overcome by extremely high opioid doses. Hence recommendations are usually that buprenorphine should be discontinued before surgery so the MOR is available perioperatively. Buprenorphine is considered to have a “ceiling” analgesic effect rather than a classic opioid dose-response curve; it should not be effective for postoperative analgesia. This case supports an …

Postoperative Non-Steroidal Anti-Inflammatory Drugs And Risk Of Bleeding In Pediatric Intracapsular Tonsillectomy, Jill N. D'Souza, Md, Julie P. Adelman, Bs, Richard J. Schmidt, Md, Heather C. Nardone, Md

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

Tonsillectomy with or without adenoidectomy is one of the most frequently performed surgeries in the United States, with over 500,000 performed annually. Post-tonsillectomy hemorrhage is one of the most feared complications; thus, medications that could increase the risk of postoperative bleeding traditionally have been avoided. With recent FDA guidelines encouraging a departure from codeine-based medications in pediatric patients undergoing tonsillectomy, we examined the use of ibuprofen for post-tonsillectomy pain control. The records of 449 children who underwent tonsillectomy and received ibuprofen for postoperative pain control were reviewed and compared to a cohort of 1731 children who received codeine for pain …

The P53-Induced Factor Ei24 Inhibits Nuclear Import Through An Importin Β-Binding-Like Domain., Kim G Lieu, Eun-Hee Shim, Jinling Wang, Ravi K Lokareddy, Tao Tao, Gino Cingolani, Gerard P Zambetti, David A Jans

Department of Biochemistry and Molecular Biology Faculty Papers

The etoposide-induced protein Ei24 was initially identified as a p53-responsive, proapoptotic factor, but no clear function has been described. Here, we use a nonbiased proteomics approach to identify members of the importin (IMP) family of nuclear transporters as interactors of Ei24 and characterize an IMPβ-binding-like (IBBL) domain within Ei24. We show that Ei24 can bind specifically to IMPβ1 and IMPα2, but not other IMPs, and use a mutated IMPβ1 derivative to show that Ei24 binds to the same site on IMPβ1 as the IMPα IBB. Ectopic expression of Ei24 reduced the extent of IMPβ1- or IMPα/β1-dependent nuclear protein import specifically, …

Prospective Unmasked Randomized Evaluation Of The Istent Inject (®) Versus Two Ocular Hypotensive Agents In Patients With Primary Open-Angle Glaucoma., Antonio M Fea, Jose I Belda, Marek Rękas, Anselm Jünemann, Lydia Chang, Luis Pablo, Lilit Voskanyan, L Jay Katz

Wills Eye Hospital Papers

PURPOSE: The purpose of this study was to compare outcomes of subjects with open-angle glaucoma (OAG) not controlled on one medication who underwent either implantation of two iStent inject (®) trabecular micro-bypass devices or received medical therapy consisting of a fixed combination of latanoprost/timolol.

PATIENTS AND METHODS: Of 192 subjects who qualified for the study and were enrolled, 94 were randomized to surgery with implantation of two iStent inject(®) devices in the treated eye and 98 to receive medical therapy.

RESULTS: At the month 12 visit, 94.7% of eyes (89/94) in the stent group reported an unmedicated intraocular pressure (IOP) …

Evaluation Of Echogenic Material On Transvenous Leads By Transesophageal Echocardiography In Patients With And Without Lead-Associated Endocarditis, Toshimasa Okabe, Md, Praveen Mehrotra, Md, Henry Siu, Md, Arnold J. Greenspon, Md

Division of Cardiology Faculty Papers

Echogenic material (EM) on non-infected leads in patients with cardiac implantable device is common on transesophageal echocardiography (TEE). Although several morphologic characteristics of EM are more commonly seen in transvenous lead-associated endocarditis, these characteristics alone are not diagnostic for lead-associated endocardiatis. Lead-associated EM on TEE should be interpreted within the overall clinical context.

Permeation Redux: Thermodynamics And Kinetics Of Ion Movement Through Potassium Channels., Richard Horn, Benoît Roux, Johan Aqvist

Department of Molecular Physiology and Biophysics Faculty Papers

The fundamental biophysics underlying the selective movement of ions through ion channels was launched by George Eisenman in the 1960s, using glass electrodes. This minireview examines the insights from these early studies and the explosive progress made since then.