Medical Specialties Commons^™

The Quest For The Perfect Prostate Biopsy Continues, Leonard G. Gomella

Kimmel Cancer Center Faculty Papers

No abstract provided.

Nociceptive Neuropeptide Increases And Periorbital Allodynia In A Model Of Traumatic Brain Injury., Melanie B. Elliott, Michael L. Oshinsky, Peter S. Amenta, Olatilewa Awe, Jack I. Jallo

Department of Neurosurgery Faculty Papers

OBJECTIVE: This study tests the hypothesis that injury to the somatosensory cortex is associated with periorbital allodynia and increases in nociceptive neuropeptides in the brainstem in a mouse model of controlled cortical impact (CCI) injury.

METHODS: Male C57BL/6 mice received either CCI or craniotomy-only followed by weekly periorbital von Frey (mechanical) sensory testing for up to 28 days post-injury. Mice receiving an incision only and naïve mice were included as control groups. Changes in calcitonin gene-related peptide (CGRP) and substance P (SP) within the brainstem were determined using enzyme-linked immunosorbent assay and immunohistochemistry, respectively. Activation of ionized calcium-binding adaptor molecule-1-labeled …

Does The Load-Sharing Classification Predict Ligamentous Injury, Neurological Injury, And The Need For Surgery In Patients With Thoracolumbar Burst Fractures?: Clinical Article., Kristen Radcliff, Christopher K Kepler, Todd A Rubin, Motasem Maaieh, Alan S Hilibrand, James Harrop, Jeffrey A Rihn, Todd J Albert, Alexander R Vaccaro

Department of Orthopaedic Surgery Faculty Papers

OBJECT: The load-sharing score (LSS) of vertebral body comminution is predictive of results after short-segment posterior instrumentation of thoracolumbar burst fractures. Some authors have posited that an LSS > 6 is predictive of neurological injury, ligamentous injury, and the need for surgical intervention. However, the authors of the present study hypothesized that the LSS does not predict ligamentous or neurological injury.

METHODS: The prospectively collected spinal cord injury database from a single institution was queried for thoracolumbar burst fractures. Study inclusion criteria were acute (< 24 hours) burst fractures between T-10 and L-2 with preoperative CT and MRI. Flexion-distraction injuries and pathological fractures were excluded. Four experienced spine surgeons determined the LSS and posterior ligamentous complex (PLC) integrity. Neurological status was assessed from a review of the medical records.

RESULTS: Forty-four patients were included in the study. There were 4 patients for whom all observers …

Proline-Rich Tyrosine Kinase 2 (Pyk2) Regulates Igf-I-Induced Cell Motility And Invasion Of Urothelial Carcinoma Cells, Marco Genua, Shi-Qiong Xu, Simone Buraschi, Stephen C. Peiper, Leonard G. Gomella, Antonio Belfiore, Renato V. Iozzo, Andrea Morrione

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

The insulin-like growth factor receptor I (IGF-IR) plays an essential role in transformation by promoting cell growth and protecting cancer cells from apoptosis. We have recently demonstrated that the IGF-IR is overexpressed in invasive bladder cancer tissues and promotes motility and invasion of urothelial carcinoma cells. These effects require IGF-I-induced Akt- and MAPK-dependent activation of paxillin. The latter co-localizes with focal adhesion kinases (FAK) at dynamic focal adhesions and is critical for promoting motility of urothelial cancer cells. FAK and its homolog Proline-rich tyrosine kinase 2 (Pyk2) modulate paxillin activation; however, their role in regulating IGF-IR-dependent signaling and motility in …

Development Of Myogenic Ias Reconstructs From Human Internal Anal Sphincter (Ias) Smooth Muscle Cells (Smcs) With Functional And Molecular Properties Similar To Intact Human Ias, Jagmohan Singh, Satish Rattan

Division of Gastroenterology and Hepatology Faculty Papers

Poster presented at: Digestive Disease Week (DDW) International meeting in San Diego, California.

Background and Aims:

Rectoanal incontinence is associated with defective Internal Anal Sphincter (IAS). Current therapies are not satisfactory, raising a potential for the replacement of the dysfunctional IAS with the reconstructs. Present studies were performed to develop human IAS smooth muscle reconstructs with functional and molecular attributes similar to the intact human IAS Smooth muscle (SM).

Rhoa/Rock Pathway Is The Major Molecular Determinant Of Basal Tone In Intact Human Internal Anal Sphincter, Satish Rattan, Jagmohan Singh

Division of Gastroenterology and Hepatology Faculty Papers

Poster presented at: Digestive Disease Week (DDW) International meeting in San Diego, California.

Background and Aims

Knowledge of molecular control mechanisms underlying the basal tone in the intact human IAS is critical for the pathophysiology and rational therapy for debilitating rectoanal motility disorders.

Effect Of Pooled Human Intravenous Globulin (Ivig) On The Reversal Of Cholinergic Inhibition Of Smooth Muscle By Immunoglobulins (Iggs) From Patients With Scleroderma (Ssc), Jagmohan Singh, Vaibhav Mehendiratta, Sergio A. Jimenez, Sidney Cohen, Anthony J. Dimarino, Satish Rattan

Division of Gastroenterology and Hepatology Faculty Papers

Poster presented at: Digestive Disease Week (DDW) International meeting in San Diego, California.

Backgrounds and Aims:

The gastrointestinal (GI) tract is the most common internal organ system affected in SSc. We and others have shown before that the SSc immunoglobulins (IgGs) cause selective blockade of muscarinic type-3 cholinergic (M3-R) in the GI tract. Presently, there is no effective treatment for SSc although numerous cytotoxic and immunomodulatory agents have been employed with limited success and are marred with serious side effects. Present studies investigated the reversibility of SScIgGs-caused M3-R blockade by the pooled Intravenous immunoglobulins (IVIG).

Egr-1 Induces Darpp-32 Expression In Striatal Medium Spiny Neurons Via A Conserved Intragenic Element., Serene Keilani, Samira Chandwani, Georgia Dolios, Alexey Bogush, Heike Beck, Antonis K Hatzopoulos, Gadiparthi N Rao, Elizabeth A Thomas, Rong Wang, Michelle E Ehrlich

Farber Institute for Neuroscience Faculty Papers

DARPP-32 (dopamine and adenosine 3', 5'-cyclic monophosphate cAMP-regulated phosphoprotein, 32 kDa) is a striatal-enriched protein that mediates signaling by dopamine and other first messengers in the medium spiny neurons. The transcriptional mechanisms that regulate striatal DARPP-32 expression remain enigmatic and are a subject of much interest in the efforts to induce a striatal phenotype in stem cells. We report the identification and characterization of a conserved region, also known as H10, in intron IV of the gene that codes for DARPP-32 (Ppp1r1b). This DNA sequence forms multiunit complexes with nuclear proteins from adult and embryonic striata of mice and rats. …

A Step Backward For Italy's Meritocracy., Ignazio Roberto Marino

Department of Surgery Faculty Papers

Italian scientists have long lamented the lack of resources, political attention, and meritocracy in assigning taxpayers’ money.

Genetic Ablation Of Cav1 Differentially Affects Melanoma Tumor Growth And Metastasis In Mice: Role Of Cav1 In Shh Heterotypic Signaling And Transendothelial Migration., Franco Capozza, Casey Trimmer, Remedios Castello-Cros, Sanjay Katiyar, Diana Whitaker-Menezes, Antonia Follenzi, Marco Crosariol, Gemma Llaverias, Federica Sotgia, Richard G Pestell, Michael P Lisanti

Department of Cancer Biology Faculty Papers

Both cell-autonomous and non-cell-autonomous factors contribute to tumor growth and metastasis of melanoma. The function of caveolin-1 (Cav1), a multifunctional scaffold protein known to modulate several biologic processes in both normal tissue and cancer, has been recently investigated in melanoma cancer cells, but its role in the melanoma microenvironment remains largely unexplored. Here, we show that orthotopic implantation of B16F10 melanoma cells in the skin of Cav1KO mice increases tumor growth, and co-injection of Cav1-deficient dermal fibroblasts with melanoma cells is sufficient to recapitulate the tumor phenotype observed in Cav1KO mice. Using indirect coculture experiments with fibroblasts and melanoma cells …

Prevention Of Stone Migration With The Accordion During Endoscopic Ureteral Lithotripsy., Christopher J Pagnani, Magdy El Akkad, Demetrius H Bagley

Department of Urology Faculty Papers

BACKGROUND AND PURPOSE: Endoscopic lithotripsy is often prolonged secondary to the retrograde migration of calculous fragments. Various balloons, baskets, and other devices have been used to prevent this migration. Our purpose is to analyze the effect of the Accordion(®) on stone migration and overall efficiency during lithotripsy.

PATIENTS AND METHODS: We prospectively evaluated 21 patients with a total of 23 distal ureteral stones. Patients underwent lithotripsy using an endoscopic impact lithotriptor. The Accordion was randomly used in 11 of these 21 patients. Data were collected regarding stone migration, stone size, stone ablation, ureteral clearing, and lengths of time for various …

Influence Of The Menstrual Cycle On The Incidence Of Nausea And Vomiting After Laparoscopic Gynecological Surgery: A Pilot Study., Tatjana Simurina, Boris Mraovic, Neven Skitarelić, Tatjana Andabaka, Zdenko Sonicki

Department of Anesthesiology Faculty Papers

STUDY OBJECTIVE: To investigate whether the phase of menstrual cycle influences the incidence of postoperative nausea and vomiting (PONV) in women undergoing general anesthesia for elective laparoscopic gynecological surgery.

DESIGN: Prospective, observational, blinded study.

SETTING: General hospital, Postanesthesia Care Unit, and gynecologic floor room.

PATIENTS: 111 ASA physical status 1 and 2 women, aged 18 to 53 years.

INTERVENTIONS: Patients were classified into three groups according to the phase of menstrual cycle at the time of anesthesia: Group F1: follicular phase (menstrual days 1-8; n = 34); Group O2: ovulatory phase (days 9-15; n = 40); and Group L3: luteal …

The Use Of Infliximab In Older Inflammatory Bowel Disease Patients, Stephanie M. Moleski, Christina C. Lindenmeyer, Patricia L. Kozuch

Department of Medicine Faculty Papers

Limited data suggest anti-tumor necrosis factor (TNF) antibodies have equal efficacy but higher morbidity and mortality in older compared to younger inflammatory bowel disease (IBD) patients(1).

Relative Telomere Length: A Novel Non-Invasive Biomarker For The Risk Of Non-Cirrhotic Hepatocellular Carcinoma In Patients With Chronic Hepatitis B Infection., Xiaoying Fu, Shaogui Wan, Hie-Won Hann, Md, Ronald E Myers, Phd, Richard S Hann, Jennifer Au, Bicui Chen, Jinliang Xing, Hushan Yang

Division of Gastroenterology and Hepatology Faculty Papers

BACKGROUND AND AIMS: Telomere length has emerged as a promising risk predictor of various cancers including hepatocellular carcinoma (HCC). However, the majority of studies in this area measured telomere length in hepatocytes and one in lymphocytes with conflicting results. Moreover, no studies have been reported on using circulating DNA telomere length as a non-invasive HCC biomarker.

METHODS: We conducted a nested case-control study to determine the relative telomere length (RTL) in serum DNA from 140 hepatitis B virus (HBV)-related HCC cases and 280 frequency-matched cancer-free HBV controls.

RESULTS: Cases had a significantly longer RTL (median, 0.31; range, 0.02-2.31) than controls …

Cardiac G-Protein-Coupled Receptor Kinase 2 Ablation Induces A Novel Ca2+ Handling Phenotype Resistant To Adverse Alterations And Remodeling After Myocardial Infarction., Philip W Raake, Xiaoying Zhang, Leif E Vinge, Henriette Brinks, Erhe Gao, Naser Jaleel, Yingxin Li, Mingxin Tang, Patrick Most, Gerald W Dorn, Steven R Houser, Hugo A Katus, Xiongwen Chen, Walter J Koch

Center for Translational Medicine Faculty Papers

BACKGROUND: G-protein-coupled receptor kinase 2 (GRK2) is a primary regulator of β-adrenergic signaling in the heart. G-protein-coupled receptor kinase 2 ablation impedes heart failure development, but elucidation of the cellular mechanisms has not been achieved, and such elucidation is the aim of this study.

METHODS AND RESULTS: Myocyte contractility, Ca(2+) handling and excitation-contraction coupling were studied in isolated cardiomyocytes from wild-type and GRK2 knockout (GRK2KO) mice without (sham) or with myocardial infarction (MI). In cardiac myocytes isolated from unstressed wild-type and GRK2KO hearts, myocyte contractions and Ca(2+) transients were similar, but GRK2KO myocytes had lower sarcoplasmic reticulum (SR) Ca(2+) content …

Management Of Sexual Disorders In Spinal Cord Injured Patients., Vafa Rahimi-Movaghar, Alexander R Vaccaro

Department of Neurosurgery Faculty Papers

Spinal cord injured (SCI) patients have sexual disorders including erectile dysfunction (ED), impotence, priapism, ejaculatory dysfunction and infertility. Treatments for erectile dysfunction include four steps. Step 1 involves smoking cessation, weight loss, and increasing physical activity. Step 2 is phosphodiesterase type 5 inhibitors (PDE5I) such as Sildenafil (Viagra), intracavernous injections of Papaverine or prostaglandins, and vacuum constriction devices. Step 3 is a penile prosthesis, and Step 4 is sacral neuromodulation (SNM). Priapism can be resolved spontaneously if there is no ischemia found on blood gas measurement or by Phenylephrine. For anejaculatory dysfunction, massage, vibrator, electrical stimulation and direct surgical biopsy …

Structural Changes In Glaucoma: A Volumetric Mri Study, John Lackey, Alice L. Williams, Srinivas Gatla, Sheryl S. Wizov, Thomas Chia, George Spaeth, Song Lai

Department of Radiology Faculty Papers

Purpose: To investigate brain structural changes in patients with glaucoma.

Methods: High resolution 3D T1-weighted MP-RAGE MRI images were collected in 11 glaucoma patients (5 female, 6 male, 65+/-11 yrs), and 11 age- and gender-matched controls (64+/-12 yrs). The images were first analyzed using an automatic voxel-based morphometry technique which combines a fully automated spatial normalization approach, dubbed HAMMER [1], in conjunction with a tissue mass preserving framework called RAVENS [2]. Four consecutive steps were carried out: removal of non-brain voxels, tissue segmentation, spatial normalization to a standardized template, and generation of a mass-preserving tissue density map (i.e. RAVENS map) …

Progesterone And Preterm Birth Prevention: Translating Clinical Trials Data Into Clinical Practice, Vincenzo Berghella

Department of Obstetrics and Gynecology Faculty Papers

OBJECTIVE:

We sought to provide evidence-based guidelines for using progestogens for the prevention of preterm birth (PTB).

METHODS:

Relevant documents, in particular randomized trials, were identified using PubMed (US National Library of Medicine, 1983 through February 2012) publications, written in English, which evaluate the effectiveness of progestogens for prevention of PTB. Progestogens evaluated were, in particular, vaginal progesterone and 17-alpha-hydroxy-progesterone caproate. Additionally, the Cochrane Library, organizational guidelines, and studies identified through review of the above were utilized to identify relevant articles. Data were evaluated according to population studied, with separate analyses for singleton vs multiple gestations, prior PTB, or short …

Adult Ecmo And Gastrointestinal Bleeding From Small Bowel Arteriovenous Malformations: A Novel Treatment Using Spiral Enteroscopy., Konrad Sarosiek, Hitoshi Hirose, Harrison T Pitcher, Nicholas C. Cavarocchi

Department of Surgery Faculty Papers

Hemorrhagic complications on extracorporeal membrane oxygenation (ECMO) are common because of the need for anticoagulation to maintain the oxygenator and circuitry. Gastrointestinal bleeding (GIB) is reported to occur in 3-6% of ECMO patients, ¹ requiring frequent transfusions as well as multiple diagnostic and therapeutic interventions. Multiple transfusions can result in volume overload, coagulopathies and infections leading to significant morbidity and mortality. We present the first published case of GIB from an arteriovenous malformation (AVM) treated with a novel therapy termed spiral enteroscopy while the patient remained on venoarterial (VA) ECMO.

Predictive Prognosis Value Of Baseline Volumetric Mri, Song Lai, John Lackey

Department of Radiology Faculty Papers

Atrophic changes have been proposed as biomarkers for differential diagnosis of Alzheimer's disease (AD) and amnestic mild cognitive impairment (MCI), and different atrophic rates have been observed in AD, MCI-tp-AD converters (cMRI), stable MCI (sMCI), and normal healthy controls[1]. Measurement of atrophic changes, however, requires longitudinal MRI studies. The purpose of this study was to investigate the following questions: 1. Is it possible to use baseline volumetric MRI to predict MCI conversion to AD, i.e., to tell if a MCI patient is a cMCI or a sMCI? 2. What are the predictive values of APOE genotype, and clinical cognitive …

Mitochondrial Lysyl-Trna Synthetase Independent Import Of Trna Lysine Into Yeast Mitochondria., Naresh Babu V Sepuri, Madhavi Gorla, Michael P King

Department of Biochemistry and Molecular Biology Faculty Papers

Aminoacyl tRNA synthetases play a central role in protein synthesis by charging tRNAs with amino acids. Yeast mitochondrial lysyl tRNA synthetase (Msk1), in addition to the aminoacylation of mitochondrial tRNA, also functions as a chaperone to facilitate the import of cytosolic lysyl tRNA. In this report, we show that human mitochondrial Kars (lysyl tRNA synthetase) can complement the growth defect associated with the loss of yeast Msk1 and can additionally facilitate the in vitro import of tRNA into mitochondria. Surprisingly, the import of lysyl tRNA can occur independent of Msk1 in vivo. This suggests that an alternative mechanism is present …

John H. Moore Jr., Md Clinical Professor Of Plastic Surgery And Former Alumni Association President

Jefferson Surgical Solutions

John H. Moore Jr., MD, longtime clinical professor of plastic surgery at Jefferson and former president of the Jefferson Medical College (JMC) Alumni Association, died at home on September 26, 2011.

Born in Pittsburgh in 1953, Moore received his bachelor’s degree from the University of Virginia, where he stayed on for his medical degree. After completing his internship at Thomas Jefferson University Hospital in 1980, he completed a general surgery residency. He then participated in a fellowship in hand surgery and microsurgery at Jefferson and completed a plastic surgery residency at the Eastern Virginia Graduate School of Medicine.

In 1987, …

News In Brief

Jefferson Surgical Solutions

Alejandro Perez, MD, has joined the Jefferson Vascular Center at Methodist Hospital with a dual faculty appointment in the Departments of Medicine and Surgery at Thomas Jefferson University. Dr. Perez completed his residency and fellowship training in vascular medicine at the Cleveland Clinic. He specializes in deep vein thrombosis, pulmonary embolism and hyperbaric oxygen therapy.

Ehyal Shweiki, MD, FACS, has joined the Division of Acute Care Surgery. Dr. Shweiki is fellowship-trained in both cardiothoracic surgery (University of Louisville) and surgical critical care (Washington University/Barnes Jewish Hospital). He also holds an MS in Bioethics. He will serve patients at our …

Zhi Ven Fong, Jmc ’12 Secretary, Gibbon Surgical Society

Jefferson Surgical Solutions

Born and raised in Kuala Lumpur, Malaysia, Zhi Ven Fong spent his first two years of medical school at the International Medical University (IMU) in Malaysia before coming to Philadelphia to study at Jefferson Medical College. And while medical school alone would be enough to keep most students busy, Zhi, 23, has seized every opportunity to build his skills and knowledge as a physician scientist.

“I aspire to be a leader in an academic field like surgery, so I realized I needed experience in research,” Zhi says. “After consulting with senior students, I reached out to Dr. Ernest Rosato, who …

Building A Legacy Of Hope Against Ovarian Cancer

Jefferson Surgical Solutions

Cancer – let alone a rare form of ovarian cancer – wasn’t on Sandy Parvin’s radar when her 11-year-old daughter Sarah was nauseous and vomiting for a few days in the spring of 2005.

“Honestly, we thought she had the flu,” Sandy said. The virus had been going around so Sandy took her daughter to their family physician.

The doctor sent Sarah to the hospital to get some IV fluids. It quickly turned into a parent’s worst nightmare. Sarah was put on a heart monitor and four physicians were there asking questions. Her calcium levels were far too high.

“They …

Gerald A. Isenberg, Md, Facs

Jefferson Surgical Solutions

As Professor of Surgery, Division of Colorectal Surgery; Director, Surgical Undergraduate Education, Jefferson Medical College (JMC); Program Director, Colorectal Residency Program, Thomas Jefferson University Hospital; and Chair, Curriculum Committee, JMC, Gerald A. Isenberg, MD, FACS, is equally focused on – and passionate about – clinical practice and medical education.

Indeed, as he reflects on his career at Jefferson, which spans nearly 25 years, Dr. Isenberg is appreciative of the opportunity to build a busy and vibrant colorectal surgery practice. But he clearly also values his experiences as an educator – particularly the many opportunities to lead and innovate.

In years …

Jefferson Researchers Identify Potential Diagnostic, Prognostic Tools For Pancreatic Cancer

Jefferson Surgical Solutions

When it comes to diagnosing and treating cancer, early detection is important. While other cancers can be identified through routine screenings, pancreatic cancer has been notoriously difficult to diagnose early. After pancreatic cancer is diagnosed, the optimal course of treatment is not always clear.

Hwyda Arafat, MD, PhD, Associate Professor of Surgery at Thomas Jefferson University and co-director of the Jefferson Pancreatic, Biliary and Related Cancers Center, and Jordan M. Winter, MD, Assistant Professor of Surgery, are working to change that.

Together with Mon-Li Chu, PhD, Professor and Vice Chair of the Department of Dermatology and Cutaneous Biology, Dr. Arafat …

Overview

Jefferson Surgical Solutions

Charles J. Yeo, MD, FACS

Samuel D. Gross Professor and

Chair, Department of Surgery

In this issue, Surgical Solutions focuses on our trauma expertise, recent progress in bench research, the contributions of Dr. Gerald Isenberg, insights from medical student Zhi Ven Fong, and pays tribute to Dr. John Moore. A very busy issue!

I was moved by a recent editorial in the New England Journal of Medicine dated February 16, 2012. In the piece entitled “What We Talk About When We Talk About Health Care Costs”, Peter Neumann of Tufts University quotes from the American College of Physicians Ethics Manual, …

Surgeon Speaks

Jefferson Surgical Solutions

Kris Kaulback, MD, FACS

Assistant Professor,

Division of Acute Care Surgery at Jefferson

Medical Director, Trauma Center at Paoli Hospital

Following a major, multisystem trauma, being seen by a trauma center within 60 minutes can mean the difference between life and death. Thanks to Paoli Hospital’s accredited Level II trauma center, which opened on October 1, 2010, more people in Chester County are receiving critical care within the “golden hour.”

As Kris Kaulback, MD, FACS, explains, Paoli earned accreditation by addressing the extensive standards outlined by the Pennsylvania State Trauma Foundation (PSTF). Accreditation reflects the resources available at Paoli around …

Obstructive Sleep Apnea Syndrome And Perioperative Complications: A Systematic Review Of The Literature., Tajender S. Vasu, Md, Ms, Ritu G. Grewal, Md, Karl Doghramji, Md

Department of Sleep Medicine Faculty Papers

Obstructive sleep apnea syndrome (OSAS) is a common sleep related breathing disorder. Its prevalence is estimated to be between 2% and 25% in the general population. However, the prevalence of sleep apnea is much higher in patients undergoing elective surgery. Sedation and anesthesia have been shown to increase the upper airway collapsibility and therefore increasing the risk of having postoperative complications in these patients. Furthermore, the majority of patients with sleep apnea are undiagnosed and therefore are at risk during the perioperative period. It is important to identify these patients so that appropriate actions can be taken in a timely …