Translational Medical Research Commons^™

Procedural And Clinical Outcomes Of Transitioning To High Power Short Duration Guided Ablation For Atrial Fibrillation, Zachary Pang, Sean J. Dikdan, Joey Junarta, Sairamya Bodempudi, Naman Upadhyay, Md, Daniel R. Frisch

Phase 1

Introduction: High-power short-duration (HPSD; 50W for up to 15s) ablation is a novel way to use a contact force-sensing catheter optimized for power-controlled radiofrequency ablation of atrial fibrillation (AF). Our goal was to compare the procedural and clinical outcomes of AF ablation with HPSD to previous ablation methods used, including standard-power standard duration (SPSD; 20-25W, up to 60s) and temperature-controlled non-contact (TCNC; 20-40W, up to 60s).

Methods: Procedural and clinical data was from consecutive cases of patients with paroxysmal or persistent AF undergoing pulmonary vein isolation with HPSD, TCNC and SPSD between 7/1/13 to 11/1/19. A total of 171 patients …

Expanding The Whipple Accelerated Recovery Pathway (Warp) To All Patients Undergoing Pancreaticoduodenectomy (Pd), Taylor R. Kavanagh, Clifford Yudkoff, Ava Torjani, Geoffrey W. Krampitz, Wilbur Bowne, Hamza Rshaidat, Cyrus J. Sholevar, Alexandra C. Leto, William Preston, Elwin Tham, Mandeep Shergill, Shawnna Cannaday, Theresa Yeo, Harish Lavu, Charles J. Yeo

Phase 1

Introduction:

Pancreaticoduodenectomy (PD) is a complex abdominal procedure with high rates of perioperative morbidity. The Whipple Accelerated Recovery Pathway (WARP) was developed for highly selected patients undergoing PD to reduce hospital length of stay (LOS) and time to adjuvant therapy (TTAT), without increasing post-operative complications (POC) or readmission rates (RR). The purpose of this study was to determine if WARP could be implemented for all-risk patients undergoing PD.

Methods:

A single-institution, retrospective analysis of 281 patients implemented on the WARP between 2017-2020 was performed. 119 patients were categorized as WARP-eligible (WEPs) according to original inclusion criteria, and 162 were …

Efficacy Of An Appointment Specialist In Reducing Loss To Follow Up In A Retina Practice, Turner D. Wibbelsman, Michael Ammar, Md, Anthony Obeid, Md, Mph, Jason Hsu, Md

Phase 1

Introduction:

Although a new armamentarium has greatly benefitted patients with retinal disease, novel therapeutic approaches require more frequent clinic visits, which may lead to missed treatments and vision loss. This study characterizes patient-reported reasons for missed visits and assesses the efficacy of calling patients for rescheduling missed visits.

Methods:

This retrospective cohort study included patients who missed an appointment for an intravitreal injection between January 2018 and February 2020 at the Retina Service of Wills Eye Hospital. Two calls were made to each patient by an appointment specialist to reschedule the visit and record a reason for the …

Anatomic Location And Mortality Of Pancreatic Adenocarcinoma: A Single Institution Study, Sophia Lam, Randi Zukas, Ida Micaily, Atrayee Basu Mallick

Phase 1

In pancreatic adenocarcinoma, it is believed that patients with proximal tumors (head) have earlier diagnosis and higher survival due to anatomic location compared to patients with distal tumors (body/tail). We hypothesized that differences in tumor biology would contribute to poorer survival in body/tail tumors compared to head tumors when diagnosed at the same stage.

We performed a retrospective chart review on 324 patients with pancreatic adenocarcinoma (236 head and 88 body/tail) diagnosed from 2011-2017. We gathered electronic health records from a single center with a high volume of pancreatic cancer directed surgery. We compared median patient survival from onset of …

Factors Influencing Efficacy And Satisfaction In Prenatal Counseling For Families With Single Ventricle Heart Disease, Taylor Hartzel Houlihan, Jack Rychik, Md

Phase 1

Introduction: The Fetal Heart Program at Children’s Hospital of Philadelphia offers prenatal counseling to families with congenital heart disease diagnoses. This center has yet to examine family satisfaction with counseling, especially those with complicated single ventricle diagnoses. While families may receive sufficient education about their child’s condition, better communication may be needed to prepare them for potential neurological and behavioral complications.

Methods: Through chart review, 355 patient families with single ventricle diagnoses who utilized CHOP prenatal counseling within the past 10 years were identified. Retrospective surveys including Likert scales and open-ended questions were distributed by email. 65 responses were …

Treatment Of Distal Radius Fractures In Patients Over 80 Years Of Age: Functional Outcomes After Open Reduction And Internal Fixation Versus Nonoperative Treatment, Robert Gallivan, Lili E. Schindelar, Md, Mph, Richard Mcentee, Pedro K. Beredjiklian, Md

Phase 1

INTRODUCTION

Distal radius fractures are one of the most common fractures seen in the elderly. With the younger physiological age of patients over 60 years, the expectation of functional outcomes is changing. The management of distal radius fractures in the elderly patient, especially those over the age of 80, has not been well defined. The purpose of this study was to compare operative to nonoperative treatment of distal radius fractures in patients older than 80 years to determine if there is any difference in functional outcomes or complications.

METHODS

A retrospective review was performed to identify patients 80 years or …

Coronary Artery Disease And Nonalcoholic Fatty Liver Disease: Clinical Correlation Using Ct Coronary Calcium Scans, Richard S. Kirby, Dina Halegoua-De Marzio

Phase 1

Introduction: Nonalcoholic fatty liver disease (NAFLD) and coronary artery disease (CAD) have been explored with coronary angiography which showed a link between severe NAFLD and CVD risk. This study’s aim is to determine if CT coronary artery calcium (CAC) scores used to determine CAD severity in asymptomatic populations can help predict presence of NAFLD.

Methods: Retrospective cross-sectional study of positive CT CAC scores and liver imaging with either CT, ultrasound, or MRI of the abdomen or CT of the chest. Drinking 7 or 14 drinks per week for a woman or man respectively and chronic viral hepatitis diagnosis …

Abcd Progression Post Crosslinking For Keratoconus, Sonali Patel, Neil Vadhar, Zeba Syed

Phase 1

Introduction:

Keratoconus is a corneal disease that leads to various ocular illnesses such as scarring and thinning and the most common treatment for this disease at this time is Cross Linking. Previously, post-surgical outcomes of cross linking were analyzed using the AK (Amsler- Krumeich) system which didn’t account for posterior corneal surface and corneal thickness. In order to overcome these shortcomings, a new ABCD classification was developed which accounts for anterior (A) and posterior (B) radius of curvature, thinnest corneal pachymetry (C) and distance for best corrected vision (D).

Methods:

A retrospective study was done using 104 patients who …

Does Prior Acromioplasty Increase The Incidence Of Acromial Fracture Following Reverse Total Shoulder Arthroplasty? A Retrospective Matched Cohort Analysis, Olivia Blaber, Brandon J. Erickson, Md, Christopher Hadley

Phase 1

Introduction: Reverse total shoulder arthroplasty (RTSA) is an effective treatment option for multiple shoulder pathologies. Arthroscopic acromioplasty is a treatment for subacromial impingement. RTSA can place excess stress on the acromion. No studies have evaluated outcomes following RTSA among patients with prior acromioplasty. The purpose of this study was to report outcomes in patients following RTSA who have had a prior acromioplasty. The authors hypothesized patients with prior acromioplasty who undergo RTSA will have significant improvements in clinical outcomes with no increased risk of acromial fracture.

Methods: Patients from a single institution who underwent RTSA with a history of acromioplasty …

Assessment Of Treatment Response Of Keloid Patients, Rachel Zachian, Mary Metkus, John Bruckbauer, Neda Nikbakht

Phase 1

Introduction: Keloids are benign exophytic scars ranging from asymptomatic, small papules to large symptomatic plaques that affect patients’ quality of life. The most effective treatment for this troublesome condition has yet to be determined. This study aims to demonstrate that intralesional Kenalog injections produce better keloid outcomes than surgical excision.

Methods: Researchers called 504 Jefferson keloid patients to determine their keloid outcomes post-treatment. Patients were asked to confirm their last treatment method, describe the percent change in size of their lesion(s), and rate their symptoms (pruritis and pain) on a scale of 0-10 before and after treatment. Excision and …

Return To Play Criteria Following Operative Management Of Acromioclavicular Joint Separation: A Systematic Review, Richard J. Gawel, Taylor D'Amore, Md, Peters Otlans, Md, Somnath Rao, Steven B. Cohen, Md, Michael G. Ciccotti, Md

Phase 1

Introduction: Acromioclavicular (AC) joint separation is a leading cause of shoulder injury among athletes. High grade injuries may require operative fixation, and comprehensive return to play guidelines have not yet been established. The purpose of this investigation is to summarize return to play criteria following operative management of AC joint separation.

Methods: A systematic review of the literature was performed to evaluate clinical evidence regarding return to play following operative management of isolated AC joint separation. Studies satisfying inclusion criteria were analyzed for return to play timeline and other factors used to guide return to play following surgery.

Results: Sixty-three …

Real-Time Baseline Coagulation Profiles Using Rotem In Patients Undergoing Liver Transplantation, Paul Del Prato, Uzung Yoon, Md

Phase 1

Real-time monitoring of blood coagulation during invasive surgeries is an important component of ensuring patient safety and effective treatment. Rotational thromboelastometry (ROTEM) is a viscoelastic monitoring system of hemostasis in blood that allows for ongoing measurement of global markers of coagulation. This study compares coagulation in a population of hepatocellular carcinoma liver-transplant patients (HCC) with a transplant population of other etiologies (non-HCC). A database of ROTEM measurements acquired peri-operatively during liver transplantation was compiled from over 400 Jefferson patients. A baseline profile was developed comprised of ROTEM measurements of clot initiation/stability that can be used as a methodological standard. Analysis …

Predictive Value Of Index Lesion Cross-Sectional Area In Diffuse Large B Cell Lymphoma Patients Treated With Chimeric Antigen Receptor T-Cells, Nicole Winchell, Drew Torigian, Md, Stephen Schuster, Md

Phase 1

No abstract provided.

Assessment Of Hyperfibrinolysis In Liver Transplantation Surgery As Measured By Rotational Thromboelastometry, Ryan Madsen, Uzung Yoon, Marc Torjman

Phase 1

Hyperfibrinolysis is a significant concern during liver transplantation surgeries. Rotational thromboelastometry (ROTEM) is a point of care device that is capable of intraoperatively measuring the clotting properties of whole blood samples, including the rate of fibrinolysis. The aim of this study was to use ROTEM to determine if improved surgical techniques have lowered rates of hyperfibrinolysis during liver transplantations. Blood samples were taken from 284 patients during liver transplantations that took place over five years from 2014-2019. The blood samples were drawn at various time points during the preanhepatic phase, anhepatic phase, and neohepatic phase of the surgery. Hyperfibrinolysis was …

Usage Of Sleep Domain Of Snot-22 Scores In Screening For Osa In Patients Of Chronic Rhinosinusitis., Patrick Zhu, Mindy Rabinowitz, Md

Phase 1

Introduction: SNOT-22 is a screening tool universally applied in perioperative settings for endoscopic sinus surgery (ESS), typically for chronic rhinosinusitis (CRS). Comorbid obstructive sleep apnea (OSA) increases risk of perioperative complications following ESS, yet pre-ESS OSA screening is not performed. This study sought to determine whether the sleep subdomain SNOT-22 (SD-SNOT) score could be useful for OSA screening.

Methods: A retrospective study was performed by reviewing electronic records of 108 patients that underwent endoscopic sinus surgery between November 2019 – January 2020. Pre-operative and 2 months post-operative SD-SNOT scores were compared with the presence or absence of OSA.

Results: Mean …

Patient And Renal Allograft Outcomes Of Anticoagulation Therapy In Kidney Transplantation, Rachel Greene, Goni Katz-Greenberg, Md

Phase 1

Introduction: Kidney transplant recipients are often on anticoagulation or antiplatelet therapy, for a variety of indications. These medications are associated with increased risk of bleeding but may reduce risk of thrombosis and possible complications such as allograft loss. The aim of our study is to evaluate the effect of perioperative anticoagulation or antiplatelet therapy on patient and allograft outcomes.

Methods: Data collection was done by retrospective chart review of all patients who underwent a kidney or kidney/pancreas transplantation at Thomas Jefferson University Hospital (TJUH) from 2012-2019. We recorded perioperative anticoagulation and antiplatelet therapy, risk factors for bleeding and thrombosis, …

Short Term Response To Trigger Finger Injections, Neil Patel, Richard Mcentee, Daniel Seigerman

Phase 1

Introduction: Pain, clicking, and locking are common presentations in patients with hand conditions and more often than not, the cause is a trigger finger. The common practice to treat trigger fingers is a corticosteroid injection. The purpose of this study was to determine how these injections affect patients in the short term.

Methods: Patients who underwent corticosteroid injections from June 2019 to September 2019 was the population of study. Phone interviews were conducted with patients each week for 3 weeks following their injection. Patients were questioned about pain and triggering symptoms. Other demographic data was collected to be reviewed …

Effects Of Continuous Positive Airway Pressure On Cardiovascular Risk In Obstructive Sleep Apnea, Natali Salinas, Amy He, Dani Yellanki, Peter Zhang, Grace Severance, Zachary Feuer, Cynthia Cheng, Md, Phd

Phase 1

Obstructive sleep apnea (OSA) has been shown to significantly promote cardiovascular risk, in part possibly due to activation of the sympathetic nervous system during respiratory events in sleep and its subsequent effects on blood pressure and heart rate. Previous studies have also found associations between long term variability of blood pressure and heart rate with cardiovascular outcomes. We hypothesize that compliance to continuous positive airway pressure (CPAP) therapy will decrease the incidence of cardiovascular events in a dose dependent fashion in patients with moderate to severe OSA.

This retrospective study population consists of patients from the Jefferson Sleep Center with …

Celiac Disease: Clinical-Pathological Correlation In 100 Consecutive Patients, Michael J. Dimarino, Sidney Cohen, Md, Stephanie Moleski, Md, Christopher Cao, Md, Michael C. Dimarino, Md, Anthony Dimarino, Md

Phase 1

Introduction: Celiac Disease (CD) is an autoimmune disease that manifests as inflammation in the small intestine that can be measured by both serology (tTG-IgA) and pathology (Marsh scores). Despite having two clear etiologies defining the disease, the relationship between these markers and the clinical presentation is unclear but the age at presentation has thought to be correlated with a worsened pathology.

Methods: This was a retrospective chart review at Thomas Jefferson University Hospital (TJUH). The study consisted of patients diagnosed with Celiac Disease at TJUH with both a Marsh score and a tTG-IgA antibody result. Analysis via correlation statistics …

Predictors And Characteristics Of Rib Fracture Following Sbrt For Lung Tumors, Michael P. Carducci, Baskaran Sundaram, Md, Benjamin Greenberger, Md, Maria Werner-Wasik, Md, Gregory C. Kane, Md

Phase 1

See Additional Files section for the abstract.

Likelihood Of Germline Mutation With Solitary Unilateral Retinoblastoma Based On Patient Age At Presentation. A Real-World Analysis Of 482 Consecutive Patients., Martin Calotti, Carol L. Shields, Md, Philip Dockery, Md, Mph, Megan Ruben, Antonio Yaghy, Md, Madalyne A. Sunday, Emily R. Duffner, Hannah J. Levin, Olivia S. Taylor, Sara E. Lally, Md, Jerry A. Shields, Md

Phase 1

Introduction: Retinoblastoma due to germline mutation has a greater risk of bilateral presentation, and multifocal or extraocular involvement. In solitary unilateral retinoblastoma, the inheritance pattern is less understood and assumed to be somatic. We assessed the likelihood of germline inheritance in children with unilateral retinoblastoma and whether it varies based on age at presentation.

Methods: This was a retrospective case study assessing 482 consecutive patients with solitary unilateral retinoblastoma at Wills Eye Hospital between 1972 and 2020 for the likelihood of germline inheritance based on age at presentation (≤1 year vs. >1 year). Germline inheritance was deemed likely if …

Investigation Of Medication Adherence And Rejection In Liver Transplant For Cystic Fibrosis (Cf), Lucia Sanchez, Elizabeth Rand, Md, Phoebe Wood

Phase 1

Introduction: 40% of transplant recipients are non-adherent to medications, causing increased risk of rejection and diminished survival. The relationship between adherence measured as Medication Level Variability Index (MLVI) and graft rejection rates in pediatric liver transplant recipients with CF compared to those without CF will be evaluated. We hypothesize that MLVI is higher and rejection rates are lower in subjects with CF.

Methods: Retrospective chart review of pediatric liver transplants performed at the Children’s Hospital of Philadelphia between 1995-2018 identified 9 CF liver transplant recipients and 9 age matched controls. Medication adherence was assessed using MLVI. An unpaired t-test was …

Machine Learning By Ultrasonography For Risk Stratification Of Axillary Breast Lymph Nodes, Joshua Yu, John Eisenbrey, Phd, Aylin Tahmasebi, Md

Phase 1

Introduction: Breast cancer is the most common cancer among women worldwide, and ultrasonography has been an essential tool in the management of breast cancer. In order to improve upon ultrasonography efficacy, establishing a machine learning image analysis model would provide additional prognostic and diagnostic factors in the evaluation, monitoring, and treatment of breast cancer.

Methods: This retrospective study utilizes axillary lymph node ultrasound images of patients at Thomas Jefferson University Hospital who have had axillary lymph node biopsies. Automated machine learning of the images was performed on AutoML Vision; Google LLC which generated custom models for classification. About 80% of …

Antithrombotic Choice And Timing In Patients Presenting With Symptomatic Hemorrhagic Conversion Of Ischemic Stroke, Joshua Margolis, Robin Dharia, Md, Judy Diep, Md

Phase 1

The primary aim of this research project is to determine the optimal time for antithrombotic agent initiation post ischemic stroke without resulting hemorrhagic conversion. We hypothesize that not only is hemorrhagic conversion risk often inaccurately estimated, but also that antiplatelet agents and anticoagulants may pose similar risk of hemorrhagic conversion, particularly when initiated seven days post ischemic stroke. This risk potentially outweighs their protective effects against recurrent stroke. We are in the process of identifying patients with hemorrhagic conversion of ischemic stroke at Thomas Jefferson University Hospital and will analyze the type and timing of antithrombotic agents. Additional risk factors …

Transradial Approach For Diagnostic Cerebral Angiograms In The Elderly: A Comparative Observational Study, Cannon Greco Hiranaka, Ahmad Sweid, Somnath Das, Joshua H. Weinberg, Kareem El Naamani, Julie Kim, Darcy Curtis, Daniel Joffe, Darshana Vijaywargiya, Chrissa Sioka, Mazen Oneissi, Abdel Hadi El Hajjar, Michael Reid Gooch, Nabeel Herial, Stavropoula I. Tjoumakaris, Robert H. Rosenwasswer, Pascal Jabbour

Phase 1

Introduction: The transradial approach (TRA) reduces mortality, morbidity, access site complications, hospital cost, and length of stay while maximizing patient satisfaction. We aimed to assess the technical success and safety of TRA for elderly patients (aged ≥75 years).

Methods: A retrospective chart review and comparative analysis was performed for elderly patients undergoing a diagnostic cerebral angiogram performed via TRA versus transfemoral approach (TFA). Also, a second comparative analysis was performed among the TRA cohort between elderly patients and their younger counterparts.

Results: Comparative analysis in the elderly (TRA vs TFA) showed no significant differences for contrast dose per vessel, fluoroscopy …

Factors Influencing General Surgeons To Involve Urologists In Bladder Trauma Management, Joseph Schultz, Paul Chung, Md

Phase 1

Introduction: Bladder trauma injuries, which are graded by severity, often require immediate care and surgical management by General Surgeons (GS) or Urologists. This study seeks to understand the inconsistencies that exist in collaboration between GS and Urologists in bladder trauma management. We hypothesize that the decision for GS to involve Urologists in bladder trauma management is a multifactorial decision with severity of bladder trauma being the primary determining factor as opposed to other factors like provider experience or hospital setting.

Methods: This cross-sectional descriptive study surveyed GS to determine how likely they were to involve Urologists in bladder trauma …

A Virtual Educational Intervention Addressing Weight Bias In Medical Students, Gina Goldberg, Joseph Majdan, Md

Phase 1

Introduction:

Individuals with higher body weight experience severe and pervasive discrimination in nearly every walk of life. Stigmatizing treatment from healthcare providers increases anxiety, depression, body dissatisfaction and risk of weight gain while decreasing the likelihood that patients will seek preventative or emergency care. This study assessed whether a virtual session exploring obesity, which included the personal testimony of a Physician Professor with obesity, positively influenced the explicit attitudes and implicit biases of medical students towards people with higher body weight.

Methods:

SKMC medical students completed an Implicit Associations Test (IAT), a Universal Measure of Bias (UMB) and a …

The Use Of Imiquimod For The Treatment Of Empd From The Patients’ Perspective, Darren D'Mello, Paul Chung, Md

Phase 1

Introduction:

Imiquimod is a topical medication used to treat many dermatologic conditions, and it has been used to treat patients with Extra-Mammary Paget’s Disease. There have been case reports that described the effects and outcomes of patients who were treated with Imiquimod, but more research on its use for EMPD must be done. There have been no studies that gathered data from the patients themselves; this is what our study hopes to accomplish. We hypothesize that patients with EMPD who were treated with Imiquimod early after their diagnoses or after surgery had better outcomes than those who did not use …

Using Silac-Based Proteomics To Investigate Pathogenic Mechanisms In Spinal And Bulbar Muscular Atrophy, Debotri Chatterjee

Phase 1

Introduction: Spinal and bulbar muscular atrophy (SBMA) is a neurodegenerative disease caused by a polyglutamine (polyQ) expansion in the androgen receptor (AR). Instead of being exported out and degraded, mutant polyQ-AR remains in the nucleus, forming aggregates. We hypothesize that the cellular toxicity in SBMA is caused by aberrant intra-nuclear interactions (both gained and lost) of polyQ-AR aggregates.

Methods: We utilized SILAC proteomics on a cell model of SBMA to develop an AR interactome and investigate which intra-nuclear proteins and protein networks are affected through interaction with polyQ-AR (population C18) in comparison to wild type AR (C21). A candidate …

Using Rna-Seq To Identify Biomarkers For Guanylyl Cyclase C Activity, Gerard Hoeltzel, Scott Waldman, Md, Phd

Phase 1

Introduction: Deficiencies of guanylyl Cyclase C (GCC), a transmembrane receptor of large intestine epithelial cells, is associated with an increased risk for colorectal cancer (CRC) in mice. Therefore, elucidating the downstream pathways associated with GCC may help inform new therapeutic targets for treating CRC. We performed an RNA-sequencing analysis of GCC^+/+ and GCC^-/- mice and hypothesizes that the two groups would demonstrate significant variations in gene products that may be tied to the GCC signaling pathway.

Methods: Cells from five GCC^+/+ and five GCC^-/- mice were collected and analyzed for mRNA expression levels of over …