Translational Medical Research Commons^™

Translation Of Ephb2 In Pkcgamma And Calretinin Interneuron Subpopulations After Spinal Cord Injury, David A. Jaffe, Nicolette Heinsinger, Angelo Lepore

Phase 1

Introduction: Neuropathic pain is a common, debilitating occurrence after spinal cord injury (SCI). EphB signaling has been implicated in neuropathic pain, but different populations of neurons that upregulate EphB after SCI must be discovered. Understanding whether EphB2 is upregulated in specific subpopulations of dorsal horn interneurons (e.g. those expressing PKCgamma or calretinin) after injury would increase the understanding of SCI-induced neuropathic pain.

Methods: Mice were either given a contusion-type SCI (n=7) or a laminectomy-only (n=6) at cervical level 5/6. After two weeks of recovery, mRNA was labeled using RNAscope in the sectioned spinal cords. Four different targets were visualized …

Appropriate Ecmo Screening Protocols For Critically Ill Patients During Covid-19, Hudson Carter, Michael Baram, Md

Phase 1

Introduction: The use of Extracorporeal membrane oxygenation (ECMO) for COVID-19 patients has proven to have several advantages that advocate for increased use, but current screening protocols have limited its use and availability. The purpose of this study was to evaluate screening criteria for ECMO patients during COVID-19 and determine their appropriateness based on resource availability.

Methods: The population included patients referred for ECMO screening, and were stratified based upon referral outcome, survival length and patient disposition. The referring physicians were contacted to gather information regarding the referral process, the patient’s status prior to referral, and possible referral to another …

Effectiveness Of A Primary Care Nutrition Education/Vlcd Diet Program, Jessica Vitale, Ayesha Baig, Steven Chang, Hannah Kostan, Connor Mcelwee, Ketav Patel, Cindy Cheng

Phase 1

Introduction: Jefferson currently has a Medical Nutrition Therapy (MNT) program via an educational component delivered via Zoom to assist patients with managing their diet, exercise, medication changes and understanding the physiology of their conditions. We aim to study the effectiveness of the MNT program, along with the impact of duration of program participation, on weight loss, blood pressure, glucose and total cholesterol. In addition, I am focusing on triglycerides, HDL and LDL. We hypothesize that patients in our MNT program will have lower weight, blood pressure, blood glucose and total cholesterol, with a further positive effect of longer participation …

Continuous Positive Airway Pressure Therapy Effects On Lipid And Hepatic Function Test Values, Grace Severance, Cynthia Cheng, Md, Phd, Amy He, Peter Zhang, Dani Yellanki, Zachary Feuer, Olivia Taylor, Natali Salinas

Phase 1

Introduction : Continuous positive airway pressure (CPAP) therapy is an established therapy for patients diagnosed with obstructive sleep apnea (OSA). The following study aims to measure the impact of CPAP therapy on lipid and liver profiles of patients diagnosed with OSA. We hypothesize that CPAP therapy will improve patient serum lipid and liver measures in this patient population compared to patient baseline prior to CPAP therapy. Furthermore, we also will examine differences in hepatic ultrasound results for OSA patients on CPAP therapy.

Methods: The target patient population has moderate-severe OSA, defined as an Apnea-Hypopnea Index greater than 15. The intervention …

Validation And Accuracy Of Synovial Alpha Defensin In A Suburban Academic Center After Implantation As Part Of The Workup For Periprosthetic Joint Infections, Donald Willier, Iii, Kenneth J. Mcalpine, Md, Anthony F. De Giacomo, Md, John S. Garfi, Ms, Lawrence M. Specht, Md, Michael S. Kain, Md

Phase 1

Introduction

Periprosthetic joint infection (PJI) is a leading cause of total hip and knee arthroplasty failure. The Musculoskeletal Infection Society (MSIS) criteria for PJI has allowed diagnosis standardization. To increase the MSIS criteria accuracy, synovial fluid biomarkers have been tested. Studies evaluating synovial alpha defensin have reported both sensitivity and specificity up to 100%. In this study, we report our analysis on the use of alpha defensin testing in a suburban academic tertiary referral center.

Methods

We performed a retrospective analysis of a prospectively collected database of 133 patients tested for PJI over a 6 year period. From 2014, our …

A Meta-Analysis Of The Effects Of Sglt-2 Inhibitors On Serum Electrolytes, Mark Leibensperger, Jingjing Zhang, Md, Phd, Yonghong Huan, Md

Phase 1

Introduction: Previous studies have reported that sodium-glucose co-transporter 2 (SGLT2) inhibitors affect serum electrolytes levels, especially magnesium. This study aims to integrate direct and indirect trial evidence to evaluate the relative effects of all SGLT2 inhibitors against each other on electrolyte levels in patients with type 2 diabetes (T2D).

Methods: Electronic databases were systematically searched through December 2018 to identify eligible randomized controlled trials (RCTs) that reported mean changes in serum electrolyte levels, including magnesium, sodium, potassium, phosphate, calcium, and urate in patients with T2D. Random-effects pairwise and network meta-analyses were performed to calculate the weighted mean difference (WMD) …

Radiographic Results Of Expandable Interbody Devices, Jonathan Ledesma, Mark Kurd, Md, Kris Radcliff, Md, D. Greg Anderson, Md

Phase 1

Introduction: Minimally invasive surgery for transforaminal lumbar interbody fusion (MIS-TLIF) has become a mainstay procedure in the treatment of degenerative conditions of the lumbar spine. Expandable interbody devices have gained popularity in recent times due to several well-cited advantages including greater correction of disc height and lordosis and decreased intraoperative disruption of neurologic structures. However, the clinical benefits offered by these devices compared to traditional static implants remain unclear. This study seeks to investigate differences in the radiographic and clinical outcomes between traditional static versus expandable interbody devices used in MIS-TLIF.

Methods: Patients who underwent MIS-TLIF performed by three …

Effect Of Recipient Diabetes Status On Immune Rejection After Descemet Stripping Endothelial Keratoplasty, Elliot Cherkas, Zeba Syed, Michael Sulewski

Phase 1

This study seeks to determine whether recipient diabetes status relates to incidence of immune rejection following Descemet Stripping Endothelial Keratoplasty (DSEK). We hypothesized that patients with diabetes would have a greater risk of graft immune rejection.

This is a retrospective cohort study to compare recipient diabetes status in 794 DSEK surgeries at Wills Eye Hospital between January 2008 and July 2019. Kaplan-Meier functions of survival time until first immune rejection was compared between groups. Pearson’s chi square test and Wilcoxon test were used to test the null hypothesis.

During the study period, 146 of 794 DSEK recipients had diabetes. At …

Evaluating The Efficacy Of Telestroke Intervention In A Large Community Hospital Network, Daniel Moylan, Daniel Joffe, Charles Morse, Michael Knapp, Ahmad Sweid, Pascal Jabbour

Phase 1

Introduction: Telemedicine for acute ischemic stroke (Telestroke) allows live consultation between patients, remote stroke specialists, and providers to facilitate administration of IV tissue plasminogen activator (IV-tPA) within the 4.5 hour window. Small cohort studies have demonstrated thrombolytic therapy conveys significant benefit to stroke outcomes and yet is underutilized due to difficulties in recognition and delivery of medication. This study proposes that access to telestroke care across the Thomas Jefferson University Hospital network will result in increased thrombolytic reperfusion rates and improved patient outcomes for stroke.

Methods: A retrospective cohort study was designed to utilize a telestroke database collecting information from …

Tumor Doubling Time Of Pulmonary Carcinoid Tumors Measured By Ct, Douglas Russ, Julie Barta, Md, Nathaniel R. Evans, Md, Robert T. Stapp, Do, Gregory C. Kane, Md

Phase 1

Introduction:

Pulmonary carcinoid tumor (PCT) is a rare neuroendocrine lung cancer that is known clinically to be a slow-growing neoplasm. Few studies have established the true growth rate of these tumors when followed over time by radiography. Therefore, we sought to determine PCT tumor doubling time using longitudinal Computed Tomography (CT) scans. Nodule guidelines may misclassify early PCT nodules with a small diameter as benign if tumor growth is too slow to be appreciable on follow up radiographic scans completed between six months and two years after initial detection.

Methods:

We performed a retrospective analysis of available CT imaging …

Evaluation Of Firearm Suicide Among Patients Treated Across The Jefferson Enterprise, Connor Mcpartland, Allegra Bermudez, Stanton B. Miller, Md, Mph, Facs

Phase 1

Introduction and Objective:

Firearm suicide is a leading cause of mortality. This study aims to identify risk factors associated with patients who attempt suicide with a firearm. The hypothesis is that adolescents of non-Hispanic white race/ethnicity are at the highest risk of firearm suicide.

Methods:

Patients treated at Thomas Jefferson University Hospital between 3/1/2017 and 12/1/2020 for a self-inflicted gunshot wound and/or attempted suicide were included in the study. Patients were identified through ICD-10 codes and a clinical research software tool known as TriNetX was used to analyze incidence of suicide as well as potential risk factors such as …

Contrast-Enhanced Endoscopic Ultrasound For Identification Of Sentinel Lymph Nodes In Esophageal Cancer, Bethanne Venkatesan, Ji-Bin Liu, Md, John R. Eisenbrey, Phd, Sriharsha Gummadi, Md, Thomas Kowalski, Md, Robert Coben, Md, Flemming Forsberg, Phd, Corinne Wessner, Priscilla Machado, Md, David Loren, Md

Phase 1

Introduction:

In esophageal carcinoma, lymph node involvement is a crucial aspect of nodal staging and determining treatment strategies. Although grayscale endoscopic ultrasound (EUS) is the standard of care for staging, it is unable to identify lymph node drainage from primary tumors or sentinel lymph nodes (SLN). The goal of this study was to determine if Contrast Enhanced Endoscopic Ultrasound (CE- EUS) is superior to EUS in the identification of SLNs and nodal staging in esophageal carcinoma.

Methods:

In the unblinded pilot study, patients with newly diagnosed esophageal carcinoma were recruited to undergo CE-EUS and standard EUS. EUS was performed …

The Effect Of Cpap Treatment On T2dm In Moderate To Severe Osa Subjects, Dani Yellanki, Amy He, Grace Severance, Peter Zhang, Zach Feuer, Natali Salinas, Olivia Taylor, Rani Patel, Hannah Kostan, Carl Sun, Catherine Liu, Humaal Khan, Katie Keck, Mikayla Cochrane, Ronak Ahir, Sammy Alfonsi, Will Connolly, Cynthia Cheng, Md, Phd

Phase 1

Introduction: Obstructive sleep apnea (OSA) is a significant risk factor for type 2 diabetes mellitus (T2DM). CPAP treatment can potentially improve glycemic control in such subjects. However, the exact effects of CPAP treatment on diabetes are uncertain. The objective of this study is to examine the effect of CPAP treatment on HbA1c levels in subjects with moderate to severe OSA and T2DM.

Methods: This is a combined retrospective and prospective study collecting data through EPIC medical record reviews. We are collecting HbA1c levels (primary outcome variable) before and after CPAP treatment in subjects with moderate to severe OSA and T2DM. …

Evaluating The Accuracy And Use Of Continuous Glucose Monitoring In Hospitalized Patients: A Systematic Review And Meta-Analysis, Caroline Purcell, Jeffrey I. Joseph, Do

Phase 1

Introduction:

Glycemic variability in hospitalized patients is associated with poor clinical outcomes, longer length of stay, and increased cost. Advances in subcutaneous continuous glucose monitoring (CGM) technology may reduce glycemic excursions and improve clinical outcomes in hospitalized patients, yet CGM is not used due to a lack of evidence on accuracy. The objective of this study was to review and summarize the evidence on the accuracy of CGM in hospitalized, diabetic patients.

Methods:

A search was conducted for literature evaluating CGM accuracy in hospitalized, diabetic patients. Relevant studies were identified through full-text review and data was extracted for analysis. …

The Effect Of Medical Nutrition Therapy On Weight Loss, Ayesha Baig, Hannah Kostan, Cynthia Cheng

Phase 1

Introduction: In this retrospective study, we evaluated the effects of Jefferson’s medical nutrition therapy (MNT) program on weight loss. We anticipate that participation in the MNT program will lead to an improvement in weight and metabolic syndrome parameters.

Methods: We selected a convenience sample of 10 participants with BMI > 25 for this pilot retrospective chart review. Subjects were screened for various exclusion criteria such as past bariatric surgery, heart failure, malignancy, renal dialysis, and uncontrolled conditions such as hypothyroidism, anemia, or B12 deficiency. Weight measurements were collected from EPIC records starting from baseline, defined as 3 months prior to initiation …

Outcomes Following Open Reduction And Internal Fixation For Distal Humerus Fracture: Does Handedness Matter?, Charlotte N. Shields, Joseph R. Johnson, Jack M. Haglin, Sanjit R. Konda, Md, Kenneth A. Egol, Md

Phase 1

Introduction: No studies have assessed the relationship between extremity dominance and distal humerus fractures. This study sought to compare post-operative outcomes between patients with distal humerus fractures treated by open reduction and internal fixation (ORIF) of their non-dominant vs dominant arm.

Methods: A retrospective review of patients who sustained a distal humerus fracture treated with ORIF at one hospital between 2011-2015 was performed. Data collection included demographics, hand dominance, injury information, and surgical management. Post-operative outcomes included complications, time to fracture union, painful hardware, removal of hardware, Mayo Elbow Performance Index (MEPI), and range of motion.

Results: Of the …

Primary Care Obstructive Sleep Apnea Screening, Benjamin Espenhorst, Grant Gillan, Cynthia Cheng, Md, Phd

Phase 1

Introduction: Obstructive sleep apnea (OSA), a disorder characterized by upper airway collapse during sleep, is currently underdiagnosed and undertreated. The goal of this project is to evaluate the efficacy of utilizing a targeted screening protocol to identify previously undiagnosed OSA in an adult primary care population.

Methods: This prospective quality improvement project included 210 patients in the Jefferson Department of Family Medicine not previously diagnosed with OSA. These patients were targeted based on 3 STOP-BANG criteria: hypertension, age >50 years, and BMI >35 kg/m2. Patients were initially contacted by mail, followed by 3 weekly phone calls. Patients were screened …

Chronic Kidney Disease Is Associated With Mortality From Covid-19 During Hospitalization In Male Vs. Female Adults, Katherine Senter, Jingjing Zhang

Phase 1

No abstract provided.

Incidence Of Marginal Ulceration Following Primary Versus Revisional Roux-En-Y Gastric Bypass Surgery: A Multi-Center Retrospective, Brigitte Anderson, Talar Tatarian, Md, Alec Beekley, Md

Phase 1

No abstract provided.

Epidemiology And Outcomes Of Hospitalized Adults With Sars-Cov-2 Community-Acquired Pneumonia In Louisville, Kentucky, Julio A. Ramirez, T'Shura Ali, Thomas Chandler, Stephen P. Furmanek, Daniya Sheikh, Vidyulata Salunkhe, Steven Gootee, Mohammad Tahboub, William A. Mattingly, Demetra Antimisiaris, Jiapeng Huang, Jose Bordon, Rodrigo Cavallazzi, Paul Schulz, William P. Mckinney, Dawn Balcom, Mark Burns, Ruth Carrico, Forest W. Arnold, Cerid Covid-19 Study Group

The University of Louisville Journal of Respiratory Infections

Background: During the ongoing pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), SARS-CoV-2 community-acquired pneumonia (CAP) has been the primary cause of hospitalization. The objective of this study was to evaluate the clinical characteristics and outcomes of 1,013 patients hospitalized with SARS-CoV-2 CAP from September 2020 through March 2021 in Louisville, Kentucky.

Methods: This was a retrospective observational study of 1,013 patients hospitalized with SARS-CoV-2 CAP at eight of the adult hospitals in the city of Louisville from September 2020 through March 2021. Patients with 1) a positive reverse transcriptase-polymerase chain reaction (RT-PCR) for SARS-CoV-2, 2) fever, cough, or …

Identifying The Roadblocks To Successful Pediatric Imaging Without Sedation Or Anesthesia, Iman Soliman, Ammie M. White, Md, J. Christopher Edgar, Phd, Laura Cadge, Ccls, Margaret Hamel-Daymon, Crnp, Sandra Saade-Lemus, Md, Rochelle Bagatell, Md, Elizabeth T. Drum, Md, Lisa States, Md

Phase 1

Background: Modern imaging modalities allow for assessment of a wide array of medical conditions. Because it is difficult for young children to remain still during lengthy imaging studies, there is a need for sedation and general anesthesia (GA). A growing literature, however, suggests that there may be deleterious neurocognitive effects of sedation/GA in young children. As such, it is in our patients’ best interest to critically evaluate the use of sedation/GA.

Objective: To identify the roadblocks to obtaining clinical pediatric magnetic resonance imaging (MRI) exams without sedation/GA.

Materials and Methods: Participants included 63 parents/guardians of 5- to 9-year-old patients who …

Health Disparities Among Pregnant Women Diagnosed With Covid-19 In Philadelphia, Vasundhara Acharya, Emily Oliver, Mbbs, Danielle Tsevat, Md, Guillermo Gurza, Md, Rupsa Boelig, Md

Phase 1

Introduction:

The CDC has cited language barriers and racial discrimination as some of the social determinants of health during the COVID-19 pandemic. This study aims to investigate the socioeconomic factors that affect COVID-19 diagnosis and outcomes in pregnant women. We hypothesize that women whose primary language is not English will have higher rates of COVID-19 compared to women whose primary language is English.

Methods:

This is a retrospective cohort study of women who delivered at TJUH between 04/13/2020 and 06/31/2020. Data on demographics, SARS-CoV-2 PCR, maternal, fetal, neonatal outcomes were collected. The primary outcome was the proportion of English …

Cryo Vs Rf P-Wave Characteristics Comparative Analysis, Waleed Khan, Behzad Pavri, John Schanz

Phase 1

Introduction:

Atrial fibrillation is one of the leading causes of heart failure and stroke in the US, meaning that optimizing treatment is essential. There are two catheter based PVI techniques used to treat drug-refractory AF patients: radiofrequency and cryo-balloon ablation. The goal of this study is to determine if there is a difference in efficacy between these two procedures.

Methods:

The study consisted of a retrospective chart review and ECG analysis of approximately 130 patients. The criteria for involvement is patients diagnosed with drug-refractory paroxysmal AF and who have undergone an ablation procedure in the past two years. Baseline characteristics …

Prevalence And Risk Factors For Abnormal M-Tics, Maëlys Yepes, Michael Chang, Cynthia Cheng, Md, Phd

Phase 1

Introduction: The lack of effective treatments for Alzheimer’s Disease (AD) underscores the importance of prevention and early detection of amnestic mild cognitive impairment (aMCI), its prodromal state. While studies have proposed a number of potential mechanisms underlying the pathogenesis of AD, such as hypoxia and neuropsychiatric symptoms, little research has been done to evaluate predictive risk factors.

Objective: The objective of this pilot study is to assess the prevalence and risk factors for aMCI.

Methods: This cross-sectional study was performed using data from patients screened for Memories 2, a clinical trial evaluating the effect of CPAP usage in patients with …

Adverse Events Following Screening Eye Examinations For Retinopathy Of Prematurity In Premature Infants, Aditi Kale, Pedro Urday, Zubair H. Aghai

Phase 1

Introduction: The retinopathy of prematurity (ROP) examination is recommended for high-risk preterm infants to prevent its complications but may be associated with adverse events. The goal of this study is to determine whether the ROP examination increases the incidence of adverse events in premature infants.

Design/Methods: This was a retrospective study on all preterm infants (32 weeks gestation) born between 03/2017 and 12/2019 who survived until the first eye examination. The number of episodes of apnea (A), bradycardia (B), desaturation (D), number of infants on mechanical ventilation, and number of infants requiring sepsis evaluation were compared before and …

Outcomes Of Surgical Treatment For Carcinoid Heart Disease: A Systematic Review And Meta-Analysis, Diana C. Jiminez, Thomas J. O'Malley, Md, Abhiraj Saxena, Matthew P. Weber, Louis E. Samuels, John W. Entwistle, T. Sloane Guy, H. Todd Massey, Rohinton Morris, Vakhtang Tchantchaleishvili

Phase 1

Introduction and Objective: Carcinoid Heart Disease (CaHD) develops from vasoactive substances released by neuroendocrine tumors causing significant patient morbidity and mortality necessitating surgical intervention. We performed a systematic review and meta-analysis to elucidate granular perioperative details and long-term outcomes in these patients.

Methods: Electronic search of Ovid, Scopus, Cumulative Index of Nursing and Allied Health Literature, and Cochrane Controlled Trials Register was performed. Nine articles comprising 416 patients who received surgery were selected. Primary outcomes investigated included patient characteristics, surgical characteristics and survival data. Study-level data were extracted and pooled for meta-analysis.

Results: Primary outcomes consisted of …

Characterizing The Anesthetic Management Of Patients Undergoing Transradial Cardiac And Cerebrovascular Interventions: A Single-Institution Study, Steven Bieser, Somnath Das, Lohit Velagapudi, Heli Patel, Joshua Weinberg, Lisa Moss, Marguerite Davis, Nicholas Ruggiero, Pascal Jabbour, Victor Romo

Phase 1

Introduction:

Transradial approaches are shown to reduce mortality, morbidity, access-site complications, hospital stay and costs when compared to the transfemoral approach in multiple cardiac trials. Use of the antispasmotic cocktail for these interventions poses challenges for anesthetic management. Differing practices between fields may need to be consolidated. This study aims to characterize the safety profile of cardiac and neuroanesthetic management protocols for transradial interventions, hypothesizing that the cocktail is safe from an anesthetic perspective.

Methods:

We performed a retrospective chart review of patients undergoing transradial diagnostic cardiac and cerebrovascular interventions. Data collected included age, sex, comorbidities, prior antihypertensive medications, dose …

Development Of A Method Using Retrograde Neuronal Tracers To Neuroanatomically Characterize Respiratory Neural Circuitry, Samantha Thomas, Angelo Lepore

Phase 1

Introduction:

Loss of respiratory function is one of the leading causes of death following spinal cord injury (SCI). Existing studies have demonstrated that pre-phrenic interneurons (PPIN’s) can be recruited into the phrenic motor neuron (PhMN) pathway following cervical SCI and may contribute to respiratory recovery, but there is still a lack of information detailing the nature of these changes and the extent they may improve diaphragm function. This project aims to validate a method of utilizing neuronal tracers to further characterize the intact respiratory circuitry.

Methods:

This study was carried out using a rat model. A fluorophore-conjugated retrograde neuronal …

Effectiveness Of Nutritional Counseling And Vlcd (Very Low Calorie Diet) For Weight Loss And Metabolic Syndromeketav., Ketav Patel, Ayesha Baig, Connor Mcelwee, Jessica Vitale, Cynthia Cheng, Md, Phd

Phase 1

Introduction: Obesity and Diabetes are highly prevalent conditions worldwide. Morbidity and mortality stemming from these conditions has critical implications on the health and day to day lives of patients. A Very Low- Calorie Diet (VLCD) may be an effective tool to aid in lowering weight for both obese and diabetic patients, but has not been well studied. Thus, the efficacy of a VLCD on lowering weight, BMI, blood pressure, HbA1c, Lipid levels, and blood glucose was explored in this pilot study.

Methods: The study’s population is taken from an MNT (medical nutrition therapy) program at Jefferson. Patients who had prior …

Role Of Il-6 In Uremia-Induced Muscle Dysfunction, Taylor Penzel, Maria P. Martinez Cantarin

Phase 1

Introduction: Defects in mitochondrial function and increased circulating interleukin-6 (IL-6) caused by uremia of chronic kidney disease (CKD) are significant contributors to skeletal muscle atrophy and weakness, and to increased mortality. This study evaluated the effect of abrogation of IL-6 on markers of muscle and mitochondrial dysfunction.

Methods: Adenine supplementation was used to induce uremia in wild-type (WT) and IL-6-knockout (KO) mice, which were compared to control diet WT and IL-6-KO mice, respectively. Body weight, individual muscle weights, quantity and diameter of extensor digitorum longus (EDL) fibers by type (1, 2A, 2B and 2X), optical density of mitochondrial complexes …