Translational Medical Research Commons^™

The Use Of Advanced Ultrasound Techniques For The Evaluation Of Uterine Fibroids Pre And Post Uterine Artery Embolization, Kathleen Gillmore, Priscilla Machado, Alison Tan, Carin F Gonsalves, Flemming Forsberg

Phase 1

Introduction: Uterine fibroids are the most common benign tumor in females of reproductive age. Uterine artery embolization (UAE) is a less-invasive alternative to hysterectomy. Our objective is to assess the ability of superb microvascular imaging (SMI) to characterize fibroid microvascularity before and after UAE compared to conventional Doppler modes using contrast-enhanced ultrasound (CEUS) and clinical outcomes as reference standards.

Methods: Participants will be 40 adult females who are scheduled for UAE. Participants receive three transabdominal ultrasounds at day 0, day 14 and day 90 post-UAE using an Aplio i800 scanner. Subjects undergo examination with four non-contrast ultrasound modalities— color doppler …

Clinical Outcomes Following Lumbar Fusion In Patients With And Without A History Of Spinal Cord Stimulation Therapy, Jake Budlow, Ellina Hattar, Heli Patel, Thiago S. Montenegro, Glenn A. Gonzalez, Garrett Largoza, Christopher Elia, Caio M. Matias, Chengyuan Wu, Ashwini D. Sharan, James S. Harrop

Phase 1

Introduction:

The treatment of chronic back pain is a challenging and costly issue faced by patients across the United States. Spinal cord stimulators (SCS) or lumbar fusion surgery can be utilized in cases of intractable pain. This study aims to determine if a history of a thoracic SCS influences patient recorded outcomes measures (PROMs) of lumbar fusions at six months.

Methods:

This retrospective cohort study includes patients who underwent elective lumbar fusions at Thomas Jefferson University Hospital between January 2018 and December 2019. PROMs were measured, specifically the Oswestry Disability Index (ODI), preoperatively and 6 months postoperatively. Clinical outcomes …

Evaluating The Effect Of Telestroke Intervention On Patient Treatment And Outcomes, Charles Morse, Daniel Moylan, Daniel Joffe, Michael Knapp, Ahmad Sweid

Phase 1

Acute ischemic strokes (AIS) are a prominent cause of death and have the potential to cause lifelong neurological deficits. We hypothesize that through telestroke intervention, patients will receive treatment more rapidly and therefore have reduced complications as a result of AIS. To analyze the efficacy of telestroke intervention, we completed a retrospective chart review of suspected AIS patients at hospitals in the greater Philadelphia region from 2015-2019. We then assessed whether a patient received a telestroke consultation and any subsequent care. Several variables were then used to determine the effectiveness of this intervention, such as the promptness of treatment, length …

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

Phase 1

Introduction: Keloids are benign skin overgrowths, often accompanied by pain and pruritis. Despite many modalities, treatment of keloids is difficult due to variable response and high recurrence rates. This study evaluated the efficacy of surgical excision compared to intralesional triamcinolone in the treatment of keloids.

Methods: This was a retrospective study. Through a medical chart review, patients with keloids treated in the Jefferson Health System from 2018-2020 were identified and included. Participants were surveyed via telephone to assess change in size, pain and pruritis of their keloid in response to treatment. Participants ranked pain and pruritis severity from 1-10 before …

Assessment Of The Diagnostic Accuracy Of Core Needle Biopsies In The Diagnosis Of Lymphoma, Austin Redilla, George Ye, Catherine Tucker, Md, Christopher Gardner, Guldeep Uppal, Md, Adam F. Binder, Md

Phase 1

Introduction: Excisional biopsy remains the gold standard in the diagnosis of lymphomas. However, recent studies have shown that core needle biopsy (CNB) may have similar accuracy. CNB offers several advantages over excisional biopsy, including reduced cost and morbidity, thus we set out to determine the diagnostic accuracy of CNB at Thomas Jefferson University Hospital (TJUH) to understand if this approach should be utilized more in our system.

Methods: We performed a retrospective chart review of all suspected new diagnosis of lymphoma at TJUH from January 1^st, 2016 to December 31^st, 2019. All CNB and excisional …

Peri-Operative Urodynamic Assessment Has Poor Predictive Value For Developing Post-Operative Urinary Retention, Baylor Wickes, Robert Pivec, Md, Mathew S. Austin, Md

Phase 1

Introduction: Post-operative urinary retention (POUR) following primary total joint arthroplasty (TJA) has a reported prevalence up to 35%. Risk factors for developing POUR have traditionally included surrogate markers such as the presence or absence of urologic disease. However, dynamic measurement of the renal system with post-void residual volumes (PVR) has not been investigated as a tool for assessing POUR risk.

Methods: All male TJA patients underwent an pre-operative screen for POUR, including PVR measurements, patient-derived subjective urinary retention scores, and assessment of urologic disease. This was combined with a post-operative monitoring and catheterization protocol developed in partnership with a …

The Impact Of Patient Characteristics On Quality Of Life In Keloid Patients, Jonathan Wang, Romsin Zaya, Rachel Zachian, Mary Metkus, Neda Nikbakht

Phase 1

Introduction: Quality of life (QoL) is an important metric in assessing dermatological diseases such as keloids. This study evaluated the effects of patient characteristics on QoL in keloid patients.

Methods: This was a cross-sectional study. 36 patients presenting to the keloid clinic at TJUH were surveyed. QoL subscale scores for emotion, symptom, and function were calculated in addition to a total score for each patient using a keloid-specific questionnaire. The association between the QoL scores and patient characteristics of sex, ethnicity, as well as keloid location, duration, visibility, size, number, pain score, and pruritis score were evaluated using t-tests. …

The Psychosocial Impact Of Penile Implant Treatment, Taylor Tidwell, Paul Chung, Md

Phase 1

Introduction: Erectile dysfunction affects nearly 2/3rds of men age 50 or older worldwide and involves multiple hormonal, neurologic, psychological and environmental etiologies. Although contemporary research suggests that ED causes increased anxiety and depressive symptoms, there is relatively little information on how specific treatments impact mental health.

The purpose of this study is to answer the question: How do penile implants influence the psychosocial and emotional wellbeing of patients with ED compared to those without implants?

Methods: Our study uses a free-listing technique to interview via phone 50 patients with erectile dysfunction (25 with implant treatment, 25 without) regarding their emotional, …

Cns Derived Extracellular Vesicles As Biomarkers In Multiple Sclerosis (Ms), Anshel Kenkare, Abdolmohamad Rostami

Phase 1

This project aims to develop biomarkers for the diagnosis and treatment of multiple sclerosis (MS), a clinically heterogenous disease resulting from demyelination of the central nervous system. Extracellular vesicles (EVs) have shown potential as such a biomarker.

EVs were isolated from the plasma and cerebrospinal fluid (CSF) of patients with suspected MS and patients with headaches. Participants are recruited before starting treatment for their condition and controls were only included if the cause of headache was determined to be non-inflammatory. Proteomic analysis will be conducted on the plasma and CSF before isolating the EVs, as well as the isolated plasma …

Comparative Observational Study For Bifurcating Aneurysm Treatment; Open Versus Endovascular Approaches And Classical Versus New Techniques., Samuel Fallon, Ahmad Sweid, Md, Nikolaos Mouchtouris, Md, Michael Reid Gooch, Md, Pascal Jabbour, Md

Phase 1

Introduction: Aneurysm occur in approximately 3.2% of the population with a mean age of 50 years, a 1:1 gender ratio, and an estimate mortality rate of 70%. Aneurysms develop at branch points with elevated intravascular turbulence and vessel wall shear stress. we aim to compare the efficacy and safety of different surgical treatment modalities for bifurcating intracranial aneurysms.

Methods: A retrospective review of 398 patients who underwent surgical management of a bifurcating aneurysm at Thomas Jefferson University hospital from 2010 to 2020. Aneurysm size, location, modality of treatment, and treatment complications were assessed.

Results: Data analysis is expected to …

Assessing The Utilization And Effectiveness Of Pediatric Order Sets In Hpv Vaccine Administration In A Large Urban Family Medicine Practice, Lakshmi Narayanam, Krys Foster, Md, Mph

Phase 1

Introduction: Human papilloma virus (HPV) vaccination remains a controversial topic with low rates of vaccination completion. According to a 2017 National Immunization Survey, only 49% of adolescents were up to date (UTD) on their HPV vaccination, an alarming statistic given its importance in reducing HPV-related cancers. This project seeks to determine the effectiveness of pediatric order sets in affecting rates of HPV vaccine administration in a large urban family medicine practice.

Methods: A retrospective, qualitative chart review was conducted on patients nine years or older seen at Jefferson Family Medicine Associates in Philadelphia, PA from April 2019 to April …

The Prevalence Of Orally Administered Glucocorticoids, Generalized Pustular Psoriasis And Erythrodermic Psoriasis In The Treatment Of Adult Plaque Psoriasis Provided By U.S. Dermatologists, Katherine Awh, Kumar Nasham, Christian Albornoz, Steven Feldman, Anthony Albornoz

Phase 1

Introduction: Orally administered glucocorticoids (OAG) are not recommended for the management of plaque psoriasis (PsO) due to the classically feared outcomes of generalized pustular psoriasis (GPP) and erythrodermic psoriasis (EP). Given their widespread anecdotal use, we hypothesize that the use of OAG is not infrequent among US dermatologists and is rarely complicated by GPP or EP.

Methods: Anonymous electronic survey of 50 US dermatologists. Primary outcomes of interest were the prevalence of OAG in the management of PsO and the prevalence of GPP and EP in the context of OAG tapering.

Results: Overall, 9 out of 50 (18%) respondents …

Correlates Of Rem Sleep Without Atonia In Dream Enactment Behavior Associated With Parkinson’S Disease, Nisha Bagchi, Ritu Grewal, Abigail Quintos, Rohin Saroya

Phase 1

Introduction: Parkinson’s Disease (PD), a common neurodegenerative disease worldwide, has few reliable biomarkers. PD has been linked to REM Behavioral Disorder (RBD), a condition where patients abnormally experience REM sleep without atonia (RSWA). We aim to determine whether chin movements, a feature of RSWA, could serve as a PD biomarker. We hypothesize that those with higher RSWA are more likely to have PD.

Methods: Our study examined patients who underwent polysomnograms from 2015 onwards at the Jefferson Sleep Disorders Center. We did a retrospective EPIC chart review and compared 2 groups, those with RBD and PD (n=12) versus RBD …

Clinical Utility Of Molecular Profiling In Recurrent Glioblastoma Multiforme, Rebecca P. Bystrom, Pavalan Selvam, Jens Rueter, Honey Reddi, Christine Lu-Emerson

Journal of Maine Medical Center

Introduction: Glioblastoma multiforme (GBM) is the most common and aggressive primary malignant brain tumor found in adults. GBM has limited therapeutic options. Initial tumor sampling establishes the histopathologic diagnosis, identifies prognostic and therapeutic biomarkers, and provides an opportunity for molecular profiling. By contrast, the utility of repeat tumor sampling and molecular profiling in recurrent GBM is not well established.

Clinical Findings: We present a 69-year-old woman with GBM whose tumor recurred after standard treatment with temozolomide (TMZ) and concurrent radiation, followed by adjuvant TMZ. This patient had a methylated O6-methylguanine-DNA methyltransferase (MGMT) promoter, which ordinarily predicts a favorable response to …

Peer-Taught Virtual Research Workshops For Surgical Residents: Protocol For A Novel And Sustainable Solution To Improving Surgical Research In Pakistan, Russell S. Martins, Ronika Devi Ukrani, Mohummad Hassan Raza Raja, Maria Khan, Haissan Iftikhar, Syeda Sadia Fatima, Saulat Fatimi

Medical College Documents

Objective: To generate a protocol describing the methodology for a study assessing the effectiveness of a comprehensive series of peer-taught online research workshops for surgical residents across Pakistan in terms of improving research-related knowledge and skills, and long-term research involvement and output.
Methods: The quasi-experimental study will consist of a series of six online research workshops conducted over Zoom for surgical residents across Pakistan. An online sign-up form will be circulated on social media to current surgical residents throughout Pakistan. Curricular content covered in the workshops will be developed in collaboration with experienced research faculty at the Departments of Surgery …

Role Of P53 Deficient Clonogenic Endothelial Cells In The Pathogenesis Of Pulmonary Hypertension, Aneel Roy Bhagwani

Theses and Dissertations

Pulmonary Artery Hypertension (PAH) is a progressive disorder of the small vessels of the pulmonary vasculature. It is characterized by occlusive vascular remodeling leading to right heart failure and ultimately death. PAH pathogenesis involves a multifactorial etiology leading to formation of occlusive lesions in small (preacinary) pulmonary arteries. These lesions contain hyper-proliferative, apoptosis resistant endothelial cells (ECs), smooth muscle cells and fibroblasts. ECs play a major role in the development of PAH. These ECs in vascular lesions are primitive and express progenitor cell markers, including CD117 (c-kit).

We have isolated clonally expanded, c-kit+ ECs from the lungs of Green Fluorescent …

A Novel Immunostimulatory Platform For Amplifying The Abscopal Response Rates Of Radiation Therapy, Patrick A. Paez

Theses and Dissertations

Radiation therapy (RT) is one of the primary treatment modalities for head and neck squamous cell carcinoma (HNSCC). At the time of diagnosis two-thirds of HNSCC patients have local-advanced disease and 50-60% of these patients will experience a local-regional or metastatic relapse within three years. Improving the immunogenic response of RT may help address this clinical problem. However, current RT regimens have failed to reliably generate robust antitumor immunity as evidenced by the rarity of clinical abscopal responses. Recently we engineered a chimeric fusion molecule called Flagrp170, a novel immunostimulatory agent highly capable of promoting antigen presentation and T-cell activation. …

The Use Of Mechanotherapy To Promote The Recovery From Disuse Atrophy In Aging Rat Skeletal Muscle, Zachary Hettinger

Theses and Dissertations--Rehabilitation Sciences

The combination of age and disuse-related skeletal muscle atrophy predisposes older adults to reduced mobility, loss of independence, and poor quality of life. Poor health outcomes resulting from periods of disuse in older adults are exacerbated by an inability to fully recover, ultimately accelerating geriatric populations towards further functional decline. Aged-related changes to skeletal muscle viscoelastic properties, specifically of muscle extracellular matrix (ECM) stiffness, may not only impact how muscle responds during recovery, but also to interventions intended to augment recovery. Remodeling of muscle ECM in the aged may therefore benefit muscle mass recovery, yet therapies focused on ECM remodeling …

Human Regulatory T Cells Control Inflammation From Effector T Cells In Prediabetes, Rui Liu

Theses and Dissertations--Pharmacy

Type 2 diabetes (T2D) is a chronic low-grade inflammatory disease. A T cell cytokine profile (Th17) from PBMCs can distinguish obese T2D from obese non-diabetes subjects. Individual T cell subsets interact with each other and the diverse subsets jointly determine overall inflammation. Cellular metabolism drives cytokine production of CD4⁺ T cells, and therefore contributes to inflammation in T2D. However, specific changes in metabolism and function of CD4⁺ T cells during the progression from lean healthy to obese and diabetic stages in people have not been clarified.

We hypothesize that human regulatory T cells (Treg) impact metabolism of effector …

Utilizing Patient-Derived Epithelial Ovarian Cancer Tumor Organoids To Predict Carboplatin Resistance, Justin W. Gorski

Theses and Dissertations--Clinical and Translational Science

The development of patient-derived tumor organoids (TOs) from epithelial ovarian cancer tumor obtained at the time of primary or interval debulking surgery has the potential to play an important role in precision medicine.

Here, we utilize TOs to test front-line chemotherapy sensitivity and to investigate genomic drivers of carboplatin resistance. We developed six high grade serous epithelial ovarian cancer tumor organoids from tissue obtained during debulking surgery (2 neoadjuvant carboplatin exposed, 4 chemo-naïve). Each organoid line was screened for sensitivity to carboplatin at four different doses (100, 10, 1 and 0.1µM). Cell viability curves and resultant EC50 values were determined …

The Precaution Adoption Process Model In Describing Emergency Action Plan Adoption, Samantha E. Scarneo-Miller, Douglas J. Casa, Shuang Yin, Timothy E. Moore, Yuki Murata, Johna Kay Register-Mihalik, Lindsay J. Distefano

Internet Journal of Allied Health Sciences and Practice

Purpose: The purpose of this study was to identify the ability of the Precaution Adoption Process Model (PAPM) to classify athletic trainers (ATs) and athletic directors (ADs) readiness to act with regards to adopting an emergency action plan (EAP), and describe factors influencing PAPM stages. Method: We used a cross-sectional questionnaire design to evaluate readiness to act for developing an EAP among ATs and ADs working in United States high schools. The PAPM is a participant-driven model to identify someone’s readiness to act or change and has seven stages: Unaware, Unengaged, Undecided, Decided not to Act, Decided to Act, Acting …

Enlightening Ways To Relax Airway Smooth Muscle: Opsins., Vera P. Krymskaya, Raymond B. Penn

Center for Translational Medicine Faculty Papers

No abstract provided.

A Comparison Of Exhaustive And Non-Lattice-Based Methods For Auditing Hierarchical Relations In Gene Ontology, Rashmie Abeysinghe, Fengbo Zheng, Licong Cui

Faculty, Staff and Student Publications

Uncovering and fixing errors in biomedical terminologies is essential so that they provide accurate knowledge to downstream applications that rely on them. Non-lattice-based methods have been applied to identify various kinds of inconsistencies in different biomedical terminologies. In previous work, we have introduced two inference-based approaches that were applied in an exhaustive manner to audit hierarchical relations in the Gene Ontology: (1) Lexical-based inference framework, and (2) Subsumption-based sub-term inference framework. However, it is unclear how effective these exhaustive approaches perform compared with their corresponding non-lattice-based approaches. Therefore, in this paper, we implement the non-lattice versions of these two exhaustive …

Statins In Patients With Covid-19: A Retrospective Cohort Study In Iranian Covid-19 Patients., Payam Peymani, Tania Dehesh, Farnaz Aligolighasemabadi, Mohammadamin Sadeghdoust, Katarzyna Kotfis, Mazaher Ahmadi, Parvaneh Mehrbod, Pooya Iranpour, Sanaz Dastghaib, Ahmad Nasimian, Amir Ravandi, Biniam Kidane, Naseer Ahmed, Pawan Sharma, Shahla Shojaei, Kamran Bagheri Lankarani, Andrzej Madej, Nima Rezaei, Tayyebeh Madrakian, Marek J Los, Hagar Ibrahim Labouta, Pooneh Mokarram, Saeid Ghavami

Center for Translational Medicine Faculty Papers

Background: The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has profoundly affected the lives of millions of people. To date, there is no approved vaccine or specific drug to prevent or treat COVID-19, while the infection is globally spreading at an alarming rate. Because the development of effective vaccines or novel drugs could take several months (if not years), repurposing existing drugs is considered a more efficient strategy that could save lives now. Statins constitute a class of lipid-lowering drugs with proven safety profiles and various known beneficial pleiotropic effects. Our previous …

Intermittent Theta Burst Stimulation: Application To Spinal Cord Injury Rehabilitation And Computational Modeling, Neil Mittal

Theses and Dissertations

Loss of motor function from spinal cord injuries (SCI) results in loss of independence. Rehabilitation efforts are targeted to enhance the ability to perform activities of daily living (ADLs), but outcomes from physical therapy alone are often insufficient. Neuromodulation techniques that induce neuroplasticity may push the limits on recovery. Neuromodulation by intermittent theta burst transcranial magnetic stimulation (iTBS) induces neuroplasticity by increasing corticomotor excitability, though this has most frequently been studied with motor targets and on individuals not in need of rehabilitation. Increased corticomotor excitability is associated with motor learning. The response to iTBS, however, is highly variable and unpredictable, …

Covid-10, Healthcare Interior Design + Provider Experience - How Does Your Space Work For You?, Ruth E.P. Deibler

Graduate Research Posters

The lack of research on healthcare staff experience and interior design of the spaces they work in is evident. A focus on staff perspective is needed, particularly staff who navigated the COVID-19 pandemic. This research seeks to capture those stories to develop further research in order to improve staff experience. The initial phase of this mixed-methods approach is a survey. Hypothetically, by placing providers at the center of qualitative research related to healthcare interior design, we can better understand existing healthcare spaces. Ideally, we can develop additional evidence-based, human-centered solutions to transform interior environments in healthcare.

The 20-year Women’s Health …

Identifying Sleep-Related Factors Associated With Cognitive Function In A Hispanics/Latinos Cohort: A Dual Random Forest Approach, Li Xiaojin, Cui Licong, Wang Fei, Paul E Schulz, Guo-Qiang Zhang

Faculty, Staff and Student Publications

Disordered sleep is associated with poor cognitive function and cognitive decline. However, little is known regarding the association of sleep-related factors with cognitive function in underrepresented cohorts such as the Hispanic/Latino population. Leveraging the National Sleep Research Resource, one of the most comprehensive collections of sleep studies, we identified a Hispanic/Latino cohort of 1,031 lower cognitive function cases and 2,062 normal controls. We developed a novel dual random forest (DRF) approach to discriminate cases against controls for estimating the potential impact of sleep-related variables related to the decline of cognitive function. Several important sleep-related factors were identified which may be …

Student-Led Surgical Research Network: Enhancing Medical Student Research Opportunities, Ronika Devi Ukrani, Muhammad Musaab Munir, Areesh Bhatti, Shahryar Noordin

Medical College Documents

The current paper was planned to describe a student-led surgical research network established by the Research Division of the Surgery Interest Group at the Aga Khan University, Karachi. The project involved the creation of a collaborative network to provide opportunities to medical students to work with faculty on research projects. Over 25 students were directly connected with faculty and research mentors to work on research projects in the surgical specialty of their choice. The initiative of establishing a student-led surgical research network was successfully implemented and provided medical students with novel research opportunities by helping bridge the gap between the …

Another Step In Diagnostics Consultation Model© Actualization: Examining The Impact Of Consultation Workflow Processes On Providers' Clinical Decision Making, Elizabeth K. Leibach

Theses and Dissertations

Background
Communication errors in health services delivery significantly compromise quality in clinical decision making (CDM). Diagnostic information generated by clinical laboratories (CL) accounts for as much as 93% of objective data in the clinical record and therefore is foundational in CDM. This work describes the Diagnostics Consultation Model© (DCM©), a CL communications portal, which supports CDM within interprofessional teams, providers, and institutions. Specific aims were to develop and validate a workflow prediction index (the complexity index, CI) to assign resolution of consultation requests based on an algorithm comprised of characteristics available at the point of consultation initiation. The CI functions …

Comparison Of Circulating Tumour Dna And Extracellular Vesicle Dna By Low-Pass Whole-Genome Sequencing Reveals Molecular Drivers Of Disease In A Breast Cancer Patient, Olivia Ruhen, Bob Mirzai, Michael E. Clark, Bella Nguyen, Carlos Salomon, Wendy Erber, Katie Meehan

Research outputs 2014 to 2021

© 2020 by the authors. Licensee MDPI, Basel, Switzerland. There is increasing recognition of circulating tumour DNA (ctDNA) as a non-invasive alternative to tumour tissue for the molecular characterisation and monitoring of disease. Recent evidence suggests that cancer-associated changes can also be detected in the DNA contained within extracellular vesicles (EVs). As yet, there has been limited investigation into the relationship between EV DNA and ctDNA, and no studies have examined the EV DNA of breast cancer patients. The aim of this study was to use low-pass whole-genome sequencing to identify copy number variants (CNVs) in serial samples of both …