Translational Medical Research Commons^™

Effects Of Continuous Positive Airway Pressure (Cpap) Sleep Apnea Treatment On Mild Cognitive Impairment (Mci) And Cardiovascular Risk, Olivia Taylor, Cynthia Cheng, Md, Phd

Phase 1

There is a documented association between sleep apnea and earlier onset of cognitive impairment later in life. We hypothesize that nightly treatment with CPAP therapy will improve MCI status as estimated by a panel of neuropsychiatry tests in patients >55 with OSA and concomitant memory complaints. With a prospective cohort design, patients compliant with CPAP therapy are being compared to noncompliant patients and a non-OSA control group. My role in this multi-site project was to screen potential patients from Jefferson’s sleep clinic for eligibility for study enrollment. This study is still ongoing. OSA’s high prevalence makes it a worthwhile endeavor …

Characterizing The Timeline Of Drug Resistant Epilepsy Surgery., Nicole Belliard Martuscelli, Caio Matias, Ashwini Sharan

Phase 1

Introduction: Although early detection and surgery are crucial for positive outcomes in individuals with drug-resistant epilepsy (DRE), a minority of qualifying patients receive it in the US. This retrospective study investigates why some DRE patients who undergo complete pre-surgical assessment end up not receiving surgery.

Methods: We analyzed 211 EPIC charts from all of Jefferson Comprehensive Epilepsy Center's patients who underwent DRE surgical evaluation from 2017 through 2019. To that end, we characterized the DRE surgery timeline and collected data on age, onset of seizures and drug resistance, surgery dates, surgical modalities, and notes that elucidated the reasoning behind …

The Role Of Toll-Like Receptor 4 In The Progression Of Keloids, Madison Brandes, Nishi Srivastava, Neda Nikbakht

Phase 1

Keloids are highly prevalent in the population and their pathogenesis is largely unknown. T-cell lymphoma research shows that toll like receptor-4 (TLR-4) is highly expressed on CD206+ immunosuppressive macrophages and is implicated in maintaining the tumor microenvironment. Additionally, fibronectin, specifically extra domain A (EDA), is highly expressed and is associated with immunosuppression via the TLR-4 pathway. Assuming that keloids mimic the tumor microenvironment, we hypothesize that TLR-4 is implicated in the pathogenesis of keloids. Using keloid tissue samples and normal breast tissue as a control, immunohistochemistry was performed to observe the presence and co-localization of these markers. Three antibodies were …

Assessing Patient Satisfaction And Confidence After Use Of Educational Video To Augment Surgical Consent For Thyroid Surgery, Michelle Schafer, Katie Holland, Alexander Duffy, Kelley Yuan, Marisa Wu, Raphael Banoub, Elizabeth Cottrill

Phase 1

Introduction: Informed consent is a crucial aspect of ethical patient care, yet the increase in surgical complexity presents a challenge in achieve this properly. This study explores the use of an educational video to help standardize the consent process, increase patient retention of information, and promote patient understanding by allowing patients to replay the information remotely as often as needed.

Methods: This is a perspective, survey-based study of adult patients undergoing thyroid surgery. A novel video detailing thyroid surgery containing the standard contents of informed consent was shown to patients after traditional informed consent followed by a survey on …

Effect Of Palmitic Acid On B2 Receptor Expression In Airway Smooth Muscle Cells, John Magagna, Deepak A. Deshpande, Ajay P. Nayak

Phase 1

Introduction: People with asthma and obesity struggle to control asthma flares. B2 agonists are often the acute treatment of choice during these flares, so the decreased asthma control in this population may be due to a decrease in B2 receptor activity. We tested the hypothesis that B2 receptor expression will decrease in airway smooth muscle cells exposed to Palmitic Acid, a saturated fatty acid, compared to Oleic Acid and untreated cells.

Methods: Airway smooth muscle cells were plated and treated with Palmitic Acid and Oleic Acid at 100uM and 200uM concentrations while other untreated cells served as controls. Cells …

Reliability Of Surgical Margin Labels Using 3d Radiographic Software, Heather Ross, Raphael Banoub, Md, Brian Swendseid, Md, Joseph Curry, Md

Phase 1

Introduction: Surgical resection is a primary treatment for head and neck cancers that improves prognosis and quality of life for patients. Margin assessment is a critical component in this process as positive margins are associated with poor clinical outcomes. However, there is a lack of consensus on how surgical margins should be labeled for accurate origin identification. The objective of this project is to determine the difference in interpretation of surgical margin labels between and within Thomas Jefferson otolaryngologists and pathologists.

Methods: Adults with head and neck cancer who underwent surgical resection were identified. Pre-operative head and neck CT DICOM …

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

Phase 1

Introduction: Telestroke medicine (TM) involves clinical stroke care by digitally connecting patients and their providers to neurovascular specialists to decrease the time to thrombolytic reperfusion during an acute ischemic stroke (AIS). Rapid administration of intravenous tissue plasminogen activator (iv-tPA) improves AIS outcomes yet no large scale research has evaluated the effectiveness of TM. This study proposes that TM utilization across the Jefferson University Hospital network will increase thrombolytic reperfusion rates and improve overall stroke outcomes.

Methods: A retrospective cohort study design with data from a Jefferson Telestroke database contained information for 9,702 patients across 36 hospital affiliates. These patients were …

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

Phase 1

Introduction: Excisional biopsy (EB) of lymph nodes is the gold standard for diagnosing lymphoma. Recent literature suggests that diagnostic techniques such as immunohistochemistry, flow cytometry and FISH/Cytogenetics yield similar diagnostic adequacy rates when paired with less invasive procedures, like Core Needle Biopsy (CNB). We were interested in comparing the diagnostic odds ratio and adequacy of patients suspected of lymphoma who underwent CNB to EB at Thomas Jefferson University Hospital (TJUH).

Methods: We performed a retrospective cohort study on biopsies collected from 01/01/2016 and 12/31/2019 at TJUH. Specimens were considered diagnostically inadequate if there was not enough lesional tissue for …

Timing Of Preoperative Surgical Antibiotic Prophylaxis Prior To One-To-Three Level Elective Lumbar Fusion, Akash Singh, Gregory Schroeder, Md, Jose Canseco, Md, Alexander Vaccaro, Md, Parthik Patel, Md, Ariana Reyes, Md

Phase 1

Introduction: Surgical site infections (SSIs) in patients who have undergone lumbar fusion surgery can be a devastating complication. The aim of this study was to examine the relationship between timing of preoperative antibiotic prophylaxis and adverse outcomes such as SSIs with subgroup analysis stratified by antibiotic type.

Methods: This retrospective cohort included patients having undergone a 1-3 level lumbar fusion who were allocated into 5 groups based on the time from antibiotic administration to incision (Group A = 0-15 min, Group B = 16-30 min, Group C = 31-45 min, Group D = 46 – 60 min, and Group …

Impact Of Covid-19 On Individuals With Opioid Use Disorder’S Access To Services And Substance Use, Camryn Bernheimer, Lara Weinstein, Md

Phase 1

Introduction: The opioid epidemic has already devastated Philadelphia and COVID-19 has the potential to exacerbating this existing crisis. The goal of this study is to investigate how COVID-19 has impacted Medication Assisted Treatment (MAT) service utilization and substance use for individuals with opioid use disorder (OUD).

Methods: 170 participants with OUD in group-based MAT programs in Philadelphia were analyzed three months prior to and after COVID-19. The data provided participant age, gender, race/ethnicity, MAT visits, primary care physician (PCP) visits, behavioral health consult visits (BHC), and urine drug screen (UDS) results from health records. Pre-post COVID-19 relationships were examined …

Impact Of Medical Nutrition Therapy On Blood Pressure, Connor Mcelwee, Jessica Vitale, Cynthia Cheng, Md, Phd

Phase 1

Introduction:

We are studying how Jefferson’s Medical Nutrition Therapy (MNT) program has impacted biometric variables in program participants. These variables include body weight, HgA1C, lipids, and blood pressure (BP). My poster will focus on the impact of Jefferson’s MNT on blood pressure. My hypothesis is that participation in MNT will result in reduced blood pressure.

Methods:

The target population is patients who have participated in Jefferson’s MNT program. Study exclusion criteria included history of gastric bypass surgery, medical conditions or medication usage that might impact weight loss and other dependent variables. Data was abstracted from patients’ medical records, as …

Ifn-Γ/Il-27 Axis Induces Pd-L1 Expression In Monocyte-Derived Dendritic Cells And Restores Immune Tolerance In Cns Autoimmunity, Asrita Vattikonda, Giacomo Casella, Javad Rasouli, Rodolfo Thome, Hélène C. Descamps, Larissa Ishikawa, Alexandra Boehm, Daniel Hwang, Weifeng Zhang, Dan Xiao, Jeongho Park, Guang-Xian Zhang, Jorge I. Alvarez, Abdolmohamad Rostami, Bogoljub Ciric

Phase 1

Antigen (Ag)-specific tolerance induction by intravenous (i.v.) injection of high-dose auto-Ags has been explored for therapy of autoimmune diseases, including multiple sclerosis (MS). It is thought that the advantage of such Ag-specific therapy over non-specific immunomodulatory treatments would be selective suppression of a pathogenic immune response without impairing systemic immunity, thus avoiding adverse effects of immunosuppression. Auto-Ag i.v. tolerance induction has been extensively studied in experimental autoimmune encephalomyelitis (EAE), an animal model of MS, and limited clinical trials demonstrated that it is safe and beneficial to a subset of MS patients. Nonetheless, mechanisms of i.v. tolerance induction are incompletely understood, …

Acute Depression And Anxiety Symptoms Following Concussion In An Adolescent Outpatient Population, Ari M. Fish, Julia Vanni, Kristy Arbogast, Phd, Catherine C. Mcdonald, Phd, Rn, Christina Master, Md, Caqsm

Phase 1

Introduction: Research has shown that concussed youth are at increased risk of developing psychiatric symptoms as compared to non-concussed youth. Few studies, however, have detailed the presence and severity of acute depression and anxiety symptoms following a concussion in adolescents, specifically. Thus, the current study aims to describe depression and anxiety symptoms in concussed and non-concussed adolescents using validated measures of depression and anxiety.

Methods: The current study includes 284 adolescents (114 cases, 170 controls), 13-18 years of age. Cases included concussed patients at the Children’s Hospital of Philadelphia, and controls were recruited from a local, Philadelphia high school. …

Nccn Intermediate Risk Prostate Cancer- Long-Term Outcomes Of Active Surveillance Compared To Active Treatment, A Population-Based Analysis, Adam Schneider, Thenappan Chandrasekar, Nicholas Bowler, Hanan Goldberg, James R. Mark, Edouard J. Trabulsi, Costas D. Lallas, Leonard G. Gomella

Phase 1

Background: While active surveillance (AS) is an established standard of care for low-risk (LR) prostate cancer (PCa), its utility for intermediate risk (IR) PCa is less evident. Prior studies were limited by the inability to differentiate between AS and watchful waiting (WW). Using a recent update in the Surveillance, Epidemiology and End Results (SEER) Database that allows for enhanced distinction between AS and WW, we aimed to compare survival outcomes of men with LR and IR PCa treated with either AS, WW or active treatment (AT).

Methods: 166,244 men were initially identified by biopsy Gleason Grade Group (GG) alone – …

Investigation Of The Reciprocal Relationship Between C7, Tsp1, And Tgf-Β Activation In Normal Fibroblasts, Alicia Kenyon, Andrew South, Phd

Phase 1

Introduction: Recessive dystrophic epidermolysis bullosa (RDEB) is a rare skin blistering disorder due to a loss of function mutation in the collagen 7 (C7) gene. C7 activity loss upregulates thrombospondin-1 (TSP1), stimulating tissue growth factor-ß (TGF-ß), which promotes the development of cutaneous squamous cell carcinoma (cSCC) in RDEB patients. This C7-TSP1 interaction has not been described in normal fibroblasts; therefore, in this study, we tested the hypothesis that the level of intracellular C7 negatively correlates with TSP1 expression in normal fibroblasts.

Methods: In this basic research cell study, C7, TSP1, and pSMAD3 (phosphorylated SMAD3), a marker of TGF-ß activation, were …

Endovascular Intervention For Tracheo-Innominate Fistula: A Systematic Review And Meta-Analysis, Andrew M. Jordan, Thomas J. O'Malley, Kyle W. Prochno, Abhiraj Saxena, Elizabeth Maynes, Brandon Ferrell, T. Sloane Guy, John W. Entwistle, H. Todd Massey, Rohinton J. Morris, Babak Abai, Vakhtang Tchantchaleishvili

Phase 1

Introduction: Fistula formation between the trachea and the innominate artery is a life-threatening complication rarely seen with existing or previous tracheostomy. Fatal upon rupture, swift diagnosis and immediate intervention are paramount for survival. We aim to identify feasibility and outcomes of endovascular intervention for trachea-innominate fistula (TIF).

Methods: Patient-level data of reported individuals above the age of 14 that underwent endovascular intervention for TIF was extracted and analyzed. Identification of 25 patients from 27 studies was accomplished by electronic database search of Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, Ovid Medline, …

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

Phase 1

Introduction:

Obstructive sleep apnea (OSA) has been previously linked to the development of hypertension, possibly through the proposed mechanism of recurrent episodes of intermittent hypoxia leading to endothelial dysfunction, inflammation, and metabolic dysregulation. This study aims to investigate continuous positive airway pressure (CPAP) therapy, a first-line therapy for OSA, and its effects on blood pressure in patients with moderate to severe OSA. We hypothesize that compliance to CPAP leads to a decrease in average annual systolic and diastolic blood pressure, compared to noncompliant and non-CPAP use.

Methods:

Our study is a combined retrospective and prospective EPIC chart review study. Moderate …

Cardiac Arrest Clinical Outcomes In Patients Presenting With Opioid Overdose, Andrew Toron, Morgan Hutchinson, Md, David Gaieski

Phase 1

Introduction: Understanding opioids and their potential to cause cardiac arrests is integral in learning how to lower mortality rates in patients who overdose on them. Few studies have specifically examined the association of out-of-hospital cardiac arrests with opioid overdoses. We hypothesized that cardiac arrests caused by opioid overdoses will result in longer hospital stays and a higher mortality rate than other cardiac arrests.

Methods: This study is a secondary analysis of data from the Cardiac Arrest Registry to Enhance Survival. Data regarding 35 patients who presented to Jefferson and Methodist hospitals with out-of-hospital cardiac arrests due to opioid overdose …

Deep Supratentorial Extension Is Associated With Poor Clinical Outcomes After Glioblastoma Resection, Adam Barsouk, Michael P. Baldassari, Omaditya Khanna, Donald Ye, Erica Cunningham, Christopher Farrell, David Andrews, James Evans, Kevin Judy

Phase 1

Introduction: Glioblastoma (GBM) often extends to deep supratentorial locations, which limits the extent of maximal safe resection. Deep supratentorial extension (DSE) may be a clinically convenient prognostic indicator following GBM resection.

Methods: 582 GBM resections from 2012-2018 were retrospectively reviewed. DSE was defined as tumoral extension to the basal ganglia, thalamus, corpus callosum, internal capsule, hypothalamus, caudate, or putamen as identified on preoperative imaging.

Results: DSE was identified in 32.9% cases (192), while 52.5% (306) involved only superficial supratentorial locations (frontal, parietal, temporal and occipital lobes). Within the DSE cohort, the most commonly affected anatomical locations were the corpus …

Angiogram Negative Subarachnoid Hemorrhage: Incidence, Outcomes, And Predisposition, Victoria Coaxum, Ahmad Sweid, Md, Julie Barbera, Nicolas Nelson, Grace Severance, Angelo D'Antonio-Bertagnolli, Manan Parekh

Phase 1

Introduction: Subarachnoid hemorrhage (SAH) is a medical emergency that may lead to deleterious outcomes unless the underlying cause is determined and managed promptly to prevent further rebleed. Though a significant percentage of cases of SAH have no identifiable pathology, there is a lack of data related to outcomes, predispositions, and whether there has been an increase in the incidence of angiogram negative SAH (anSAH). This study aimed to assess the current incidence of anSAH and factors that are associated with outcomes and predisposition among patients diagnosed with anSAH.

Methods: A retrospective chart review was performed. Medical records of patients …