2024-03-29T12:49:23Z
http://jdc.jefferson.edu/do/oai/
oai:jdc.jefferson.edu:emfp-1000
2017-03-21T13:56:22Z
publication:em
publication:emfp
publication:jmc
Anthroposophic perspectives in primary care
Cantor, Ira S., MD
Rosenzweig, Steven, MD
A core challenge of contemporary medicine is to integrate the technological successes of biomedical science with a comprehensive under-standing of the physical, psychosocial, ecological, and spiritual dimensions of health and illness. Toward this end, bridges are being created between conventional medicine and alternative systems of healing which reflect a holistic model of the human being. Even when both conventional and complementary approaches are used side-by-side in the same patient, they remain separate in their basic assumptions and goals. Today's mechanistic disease model is cut off from such notions as life-energy, consciousness, and spirituality, so integral to many alternative paradigms. Anthroposophically Extended Medicine (AEM) is a comprehensive healing system that successfully integrates biomedicine with a more complete understanding of human reality. Originating in Europe at the beginning of the 20th century, AEM has its roots in the Western, scientific worldview. By expanding this worldview, anthroposophy offers the clinician new possibilities for scientific investigation; it also creates bridges to the wisdom of older healing traditions of both East and West.
1997-12-01T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/1
https://jdc.jefferson.edu/context/emfp/article/1000/viewcontent/auto_convert.pdf
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
complementary therapies
anthroposophy
spirituality
holistic health
Alternative and Complementary Medicine
oai:jdc.jefferson.edu:emfp-1002
2009-05-11T15:24:04Z
publication:em
publication:emfp
publication:jmc
Heme oxygenase activity and hemoglobin neurotoxicity are attenuated by inhibitors of the MEK/ERK pathway.
Chen-Roetling, Jing
Li, Zhi
Chen, Mai
Awe, Olatilewa O
Regan, Raymond F
Hemoglobin breakdown produces an iron-dependent neuronal injury after experimental CNS hemorrhage that may be attenuated by heme oxygenase (HO) inhibitors. The HO enzymes are phosphoproteins that are activated by phosphorylation in vitro. While testing the effect of kinase inhibitors in cortical cell cultures, we observed that HO activity was consistently decreased by the MEK inhibitor U0126. The present study tested the hypothesis that MEK/ERK pathway inhibitors reduce HO activity and neuronal vulnerability to hemoglobin. The MEK inhibitors U0126 and SL327 and the ERK inhibitor FR180204 reduced baseline culture HO activity by 35-50%, without altering the activity of recombinant HO-1 or HO-2; negative control compounds U0124 and FR180289 had no effect. Hemoglobin exposure for 16h produced widespread neuronal injury, manifested by release of 59.2+/-7.8% of neuronal lactate dehydrogenase and a twelve-fold increase in malondialdehyde; kinase inhibitors were highly protective. HO-1 induction after hemoglobin treatment was also decreased by U0126, SL327, and FR180204. These results suggest that reduction in HO activity may contribute to the protective effect of MEK and ERK inhibitors against heme-mediated neuronal injury.
2009-04-01T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/2
https://jdc.jefferson.edu/context/emfp/article/1002/viewcontent/auto_convert.pdf
https://jdc.jefferson.edu/context/emfp/article/1002/filename/0/type/additional/viewcontent/MEK_paper_1_12_09.ppt
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Cell culture
Free radical
Hemoglobin toxicity
Intracerebral hemorrhage
Mouse
Oxidative stress
Alternative and Complementary Medicine
Medicine and Health Sciences
oai:jdc.jefferson.edu:emfp-1003
2010-05-04T22:43:26Z
publication:em
publication:emfp
publication:jmc
Heme oxygenase-2 gene deletion attenuates oxidative stress in neurons exposed to extracellular hemin.
Regan, Raymond F
Chen, Jing
Benvenisti-Zarom, Luna
BACKGROUND: Hemin, the oxidized form of heme, accumulates in intracranial hematomas and is a potent oxidant. Growing evidence suggests that it contributes to delayed injury to surrounding tissue, and that this process is affected by the heme oxygenase enzymes. In a prior study, heme oxygenase-2 gene deletion increased the vulnerability of cultured cortical astrocytes to hemin. The present study tested the effect of HO-2 gene deletion on protein oxidation, reactive oxygen species formation, and cell viability after mixed cortical neuron/astrocyte cultures were incubated with neurotoxic concentrations of hemin. RESULTS: Continuous exposure of wild-type cultures to 1-10 microM hemin for 14 h produced concentration-dependent neuronal death, as detected by both LDH release and fluorescence intensity after propidium iodide staining, with an EC50 of 1-2 microM; astrocytes were not injured by these low hemin concentrations. Cell death was consistently reduced by at least 60% in knockout cultures. Exposure to hemin for 4 hours, a time point that preceded cell lysis, increased protein oxidation in wild-type cultures, as detected by staining of immunoblots for protein carbonyl groups. At 10 microM hemin, carbonylation was increased 2.3-fold compared with control sister cultures subjected to medium exchanges only; this effect was reduced by about two-thirds in knockout cultures. Cellular reactive oxygen species, detected by fluorescence intensity after dihydrorhodamine 123 (DHR) staining, was markedly increased by hemin in wild-type cultures and was localized to neuronal cell bodies and processes. In contrast, DHR fluorescence intensity in knockout cultures did not differ from that of sham-washed controls. Neuronal death in wild-type cultures was almost completely prevented by the lipid-soluble iron chelator phenanthroline; deferoxamine had a weaker but significant effect. CONCLUSIONS: These results suggest that HO-2 gene deletion protects neurons in mixed neuron-astrocyte cultures from heme-mediated oxidative injury. Selective inhibition of neuronal HO-2 may have a beneficial effect after CNS hemorrhage.
2004-09-17T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/4
https://jdc.jefferson.edu/context/emfp/article/1003/viewcontent/1471_2202_5_34.pdf
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Animals
Astrocytes
Cell Death
Cells
Cultured
Heme Oxygenase (Decyclizing)
Hemin
Iron Chelating Agents
Isoenzymes
Mice
Mice
Knockout
Neurons
Oxidative Stress
Alternative and Complementary Medicine
Medical Genetics
oai:jdc.jefferson.edu:emfp-1004
2010-05-10T00:08:43Z
publication:em
publication:emfp
publication:jmc
The interaction of HAb18G/CD147 with integrin alpha6beta1 and its implications for the invasion potential of human hepatoma cells.
Dai, Jing-yao
Dou, Ke-feng
Wang, Cong-hua
Zhao, Pu
Lau, Wayne Bond
Tao, Ling
Wu, Ya-mei
Tang, Juan
Jiang, Jian-li
Chen, Zhi-nan
BACKGROUND: HAb18G/CD147 plays pivotal roles in invasion by hepatoma cells, but the underlying mechanism remains unclear. Our previous study demonstrated that overexpression of HAb18G/CD147 promotes invasion by interacting with integrin alpha3beta1. However, it has never been investigated whether alpha3beta1 is solely responsible for this process or if other integrin family members also interact with HAb18G/CD147 in human hepatoma cells. METHODS: Human SMMC-7721 and FHCC98 cells were cultured and transfected with siRNA fragments against HAb18G/CD147. The expression levels of HAb18G/CD147 and integrin alpha6beta1 were determined by immunofluorescent double-staining and confocal imaging analysis. Co-immunoprecipitation and Western blot analyses were performed to examine the native conformations of HAb18G/CD147 and integrin alpha6beta1. Invasion potential was evaluated with an invasion assay and gelatin zymography. RESULTS: We found that integrin alpha6beta1 co-localizes and interacts with HAb18G/CD147 in human hepatoma cells. The enhancing effects of HAb18G/CD147 on invasion capacity and secretion of matrix metalloproteinases (MMPs) were partially blocked by integrin alpha6beta1 antibodies (P < 0.01). Wortmannin, a specific phosphatidylinositol kinase (PI3K) inhibitor that reverses the effect of HAb18G/CD147 on the regulation of intracellular Ca2+ mobilization, significantly reduced cell invasion potential and secretion of MMPs in human hepatoma cells (P < 0.05). Importantly, no additive effect between Wortmannin and alpha6beta1 antibodies was observed, indicating that alpha6beta1 and PI3K transmit the signal in an upstream-downstream relationship. CONCLUSION: These results suggest that alpha6beta1 interacts with HAb18G/CD147 to mediate tumor invasion and metastatic processes through the PI3K pathway.
2009-01-01T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/5
https://jdc.jefferson.edu/context/emfp/article/1004/viewcontent/1471_2407_9_337.pdf
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Thomas Jefferson University
Department of Emergency Medicine
Antigens
CD147
Carcinoma
Hepatocellular
Cell Line
Tumor
Humans
Integrin alpha6beta1
Neoplasm Invasiveness
Protein Binding
Protein Transport
Alternative and Complementary Medicine
Medical Cell Biology
oai:jdc.jefferson.edu:emfp-1005
2010-05-17T00:22:14Z
publication:em
publication:emfp
publication:jmc
Identifying inaccuracies on emergency medicine residency applications.
Katz, Eric D
Shockley, Lee
Kass, Lawrence
Howes, David
Tupesis, Janis P
Weaver, Christopher
Sayan, Osman R
Hogan, Victoria
Begue, Jason
Vrocher, Diamond
Frazer, Jackie
Evans, Timothy
Hern, Gene
Riviello, Ralph
Rivera, Antonio
Kinoshita, Keith
Ferguson, Edward
BACKGROUND: Previous trials have showed a 10-30% rate of inaccuracies on applications to individual residency programs. No studies have attempted to corroborate this on a national level. Attempts by residency programs to diminish the frequency of inaccuracies on applications have not been reported. We seek to clarify the national incidence of inaccuracies on applications to emergency medicine residency programs. METHODS: This is a multi-center, single-blinded, randomized, cohort study of all applicants from LCME accredited schools to involved EM residency programs. Applications were randomly selected to investigate claims of AOA election, advanced degrees and publications. Errors were reported to applicants' deans and the NRMP. RESULTS: Nine residencies reviewed 493 applications (28.6% of all applicants who applied to any EM program). 56 applications (11.4%, 95%CI 8.6-14.2%) contained at least one error. Excluding "benign" errors, 9.8% (95% CI 7.2-12.4%), contained at least one error. 41% (95% CI 35.0-47.0%) of all publications contained an error. All AOA membership claims were verified, but 13.7% (95%CI 4.4-23.1%) of claimed advanced degrees were inaccurate. Inter-rater reliability of evaluations was good. Investigators were reluctant to notify applicants' dean's offices and the NRMP. CONCLUSION: This is the largest study to date of accuracy on application for residency and the first such multi-centered trial. High rates of incorrect data were found on applications. This data will serve as a baseline for future years of the project, with emphasis on reporting inaccuracies and warning applicants of the project's goals.
2005-01-01T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/6
https://jdc.jefferson.edu/context/emfp/article/1005/viewcontent/1472_6920_5_30.pdf
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Adult
Credentialing
Data Collection
Databases
Bibliographic
Deception
Education
Graduate
Educational Status
Emergency Medicine
Humans
Internship and Residency
Job Application
Professional Misconduct
Publishing
Records as Topic
School Admission Criteria
Schools
Medical
United States
Alternative and Complementary Medicine
Emergency Medicine
Health and Medical Administration
oai:jdc.jefferson.edu:emfp-1007
2011-03-01T15:24:18Z
publication:em
publication:emfp
publication:jmc
Apotransferrin Protects Cortical Neurons from Hemoglobin Toxicity
Chen-Roetling, Jing
Chen, Lifen
Regan, Raymond F.
The protective effect of iron chelators in experimental models of intracerebral hemorrhage suggests that nonheme iron may contribute to injury to perihematomal cells. Therapy with high affinity iron chelators is limited by their toxicity, which may be due in part to sequestration of metals in an inaccessible complex. Transferrin is unique in chelating iron with very high affinity while delivering it to cells as needed via receptor-mediated endocytosis. However, its efficacy against iron-mediated neuronal injury has never been described, and was therefore evaluated in this study using an established cell culture model of hemoglobin neurotoxicity. At concentrations similar to that of CSF transferrin (50-100 micrograms/ml), both iron-saturated holotransferrin and apotransferrin were nontoxic per se. Overnight exposure to 3 μM purified human hemoglobin in serum-free culture medium resulted in death, as measured by lactate dehydrogenase release assay, of about three-quarters of neurons. Significant increases in culture iron, malondialdehyde, protein carbonyls, ferritin and heme oxygenase-1 were also observed. Holotransferrin had no effect on these parameters, but all were attenuated by 50-100 micrograms/ml apotransferrin. The effect of apotransferrin was very similar to that of deferoxamine at a concentration that provided equivalent iron binding capacity, and was not antagonized by concomitant treatment with holotransferrin. Transferrin receptor-1 expression was localized to neurons and was not altered by hemoglobin or transferrin treatment. These results suggest that apotransferrin may mitigate the neurotoxicity of hemoglobin after intracerebral hemorrhage. Increasing its concentration in perihematomal tissue may be beneficial.
2011-02-01T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/7
https://jdc.jefferson.edu/context/emfp/article/1007/viewcontent/auto_convert.pdf
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Intracerebral hemorrhage
Iron
Oxidative
emergency medicine
thomas jefferson university
Alternative and Complementary Medicine
Emergency Medicine
oai:jdc.jefferson.edu:emfp-1008
2012-03-22T16:37:38Z
publication:em
publication:emfp
publication:jmc
Reduced cardioprotective action of adiponectin in high-fat diet-induced type II diabetic mice and its underlying mechanisms.
Yi, Wei
Sun, Yang
Gao, Erhe
Wei, Xufeng
Lau, Wayne Bond
Zheng, Qijun
Wang, Yajing
Yuan, Yuexing
Wang, Xiaoliang
Tao, Ling
Li, Rong
Koch, Walter
Ma, Xin-Liang
Diabetes exacerbates ischemic heart disease morbidity and mortality via incompletely understood mechanisms. Although adiponectin (APN) reduces myocardial ischemia/reperfusion (MI/R) injury in nondiabetic animals, whether APN's cardioprotective actions are altered in diabetes, a pathologic condition with endogenously reduced APN, has never been investigated. High-fat diet (HD)-induced diabetic mice and normal diet (ND) controls were subjected to MI via coronary artery ligation, and given vehicle or APN globular domain (gAPN, 2 μg/g) 10 min before reperfusion. Compared to ND mice (where gAPN exerted pronounced cardioprotection), HD mice manifested greater MI/R injury, and a tripled gAPN dose was requisite to achieve cardioprotective extent seen in ND mice (i.e., infarct size, apoptosis, and cardiac function). APN reduces MI/R injury via AMP-activated protein kinase (AMPK)-dependent metabolic regulation and AMPK-independent antioxidative/antinitrative pathways. Compared to ND, HD mice manifested significantly blunted gAPN-induced AMPK activation, basally and after MI/R (p<0.05). Although both low- and high-dose gAPN equally attenuated MI/R-induced oxidative stress (i.e., NADPH oxidase expression and superoxide production) and nitrative stress (i.e., inducible nitric oxide synthase expression, nitric oxide production, and peroxynitrite formation) in ND mice, only high-dose gAPN efficaciously did so in HD mice. We demonstrate for the first time that HD-induced diabetes diminished both AMPK-dependent and AMPK-independent APN cardioprotection, suggesting an unreported diabetic heart APN resistance.
2011-10-01T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/8
https://jdc.jefferson.edu/context/emfp/article/1008/viewcontent/PMID_21091073.pdf
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Thomas Jefferson University
Department of Emergency Medicine
Center for Translational Medicine
Acetyl-CoA Carboxylase
Adenylate Kinase
Adiponectin
Animals
Antioxidants
Blood Pressure
Cardiotonic Agents
Diabetes Mellitus
Type 2
Diet
High-Fat
Enzyme Activation
Male
Mice
Mice
Inbred C57BL
Myocardial Ischemia
Myocardial Reperfusion Injury
Myocardium
Nitric Oxide
Nitric Oxide Synthase Type II
Peroxynitrous Acid
Superoxides
Ventricular Dysfunction
Left
Diabetes Mellitus, Type 2
Diet, High-Fat
Mice, Inbred C57BL
Ventricular Dysfunction, Left
Alternative and Complementary Medicine
Emergency Medicine
oai:jdc.jefferson.edu:emfp-1009
2012-03-22T18:33:35Z
publication:em
publication:emfp
publication:jmc
Systemic adiponectin malfunction as a risk factor for cardiovascular disease.
Lau, Wayne Bond
Tao, Ling
Wang, Yajing
Li, Rong
Ma, Xin L
Adiponectin (Ad) is an abundant protein hormone regulatory of numerous metabolic processes. The 30 kDa protein originates from adipose tissue, with full-length and globular domain circulatory forms. A collagenous domain within Ad leads to spontaneous self-assemblage into various oligomeric isoforms, including trimers, hexamers, and high-molecular-weight multimers. Two membrane-spanning receptors for Ad have been identified, with differing concentration distribution in various body tissues. The major intracellular pathway activated by Ad includes phosphorylation of AMP-activated protein kinase, which is responsible for many of Ad's metabolic regulatory, anti-inflammatory, vascular protective, and anti-ischemic properties. Additionally, several AMP-activated protein kinase-independent mechanisms responsible for Ad's anti-inflammatory and anti-ischemic (resulting in cardioprotective) effects have also been discovered. Since its 1995 discovery, Ad has garnered considerable attention for its role in diabetic and cardiovascular pathology. Clinical observations have demonstrated the association of hypoadiponectinemia in patients with obesity, cardiovascular disease, and insulin resistance. In this review, we elaborate currently known information about Ad malfunction and deficiency pertaining to cardiovascular disease risk (including atherosclerosis, endothelial dysfunction, and cardiac injury), as well as review evidence supporting Ad resistance as a novel risk factor for cardiovascular injury, providing insight about the future of Ad research and the protein's potential therapeutic benefits.
2011-10-01T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/9
https://jdc.jefferson.edu/context/emfp/article/1009/viewcontent/PMID_21091079.pdf
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Thomas Jefferson University
Department of Emergency Medicine
Adenylate Kinase
Adiponectin
Animals
Antioxidants
Cardiovascular Diseases
Drug Resistance
Endothelium
Humans
Protein Structure
Tertiary
Receptors
Adiponectin
Risk Factors
Signal Transduction
Protein Structure, Tertiary
Receptors, Adiponectin
Alternative and Complementary Medicine
Emergency Medicine
oai:jdc.jefferson.edu:emfp-1010
2012-03-22T18:39:41Z
publication:em
publication:emfp
publication:jmc
Advanced glycation end products accelerate ischemia/reperfusion injury through receptor of advanced end product/nitrative thioredoxin inactivation in cardiac microvascular endothelial cells.
Liu, Yi
Ma, Yanzhuo
Wang, Rutao
Xia, Chenhai
Zhang, Rongqing
Lian, Kun
Luan, Ronghua
Sun, Lu
Yang, Lu
Lau, Wayne B
Wang, Haichang
Tao, Ling
The advanced glycation end products (AGEs) are associated with increased cardiac endothelial injury. However, no causative link has been established between increased AGEs and enhanced endothelial injury after ischemia/reperfusion. More importantly, the molecular mechanisms by which AGEs may increase endothelial injury remain unknown. Adult rat cardiac microvascular endothelial cells (CMECs) were isolated and incubated with AGE-modified bovine serum albumin (BSA) or BSA. After AGE-BSA or BSA preculture, CMECs were subjected to simulated ischemia (SI)/reperfusion (R). AGE-BSA increased SI/R injury as evidenced by enhanced lactate dehydrogenase release and caspase-3 activity. Moreover, AGE-BSA significantly increased SI/R-induced oxidative/nitrative stress in CMECs (as measured by increased inducible nitric oxide synthase expression, total nitric oxide production, superoxide generation, and peroxynitrite formation) and increased SI/R-induced nitrative inactivation of thioredoxin-1 (Trx-1), an essential cytoprotective molecule. Supplementation of EUK134 (peroxynitrite decomposition catalyst), human Trx-1, or soluble receptor of advanced end product (sRAGE) (a RAGE decoy) in AGE-BSA precultured cells attenuated SI/R-induced oxidative/nitrative stress, reduced SI/R-induced Trx-1 nitration, preserved Trx-1 activity, and reduced SI/R injury. Our results demonstrated that AGEs may increase SI/R-induced endothelial injury by increasing oxidative/nitrative injury and subsequent nitrative inactivation of Trx-1. Interventions blocking RAGE signaling or restoring Trx activity may be novel therapies to mitigate endothelial ischemia/reperfusion injury in the diabetic population.
2011-10-01T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/10
https://jdc.jefferson.edu/context/emfp/article/1010/viewcontent/PMID_21126209.pdf
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Thomas Jefferson University
Department of Emergency Medicine
Animals
Cell Hypoxia
Cells
Cultured
Endothelial Cells
Glycosylation End Products
Advanced
L-Lactate Dehydrogenase
Male
Microvessels
Myocardial Ischemia
Myocardial Reperfusion Injury
Nitrates
Nitric Oxide
Oxidative Stress
Primary Cell Culture
Rats
Rats
Wistar
Receptors
Immunologic
Serum Albumin
Bovine
Superoxides
Thioredoxins
Cells, Cultured
Glycosylation End Products, Advanced
Rats, Wistar
Receptors, Immunologic
Serum Albumin, Bovine
Alternative and Complementary Medicine
Cardiology
Emergency Medicine
oai:jdc.jefferson.edu:emfp-1011
2012-08-03T15:53:37Z
publication:em
publication:emfp
publication:jmc
Increased susceptibility to metabolic syndrome in adult offspring of Angiotensin type 1 receptor autoantibody-positive rats.
Zhang, Suli
Zhang, Xi
Yang, Lihong
Yan, Zi
Yan, Li
Tian, Jue
Li, Xiaoyu
Song, Li
Wang, Li
Yang, Xiaoli
Zheng, Ronghua
Lau, Wayne Bond
Ma, Xinliang
Liu, Huirong
Abstract Aims: Abnormal fetal and early postnatal growth is closely associated with adult-onset metabolic syndrome (MetS). However, the underlying etiological factors remain complex. The presence of the autoantibody against the angiotensin II type 1 receptor (AT1-Ab), a known risk factor for pre-eclampsia, may create a suboptimal intrauterine fetal environment. The current study investigated whether middle-aged offspring of AT1-Ab-positive mothers were prone to metabolic disorder development. Results: The AT1-Abs was detected in placental trophoblastic cells, capillary endothelium, and milk of pregnant rats actively immunized with the second extracellular loop of the AT1 receptor. AT1-Abs in newborn rats induced vasoconstriction, increased intracellular-free Ca(2+) in vitro, and was undetectable 7 weeks later. Immunized group offspring exhibited increased weight variability and insulin resistance at 40 weeks of age under a normal diet, evidenced by elevated fasting serum insulin and homeostasis model assessment score compared with the vehicle control. To further observe metabolic alterations, the offspring were given a high-sugar diet (containing 20% sucrose) 40-48 weeks postnatally. The fasting plasma glucose in immunized group offspring was markedly increased. Concomitantly, these offspring manifested increased visceral adipose tissue, increased fatty liver, increased triglycerides, decreased high-density lipoprotein cholesterol, and decreased adiponectin levels, indicative of MetS. Innovation: AT1-Abs could be transferred from mother to offspring via the placenta and milk. Moreover, offspring of an AT1-Ab-positive mother were more vulnerable to MetS development in middle age. Conclusion: AT1-Ab-positivity of mothers during pregnancy is a previously unrecognized "silent" risk factor for MetS development in their offspring. Antioxid. Redox Signal. 17, 733-743.
2012-09-01T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/11
https://jdc.jefferson.edu/context/emfp/article/1011/viewcontent/22304458.pdf
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Thomas Jefferson University
Department of Emergency Medicine
metabolic syndrome
autoantibody
angiotensin
type 1 receptor
metabolic
Alternative and Complementary Medicine
Medical Pathology
Medical Physiology
oai:jdc.jefferson.edu:emfp-1012
2012-08-03T16:05:41Z
publication:em
publication:emfp
publication:jmc
Essential role of caveolin-3 in adiponectin signalsome formation and adiponectin cardioprotection.
Wang, Yajing
Wang, Xiaoliang
Jasmin, Jean-François
Lau, Wayne Bond
Li, Rong
Yuan, Yuexin
Yi, Wei
Chuprun, Kurt
Lisanti, Michael P.
Koch, Walter J
Gao, Erhe
Ma, Xin-Liang
OBJECTIVE: Adiponectin (APN) system malfunction is causatively related to increased cardiovascular morbidity/mortality in diabetic patients. The aim of the current study was to investigate molecular mechanisms responsible for APN transmembrane signaling and cardioprotection.
METHODS AND RESULTS: Compared with wild-type mice, caveolin-3 knockout (Cav-3KO) mice exhibited modestly increased myocardial ischemia/reperfusion injury (increased infarct size, apoptosis, and poorer cardiac function recovery; P
CONCLUSIONS: Taken together, these results demonstrated for the first time that Cav-3 plays an essential role in APN transmembrane signaling and APN anti-ischemic/cardioprotective actions.
2012-04-01T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/12
https://jdc.jefferson.edu/context/emfp/article/1012/viewcontent/22328772.pdf
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Thomas Jefferson University
department of emergency medicine
department of stem cell biology and regenerative medicine
center for translational medicine
AMP-Activated Protein Kinases
Adaptor Proteins
Signal Transducing
Adenylate Cyclase
Adiponectin
Animals
Apoptosis
Cadherins
Caveolin 3
Cyclic AMP
Disease Models
Animal
Enzyme Activation
Enzyme Activators
HEK293 Cells
Humans
Male
Mice
Mice
Knockout
Myocardial Infarction
Myocardial Reperfusion Injury
Myocardium
Protein Interaction Domains and Motifs
Receptors
Adiponectin
Signal Transduction
Time Factors
Transfection
Ventricular Function
Left
Adaptor Proteins, Signal Transducing
Disease Models, Animal
Mice, Knockout
Receptors, Adiponectin
Ventricular Function, Left
Alternative and Complementary Medicine
Emergency Medicine
Medical Cell Biology
Medical Physiology
oai:jdc.jefferson.edu:emfp-1013
2012-10-22T14:39:46Z
publication:em
publication:emfp
publication:jmc
The effect of vessel depth, diameter, and location on ultrasound-guided peripheral intravenous catheter longevity.
Fields, J Matthew
Dean, Anthony J
Todman, Raleigh W
Au, Arthur K
Anderson, Kenton L
Ku, Bon S
Pines, Jesse M
Panebianco, Nova L
INTRODUCTION: Ultrasound-guided peripheral intravenous catheters (USGPIVs) have been observed to have poor durability. The current study sets out to determine whether vessel characteristics (depth, diameter, and location) predict USGPIV longevity.
METHODS: A secondary analysis was performed on a prospectively gathered database of patients who underwent USGPIV placement in an urban, tertiary care emergency department. All patients in the database had a 20-gauge, 48-mm-long catheter placed under ultrasound guidance. The time and reason for USGPIV removal were extracted by retrospective chart review. A Kaplan-Meier survival analysis was performed.
RESULTS: After 48 hours from USGPIV placement, 32% (48/151) had failed prematurely, 24% (36/151) had been removed for routine reasons, and 44% (67/151) remained in working condition yielding a survival probability of 0.63 (95% confidence interval [CI], 0.53-0.70). Survival probability was perfect (1.00) when placed in shallow vessels (
CONCLUSION: Cannulation of deep and proximal vessels is associated with poor USGPIV survival. Careful selection of target vessels may help improve success of USGPIV placement and durability.
2012-09-01T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/13
https://jdc.jefferson.edu/context/emfp/article/1013/viewcontent/AJEM_Manuscript_revised_7_27_11.pdf
https://jdc.jefferson.edu/context/emfp/article/1013/filename/0/type/additional/viewcontent/AJEM_Table_1.pdf
https://jdc.jefferson.edu/context/emfp/article/1013/filename/1/type/additional/viewcontent/AJEM_Table_2.pdf
https://jdc.jefferson.edu/context/emfp/article/1013/filename/2/type/additional/viewcontent/Figure_1__KM_Survival_Curve_USGPIVs.pdf
https://jdc.jefferson.edu/context/emfp/article/1013/filename/3/type/additional/viewcontent/Figure_2a__Survival_by_Depth.pdf
https://jdc.jefferson.edu/context/emfp/article/1013/filename/4/type/additional/viewcontent/Figure_2b_Survival_by_Vessel_Location.pdf
https://jdc.jefferson.edu/context/emfp/article/1013/filename/5/type/additional/viewcontent/Figure_3___Multiple_Survival_Curve_Graph.pdf
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Thomas Jefferson University; Department of Emergency Medicine; adult; aged; catheter longevity; catheter removal; female; human; intravenous catheter; major clinical study; male; medical record review; priority journal; product parameters; retrospective study; review; secondary analysis; ultrasound guided peripheral intravenous catheter
Alternative and Complementary Medicine
Emergency Medicine
oai:jdc.jefferson.edu:emfp-1014
2012-11-09T16:01:45Z
publication:em
publication:emfp
publication:jmc
Decrease in Central Venous Catheter Placement and Complications Due to Utilization of Ultrasound-Guided Peripheral Intravenous Catheters
Au, Arthur K
Rotte, Masashi
Grzybowski, Robert
Ku, Bon
Fields, Jason M.
Poster presented at: American College of Emergency Physicians (ACEP) conference.
Introduction: -Up to 40% of ED visits include diagnostic blood tests and 26% result in administration of IV fluids necessitating successful peripheral intravenous (IV) catheter placement.1 -There is a subset of patients with difficult IV access (DIVA) in which traditional cannulation methods are unsuccessful resulting in central venous cannulation (CVC). -CVCs have a 5-15 percent complication rate2 and attributable costs per CVC related infection have been estimated at $34,508-$56,000.3 -Ultrasound-guided peripheral IV catheters (USGPIVs) provide a method of potentially decreasing the need for CVC placement, however due to poor durability of USGPIVs the actual reduction in CVCs is unclear. -This study set out to quantify the reduction in CVCs in patients with DIVA by utilization of USGPIVs. Paper will be be published in: American Journal of Emergency Medicine
2012-11-01T07:00:00Z
poster
application/pdf
https://jdc.jefferson.edu/emfp/14
https://jdc.jefferson.edu/context/emfp/article/1014/viewcontent/Patient_Safety_Congress.pdf
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Decrease in Central Venous Catheter Placement and Complications Due to Utilization of Ultrasound-Guided Peripheral Intravenous Catheters
poster
American College of Emergency Physicians (ACEP) conference.
Emergency Medicine
oai:jdc.jefferson.edu:emfp-1015
2013-01-03T16:13:33Z
publication:em
publication:emfp
publication:jmc
Association of maximum weight with hyperuricemia risk: a retrospective study of 21,414 chinese people.
Gao, Bin
Zhou, Jie
Ge, Jiapu
Zhang, Yaping
Chen, Fei
Lau, Wayne B
Wan, Yi
Zhang, Nanyan
Xing, Ying
Wang, Li
Fu, Jianfang
Li, Xiaomiao
Jia, Hongxia
Zhao, Xin
Ji, Qiuhe
BACKGROUND: Obesity has been demonstrated to be associated with increased serum uric acid (SUA); however, little is known regarding the relationship between maximum weight, or maximum weight fluctuation, and uric acid concentration. Through retrospective means, we determined the association of maximum weight with SUA risk.
METHODS: Data of 21,414 participants (8,630 males and 12,784 females) from the 2007-8 China National Diabetes and Metabolic Disorders Study were analyzed for parameters including lifestyle habits, biochemical blood analysis and self-reported maximum weight.
RESULTS: Elevated SUA subjects shared a cluster of demographic features. After adjustment for age, gender, education, smoking, drinking, physical activity, WHR, height, eGFR(evaluate glomerular filtration rate), and diuretic usage, multivariate logistic regression models demonstrated maximum weight was associated with increased risk of elevated SUA level (P
CONCLUSIONS: Maximum weight is a strong risk factor for increased uric acid level in the Chinese population, which might serve as a novel clinical indicator suggesting hyperuricemia. Controlling maximum weight, keeping weight to the appropriate range, and maintaining the stable weight may be conducive for decreasing risk of hyperuricemia.
2012-01-01T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/15
https://jdc.jefferson.edu/context/emfp/article/1015/viewcontent/23226486.pdf
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
adult; age distribution; area under the curve; article; blood analysis; body weight; Chinese; drinking behavior; educational status; female; high risk population; human; hyperuricemia; male; physical activity; receiver operating characteristic; retrospective study; risk assessment; self report; sex difference; smoking habit; uric acid blood level; waist circumference; waist hip ratio; weight reduction
Emergency Medicine
Endocrinology, Diabetes, and Metabolism
oai:jdc.jefferson.edu:emfp-1016
2013-01-16T19:13:43Z
publication:em
publication:emfp
publication:jmc
Aortic dissection presenting as gait disturbance: a case report.
Estreicher, Michael
Portale, Joseph
Lopez, Bernard
Emergency medicine dogma traditionally teaches that aortic dissection presents as tearing chest pain, radiating to the back. This case report describes a 55 year old woman presenting with a left homonymous hemianopsia and resultant gait disturbance. Initial head CT demonstrated a right parietal infarct, and chest radiograph demonstrated a markedly widened mediastinum. Acute Stanford Type A aortic dissection was subsequently confirmed. This report provides further evidence for atypical, painless presentations of aortic dissection. Given recent literature on the increasing prevalence of painless dissection, the disease entity should be included in the differential diagnosis for stroke, and a simple portable chest x-ray should always be obtained prior to administering thrombolytics.
2013-01-01T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/16
https://jdc.jefferson.edu/context/emfp/article/1016/viewcontent/Aortic_Dissection.pdf
https://jdc.jefferson.edu/context/emfp/article/1016/filename/0/type/additional/viewcontent/CT_Head__Figure_1.tif
https://jdc.jefferson.edu/context/emfp/article/1016/filename/1/type/additional/viewcontent/Chest_Xray__Figure_2.tif
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Aortic dissection presenting as gait disturbance
a case report
emergency medicine
Thomas Jefferson University
Emergency Medicine
oai:jdc.jefferson.edu:emfp-1017
2013-05-02T13:47:08Z
publication:em
publication:emfp
publication:jmc
Effect of Iron Chelators on Methemoglobin and Thrombin Preconditioning.
Chen-Roetling, Jing
Sinanan, Jesse
Regan, Raymond F.
Cell loss immediately adjacent to an intracerebral hemorrhage may be mediated in part by the toxicities of extracellular hemoglobin (Hb) and thrombin. However, at low concentrations, these proteins induce tolerance to hemin and iron that may limit further peri-hematomal injury as erythrocyte lysis progresses. The mechanisms mediating these preconditioning effects have not been completely defined, but increased expression of both heme oxygenase (HO)-1 and iron binding proteins likely contributes. In the present study, we hypothesized that iron chelator therapy would attenuate this protective response. Pretreatment of cortical glial cultures (> 90 % GFAP+) with 3 μM methemoglobin (metHb) or 5 units/ml thrombin for 24 h was nontoxic per se, and increased HO-1 and ferritin expression. When challenged with a toxic concentration of hemin, the increase in cellular redox-active iron was attenuated in preconditioned cultures and cell survival was increased. However, if cultures were pretreated with metHb or thrombin plus deferoxamine or 2,2'-bipyridyl, ferritin induction was prevented and cellular redox-active iron increased with hemin treatment. Preconditioning-mediated cytoprotection was consistently reduced by deferoxamine, while 2,2'-bipyridyl had a variable effect. Neither chelator altered HO-1 expression. A cytoprotective response was preserved when chelator therapy was limited to 11 hours of the 24 h preconditioning interval. These results suggest a potentially deleterious effect of continuous iron chelator therapy after ICH. Intermittent therapy may remove peri-hematomal iron without negating the benefits of exposure to low concentrations of Hb or thrombin.
2012-12-01T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/17
https://jdc.jefferson.edu/context/emfp/article/1017/viewcontent/Rubrics.pdf
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Heme
Intracerebral hemorrhage
Iron
Ischemia
Stroke
Subarachnoid hemorrhage
Emergency Medicine
oai:jdc.jefferson.edu:emfp-1018
2013-07-17T17:49:20Z
publication:em
publication:emfp
publication:jmc
Tumor necrosis factor-α and lymphotoxin-α mediate myocardial ischemic injury via TNF receptor 1, but are cardioprotective when activating TNF receptor 2.
Zhang, Yanqing
Zhao, Jianli
Lau, Wayne Bond
Jiao, Li-Yuan
Liu, Baojiang
Yuan, Yuexing
Wang, Xiaoliang
Gao, Erhe
Koch, Walter J
Ma, Xin-Liang
Wang, Yajing
OBJECTIVE: This study determines the roles of tumor necrosis factor-α (TNFα) and lymphotoxin-α (LTα) in post-myocardial infarction (post-MI) cardiac injury, and identifies the TNF receptor type responsible for TNFα- and LTα-mediated cardiac injury.
METHODS AND RESULTS: Adult male wild type (WT), TNFα(-/-), LTα(-/-), TNFR1(-/-), and TNFR2(-/-) mice were subjected to MI via coronary artery occlusion. Functional, histological, and biochemical analyses were performed 1 to 7 days post-MI. In WT mice, MI significantly increased both TNFα and LTα levels in plasma, but in distinct temporal manner. Plasma TNFα peaked 1 day after MI, and decreased toward baseline 3 days after MI. In contrast, plasma LTα became significantly increased 3 days post-MI, and remained elevated thereafter. TNFα deletion significantly improved cardiac function 3 days, but not 7 days, after MI. In contrast, LTα deletion had no effect upon cardiac dysfunction 3 days after MI, but improved cardiac function 7 days after MI. More importantly, knockout of TNFR1 and TNFR2 had opposite effects upon post-MI cardiac dysfunction, which was markedly attenuated by TNFR1 deletion (P
CONCLUSION: Our study demonstrates that TNFα and LTα overproduction contribute to early and late cardiac dysfunction after MI, respectively. We provide clear evidence that both TNFα and LTα mediate post-MI cardiac dysfunction via TNFR1 stimulation, whereas TNFR2 activation is cardioprotective against ischemic injury. Simultaneous inhibition of TNFα and LTα or specific TNFR1 function blockade may represent superior cardioprotective approaches over general TNF activity suppression.
2013-01-01T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/18
https://jdc.jefferson.edu/context/emfp/article/1018/viewcontent/journal.pone.0060227.pdf
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Tumor necrosis factor-α and lymphotoxin-α mediate myocardial ischemic injury via TNF receptor 1
but are cardioprotective when activating TNF receptor 2.
Emergency Medicine
oai:jdc.jefferson.edu:emfp-1019
2013-08-09T15:38:38Z
publication:em
publication:emfp
publication:jmc
publication:surgery
publication:surgeryfp
Rewarming for accidental hypothermia in an urban medical center using extracorporeal membrane oxygenation.
Morley, David
Yamane, Kentaro
O'Malley, Rika
Cavarocchi, Nicholas
Hirose, Hitoshi
BACKGROUND: Accidental hypothermia complicated by cardiac arrest carries a high mortality rate in urban areas. For moderate hypothermia cases conventional rewarming methods are usually adequate, however in severe cases extracorporeal membrane oxygenation (ECMO) is known to provide the most efficient rewarming with complete cardiopulmonary support. We report a case of severe hypothermia complicated by prolonged cardiac arrest successfully resuscitated using ECMO.
CASE REPORT: A 45 year old female was brought to our emergency department with a core body temperature
CONCLUSIONS: This case demonstrates the advantages of advanced internal rewarming techniques, such as ECMO, for quick and efficient rewarming of severely hypothermic patients. This case supports the use of ECMO in severely hypothermic patients as the standard of care.
2013-01-01T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/19
https://jdc.jefferson.edu/context/emfp/article/1019/viewcontent/amjcaserep_14_6.pdf
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
cardiac arrest
extracorporeal membrane oxygenation
hypothermia
rewarming
Emergency Medicine
oai:jdc.jefferson.edu:emfp-1020
2013-08-17T21:03:22Z
publication:em
publication:emfp
publication:jmc
C1q/tumor necrosis factor-related protein-3, a newly identified adipokine, is a novel antiapoptotic, proangiogenic, and cardioprotective molecule in the ischemic mouse heart.
Yi, Wei
Sun, Yang
Yuan, Yuexing
Lau, Wayne Bond
Zheng, Qijun
Wang, Xiaoliang
Wang, Yajing
Shang, Xiying
Gao, Erhe
Koch, Walter J
Ma, Xin-Liang
BACKGROUND: Obesity and diabetes mellitus adversely affect postischemic heart remodeling via incompletely understood mechanisms. C1q/tumor necrosis factor-related protein-3 (CTRP3) is a newly identified adipokine exerting beneficial metabolic regulation, similar to adiponectin. The aim of the present study was to determine whether CTRP3 may regulate postischemic cardiac remodeling and cardiac dysfunction, and, if so, to elucidate the underlying mechanisms.
METHODS AND RESULTS: Male adult mice were subjected to myocardial infarction (MI) via left anterior descending coronary artery occlusion. Both the effect of MI on endogenous CTRP3 expression/production and the effect of exogenous CTRP3 (adenovirus or recombinant CTRP3) replenishment on MI injury were investigated. MI significantly inhibited adipocyte CTRP3 expression and reduced the plasma CTRP3 level, reaching a nadir 3 days after MI. CTRP3 replenishment improved survival rate (P
CONCLUSION: CTRP3 is a novel antiapoptotic, proangiogenic, and cardioprotective adipokine, the expression of which is significantly inhibited after MI.
2012-06-26T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/20
https://jdc.jefferson.edu/context/emfp/article/1020/viewcontent/RefId11464.pdf
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Department of Emergency Medicine
Thomas Jefferson University
Adipokines
Angiogenesis Inducing Agents
Animals
Apoptosis Regulatory Proteins
Cardiotonic Agents
Gene Knockdown Techniques
Human Umbilical Vein Endothelial Cells
Humans
Male
Mice
Mice
Inbred C57BL
Myocardial Ischemia
Random Allocation
Mice, Inbred C57BL
Emergency Medicine
oai:jdc.jefferson.edu:emfp-1021
2013-09-11T20:05:27Z
publication:em
publication:emfp
publication:jmc
Physicians' ability to predict hospital length of stay for patients admitted to the hospital from the emergency department.
Mak, Gregory
Grant, William D
McKenzie, James C
McCabe, John B
Accurate predictions of patient length of stay (LOS) in the hospital can effectively manage hospital resources and increase efficiency of patient care. A study was done to assess emergency medicine physicians' ability of predicting the LOS of patients who enter the hospital through the ER. Results indicate that EM physicians are relatively accurate with their pediatric patients than any other age groups. In addition, as actual hospital LOS increases, the prediction accuracy decreases. Possible reasons may be due increasing medical complications associated with increasing age and this may lead to overall longer stays. Other variables such as the admitted service of the patient are not statistically significant in predicting LOS in this study. Future studies should be done in order to determine other variables that may affect LOS predictions.
2012-01-01T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/21
https://jdc.jefferson.edu/context/emfp/article/1021/viewcontent/EMI2012_824674.pdf
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Physicians' ability to predict hospital length of stay for patients admitted to the hospital from the emergency department.
Emergency Medicine
oai:jdc.jefferson.edu:emfp-1022
2013-09-13T14:15:50Z
publication:em
publication:emfp
publication:jmc
Interactions between CKD and MetS and the Development of CVD.
Aihara, Ken-Ichi
Mogi, Masaki
Shibata, Rei
Bishop-Bailey, David
Ma, Xin-Liang
Metabolic syndrome (MetS) consists of a combination of metabolic disorders, including increased abdominal circumference, hyperglycemia, elevated blood pressure, and lipid disorders. MetS is now widely accepted as a crucial risk factor for the development of cardiovascular disease (CVD) and mortality. In addition, persistent proteinuria indicating chronic kidney disease (CKD) is well known as a powerful risk factor for the progression of end-stage renal disease and CVD. In recent years, patients with CKD and MetS appear to be increasing along with increasing incidence of CVD in industrial countries.
2011-01-01T08:00:00Z
article
https://jdc.jefferson.edu/emfp/22
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3099205/
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Interactions between CKD and MetS and the Development of CVD.
Emergency Medicine
oai:jdc.jefferson.edu:emfp-1023
2013-09-28T22:11:48Z
publication:em
publication:emfp
publication:jmc
Inhibition of Fas-Associated Death Domain-Containing Protein (FADD) Protects against Myocardial Ischemia/Reperfusion Injury in a Heart Failure Mouse Model.
Fan, Qian
Huang, Zheng M
Boucher, Matthieu
Shang, Xiying
Zuo, Lin
Brinks, Henriette
Lau, Wayne Bond
Zhang, Jianke
Chuprun, J Kurt
Gao, Erhe
AIM: As technological interventions treating acute myocardial infarction (MI) improve, post-ischemic heart failure increasingly threatens patient health. The aim of the current study was to test whether FADD could be a potential target of gene therapy in the treatment of heart failure.
METHODS: Cardiomyocyte-specific FADD knockout mice along with non-transgenic littermates (NLC) were subjected to 30 minutes myocardial ischemia followed by 7 days of reperfusion or 6 weeks of permanent myocardial ischemia via the ligation of left main descending coronary artery. Cardiac function were evaluated by echocardiography and left ventricular (LV) catheterization and cardiomyocyte death was measured by Evans blue-TTC staining, TUNEL staining, and caspase-3, -8, and -9 activities. In vitro, H9C2 cells transfected with ether scramble siRNA or FADD siRNA were stressed with chelerythrin for 30 min and cleaved caspase-3 was assessed.
RESULTS: FADD expression was significantly decreased in FADD knockout mice compared to NLC. Ischemia/reperfusion (I/R) upregulated FADD expression in NLC mice, but not in FADD knockout mice at the early time. FADD deletion significantly attenuated I/R-induced cardiac dysfunction, decreased myocardial necrosis, and inhibited cardiomyocyte apoptosis. Furthermore, in 6 weeks long term permanent ischemia model, FADD deletion significantly reduced the infarct size (from 41.20±3.90% in NLC to 26.83±4.17% in FADD deletion), attenuated myocardial remodeling, improved cardiac function and improved survival. In vitro, FADD knockdown significantly reduced chelerythrin-induced the level of cleaved caspase-3.
CONCLUSION: Taken together, our results suggest FADD plays a critical role in post-ischemic heart failure. Inhibition of FADD retards heart failure progression. Our data supports the further investigation of FADD as a potential target for genetic manipulation in the treatment of heart failure.
2013-09-13T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/23
https://jdc.jefferson.edu/context/emfp/article/1023/viewcontent/RefID13325.pdf
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Deparment of Emergency Medicine
Department of Microbiology and Immunology
Thomas Jefferson University
Fas-Associated Death Domain-Containing Protein (FADD)
Myocardial Ischemia/Reperfusion Injury
Emergency Medicine
oai:jdc.jefferson.edu:emfp-1024
2013-10-04T13:45:38Z
publication:em
publication:emfp
publication:jmc
Myopericarditis diagnosed by a 64-slice coronary CT angiography "triple rule out" protocol.
Takakuwa, Kevin M
Ku, Bon S.
Halpern, Ethan J
We report a case of myopericarditis in a 30-year-old male complaining of shortness of breath. In an emergency department (ED) setting, the symptoms of myopericarditis may overlap with many disease entities and can be a challenging diagnosis to make. However, with the use of a 64-section coronary CT angiography in a "triple rule out" (TRO) protocol, we were able to detect a large pericardial effusion surrounding the heart and moderate global hypokinesis in the setting of normal-sized heart chambers and normal coronary arteries. We were further able to exclude pulmonary embolism and thoracic dissection. This is the first reported case of diagnosing myopericarditis using a TRO protocol. It demonstrates the usefulness of TRO in making an emergent diagnosis of myopericarditis while excluding other life-threatening diseases that can lead to earlier appropriate ED disposition and care.
2010-08-01T07:00:00Z
article
https://jdc.jefferson.edu/emfp/24
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
CT angiography
Myocarditis
Myopericarditis
Pericarditis
Sixty-four section
Triple rule-out
Emergency Medicine
oai:jdc.jefferson.edu:emfp-1025
2013-10-18T14:03:24Z
publication:em
publication:emfp
publication:jmc
Intermedin protects against myocardial ischemia-reperfusion injury in diabetic rats.
Li, Hong
Bian, Yunfei
Zhang, Nana
Guo, Jia
Wang, Cheng
Lau, Wayne Bond
Xiao, Chuanshi
BACKGROUND: Diabetic patients, through incompletely understood mechanisms, endure exacerbated ischemic heart injury compared to non-diabetic patients. Intermedin (IMD) is a novel calcitonin gene-related peptide (CGRP) superfamily member with established cardiovascular protective effects. However, whether IMD protects against diabetic myocardial ischemia/reperfusion (MI/R) injury is unknown. METHODS: Diabetes was induced by streptozotocin in Sprague--Dawley rats. Animals were subjected to MI via left circumflex artery ligation for 30 minutes followed by 2 hours R. IMD was administered formally 10 minutes before R. Outcome measures included left ventricular function, oxidative stress, cellular death, infarct size, and inflammation. RESULTS: IMD levels were significantly decreased in diabetic rats compared to control animals. After MI/R, diabetic rats manifested elevated intermedin levels, both in plasma (64.95 +/- 4.84 pmol/L, p < 0.05) and myocardial tissue (9.8 +/- 0.60 pmol/L, p < 0.01) compared to pre-MI control values (43.62 +/- 3.47 pmol/L and 4.4 +/- 0.41). IMD administration to diabetic rats subjected to MI/R decreased oxidative stress product generation, apoptosis, infarct size, and inflammatory cytokine release (p < 0.05 or p < 0.01). CONCLUSIONS: By reducing oxidative stress, inflammation, and apoptosis, IMD may represent a promising novel therapeutic target mitigating diabetic ischemic heart injury.
2013-06-18T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/25
https://jdc.jefferson.edu/context/emfp/article/1025/viewcontent/1475_2840_12_91.pdf
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Intermedin protects against myocardial ischemia-reperfusion injury in diabetic rats.
Emergency Medicine
oai:jdc.jefferson.edu:emfp-1026
2013-10-22T13:58:28Z
publication:em
publication:emfp
publication:jmc
Clinician-performed Beside Ultrasound for the Diagnosis of Traumatic Pneumothorax.
Ku, Bon S.
Fields, Jason M
Carr, Brendan
Everett, Worth W
Gracias, Vincent H
Dean, Anthony J
INTRODUCTION: Prior studies have reported conflicting results regarding the utility of ultrasound in the diagnosis of traumatic pneumothorax (PTX) because they have used sonologists with extensive experience. This study evaluates the characteristics of ultrasound for PTX for a large cohort of trauma and emergency physicians.
METHODS: This was a prospective, observational study on a convenience sample of patients presenting to a trauma center who had a thoracic ultrasound (TUS) evaluation for PTX performed after the Focused Assessment with Sonography for Trauma exam. Sonologists recorded their findings prior to any other diagnostic studies. The results of TUS were compared to one or more of the following: chest computed tomography, escape of air on chest tube insertion, or supine chest radiography followed by clinical observation.
RESULTS: There were 549 patients enrolled. The median injury severity score of the patients was 5 (inter-quartile range [IQR] 1-14); 36 different sonologists performed TUS. Forty-seven of the 549 patients had traumatic PTX, for an incidence of 9%. TUS correctly identified 27/47 patients with PTX for a sensitivity of 57% (confidence interval [CI] 42-72%). There were 3 false positive cases of TUS for a specificity of 99% (CI 98%-100%). A "wet" chest radiograph reading done in the trauma bay showed a sensitivity of 40% (CI 23-59) and a specificity of 100% (99-100).
CONCLUSION: In a large heterogenous group of clinicians who typically care for trauma patients, the sonographic evaluation for pneumothorax was as accurate as supine chest radiography. Thoracic ultrasound may be helpful in the initial evaluation of patients with truncal trauma.
2013-03-01T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/26
https://jdc.jefferson.edu/context/emfp/article/1026/viewcontent/wjem_14_103.pdf
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Clinician-performed Beside Ultrasound for the Diagnosis of Traumatic Pneumothorax
Emergency Medicine
oai:jdc.jefferson.edu:emfp-1027
2013-11-11T15:16:16Z
publication:em
publication:emfp
publication:jmc
Increased expression of pigment epithelium-derived factor in aged mesenchymal stem cells impairs their therapeutic efficacy for attenuating myocardial infarction injury.
Liang, Hongliang
Hou, Huiyuan
Yi, Wei
Yang, Guodong
Gu, Chunhu
Lau, Wayne Bond
Gao, Erhe
Ma, Xinliang
Lu, Zifan
Wei, Xufeng
Pei, Jianming
Yi, Dinghua
AIMS: Mesenchymal stem cells (MSCs) can ameliorate myocardial infarction (MI) injury. However, older-donor MSCs seem less efficacious than those from younger donors, and the contributing underlying mechanisms remain unknown. Here, we determine how age-related expression of pigment epithelium-derived factor (PEDF) affects MSC therapeutic efficacy for MI.
METHODS AND RESULTS: Reverse transcriptase-polymerized chain reaction and enzyme-linked immunosorbent assay analyses revealed dramatically increased PEDF expression in MSCs from old mice compared to young mice. Morphological and functional experiments demonstrated significantly impaired old MSC therapeutic efficacy compared with young MSCs in treatment of mice subjected to MI. Immunofluorescent staining demonstrated that administration of old MSCs compared with young MSCs resulted in an infarct region containing fewer endothelial cells, vascular smooth muscle cells, and macrophages, but more fibroblasts. Pigment epithelium-derived factor overexpression in young MSCs impaired the beneficial effects against MI injury, and induced cellular profile changes in the infarct region similar to administration of old MSCs. Knocking down PEDF expression in old MSCs improved MSC therapeutic efficacy, and induced a cellular profile similar to young MSCs administration. Studies in vitro showed that PEDF secreted by MSCs regulated the proliferation and migration of cardiac fibroblasts.
CONCLUSIONS: This is the first evidence that paracrine factor PEDF plays critical role in the regulatory effects of MSCs against MI injury. Furthermore, the impaired therapeutic ability of aged MSCs is predominantly caused by increased PEDF secretion. These findings indicate PEDF as a promising novel genetic modification target for improving aged MSC therapeutic efficacy.
2013-06-01T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/27
https://jdc.jefferson.edu/context/emfp/article/1027/viewcontent/ehr131.pdf
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Mesenchymal stem cells
Myocardial infarction
Paracrine
Pigment epithelium-derived factor
Emergency Medicine
oai:jdc.jefferson.edu:emfp-1028
2013-11-20T18:13:56Z
publication:em
publication:emfp
publication:jmc
Ginsenoside Rd attenuates myocardial ischemia/reperfusion injury via Akt/GSK-3β signaling and inhibition of the mitochondria-dependent apoptotic pathway.
Wang, Yang
Li, Xu
Wang, Xiaoliang
Lau, Wayne Bond
Wang, Yajing
Xing, Yuan
Zhang, Xing
Ma, Xinliang
Gao, Feng
Evidence suggests Ginsenoside Rd (GSRd), a biologically active extract from the medical plant Panax Ginseng, exerts antioxidant effect, decreasing reactive oxygen species (ROS) formation. Current study determined the effect of GSRd on myocardial ischemia/reperfusion (MI/R) injury (a pathological condition where ROS production is significantly increased) and investigated the underlying mechanisms. The current study utilized an in vivo rat model of MI/R injury and an in vitro neonatal rat cardiomyocyte (NRC) model of simulated ischemia/reperfusion (SI/R) injury. Infarct size was measured by Evans blue/TTC double staining. NRC injury was determined by MTT and lactate dehydrogenase (LDH) leakage assay. ROS accumulation and apoptosis were assessed by flow cytometry. Mitochondrial membrane potential (MMP) was determined by 5, 5', 6, 6'-tetrachloro-1, 1', 3, 3'-tetrathylbenzimidazol carbocyanine iodide (JC-1). Cytosolic translocation of mitochondrial cytochrome c and expression of caspase-9, caspase-3, Bcl-2 family proteins, and phosphorylated Akt and GSK-3β were determined by western blot. Pretreatment with GSRd (50 mg/kg) significantly augmented rat cardiac function, as evidenced by increased left ventricular ejection fraction (LVEF) and ±dP/dt. GSRd reduced myocardial infarct size, apoptotic cell death, and blood creatine kinase/lactate dehydrogenase levels after MI/R. In NRCs, GSRd (10 µM) inhibited SI/R-induced ROS generation (P
2013-01-01T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/28
https://jdc.jefferson.edu/context/emfp/article/1028/viewcontent/pone.0070956.pdf
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Ginsenoside Rd attenuates myocardial ischemia/reperfusion injury via Akt/GSK-3β signaling and inhibition of the mitochondria-dependent apoptotic pathway
Thomas Jefferson University
Emergency Medicine
oai:jdc.jefferson.edu:emfp-1029
2013-11-27T01:35:25Z
publication:em
publication:emfp
publication:jmc
CREG promotes the proliferation of human umbilical vein endothelial cells through the ERK/cyclin E signaling pathway.
Tao, Jie
Yan, Chenghui
Tian, Xiaoxiang
Liu, Shaowei
Li, Yang
Zhang, Jian
Sun, Mingyu
Ma, Xinliang
Han, Yaling
Cellular repressor of E1A-stimulated genes (CREG) is a recently discovered secreted glycoprotein involved in homeostatic modulation. We previously reported that CREG is abundantly expressed in the adult vascular endothelium and dramatically downregulated in atherosclerotic lesions. In addition, CREG participates in the regulation of apoptosis, inflammation and wound healing of vascular endothelial cells. In the present study, we attempted to investigate the effect of CREG on the proliferation of vascular endothelial cells and to decipher the underlying molecular mechanisms. Overexpression of CREG in human umbilical vein endothelial cells (HUVEC) was obtained by infection with adenovirus carrying CREG. HUVEC proliferation was investigated by flow cytometry and 5-bromo-2'-deoxy-uridine (BrdU) incorporation assays. The expressions of cyclins, cyclin-dependent kinases and signaling molecules were also examined. In CREG-overexpressing cells, we observed a marked increase in the proportion of the S and G2 population and a decrease in the G0/G1 phase population. The number of BrdU positively-stained cells also increased, obviously. Furthermore, silencing of CREG expression by specific short hairpin RNA effectively inhibited the proliferation of human umbilical vein endothelial cells (HUVEC). CREG overexpression induced the expression of cyclin E in both protein and mRNA levels to regulate cell cycle progression. Further investigation using inhibitor blocking analysis identified that ERK activation mediated the CREG modulation of the proliferation and cyclin E expression in HUVEC. In addition, blocking vascular endothelial growth factor (VEGF) in CREG-overexpressed HUVEC and supplementation of VEGF in CREG knocked-down HUVEC identified that the pro-proliferative effect of CREG was partially mediated by VEGF-induced ERK/cyclin E activation. These results suggest a novel role of CREG to promote HUVEC proliferation through the ERK/cyclin E signaling pathway.
2013-09-06T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/29
https://jdc.jefferson.edu/context/emfp/article/1029/viewcontent/PDF11.pdf
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
article; cell cycle G0 phase; cell cycle G1 phase; cell cycle G2 phase; cell cycle S phase; cell proliferation; controlled study; CREG gene; flow cytometry; gene; gene overexpression; gene silencing; human; human cell; protein function; protein secretion; signal transduction; umbilical vein endothelial cell
Emergency Medicine
oai:jdc.jefferson.edu:emfp-1030
2014-02-03T19:15:21Z
publication:em
publication:emfp
publication:jmc
Early quick acuity score provides more complete data on emergency department walkouts.
Lovett, MD, Paris B
Kahn, MD, J Akiva
Greene, MD, Stuart E
Bloch, MD, Matthew A
Brandt, MD, Daniel R
Minckler, MD, Michael R
INTRODUCTION: Many prior studies have compared the acuity of Emergency Department (ED) patients who have Left Without Being Seen (LWBS) against non-LWBS patients. A weakness in these studies is that patients may walk out prior to the assignment of a triage score, biasing comparisons. We report an operational change whereby acuity was assessed immediately upon patient arrival. We hypothesized more patients would receive acuity scores with EQAS. We also sought to compare LWBS and non-LWBS patient characteristics with reduced bias.
SETTING: urban, academic medical center. Retrospective cohort study, electronic chart review, collecting data on all ED patients presenting between 4/1/2010 and 10/31/2011 ("Traditional Acuity Score" period, TAS) and from 11/1/2011 to 3/31/2012 ("Early Quick Acuity Score" period, EQAS). We recorded disposition (LWBS versus non-LWBS), acuity and demographics. For each subject during the EQAS period, we calculated how many prior ED visits and how many prior walkouts the subject had had during the TAS period.
RESULTS: Acuity was recorded in 92,275 of 94,526 patients (97.6%) for TAS period, and 25,577 of 25,760 patients (99.3%) for EQAS period, a difference of 1.7% (1.5%, 1.8%). LWBS patients had acuity scores recorded in 5,180 of 7,040 cases (73.6%) during TAS period, compared with 897 of 1,010 cases (88.8%) during the EQAS period, a difference of 15.2% (14.8%, 15.7%). LWBS were more likely than non-LWBS to be male, were younger and had lower acuity scores. LWBS averaged 5.3 prior ED visits compared with 2.8 by non-LWBS, a difference of 2.5 (1.5, 3.5). LWBS averaged 1.3 prior ED walkouts compared with 0.2 among non-LWBS, a difference of 1.1 (0.8, 1.3).
CONCLUSIONS: EQAS resulted in a higher proportion of patients receiving acuity scores, particularly among LWBS. This offers more complete data when comparing LWBS and non-LWBS patient characteristics. The comparison reinforced findings from prior studies.
2014-01-17T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/30
https://jdc.jefferson.edu/context/emfp/article/1030/viewcontent/pone.0085776.pdf
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Early quick acuity score provides more complete data on emergency department walkouts
Emergency Medicine
oai:jdc.jefferson.edu:emfp-1031
2014-03-12T20:17:01Z
publication:em
publication:emfp
publication:jmc
Social media guidelines and best practices: recommendations from the council of residency directors social media task force.
Pillow, Malford T
Hopson, Laura
Bond, Michael
Cabrera, Daniel
Patterson, Leigh
Pearson, David
Sule, Harsh P., MD
Ankel, Felix
Fernández-Frackelton, Madonna
Hall, R.
Kegg, Jason A
Norris, Donald
Takenaka, Katrin
Social media has become a staple of everyday life among over one billion people worldwide. A social networking presence has become a hallmark of vibrant and transparent communications. It has quickly become the preferred method of communication and information sharing. It offers the ability for various entities, especially residency programs, to create an attractive internet presence and "brand" the program. Social media, while having significant potential for communication and knowledge transfer, carries with it legal, ethical, personal, and professional risks. Implementation of a social networking presence must be deliberate, transparent, and optimize potential benefits while minimizing risks. This is especially true with residency programs. The power of social media as a communication, education, and recruiting tool is undeniable. Yet the pitfalls of misuse can be disastrous, including violations in patient confidentiality, violations of privacy, and recruiting misconduct. These guidelines were developed to provide emergency medicine residency programs leadership with guidance and best practices in the appropriate use and regulation of social media, but are applicable to all residency programs that wish to establish a social media presence.
2014-02-01T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/31
https://jdc.jefferson.edu/context/emfp/article/1031/viewcontent/wjem_15_26.pdf
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Thomas Jefferson University
Education
Emergency medicine
Social media
Social networking
Emergency Medicine
oai:jdc.jefferson.edu:emfp-1032
2014-04-23T15:29:13Z
publication:em
publication:emfp
publication:jmc
BMP-2 overexpression augments vascular smooth muscle cell motility by upregulating myosin Va via Erk signaling
Zhang, Ming
Yang, Min
Liu, Liping
Lau, Wayne Bond
Gao, Hai
Xin, Mankun
Su, Lixiao
Wang, Jian
Cheng, Shujuan
Fan, Qian
Liu, Jinghua
Background. The disruption of physiologic vascular smooth muscle cell (VSMC) migration initiates atherosclerosis development. The biochemical mechanisms leading to dysfunctional VSMC motility remain unknown. Recently, cytokine BMP-2 has been implicated in various vascular physiologic and pathologic processes. However, whether BMP-2 has any effect upon VSMC motility, or by what manner, has never been investigated. Methods. VSMCs were adenovirally transfected to genetically overexpress BMP-2. VSMC motility was detected by modified Boyden chamber assay, confocal time-lapse video assay, and a colony wounding assay. Gene chip array and RT-PCR were employed to identify genes potentially regulated by BMP-2. Western blot and real-time PCR detected the expression of myosin Va and the phosphorylation of extracellular signal-regulated kinases 1/2 (Erk1/2). Immunofluorescence analysis revealed myosin Va expression locale. Intracellular Ca2+ oscillations were recorded. Results. VSMC migration was augmented in VSMCs overexpressing BMP-2 in a dose-dependent manner. siRNA-mediated knockdown of myosin Va inhibited VSMC motility. Both myosin Va mRNA and protein expression significantly increased after BMP-2 administration and were inhibited by Erk1/2 inhibitor U0126. BMP-2 induced Ca2+ oscillations, generated largely by a "cytosolic oscillator". Conclusion. BMP-2 significantly increased VSMCs migration and myosin Va expression, via the Erk signaling pathway and intracellular Ca 2+ oscillations. We provide additional insight into the pathophysiology of atherosclerosis, and inhibition of BMP-2-induced myosin Va expression may represent a potential therapeutic strategy. © 2014 Ming Zhang et al.
2014-01-01T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/32
https://jdc.jefferson.edu/context/emfp/article/1032/viewcontent/294150.pdf
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Thomas Jefferson University
vascular smooth muscle cell (VSMC)
RT-PCR
BMP-2
Medical Cell Biology
oai:jdc.jefferson.edu:emfp-1033
2014-07-09T14:43:14Z
publication:em
publication:emfp
publication:jmc
Pediatric emergency medical care in Yerevan, Armenia: a knowledge and attitudes survey of out-of-hospital emergency physicians.
Baghdassarian, Aline A.
Donaldson, Ross I.
Depiero, Andrew D
Chernett, Nancy L
Sule, Harsh P., MD
BACKGROUND: Out-of-hospital emergency care is at an early stage of development in Armenia, with the current emergency medical services (EMS) system having emergency physicians (EPs) work on ambulances along with nurses. While efforts are underway by the Ministry of Health and other organizations to reform the EMS system, little data exists on the status of pediatric emergency care (PEC) in the country. We designed this study to evaluate the knowledge and attitudes of out-of-hospital emergency physicians in pediatric rapid assessment and resuscitation, and identify areas for PEC improvement.
METHODS: We distributed an anonymous, self-administered Knowledge and Attitudes survey to a convenience sample of out-of-hospital EPs in the capital, Yerevan, from August to September 2012.
RESULTS: With a response rate of 80%, the majority (89.7%) of respondents failed a 10-question knowledge test (with a pre-defined passing score of ≥7) with a mean score of 4.17 ± 1.99 SD. Answers regarding the relationship between pediatric cardiac arrest and respiratory issues, compression-to-ventilation ratio in neonates, definition of hypotension, and recognition of shock were most frequently incorrect. None of the participants had attended pediatric-specific continuing medical education (CME) activities within the preceding 5 years. χ2 analysis demonstrated no statistically significant association between physician age, length of EMS experience, type of ambulance (general vs. resuscitation/critical care), or CME attendance and pass/fail status. The majority of participants agreed that PEC education in Armenia needs improvement (98%), that there is a need for pediatric-specific CME (98%), and that national out-of-hospital PEC guidelines would increase PEC safety, efficiency, and effectiveness (96%).
CONCLUSIONS: Out-of-hospital emergency physicians in Yerevan, Armenia are deficient in pediatric-specific emergency assessment and resuscitation knowledge and training, but express a clear desire for improvement. There is a need to support additional PEC training and CME within the EMS system in Armenia.
2014-12-01T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/33
https://jdc.jefferson.edu/context/emfp/article/1033/viewcontent/Emergency_Medicine.pdf
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Department of Emergency Medicine
Jefferson School of Population Health
Jefferson Medical College
Thomas Jefferson University
adult; aged; ambulance; Armenia; article; child care; clinical assessment; controlled study; emergency care; emergency health service; emergency physician; female; health care survey; heart arrest; human; hypotension; intensive care; lung ventilation; major clinical study; male; medical education; middle aged; physician attitude; practice guideline; priority journal; professional knowledge; recognition; respiratory tract disease; resuscitation; risk assessment; scoring system; shock; young adult
Emergency Medicine
oai:jdc.jefferson.edu:emfp-1034
2014-09-29T00:23:23Z
publication:em
publication:emfp
publication:jmc
Neuroprotective effect of heme oxygenase-2 knockout in the blood injection model of intracerebral hemorrhage.
Chen-Roetling, Jing
Cai, Ying
Regan, Raymond F
BACKGROUND: The toxicity of heme breakdown products may contribute to the pathogenesis of intracerebral hemorrhage (ICH). Heme catabolism is catalyzed by the heme oxygenase enzymes. We have previously reported that heme oxygenase-2 (HO-2), the constitutive isoform, protects neurons from hemin in vitro and reduces oxidative stress after striatal blood injection. In order to further evaluate HO-2 as a therapeutic target, we tested the hypothesis that HO-2 gene deletion protects neurons and attenuates behavioral deficits after ICH.
FINDINGS: Injection of 20 μl blood into the right striatum of HO-2 wild-type mice resulted in loss of approximately one third of striatal neurons 4-8 days later. Neuronal survival was significantly increased in HO-2 knockout mice at both time points. This was associated with reduced motor deficit as detected by the corner test; however, no differences were detected in spontaneous activity or the adhesive removal or elevated body swing tests.
CONCLUSION: HO-2 knockout attenuates perihematomal neuron loss in the blood injection ICH model, but has a weak and variable effect on neurological outcome.
2014-08-22T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/34
https://jdc.jefferson.edu/context/emfp/article/1034/viewcontent/ICH_pdf.pdf
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Department of Emergency Medicine
Thomas Jefferson University
heme oxygenase-2
intracerebral hemorrhage
ICH
Emergency Medicine
oai:jdc.jefferson.edu:emfp-1035
2014-11-01T20:17:04Z
publication:em
publication:emfp
publication:jmc
Curcumin-Induced Heme Oxygenase-1 Expression Prevents H2O2-Induced Cell Death in Wild Type and Heme Oxygenase-2 Knockout Adipose-Derived Mesenchymal Stem Cells.
Cremers, Niels A J
Lundvig, Ditte M S
van Dalen, Stephanie C M
Schelbergen, Rik F
van Lent, Peter L E M
Szarek, Walter A
Regan, Raymond F.
Carels, Carine E
Wagener, Frank A D T G
Mesenchymal stem cell (MSC) administration is a promising adjuvant therapy to treat tissue injury. However, MSC survival after administration is often hampered by oxidative stress at the site of injury. Heme oxygenase (HO) generates the cytoprotective effector molecules biliverdin/bilirubin, carbon monoxide (CO) and iron/ferritin by breaking down heme. Since HO-activity mediates anti-apoptotic, anti-inflammatory, and anti-oxidative effects, we hypothesized that modulation of the HO-system affects MSC survival. Adipose-derived MSCs (ASCs) from wild type (WT) and HO-2 knockout (KO) mice were isolated and characterized with respect to ASC marker expression. In order to analyze potential modulatory effects of the HO-system on ASC survival, WT and HO-2 KO ASCs were pre-treated with HO-activity modulators, or downstream effector molecules biliverdin, bilirubin, and CO before co-exposure of ASCs to a toxic dose of H2O2. Surprisingly, sensitivity to H2O2-mediated cell death was similar in WT and HO-2 KO ASCs. However, pre-induction of HO-1 expression using curcumin increased ASC survival after H2O2 exposure in both WT and HO-2 KO ASCs. Simultaneous inhibition of HO-activity resulted in loss of curcumin-mediated protection. Co-treatment with glutathione precursor N-Acetylcysteine promoted ASC survival. However, co-incubation with HO-effector molecules bilirubin and biliverdin did not rescue from H2O2-mediated cell death, whereas co-exposure to CO-releasing molecules-2 (CORM-2) significantly increased cell survival, independently from HO-2 expression. Summarizing, our results show that curcumin protects via an HO-1 dependent mechanism against H2O2-mediated apoptosis, and likely through the generation of CO. HO-1 pre-induction or administration of CORMs may thus form an attractive strategy to improve MSC therapy.
2014-10-08T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/35
https://jdc.jefferson.edu/context/emfp/article/1035/viewcontent/molecular_sciences.pdf
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Department of Emergency Medicine
Thomas Jefferson University
Adipose-derived mesenchymal stem cells; Apoptosis; Carbon monoxide; Heme oxygenase; Oxidative stress
Emergency Medicine
oai:jdc.jefferson.edu:emfp-1036
2014-11-23T21:31:30Z
publication:em
publication:emfp
publication:jmc
Thioredoxin reductase was nitrated in the aging heart after myocardial ischemia/reperfusion.
Wang, Ke
Zhang, Jie
Wang, Xiaoliang
Liu, Xin
Zuo, Lin
Bai, Kehua
Shang, Jianyu
Ma, Lu
Liu, Teng
Wang, Li
Wang, Wen
Ma, Xin-Liang
Liu, Huirong
The age-related loss of anti-oxidant defense reduces recovery from myocardial ischemia/reperfusion injury (MI/R) in aged people. Our previous data showed that inactivation of thioredoxin (Trx) was involved in enhanced aging MI/R injury. Thioredoxin reductase (TrxR), the enzyme known to regulate Trx, is less efficient with age. The aim of the current study was to determine why TrxR activity was reduced and whether reduced TrxR activity contributed to enhanced aging MI/R injury. Both Trx and TrxR activity were decreased in the aging heart, and this difference was further amplified after MI/R. However, MI/R injury did not change TrxR expression between young and aging rats. Increased nitrogen oxide (NOx) but decreased nitric oxide (NO) bioavailability (decreased phosphorylated vasodilator-stimulated phosphoprotein) was observed in aging hearts. Peroxynitrite (ONOO⁻) was increased in aging hearts and was further amplified after MI/R. TrxR nitration in young and aging hearts was detected by immunoprecipitation (anti-nitrotyrosine) followed by immunoblotting (anti-TrxR). Compared with young hearts, TrxR nitration was increased in the aging hearts, and this was further intensified after MI/R. The ONOO⁻ decomposition catalyst (FeTMPyp) reduced TrxR nitration and increased TrxR and Trx activity. More importantly, FeTMPyp attenuated the MI/R injury in aging hearts as evidenced by decreased caspase-3 and malondialdehyde (MDA) concentration and increased cardiac function. Increased ONOO⁻ nitrated TrxR in the aging heart as a post-translational modification, which may be related to the enhanced MI/R injury of aging rats. Interventions that inhibit nitration and restore TrxR activity might be a therapy for attenuating enhanced MI/R injury in aging heart.
2013-10-01T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/36
https://jdc.jefferson.edu/context/emfp/article/1036/viewcontent/Thioredoxin.pdf
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Department of Emergency Medicine
Thomas Jefferson University
Animals
Biocatalysis
Cardiotonic Agents
Enzyme Activation
Male
Metalloporphyrins
Myocardial Reperfusion Injury
Myocardium
Nitrosation
Peroxynitrous Acid
Rats
Rats
Sprague-Dawley
Thioredoxin-Disulfide Reductase
Rats, Sprague-Dawley
Emergency Medicine
oai:jdc.jefferson.edu:emfp-1037
2015-03-07T21:48:10Z
publication:em
publication:emfp
publication:jmc
Hemin uptake and release by neurons and glia.
Chen-Roetling, Jing
Cai, Ying
Lu, X
Regan, Raymond F.
Hemin accumulates in intracerebral hematomas and may contribute to cell injury in adjacent tissue. Despite its relevance to hemorrhagic CNS insults, very little is known about hemin trafficking by neural cells. In the present study, hemin uptake and release were quantified in primary murine cortical cultures, and the effect of the hemin-binding compound deferoxamine (DFO) was assessed. Net uptake of (55)Fe-hemin was similar in mixed neuron-glia, neuron, and glia cultures, but was 2.6-3.6-fold greater in microglia cultures. After washout, 40-60% of the isotope signal was released by mixed neuron-glia cultures into albumin-containing medium within 24 h. Inhibiting hemin breakdown with tin protoporphyrin IX (SnPPIX) had minimal effect, while release of the fluorescent hemin analog zinc mesoporphyrin was quantitatively similar to that of (55)Fe-hemin. Isotope was released most rapidly by neurons (52.2 ± 7.2% at 2 h), compared with glia (15.6 ± 1.3%) and microglia (17.6 ± 0.54%). DFO did not alter (55)Fe-hemin uptake, but significantly increased its release. Mixed cultures treated with 10 μM hemin for 24 h sustained widespread neuronal loss that was attenuated by DFO. Concomitant treatment with SnPPIX had no effect on either enhancement of isotope release by DFO or neuroprotection. These results suggest that in the presence of a physiologic albumin concentration, hemin uptake by neural cells is followed by considerable extracellular release. Enhancement of this release by DFO may contribute to its protective effect against hemin toxicity.
2014-02-01T08:00:00Z
article
https://jdc.jefferson.edu/emfp/37
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3891506/
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Department of Emergency Medicine
Thomas Jefferson University
Animals
Cells
Cultured
Cerebral Hemorrhage
Chelating Agents
Deferoxamine
Erythrocytes
Heme Oxygenase (Decyclizing)
Hemin
Metalloporphyrins
Mice
Neuroglia
Neurons
Neuroprotective Agents
Primary Cell Culture
Protoporphyrins
Cells, Cultured
Emergency Medicine
oai:jdc.jefferson.edu:emfp-1038
2015-05-27T01:52:59Z
publication:em
publication:emfp
publication:jmc
Adiponectin attenuates lung fibroblasts activation and pulmonary fibrosis induced by paraquat.
Yao, Rong
Cao, Yu
He, Ya-Rong
Lau, Wayne Bond
Zeng, Zhi
Liang, Zong-An
Pulmonary fibrosis is one of the most common complications of paraquat (PQ) poisoning, which demands for more effective therapies. Accumulating evidence suggests adiponectin (APN) may be a promising therapy against fibrotic diseases. In the current study, we determine whether the exogenous globular APN isoform protects against pulmonary fibrosis in PQ-treated mice and human lung fibroblasts, and dissect the responsible underlying mechanisms. BALB/C mice were divided into control group, PQ group, PQ + low-dose APN group, and PQ + high-dose APN group. Mice were sacrificed 3, 7, 14, and 21 days after PQ treatment. We compared pulmonary histopathological changes among different groups on the basis of fibrosis scores, TGF-β1, CTGF and α-SMA pulmonary content via Western blot and real-time quantitative fluorescence-PCR (RT-PCR). Blood levels of MMP-9 and TIMP-1 were determined by ELISA. Human lung fibroblasts WI-38 were divided into control group, PQ group, APN group, and APN receptor (AdipoR) 1 small-interfering RNA (siRNA) group. Fibroblasts were collected 24, 48, and 72 hours after PQ exposure for assay. Cell viability and apoptosis were determined via Kit-8 (CCK-8) and fluorescein Annexin V-FITC/PI double labeling. The protein and mRNA expression level of collagen type III, AdipoR1, and AdipoR2 were measured by Western blot and RT-PCR. APN treatment significantly decreased the lung fibrosis scores, protein and mRNA expression of pulmonary TGF-β1, CTGF and α-SMA content, and blood MMP-9 and TIMP-1 in a dose-dependent manner (p
2015-05-06T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/38
https://jdc.jefferson.edu/context/emfp/article/1038/viewcontent/adiponectin.pdf
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Emergency Medicine Department
Thomas Jefferson University Hospital
Adiponectin
lung fibroblasts
pulmonary fibrosis
paraquat
Emergency Medicine
oai:jdc.jefferson.edu:emfp-1039
2015-11-14T22:08:45Z
publication:em
publication:emfp
publication:jmc
Change over time in brain serotonin transporter binding in major depression: effects of therapy measured with [(123) I]-ADAM SPECT.
Amsterdam, Jay D
Newberg, MD, Andrew B.
Newman, Cory F
Shults, Justine
Wintering, Nancy
Soeller, Irene
Several studies have reported low brain serotonin transporter (SERT) binding in individuals with major depression. We hypothesized that the SERT standardized uptake ratio (SUR) values using [(123) I]-ADAM single photon emission computed tomography would increase in depressed subjects who responded to cognitive behavior therapy (CBT) compared to CBT nonresponders. [(123) I]-ADAM scans were acquired before and after 12 weeks of CBT from 20 depressed subjects and on two occasions 12 weeks apart from 10 nondepressed, healthy volunteers. The primary outcome measure was change over time in SUR values in the midbrain, medial temporal lobe, and basal ganglia regions. Depressed subjects demonstrated low pretreatment mean SUR values that significantly increased over time in the midbrain (P = .011), right medial temporal lobe (P = .008), and left medial temporal lobe (P = .000) regions. Treatment responders showed a significant increase over time in SUR values in left medial temporal lobe (P = .029) and right medial temporal lobe (P = .007) regions. Partial and nonresponder subjects also showed a significant increase over time in SUR values in the left medial temporal region (P = .040) (vs. healthy volunteers), but to a lesser degree. The findings suggest that low pretreatment SERT binding may increase over time in some depressed individuals who experience symptom improvement.
2013-10-01T07:00:00Z
article
https://jdc.jefferson.edu/emfp/39
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592779/
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Myrna Brind Center of Integrative Medicine
Department of Emergency Medicine and Radiology
Thomas Jefferson University; Brain
Cinanserin
Cognitive Therapy
Depressive Disorder
Major
Female
Humans
Male
Metabolic Clearance Rate
Radiopharmaceuticals
Reproducibility of Results
Sensitivity and Specificity
Serotonin Plasma Membrane Transport Proteins
Tissue Distribution
Tomography
Emission-Computed
Single-Photon
Treatment Outcome
Brain
Depressive Disorder, Major
Tomography, Emission-Computed, Single-Photon
Emergency Medicine
oai:jdc.jefferson.edu:emfp-1040
2015-11-21T22:03:44Z
publication:em
publication:emfp
publication:jmc
Concomitant Retrograde Coronary Venous Infusion of Basic Fibroblast Growth Factor Enhances Engraftment and Differentiation of Bone Marrow Mesenchymal Stem Cells for Cardiac Repair after Myocardial Infarction.
Wang, Xiao
Zhen, Lei
Miao, Huangtai
Sun, Qiwei
Yang, Ya
Que, Bin
Lopes Lao, Edmundo Patricio
Wu, Xingxin
Ren, Hongmei
Shi, Shutian
Lau, Wayne Bond
Ma, Xin-Liang
Ma, Changsheng
Nie, Shaoping
AIM: Basic fibroblast growth factor (bFGF) increases the migration and viability of bone marrow mesenchymal stem cells (MSCs) in vitro. Retrograde coronary venous infusion can provide both increased regional bFGF concentrations and homogeneous cell dissemination. We determined whether retrograde delivery of bFGF enhances the potency of transplanted MSCs for cardiac repair in a canine infarct model.
METHODS AND RESULTS: Under hypoxic conditions, cellular migration was significantly increased in MSCs co-cultured with bFGF compared to vascular endothelial growth factor or insulin-like growth factor, and bFGF promoted MSCs differentiation into a cardiomyocyte phenotype. A canine infarct model was employed by coronary ligation. One week later, animals were subjected to retrograde infusion of combination bFGF (200ng/mL) and MSCs (1×10(8) cells) (n=5), MSCs (1×10(8) cells, n=5), bFGF (200ng/mL, n=5), or placebo (phosphate-buffered saline, n=3). Four weeks after infusion, only the bFGF+MSCs therapy exhibited significantly increased left ventricular ejection fraction (LVEF) by echocardiography (p
CONCLUSIONS: Retrograde coronary venous bFGF infusion augments engraftment and differentiation capacity of transplanted MSCs, recovering cardiac function and preventing adverse remodeling. This novel combined treatment and delivery method is a promising strategy for cardiac repair after ischemic injury.
2015-06-08T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/40
https://jdc.jefferson.edu/context/emfp/article/1040/viewcontent/Cardiac_Repair.pdf
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Department of Emergency Medicine
Thomas Jefferson University; Cell transplantation; Growth factor; Mesenchymal stem cells; Myocardial infarction; Retrograde
Emergency Medicine
oai:jdc.jefferson.edu:emfp-1041
2016-01-18T01:47:39Z
publication:em
publication:emfp
publication:jmc
A Delphi Method Analysis to Create an Emergency Medicine Educational Patient Satisfaction Survey.
London, Kory S
Singal, Bonita
Fowler, Jennifer
Prepejchal, Rebecca
Simmons, Stefanie
Finefrock, Douglas
INTRODUCTION: Feedback on patient satisfaction (PS) as a means to monitor and improve performance in patient communication is lacking in residency training. A physician's promotion, compensation and job satisfaction may be impacted by his individual PS scores, once he is in practice. Many communication and satisfaction surveys exist but none focus on the emergency department setting for educational purposes. The goal of this project was to create an emergency medicine-based educational PS survey with strong evidence for content validity.
METHODS: We used the Delphi Method (DM) to obtain expert opinion via an iterative process of surveying. Questions were mined from four PS surveys as well as from group suggestion. The DM analysis determined the structure, content and appropriate use of the tool. The group used four-point Likert-type scales and Lynn's criteria for content validity to determine relevant questions from the stated goals.
RESULTS: Twelve recruited experts participated in a series of seven surveys to achieve consensus. A 10-question, single-page survey with an additional page of qualitative questions and demographic questions was selected. Thirty one questions were judged to be relevant from an original 48-question list. Of these, the final 10 questions were chosen. Response rates for individual survey items was 99.5%.
CONCLUSION: The DM produced a consensus survey with content validity evidence. Future work will be needed to obtain evidence for response process, internal structure and construct validity.
2015-12-01T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/41
https://jdc.jefferson.edu/context/emfp/article/1041/viewcontent/Emergency_Medicine.pdf
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Thomas Jefferson University Hospital
Department of Emergency Medicine; clinical article; consensus; consensus development; construct validity; content validity; emergency medicine; human; Likert scale; patient satisfaction
Emergency Medicine
oai:jdc.jefferson.edu:emfp-1042
2016-03-02T01:57:17Z
publication:em
publication:emfp
publication:jmc
Epigenetic repression of PDZ-LIM domain-containing protein 2 promotes ovarian cancer via NOS2-derived nitric oxide signaling.
Zhao, Linjie
Yu, Chuan
Zhou, Shengtao
Lau, Wayne Bond
Lau, Bonnie
Luo, Zhongyue
Lin, Qiao
Yang, Huiliang
Xuan, Yu
Yi, Tao
Zhao, Xia
Wei, Yuquan
Ovarian cancer constitutes one of the most lethal gynaecological malignancies worldwide and currently no satisfactory therapeutic approaches have been established. Therefore, elucidation of molecular mechanisms to develop targeted therapy of ovarian cancer is crucial. PDLIM2 is critical to promote ubiquitination of nuclear p65 and thus its role in inflammation has been highlighted recently. We demonstrate that PDLIM2 is decreased in both ovarian high-grade serous carcinoma and in various human ovarian cancer cell lines compared with normal ovary tissues and human ovarian surface epithelial cells (HOSE). Further functional analysis revealed that PDLIM2 is epigenetically repressed in ovarian cancer development and inhibition of PDLIM2 promoted ovarian cancer growth both in vivo and in vitro via NOS2-derived nitric oxide signaling, leading to recruitment of M2 type macrophages. These results suggest that PDLIM2 might be involved in ovarian cancer pathogenesis, which could serve as a promising therapeutic target for ovarian cancer patients.
2016-01-12T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/42
https://jdc.jefferson.edu/context/emfp/article/1042/viewcontent/PDZ_LIM.pdf
http://creativecommons.org/licenses/by/3.0/
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Department of Emergency Medicine
Thomas Jefferson University Hospital; DNA methylation; Nitric oxide signaling; NOS2; Ovarian cancer; PDLIM2
Emergency Medicine
oai:jdc.jefferson.edu:emfp-1043
2016-04-26T13:30:01Z
publication:em
publication:emfp
publication:jmc
Adiponectin at Physiologically Relevant Concentrations Enhances the Vasorelaxative Effect of Acetylcholine via Cav-1/AdipoR-1 Signaling.
Du, Yunhui
Li, Rui
Lau, Wayne Bond
Zhao, Jianli
Lopez, Bernard
Christopher, Theodore A
Ma, Xin-Liang
Wang, Yajing
Clinical studies have identified hypoadiponectinemia as an independent hypertension risk factor. It is known that adiponectin (APN) can directly cause vasodilation, but the doses required exceed physiologic levels several fold. In the current study, we determine the effect of physiologically relevant APN concentrations upon vascular tone, and investigate the mechanism(s) responsible. Physiologic APN concentrations alone induced no significant vasorelaxation. Interestingly, pretreatment of wild type mouse aortae with physiologic APN levels significantly enhanced acetylcholine (ACh)-induced vasorelaxation (P
2016-03-01T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/43
https://jdc.jefferson.edu/context/emfp/article/1043/viewcontent/journal.pone.0152247.PDF
http://creativecommons.org/licenses/by/4.0/
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Emergency Medicine
Medicine and Health Sciences
oai:jdc.jefferson.edu:emfp-1044
2016-05-15T20:13:55Z
publication:em
publication:emfp
publication:jmc
Telemedicine REsuscitation and Arrest Trial (TREAT): A feasibility study of real-time provider-to-provider telemedicine for the care of critically ill patients
Agarwal, Anish K
Gaieski, David F
Perman, Sarah M
Leary, Marion
Delfin, Gail
Abella, Benjamin S.
Carr, Brendan G.
2016-04-01T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/44
https://jdc.jefferson.edu/context/emfp/article/1044/viewcontent/TREAT.pdf
http://creativecommons.org/licenses/by-nc-nd/4.0/
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Thomas Jefferson University Hospital
Department of Emergency Medicine
Health sciences; Medicine
Emergency Medicine
oai:jdc.jefferson.edu:emfp-1045
2016-08-08T19:47:06Z
publication:em
publication:emfp
publication:jmc
Can a Point-of-Care Troponin I Assay be as Good as a Central Laboratory Assay? A MIDAS Investigation.
Peacock, W. Frank
Diercks, Deborah
Birkhahn, Robert
Singer, Adam J.
Hollander, Judd
Nowak, Richard
Safdar, Basmah
Miller, Chadwick D.
Peberdy, Mary
Counselman, Francis
Chandra, Abhinav
Kosowsky, Joshua
Neuenschwander, James
Schrock, Jon
Lee-Lewandrowski, Elizabeth
Arnold, William
Nagurney, John
BACKGROUND: We aimed to compare the diagnostic accuracy of the Alere Triage Cardio3 Tropinin I (TnI) assay (Alere, Inc., USA) and the PathFast cTnI-II (Mitsubishi Chemical Medience Corporation, Japan) against the central laboratory assay Singulex Erenna TnI assay (Singulex, USA).
METHODS: Using the Markers in the Diagnosis of Acute Coronary Syndromes (MIDAS) study population, we evaluated the ability of three different assays to identify patients with acute myocardial infarction (AMI). The MIDAS dataset, described elsewhere, is a prospective multicenter dataset of emergency department (ED) patients with suspected acute coronary syndrome (ACS) and a planned objective myocardial perfusion evaluation. Myocardial infarction (MI) was diagnosed by central adjudication.
RESULTS: The C-statistic with 95% confidence intervals (CI) for diagnosing MI by using a common population (n=241) was 0.95 (0.91-0.99), 0.95 (0.91-0.99), and 0.93 (0.89-0.97) for the Triage, Singulex, and PathFast assays, respectively. Of samples with detectable troponin, the absolute values had high Pearson (R(P)) and Spearman (R(S)) correlations and were R(P)=0.94 and R(S)=0.94 for Triage vs Singulex, R(P)=0.93 and R(S)=0.85 for Triage vs PathFast, and R(P)=0.89 and R(S)=0.73 for PathFast vs Singulex.
CONCLUSIONS: In a single comparative population of ED patients with suspected ACS, the Triage Cardio3 TnI, PathFast, and Singulex TnI assays provided similar diagnostic performance for MI.
2016-09-01T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/45
https://jdc.jefferson.edu/context/emfp/article/1045/viewcontent/Kjlm036_05_02.pdf
http://creativecommons.org/licenses/by-nc/3.0/
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Diagnostic accuracy
Emergency medicine
Point-of-care
Troponin
Cardiology
Medicine and Health Sciences
oai:jdc.jefferson.edu:emfp-1046
2016-09-16T17:54:48Z
publication:em
publication:emfp
publication:jmc
Academic Primer Series: Five Key Papers Fostering Educational Scholarship in Junior Academic Faculty.
Chan, Teresa M.
Gottlieb, Michael
Fant, Abra L.
Messman, Anne
Robinson, Daniel W.
Cooney, Robert R.
Papanagnou, Dimitrios
Yarris, Lalena M.
INTRODUCTION: Scholarship is an essential part of academic success. Junior faculty members are often unfamiliar with the grounding literature that defines educational scholarship. In this article, the authors aim to summarize five key papers which outline education scholarship in the setting of academic contributions for emerging clinician educators.
METHODS: The authors conducted a consensus-building process to generate a list of key papers that describe the importance and significance of academic scholarship, informed by social media sources. They then used a three-round voting methodology, akin to a Delphi study, to determine the most useful papers.
RESULTS: A summary of the five most important papers on the topic of academic scholarship, as determined by this mixed group of junior faculty members and faculty developers, is presented in this paper. These authors subsequently wrote a summary of these five papers and discussed their relevance to both junior faculty members and faculty developers.
CONCLUSION: Five papers on education scholarship, deemed essential by the authors' consensus process, are presented in this paper. These papers may help provide the foundational background to help junior faculty members gain a grasp of the academic scholarly environment. This list may also inform senior faculty and faculty developers on the needs of junior educators in the nascent stages of their careers.
2016-09-01T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/46
https://jdc.jefferson.edu/context/emfp/article/1046/viewcontent/wjem_17_519.pdf
http://creativecommons.org/licenses/by/4.0/
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Educational scholarship
Faculty development
Emergency Medicine
Medicine and Health Sciences
oai:jdc.jefferson.edu:emfp-1047
2016-12-06T20:29:41Z
publication:em
publication:emfp
publication:jmc
Adiponectin protects against paraquat-induced lung injury by attenuating oxidative/nitrative stress.
Yao, Rong
Zhou, Yaxiong
He, Yarong
Jiang, Yaowen
Liu, Peng
Ye, Lei
Zheng, Zhijie
Lau, Wayne Bond
Cao, Yu
Zeng, Zhi
The specific mechanisms underlying paraquat (PQ)-induced lung injury remain unknown, which limits understanding of its cytotoxic potential. Although oxidative stress has been established as an important mechanism underlying PQ toxicity, multiple antioxidants have proven ineffective in attenuating the deleterious effects of PQ. Adiponectin, which shows anti-oxidative and antinitrative effects, may have the potential to reduce PQ-mediated injury. The present study determined the protective action of globular domain adiponectin (gAd) on PQ-induced lung injury, and attempted to elucidate the underlying mechanism or mechanisms of action. BALB/c mice were administered PQ, with and without 12 or 36 h of gAd pre-treatment. The pulmonary oxidative/nitrative status was assessed by measuring pulmonary O2(•-), superoxide dismutase (SOD), malondialdehyde (MDA), nitric oxide (NO) and 8-hydroxy-2-dydeoxy guanosine (8-OHdG) production, and blood 3-Nitrotyrosine (3-NT). At a dose of 20 mg/kg, PQ markedly increased O2(•-), SOD, MDA, NO and 8-OHdG production 3 h post-administration, but did not significantly increase 3-NT levels until 12 h. gAd inhibited these changes in a dose-dependent manner, via transient activation of MDA, followed by attenuation of MDA formation from 6 h onwards. Histological analysis demonstrated that gAd decreased interstitial edema and inflammatory cell infiltration. These results suggest that gAd protects against PQ-induced lung injury by mitigating oxidative/nitrative stress. Furthermore, gAd may be a potential therapeutic agent for PQ-induced lung injury, and further pharmacological studies are therefore warranted.
2015-01-01T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/47
https://jdc.jefferson.edu/context/emfp/article/1047/viewcontent/etm_9_1_131_PDF.pdf
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Globular adiponectin
Lung injury
Nitrative stress
Oxidative stress
Paraquat
Emergency Medicine
Medicine and Health Sciences
oai:jdc.jefferson.edu:emfp-1049
2017-01-03T21:50:32Z
publication:em
publication:emfp
publication:jmc
Racial Disparities in Intravenous Recombinant Tissue Plasminogen Activator Use Persist at Primary Stroke Centers.
Aparicio, Hugo J.
Carr, Brendan G.
Kasner, Scott E.
Kallan, Michael J.
Albright, Karen C.
Kleindorfer, Dawn O.
Mullen, Michael T.
BACKGROUND: Primary stroke centers (PSCs) utilize more recombinant tissue plasminogen activator (rt-PA) than non-PSCs. The impact of PSCs on racial disparities in rt-PA use is unknown.
METHODS AND RESULTS: We used data from the Nationwide Inpatient Sample from 2004 to 2010, limited to states that publicly reported hospital identity and race. Hospitals certified as PSCs by The Joint Commission were identified. Adults with a diagnosis of ischemic stroke were analyzed. Rt-PA use was defined by the International Classification of Diseases, 9th Revision procedure code 99.10. Discharges (304 152 patients) from 26 states met eligibility criteria, and of these 71.5% were white, 15.0% black, 7.9% Hispanic, and 5.6% other. Overall, 24.7% of white, 27.4% of black, 16.2% of Hispanic, and 29.8% of other patients presented to PSCs. A higher proportion received rt-PA at PSCs than non-PSCs in all race/ethnic groups (white 7.6% versus 2.6%, black 4.8% versus 2.0%, Hispanic 7.1% versus 2.4%, other 7.2% versus 2.5%, all P
CONCLUSIONS: Racial disparities in intravenous rt-PA use were not reduced by presentation to PSCs. Black patients were less likely to receive thrombolytic treatment than white patients at both non-PSCs and PSCs. Hispanic patients were less likely to be seen at PSCs relative to white patients and were less likely to receive intravenous rt-PA in the fully adjusted model.
2015-10-14T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/48
https://jdc.jefferson.edu/context/emfp/article/1049/viewcontent/e001877.full.pdf
http://creativecommons.org/licenses/by-nc/4.0/
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Administration
Intravenous
Adolescent
Adult
African Americans
Aged
Chi-Square Distribution
Databases
Factual
European Continental Ancestry Group
Female
Fibrinolytic Agents
Health Policy
Health Services Accessibility
Healthcare Disparities
Hispanic Americans
Humans
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Recombinant Proteins
Retrospective Studies
Risk Factors
Socioeconomic Factors
Stroke
Thrombolytic Therapy
Tissue Plasminogen Activator
Treatment Outcome
United States
Young Adult
Administration, Intravenous
Databases, Factual
Cardiology
Medicine and Health Sciences
oai:jdc.jefferson.edu:emfp-1050
2017-01-04T17:38:23Z
publication:em
publication:emfp
publication:jmc
Shared decision making in patients with low risk chest pain: prospective randomized pragmatic trial.
Hess, Erik P.
Hollander, Judd E.
Schaffer, Jason T.
Kline, Jeffrey A.
Torres, Carlos A.
Diercks, Deborah B.
Jones, Russell
Owen, Kelly P.
Meisel, Zachary F.
Demers, Michel
Leblanc, Annie
Shah, Nilay D.
Inselman, Jonathan
Herrin, Jeph
Castaneda-Guarderas, Ana
Montori, Victor M.
OBJECTIVE: To compare the effectiveness of shared decision making with usual care in choice of admission for observation and further cardiac testing or for referral for outpatient evaluation in patients with possible acute coronary syndrome.
DESIGN: Multicenter pragmatic parallel randomized controlled trial.
SETTING: Six emergency departments in the United States.
PARTICIPANTS: 898 adults (aged >17 years) with a primary complaint of chest pain who were being considered for admission to an observation unit for cardiac testing (451 were allocated to the decision aid and 447 to usual care), and 361 emergency clinicians (emergency physicians, nurse practitioners, and physician assistants) caring for patients with chest pain.
INTERVENTIONS: Patients were randomly assigned (1:1) by an electronic, web based system to shared decision making facilitated by a decision aid or to usual care. The primary outcome, selected by patient and caregiver advisers, was patient knowledge of their risk for acute coronary syndrome and options for care; secondary outcomes were involvement in the decision to be admitted, proportion of patients admitted for cardiac testing, and the 30 day rate of major adverse cardiac events.
RESULTS: Compared with the usual care arm, patients in the decision aid arm had greater knowledge of their risk for acute coronary syndrome and options for care (questions correct: decision aid, 4.2 v usual care, 3.6; mean difference 0.66, 95% confidence interval 0.46 to 0.86), were more involved in the decision (observing patient involvement scores: decision aid, 18.3 v usual care, 7.9; 10.3, 9.1 to 11.5), and less frequently decided with their clinician to be admitted for cardiac testing (decision aid, 37% v usual care, 52%; absolute difference 15%; P
CONCLUSIONS: Use of a decision aid in patients at low risk for acute coronary syndrome increased patient knowledge about their risk, increased engagement, and safely decreased the rate of admission to an observation unit for cardiac testing.Trial registration ClinicalTrials.gov NCT01969240.
2016-12-05T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/49
https://jdc.jefferson.edu/context/emfp/article/1050/viewcontent/bmj.i6165.full.pdf
http://creativecommons.org/licenses/by-nc/4.0/
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Cardiology
Emergency Medicine
Medicine and Health Sciences
oai:jdc.jefferson.edu:emfp-1051
2017-01-04T19:47:35Z
publication:em
publication:emfp
publication:jmc
Acute post-disaster medical needs of patients with diabetes: emergency department use in New York City by diabetic adults after Hurricane Sandy.
Lee, David C.
Gupta, Vibha K.
Carr, Brendan G.
Malik, Sidrah
Ferguson, Brandy
Wall, Stephen P.
Smith, Silas W.
Goldfrank, Lewis R.
OBJECTIVE: To evaluate the acute impact of disasters on diabetic patients, we performed a geospatial analysis of emergency department (ED) use by New York City diabetic adults in the week after Hurricane Sandy.
RESEARCH DESIGN AND METHODS: Using an all-payer claims database, we retrospectively analyzed the demographics, insurance status, and medical comorbidities of post-disaster ED patients with diabetes who lived in the most geographically vulnerable areas. We compared the patterns of ED use among diabetic adults in the first week after Hurricane Sandy's landfall to utilization before the disaster in 2012.
RESULTS: In the highest level evacuation zone in New York City, postdisaster increases in ED visits for a primary or secondary diagnosis of diabetes were attributable to a significantly higher proportion of Medicare patients. Emergency visits for a primary diagnosis of diabetes had an increased frequency of certain comorbidities, including hypertension, recent procedure, and chronic skin ulcers. Patients with a history of diabetes visited EDs in increased numbers after Hurricane Sandy for a primary diagnosis of myocardial infarction, prescription refills, drug dependence, dialysis, among other conditions.
CONCLUSIONS: We found that diabetic adults aged 65 years and older are especially at risk for requiring postdisaster emergency care compared to other vulnerable populations. Our findings also suggest that there is a need to support diabetic adults particularly in the week after a disaster by ensuring access to medications, aftercare for patients who had a recent procedure, and optimize their cardiovascular health to reduce the risk of heart attacks.
2016-07-01T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/50
https://jdc.jefferson.edu/context/emfp/article/1051/viewcontent/BMJ_Open_Diab_Res_Care_2016_Lee_.pdf
http://creativecommons.org/licenses/by/4.0/
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
adult
aged
Article
comorbidity assessment
diabetic patient
dialysis
drug dependence
emergency care
female
geographic distribution
health care need
health insurance
heart infarction
human
hypertension
ICD-9
landfall
major clinical study
male
natural disaster
New York
observational study
patient care
prescription
priority journal
retrospective study
skin ulcer
Emergency Medicine
Medicine and Health Sciences
oai:jdc.jefferson.edu:emfp-1052
2017-01-04T21:46:04Z
publication:em
publication:emfp
publication:jmc
Cardiac Specific Overexpression of Mitochondrial Omi/HtrA2 Induces Myocardial Apoptosis and Cardiac Dysfunction.
Wang, Ke
Yuan, Yuexing
Liu, Xin
Lau, Wayne Bond
Zuo, Lin
Wang, Xiaoliang
Ma, Lu
Jiao, Kun
Shang, Jianyu
Wang, Wen
Ma, Xinliang
Liu, Huirong
Myocardial apoptosis is a significant problem underlying ischemic heart disease. We previously reported significantly elevated expression of cytoplasmic Omi/HtrA2, triggers cardiomyocytes apoptosis. However, whether increased Omi/HtrA2 within mitochondria itself influences myocardial survival in vivo is unknown. We aim to observe the effects of mitochondria-specific, not cytoplasmic, Omi/HtrA2 on myocardial apoptosis and cardiac function. Transgenic mice overexpressing cardiac-specific mitochondrial Omi/HtrA2 were generated and they had increased myocardial apoptosis, decreased systolic and diastolic function, and decreased left ventricular remodeling. Transiently or stably overexpression of mitochondria Omi/HtrA2 in H9C2 cells enhance apoptosis as evidenced by elevated caspase-3, -9 activity and TUNEL staining, which was completely blocked by Ucf-101, a specific Omi/HtrA2 inhibitor. Mechanistic studies revealed mitochondrial Omi/HtrA2 overexpression degraded the mitochondrial anti-apoptotic protein HAX-1, an effect attenuated by Ucf-101. Additionally, transfected cells overexpressing mitochondrial Omi/HtrA2 were more sensitive to hypoxia and reoxygenation (H/R) induced apoptosis. Cyclosporine A (CsA), a mitochondrial permeability transition inhibitor, blocked translocation of Omi/HtrA2 from mitochondrial to cytoplasm, and protected transfected cells incompletely against H/R-induced caspase-3 activation. We report in vitro and in vivo overexpression of mitochondrial Omi/HtrA2 induces cardiac apoptosis and dysfunction. Thus, strategies to directly inhibit Omi/HtrA2 or its cytosolic translocation from mitochondria may protect against heart injury.
2016-12-07T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/51
https://jdc.jefferson.edu/context/emfp/article/1052/viewcontent/srep37927.pdf
http://creativecommons.org/licenses/by/4.0/
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Medical Physiology
Medicine and Health Sciences
oai:jdc.jefferson.edu:emfp-1053
2017-01-05T15:10:28Z
publication:em
publication:emfp
publication:jmc
Branched Chain Amino Acids Cause Liver Injury in Obese/Diabetic Mice by Promoting Adipocyte Lipolysis and Inhibiting Hepatic Autophagy.
Zhang, Fuyang
Zhao, Shihao
Yan, Wenjun
Xia, Yunlong
Chen, Xiyao
Wang, Wei
Zhang, Jinglong
Gao, Chao
Peng, Cheng
Yan, Feng
Zhao, Huishou
Lian, Kun
Lee, Yan
Zhang, Ling
Lau, Wayne Bond
Ma, Xin-Liang
Tao, Ling
The Western meat-rich diet is both high in protein and fat. Although the hazardous effect of a high fat diet (HFD) upon liver structure and function is well recognized, whether the co-presence of high protein intake contributes to, or protects against, HF-induced hepatic injury remains unclear. Increased intake of branched chain amino acids (BCAA, essential amino acids compromising 20% of total protein intake) reduces body weight. However, elevated circulating BCAA is associated with non-alcoholic fatty liver disease and injury. The mechanisms responsible for this quandary remain unknown; the role of BCAA in HF-induced liver injury is unclear. Utilizing HFD or HFD+BCAA models, we demonstrated BCAA supplementation attenuated HFD-induced weight gain, decreased fat mass, activated mammalian target of rapamycin (mTOR), inhibited hepatic lipogenic enzymes, and reduced hepatic triglyceride content. However, BCAA caused significant hepatic damage in HFD mice, evidenced by exacerbated hepatic oxidative stress, increased hepatic apoptosis, and elevated circulation hepatic enzymes. Compared to solely HFD-fed animals, plasma levels of free fatty acids (FFA) in the HFD+BCAA group are significantly further increased, due largely to AMPKα2-mediated adipocyte lipolysis. Lipolysis inhibition normalized plasma FFA levels, and improved insulin sensitivity. Surprisingly, blocking lipolysis failed to abolish BCAA-induced liver injury. Mechanistically, hepatic mTOR activation by BCAA inhibited lipid-induced hepatic autophagy, increased hepatic apoptosis, blocked hepatic FFA/triglyceride conversion, and increased hepatocyte susceptibility to FFA-mediated lipotoxicity. These data demonstrated that BCAA reduces HFD-induced body weight, at the expense of abnormal lipolysis and hyperlipidemia, causing hepatic lipotoxicity. Furthermore, BCAA directly exacerbate hepatic lipotoxicity by reducing lipogenesis and inhibiting autophagy in the hepatocyte.
2016-11-01T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/53
https://jdc.jefferson.edu/context/emfp/article/1053/viewcontent/1_s2.0_S2352396416304686_main.pdf
http://creativecommons.org/licenses/by-nc-nd/4.0/
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
AMP-activated protein kinase; Branched chain amino acids; Lipolysis; Lipotoxicity; Mammalian target of rapamycin; Non-alcoholic fatty liver disease
Cardiology
Medicine and Health Sciences
oai:jdc.jefferson.edu:emfp-1054
2017-01-18T15:34:50Z
publication:em
publication:emfp
publication:jmc
Does tailoring instructional style to a medical student's self-perceived learning style improve performance when teaching intravenous catheter placement? A randomized controlled study.
Papanagnou, Dimitrios
Serrano, Antonio
Barkley, Kaitlyn
Chandra, Shruti
Governatori, Nicholas
Piela, Nicole
Wanner, Gregory K.
Shin, Richard
BACKGROUND: Students may have different learning styles. It is unclear, however, whether tailoring instructional methods for a student's preferred learning style improves educational outcomes when teaching procedures. The authors sought to examine whether teaching to a student's self-perceived learning style improved the acquisition of intravenous (IV) catheter placement skills. The authors hypothesized that matching a medical student's preferred learning style with the instructor's teaching style would increase the success of placing an IV catheter.
METHODS: Using the VARK model (i.e., visual [V], auditory [A], read/write [R] and kinesthetic [K]), third-year medical students reported their self-perceived learning style and were subsequently randomized to instructors who were trained to teach according to a specific learning format (i.e., visual, auditory). Success was gauged by: 1) the placement of an IV on the first attempt and 2) the number of attempts made until an IV line was successfully placed.
RESULTS: The average number of attempts in the matched learning style group was 1.53, compared to 1.64 in the unmatched learning style group; however, results were not statistically significant. Both matched and unmatched groups achieved a similar success rate (57 and 58 %, respectively). Additionally, a comparison of success between the unmatched and matched students within each learning style modality yielded no statistical significance.
CONCLUSIONS: Results suggest that providing procedural instruction that is congruent with a student's self-perceived learning style does not appear to improve outcomes when instructing students on IV catheter placement.
2016-08-12T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/52
https://jdc.jefferson.edu/context/emfp/article/1054/viewcontent/s12909_016_0720_3.pdf
http://creativecommons.org/licenses/by/4.0/
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Medical Education
Medicine and Health Sciences
oai:jdc.jefferson.edu:emfp-1055
2017-02-06T17:45:02Z
publication:em
publication:emfp
publication:jmc
Teaching the Emergency Department Patient Experience: Needs Assessment from the CORD-EM Task Force.
London, Kory S.
Druck, Jeffrey
Silver, Matthew
Finefrock, Douglas
INTRODUCTION: Since the creation of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction (PS) scores, patient experience (PE) has become a metric that can profoundly affect the fiscal balance of hospital systems, reputation of entire departments and welfare of individual physicians. While government and hospital mandates demonstrate the prominence of PE as a quality measure, no such mandate exists for its education. The objective of this study was to determine the education and evaluation landscape for PE in categorical emergency medicine (EM) residencies.
METHODS: This was a prospective survey analysis of the Council of Emergency Medicine Residency Directors (CORD) membership. Program directors (PDs), assistant PDs and core faculty who are part of the CORD listserv were sent an email link to a brief, anonymous electronic survey. Respondents were asked their position in the residency, the name of their department, and questions regarding the presence and types of PS evaluative data and PE education they provide.
RESULTS: We obtained 168 responses from 139 individual residencies, representing 72% of all categorical EM residencies. This survey found that only 27% of responding residencies provide PS data to their residents. Of those programs, 61% offer simulation scores, 39% provide third-party attending data on cases with resident participation, 37% provide third-party acquired data specifically about residents and 37% provide internally acquired quantitative data. Only 35% of residencies reported having any organized PE curricula. Of the programs that provide an organized PE curriculum, most offer multiple modalities; 96% provide didactic lectures, 49% small group sessions, 47% simulation sessions and 27% specifically use standardized patient encounters in their simulation sessions.
CONCLUSION: The majority of categorical EM residencies do not provide either PS data or any organized PE curriculum. Those that do use a heterogeneous set of data collection modalities and educational techniques. American Osteopathic Association and Accreditation Council for Graduate Medical Education residencies show no significant differences in their resident PS data provision or formal curricula. Further work is needed to improve education given the high stakes of PS scores in the emergency physician's career.
2017-01-01T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/55
https://jdc.jefferson.edu/context/emfp/article/1055/viewcontent/eScholarship_UC_item_1b45z8xz.pdf
http://creativecommons.org/licenses/by/4.0/
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
accreditation
career
case report
curriculum
e-mail
emergency medicine
emergency physician
emergency ward
human
information processing
landscape
medical education
needs assessment
patient satisfaction
quantitative study
resident
teaching
university
Emergency Medicine
Medicine and Health Sciences
oai:jdc.jefferson.edu:emfp-1056
2017-02-06T17:54:28Z
publication:em
publication:umedeans
publication:deanepca
publication:emfp
publication:ume
publication:jmc
Characteristics of Real-Time, Non-Critical Incident Debriefing Practices in the Emergency Department.
Nadir, Nur-Ain
Bentley, Suzanne
Papanagnou, Dimitrios
Bajaj, Komal
Rinnert, Stephan
Sinert, Richard
INTRODUCTION: Benefits of post-simulation debriefings as an educational and feedback tool have been widely accepted for nearly a decade. Real-time, non-critical incident debriefing is similar to post-simulation debriefing; however, data on its practice in academic emergency departments (ED), is limited. Although tools such as TeamSTEPPS® (Team Strategies and Tools to Enhance Performance and Patient Safety) suggest debriefing after complicated medical situations, they do not teach debriefing skills suited to this purpose. Anecdotal evidence suggests that real-time debriefings (or non-critical incident debriefings) do in fact occur in academic EDs;, however, limited research has been performed on this subject. The objective of this study was to characterize real-time, non-critical incident debriefing practices in emergency medicine (EM).
METHODS: We conducted this multicenter cross-sectional study of EM attendings and residents at four large, high-volume, academic EM residency programs in New York City. Questionnaire design was based on a Delphi panel and pilot testing with expert panel. We sought a convenience sample from a potential pool of approximately 300 physicians across the four sites with the goal of obtaining >100 responses. The survey was sent electronically to the four residency list-serves with a total of six monthly completion reminder emails. We collected all data electronically and anonymously using SurveyMonkey.com; the data were then entered into and analyzed with Microsoft Excel.
RESULTS: The data elucidate various characteristics of current real-time debriefing trends in EM, including its definition, perceived benefits and barriers, as well as the variety of formats of debriefings currently being conducted.
CONCLUSION: This survey regarding the practice of real-time, non-critical incident debriefings in four major academic EM programs within New York City sheds light on three major, pertinent points: 1) real-time, non-critical incident debriefing definitely occurs in academic emergency practice; 2) in general, real-time debriefing is perceived to be of some value with respect to education, systems and performance improvement; 3) although it is practiced by clinicians, most report no formal training in actual debriefing techniques. Further study is needed to clarify actual benefits of real-time/non-critical incident debriefing as well as details on potential pitfalls of this practice and recommendations for best practices for use.
2017-01-01T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/54
https://jdc.jefferson.edu/context/emfp/article/1056/viewcontent/eScholarship_UC_item_6w07t1b4.pdf
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
clinical trial
controlled clinical trial
controlled study
convenience sample
cross-sectional study
e-mail
education
emergency medicine
emergency ward
human
multicenter study
New York
patient safety
questionnaire
resident
skill
Emergency Medicine
Medicine and Health Sciences
oai:jdc.jefferson.edu:emfp-1057
2017-02-06T18:13:36Z
publication:em
publication:emfp
publication:jmc
T-cadherin deficiency increases vascular vulnerability in T2DM through impaired NO bioactivity.
Wang, Han
Tao, Ling
Ambrosio, Anastasia
Yan, Wenjun
Summer, Ross
Lau, Wayne Bond
Wang, Yajing
Ma, Xin-Liang
BACKGROUND: Endothelial dysfunction plays a critical role in the development of type 2 diabetes (T2DM). T-cadherin (T-cad) has gained recognition as a regulator of endothelial cell (EC) function. The present study examined whether T-cad deficiency increases vascular vulnerability in T2DM.
METHODS: Vascular segments were isolated from WT or T-cad knockout mice. Endothelial function, total NO accumulation, and the expression of T-cad related proteins were determined.
RESULTS: Ach and acidified NaNO2 induced similar vasorelaxation in WT groups. T-cad KO mice exhibited normal response to acidified NaNO2, but manifested markedly reduced response to Ach. NO accumulation was also decreased in T-cad KO group. T-cad expression was reduced in WT mice fed 8 weeks of high fat diet (HFD). Furthermore, exacerbated reduction of vasorelaxation was observed in T-cad KO mice fed 8 weeks of HFD.
CONCLUSIONS: In the current study, we provide the first in vivo evidence that T-cadherin deficiency causes endothelial dysfunction in T2DM vascular segments, suggesting the involvement of T-cad deficiency in T2DM pathogenesis.
2017-01-19T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/56
https://jdc.jefferson.edu/context/emfp/article/1057/viewcontent/s12933_016_0488_0.pdf
http://creativecommons.org/licenses/by/4.0/
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Endothelial cell
Endothelial dysfunction
NO bioactivity
T-cadherin
T2DM
Vascular ring
Emergency Medicine
Medicine and Health Sciences
oai:jdc.jefferson.edu:emfp-1058
2017-03-06T19:51:24Z
publication:em
publication:emfp
publication:jmc
LncRNAs: the bridge linking RNA and colorectal cancer.
Yang, Yanfei
Zhao, Linjie
Lei, Lingzi
Lau, Wayne Bond
Lau, Bonnie
Yang, Qilian
Le, Xiaobing
Yang, Huiliang
Wang, Chenlu
Luo, Zhongyue
Xuan, Yu
Chen, Yi
Deng, Xiangbing
Xu, Lian
Feng, Min
Yi, Tao
Zhao, Xia
Wei, Yuquan
Zhou, Shengtao
Long noncoding RNAs (lncRNAs) are transcribed by genomic regions (exceeding 200 nucleotides in length) that do not encode proteins. While the exquisite regulation of lncRNA transcription can provide signals of malignant transformation, lncRNAs control pleiotropic cancer phenotypes through interactions with other cellular molecules including DNA, protein, and RNA. Recent studies have demonstrated that dysregulation of lncRNAs is influential in proliferation, angiogenesis, metastasis, invasion, apoptosis, stemness, and genome instability in colorectal cancer (CRC), with consequent clinical implications. In this review, we explicate the roles of different lncRNAs in CRC, and the potential implications for their clinical application.
2016-11-24T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/57
https://jdc.jefferson.edu/context/emfp/article/1058/viewcontent/13573_202665_3_PB.pdf
http://creativecommons.org/licenses/by/3.0/
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Angiogenesis
Colorectal cancer
LncRNAs
Metastasis
Proliferation
oai:jdc.jefferson.edu:emfp-1060
2017-03-27T15:58:37Z
publication:em
publication:emfp
publication:jmc
Academic Primer Series: Five Key Papers for Consulting Clinician Educators.
Chan, Teresa M.
Gottlieb, Michael
Quinn, Antonia
London, Kory S.
Conlon, Lauren W.
Ankel, Felix
INTRODUCTION: Clinician educators are often asked to perform consultations for colleagues. Invitations to consult and advise others on local problems can help foster great collaborations between centers, and allows for an exchange of ideas between programs. In this article, the authors identify and summarize several key papers to assist emerging clinician educators with the consultation process.
METHODS: A consensus-building process was used to generate a list of key papers that describe the importance and significance of educational consulting, informed by social media sources. A three-round voting methodology, akin to a Delphi study, determined the most impactful papers from the larger list.
RESULTS: Summaries of the five most highly rated papers on education consultation are presented in this paper. These papers were determined by a mixed group of junior and senior faculty members, who have summarized these papers with respect to their relevance for their peer groups.
CONCLUSION: Five key papers on the educational consultation process are presented in this paper. These papers offer background and perspective to help junior faculty gain a grasp of consultation processes.
2017-02-01T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/58
https://jdc.jefferson.edu/context/emfp/article/1060/viewcontent/eScholarship_UC_item_28382020.pdf
http://creativecommons.org/licenses/by/4.0/
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Emergency Medicine
Medicine and Health Sciences
oai:jdc.jefferson.edu:emfp-1062
2017-07-11T19:40:02Z
publication:em
publication:emfp
publication:jmc
CTRP3 is a novel biomarker for diabetic retinopathy and inhibits HGHL-induced VCAM-1 expression in an AMPK-dependent manner.
Yan, Zheyi
Zhao, Jianli
Gan, Lu
Zhang, Yanqing
Guo, Rui
Cao, Xiaoming
Lau, Wayne Bond
Ma, Xin
Wang, Yajing
OBJECTIVES: Diabetic retinopathy (DR) is a severe complication of chronic diabetes. The C1q/TNF-related protein family (CTRPs) has been demonstrated to exert protective effects against obesity and atherosclerosis in animal studies. Heretofore, the association between circulating CTRPs and DR patients has been unexplored. In the current study, we attempt to define this association, as well as the effect of CTRPs upon DR pathophysiology.
DESIGN: The present investigation is a case control study that enrolled control subjects and type 2 diabetes mellitus (T2DM) patients diagnosed with DR. Serum CTRPs and sVACM-1 were determined by ELISA.
RESULTS: Serum CTRP3 and CTRP5 levels were markedly decreased in patients with T2DM compared to controls (p
CONCLUSION: CTRP3 may serve as a novel biomarker for DR severity. CTRP3 may represent a future novel therapeutic against DR, a common ocular complication of diabetes.
2017-06-20T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/59
https://jdc.jefferson.edu/context/emfp/article/1062/viewcontent/journal.pone.0178253.pdf
http://creativecommons.org/licenses/by/4.0/
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Emergency Medicine
Medicine and Health Sciences
oai:jdc.jefferson.edu:emfp-1063
2017-07-17T15:17:57Z
publication:em
publication:emfp
publication:jmc
Findings of Cognitive Impairment at High Altitude: Relationships to Acetazolamide Use and Acute Mountain Sickness.
Phillips, Lara
Basnyat, Buddha
Chang, Yuchiao
Swenson, Erik R.
Harris, N. Stuart
Phillips, Lara, Buddha Basnyat, Yuchiao Chang, Erik R. Swenson, and N. Stuart Harris. Findings of cognitive impairment at high altitude: relationships to acetazolamide use and acute mountain sickness. High Alt Med Biol. 18:121-127, 2017.
OBJECTIVE: Acute mountain sickness (AMS) is defined by patient-reported symptoms using the Lake Louise Score (LLS), which provides limited insight into any possible underlying central nervous system (CNS) dysfunction. Some evidence suggests AMS might coexist with altered neural functioning. Cognitive impairment (CI) may go undetected unless a sensitive test is applied. Our hypothesis was that a standardized test for mild CI would provide an objective measure of CNS dysfunction, which may correlate with the symptoms of AMS and so provide a potential new tool to better characterize altitude-related CNS dysfunction. We compared a cognitive screening tool with the LLS to see if it correlated with CNS dysfunction.
METHODS: Adult native English-speaking subjects visiting Himalayan Rescue Association aid stations in Nepal at 3520 m (11,548 ft) and 4550 m (14,927 ft) were recruited. Subjects were administered the LLS and a slightly modified version of the environmental Quick mild cognitive impairment screen (eQmci). Medication use for altitude illness was recorded. Scores were compared using the Spearman's correlation coefficient. Data also included medication use.
RESULTS: Seventy-nine subjects were enrolled. A cut-off of three or greater was used for the LLS to diagnose AMS and 67 or less for the eQmci to diagnose CI. There were 22 (28%) subjects who met criteria for AMS and 17 (22%) subjects who met criteria for CI. There was a weak correlation (r(2) = 0.06, p = 0.04) between eQmci score and LLS. In matched subjects with identical LLS, recent acetazolamide use was associated with significantly more CI.
CONCLUSION: Field assessment of CI using a rapid standardized tool demonstrated that a substantial number of subjects were found to have mild CI following rapid ascent to 3520-4550 m (11,548-14,927 ft). The weak correlation between the LLS and eQmci suggests that AMS does not result in CI. Use of acetazolamide appears to be associated with CI at all levels of AMS severity.
2017-06-01T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/60
https://jdc.jefferson.edu/context/emfp/article/1063/viewcontent/auto_convert.pdf
https://jdc.jefferson.edu/context/emfp/article/1063/filename/0/type/additional/viewcontent/PhillipsFig_1.tiff
https://jdc.jefferson.edu/context/emfp/article/1063/filename/1/type/additional/viewcontent/PhillipsFig_2.tiff
https://jdc.jefferson.edu/context/emfp/article/1063/filename/2/type/additional/viewcontent/PhillipsTable1.docx
https://jdc.jefferson.edu/context/emfp/article/1063/filename/3/type/additional/viewcontent/PhillipsTable2.docx
https://jdc.jefferson.edu/context/emfp/article/1063/filename/4/type/additional/viewcontent/PhillipsTable3.docx
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
acute mountain sickness
cognitive impairment
high altitude
Emergency Medicine
Medicine and Health Sciences
oai:jdc.jefferson.edu:emfp-1064
2017-08-09T13:47:28Z
publication:em
publication:emfp
publication:jmc
Danshen-Chuanxiong-Honghua Ameliorates Cerebral Impairment and Improves Spatial Cognitive Deficits after Transient Focal Ischemia and Identification of Active Compounds.
Zhang, Xianhua
Zheng, Wan
Wang, Tingrui
Ren, Ping
Wang, Fushun
Ma, Xin-Liang
Wang, Jian
Huang, Xi
Previously, we only apply a traditional Chinese medicine (TCM) Danshen-Chuanxiong-Honghua (DCH) for cardioprotection via anti-inflammation in rats of acute myocardial infarction by occluding coronary artery. Presently, we select not only DCH but also its main absorbed compound ferulic acid (FA) for cerebra protection via similar action of mechanism above in animals of the transient middle cerebral artery occlusion (tMCAO). We investigated whether oral administration of DCH and FA could ameliorate MCAO-induced brain lesions in animals. By using liquid chromatography-tandem mass spectrometry (LC-MS/MS), we analyzed four compounds, including tanshinol, salvianolic acid B, hydroxysafflor yellow A and especially FA as the putative active components of DCH extract in the plasma, cerebrospinal fluid and injured hippocampus of rats with MCAO. In our study, it was assumed that FA played a similar neuroprotective role to DCH. We found that oral pretreatment with DCH (10 or 20 g/kg) and FA (100 mg/kg) improved neurological function and alleviated the infarct volume as well as brain edema in a dose-dependent manner. These changes were accompanied by improved ischemia-induced apoptosis and decreased the inflammatory response. Additionally, chronic treatment with DCH reversed MCAO-induced spatial cognitive deficits in a manner associated with enhanced neurogenesis and increased the expression of brain-derived neurotrophic factor in lesions of the hippocampus. These findings suggest that DCH has the ability to recover cognitive impairment and offer neuroprotection against cerebral ischemic injury via inhibiting microenvironmental inflammation and triggering of neurogenesis in the hippocampus. FA could be one of the potential active compounds.
2017-07-18T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/61
https://jdc.jefferson.edu/context/emfp/article/1064/viewcontent/fphar_08_00452.pdf
http://creativecommons.org/licenses/by/4.0/
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Danshen-Chuanxiong-Honghua (DCH)
apoptosis
cerebral ischemia
inflammation
neurogenesis
spatial cognitive function
Emergency Medicine
Medicine and Health Sciences
oai:jdc.jefferson.edu:emfp-1065
2017-08-21T19:32:59Z
publication:em
publication:emfp
publication:jmc
Cardiac arrest risk standardization using administrative data compared to registry data.
Grossestreuer, Anne V.
Gaieski, David F.
Donnino, Michael W.
Nelson, Joshua I.M.
Mutter, Eric L.
Carr, Brendan G.
Abella, Benjamin S.
Wiebe, Douglas J.
BACKGROUND: Methods for comparing hospitals regarding cardiac arrest (CA) outcomes, vital for improving resuscitation performance, rely on data collected by cardiac arrest registries. However, most CA patients are treated at hospitals that do not participate in such registries. This study aimed to determine whether CA risk standardization modeling based on administrative data could perform as well as that based on registry data.
METHODS AND RESULTS: Two risk standardization logistic regression models were developed using 2453 patients treated from 2000-2015 at three hospitals in an academic health system. Registry and administrative data were accessed for all patients. The outcome was death at hospital discharge. The registry model was considered the "gold standard" with which to compare the administrative model, using metrics including comparing areas under the curve, calibration curves, and Bland-Altman plots. The administrative risk standardization model had a c-statistic of 0.891 (95% CI: 0.876-0.905) compared to a registry c-statistic of 0.907 (95% CI: 0.895-0.919). When limited to only non-modifiable factors, the administrative model had a c-statistic of 0.818 (95% CI: 0.799-0.838) compared to a registry c-statistic of 0.810 (95% CI: 0.788-0.831). All models were well-calibrated. There was no significant difference between c-statistics of the models, providing evidence that valid risk standardization can be performed using administrative data.
CONCLUSIONS: Risk standardization using administrative data performs comparably to standardization using registry data. This methodology represents a new tool that can enable opportunities to compare hospital performance in specific hospital systems or across the entire US in terms of survival after CA.
2017-08-01T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/62
https://jdc.jefferson.edu/context/emfp/article/1065/viewcontent/journal.pone.0182864.pdf
http://creativecommons.org/publicdomain/zero/1.0/
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Cardiology
Emergency Medicine
Medicine and Health Sciences
oai:jdc.jefferson.edu:emfp-1066
2017-08-21T20:27:40Z
publication:em
publication:emfp
publication:jmc
Idarucizumab for Dabigatran Reversal - Full Cohort Analysis.
Pollack, Charles V.
Reilly, Paul A.
van Ryn, Joanne
Eikelboom, John W.
Glund, Stephan
Bernstein, Richard A.
Dubiel, Robert
Huisman, Menno V.
Hylek, Elaine M.
Kam, Chak-Wah
Kamphuisen, Pieter W.
Kreuzer, Jörg
Levy, Jerrold H.
Royle, Gordon
Sellke, Frank W.
Stangier, Joachim
Steiner, Thorsten
Verhamme, Peter
Wang, Bushi
Young, Laura
Weitz, Jeffrey I.
BACKGROUND: Idarucizumab, a monoclonal antibody fragment, was developed to reverse the anticoagulant effect of dabigatran.
METHODS: We performed a multicenter, prospective, open-label study to determine whether 5 g of intravenous idarucizumab would be able to reverse the anticoagulant effect of dabigatran in patients who had uncontrolled bleeding (group A) or were about to undergo an urgent procedure (group B). The primary end point was the maximum percentage reversal of the anticoagulant effect of dabigatran within 4 hours after the administration of idarucizumab, on the basis of the diluted thrombin time or ecarin clotting time. Secondary end points included the restoration of hemostasis and safety measures.
RESULTS: A total of 503 patients were enrolled: 301 in group A, and 202 in group B. The median maximum percentage reversal of dabigatran was 100% (95% confidence interval, 100 to 100), on the basis of either the diluted thrombin time or the ecarin clotting time. In group A, 137 patients (45.5%) presented with gastrointestinal bleeding and 98 (32.6%) presented with intracranial hemorrhage; among the patients who could be assessed, the median time to the cessation of bleeding was 2.5 hours. In group B, the median time to the initiation of the intended procedure was 1.6 hours; periprocedural hemostasis was assessed as normal in 93.4% of the patients, mildly abnormal in 5.1%, and moderately abnormal in 1.5%. At 90 days, thrombotic events had occurred in 6.3% of the patients in group A and in 7.4% in group B, and the mortality rate was 18.8% and 18.9%, respectively. There were no serious adverse safety signals.
CONCLUSIONS: In emergency situations, idarucizumab rapidly, durably, and safely reversed the anticoagulant effect of dabigatran. (Funded by Boehringer Ingelheim; RE-VERSE AD ClinicalTrials.gov number, NCT02104947 .).
2017-08-03T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/63
https://jdc.jefferson.edu/context/emfp/article/1066/viewcontent/nejmoa1707278.pdf
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Adult
Aged
Aged
80 and over
Antibodies
Antibodies
Monoclonal
Humanized
Anticoagulants
Blood Coagulation
Dabigatran
Drug Hypersensitivity
Female
Hemorrhage
Humans
Infusions
Intravenous
Male
Middle Aged
Prospective Studies
Thrombin Time
Thrombosis
Time Factors
Aged, 80 and over
Antibodies, Monoclonal, Humanized
Infusions, Intravenous
Medicine and Health Sciences
oai:jdc.jefferson.edu:emfp-1067
2017-10-02T19:12:02Z
publication:em
publication:emfp
publication:jmc
Adiponectin improves coronary no-reflow injury by protecting the endothelium in rats with type 2 diabetes mellitus.
Han, Xue
Wu, Ye
Liu, Xin
Ma, Lu
Lv, Tingting
Sun, Qi
Xu, Wenli
Zhang, Suli
Wang, Ke
Wang, Wen
Ma, Xin-Liang
Liu, Huirong
To determine the effect of adiponectin (APN) on the coronary no-reflow (NR) injury in rats with Type 2 diabetes mellitus (T2DM), 80 male Sprague-Dawley rats were fed with a high-sugar-high-fat diet to build a T2DM model. Rats received vehicle or APN in the last week and then were subjected to myocardial ischemia reperfusion (MI/R) injury. Endothelium-dependent vasorelaxation of the thoracic aorta was significantly decreased and serum levels of endothelin-1 (ET-1), intercellular cell adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) were noticably increased in T2DM rats compared with rats without T2DM. Serum APN was positively correlated with the endothelium-dependent vasorelaxation, but negatively correlated with the serum level of ET-1. Treatment with APN improved T2DM-induced endothelium-dependent vasorelaxation, recovered cardiac function, and decreased both NR size and the levels of ET-1, ICAM-1 and VCAM-1. Hypoadiponectinemia was associated with the aggravation of coronary NR in T2DM rats. APN could alleviate coronary NR injury in T2DM rats by protecting the endothelium and improving microcirculation.
2017-08-31T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/64
https://jdc.jefferson.edu/context/emfp/article/1067/viewcontent/BSR20170282.full.pdf
http://creativecommons.org/licenses/by/4.0/
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
adiponectin
coronary no reflow
endothelial cell
microcirculation
type 2 diabetes mellitus
Medicine and Health Sciences
oai:jdc.jefferson.edu:emfp-1068
2017-10-02T19:29:42Z
publication:em
publication:emfp
publication:jmc
Accuracy of Emergency Medical Services Dispatcher and Crew Diagnosis of Stroke in Clinical Practice.
Jia, Judy
Band, Roger
Abboud, Michael E.
Pajerowski, William
Guo, Michelle
David, Guy
Mechem, C. Crawford
Messé, Steven R
Carr, Brendan G.
Mullen, Michael T
BACKGROUND: Accurate recognition of stroke symptoms by Emergency Medical Services (EMS) is necessary for timely care of acute stroke patients. We assessed the accuracy of stroke diagnosis by EMS in clinical practice in a major US city.
METHODS AND RESULTS: Philadelphia Fire Department data were merged with data from a single comprehensive stroke center to identify patients diagnosed with stroke or TIA from 9/2009 to 10/2012. Sensitivity and positive predictive value (PPV) were calculated. Multivariable logistic regression identified variables associated with correct EMS diagnosis. There were 709 total cases, with 400 having a discharge diagnosis of stroke or TIA. EMS crew sensitivity was 57.5% and PPV was 69.1%. EMS crew identified 80.2% of strokes with National Institutes of Health Stroke Scale (NIHSS) ≥5 and symptom durationmodel, correct EMS crew diagnosis was positively associated with NIHSS (NIHSS 5-9, OR 2.62, 95% CI 1.41-4.89; NIHSS ≥10, OR 4.56, 95% CI 2.29-9.09) and weakness (OR 2.28, 95% CI 1.35-3.85), and negatively associated with symptom duration >270 min (OR 0.41, 95% CI 0.25-0.68). EMS dispatchers identified 90 stroke cases that the EMS crew missed. EMS dispatcher or crew identified stroke with sensitivity of 80% and PPV of 50.9%, and EMS dispatcher or crew identified 90.5% of patients with NIHSS ≥5 and symptom duration <6 >h.
CONCLUSION: Prehospital diagnosis of stroke has limited sensitivity, resulting in a high proportion of missed stroke cases. Dispatchers identified many strokes that EMS crews did not. Incorporating EMS dispatcher impression into regional protocols may maximize the effectiveness of hospital destination selection and pre-notification.
2017-09-14T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/65
https://jdc.jefferson.edu/context/emfp/article/1068/viewcontent/fneur_08_00466.pdf
http://creativecommons.org/licenses/by/4.0/
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
emergency medical services
intracranial hemorrhage
ischemic stroke
prehospital
sensitivity
stroke systems
transient ischemic attack
Emergency Medicine
Medicine and Health Sciences
Neurology
oai:jdc.jefferson.edu:emfp-1069
2017-10-18T14:08:00Z
publication:em
publication:emfp
publication:jmc
Sex Differences in rt-PA Utilization at Hospitals Treating Stroke: The National Inpatient Sample.
Boehme, Amelia K.
Carr, Brendan G.
Kasner, Scott Eric
Albright, Karen C
Kallan, Michael J.
Elkind, Mitchell S V S.V.
Branas, Charles C.
Mullen, Michael T.
BACKGROUND AND PURPOSE: Sex and race disparities in recombinant tissue plasminogen activator (rt-PA) use have been reported. We sought to explore sex and race differences in the utilization of rt-PA at primary stroke centers (PSCs) compared to non-PSCs across the US.
METHODS: Data from the National (Nationwide) Inpatient Sample (NIS) 2004-2010 was utilized to assess sex differences in treatment for ischemic stroke in PSCs compared to non-PSCs.
RESULTS: There were 304,152 hospitalizations with a primary diagnosis of ischemic stroke between 2004 and 2010 in the analysis: 75,160 (24.7%) patients were evaluated at a PSC. A little over half of the patients evaluated at PSCs were female (53.8%). A lower proportion of women than men received rt-PA at both PSCs (6.8 vs. 7.5%, p < 0.001) and non-PSCs (2.3 vs. 2.8%, p < 0.001). After adjustment for potential confounders the odds of being treated with rt-PA remained lower for women regardless of presentation to a PSC (OR 0.87, 95% CI 0.81-0.94) or non-PSC (OR 0.88, 95% CI 0.82-0.94). After stratifying by sex and race, the lowest absolute treatment rates were observed in black women (4.4% at PSC, 1.9% at non-PSC). The odds of treatment, relative to white men, was however lowest for white women (PSC OR = 0.85, 95% CI 0.78-0.93; non-PSC OR = 0.80, 95% CI 0.75-0.85). In the multivariable model, sex did not modify the effect of PSC certification on rt-PA utilization (p-value for interaction = 0.58).
CONCLUSION: Women are less likely to receive rt-PA than men at both PSCs and non-PSCs. Absolute treatment rates are lowest in black women, although the relative difference in men and women was greatest for white women.
2017-09-27T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/66
https://jdc.jefferson.edu/context/emfp/article/1069/viewcontent/fneur_08_00500.pdf
http://creativecommons.org/licenses/by/4.0/
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
acute stroke care
emergency care
health policy
healthcare delivery systems
thrombolysis
Emergency Medicine
Medicine and Health Sciences
Neurology
oai:jdc.jefferson.edu:emfp-1070
2017-11-16T16:54:59Z
publication:em
publication:emfp
publication:jmc
Chemokine signaling during midline epithelial seam disintegration facilitates palatal fusion
Suttorp, Christiaan M.
Cremers, Niels A.
Van Rheden, René E.
Regan, Raymond F.
Helmich, Pia
Van Kempen, Sven
Kuijpers-Jagtman, Anne Marie
Wagener, Frank
Disintegration of the midline epithelial seam (MES) is crucial for palatal fusion, and failure results in cleft palate. Palatal fusion and wound repair share many common signaling pathways related to epithelial-mesenchymal cross-talk. We postulate that chemokine CXCL11, its receptor CXCR3, and the cytoprotective enzyme heme oxygenase (HO), which are crucial during wound repair, also play a decisive role in MES disintegration. Fetal growth restriction and craniofacial abnormalities were present in HO-2 knockout (KO) mice without effects on palatal fusion. CXCL11 and CXCR3 were highly expressed in the disintegrating MES in both wild-type and HO-2 KO animals. Multiple apoptotic DNA fragments were present within the disintegrating MES and phagocytized by recruited CXCR3-positive wt and HO-2 KO macrophages. Macrophages located near the MES were HO-1-positive, and more HO-1-positive cells were present in HO-2 KO mice compared to wild-type. This study of embryonic and palatal development provided evidence that supports the hypothesis that the MES itself plays a prominent role in palatal fusion by orchestrating epithelial apoptosis and macrophage recruitment via CXCL11-CXCR3 signaling. © 2017 Suttorp, Cremers, van Rheden, Regan, Helmich, van Kempen, Kuijpers-Jagtman and Wagener.
2017-10-30T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/67
https://jdc.jefferson.edu/context/emfp/article/1070/viewcontent/fcell_05_00094.pdf
http://creativecommons.org/licenses/by/4.0/
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
Apoptosis
Chemokine
Cleft palate
Embryology
Heme oxygenase
Macrophage
Medicine and Health Sciences
oai:jdc.jefferson.edu:emfp-1071
2018-01-09T21:26:21Z
publication:em
publication:emfp
publication:jmc
Impact of Superstorm Sandy on Medicare Patients' Utilization of Hospitals and Emergency Departments.
Stryckman, Benoit
Walsh, Lauren
Carr, Brendan G.
Hupert, Nathaniel
Lurie, Nicole
INTRODUCTION: National health security requires that healthcare facilities be prepared to provide rapid, effective emergency and trauma care to all patients affected by a catastrophic event. We sought to quantify changes in healthcare utilization patterns for an at-risk Medicare population before, during, and after Superstorm Sandy's 2012 landfall in New Jersey (NJ).
METHODS: This study is a retrospective cohort study of Medicare beneficiaries impacted by Superstorm Sandy. We compared hospital emergency department (ED) and healthcare facility inpatient utilization in the weeks before and after Superstorm Sandy landfall using a 20% random sample of Medicare fee-for-service beneficiaries continuously enrolled in 2011 and 2012 (N=224,116). Outcome measures were pre-storm discharges (or transfers), average length of stay, service intensity weight, and post-storm ED visits resulting in either discharge or hospital admission.
RESULTS: In the pre-storm week, hospital transfers from skilled nursing facilities (SNF) increased by 39% and inpatient discharges had a 0.3 day decreased mean length of stay compared to the prior year. In the post-storm week, ED visits increased by 14% statewide; of these additional "surge" patients, 20% were admitted to the hospital. The increase in ED demand was more than double the statewide average in the most highly impacted coastal regions (35% versus 14%).
CONCLUSION: Superstorm Sandy impacted both pre- and post-storm patient movement in New Jersey; post-landfall ED surge was associated with overall storm impact, which was greatest in coastal counties. A significant increase in the number and severity of pre-storm transfer patients, in particular from SNF, as well as in post-storm ED visits and inpatient admissions, draws attention to the importance of collaborative regional approaches to healthcare in large-scale events.
2017-10-01T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/68
https://jdc.jefferson.edu/context/emfp/article/1071/viewcontent/qt8t61v46p.pdf
http://creativecommons.org/licenses/by/4.0/
Department of Emergency Medicine Faculty Papers
Jefferson Digital Commons
adult
attention
cohort analysis
controlled study
emergency ward
female
health care utilization
hospital admission
hospital patient
human
length of stay
major clinical study
male
medicare
New Jersey
nursing home
outcome assessment
random sample
retrospective study
Emergency Medicine
Medicine and Health Sciences
oai:jdc.jefferson.edu:emfp-1072
2018-03-26T16:12:34Z
publication:em
publication:emfp
publication:jmc
Associations of Emergency Department Length of Stay With Publicly Reported Quality-of-care Measures.
Chang, Anna Marie
Lin, Amber
Fu, Rongwei
McConnell, K. John
Sun, Benjamin
OBJECTIVE: The Institute of Medicine identified emergency department (ED) crowding as a critical threat to patient safety. We assess the association between changes in publicly reported ED length of stay (LOS) and changes in quality-of-care measures in a national cohort of hospitals.
METHODS: Longitudinal analysis of 2012 and 2013 data from the American Hospital Association (AHA) Survey, Center for Medicare and Medicaid Services (CMS) Cost Reports, and CMS Hospital Compare. We included hospitals reporting Hospital Compare timeliness measure of LOS for admitted patients. We used AHA and CMS data to incorporate hospital predictors of interest. We used the method of first differences to test for relationships in the change over time between timeliness measures and six hospital-level measures.
RESULTS: The cohort consisted of 2,619 hospitals. Each additional hour of ED LOS was associated with a 0.7% decrease in proportion of patients giving a top satisfaction rating, a 0.7% decrease in proportion of patients who would "definitely recommend" the hospital, and a 6-minute increase in time to pain management for long bone fracture (p < 0.01 for all). A 1-hour increase in ED LOS is associated with a 44% increase in the odds of having an increase in left without being seen (95% confidence interval = 25% to 68%). ED LOS was not associated with hospital readmissions (p = 0.14) or time to percutaneous coronary intervention (p = 0.14).
CONCLUSION: In this longitudinal study of hospitals across the United States, improvements in ED timeliness measures are associated with improvements in the patient experience.
2017-02-01T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/69
https://jdc.jefferson.edu/context/emfp/article/1072/viewcontent/nihms_818274.pdf
Department of Emergency Medicine Faculty Papers
English
Jefferson Digital Commons
Crowding
Emergency Service
Hospital
Female
Hospitals
Humans
Length of Stay
Linear Models
Longitudinal Studies
Male
Patient Satisfaction
Quality of Health Care
Time Factors
United States
Emergency Service, Hospital
Emergency Medicine
Medicine and Health Sciences
oai:jdc.jefferson.edu:emfp-1073
2018-03-26T20:16:44Z
publication:em
publication:emfp
publication:jmc
Design and challenges of a randomized clinical trial of medical expulsive therapy (tamsulosin) for urolithiasis in the emergency department.
Burrows, Pamela K.
Hollander, Judd E.
Wolfson, Allan B.
Kurz, Michael C.
Richards, Lorna
DiFiore, Sara
Watts, Phillip
Patkar, Nivedita
Brown, Jeremy
Jackman, Stephen
Kirkali, Ziya
Kusek, John W.
Michel, Chloe
Meltzer, Andrew C.
Urolithiasis or urinary stone disease has been estimated to affect about 1 in 11 Americans. Patients with urinary stone disease commonly present to the emergency department for management of their acute pain. In addition to providing analgesia, administration of drug (medical expulsive therapy) is often prescribed to assist passage of the urinary stone. In this methodology paper, we describe the design of a prospective, multi-center, randomized, double-blind placebo controlled clinical trial of the alpha-adrenergic blocker, tamsulosin, to evaluate its effectiveness as medical expulsive therapy. In addition, we describe the unique challenges of conducting a trial of this type within the setting of the emergency department.
2017-01-01T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/70
https://jdc.jefferson.edu/context/emfp/article/1073/viewcontent/nihms833563.pdf
http://creativecommons.org/licenses/by-nc-nd/4.0/
Department of Emergency Medicine Faculty Papers
English
Jefferson Digital Commons
Analgesics
Double-Blind Method
Emergency Service
Hospital
Humans
Pain Management
Sulfonamides
Treatment Outcome
Urolithiasis
Urological Agents
Emergency Service, Hospital
Emergency Medicine
Medicine and Health Sciences
Urology
oai:jdc.jefferson.edu:emfp-1074
2018-03-26T20:28:36Z
publication:em
publication:emfp
publication:jmc
The 2016 Academic Emergency Medicine Consensus Conference, "Shared Decision Making in the Emergency Department: Development of a Policy-relevant Patient-centered Research Agenda" Diagnostic Testing Breakout Session Report.
Barrett, Tyler W.
Rising, Kristin L.
Bellolio, M. Fernanda
Hall, M. Kennedy
Brody, Aaron
Dodd, Kenneth W.
Grieser, Mira
Levy, Phillip D.
Raja, Ali S.
Self, Wesley H.
Weingarten, Gail
Hess, Erik P.
Hollander, Judd
Diagnostic testing is an integral component of patient evaluation in the emergency department (ED). Emergency clinicians frequently use diagnostic testing to more confidently exclude "worst-case" diagnoses rather than to determine the most likely etiology for a presenting complaint. Increased utilization of diagnostic testing has not been associated with reductions in disease-related mortality but has led to increased overall healthcare costs and other unintended consequences (e.g., incidental findings requiring further workup, unnecessary exposure to ionizing radiation or potentially nephrotoxic contrast). Shared decision making (SDM) presents an opportunity for clinicians to discuss the benefits and harms associated with diagnostic testing with patients to more closely tailor testing to patient risk. This article introduces the challenges and opportunities associated with incorporating SDM into emergency care by summarizing the conclusions of the diagnostic testing group at the 2016 Academic Emergency Medicine Consensus Conference on SDM. Three primary domains emerged: 1) characteristics of a condition or test appropriate for SDM, 2) critical elements of and potential barriers to SDM discussions on diagnostic testing, and 3) financial aspects of SDM applied to diagnostic testing. The most critical research questions to improve engagement of patients in their acute care diagnostic decisions were determined by consensus.
2016-12-01T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/71
https://jdc.jefferson.edu/context/emfp/article/1074/viewcontent/nihms802101.pdf
Department of Emergency Medicine Faculty Papers
English
Jefferson Digital Commons
Consensus
Decision Making
Diagnostic Techniques and Procedures
Emergency Medicine
Emergency Service
Hospital
Humans
Patient Participation
Patient-Centered Care
Policy
Emergency Service, Hospital
Emergency Medicine
Medicine and Health Sciences
oai:jdc.jefferson.edu:emfp-1075
2018-03-27T20:40:01Z
publication:em
publication:emfp
publication:jmc
The RNA binding protein SORBS2 suppresses metastatic colonization of ovarian cancer by stabilizing tumor-suppressive immunomodulatory transcripts.
Zhao, Linjie
Wang, Wei
Huang, Shuang
Yang, Zhengnan
Xu, Lian
Yang, Qilian
Zhou, Xiu
Wang, Jinjin
Shen, Qiuhong
Wang, Chenlu
Le, Xiaobing
Feng, Min
Zhou, Nianxin
Lau, Wayne Bond
Lau, Bonnie
Yao, Shaohua
Yi, Tao
Wang, Xin
Zhao, Xia
Wei, Yuquan
Zhou, Shengtao
BACKGROUND: Ovarian cancer constitutes one of the most lethal gynecologic malignancies for females. Currently, early detection strategies and therapeutic options for ovarian cancer are far from satisfactory, leading to high diagnosis rates at late stages and disease relapses. New avenues of therapy are needed that target key processes in ovarian cancer progression. While a variety of non-coding RNAs have been proven to regulate ovarian cancer metastatic progression, the functional roles of RNA-binding proteins (RBPs) in this process are less well defined.
RESULTS: In this study, we identify that the RBP sorbin and SH3 domain containing 2 (SORBS2) is a potent suppressor of ovarian cancer metastatic colonization. Mechanistic studies show that SORBS2 binds the 3' untranslated regions (UTRs) of WFDC1 (WAP four-disulfide core domain 1) and IL-17D (Interleukin-17D), two secreted molecules that are shown to act as metastasis suppressors. Enhanced expression of either WFDC1 or IL-17D potently represses SORBS2 depletion-mediated cancer metastasis promotion. By enhancing the stability of these gene transcripts, SORBS2 suppresses ovarian cancer invasiveness and affects monocyte to myeloid-derived suppressor cell and M2-like macrophage polarization, eliciting a tumor-suppressive immune microenvironment.
CONCLUSIONS: Our data illustrate a novel post-transcriptional network that links cancer progression and immunomodulation within the tumor microenvironment through SORBS2-mediated transcript stabilization.
2018-03-16T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/72
https://jdc.jefferson.edu/context/emfp/article/1075/viewcontent/document_5_.pdf
http://creativecommons.org/licenses/by/4.0/
Department of Emergency Medicine Faculty Papers
English
Jefferson Digital Commons
IL-17D
Immunomodulation
Metastasis
Ovarian cancer
RNA binding protein
SORBS2
WFDC1
mRNA stability
Medicine and Health Sciences
Oncology
oai:jdc.jefferson.edu:emfp-1076
2018-03-29T20:38:25Z
publication:em
publication:emfp
publication:jmc
Recurrent violent injury: magnitude, risk factors, and opportunities for intervention from a statewide analysis.
Kaufman, Elinore
Rising, MD, MS, Kristin L.
Wiebe, Douglas J.
Ebler, David J.
Crandall, Marie L.
Delgado, M. Kit
INTRODUCTION: Although preventing recurrent violent injury is an important component of a public health approach to interpersonal violence and a common focus of violence intervention programs, the true incidence of recurrent violent injury is unknown. Prior studies have reported recurrence rates from 0.8% to 44%, and risk factors for recurrence are not well established.
METHODS: We used a statewide, all-payer database to perform a retrospective cohort study of emergency department visits for injury due to interpersonal violence in Florida, following up patients injured in 2010 for recurrence through 2012. We assessed risk factors for recurrence with multivariable logistic regression and estimated time to recurrence with the Kaplan-Meier method. We tabulated hospital charges and costs for index and recurrent visits.
RESULTS: Of 53 908 patients presenting for violent injury in 2010, 11.1% had a recurrent violent injury during the study period. Trauma centers treated 31.8%, including 55.9% of severe injuries. Among recurrers, 58.9% went to a different hospital for their second injury. Low income, homelessness, Medicaid or uninsurance, and black race were associated with increased odds of recurrence. Patients with visits for mental and behavioral health and unintentional injury also had increased odds of recurrence. Index injuries accounted for $105 million in costs, and recurrent injuries accounted for another $25.3 million.
CONCLUSIONS: Recurrent violent injury is a common and costly phenomenon, and effective violence prevention programs are needed. Prevention must include the nontrauma centers where many patients seek care.
2016-09-01T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/73
https://jdc.jefferson.edu/context/emfp/article/1076/viewcontent/nihms805635.pdf
Department of Emergency Medicine Faculty Papers
English
Jefferson Digital Commons
Adolescent
Adult
African Americans
Cohort Studies
Emergency Service
Hospital
Female
Florida
Homeless Persons
Hospital Charges
Hospital Costs
Humans
Kaplan-Meier Estimate
Logistic Models
Male
Medicaid
Medically Uninsured
Mental Disorders
Middle Aged
Multivariate Analysis
Poverty
Recurrence
Retrospective Studies
Risk Factors
Trauma Centers
United States
Violence
Wounds and Injuries
Young Adult
Emergency Service, Hospital
Emergency Medicine
Medicine and Health Sciences
Surgery
oai:jdc.jefferson.edu:emfp-1077
2018-03-29T20:44:02Z
publication:em
publication:emfp
publication:jmc
Right ventricular dysfunction after resuscitation predicts poor outcomes in cardiac arrest patients independent of left ventricular function.
Ramjee, Vimal
Grossestreuer, Anne V.
Yao, Yuan
Perman, Sarah M.
Leary, Marion
Kirkpatrick, James N.
Forfia, Paul R.
Kolansky, Daniel M.
Abella, Benjamin S.
Gaieski, David F
OBJECTIVE: Determination of clinical outcomes following resuscitation from cardiac arrest remains elusive in the immediate post-arrest period. Echocardiographic assessment shortly after resuscitation has largely focused on left ventricular (LV) function. We aimed to determine whether post-arrest right ventricular (RV) dysfunction predicts worse survival and poor neurologic outcome in cardiac arrest patients, independent of LV dysfunction.
METHODS: A single-center, retrospective cohort study at a tertiary care university hospital participating in the Penn Alliance for Therapeutic Hypothermia (PATH) Registry between 2000 and 2012.
PATIENTS: 291 in- and out-of-hospital adult cardiac arrest patients at the University of Pennsylvania who had return of spontaneous circulation (ROSC) and post-arrest echocardiograms.
MEASUREMENTS AND MAIN RESULTS: Of the 291 patients, 57% were male, with a mean age of 59 ± 16 years. 179 (63%) patients had LV dysfunction, 173 (59%) had RV dysfunction, and 124 (44%) had biventricular dysfunction on the initial post-arrest echocardiogram. Independent of LV function, RV dysfunction was predictive of worse survival (mild or moderate: OR 0.51, CI 0.26-0.99, p
CONCLUSIONS: Echocardiographic findings of post-arrest RV dysfunction were equally prevalent as LV dysfunction. RV dysfunction was significantly predictive of worse outcomes in post-arrest patients after accounting for LV dysfunction. Post-arrest RV dysfunction may be useful for risk stratification and management in this high-mortality population.
2015-11-01T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/74
https://jdc.jefferson.edu/context/emfp/article/1077/viewcontent/nihms945537.pdf
Department of Emergency Medicine Faculty Papers
English
Jefferson Digital Commons
Echocardiography
Female
Follow-Up Studies
Heart Arrest
Humans
Hypothermia
Induced
Male
Middle Aged
Pennsylvania
Prognosis
Resuscitation
Retrospective Studies
Survival Rate
Treatment Outcome
Ventricular Dysfunction
Right
Ventricular Function
Left
Hypothermia, Induced
Ventricular Dysfunction, Right
Ventricular Function, Left
Cardiology
Emergency Medicine
Medicine and Health Sciences
oai:jdc.jefferson.edu:emfp-1078
2018-07-03T13:43:38Z
publication:em
publication:emfp
publication:jmc
Cardiac-derived CTRP9 protects against myocardial ischemia/reperfusion injury via calreticulin-dependent inhibition of apoptosis.
Zhao, Dajun
Feng, Pan
Sun, Yang
Qin, Zhigang
Zhang, Zhengbin
Tan, Yanzhen
Gao, Erhe
Lau, Wayne Bond
Ma, Xin-Liang
Yang, Jian
Yu, Shiqiang
Xu, Xuezeng
Yi, Dinghua
Yi, Wei
Cardiokines play an essential role in maintaining normal cardiac functions and responding to acute myocardial injury. Studies have demonstrated the heart itself is a significant source of C1q/TNF-related protein 9 (CTRP9). However, the biological role of cardiac-derived CTRP9 remains unclear. We hypothesize cardiac-derived CTRP9 responds to acute myocardial ischemia/reperfusion (MI/R) injury as a cardiokine. We explored the role of cardiac-derived CTRP9 in MI/R injury via genetic manipulation and a CTRP9-knockout (CTRP9-KO) animal model. Inhibition of cardiac CTRP9 exacerbated, whereas its overexpression ameliorated, left ventricular dysfunction and myocardial apoptosis. Endothelial CTRP9 expression was unchanged while cardiomyocyte CTRP9 levels decreased after simulated ischemia/`reperfusion (SI/R) in vitro. Cardiomyocyte CTRP9 overexpression inhibited SI/R-induced apoptosis, an effect abrogated by CTRP9 antibody. Mechanistically, cardiac-derived CTRP9 activated anti-apoptotic signaling pathways and inhibited endoplasmic reticulum (ER) stress-related apoptosis in MI/R injury. Notably, CTRP9 interacted with the ER molecular chaperone calreticulin (CRT) located on the cell surface and in the cytoplasm of cardiomyocytes. The CTRP9-CRT interaction activated the protein kinase A-cAMP response element binding protein (PKA-CREB) signaling pathway, blocked by functional neutralization of the autocrine CTRP9. Inhibition of either CRT or PKA blunted cardiac-derived CTRP9's anti-apoptotic actions against MI/R injury. We further confirmed these findings in CTRP9-KO rats. Together, these results demonstrate that autocrine CTRP9 of cardiomyocyte origin protects against MI/R injury via CRT association, activation of the PKA-CREB pathway, ultimately inhibiting cardiomyocyte apoptosis.
2018-07-01T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/75
https://jdc.jefferson.edu/context/emfp/article/1078/viewcontent/s41419_018_0726_3.pdf
http://creativecommons.org/licenses/by/4.0/
Department of Emergency Medicine Faculty Papers
English
Jefferson Digital Commons
Cardiology
Medicine and Health Sciences
oai:jdc.jefferson.edu:emfp-1079
2018-10-31T15:05:54Z
publication:em
publication:emfp
publication:jmc
Systemwide Clinical Ultrasound Program Development: An Expert Consensus Model.
Strony, Robert
Marin, Jennifer R.
Bailitz, John
Dean, Anthony J.
Blaivas, Mike
Tayal, Vivek
Raio, Chris
Liu, Rachel
Woods, Aimee
Zwank, Michael
Fields, Matthew
Abo, Alyssa
Wu, Stan
Kang, Tarina
Liu, Teresa
Leo, Megan
Smalley, Courtney
Chiricolo, Jerry
Chilstrom, Mikaela
Lewiss, Resa E.
Clinical ultrasound (CUS) is integral to the practice of an increasing number of medical specialties. Guidelines are needed to ensure effective CUS utilization across health systems. Such guidelines should address all aspects of CUS within a hospital or health system. These include leadership, training, competency, credentialing, quality assurance and improvement, documentation, archiving, workflow, equipment, and infrastructure issues relating to communication and information technology. To meet this need, a group of CUS subject matter experts, who have been involved in institution- and/or systemwide clinical ultrasound (SWCUS) program development convened. The purpose of this paper was to create a model for SWCUS development and implementation.
2018-07-01T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/76
https://jdc.jefferson.edu/context/emfp/article/1079/viewcontent/qt4fp97925.pdf
https://jdc.jefferson.edu/context/emfp/article/1079/filename/0/type/additional/viewcontent/qt5mk68932.pdf
http://creativecommons.org/licenses/by/4.0/
Department of Emergency Medicine Faculty Papers
English
Jefferson Digital Commons
accreditation
article
consensus
documentation
human
information technology
leadership
program development
quality control
ultrasound
workflow
Emergency Medicine
Medicine and Health Sciences
oai:jdc.jefferson.edu:emfp-1080
2018-08-22T15:50:36Z
publication:em
publication:emfp
publication:jmc
Epigenetics in ovarian cancer: premise, properties, and perspectives.
Yang, Qilian
Yang, Yuqing
Zhou, Nianxin
Tang, Kexin
Lau, Wayne Bond
Lau, Bonnie
Wang, Wei
Xu, Lian
Yang, Zhengnan
Huang, Shuang
Wang, Xin
Yi, Tao
Zhao, Xia
Wei, Yuquan
Wang, Hongjing
Zhao, Linjie
Zhou, Shengtao
Malignant ovarian tumors bear the highest mortality rate among all gynecological cancers. Both late tumor diagnosis and tolerance to available chemical therapy increase patient mortality. Therefore, it is both urgent and important to identify biomarkers facilitating early identification and novel agents preventing recurrence. Accumulating evidence demonstrates that epigenetic aberrations (particularly histone modifications) are crucial in tumor initiation and development. Histone acetylation and methylation are respectively regulated by acetyltransferases-deacetylases and methyltransferases-demethylases, both of which are implicated in ovarian cancer pathogenesis. In this review, we summarize the most recent discoveries pertaining to ovarian cancer development arising from the imbalance of histone acetylation and methylation, and provide insight into novel therapeutic interventions for the treatment of ovarian carcinoma.
2018-07-31T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/77
https://jdc.jefferson.edu/context/emfp/article/1080/viewcontent/document_7_.pdf
http://creativecommons.org/licenses/by/4.0/
Department of Emergency Medicine Faculty Papers
English
Jefferson Digital Commons
Epigenetics
Histone acetylation
Histone methylaiton
Ovarian cancer
Medicine and Health Sciences
Obstetrics and Gynecology
Oncology
Surgery
oai:jdc.jefferson.edu:emfp-1081
2018-09-18T19:16:29Z
publication:em
publication:emfp
publication:jmc
Introduction to direct oral anticoagulants and rationale for specific reversal agents.
Pollack, Charles V.
2016-11-01T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/78
https://jdc.jefferson.edu/context/emfp/article/1081/viewcontent/1_s2.0_S0735675716306465_main.pdf
http://creativecommons.org/licenses/by-nc-nd/4.0/
Department of Emergency Medicine Faculty Papers
English
Jefferson Digital Commons
Antibodies
Monoclonal
Humanized
Anticoagulants
Antidotes
Arginine
Factor Xa
Humans
Piperazines
Recombinant Proteins
Antibodies, Monoclonal, Humanized
Emergency Medicine
Medicine and Health Sciences
oai:jdc.jefferson.edu:emfp-1082
2018-09-18T19:21:26Z
publication:em
publication:emfp
publication:jmc
Evidence supporting idarucizumab for the reversal of dabigatran.
Pollack, Charles V.
Idarucizumab is a monoclonal antibody fragment specifically targeted to dabigatran. It has demonstrated prompt and durable reversal of the anticoagulant effects of dabigatran in animal studies and phase 1 studies of young, elderly, and renally impaired volunteers. Although elective invasive procedures and most bleeding complications in dabigatran-treated patients can be managed by temporarily stopping dabigatran therapy and using supportive measures, there are rare clinical situations that require urgent reversal of the anticoagulant effect of dabigatran. The effectiveness and safety of 5 g of intravenous idarucizumab is being investigated in a prospective, open-label, single-cohort study in patients with serious bleeding or in those requiring an urgent procedure. In an interim analysis of the first 90 participants, idarucizumab rapidly and completely reversed the anticoagulant activity of dabigatran in 88%-98% of participants, and there were no safety concerns, with no deaths or serious adverse events being attributable to idarucizumab. Supported by these interim results, idarucizumab has been approved in the United States and the European Union for use when reversal of the anticoagulant effects of dabigatran is needed for emergency surgery/urgent procedures or in patients with life-threatening or uncontrolled bleeding. Clinical use of idarucizumab should follow the same processes as patient enrollment in this study, which is projected to be completed in 2016. The outcomes achieved with this specific reversal agent are likely to be of continued interest to treating physicians.
2016-11-01T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/79
https://jdc.jefferson.edu/context/emfp/article/1082/viewcontent/1_s2.0_S0735675716306520_main.pdf
http://creativecommons.org/licenses/by-nc-nd/4.0/
Department of Emergency Medicine Faculty Papers
English
Jefferson Digital Commons
Antibodies
Monoclonal
Humanized
Dabigatran
Emergencies
Hemorrhage
Humans
Thrombin Time
Whole Blood Coagulation Time
Antibodies, Monoclonal, Humanized
Emergency Medicine
Medicine and Health Sciences
oai:jdc.jefferson.edu:emfp-1083
2018-09-19T15:53:08Z
publication:em
publication:emfp
publication:jmc
Targeting the Nrf2-Heme Oxygenase-1 Axis after Intracerebral Hemorrhage.
Chen-Roetling, Jing
Regan, Raymond F.
BACKGROUND: Injury to cells adjacent to an intracerebral hemorrhage (ICH) is likely mediated at least in part by toxins released from the hematoma that initiate complex and interacting injury cascades. Pharmacotherapies targeting a single toxin or pathway, even if consistently effective in controlled experimental models, have a high likelihood of failure in a variable clinical setting. Nuclear factor erythroid-2 related factor 2 (Nrf2) regulates the expression of heme oxygenase-1 (HO-1) and multiple other proteins with antioxidant and antiinflammatory effects, and may be a target of interest after ICH.
METHODS: Studies that tested the effect of HO and Nrf2 in models relevant to ICH are summarized, with an effort to reconcile conflicting data by consideration of methodological limitations.
RESULTS: In vitro studies demonstrated that Nrf2 activators rapidly increased HO-1 expression in astrocytes, and reduced their vulnerability to hemoglobin or hemin. Modulating HO-1 expression via genetic approaches yielded similar results. Systemic treatment with small molecule Nrf2 activators increased HO-1 expression in perivascular cells, particularly astrocytes. When tested in mouse or rat ICH models, Nrf2 activators were consistently protective, improving barrier function and attenuating edema, inflammation, neuronal loss and neurological deficits. These effects were mimicked by selective astrocyte HO-1 overexpression in transgenic mice.
CONCLUSION: Systemic treatment with Nrf2 activators after ICH is protective in rodents. Two compounds, dimethyl fumarate and hemin, are currently approved for treatment of multiple sclerosis and acute porphyria, respectively, and have acceptable safety profiles over years of clinical use. Further development of these drugs as ICH therapeutics seems warranted.
2017-01-01T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/80
https://jdc.jefferson.edu/context/emfp/article/1083/viewcontent/nihms852091.pdf
Department of Emergency Medicine Faculty Papers
English
Jefferson Digital Commons
Animals
Cerebral Hemorrhage
Heme Oxygenase-1
Humans
NF-E2-Related Factor 2
Emergency Medicine
Medicine and Health Sciences
oai:jdc.jefferson.edu:emfp-1084
2019-01-22T20:05:37Z
publication:em
publication:emfp
publication:jmc
The power of the group: comparison of interviews and group concept mapping for identifying patient-important outcomes of care.
Rising, Kristin L.
LaNoue, Marianna
Gentsch, Alexzandra
Doty, Amanda
Cunningham, Amy
Carr, Brendan G.
Hollander, Judd E.
Latimer, Lori
Loebell, Larry
Weingarten, Gail
White, Neva
Mills, Geoffrey
BACKGROUND: Data are limited regarding how to effectively and efficiently identify patient priorities for research or clinical care. Our goal was to compare the comprehensiveness and efficiency of group concept mapping (GCM), a group participatory method, to interviews for identifying patient goals when seeking care.
METHODS: We engaged patients with moderately- to poorly-controlled diabetes mellitus in either GCM or an individual interview. The primary outcome was the comprehensiveness of GCM brainstorming (the first stage of GCM) as compared to interviews for eliciting patient-important outcomes (PIOs) related to seeking care. Secondary outcomes included 1) comprehensiveness of GCM brainstorming and interviews compared to a master list of PIOs and 2) efficiency of GCM brainstorming, the entire GCM process and interviews.
RESULTS: We engaged 89 interview participants and 52 GCM participants (across 3 iterations of GCM) to identify outcomes most important to patients when making decisions related to diabetes management. We identified 26 PIOs in interviews, 33 PIOs in the first GCM brainstorming session, and 38 PIOs across all three GCM brainstorming sessions. The initial GCM brainstorming session identified 77% (20/26) of interview PIOs, and all 3 GCM brainstorming sessions combined identified 88% (23/26). When comparing GCM brainstorming and interviews to the master list of PIOs, the initial GCM brainstorming sessions identified 80% (33/41), all 3 GCM brainstorming sessions identified 93% (38/41) and interviews identified 63% (26/41) of all PIOs. Compared to interviews, GCM brainstorming required less research team time, more patient time, and had a lowest cost. The entire GCM process still required less research team time than interviews, though required more patient time and had a higher cost than interviews.
CONCLUSIONS: GCM brainstorming is a powerful tool for effectively and efficiently identifying PIOs in certain scenarios, though it does not provide the breadth and depth of individual interviews or the higher level conceptual organization of the complete process of GCM. Selection of the optimal method for patient engagement should include consideration of multiple factors including depth of patient input desired, research team expertise, resources, and the population to be engaged.
TRIAL REGISTRATION: Registered on ClinicalTrials.gov , NCT02792777. Registration information submitted 6/2/2016, with the registration first posted on the ClinicalTrials.gov website 6/8/2016. Data collection began on 4/29/2016.
2019-01-08T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/81
https://jdc.jefferson.edu/context/emfp/article/1084/viewcontent/document_29_.pdf
http://creativecommons.org/licenses/by/4.0/
Department of Emergency Medicine Faculty Papers
English
Jefferson Digital Commons
Brainstorming
Group concept mapping
Interviews
Outcome elicitation
Patient engagement
Patient-centered outcomes
Emergency Medicine
Medicine and Health Sciences
oai:jdc.jefferson.edu:emfp-1085
2019-01-28T16:41:39Z
publication:em
publication:emfp
publication:jmc
Association of Obstructive Sleep Apnea With Cardiovascular Outcomes in Patients With Acute Coronary Syndrome.
Fan, Jingyao
Wang, Xiao
Ma, Xin-Liang
Somers, Virend K.
Nie, Shaoping
Wei, Yongxiang
Background The prognostic significance of obstructive sleep apnea ( OSA ) in patients with acute coronary syndrome ( ACS ) in the contemporary era is unclear. We performed a large, prospective cohort study and did a landmark analysis to delineate the association of OSA with subsequent cardiovascular events after ACS onset. Methods and Results Between June 2015 and May 2017, consecutive eligible patients admitted for ACS underwent cardiorespiratory polygraphy during hospitalization. OSA was defined as an apnea-hypopnea index ≥15 events·h-1. The primary end point was major adverse cardiovascular and cerebrovascular event ( MACCE ), including cardiovascular death, myocardial infarction, stroke, ischemia-driven revascularization, or hospitalization for unstable angina or heart failure. OSA was present in 403 of 804 (50.1%) patients. During median follow-up of 1 year, cumulative incidence of MACCE was significantly higher in the OSA group than in the non- OSA group (log-rank, P=0.041). Multivariate analysis showed that OSA was nominally associated with incidence of MACCE (adjusted hazard ratio, 1.55; 95% CI, 0.94-2.57; P=0.085). In the landmark analysis, patients with OSA had 3.9 times the risk of incurring a MACCE after 1 year (adjusted hazard ratio, 3.87; 95% CI, 1.20-12.46; P=0.023), but no increased risk was found within 1-year follow-up (adjusted hazard ratio, 1.18; 95% CI, 0.67-2.09; P=0.575). No significant differences were found in the incidence of cardiovascular death, myocardial infarction, and ischemia-driven revascularization, except for a higher rate of hospitalization for unstable angina in the OSA group than in the non- OSA group (adjusted hazard ratio, 2.10; 95% CI, 1.09-4.05; P=0.027). Conclusions There was no independent correlation between OSA and 1-year MACCE after ACS . The increased risk associated with OSA was only observed after 1-year follow-up. Efficacy of OSA treatment as secondary prevention after ACS requires further investigation.
2019-01-22T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/82
https://jdc.jefferson.edu/context/emfp/article/1085/viewcontent/JAHA.118.010826.pdf
http://creativecommons.org/licenses/by-nc/4.0/
Department of Emergency Medicine Faculty Papers
English
Jefferson Digital Commons
acute coronary syndrome
obstructive sleep apnea
outcome
Emergency Medicine
Medicine and Health Sciences
oai:jdc.jefferson.edu:emfp-1086
2019-02-11T16:51:43Z
publication:em
publication:umedeans
publication:deanepca
publication:emfp
publication:ume
publication:jmc
Assessing the use of social media in physician assistant education.
Wanner, Gregory K.
Phillips, Andrew W.
Papanagnou, MD, Dimitrios
Objectives: This study aims to assess physician assistant (PA) students' experiences with social media (SM) as a part of their medical education.
Methods: The study is split into two phases: Phase 1- A cross-sectional survey emailed to all PA students at four PA school campuses to assess students' prior SM experiences (226 responses, 71.1% response rate); and Phase 2- Inclusion of SM educational resources, via Twitter, within lectures performed at two PA schools. A phase-2 survey assessed students' opinions of educational SM (50 responses, 59.5% response rate) and SM usage was tracked.
Results: The phase-1 survey respondents indicated that 97.3% (n=220) use social media; often used as a part of their education, 65% (n=147) informally and 2.7% (n=6) formally incorporated. Students most commonly use Facebook, YouTube, and Instagram, but rarely use Twitter. Currently using SM for medical education was significantly associated with predicting that future PA education will formally include SM [r
Conclusions: Many PA students are currently using various forms of social media to augment their education. Most PA students support formal incorporation of social media into their education. PA educators should consider using our data and methods of social media inclusion when designing curricula and while clinically precepting PA students.
2019-01-29T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/83
https://jdc.jefferson.edu/context/emfp/article/1086/viewcontent/social_media_in_physician_assistant_education.pdf
http://creativecommons.org/licenses/by/3.0/
Department of Emergency Medicine Faculty Papers
English
Jefferson Digital Commons
education
medical education
physician assistant
social media
technology
Emergency Medicine
Medical Education
Medicine and Health Sciences
oai:jdc.jefferson.edu:emfp-1087
2019-03-06T15:36:05Z
publication:em
publication:emfp
publication:jmc
Design-thinking, making, and innovating: Fresh tools for the physician's toolbox
Albala, L.
Bober, T.
Mallozzi, M.
Koeneke-Hernandez, L.
Ku, B.
Medical school education should foster creativity by enabling students to become 'makers' who prototype and design. Healthcare professionals and students experience pain points on a daily basis, but are not given the tools, training, or opportunity to help solve them in new, potentially better ways. The student physician of the future will learn these skills through collaborative workshops and having dedicated 'innovation time.' This pre-clinical curriculum would incorporate skills centered on (1) Digital Technology and Small Electronics (DTSE), (2) Textiles and Medical Materials (TMM), and (3) Rapid Prototyping Technologies (RPT). Complemented by an on-campus makerspace, students will be able to prototype and iterate on their ideas in a fun and accessible space. Designing and making among and between patients and healthcare professionals would change the current dynamic of medical education, empowering students to solve problems in healthcare even at an early stage in their career. By doing so, they will gain empathy, problem-solving abilities, and communication skills that will extend into clinical practice. Our proposed curriculum will equip medical students with the skills, passion, and curiosity to impact the future of healthcare.
2018-01-01T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/84
https://jdc.jefferson.edu/context/emfp/article/1087/viewcontent/EJ1165474.pdf
http://creativecommons.org/licenses/by/4.0/
Department of Emergency Medicine Faculty Papers
English
Jefferson Digital Commons
Design
Medical Schools
Health Services
Medical Education
Health Personnel
Patients
Physicians
Medicine
Medical Students
Hospitals
Problem Solving
Empathy
Art and Design
Medicine and Health Sciences
oai:jdc.jefferson.edu:emfp-1088
2019-03-08T20:00:34Z
publication:em
publication:emfp
publication:jmc
A Three-dimensional Printed Low-cost Anterior Shoulder Dislocation Model for Ultrasound-guided Injection Training.
Risler, Zachary
Magee, Mark A.
Mazza, Jacob M.
Goodsell, Kelly
Au, Arthur K.
Lewiss, Resa E.
Pugliese, Robert S.
Ku, Bon
Anterior shoulder dislocations are the most common, large joint dislocations that present to the emergency department (ED). Numerous studies support the use of intraarticular local anesthetic injections for the safe, effective, and time-saving reduction of these dislocations. Simulation training is an alternative and effective method for training compared to bedside learning. There are no commercially available ultrasound-compatible shoulder dislocation models. We utilized a three-dimensional (3D) printer to print a model that allows the visualization of the ultrasound anatomy (sonoanatomy) of an anterior shoulder dislocation. We utilized an open-source file of a shoulder, available from embodi3D® (Bellevue, WA, US). After approximating the relative orientation of the humerus to the glenoid fossa in an anterior dislocation, the humerus and scapula model was printed with an Ultimaker-2 Extended+ 3D® (Ultimaker, Cambridge, MA, US) printer using polylactic acid filaments. A 3D model of the external shoulder anatomy of a live human model was then created using Structure Sensor®(Occipital, San Francisco, CA, US), a 3D scanner. We aligned the printed dislocation model of the humerus and scapula within the resultant external shoulder mold. A pourable ballistics gel solution was used to create the final shoulder phantom. The use of simulation in medicine is widespread and growing, given the restrictions on work hours and a renewed focus on patient safety. The adage of "see one, do one, teach one" is being replaced by deliberate practice. Simulation allows such training to occur in a safe teaching environment. The ballistic gel and polylactic acid structure effectively reproduced the sonoanatomy of an anterior shoulder dislocation. The 3D printed model was effective for practicing an in-plane ultrasound-guided intraarticular joint injection. 3D printing is effective in producing a low-cost, ultrasound-capable model simulating an anterior shoulder dislocation. Future research will determine whether provider confidence and the use of intraarticular anesthesia for the management of shoulder dislocations will improve after utilizing this model.
2018-11-02T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/85
https://jdc.jefferson.edu/context/emfp/article/1088/viewcontent/1546562132_20190104_261_rmsj1a.pdf
http://creativecommons.org/licenses/by/3.0/
Department of Emergency Medicine Faculty Papers
English
Jefferson Digital Commons
medical simulation
3d printing
anterior shoulder dislocation
emergency medicine
Emergency Medicine
Medical Education
Medicine and Health Sciences
oai:jdc.jefferson.edu:emfp-1089
2019-05-09T13:59:47Z
publication:em
publication:emfp
publication:jmc
The Vitamin C, Thiamine and Steroids in Sepsis (VICTAS) Protocol: a prospective, multi-center, double-blind, adaptive sample size, randomized, placebo-controlled, clinical trial.
Hager, David N.
Hooper, Michael H.
Bernard, Gordon R.
Busse, Laurence W.
Ely, E. Wesley
Fowler, Alpha A.
Gaieski, David F.
Hall, Alex
Hinson, Jeremiah S.
Jackson, James C.
Kelen, Gabor D.
Levine, Mark
Lindsell, Christopher J.
Malone, Richard E.
McGlothlin, Anna
Rothman, Richard E.
Viele, Kert
Wright, David W.
Sevransky, Jonathan E.
Martin, Greg S.
BACKGROUND: Sepsis accounts for 30% to 50% of all in-hospital deaths in the United States. Other than antibiotics and source control, management strategies are largely supportive with fluid resuscitation and respiratory, renal, and circulatory support. Intravenous vitamin C in conjunction with thiamine and hydrocortisone has recently been suggested to improve outcomes in patients with sepsis in a single-center before-and-after study. However, before this therapeutic strategy is adopted, a rigorous assessment of its efficacy is needed.
METHODS: The Vitamin C, Thiamine and Steroids in Sepsis (VICTAS) trial is a prospective, multi-center, double-blind, adaptive sample size, randomized, placebo-controlled trial. It will enroll patients with sepsis causing respiratory or circulatory compromise or both. Patients will be randomly assigned (1:1) to receive intravenous vitamin C (1.5 g), thiamine (100 mg), and hydrocortisone (50 mg) every 6 h or matching placebos until a total of 16 administrations have been completed or intensive care unit discharge occurs (whichever is first). Patients randomly assigned to the comparator group are permitted to receive open-label stress-dose steroids at the discretion of the treating clinical team. The primary outcome is consecutive days free of ventilator and vasopressor support (VVFDs) in the 30 days following randomization. The key secondary outcome is mortality at 30 days. Sample size will be determined adaptively by using interim analyses with pre-stated stopping rules to allow the early recognition of a large mortality benefit if one exists and to refocus on the more sensitive outcome of VVFDs if an early large mortality benefit is not observed.
DISCUSSION: VICTAS is a large, multi-center, double-blind, adaptive sample size, randomized, placebo-controlled trial that will test the efficacy of vitamin C, thiamine, and hydrocortisone as a combined therapy in patients with respiratory or circulatory dysfunction (or both) resulting from sepsis. Because the components of this therapy are inexpensive and readily available and have very favorable risk profiles, demonstrated efficacy would have immediate implications for the management of sepsis worldwide.
TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03509350 . First registered on April 26, 2018, and last verified on December 20, 2018. Protocol version: 1.4, January 9, 2019.
2019-04-05T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/86
https://jdc.jefferson.edu/context/emfp/article/1089/viewcontent/document_35_.pdf
http://creativecommons.org/licenses/by/4.0/
Department of Emergency Medicine Faculty Papers
English
Jefferson Digital Commons
Hydrocortisone
Mortality
Randomized controlled trial
Sepsis
Septic shock
Thiamine
Vitamin C
Emergency Medicine
Medicine and Health Sciences
oai:jdc.jefferson.edu:emfp-1090
2019-05-09T17:04:09Z
publication:em
publication:emfp
publication:jmc
Coronary Angiography after Cardiac Arrest - The Right Timing or the Right Patients?
Abella, Benjamin S.
Gaieski, David F
2019-04-11T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/87
https://jdc.jefferson.edu/context/emfp/article/1090/viewcontent/nejme1901651.pdf
Department of Emergency Medicine Faculty Papers
English
Jefferson Digital Commons
Arrhythmias
Cardiac
Coronary Angiography
Humans
Out-of-Hospital Cardiac Arrest
Arrhythmias, Cardiac
Cardiology
Emergency Medicine
Medicine and Health Sciences
oai:jdc.jefferson.edu:emfp-1091
2019-05-28T19:58:38Z
publication:em
publication:emfp
publication:jmc
Antibody-Based Ticagrelor Reversal Agent in Healthy Volunteers.
Bhatt, Deepak L.
Pollack, Charles V.
Weitz, Jeffrey I.
Jennings, Lisa K.
Xu, Sherry
Arnold, Susan E.
Umstead, Bret R.
Mays, Michael C.
Lee, John S.
BACKGROUND: Ticagrelor is an oral P2Y12 inhibitor that is used with aspirin to reduce the risk of ischemic events among patients with acute coronary syndromes or previous myocardial infarction. Spontaneous major bleeding and bleeding associated with urgent invasive procedures are concerns with ticagrelor, as with other antiplatelet drugs. The antiplatelet effects of ticagrelor cannot be reversed with platelet transfusion. A rapid-acting reversal agent would be useful.
METHODS: In this randomized, double-blind, placebo-controlled, phase 1 trial, we evaluated intravenous PB2452, a monoclonal antibody fragment that binds ticagrelor with high affinity, as a ticagrelor reversal agent. We assessed platelet function in healthy volunteers before and after 48 hours of ticagrelor pretreatment and again after the administration of PB2452 or placebo. Platelet function was assessed with the use of light transmission aggregometry, a point-of-care P2Y12 platelet-reactivity test, and a vasodilator-stimulated phosphoprotein assay.
RESULTS: Of the 64 volunteers who underwent randomization, 48 were assigned to receive PB2452 and 16 to receive placebo. After 48 hours of ticagrelor pretreatment, platelet aggregation was suppressed by approximately 80%. PB2452 administered as an initial intravenous bolus followed by a prolonged infusion (8, 12, or 16 hours) was associated with a significantly greater increase in platelet function than placebo, as measured by multiple assays. Ticagrelor reversal occurred within 5 minutes after the initiation of PB2452 and was sustained for more than 20 hours (P<0.001 after Bonferroni adjustment across all time points for all assays). There was no evidence of a rebound in platelet activity after drug cessation. Adverse events related to the trial drug were limited mainly to issues involving the infusion site.
CONCLUSIONS: In healthy volunteers, the administration of PB2452, a specific reversal agent for ticagrelor, provided immediate and sustained reversal of the antiplatelet effects of ticagrelor, as measured by multiple assays. (Funded by PhaseBio Pharmaceuticals; ClinicalTrials.gov number, NCT03492385.).
2019-05-09T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/88
https://jdc.jefferson.edu/context/emfp/article/1091/viewcontent/nejmoa1901778.pdf
Department of Emergency Medicine Faculty Papers
English
Jefferson Digital Commons
Adult
Antibodies
Neutralizing
Blood Platelets
Coagulants
Dose-Response Relationship
Drug
Double-Blind Method
Female
Healthy Volunteers
Humans
Infusions
Intravenous
Male
Platelet Aggregation Inhibitors
Ticagrelor
Antibodies, Neutralizing
Dose-Response Relationship, Drug
Infusions, Intravenous
Cardiology
Medicine and Health Sciences
oai:jdc.jefferson.edu:student_papers-1029
2019-06-06T17:56:02Z
publication:student
publication:em
publication:tju
publication:emfp
publication:library
publication:oapubfund
publication:jmc
publication:student_papers
publication:jeffoapubs
A Case Report of Case Report Pursuit by Medical Student
Li, Jonathan
Wilson, Jennifer
Lau, Wayne Bond
Medical students often seek case reports as vehicles for academic writing opportunities, conference presentation avenues, and residency/fellowship application highlights. Here we review a case where, due to unfortunate circumstances, a student made a unique diagnosis central to proper patient clinical care, wished to write up the case subsequently, but was ultimately excluded from the final work stemming from the patient case. We review the pitfalls that occurred in the process of pursuing publication of an interesting case, the educational value of pursuing case reports for students, the necessity for strong mentorship in this process, and general principles that medical students can follow regarding case report creation to avoid being "burned".
2019-04-01T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/student_papers/28
https://jdc.jefferson.edu/context/student_papers/article/1029/viewcontent/MededPublish___2305.pdf
http://creativecommons.org/licenses/by-sa/4.0/
Student Papers, Posters & Projects
English
Jefferson Digital Commons
Undergraduate Medical Education
Case Report
Mentorship
Medical Student
Academic Medicine
Medical Teaching
Communication
Medical Education
Medicine and Health Sciences
Technical and Professional Writing
oai:jdc.jefferson.edu:emfp-1092
2019-07-01T19:57:17Z
publication:em
publication:emfp
publication:jmc
Temporal Trends in Incidence, Sepsis-Related Mortality, and Hospital-Based Acute Care After Sepsis.
Meyer, Nathaniel
Harhay, Michael O.
Small, Dylan S.
Prescott, Hallie C.
Bowles, Kathryn H.
Gaieski, David F.
Mikkelsen, Mark E
OBJECTIVES: A growing number of patients survive sepsis hospitalizations each year and are at high risk for readmission. However, little is known about temporal trends in hospital-based acute care (emergency department treat-and-release visits and hospital readmission) after sepsis. Our primary objective was to measure temporal trends in sepsis survivorship and hospital-based acute care use in sepsis survivors. In addition, because readmissions after pneumonia are subject to penalty under the national readmission reduction program, we examined whether readmission rates declined after sepsis hospitalizations related to pneumonia.
DESIGN AND SETTING: Retrospective, observational cohort study conducted within an academic healthcare system from 2010 to 2015.
PATIENTS: We used three validated, claims-based approaches to identify 17,256 sepsis or severe sepsis hospitalizations to examine trends in hospital-based acute care after sepsis.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: From 2010 to 2015, sepsis as a proportion of medical and surgical admissions increased from 3.9% to 9.4%, whereas in-hospital mortality rate for sepsis hospitalizations declined from 24.1% to 14.8%. As a result, the proportion of medical and surgical discharges at-risk for hospital readmission after sepsis increased from 2.7% to 7.8%. Over 6 years, 30-day hospital readmission rates declined modestly, from 26.4% in 2010 to 23.1% in 2015, driven largely by a decline in readmission rates among survivors of nonsevere sepsis, and nonpneumonia sepsis specifically, as the readmission rate of severe sepsis survivors was stable. The modest decline in 30-day readmission rates was offset by an increase in emergency department treat-and-release visits, from 2.8% in 2010 to a peak of 5.4% in 2014.
CONCLUSIONS: Owing to increasing incidence and declining mortality, the number of sepsis survivors at risk for hospital readmission rose significantly between 2010 and 2015. The 30-day hospital readmission rates for sepsis declined modestly but were offset by a rise in emergency department treat-and-release visits.
2018-03-01T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/89
https://jdc.jefferson.edu/context/emfp/article/1092/viewcontent/nihms914266.pdf
Department of Emergency Medicine Faculty Papers
English
Jefferson Digital Commons
Emergency Medicine
Medicine and Health Sciences
oai:jdc.jefferson.edu:emfp-1093
2019-07-31T14:41:39Z
publication:em
publication:emfp
publication:jmc
Quality Assurance in Telehealth: Adherence to Evidence-Based Indicators.
Halpren-Ruder, Daniel
Chang, Anna Marie
Hollander, Judd E.
Shah, Anuh
Background: Value enhancing telehealth (TH) lacks a robust body of formal clinically focused quality assessment studies. Innovations such as telehealth must always demonstrate that it preserves or hopefully advances quality. Introduction: We sought to determine whether adherence to the evidence-based Choosing Wisely (CW) recommendations (antibiotic stewardship) for acute sinusitis differs for encounters through direct-to-consumer (DTC) telemedicine verses "in-person" care in an emergency department (ED) or an urgent care (UC) center.
Materials and Methods: Study design was a retrospective review. Patients with a symptom complex consistent with acute sinusitis treated through DTC were matched with ED and UC patients, based upon time of visit. Charts were reviewed to determine patient characteristics, chief complaint, final diagnosis, presence or absence of criteria within the CW guidelines, and whether or not antibiotics were prescribed. The main outcome was adherence to the CW campaign recommendations.
Results: A total of 570 visits were studied: 190 DTC, 190 ED, and 190 UC visits. The predominant chief complaints were upper respiratory infection (36%), sore throat (25%), and sinusitis (18%). Overall, there was a 67% (95% CI 62.3-71.7) adherence rate with the CW guidelines for sinusitis: DTC visits (71%), ED visits (68%), and UC visits (61%). There was a nonsignificant difference (p = 0.29) in adherence to CW guidelines based upon type of visit (DTC, UC, and ED).
Discussion: The challenge is to demonstrate whether or not DTC TH compromises quality.
Conclusion: In this study, DTC visits were associated with at least as good an adherence to the CW campaign recommendations as emergency medicine (EM) and UC in-person visits.
© Daniel Halpren-Ruder et al.
2019-07-01T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/90
https://jdc.jefferson.edu/context/emfp/article/1093/viewcontent/tmj.2018.0149.pdf
http://creativecommons.org/licenses/by-nc/4.0/
Department of Emergency Medicine Faculty Papers
English
Jefferson Digital Commons
education
information management
medical records
telemedicine
Emergency Medicine
Medicine and Health Sciences
Telemedicine
oai:jdc.jefferson.edu:emfp-1094
2019-08-07T16:40:16Z
publication:em
publication:emfp
publication:jmc
Electrocardiogram and cardiac testing among patients in the emergency department with seizure versus syncope.
White, Jennifer L.
Hollander, Judd E.
Pines, Jesse M.
Mullins, Peter M.
Chang, Anna Marie
OBJECTIVE: Cardiogenic syncope can present as a seizure. The distinction between seizure disorder and cardiogenic syncope can only be made if one considers the diagnosis. Our main objective was to identify whether patients presenting with a chief complaint (reason for visit) as seizure or syncope received an electrocardiogram in the emergency department across all age groups.
METHODS: We conducted a secondary analysis of data collected in the 2010 to 2014 National Hospital Ambulatory Medical Care Survey comparing patients presenting with a chief complaint of syncope versus seizure to determine likelihood of getting an evaluation for possible life threatening cardiovascular disease. The primary endpoint was receiving an electrocardiogram in the emergency department; secondary endpoint was receiving cardiac biomarkers.
RESULTS: There was a total of 144,094 patient encounters. Of these visits, 1,553 had syncope and 1,470 had seizure (60.3% vs. 44.2% female, 19.9% vs. 29.0% non-white). After adjusting for age, sex, mode of arrival and insurance, patients with syncope were more likely to receive an electrocardiogram compared to patients with seizure (odds ratio, 10.86; 95% confidence interval [CI], 8.52 to 13.84). This was true across all age groups (0 to 18 years, 56% vs. 7.5%; 18 to 44 years, 60% vs. 27%; 45 to 64 years, 82% vs. 41%; ≥65 years, 85% vs. 68%; P<0.01 for all). Car- diac biomarkers were also obtained more frequently in adult patients with syncope patients (18 to 44 years, 17.5% vs. 10.5%; 45 to 64 years, 33.8% vs. 21.4%; ≥65 years, 47.1% vs. 32.3%; P<0.01 for all).
CONCLUSION: Patients evaluated in the emergency department for syncope received an electrocar- diogram and cardiac biomarkers more frequently than those that had seizure.
2019-06-01T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/91
https://jdc.jefferson.edu/context/emfp/article/1094/viewcontent/ceem_18_003.pdf
http://creativecommons.org/licenses/by-nc/4.0/
Department of Emergency Medicine Faculty Papers
English
Jefferson Digital Commons
Electrocardiography
Seizures
Syncope
Emergency Medicine
Medicine and Health Sciences
oai:jdc.jefferson.edu:emfp-1095
2019-09-13T15:04:14Z
publication:em
publication:fmfp
publication:fm
publication:healthpolicy
publication:tju
publication:emfp
publication:healthpolicyfaculty
publication:library
publication:oapubfund
publication:jmc
publication:jcph
publication:jeffoapubs
Patient experience and challenges in group concept mapping for clinical research.
Mills, Geoffrey D.
LaNoue, Marianna
Gentsch, Alexzandra T.
Doty, Amanda M.B.
Cunningham, Amy
Nord, Garrison
Rising, Kristin L.
BACKGROUND AND OBJECTIVE: Group concept mapping (GCM) is a research method that engages stakeholders in generating, structuring and representing ideas around a specific topic or question. GCM has been used with patients to answer questions related to health and disease but little is known about the patient experience as a participant in the process. This paper explores the patient experience participating in GCM as assessed with direct observation and surveys of participants.
METHODS: This is a secondary analysis performed within a larger study in which 3 GCM iterations were performed to engage patients in identifying patient-important outcomes for diabetes care. Researchers tracked the frequency and type of assistance required by each participant to complete the sorting and rating steps of GCM. In addition, a 17-question patient experience survey was administered over the telephone to the participants after they had completed the GCM process. Survey questions asked about the personal impact of participating in GCM and the ease of various steps of the GCM process.
RESULTS: Researchers helped patients 92 times during the 3 GCM iterations, most commonly to address software and computer literacy issues, but also with the sorting phase itself. Of the 52 GCM participants, 40 completed the post-GCM survey. Respondents averaged 56 years of age, were 50% female and had an average hemoglobin A1c of 9.1%. Ninety-two percent (n = 37) of respondents felt that they had contributed something important to this research project and 90% (n = 36) agreed or strongly agreed that their efforts would help others with diabetes. Respondents reported that the brainstorming session was less difficult when compared with sorting and rating of statements.
DISCUSSION: Our results suggest that patients find value in participating in GCM. Patients reported less comfort with the sorting step of GCM when compared with brainstorming, an observation that correlates with our observations from the GCM sessions. Researchers should consider using paper sorting methods and objective measures of sorting quality when using GCM in patient-engaged research to improve the patient experience and concept map quality.
2019-08-15T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/92
https://jdc.jefferson.edu/context/emfp/article/1095/viewcontent/document_38_.pdf
http://creativecommons.org/licenses/by/4.0/
Department of Emergency Medicine Faculty Papers
English
Jefferson Digital Commons
Group concept mapping
Patient reported outcomes
Diabetes
Quality of life
Brainstorming
Emergency Medicine
Family Medicine
Medicine and Health Sciences
oai:jdc.jefferson.edu:emfp-1096
2019-09-24T14:55:44Z
publication:em
publication:emfp
publication:jmc
Surgical stress and cancer progression: the twisted tango.
Chen, Zhiwei
Zhang, Peidong
Xu, Ya
Yan, Jiahui
Liu, Zixuan
Lau, Wayne Bond
Lau, Bonnie
Li, Ying
Zhao, Xia
Wei, Yuquan
Zhou, Shengtao
Surgical resection is an important avenue for cancer treatment, which, in most cases, can effectively alleviate the patient symptoms. However, accumulating evidence has documented that surgical resection potentially enhances metastatic seeding of tumor cells. In this review, we revisit the literature on surgical stress, and outline the mechanisms by which surgical stress, including ischemia/reperfusion injury, activation of sympathetic nervous system, inflammation, systemically hypercoagulable state, immune suppression and effects of anesthetic agents, promotes tumor metastasis. We also propose preventive strategies or resolution of tumor metastasis caused by surgical stress.
2019-09-02T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/93
https://jdc.jefferson.edu/context/emfp/article/1096/viewcontent/document.pdf
http://creativecommons.org/licenses/by/4.0/
Department of Emergency Medicine Faculty Papers
English
Jefferson Digital Commons
cancer
circulating tumor cells (CTCs)
coagulation system
disseminated tumor cells (DTCs)
immunosuppression
inflammation
ischemia/reperfusion injury (IRI)
nervous system
surgical stress
Medicine and Health Sciences
Oncology
Surgery
oai:jdc.jefferson.edu:emfp-1097
2019-09-26T19:39:43Z
publication:em
publication:emfp
publication:jmc
Identification of Emergency Care-Sensitive Conditions and Characteristics of Emergency Department Utilization.
Vashi, Anita A.
Urech, Tracy
Carr, Brendan
Greene, Liberty
Warsavage, Theodore
Hsia, Renee
Asch, Steven M.
Importance: Monitoring emergency care quality requires understanding which conditions benefit most from timely, quality emergency care.
Objectives: To identify a set of emergency care-sensitive conditions (ECSCs) that are treated in most emergency departments (EDs), are associated with a spectrum of adult age groups, and represent common reasons for seeking emergency care and to provide benchmark national estimates of ECSC acute care utilization.
Design, Setting, and Participants: A modified Delphi method was used to identify ECSCs. In a cross-sectional analysis, ECSC-associated visits by adults (aged ≥18 years) were identified based on International Statistical Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes and analyzed with nationally representative data from the 2016 US Nationwide Emergency Department Sample. Data analysis was conducted from January 2018 to December 2018.
Main Outcomes and Measures: Identification of ECSCs and ECSC-associated ED utilization patterns, length of stay, and charges.
Results: An expert panel rated 51 condition groups as emergency care sensitive. Emergency care-sensitive conditions represented 16 033 359 of 114 323 044 ED visits (14.0%) in 2016. On average, 8 535 261 of 17 886 220 ED admissions (47.7%) were attributed to ECSCs. The most common ECSC ED visits were for sepsis (1 716 004 [10.7%]), chronic obstructive pulmonary disease (1 273 319 [7.9%]), pneumonia (1 263 971 [7.9%]), asthma (970 829 [6.1%]), and heart failure (911 602 [5.7%]) but varied by age group. Median (interquartile range) length of stay for ECSC ED admissions was longer than non-ECSC ED admissions (3.2 [1.7-5.8] days vs 2.7 [1.4-4.9] days; P < .001). In 2016, median (interquartile range) ED charges per visit for ECSCs were $2736 ($1684-$4605) compared with $2179 ($1118-$4359) per visit for non-ECSC ED visits (P < .001).
Conclusions and Relevance: This comprehensive list of ECSCs can be used to guide indicator development for pre-ED, intra-ED, and post-ED care and overall assessment of the adult, non-mental health, acute care system. Health care utilization and costs among patients with ECSCs are substantial and warrant future study of validation, variations in care, and outcomes associated with ECSCs.
2019-08-07T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/94
https://jdc.jefferson.edu/context/emfp/article/1097/viewcontent/vashi_2019_oi_190343.pdf
http://creativecommons.org/licenses/by/4.0/
Department of Emergency Medicine Faculty Papers
English
Jefferson Digital Commons
Emergency Medicine
Medicine and Health Sciences
oai:jdc.jefferson.edu:emfp-1098
2019-11-18T16:30:49Z
publication:em
publication:emfp
publication:jmc
Chemical Disaster Preparedness for Hospitals and Emergency Departments
Wanner, DO, Gregory K.
Atti, MD, Sukhi
Jasper, MD, Edward
Preparing to evaluate and treat victims of a chemical exposure incident is one aspect of hospital disaster preparedness. Past chemical disasters, including terrorist attacks and industrial or transit accidents, have highlighted the need for hospital planning, preparation, and training. Emergency department and hospital staff members must be familiar with their facility-specific protocols and be trained for their individual roles during these incidents. This article provides a brief review of the requirements and guidelines related to chemical disaster response from a healthcare perspective. Resources for training and the evaluation of chemically contaminated patients are discussed. Decontamination procedures, including pre-hospital and hospital-based decontamination of ambulatory, non-ambulatory, and at-risk patients are also reviewed. Physicians and clinicians, especially in the emergency department, must be familiar with methods of evaluating chemical exposures, identifying substances, recognizing toxidromes, ensuring appropriate personal protective equipment (PPE) use, performing decontamination, and initiating treatments for life-threatening conditions. By understanding the guidelines and resources available, clinicians will be better equipped to safely evaluate and treat chemically exposed or contaminated patients.
2019-10-01T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/95
https://jdc.jefferson.edu/context/emfp/article/1098/viewcontent/DJPH__ChemicalDisasters_October_2019.pdf
Department of Emergency Medicine Faculty Papers
English
Jefferson Digital Commons
Emergency Medicine
Medicine and Health Sciences
oai:jdc.jefferson.edu:emfp-1099
2019-11-20T17:21:49Z
publication:em
publication:emfp
publication:jmc
Heat shock factor 1-mediated transcription activation of Omi/HtrA2 induces myocardial mitochondrial apoptosis in the aging heart.
Liu, Dan
Wu, Linguo
Wu, Ye
Wei, Xin
Wang, Wen
Zhang, Suli
Yi, Ming
Li, Jing
Liu, Huirong
Ma, Xin-Liang
BACKGROUND: Increased cardiac apoptosis is a hallmark of the elderly, which in turn increases the risk for developing cardiac disease. The overexpression of Omi/HtrA2 mRNA and protein contributes to apoptosis in the aged heart. Heat shock factor 1 (HSF1) is a transcription factor that binds to the promoter of Omi/HtrA2 in the aging myocardium. However, whether HSF1 participates in cardiomyocyte apoptosis via transcriptional regulation of Omi/HtrA2 remains unclear. The present study was designed to investigate whether HSF1 plays a role in Omi/HtrA2 transcriptional regulation and myocardial apoptosis.
METHODS AND RESULTS: Assessment of the hearts of mice of different ages was performed, which indicated a decrease in cardiac function reserve and an increase in mitochondrial apoptosis. Omi/HtrA2 overexpression in the elderly was negatively correlated with left ventricular function after exercise overload and positively correlated with myocardial Caspase-9 apoptosis. Chromatin immunoprecipitation (ChIP) of aging hearts and plasmid transfection/RNA interference of H9C2 cells revealed that enhancement of HSF1 expression promotes Omi/HtrA2 expression by inducing the promoter activity of Omi/HtrA2 while also increasing mitochondrial apoptosis by upregulating Omi/HtrA2 expression.
CONCLUSIONS: HSF1 acts as a transcriptional factor that induces Omi/HtrA2 expression and Caspase-9 apoptosis in aged cardiomyocytes, while also decreasing cardiac function reserve.
2019-10-18T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/96
https://jdc.jefferson.edu/context/emfp/article/1099/viewcontent/Wbuzn2RCeo6L86Stj.pdf
http://creativecommons.org/licenses/by/3.0/
Department of Emergency Medicine Faculty Papers
English
Jefferson Digital Commons
Omi/HtrA2
age-related pathology
cardiovascular
mitochondria
transcriptional regulation
Cardiology
Medicine and Health Sciences
oai:jdc.jefferson.edu:emfp-1100
2019-11-22T21:08:45Z
publication:em
publication:emfp
publication:jmc
Mount Fuji sign following nasal polypectomy: Conservative management of pneumocephalus
Szymaszek, Matthew
Toshkezi, Gentian
Pneumocephalus is seen in conjunction with a variety of conditions, particularly traumatic injury, neurosurgical, and ears, nose, and throat (ENT) procedures. We describe the successful, non-operative management with supplemental oxygen of symptomatic pneumocephalus following polypectomy without further complication. This case adds to other case reports of pneumocephalus but differs in the non-invasive, conservative management with supplemental oxygen obviating the need for more invasive neurosurgical intervention such as decompressive craniectomy, burr holes, or drain placement.
2020-03-01T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/97
https://jdc.jefferson.edu/context/emfp/article/1100/viewcontent/Mount_Fuji_sign.pdf
http://creativecommons.org/licenses/by-nc-nd/4.0/
Department of Emergency Medicine Faculty Papers
English
Jefferson Digital Commons
Pneumocephalus
| General Surgery
Tension pneumocephalus
Emergency Medicine
oai:jdc.jefferson.edu:emfp-1101
2019-12-13T16:58:08Z
publication:em
publication:emfp
publication:jmc
Identifying Emergency Department Symptom-Based Diagnoses with the Unified Medical Language System.
Slovis, Benjamin H.
McCarthy, Danielle M.
Nord, Garrison
Doty, Amanda
Piserchia, Katherine
Rising, Kristin L.
INTRODUCTION: Many patients who are discharged from the emergency department (ED) with a symptom-based discharge diagnosis (SBD) have post-discharge challenges related to lack of a definitive discharge diagnosis and follow-up plan. There is no well-defined method for identifying patients with a SBD without individual chart review. We describe a method for automated identification of SBDs from ICD-10 codes using the Unified Medical Language System (UMLS) Metathesaurus.
METHODS: We mapped discharge diagnosis, with use of ICD-10 codes from a one-month period of ED discharges at an urban, academic ED to UMLS concepts and semantic types. Two physician reviewers independently manually identified all discharge diagnoses consistent with SBDs. We calculated inter-rater reliability for manual review and the sensitivity and specificity for our automated process for identifying SBDs against this "gold standard."
RESULTS: We identified 3642 ED discharges with 1382 unique discharge diagnoses that corresponded to 875 unique ICD-10 codes and 10 UMLS semantic types. Over one third (37.5%, n = 1367) of ED discharges were assigned codes that mapped to the "Sign or Symptom" semantic type. Inter-rater reliability for manual review of SBDs was very good (0.87). Sensitivity and specificity of our automated process for identifying encounters with SBDs were 84.7% and 96.3%, respectively.
CONCLUSION: Use of our automated process to identify ICD-10 codes that classify into the UMLS "Sign or Symptom" semantic type identified the majority of patients with a SBD. While this method needs refinement to increase sensitivity of capture, it has potential to automate an otherwise highly time-consuming process. This novel use of informatics methods can facilitate future research specific to patients with SBDs.
2019-10-24T07:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/98
https://jdc.jefferson.edu/context/emfp/article/1101/viewcontent/eScholarship_UC_item_2mp288x5.pdf
http://creativecommons.org/licenses/by/4.0/
Department of Emergency Medicine Faculty Papers
English
Jefferson Digital Commons
Emergency Medicine
Medicine and Health Sciences
oai:jdc.jefferson.edu:emfp-1102
2020-01-21T15:56:21Z
publication:em
publication:emfp
publication:jmc
Clinical significance of obstructive sleep apnea in patients with acute coronary syndrome in relation to diabetes status.
Wang, Xiao
Fan, Jingyao
Du, Yunhui
Ma, Changsheng
Ma, Xin-Liang
Nie, Shaoping
Wei, Yongxiang
Objective: The prognostic significance of obstructive sleep apnea (OSA) in patients with acute coronary syndrome (ACS) according to diabetes mellitus (DM) status remains unclear. We aimed to elucidate the association of OSA with subsequent cardiovascular events in patients with ACS with or without DM.
Research design and methods: In this prospective cohort study, consecutive eligible patients with ACS underwent cardiorespiratory polygraphy between June 2015 and May 2017. OSA was defined as an Apnea Hypopnea Index ≥15 events/hour. The primary end point was major adverse cardiovascular and cerebrovascular events (MACCEs), including cardiovascular death, myocardial infarction, stroke, ischemia-driven revascularization, or hospitalization for unstable angina or heart failure.
Results: Among 804 patients, 248 (30.8%) had DM and 403 (50.1%) had OSA. OSA was associated with 2.5 times the risk of 1 year MACCE in patients with DM (22.3% vs 7.1% in the non-OSA group; adjusted HR (HR)=2.49, 95% CI 1.16 to 5.35, p=0.019), but not in patients without DM (8.5% vs 7.7% in the non-OSA group, adjusted HR=0.94, 95% CI 0.51 to 1.75, p=0.85). Patients with DM without OSA had a similar 1 year MACCE rate as patients without DM. The increased risk of events was predominately isolated to patients with OSA with baseline glucose or hemoglobin A1c levels above the median. Combined OSA and longer hypoxia duration (time with arterial oxygen saturation22 min) further increased the MACCE rate to 31.0% in patients with DM.
Conclusions: OSA was associated with increased risk of 1 year MACCE following ACS in patients with DM, but not in non-DM patients. Further trials exploring the efficacy of OSA treatment in high-risk patients with ACS and DM are warranted.
2019-12-18T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/99
https://jdc.jefferson.edu/context/emfp/article/1102/viewcontent/e000737.full.pdf
http://creativecommons.org/licenses/by/4.0/
Department of Emergency Medicine Faculty Papers
English
Jefferson Digital Commons
acute coronary syndrome
obstructive sleep apnea syndrome
outcomes
type 2 diabetes
Endocrinology, Diabetes, and Metabolism
Medicine and Health Sciences
oai:jdc.jefferson.edu:emfp-1103
2020-02-12T16:45:25Z
publication:em
publication:tju
publication:emfp
publication:library
publication:oapubfund
publication:jmc
publication:jeffoapubs
Sevoflurane Pre-conditioning Ameliorates Diabetic Myocardial Ischemia/Reperfusion Injury Via Differential Regulation of p38 and ERK.
Xie, Dina
Zhao, Jianli
Guo, Rui
Jiao, Liyuan
Zhang, Yanqing
Lau, Wayne Bond
Lopez, Bernard
Christopher, Theodore
Gao, Erhe
Cao, Jimin
Ma, Xin-Liang
Wang, Yajing
Diabetes mellitus (DM) significantly increases myocardial ischemia/reperfusion (MI/R) injury. During DM, cardioprotection induced by conventional pre-conditioning (PreCon) is decreased due to impaired AMP-activated protein kinase (AMPK) signaling. The current study investigated whether PreCon with inhaled anesthetic sevoflurane (SF-PreCon) remains cardioprotective during DM, and identified the involved mechanisms. Normal diet (ND) and high-fat diet (HFD)-induced DM mice were randomized into control and SF-PreCon (3 cycles of 15-minute period exposures to 2% sevoflurane) groups before MI/R. SF-PreCon markedly reduced MI/R injury in DM mice, as evidenced by improved cardiac function (increased LVEF and ±Dp/dt), decreased infarct size, and decreased apoptosis. To determine the relevant role of AMPK, the effect of SF-PreCon was determined in cardiac-specific AMPKα2 dominant negative expressing mice (AMPK-DN). SF-PreCon decreased MI/R injury in AMPK-DN mice. To explore the molecular mechanisms responsible for SF-PreCon mediated cardioprotection in DM mice, cell survival molecules were screened. Interestingly, in ND mice, SF-PreCon significantly reduced MI/R-induced activation of p38, a pro-death MAPK, without altering ERK and JNK. In DM and AMPK-DN mice, the inhibitory effect of SF-PreCon upon p38 activation was significantly blunted. However, SF-PreCon significantly increased phosphorylation of ERK1/2, a pro-survival MAPK in DM and AMPK-DN mice. We demonstrate that SF-PreCon protects the heart via AMPK-dependent inhibition of pro-death MAPK in ND mice. However, SF-PreCon exerts cardioprotective action via AMPK-independent activation of a pro-survival MAPK member in DM mice. SF-PreCon may be beneficial compared to conventional PreCon in diabetes or clinical scenarios in which AMPK signaling is impaired.
2020-01-08T08:00:00Z
article
application/pdf
https://jdc.jefferson.edu/emfp/100
https://jdc.jefferson.edu/context/emfp/article/1103/viewcontent/s41598_019_56897_8.pdf
http://creativecommons.org/licenses/by/4.0/
Department of Emergency Medicine Faculty Papers
English
Jefferson Digital Commons
Anesthesiology
Cardiology
Medicine and Health Sciences
71914/oai_dc/100//