Alpha Omega Alpha Research Symposium Posters

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  Designing a Multilingual Instructional Language Tool for Patient Communication in Interventional Radiology

  Samuel Almodóvar; Ahlam Houssein; Gregg Khodorov, MD, MBA; Sahib Sohal, MD; Robert Pugliese, PharmD; and David Dwyer, MD

  Introduction: Current efforts to provide language-inclusive radiological care fall short, resulting in suboptimal imaging, increased procedural time, and greater radiation exposure. Inadequate language accessibility results in poor communication, suboptimal care, and increased patient dissatisfaction. A digital language tool was developed to provide patient instructions during interventional radiology (IR) procedures, addressing this gap and enhancing patient care.

  Methods: Observations were carried out to better understand workflow during IR procedures and identify how to incorporate the tool. We conducted interviews with IR physicians, nurses, and technologists to gather common procedural phrases and patient instructions. Spanish and Mandarin were selected because they are the most commonly spoken non-English languages among patients seen at an academic medical center in a large urban area.

  Results: We developed a digital language tool that plays pre-recorded audio files of instructions in Spanish and Mandarin aloud. The tool organizes thirty-two phrases in each language into sequential pre-, peri-, and post-procedural slides. IR technologists prompt the tool to play phrases as needed throughout the procedure.

  Conclusions: This tool enables staff to interact with patients who speak Spanish and Mandarin as their primary language in an innovative way during IR procedures. We predict it will enhance patient-physician communication, promote equitable care, and improve patient safety. Future research will focus on evaluating the usability of the tool; patient outcomes, including procedural time and radiation exposure; image quality; and IR staff and patient experiences. This tool will be expanded to include other commonly spoken languages to minimize language inaccessibility for a broader set of patients.

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  The Impact of Neighborhood Socioeconomic Factors and Insurance Status on Outcomes Following Reduction Mammoplasty

  Teresa Chan; Kelsey Van Housen, MSPAS; Emily Isch, MD; Judith Monzy; Julianne Bartz; Matthew Jekins, MD; David Kim, MD; Andrew Newsman, MD; and Heather McMahon, MD

  Purpose: The impact of socioeconomic status (SES) and neighborhood-level deprivation on surgical outcomes in breast reduction remains unclear. This study evaluated the effect of area deprivation index (ADI) and insurance status on postoperative outcomes following reduction mammoplasty.

  Methods: A retrospective review of reduction mammoplasty cases was conducted at a single institution over a 7-year period. Patients ≥18 years old who underwent reduction mammoplasty for benign macromastia were included. Zip-code linked ADI, insurance type, and postoperative complication rate were assessed.

  Results: A total of 594 patients were analyzed. Mean age was 36.2 ± 13.1 years and mean body mass index (BMI) was 32.6 ± 5.2 kg/m². Most patients identified as Black race (386 [65%]), while 196 (33%) used Medicaid insurance. Patients living in more deprived neighborhoods (higher ADI quartiles) were more likely to identify as Black, have higher BMI, and use Medicaid compared to lower ADI quartiles. Following surgery, 213 (35.9%) patients developed minor complications. Wound healing complications (N=139, 23.4%) were the most common. In an adjusted multivariable analysis, only higher BMI and Medicaid status (OR: 2.39, CI: 1.56-3.68, p< 0.001) were significantly associated with increased odds of developing a minor complication. Compared to normal BMI, overweight (OR: 2.51, 95% CI: 1.07–6.44, p = 0.042), obese (OR: 3.32, CI: 1.42–8.53, p = 0.008), and severely obese (OR: 3.96, CI: 1.64–10.5, p = 0.003) patients had higher odds of having a minor complication. Black race was associated with decreased odds of minor complications (OR: 0.42, CI: 0.24-0.71, p=0.002). ADI quartile was not significantly associated with complication rate.

  Conclusions: Higher BMI and Medicaid status were independently associated with increased risk of minor complications following reduction mammoplasty, while Black race was associated with lower odds. ADI was not associated with risk of postoperative complications, suggesting that disparities in reduction mammoplasty outcomes may reflect insurance status differences rather than neighborhood factors.

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  Systematic Evaluation of Batch Effects in The Cancer Genome Atlas Program Underscores the Need for Batch-Controlled Analysis

  Zhongxuan Chen, Stepan Nersisyan, Isidore Rigoutsos, and Eric Londin

  Purpose: To systematically assess the impact of batch effects on differential expression of isomiR, mRNA, and non-coding RNA (sncRNA) across 13 The Cancer Genome Atlas (TCGA) cancer types and develop a standardized, batch-controlled analysis protocol for TCGA datasets.

  Methods: Data analysis and visualization were performed using Python v3.12. Plots were generated using matplotlib and seaborn. isomiR, mRNA, and sncRNA sequences across 13 TCGA cancer types were used. Principal Component Analysis (PCA) was performed using scikit-learn for dimensionality reduction. Differential expression was conducted using DESeq2 under the following protocols: 1) primary tumor samples vs matched normal samples processed in the same batch as the control; 2) all primary tumor vs all normal samples with batch correction; 3) randomly down-sampled primary tumor to the same sample size as normal vs all normal samples without batch correction; and 4) randomly down-sampled primary tumor to the same sample size as normal vs all normal samples with batch correction.

  Results: PCA revealed distinct clustering of normal and primary tumor samples across 13 cancer types and all RNA molecules, indicating the presence of batch effects. Moreover, using differential expression outcomes from normal and primary tumor samples processed within the same batch as control, we found that existing batch effects introduce false-positive differentially expressed molecules and obscure molecules that are potentially truly differentially expressed. After correcting batch effects using DESeq2, we observed a greater overlap in differentially expressed molecules between the control and the batch-corrected analyses across 13 cancer types. Additionally, we identified a set of non-overlapping differentially expressed molecules that appeared exclusively in the control analysis.

  Conclusions: TCGA plays a critical role in guiding the development of molecular markers used in clinical research and translational oncology. However, because batch effects in TCGA data sets are not comprehensively evaluated in the literature, researchers may be misled by batch-driven artifacts. We recommend implementing a batch-controlled protocol when analyzing TCGA datasets to minimize false positives and identify true differentially expressed molecules that may be masked by batch effects.

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  NSD2 Mutation Contributes to Oncogenic Reprogramming through Aberrant Histone Modification and Localization within the Nucleus

  Venkata Dasuri; Samuel Sey, PhD; Tian Yuan; and Jianping Li

  Background: Nuclear Receptor Binding SET Domain Protein 2 (NSD2/WHSC1/MMSET) is a histone methyltransferase, specific to H3K36me2. Commonly, aberrant histone modification levels or localization within the nucleus contribute to dysregulation of gene transcription and cancer development. Most NSD2 mutations, p.E1099K, are identified in its catalytic SET domain, resulting in increased H3K36me2 levels and decreased H3K27me3 levels in acute lymphoblastic leukemia (ALL). However, whether the NSD2 mutation alters histone modification localization within the nucleus remains unclear. This study aims to define NSD2 mutation-driven histone modification and localization in ALL.

  Methods: Histone modifications H3K36me2 and H3K27me3 in multiple NSD2 mutant human ALL cell lines and mouse B-cell leukemic cells were determined using Western Blots. The dislocation of H3K36me2 and H3K27me3 in isogenic RCH-ACV cell lines was determined using immunofluorescence via confocal microscopy. Further, isogenic RCH-ACV cell lines with or without NSD2 mutation were treated with a novel NSD2 inhibitor (EX-A5782), followed by Western Blots and immunofluorescence for histone modification level and dislocation detection within the nucleus.

  Results: NSD2 mutation drove a significant increase of active marker H3K36me2 and a decrease of repressive marker H3K27me3 in B-ALL, T-ALL cell lines and mouse leukemia cells, leading to oncogenic reprogramming. Surprisingly, the NSD2 mutation caused an aberrant dislocation of H3K36me2, not H3K27me3, to the perinuclear regions. With the treatment of the NSD2 inhibitor, H3K36me2 was reduced in both NSD2 mutant and WT cells, while H3K27me3 was only restored in NSD2 mutant cells. There was no change of H3K27me3 in NSD2 WT cells. NSD2 inhibitor reversed the H3K36me2 distribution in the nucleus as well.

  Conclusion: These findings suggest that NSD2 mutation drives an imbalance of H3K36me2 and H3K27me3 and aberrant localization of H3K36me2 within the nucleus, contributing to oncogenic reprogramming in ALL. Targeting NSD2 mutation therapy significantly reversed this dysregulation, suggesting a potential treatment for NSD2 mutant ALL.

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  Assessing Familiarity and Comfortability of Phase 2 SKMC Students in Working with the Intellectually Disabled Population

  Lily N. Dudash; Jessica Tomaszewski, MD; Talia Gillespie; and Katie Labgold, PhD, MPH

  Purpose: People living with an intellectual or developmental disability (IDD) are at increased risk of poor health outcomes due to inadequate access to quality healthcare. Literature suggests that trainees are underprepared to adjust their clinical practice to treat these patients, which may implicate undergraduate medical education curriculum. This study assessed the comfortability of SKMC students who have completed Phase 2 of the JeffMD curriculum in performing clinical tasks while caring for patients with IDD, and if that comfort is affected by prior experience. We predict that students will report low levels of comfort and be engaged in an educational intervention.

  Methods: Curricular assessment was performed via quantitative survey, administered to SKMC students who completed Phase 2 of the JeffMD curriculum. The survey was designed and delivered via REDCap. Survey assessment of comfortability employed matrices and other rating scales. Demographics and prior experience data were collected. Simple descriptive and non-parametric statistical testing were completed to analyze data.

  Results: Students indicated the least comfort with reviewing care plans with IDD patients, adapting exam skills, and identifying comorbidities. Students with prior experience working with the IDD population were more comfortable (p=0.012). The majority of students, regardless of planned specialty, identified need and interest in curricular intervention.

  Conclusions: Results indicate a lack of comfort among students in caring for patients with IDD. Prior experience reduces this deficit. This study identifies an opportunity to fill an educational gap in caring for individuals with IDD, which can lessen the burden of disparities and improve healthcare outcomes for this vulnerable population.

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  Neck Circumference as a Novel Predictor of Cardiovascular Risk Assessed Using Framingham and PREVENT Equations

  Stephen Garrova, Roshaan Gilani, Steven Muller, Jean Pierre Charpentier, Brian Fedgchin, Glenn Cooper, and Cindy Cheng

  Purpose: While body mass index (BMI) and waist circumference (WC) are standard clinical tools for anthropometric cardiovascular risk assessment, they are limited by measurement variability and patient discomfort. Neck circumference (NC) may offer a novel, convenient, and accurate alternative anthropometric measure for assessment of cardiovascular risk.

  Methods: Standardized anthropometric measurements (NC, WC, BMI) were obtained by trained medical students from eligible patients (n = 110, 68% female, 75% African American) from primary care and cardiology offices in an IRB-approved cohort study with retrospective chart review. Electronic medical record data extraction via double data entry was used to calculate cardiovascular risk scores: Framingham, PREVENT CVD, PREVENT ASCVD, and PREVENT HF. Pearson correlation assessed unadjusted associations between NC and cardiovascular risk scores. Separate multivariate linear regression models were constructed for each score, adjusting for age, sex, race, and ethnicity.

  Results: The African American patient subgroup (n = 82) displayed a positive association of NC with PREVENT Heart Failure Risk (r = 0.22, p = 0.048). Multivariate regression adjusted for age, sex, race, and ethnicity further demonstrated NC as a positive predictor of PREVENT Heart Failure Risk across the entire cohort (β = 0.60, p < 0.01). NC was not predictive of Framingham, PREVENT CVD, or PREVENT ASCVD risk scores, possibly due to sample size limitations. Subject accrual to increase sample size is ongoing.

  Conclusion: Preliminary data suggest that NC shows potential as a practical tool for clinical prediction of heart failure and cardiovascular risk, particularly in at-risk African Americans.

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  Jackson-Pratt Drain-Related Challenges and a Potential Explanation for Associated Surgical Site Pain Variability Following Breast Mastectomy and Reconstruction

  Spencer Haber, BS; Krishna Koka, BS; Elizabeth Simon, BS; Devin Williams, BS; and Andrew Newman, MD

  Background: The Jackson-Pratt (JP) drain is a closed suction drain used in surgeries throughout the body. This prevents seroma formation through continual negative pressure drainage while resisting collapse and obstruction. JP drains are mainstays in breast reconstruction and mastectomy.

  Methods: Through a literature review using keywords such as “Surgical Site Infection” (SSI), “Quality of Life” (QOL), and “Surgical Site Pain” (SSP), we summarized JP drain-related complications in breast reconstruction and mastectomy. Although the drain effectively reduces seroma formation, there has been a lack of innovation in addressing these issues. There is no standardized approach to JP drain post-operative care or pain minimization addressing the variables contributing to pain, such as nerve structures, to inform placement.

  Results: In a cross-sectional survey, patients reported increased pain at the body wall, incision site, and drain entry site, all significantly associated with drain durations of over 2 weeks. 84.7% of patients reported JP drains increased difficulty completing daily tasks, and 66% reported a negative impact on mood.

  Conclusion: A standard practice to address these issues does not exist. There is a need for innovation within the JP drain space to improve QOL, reduce SSI rates, and reduce SSP. Chronic pain following mastectomy is a well-described phenomenon, likely from proximity to many peripheral nerves travelling along the anterior and lateral chest wall. Among the cutaneous distributions of these nerves, there may be certain locations where exit sites are particularly painful, a possible pain modifier that can be explored in future studies to decrease SSP.

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  A General Strategy to Improve the Safety and Efficacy of GPCR-Targeted Drugs

  Hajae Ko and Charles Scott

  Purpose: G protein-coupled receptors (GPCRs) are integral membrane proteins that constitute the largest family of drug targets. They respond to hormones or drugs and activate downstream signaling pathways via G proteins and β-arrestins, eliciting therapeutic benefits and side effects. For example, β2-adrenergic receptor (β2AR) agonists relax airways in asthma through G protein activation, but cause tolerance, tachyphylaxis, reduced duration of action, and inflammation through activation of β-arrestin signaling. Developing general strategies to bias signaling toward therapeutically relevant pathways could make GPCR-targeted drugs safer and more effective. This project investigates the generality of signaling bias by introducing mutations into the β1-adrenergic receptor (β1AR) that confer sensitivity to the β2AR-selective 'molecular glue' difluorophenylquinazoline (DFPQ), which inhibits harmful β-arrestin signaling without affecting beneficial G protein activation.

  Methods: Chimeric β1AR variants were created with a β2AR-derived mutation (L154V) in transmembrane helix 3 (TM3), a TM4 segment from β2AR, or both, and expressed in HEK293 cells. DFPQ inhibition of isoproterenol-induced β-arrestin-2 recruitment was measured using bioluminescence resonance energy transfer (BRET).

  Results: Wild-type β1AR exhibited minimal response to DFPQ. The L154V mutant and TM4 chimera each conferred moderate DFPQ sensitivity, partially inhibiting β-arrestin recruitment. The combination variant greatly enhanced this effect, revealing additive contributions of TM3 and TM4 residues in forming the drug-binding site.

  Conclusions: These results demonstrate that TM3/TM4 residues create a transferable allosteric pocket, enabling engineered bias toward G protein signaling in β1AR. Future efforts will assess additional TM3/TM4 variants and design β1AR-selective allosteric drugs that achieve improved cardiovascular outcomes through GPCR signaling bias.

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  Exploring Physician Views on Birth Method and Route of Delivery

  Vivian Nguyen and Vincenzo Berghella, MD

  Purpose: In the United States, rates of cesarean deliveries (CD) have been increasing. Despite recommendations from the American College of Obstetrics and Gynecology to prevent increasing rates of CDs, planned CD has been associated with lower rates of perinatal deaths and better maternal outcomes when compared to planned vaginal delivery (VD). However, the data is limited, so it is important that we conduct randomized controlled trials (RCTs) comparing maternal and perinatal outcomes in planned CD vs planned vaginal delivery (VD) for nulliparous, term, single, vertex pregnancies. The purpose of study is to survey obstetricians and gynecologists (ob/gyns) on their views of birth methodology, route of delivery, and willingness to enroll patients in such a trial.

  Methods: A web-based survey was sent to attending ob/gyns. The survey was open for eight weeks and hosted on the institution’s REDCap.

  Results: Eighteen physicians participated, predominantly women (15, 83.3%) with 10-19 years of experience (8, 44.4%). Nearly all respondents (16, 88.9%) reported that patients often request planned VD, while requests for planned CD occur < 4 times per month (11, 61.1%) or between 4-8 times per month (3, 16.7%). Eleven (61.1%) agreed a trial evaluating planned CD is reasonable. Six (33.3%) expressed willingness to enroll all eligible patients; 3 (16.7%) would enroll some patients.

  Conclusion: More than half of physicians agreed to conducting an RCT on planned VD versus planned CD. However, few expressed willingness to enroll patients in such a trial, suggesting that physician hesitancy may be a barrier to trial feasibility and recruitment.

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  Italian Medical Students' Knowledge, Attitudes and Beliefs about Medical Marijuana and their Implications on the Italian Medical Curriculum

  Sneh S. Shah; Roberta Pastorino, PhD; and Giovanni Gambassi, MD

  Purpose: Medical marijuana is gaining clinical and legislative relevance in Italy, yet little is known about Italian medical students’ knowledge, attitudes, and preparedness regarding its therapeutic use. As future physicians, medical students will play a key role in integrating cannabis-based therapies safely into patient care. This study assessed Italian medical students’ perceived knowledge, clinical exposure, and attitudes toward medical marijuana, and evaluated implications for the medical curriculum.

  Methods: A cross-sectional, anonymous online survey was distributed to students across Italian medical universities from May 2023 to March 2024. The survey used Likert-scale items to assess attitudes, perceived knowledge, educational exposure, and acceptability across various medical conditions. Descriptive statistics were generated, and chi-square tests examined differences by demographics, year of study, and university type (public vs private).

  Results: Among 382 participants, attitudes were overwhelmingly positive: 95.0% supported inclusion in medical curricula, and 86.6% would prescribe it under current laws. However, a significant gap exists between support and preparedness. Among clinical-year students (n=155), only 12.9% felt adequately knowledgeable to counsel patients, and only 5.8% had participated in the care of a patient using medical marijuana. While 43.2% reported classroom instruction, only 12.9% received adequate clinical instruction.

  Conclusion: Medical students in Italy strongly support the use and study of medical cannabis but lack the formal knowledge and clinical exposure necessary for safe practice. These findings highlight the need for improved clinical training, and inclusion of evidence-based instruction in the medical curriculum to prepare future physicians for safe prescribing in an environment of evolving legislation.

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  Exercise Performance in Ordinary Children and Adolescents: Baseline, Pandemic, and Post-Pandemic

  Abby Skiena; Gina D'Aloisio, MS; and Takeshi Tsuda, MD

  Background: The COVID-19 pandemic might have created considerable negative impacts on the physical fitness of ordinary adolescents, which may pose a major threat to long-term cardiovascular health.

  Methods: Healthy adolescents (ages 11 to 18) who underwent cardiopulmonary exercise testing (CPET) were grouped into baseline (~ 3/2020), pandemic (4/2020 ~12/2022), and post-pandemic (1/2023~ 5/2024) periods. Data are shown as mean ± standard deviation.

  Results: Peak oxygen consumption (VO2/kg) and peak work rate (WR/kg) were significantly reduced during pandemic in both sexes and did not improve during post-pandemic in males (Table 1). The decline of peak oxygen pulse (OP/kg) during pandemic persisted through post-pandemic in both sexes. Submaximal slope parameters including oxygen uptake efficiency slope/kg, Δ[VO2/kg]/Δheart rate, and work efficiency (ΔVO2/ΔWR) were significantly diminished from baseline with no difference between pandemic and post-pandemic periods in both sexes. Ventilatory anaerobic threshold (VAT)/kg remained unaltered over all periods in both sexes. Peak respiratory exchange ratio and ventilatory efficiency (ΔVE/ΔVCO2) revealed some sex differences.

  Conclusions: Exercise performance was significantly reduced during pandemic and did not improve during post-pandemic when the pandemic restriction was released. These CPET trends, including some sex differences, may characterize

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  Jefferson Heart Health (JHH): A Successful Student-delivered Motivational Interviewing Pilot Program to Lower Cardiovascular Disease (CVD) Risk

  Nicholas Tomasko, BS; Cindy Cheng, MD, PhD; Rafael Hernandez, BS; and Alessandra Sapon, BS

  Purpose: The Jefferson Heart Health (JHH) program utilizes student health coaching by trained undergraduate and medical students supporting patients to sustain lifestyle changes and subsequently determine: how can we effectively educate patients by improving adherence to lifestyle recommendations? Also, what is the effectiveness of student-delivered health coaching for reducing patient cardiovascular risk? With our unique student-delivered program, we promote cost-effective lifestyle interventions for lowering overall cardiovascular disease (CVD) burden.

  Methods: We successfully completed a four-week pilot with consistent patient attendance. Certified student JHH coaches, supervised by the certified obesity-management specialist and principal investigator, met weekly with 23 patients: 82.6% female/17.4% male, a mean age of 56, and a mean BMI of 34. Our program involves interactive 15-20 minute lessons based on the American Heart Association (AHA) “Life’s Essential Eight.” These group lessons are then supplemented by the novel PennDitti app that tracks real-time adherence as patients listen to three minute audio summaries of each lesson. Patient CVD risk was assessed at the beginning and end of the program using Framingham and PREVENT equations along with metabolic endpoints, including blood pressure, cholesterol, and A1C levels. Data analysis is ongoing.

  Results: We will report our final data analysis in the poster that I hypothesize will demonstrate lower CVD risk burdens for JHH patient participants.

  Conclusion: With students serving as medical extenders, our pilot JHH coaching program demonstrates successful implementation of an accessible and low-cost methodology to deliver evidence-based knowledge that improves health outcomes for underserved patients in Philadelphia.

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  Medicine During the Holocaust: A Comparative Study of Righteous Dutch, German, and Italian Physicians

  Vincent Tse and Salvatore Mangione

  Purpose: Authoritarianism can hinder altruism, even among physicians, the most altruistic members of society. Hence, we postulated that the proportion of doctors who saved Jews during the Holocaust (i.e. “Righteous Among the Nations”) was higher in a democratic country like the Netherlands as compared to authoritarian ones like Germany and Italy.

  Methods: We analyzed the Yad Vashem database and other census data to determine the total populations, numbers of physicians, numbers of “Righteous”, and numbers of “Righteous” physicians in Germany, Italy, and the Netherlands during WWII. A chi-squared analysis for independence evaluated the association between proportion of “Righteous” physicians to total physicians in Germany, Italy, and the Netherlands.

  Results: We found 8/651 physicians among the “Righteous” in Germany (out of 68.6 million people); 13/766 in Italy (out of 45 million); and 46/5,982 in the Netherlands (out of 9.3 million). There was a statistically significant difference (α = 0.05) in the proportion of “Righteous” physicians in Germany vs. Italy (p = 0.0328), Germany vs. the Netherlands (p < 0.00001), and Italy vs. the Netherlands (p < 0.00001).

  Conclusions: These results support our hypothesis, despite small but significant differences between Germany and Italy. Among the “Righteous”, selfless humanitarian values seemed to be defining traits. Authoritarian influences from Fascist and antisemitic ideology appeared to curb altruism, resulting in lower numbers of “Righteous”, including physicians. This study found only association, not causation. Further research should evaluate causation, but also the effects of authoritarianism in modern medicine.

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  Characterizing the Effects of Antimuscarinics on RhoA Signaling

  Zuhra Tukhtamisheva, Elizabeth L. McDuffie, Jordan Lee, Steven S. An, Reynold A. Panettieri Jr., and Charles Scott

  Purpose: Airway hyperresponsiveness in asthma is driven by acetylcholine-mediated activation of the muscarinic acetylcholine 3 receptor (M3R), promoting bronchoconstriction, mucus hypersecretion, and airway remodeling. Despite directly targeting this pathway, antimuscarinics remain adjunctive rather than first-line therapy, suggesting a disconnect between biological rationale and clinical efficacy. Recent work from the Scott Lab at Thomas Jefferson University demonstrates that M3R in human airway smooth muscle (HASM) cells drives muscle shortening through G_12/13–driven RhoA signaling rather than through G_q/11-dependent calcium flux. We therefore investigated whether clinically prescribed antimuscarinics effectively inhibit G_12/13-dependent RhoA signaling in HASM cells.

  Methods: Human telomerase reverse transcriptase immortalized HASM cells with Renilla luciferase under the control of a serum response element (hTERT-SRE) were used to evaluate ligand-dependent RhoA activation. Cells were stimulated for 5 hours with drug, either alone or combined with 100 µM acetylcholine. Luciferase activity was measured and normalized to the maximal acetylcholine response, using 3-parameter nonlinear regression to determine residual RhoA activation.

  Results: Ipratropium bromide, revefenacin, tiotropium bromide and umeclidinium bromide exhibited partial agonism of the M3R-dependent RhoA signaling pathway that governs HASM contraction. In preliminary studies, glycopyrrolate appears to behave as a neutral antagonist of M3R signaling. Partial agonism by erstwhile muscarinic antagonists may sustain pro-contractile signaling despite receptor blockade.

  Conclusions: These findings suggest that many anticholinergics inadvertently preserve G_12/13–RhoA signaling, limiting their bronchoprotective efficacy. Defining this signaling bias across antimuscarinic agents provides a framework for developing next-generation therapies that more effectively suppress the G_12/13–RhoA axis to control airway hyperresponsiveness and hypertrophy.

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  Interrelationship between Body Mass Index, Venous Sinus Pressures, Craniospinal Elastance, and Intracranial Pressure In Idiopathic Intracranial Hypertension

  Rachel Wang, BA, BS; Scott W. Keith, PhD; Pascal M. Jabbour, MD; Stavropoula I. Tjoumakaris, MD; Michael J. Marmura, MD; Michael R. Gooch, MD; and Hsiangkuo Yuan, MD, PhD

  Purpose: To investigate the interrelationship between body mass index (BMI), venous sinus pressure (VSP), and craniospinal elastance in determining lumbar puncture opening pressure (LP OP) in idiopathic intracranial hypertension (IIH).

  Methods: A single-center retrospective chart review was conducted to identify patients who received venous manometry (8/2021-11/2025) followed by LP within 7 days before stenting. VSPs were measured at standardized locations, including the torcula (TP) and sigmoid/jugular (SIJ) sinuses. Elastance was calculated as (OP – closing pressure)/volume of CSF removed. Statistical analysis (JASP 0.19.3) was performed using generalized linear model (Gaussian identity; scaled center) to assess relationships between LP OP, BMI, TP, elastance, and BMI×elastance interaction while controlling for age and sex, with random intercept, and hierarchical removal of interaction terms.

  Results: Of 135 screened patients, 28 refractory IIH patients (92.9% female; BMI 38.2±9.5) met criteria. Racial distribution included 50.0% Caucasian, 39.3% African American, and 10.7% other groups. Mean LP OP was 32.7±14.1cmH₂O; mean TP 30.0±15.8mmHg; mean SIJ 15.6±6.5mmHg; and mean elastance 0.784±0.377cmH₂O/mL. TP, elastance, and the BMI×elastance interaction were significant predictors of LP OP. Notably, BMI’s effect on LP OP became significantly stronger as elastance increased.

  Conclusions: These findings suggest that craniospinal elastance modulates how BMI contributes to intracranial pressure elevation in IIH, providing a potential explanation for heterogeneity in pressure responses among patients with similar BMI. Patients with elevated elastance may be particularly vulnerable to BMI-related pressure increases. Larger prospective studies are needed to validate these interactions and clarify their relevance to IIH pathophysiology and clinical management.

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  Elucidating the Binding Site of the Arrestin-Biased Agonist ICL1-20

  Kesara Wein, Roger Armen, Jeffrey L. Benovic, and Charles P. Scott

  Background and Purpose: 6.7 million Americans live with congestive heart failure (CHF). In CHF, catecholamines are released into cardiac tissue, bind β-adrenergic receptors (βARs), and activate G-protein signaling cascades, causing ischemia and apoptosis. Accordingly, β-blockers are used to antagonize catecholamine binding to βARs and suppress apoptotic downstream effects. However, β-blockers have dose-limiting hypotension, bradycardia and fail to stimulate the cardioprotective β-arrestin signaling pathway. These limits create opportunities for the development of drugs that selectively stimulate β-arrestin signaling while suppressing cardiotoxic G protein signaling. We have previously reported a biased agonist of the β-arrestin pathway (ICL1-20) that selectively stimulates β-arrestin recruitment to the β2AR, but not the β1AR. The mechanism through which ICL1-20 recruits β-arrestin to the β2AR is unclear.

  Methods: This project aims to identify residues on the β2AR critical for ICL1-20 function through chimera mutagenesis. For this method, a series of chimeric receptors were created in which secondary structural elements from β2AR were replaced with corresponding ones from β1AR (e.g., intracellular loop 1 (ICL1), extracellular loop 1 (ECL1), etc). Chimeric receptors were tested for sensitivity to ICL1-20. Loss of ICL1-20 agonism of β-arrestin recruitment to chimeric receptors indicates loss of β2AR sequence important for ICL1-20 recognition or function.

  Results: Preliminary mutagenesis results suggest that intracellular loop 1 (ICL1) of the β2AR contributes to ICL1-20 recognition by the β2AR and subsequent β-arrestin recruitment.

  Conclusion: Results from comprehensive chimera mutagenesis studies should define structural determinants of ICL1-20 function and inform the development of drug-like molecules that can promote arrestin-biased agonism of the β2AR.

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  Survival Impact of Intraoperative CO2 Dysregulation in patients undergoing Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma

  Ashley Wetzel; Andrea Feci; Joseph Gorman; Isabel Lavine; Edoardo Manca; Richard Zheng, MD; Nader Hanna, MD; Harish Lavu, MD; Charles J. Yeo, MD; and Avinoam Nevler, MD

  Purpose: Pancreatic ductal adenocarcinomas (PDAC) are aggressive malignancies with poor prognoses. Emerging evidence suggests tissue hypercapnia (elevated CO₂) promotes aggressive, treatment resistant tumor biology. End-tidal CO₂ (ETCO₂) offers a composite measure of ventilation, systemic perfusion, and tissue CO₂ production. During curative-intent pancreaticoduodenectomy, we hypothesized that intraoperative ETCO₂ could serve as a marker of tissue CO₂ dyscapnia; both low levels indicating decreased circulatory reserves and high levels indicating tissue hypercapnia may result in worse outcomes.

  Methods: We conducted a retrospective review (2017-2023) of 343 patients undergoing pancreaticoduodenectomy for PDAC. Intraoperative ETCO₂ data were obtained from anesthesia records, excluding the first and last 45 minutes of surgery. Patients with overall or disease-free survival (OS & DFS) under 90 days or intraoperative metastasis discovery were excluded. Mean ETCO₂ was calculated per patient. ETCO₂ groups were stratified by quartiles: low (Q1), normal (Q2-3), and high (Q4). Primary endpoints were DFS and OS.

  Results: 243 total patients (49% male, average age: 68.5 (61.3–74.9 years)) were analyzed. Normocapnic patients had significantly better OS and DFS compared with both low and high ETCO₂ groups (P< 0.05, each, Figure 1A). Hypocapnia had poorer DFS than normocapnia (12.9 vs. 22.4 months, P=0.03, Figure 1B). Cox regression showed both hypocapnia and hypercapnia independently predicted recurrence (HR=1.58 and 1.50; P=0.02 and 0.05, respectively) and mortality (HR=1.65 and 1.66; P=0.03 and 0.04, respectively).

  Conclusions: Mean intraoperative ETCO₂ is strongly associated with oncologic outcomes post- pancreaticoduodenectomy for PDAC. Both low and high ETCO₂ were linked to worse survival, indicating ETCO₂’s potential as a clinically relevant prognostic marker.

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  Evaluating the Impact of BARD1 Isoform Targeting on PDAC Growth and Response to Olaparib

  Lily Zekavat, Samuel Zion, Boxuan Wei, Avinoam Nevler, and Aditi Jain

  Poster embargoed until March 30, 2026.

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  Longitudinal Monitoring of Gait Parameters for Lower Limb Prosthetic Users with Physical Therapy Using Video-Based Gait Analysis

  Alisha Agarwal, BS; Anthony Cimorelli, CPO; and R. James Cotton, MD, PhD

  Introduction

  Gait training in physical therapy is a common standard of practice for new lower limb prosthetic users. Progress is typically assessed through functional outcome measures such as the 10-meter or 6-minute walk tests1. While these tests measure walking speed and endurance, they fall short of capturing gait quality or quantifying gait parameters which literature shows to be of therapeutic value 2,3. Routine access to quantitative gait assessment could provide clinicians with benchmarks to optimize treatment interventions. Traditional gait analysis systems require specialized equipment making them very resource-intensive and inconvenient to operate. Using human pose estimation techniques, we have developed and trained a custom gait analysis system that allows us to measure spatiotemporal gait parameters from video4,5. Lower limb prosthetic users were recorded while ambulating during routine physical therapy appointments. Manual annotation of these videos was used to categorize system performance. The goal of the study was to demonstrate if longitudinal tracking of various gait parameters such as cadence and velocity across numerous subjects showed improvements that reflected coinciding functional outcome measures.

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  Melanosome Maturation Defects in TYROSINASE Deficient Human Retinal Pigment Epithelium

  Charles DeYoung, Aman George, and Brian P. Brooks

  Purpose

  • Oculocutaneous albinism type 1A (OCA1A) = recessive genetic condition caused by mutations in TYROSINASE
  • Created in vitro disease model for OCA1A using human induced pluripotent stem cell (iPSC) derived retinal pigment epithelium (RPE)
  • Role of autophagy (Fig. 2) in melanosome degradation and melanosomal trafficking
  • Aim to investigate whether loss of melanosomes in OCA1A-iRPE might impact autophagy

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  Aging Expectations Predict Subjective Cognitive Decline Among Community-Dwelling Older Adults

  Justin Do, BS; Casey Fishman, BA; Sakshi Bhargava, PhD; Emily Bratlee-Whitaker, PhD, RN; Jennifer R. Turner, PhD; Jacqueline Mogle, PhD, MS; and Nikki L. Hill, PhD, RN

  Purpose: Subjective cognitive decline (SCD), or perceived decline in cognition, is a precursor to mild cognitive impairment, a prodrome of Alzheimer’s disease. SCD’s predictive utility is limited as it is impacted by multiple psychosocial factors. Expectations regarding aging among older adults have been linked to self-efficacy and health-related outcomes; however, their relationship with SCD is unknown. The aim of this cross-sectional study was to investigate the relationships between older adults’ aging expectations regarding physical, mental, and cognitive health, and SCD.

  Methods: An online survey of community-dwelling adults aged 65 years or older (n=582, M(SD)=71.36(4.80)) with no history of dementia or cognitive impairment was conducted in the United States. Measures included the Expectations Regarding Aging scale (ERA-12), the Everyday Cognition scale (ECog-12), as well as demographics and self-reported health. General linear models demonstrated relationships between the physical, mental, and cognitive expectations subscales of the ERA-12 and ECog-12 scores.

  Results:All three domains of aging expectations regarding physical health (b(SE)=-0.033(0.007), p

  Conclusion: Older adults' aging expectations were predictive of subjective cognitive decline (SCD) across all domains, indicating a broader impact beyond cognitive function alone. Future research should explore whether this relationship holds in other patient populations, including middle-aged adults and different ethnic groups and whether interventions to modify aging expectations may promote positive perceptions of cognitive function among older adults, which can improve cognitive outcomes.

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  Emotional Stressors Faced by Medical Students Expressed Using Cartoons: A Qualitative Study

  Casey Fishman, BA; Justin Do, BS; and Fred W. Markham Jr., MD

  Purpose: Empathy, a fundamental pillar of medicine, has been shown to decrease in medical school. Increased stress is linked to decreased empathy, but specific stressors remain unclear. The goal of this study was to qualitatively explore specific stressors among third year medical students.

  Methods: Third year medical students (n=248) participated in Reflection Rounds with a clinician and a member of pastoral care at Thomas Jefferson University and in their final sessions created a cartoon to express sentiments surrounding medicine. Qualitative analysis of the cartoons was conducted on both the images and text. Common themes were identified from the students’ visualizations and each cartoon was coded into one or more of these themes. Words, punctuation, and visual facial expressions were thematically coded, and their frequency was tabulated.

  Results: The three most common themes in the cartoons were learning (17%), work-life balance (12%), and insecurity (12%). The seven other themes were working with residents, how students are treated, stress, heart, working with attendings, how patients are treated, and burnout. Multiple punctuation marks were present in 34% of the cartoons, and 32% of the cartoons demonstrated a worried facial expression. Some of the prevalent words in the word cloud analysis were “think, know, student, thanks, and time”.

  Conclusion: The cartoons demonstrated that medical students have multiple worries, namely: work-life balance, insecurity in their position, and time management. These findings may inform future research on emotional burdens that medical students face, and modifications to these burdens may lead to increased empathy.

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  Actin Depolymerization of Tenocytes Promotes a Tendinosis-like Gene Expression

  Kameron Inguito, BA; Valerie West; Karl Matthew Ebron; and Justin Parreno, PhD

  Optimal cellular mechanotransduction is essential for tendon matrix homeostasis. We recently developed an in vivo rat model of tendinosis, where the plantaris tendon are overloaded through ablation of the synergistic Achilles tendon. Using this model we determined that tissue overload disrupts matrix-cell interactions, which results in under-stimulation of tendon cells (tenocytes) (Fig.1)

  Using an ex vivo model of tendon stress deprivation by maintaining tail tendon fascicles in floating culture we showed that tenocyte under-stimulation results in destabilization of filamentous (F-)actin (Fig.2). F-actin destabilization coincides with tendinosis-like gene expression: downregulation of tenogenic genes (Col1, Tnc, asma, Scx), upregulation of chondrogenic (Acan, Sox9) and matrix metalloproteinases (Mmp-3, Mmp-13).²

  Figure 2. Whole mount confocal images of tail tendons stained for G- and F-actin (DNAse-I and Phallodin, respectively) The mechanisms regulating gene expression by F-actin depolymerization are unknown in tendon. However, we have shown in other cell types (chondrocytes, lens epithelial cells) that F-actin depolymerization regulates gene expression by a G-actin binding transcription factor, myocardin related transcription factor.³

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  The Effectiveness of JeffWLP for Weight Loss and General Nutritional Knowledge in Obese Patients

  Scott Kozarsky, BA; Olivia Ackley, BS; and Cynthia Cheng, MD, PhD

  PURPOSE: The increasing prevalence of obesity urgently requires effective management strategies. This study evaluates the effectiveness of Jefferson Weight Loss Program (JeffWLP), a trained medical student-delivered health education program in a predominantly African-American patient cohort.

  METHODS: A randomized controlled trial was performed enrolling 30 patients with an average socioeconomic status of 5.8 (10 maximum). The intervention group (n=18) completed JeffWLP, a low-cost, 12-week health coaching program combining education sessions with graded step exercises. The control group (n=12) received usual care. Mean baseline age, BMI, and General Nutritional Knowledge Questionnaire (GNKQ) scores were: 46±13 years, 38±5, and 14.7±1.9 (maximum score=17) respectively.

  RESULTS: Patients completing JeffWLP achieved greater weight loss, with mean weight loss of 6.1±7.8 pounds (p=0.01) compared to 4.4±7.5 pounds weight gain in controls (p=0.14). This corresponded to 2.7±3.3% weight reduction (p=0.01) and 2.0±3.5% weight gain (p=0.15). Mean endpoint GNKQ scores decreased overall slightly to 14.5±1.9, but improvement correlated with total, group, and 1:1 class attendance (R=0.81, 0.75, 0.77, p=0.0004, 0.002, 0.001 respectively).

  CONCLUSIONS: The significant weight reduction of 2.7±3.3% achieved in just 12 weeks of JeffWLP suggests meaningful progress towards improving cardiovascular health. Correlation of GNKQ scores to attendance suggests that patients acquired knowledge facilitating these positive outcomes. Our results support the establishment of student-delivered patient education programs to help combat the obesity epidemic.

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  Epidemiologic Profile and Treatment Analysis of Cervicalgia in Patients with Migraine vs. Tension-Type Headaches from a Multicenter Electronic Medical Record Database (TriNetX)

  Ethan J. Le; Victor S. Wang, MD; and Hsiangkuo Yuan, MD, PhD

  BACKGROUND

  • Cervicalgia, or chronic neck pain, remains an understudied and undertreated comorbid condition in patients with headache disorders that benefits from both pharmacologic and non-pharmacologic treatment profiles.

  • Cervicogenic headaches present a significant global healthcare burden, with estimates projecting up to 4.1% of the global population and 20% of headache complaints are attributed to cervicalgia (Fernandez et al. 2020).

  • What is the global demographic, treatment, and migraine preventive profile of cervicalgia in patients with either concurrent migraine (CM) or tension-type (CT) headaches?