There is an annual poster session hosted by the AOA to highlight research endeavors of SKMC students. This day offers an opportunity for students to network with faculty and features a physician keynote speaker. The event also awards student investigators who have displayed significant research findings.
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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?
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Preoperative Predictors of Arthroscopic Partial Meniscectomy Outcomes: The APM Index Score
Natalie Lowenstein, Yuchiao Chang, Hanna Mass, Angela M. Mercurio, Chierika Ukogu, Jeffrey N. Katz, and Elizabeth G. Matzkin
Problem Statement:
- Arthroscopic partial meniscectomy (APM) has been shown to be the most common meniscal surgical treatment in the United States
- Pre-op risk factors known to contribute to poor outcomes after APM:
- Symptom duration and radiographic OA at baseline
- Baseline knee functional score, location of meniscal tear, BMI, activity level, age, sex, and chondral damage on MRI
Project AIM:
To create an index score using easily available preoperative risk factors such as Kellgren-Lawrence (KL) grade, age, duration of symptoms, BMI, activity level, and preoperative outcome scores to predict the likelihood of favorable outcomes after APM.
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Prognostic Properties of KRAS Gene Mutation Subtypes in Resected Pancreatic Cancer
Faria Nusrat; Eliyahu Gorgov, MD; Wilbur Bowne, MD; Obehioye Isesele; Akshay Khanna; Harish Lavu, MD; Aditi Jain, PhD; Charles J. Yeo, MD; and Avinoam Nevler, MD
Introduction
- Pancreatic ductal adenocarcinoma (PDAC) is an aggressive and therapy-resistant cancer with an overall 5-year survival rate of almost 12%, making it among the most lethal of all major cancers.1
- PDAC has a distinct genomic profile, with somatic KRAS protooncogene mutations in ~90% of cases.2,3
- Current literature has not reached a consensus on disease prognosis based on KRAS mutation subtype.2-5
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A Konnyaku Jelly Model for Ultrasound-Guided Fascia Iliaca Compartment Block
Arthraj J. Vyas; Matthew C. Lo; and Arthur Au, MD
Purpose
Konnyaku Jelly:
•Previously used as effective ultrasound-guided IV access phantom
•Withstands multiple needle piercings without phantom deterioration
•<$3 per pack
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Determining Bystander Motivations and Hesitations to Intervene During an Opioid Overdose Event
John Wahlstedt, Alana Platukus, Eric Fei, Yasmine Eichbaum, Noah Streitfeld, Robert S. Pugliese, and Kelly Kehm
Background
Harm reduction initiatives have been shown to improve morbidity and mortality of overdose; however, the rate of death due to opioid overdose continues to rise in Philadelphia. One aspect of the overdose scenario that requires more focus is the response of witnesses to overdose.
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Broad Efficacy of a Computationally Designed ACE2 Decoy Against SARS-CoV-2 Omicron Variants and Related Viruses In Vitro and In Vivo
Brandon Havranek, Graeme W. Lindsey, Yusuke Higuchi, Yumi Itoh, Tatsuya Suzuki, Toru Okamoto, Atsushi Hoshino, Erik Procko, and Shahidul M. Islam
Background: The SARS-CoV-2 omicron variant (B.1.1.529) and its sublineages are currently the dominant variants in the United States accounting for 100% of COVID-19 cases. Problem: The S protein receptor-binding domain (RBD), located in the S1 subunit of the S protein, binds the human angiotensin-converting enzyme 2 (hACE2) leading to S1 shedding and proteolytic processing of S2 that is important for membrane fusion and release of viral RNA. Various neutralizing therapeutics including protein minibinders, peptides, monoclonal antibodies, and nanobodies have been developed to block the critical interaction between the RBD and hACE2. However, these therapeutics are often developed against the S protein of wildtype or a specific variant of SARSCoV- 2, making them highly susceptible to mutational escape.1 Solution: A strategy employed by our group includes using sACE2 (soluble dimeric ACE2 that contains both the protease and dimerization domains) with enhanced S RBD affinity to outcompete native ACE2 expressed on host cells, acting as a ‘decoy’ to block the interaction between the RBD and hACE2 (Figure 1). sACE2 has moderate affinity for the S protein (~20 nM)2. Therefore, sACE2 must be engineered (by introducing affinity enhancing mutations) to bind with tighter affinity to outcompete membrane bound ACE2-S interaction and rival the potency of mAbs. These sACE2 derivatives maintain close similarity to the native ACE2 receptor making them extremely resistant to virus escape. Any mutation in the RBD that limits binding to the sACE2 derivative will likely have reduced binding towards native ACE2 receptors potentially making the virus unfit to propagate.
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Evaluation of Autofluorescence Technology in the Identification of Tissue Types in Anterior Neck Surgery
Natalie M. Perlov; Elliott Sina; Sruti Tekumalla; Annie Moroco, MD; and Elizabeth Cottrill, MD
Background
- Iatrogenic parathyroidectomy and hypocalcemia are potential risks of central neck surgery1
- Resected parathyroid tissue may be reimplanted if identified quickly, mitigating risk of hypocalcemia2
- Current practices of identifying and preserving parathyroids, such as frozen specimens, may incur significant costs in time and expense
- Autofluorescence (AF) technology takes baseline AF readings from healthy thyroid tissue and compares to other tissues in the neck
- There is limited data on AF profiles of all tissue types in the central neck (thyroid, thymus, benign vs. malignant lymph nodes, adipose tissue)
Preliminary Outcomes
- (1) Investigate the impact of AF on iatrogenic hypoparathyroidism
- (2) Assess new AF profiles for different tissue types in the anterior neck
