Thomas Jefferson University Hospital

About: Thomas Jefferson University Hospital is a healthcare organization based out in Philadelphia, Pennsylvania, United States. It is known for research contribution in the topics: Population & Medicine. The organization has 6173 authors who have published 7631 publications receiving 197620 citations.

Apoptosis of circulating tumor cells in prostate cancer patients.

Abstract: Background The prescence of circulating tumor cells (CTCs) in the peripheral blood of cancer patients and their frequency has been correlated with disease status. Methods In this study, CTCs were characterized by flow cytometry and fluorescence microscopy after immunomagnetic enrichment from 7.5-ml blood samples collected from patients with prostate cancer in evacuated blood-draw tubes that contained an anticoagulant and a preservative. Events were classified as tumor cell candidates if they expressed cytokeratin, lacked CD45, and stained with the nucleic acid dye 4,6-diamidino-2-phenylindole. Results In the blood of prostate cancer patients, only few of these events were intact cells. Other CTC events appeared as damaged cells or cell fragments by microscopy. By flow cytometry, these events stained variably with 4,6-diamidino-2-phenylindole and frequently expressed the apoptosis-induced, caspase-cleaved cytokeratin 18. Similar patterns of cell disintegration were observed when cells of the prostate line LNCaP were exposed to paclitaxel before spiking the cells into normal blood samples. Conclusions The different observed stages of tumor cell degradation or apoptosis varied greatly between patients and were not found in blood of normal donors. Enumeration of CTCs and identification of CTCs undergoing apoptosis may provide relevant information to evaluate the response to therapy in cancer patients. © 2004 Wiley-Liss, Inc.

Transgenic mice overexpressing the wild-type form of the HMGA1 gene develop mixed growth hormone/prolactin cell pituitary adenomas and natural killer cell lymphomas.

Abstract: Overexpression of HMGA1 proteins is a constant feature of human carcinomas. Moreover, rearrangements of this gene have been detected in several human benign tumors of mesenchymal origin. To define the role of these proteins in cell transformation in vivo, we have generated transgenic mice overexpressing ubiquitously the HMGA1 gene. These mice developed mixed growth hormone/prolactin cell pituitary adenomas and natural killer (NK)-T/NK cell lymphomas. The HMGA1-induced expression of IL-2 and IL-15 proteins and their receptors may account for the onset of these lymphomas. At odds with mice overexpressing a wild-type or a truncated HMGA2 protein, adrenal medullar hyperplasia and pancreatic islet cell hyperplasia frequently occurred and no increase in body size and weight was observed in HMGA1 mice. Taken together, these data indicate an oncogenic role of the HMGA1 gene also in vivo.

A.S.P.E.N. Clinical Guidelines Nutrition Support of Hospitalized Adult Patients With Obesity

Abstract: Background: Due to the high prevalence of obesity in adults, nutrition support clinicians are encountering greater numbers of obese patients who require nutrition support during hospitalization. The purpose of this clinical guideline is to serve as a framework for the nutrition support care of adult patients with obesity. Method: A systematic review of the best available evidence to answer a series of questions regarding management of nutrition support in patients with obesity was undertaken and evaluated using concepts adopted from the Grading of Recommendations, Assessment, Development and Evaluation working group. A consensus process, that includes consideration of the strength of the evidence together with the risks and benefits to the patient, was used to develop the clinical guideline recommendations prior to multiple levels of external and internal review and approval by the A.S.P.E.N. Board of Directors. Questions: (1) Do clinical outcomes vary across levels of obesity in critically ill or hospitalized non-intensive care unit (ICU) patients? (2) How should energy requirements be determined in obese critically ill or hospitalized non-ICU patients? (3) Are clinical outcomes improved with hypocaloric, high protein diets in hospitalized patients? (4) In obese patients who have had a malabsorptive or restrictive surgical procedure, what micronutrients should be evaluated? (JPEN J Parenter Enteral Nutr. XXXX;XX:XX-XX)

A systematic review of occipital cervical fusion: techniques and outcomes.

Abstract: OBJECT Numerous techniques have been historically used for occipitocervical fusion with varied results. The purpose of this study was to examine outcomes of various surgical techniques used in patients with various disease states to elucidate the most efficacious method of stabilization of the occipitocervical junction. METHODS A literature search of peer-reviewed articles was performed using PubMed and CINAHL/Ovid. The key words "occipitocervical fusion," "occipitocervical fixation," "cervical instrumentation," and "occipitocervical instrumentation" were used to search for relevant articles. Thirty-four studies were identified that met the search criteria. Within these studies, 799 adult patients who underwent posterior occipitocervical fusion were analyzed for radiographic and clinical outcomes including fusion rate, time to fusion, neurological outcomes, and the rate of adverse events. RESULTS No articles stronger than Class IV were identified in the literature. Among the patients identified within the cited articles, the use of posterior screw/rod instrumentation constructs were associated with a lower rate of postoperative adverse events (33.33%) (p < 0.0001), lower rates of instrumentation failure (7.89%) (p < 0.0001), and improved neurological outcomes (81.58%) (p < 0.0001) when compared with posterior wiring/rod, screw/plate, and onlay in situ bone grafting techniques. The surgical technique associated with the highest fusion rate was posterior wiring and rods (95.9%) (p = 0.0484), which also demonstrated the shortest fusion time (p < 0.0064). Screw/rod techniques also had a high fusion rate, fusing in 93.02% of cases. When comparing outcomes of surgical techniques depending on the disease status, inflammatory diseases had the lowest rate of instrumentation failure (0%) and the highest rate of neurological improvement (90.91%) following the use of screw/rod techniques. Occipitocervical fusion performed for the treatment of tumors by using screw/rod techniques had the lowest fusion rate (57.14%) (p = 0.0089). Traumatic causes of occipitocervical instability had the highest percentage of pain improvement with the use of screw/plates (100% improvement) (p < 0.0001). CONCLUSIONS Based on the existing literature, techniques that use screw/rod constructs in occipitocervical fusion are associated with very favorable outcomes in all categories assessed for all disease processes. For patients requiring occipitocervical arthrodesis for the treatment of inflammatory diseases, screw/rod constructs are associated with the most favorable outcomes, while posterior wiring and onlay in situ bone grafting is associated with the least favorable outcomes. Occipitocervical arthrodesis performed for the diagnosis of tumor is associated with the lowest rate of successful arthrodesis using screw/rod techniques, while posterior wiring and rods have the highest rate of arthrodesis. The nonspecified disease group had the lowest rate of surgical adverse events and the highest rate of neurological improvement.