Philadelphia College Research Articles

Cadaveric Study: Sign of Leser-Trélat Associated with Breast Cancer

INTRODUCTION: Seborrheic keratoses (SK) is considered the most common benign skin lesions found in individuals that are middle aged and older. In dermatology practice, these lesions pose no threat to the individual but can be concerning for cosmetic and underlying malignancy reasons when they cover most of the skin surface. Of specific concern is the sign of Leser-Trélat, which has been documented as a cutaneous harbinger of underlying malignancy associated with proliferation of the size and/or number seborrheic keratoses. The rare sign is usually caused by malignancies such as gastrointestinal adenocarcinoma, but also lung, kidney, liver, or pancreatic cancer. This case report will describe the histology of the skin lesions in Lesar Trélat and analyze the current literature regarding its association with breast cancer, which is quite rare. RESOURCES: For this case study, a cadaver from the body donor program in Philadelphia College of Osteopathic Medicine (PCOM), South Georgia was used. Skin samples were sent to Colquitt Regional Center for processing, where sections were embedded in paraffin and were stained with H&E stain. A pathologist reported histopathological findings of the skin lesions and the breast tissue samples. DESCRIPTION: Multiple SK lesions covering the face, abdomen, back, as well as both upper and lower extremities were observed in one of the cadavers in the gross anatomy laboratory. Due to the significant number of pigmented, verrucous lesions, the sign of Leser-Trélat was clinically postulated, later confirmed during routine laboratory dissection of the breast tissue. Histology sections confirmed not only multiple SK lesions in the skin, but also revealed an associated breast cancer in the form of an infiltrative ductal carcinoma. SIGNIFICANCE: The sign of Leser-Trélat is rare by itself and its association with breast cancer is even more uncommon. Once a clinician recognizes the multiple SK eruptions, the patient should be meticulously investigated for not only for an underlying GI malignancy, but also for other cancers like breast cancer. Additionally, a case report confirmed malignant melanoma that mimicked sign of Leser-Trélat, warranting the importance of further analyzing the pathology diagnosis when there is a proliferation of multiple seborrheic keratoses.Therefore, biopsy and histology diagnosis is crucial for ruling out both cutaneous as well as underlying malignancies and should be encouraged when patients present in clinic rather than assuming the typical benign characteristics of seborrheic keratosis.

Protein Kinase C Beta II Inhibitor Conjugated with Myristic Acid and Trans-Activator of Transcription improves intracellular delivery and cardiovascular protection in porcine myocardial ischemia/reperfusion injury

Introduction: While timely reperfusion of oxygenated blood is critical during resuscitation of ischemic myocardium, oxidative stress during reperfusion still leads to ischemia/reperfusion (I/R) injury and ultimately, cardiomyocyte death. The major sources of oxidative stress targeted in this study are NADPH oxidase (NOX-2) and mitochondria, which are both activated by protein kinase C beta II (PKCβII). In previous studies with an ex-vivo rat heart I/R model, Myristic Acid (Myr) and Trans-Activator Transcription (Tat; YGRKKRRQRRR) conjugated PKCβII inhibitor (Myr-Tat-PKCβII-; N-Myr-Tat-CC-SLNPEWNET) showed cardioprotective effects and decreased infarct size. In this study, we hypothesized that Myr-Tat-PKCβII- will offer cardioprotective effects in comparison with a scrambled peptide control (Myr-Tat-PKCβII-scram; N-Myr-Tat-CC-WNPESLNTE) in an in-vivo porcine myocardial I/R model. Methods: Regional I(1 hour)/R(3 hours) was induced in Male Yorkshire pigs (38-50kg) by inflating a balloon to occlude the Left Anterior Descending Artery (LAD) at the level of the second diagonal branch (supplies 40% of anterior left ventricle) and then deflating it to allow for reperfusion. Then, a bolus of either Myr-Tat-PKCβII- or Myr-Tat-PKCβII-scram (20ng/kg; ~100pmol in blood) was immediately administered into the LAD. Cardiac function and injury were measured by monitoring changes in ejection fraction (EF) and through routine measurements of serum creatine phosphokinase (CPK), troponin I, and myoglobin, respectively. After I/R, the hearts were stained with 1% Evans Blue dye to identify the area at risk (AR) and 1% triphenyltetrazolium chloride to determine the area of necrosis (AN). Infarct size was then quantified (AN/AR) and all data was analyzed via Student’s t-test. Results: Analysis showed that Myr-Tat-PKCβII- significantly restored EF to within 1.40.7% of baseline compared to controls which only restored EF to within 6.42.1% (p<0.05) of baseline EF. Myr-Tat-PKCβII- showed a significant increase in serum myoglobin levels at 1 hr of reperfusion (1362.1 83.4 μg/mL, n=4) compared to scrambled control (202.1197.3 μg/mL, n=3 p<0.05). Myr-Tat-PKCβII- reduced infarct size to 10.0±2.8%; n=4; compared to scrambled control hearts (28.5±8.3%; n=6; p<0.05). CPK and Troponin I levels were comparable in both groups. These results suggest that Myr-Tat-PKCβII- can help prevent cardiac injury when given immediately after an ischemic event. Conclusions: Data from ex-vivo rat heart I/R model, coupled with data from this in-vivo porcine myocardial I/R model indicate the effcacy of Myr-Tat-PKCβII- in preventing oxidative stress-induced myocardial I/R injury when given at the beginning of reperfusion. These findings suggest that Myr-Tat-PKCβII- could be useful in the clinical setting when administered immediately after cardiac resuscitation. Future studies include the treatment of rat cardiomyocyte cells with Myr-Tat-PKCβII- prior to 24 hr hypoxia/24 hr reoxygenation, followed by cell viability assays compared to untreated control. This additional data can help determine the optimal dose to use in a 12 week survival study using the same porcine myocardial I/R protocol. Funding: This study was funded by the Philadelphia College of Osteopathic Medicine, Department of Biomedical Sciences, Division of Research, and the Center for Chronic Diseases of Aging, the National Heart, Lung & Blood Institute at NIH (grant # 1R43HL160338-01) and Young Therapeutics, LLC. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Enhancing intracellular delivery of protein kinase C beta II peptide inhibitor using myristic acid-trans-activator of transcription via N-terminus conjugation in isolated rat polymorphonuclear leukocytes

Introduction: Protein kinase C beta II (PKCβII) activation promotes polymorphonuclear (PMN) superoxide (SO) production by phosphorylating serine and threonine amino acid residues on NADPH oxidase (NOX-2). Previous studies have shown that cell permeable myristic acid-conjugated PKCβII inhibitor (myr-PKCβII-; SLNPEWNET) (20 μM) remarkably attenuated phorbol 12-myristate 13-acetate (PMA)-induced PMN SO release when compared to scrambled control peptide (myr-PKCβII- scram; WNPESLNTE), unconjugated peptides and nontreated controls by ~35%. This suggests an enhanced intracellular delivery of PKCβII-. Studies have also shown that SO release is attenuated via trans-activator of transcription-conjugated (Tat; YGRKKRRQRRR) NOX-2 inhibitor (Nox2ds-Tat) (80 μM) by ~37%. There have not been evaluations of Tat- or dual myr-Tat-conjugated PKCβII-. We hypothesize that dual myr-Tat-conjugation would enhance the intracellular delivery of PKCβII- and reduce SO release compared to myr-, Tat-, and myr-Tat-PKCβII- scram. Methods: This study focused on the effects of myr-Tat-PKCβII- on intracellular delivery compared to myr-PKCβII-, Tat -PKCβII-, and myr-Tat-PKCβII- scram, with 0.5% dimethyl sulfoxide (DMSO) vehicle as the control. Sprague-Dawley (SD) male rats (~400g) were anesthetized with isoflurane and given a 0.5% glycogen i.p. injection (16ml), and 16-18hrs later, PMNs were harvested from the peritoneal cavity and incubated for 15min at 37oC with 5μM myr-Tat-PKCβII-, myr-PKCβII-, Tat-PKCβII-, or myr-Tat-PKCβII- scram. PMN SO release was calculated spectrophotometrically by the change in absorbance at 550 nm over 390s via ferricytochrome c reduction after PMA stimulation (100nM). Data were analyzed with ANOVA Fisher’s PLSD post-hoc analysis. Results: Myr-Tat-PKCβII- (n=20, 0.338±0.024, p<0.05) and Myr-PKCβII- (n=8, 0.342±0.041, p<0.05) displayed significant attenuation of SO release by 28% and 27%, respectively, compared to 0.5% DMSO control (n=81, 0.470±0.013). Tat-PKCβII- (n=5, 0.404±0.049) showed attenuated SO release by 14% when compared to the vehicle control. Myr-Tat-PKCβII- scram (n=3, 0.542±0.081) showed an increase in SO release by 15% when compared to the vehicle control. Cell viability was > 85% in all groups. Conclusion: The results of the study suggest that intracellular delivery of PKCβII- cargo using myr-Tat dual conjugation is enhanced when compared to myr-, Tat-conjugated PKCβII-, and myr-Tat-PKCβII- scram. Future studies will utilize western blot analysis and immunohistochemistry to assess the translocation and activity of PKCβII- when conjugated with myr-Tat, myr-, or Tat- peptides. Funding: This study was funded by the National Heart, Lung & Blood Institute (1R43HL160338) SBIR phase I grant that was awarded to Young Therapeutics, LLC. Philadelphia College of Osteopathic Medicine, the Department of Biomedical Sciences, the Division of Research and the Center for Chronic Diseases of Aging. and Young Therapeutics, LLC. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Naltrindole attenuates irreversible Hypercontracture during Myocardial Ischemia by a Novel Mechanism and elicits robust cardioprotective effects in Myocardial Ischemia/Reperfusion Injury

Introduction: Previous studies have shown that naltrindole (NTI) produced robust cardioprotective effects (e.g.~80% reduction of infarct size) in both ex-vivo (2.5-5μM) and in-vivo (3.75-7.5 mg/kg) rat myocardial ischemia-reperfusion (MIR) injury models. We recently showed that NTI 100-200μM attenuated phorbol 12-myristate 13-acetate (PMA) induced polymorphonuclear leukocytes (PMNs) superoxide (SO) release by a novel mechanism of action (MOA) devoid of opioid receptors. We hypothesize NTI’s novel MOA is a reduction of intracellular calcium (Ca2+). To test this hypothesis, we conducted PMN SO release and isolated perfused MIR assays using KB-R7943(KB). KB is known to reduce intracellular Ca2+ via inhibition of reverse mode Na+/Ca2+ exchanger and therefore should attenuate PMN SO release, myocardial ischemic hypercontracture, infarct size, and left ventricular end diastolic pressure (LVEDP). Methods: PMNs and hearts isolated from anesthetized male Sprague Dawley (SD) rats (~400g SO release assay, ~300g for perfused hearts). PMN SO release was stimulated using PMA (100nM) ± NTI 10-200 μM, KB 5-20 μM, or vehicle (0.5% DMSO; controls) and measured spectrophotometrically as a change in absorbance @ 550nm over 390 secs and cell viability was determined using 0.2% Trypan blue exclusion. We then infused NTI 1.25-5μM, KB 10-20μM, or naloxone (NX; negative control) 10μM for 5 min into perfused hearts, just prior to global I (30min)/R(45min). Cardiac LV function was measured via a pressure transducer and infarct size using 1% triphenyltetrazolium chloride staining in MIR assay. Data were analyzed using ANOVA and Fischers post-hoc analysis, with p<0.05 considered statistically significant. Results: PMN SO release assay: KB 10 μM, KB 20 μM, NTI 100 μM (~3.75 mg/kg), and NTI 200 μM(~7.5 mg/kg) significantly attenuated PMA induced PMN SO release by ~40% (KB 10μM, n=7, p<0.05), ~50% ((KB 20μM, n=7, p<0.05), ~30% (NTI 100 μM, n=7, p<0.05), 75% (NTI 200μM, n=7, p<0.05) respectively when compared to untreated control (n=10). MIR assay: NTI 5μM, 2.5μM, 1.25μM and KB 20 μM reduced infarct size (4.8±3%, n=5, p<0.05), (6.8±0.8%, n=6, p<0.05), (12.2±3%, n=5), and (2.9±2%, n=5, p<0.05) respectively compared to vehicle (14.1±2%, n=9) and NX 10μM controls (18±3%, n=3). NTI 5 μM and KB 20 μM had significantly improved LVEDP to (32.4±11%, n=5, p<0.05) and (22.8±4%, n=5, p<0.05) respectively compared to vehicle control (72.4±6%, n=9) and NX 10μM controls(54.2±8%, n=3) Conclusion: NTI and KB showed concentration-dependent effects on reducing PMN SO release. Both NTI (2.5μM, 5μM) and KB (20μM) reduced infarct size and improved LVEDP. The novel MOA of NTI is most likely mediated via a reduction in intracellular Ca2+ and subsequent hypercontracture during myocardial ischemia. The infarct reducing effect of NTI can benefit patients who will undergo elective PCI, CABG, and transplants. Funding: This study was funded by the Philadelphia College of Osteopathic Medicine, Department of Biomedical Sciences, Division of Research, and the Center for Chronic Diseases of Aging and Young Therapeutics, LLC. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Exploring the effectiveness of virtual and in-person instruction in culinary medicine: a survey-based study

BackgroundCulinary medicine, which has recently increased in popularity in medical education, incorporates food and nutritional interventions with principles of disease prevention and treatment. The ultimate goal is to improve overall health outcomes. The growing prevalence of diet-related chronic diseases indicates the need for physicians to have a deeper understanding of the interplay between nutrition and disease. Incorporating culinary medicine into medical education can equip medical students with the necessary skills and knowledge to promote better patient outcomes. The purpose of this study was to evaluate students’ perceptions of their foundational knowledge of a culinary medicine course after completion of the course for first- and second-year medical students at the PCOM (Philadelphia College of Osteopathic Medicine). We will also examine the difference between methods of instruction in relation to constructs discussed of knowledge gained and enjoyment of the course.MethodsThis retrospective cohort study was conducted using SurveyMonkey by Momentive. Data were collected from osteopathic medical students who enrolled in a culinary medicine course at the PCOM from 2018 to 2022 through the completion of a post-course survey. The methods of instruction included either a virtual or in-person classroom. The statistical analysis for this study was conducted using IBM SPSS Statistics version 28. To compare methods of instruction, the statistical analyses used included descriptive statistics, chi-square analysis, one-way ANOVA, and independent sample one-sided t tests.ResultsA total of 360 out of 430 participants, spanning the years 2018 to 2022, completed the course requirements and participated in the online survey. There was a valid sample size of 249 for the in-person group and 111 for the virtual instruction group. The knowledge gained construct consisted of five survey questions, for a total possible score of 25, while the enjoyment construct consisted of two questions, for a total possible score of 10. A statistically significant difference in knowledge gained was identified by one-way ANOVA, F (4,355) = 3.853, p =.004. Additionally, there was a statistically significant difference in enjoyment of the course between class years, F (4,356) = 11.977, p <.001. Independent sample t-tests revealed a statistically significant difference in enjoyment between the two methods (p <.001) even after accounting for unequal variances, with Cohen’s d equal to 0.807, indicating a moderate effect size.ConclusionsThe findings of this study suggest that overall, students were highly satisfied with the Culinary Medicine course over a five-year period. The study suggested that students who participated in in-person courses benefitted more than did the virtual students in terms of knowledge gained and enjoyment. The 360 students who completed the Culinary Medicine course were highly satisfied with the information and skills they acquired.

Court rules against former employee

Case name: Mudie v. Philadelphia College of Osteopathic Medicine, et al., No. 22‐2132 (3d Cir. 09/25/23).

Medea/Media: a glitchy counterfactual

Abstract James Ijames, the winner of a 2022 Pulitzer prize for Fat Ham, loosely based on Hamlet, has just presented a new realization of Medea, Media/Medea, which had its world premiere at Bryn Mawr College and the Community College of Philadelphia in April 2023. This article provides a reading of it, addressing the themes of irony, queer ‘authenticity’, acting, and mothering through the framing of the ‘glitchy counterfactual’ — a conceit we borrow from Legacy Russell’s manifesto for a new Black cyberfeminism to approach the most blatant innovation in Ijames’s version, the unfulfilled infanticide. This astonishing change in the script, which tightly connects Medea with her onomastic negativity and queer unbecoming, urges us to reflect upon survival and survivance in an anti-Black world; it might yield a reckoning in line with Kevin Quashie’s notion of ‘subjunctivity’, Black ‘aliveness’.

Editorial introductions.

Current Opinion in Pulmonary Medicine was launched in 1995. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of pulmonary medicine is divided into nine sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Alan FeinAlan FeinAlan Fein, MD received his medical degree from the State University of New York Downstate Medical Center in Brooklyn, USA in 1973. He completed his internship and residency in internal medicine at Albert Einstein College of Medicine, Bronx Municipal Hospital, New York, USA. From there, Dr Fein moved on to a fellowship in Pulmonary Disease at the University of California, San Francisco Cardiovascular Research Institute, USA. He served as Division Chief for Sleep, Pulmonary & Critical Care Medicine at Winthrop Hospital and then for the North Shore Long Island Jewish Health System. Dr Fein is a member of the American Academy of Sleep Medicine, the American College of Chest Physicians, the American College of Physicians, and the American College of Critical Care Medicine. He is the former President of the American Lung Association of Nassau/Suffolk and served on the national boards of the American Thoracic Society and the American College of Chest Physicians. Dr Fein is a Clinical Professor of Medicine at New York University, USA and Zucker School of Medicine, USA. He was Chief of the Pulmonary, Critical and Sleep Division of Prohealthcare Associates Optum Health. He is currently Medical director of the Post Covid Recovery Center for Optum Health. Dr Fein is on the editorial boards of Current Opinion in Pulmonary Medicine and the American Journal of Respiratory & Critical Care Medicine. Dr Fein has authored almost 100 peer-reviewed manuscripts, over 100 review articles, and book chapters on topics such as diagnosis and treatment of lung cancer, pneumonia, asthma, and chronic obstructive pulmonary diseases. David OstDavid OstDavid Ost, MD, MPH is Professor of Medicine at The University of Texas M. D. Anderson Cancer Center, Department of Pulmonary Medicine, USA. Dr Ost is a Fellow of the American College of Chest Physicians and the American College of Physicians and has served on the board of directors of the American Association of Bronchology and Interventional Pulmonology. Dr Ost is currently editor of the Journal of Bronchology and Interventional Pulmonology. He is a reviewer for many journals including Annals of Internal Medicine, the American Journal of Respiratory and Critical Care Medicine, Chest and the Journal of the American Medical Association. Dr Ost has authored over 100 manuscripts and book chapters on such topics as interventional pulmonology, lung cancer, pulmonary embolism, and ventilator associated pneumonia. Dr Ost received his medical degree from the Thomas Jefferson University, Jefferson Medical College in Philadelphia, USA. He completed his internship and residency in internal medicine at Northwestern University in Chicago, USA. Additionally, Dr Ost was a fellow in pulmonary and critical care at Northwestern. He is board certified in interventional pulmonology. He received his Masters in Public Health from Harvard University, USA, with a focus in quantitative methods. Marlies WijsenbeekMarlies WijsenbeekMarlies Wijsenbeek is pulmonary physician and Professor of Interstitial Lung Diseases at the Erasmus University Medical Centre in Rotterdam, a national expert centre for interstitial lung diseases (ILD) in the Netherlands and member of the European Reference Network for Rare Lung Diseases (ERN-Lung). She is chair of the multidisciplinary ILD centre. Her research interests include e-health, patient centred outcome measures in ILD, cough in ILD and new therapies in ILD and sarcoidosis. She is chair of group 12.01 (Idiopathic Interstitial Pneumonia) of the European Respiratory Society, chair of the functional committee for continued education of the ERN-Lung, member of the scientific advisory boards of different patient associations, Associate Editor of the European Respiratory Journal, and member of the international advisory board of The Lancet Respiratory Medicine. Catharina C. MoorCatharina C. MoorKaren Moor, M.D. Ph.D. is a pulmonologist in training and postdoctoral researcher at the Erasmus Medical Center, Rotterdam, the Netherlands. She is the current Early Career Representative for the ILD assembly within the European Respiratory Society (ERS). Her research focuses on innovative approaches for patient-centered care in interstitial lung disease (ILD), especially digital health care and home monitoring. She coordinated the first-ever randomized controlled trial on home monitoring in ILD (Am J Respir Crit Care Med Vol 202, Iss 3, pp 393–401, Aug 1, 2020). Together with Prof. Dr Marlies Wijsenbeek she is co-leading various home monitoring studies, including a large international patient-led registry study, and a nationwide implementation study.

Naltrindole Pretreatment Elicits Potent Dose Dependent Effects on Reducing Infarct Size During Ischemia Reperfusion In-Vivo

Over one million individuals experience a myocardial infarction (MI) every year. Currently, no therapeutic is available to salvage necrotic cardiac tissue following an MI. The use of a prophylactic agent to reduce infarct size in patients at high risk for an MI would attenuate the development of heart failure. Interventional cardiologists state that a 25% reduction in infarct size is clinically meaningful to reduce heart failure. Previously, a 5 min pretreatment with high dose (HD) naltrindole (NTI) (7.5 mg/kg x 5 min = 37.5 mg/kg, n=3) resulted in a robust 74% (15±6%) reduction in infarct size compared to control in an in-vivo model of ischemia reperfusion injury (IRI). This effect was accompanied by a reduction in irreversible hypercontracture known as rigor. However, it caused a transient reduction in cardiac function during the infusion period. In this study, we aim to determine the effect of intermediate (ID; 3.75 mg/kg x 5 min = 18.75 mg/kg) and low dose (LD; 0.2-1.0 mg/kg x 5 min = 1.0-5.0 mg/kg) NTI pretreatment on infarct size and cardiac function in a rat in vivo model of IRI.Female Sprague-Dawley rats (~250g) were divided into four cohorts: non-treated control (n=15), LD (n=18), ID (n=5), and HD (n=5) NTI groups. All cohorts were anesthetized with Ketamine-xylazine (90 mg/kg, 9 mg/kg). Control rats received normal saline (0.9% NaCl), while treatment groups received either HD, ID, or LD NTI infused through the jugular vein (0.4mL/min) over 5 mins before inducing regional ischemia by occluding the left descending coronary artery for 30 min followed by 3 hr reperfusion. Cardiac function was measured through a pressure transducer catheter placed into the left ventricle (LV) in NTI treated groups. Planimetered photographs of heart slices were used to determine infarct size. Data were analyzed via ANOVA, Bonferroni-Dunn, and post-hoc analysis. Probability values &lt;0.05 were considered statistically significant.HD, ID, and LD NTI reduced infarct size by 81% (11±4%) p&lt;0.05, 55% (26±7%) p&lt;0.05, and 4% (55±4%) respectively compared to control (57±2%). Cardiac function parameters such as dP/dt min, the maximal rate of LV pressure relaxation, was not significantly affected by ID NTI compared to LD NTI in contrast to the cardiac depression elicited by HD NTI. These results indicate that the cardiac depressive effects of NTI are dose dependent and the infarct reducing effects of NTI can be achieved through doses that spare cardiac function. Therefore, ID NTI prophylaxis may be an effective strategy to limit cardiac tissue death in populations at high risk of an MI. Future studies will be conducted on porcine cardiac IRI models. Funding was supported by Young Therapeutics LLC and internal grants from Philadelphia College Of Osteopathic Medicine This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Hellfall

Hellfall Theodor Däubler (bio) and Sean Zhuraw (bio) I found one of you whose oeuvreLavishes him already in soul in CocytusAnd in body on the surface seems preserved. —Dante, Inferno: XXXIII, 155–157 Around me, ravenously, the recoiling Nothing grimaces.The Sierras of Error fork into Agonies.Into my Heart inks a deadlier Indelibility:I await the Hellcourt's SentencesWhere silkstrung Anachrobatic Carapaces rib the Internees:I have a Stake, a Claim, but an Imp for Defenses!Hunger, the Unicorn with swaggings of Teats,That ten gash-gnashing Thirsthounds skin,Begins on me, sallowstaining, through to the intestine asunder it flays:And Loathing consumes me in Snailtendons.Erratic as a Steer who makes nightmarish Splices,It squirms behind me to whittle itself away in a Bound;Now Horns precipitate me to motley Displaces.But I wince again from tined Pangs [End Page 122] And grip my flickering self in the flitting Flametongues.Exquisite Disquietude wicks me like fuming under Tassels:Like Ears the flaring Goldtrim surveilsSuspiring Tendrils, gripping to dazzle,Who, increasingly, say: "Awaken, Shameful Mantles!You have the most wholesome Rawhide to ravel,Baste in your fringeflagrant Flareapparel!"The Veinclotter demands it to whimper,Which knells out as if from earthbound Chambers:"The Mouthfeelings, Indentures, a Lethe-Trespassing,Disguised, gelatinizes necrotic Susceptibilities.Pathetic Pleas curdle, imbruingThe forceful Forceps with flaming Tributaries."A chirring Vortex revolves my Thinking.I'm swept away in whimpering Fits;The flickers and fevers. A Silverlight defuses:"I was a Miss destined for your Senses.I cried out to the Man, make me into Missis, [End Page 123] I plead for Rest in the inflamed Flesh,But you didn't take me, and now inside I whirl like a Disk."The Darkness splinters its innermost Twinkle:Instantly I am softened by the Dead Air of my own Agnate.In the darkening Vanity, whispering Extracts fall involuble,For now, the lucid incidence can itself divaricate!That flickering in the Lobes, stoking in the Fingers:"Soundless and blessed, now there will be a Human fecundate.No Knowledge can dampen its Vomer,For he may reach all of Might's cold Etiquette."At that I laugh aloud: an anointed Earthling!I toast your louche, lurid Becoming.How delicately itself a germinating Being sprawls.The Recess recoils at itself. Beclouds itself in the Dark.There is Peace! Bound for the little Youngling?The Genesis of Goods, Impetus, and a Mouth for SparksIs gradually contoured by Mother's Cajoles:She can encage it with gilder Wanting. [End Page 124] She hears her Heart, its Hammering and Throbbing.Already the Lad's goldfrolic Weeks are nearing.Make your Mother happy, induce yourself, Page!She must love you now, exalt your Evolution.Accept the body from the woman, its Patronage.You shall give birth to the secluded Sun.You Peace more manifest, you friendlier Star.Lap yourself in gold, ward forward, clad your Core;Ring in the fever-pitched Sussing of the World,Ignite the Forge that secures the KnollAround which the Ringing of Psalms purl.Sustain yourself! Plunge your all into Nightfall.Be gruesome, peer through the Hellscree.To Outbreak, blister your Streak! Here, Hell, involute me. [End Page 125] Theodor Däubler theodor däubler (1876–1934) is the author of more than twenty books of poetry, prose, and art criticism, including the collections The Starchild and The Starlit Path, where "Hellfall" appears. His honors include serving as the chair of the German pen club and being awarded the Goethe Medal. Sean Zhuraw sean zhuraw's poetry and translations have appeared in Boston Review, Tin House, The Offing, Defunct, New Session, typo, Denver Quarterly, and elsewhere. He teaches English and Creative Writing at the Community College of Philadelphia and Widener University. He lives gayly in West Philly with his husband and two cats. @toystutter on Instagram. Copyright © 2023 Sean Zhuraw

Peritoneal Carcinomatosis of Prostate Cancer with PSMA-targeted 18F-DCFPyL PET/CT

HomeRadiology: Imaging CancerVol. 5, No. 2 PreviousNext Images in CancerFree AccessPeritoneal Carcinomatosis of Prostate Cancer with PSMA-targeted 18F-DCFPyL PET/CTRonald Woodruff , Cameron Henry, Phillip SchererRonald Woodruff , Cameron Henry, Phillip SchererAuthor AffiliationsFrom the Philadelphia College of Osteopathic Medicine, 4170 City Avenue, Philadelphia, PA 19131 (R.W.); and Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.H., P.S.).Address correspondence to R.W. (email: [email protected]).Ronald Woodruff Cameron HenryPhillip SchererPublished Online:Mar 17 2023https://doi.org/10.1148/rycan.220174MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Prostate cancer is the second most common cause of cancer-related death in men. Metastatic spread of prostate cancer frequently involves the bones (84%) and, less commonly, distant lymph nodes (10.6%) and the liver (10.2%) (1). Peritoneal spread of prostate adenocarcinoma is rarely described in the literature, especially without evidence of bony spread or other distant metastatic involvement (2,3). The cause of peritoneal involvement of prostate cancer is poorly understood. While treatment options such as surgical intervention combined with medical therapy have proven effective in preventing local disease recurrence, studies have proposed that laparoscopic prostatectomies may increase the risk of iatrogenic seeding of the peritoneum, causing disease recurrence later in life (4). Cases of peritoneal involvement in the absence of surgical intervention have also been reported, possibly revealing hematogenous or lymphatic spread as a cause. Visceral involvement in prostate cancer is known to be a poor prognostic indicator. Clinicians should consider this diagnosis when performing imaging for patients with a history of prostate adenocarcinoma (Figure).Prostate-specific membrane antigen–targeted fluorine 18 (18F) 2-(3-{1-carboxy-5-[(6-18F]fluoro-pyridine-3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid (DCFPyL) PET/CT images in an 88-year-old man with a history of prostate adenocarcinoma who presented with worsening fatigue and abdominal distention for over a year. The patient was treated 15 years prior with prostatectomy (Gleason score was 3 + 4 = 7) and continued to receive medical management. Despite treatment, the patient’s prostate-specific antigen level was elevated to 917.61 ng/mL. For restaging, imaging was performed. (A) Coronal PET image shows diffuse intense uptake throughout the peritoneum and omentum. (B, C) Axial PET/CT images show peritoneal nodularity (white arrow), ascites (red arrow), and extensive omental nodularity and stranding (blue arrows), with no evidence of skeletal metastasis. Histologic sample of the mesentery helped confirm prostate adenocarcinoma. No further genetic or histologic testing aided the patient’s diagnosis.Download as PowerPointOpen in Image Viewer Disclosures of conflicts of interest: R.W. No relevant relationships. C.H. Leadership or fiduciary role in Society of Cardiovascular Computed Tomography (SCCT) FiRST committee. P.S. No relevant relationships.Keywords: PET/CT, Prostate, Peritoneum, Omentum, Mesentery, MetastasesAuthors declared no funding for this work.

The Civil War Letters of Dr. Daniel Garrison Brinton, Surgeon in Charge at the US Army General Hospital in Quincy

The Civil War Letters of Dr. Daniel Garrison Brinton, Surgeon in Charge at the US Army General Hospital in Quincy

Judge rules against professor

Case name: Bank v. Community College of Philadelphia, et al., No. 22‐293 (E.D. Pa. 07/22/22).

Judge rules against professor

The Successful RegistrarVolume 22, Issue 10 p. 10-10 Disability — Americans with Disabilities Act — Racial discrimination — Hostile work Environment Judge rules against professor First published: 20 November 2022 https://doi.org/10.1002/tsr.31058Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Abstract Case name: Bank v. Community College of Philadelphia, et al., No. 22-293 (E.D. Pa. 07/22/22). Volume22, Issue10December 2022Pages 10-10 RelatedInformation

Judge rules against professor

Case name: Bank v. Community College of Philadelphia, et al., No. 22‐293 (E.D. Pa. 07/22/22).

Peculiar and proper habits: The use and production of academic dress in Colonial, Revolutionary, and Federal Philadelphia

This is a study of the adoption and use of academic dress at the University of Pennsylvania and its predecessor institutions, the College of Philadelphia and University of the State of Pennsylvania from approximately 1750–1830. Despite early interest of the College’s founder, Benjamin Franklin, to use academic dress to monitor student activities outside college bounds, there was soon contentious debate between the institution’s founding senior academics about whether academic dress should be used at all. By sheer force of will of its leading proponent, academic dress came into use at public ceremonies. These public ceremonies became a model for public political expression outside the academic context, eventually transforming the gown’s connection to European aristocratic institutions into the garment of scholar-artisans in a democratic republic. This close association between academic and civic ceremonial helped shape discussions in the next generation about greater distinction in academic gowns that foreshadow the development of the Intercollegiate Code of Academic Costume at the end of the nineteenth century. Throughout this history filled with well-known leaders of the American War of Independence, we also glimpse hidden figures within the pattern of academic dress at Philadelphia: the largely anonymous women who made and repaired academic gowns.

Osteopathic Medical Students’ Subjective Preparedness for LGBTQ+ Patient Care and Influencing Factors: A Multi-Institutional Survey Study

Abstract Objectives This study aims to investigate what factors correlate with osteopathic medical students’ preparedness to provide care for the LGBTQ+ community through a multi-institutional survey. Context This is one of the few formal research projects to assess the impact of LGBTQ+ medical education on osteopathic students’ comfort level with caring for the community. Methods This study was approved by the IRB at Western University of Health Sciences, Pomona, CA on 11/19/2020. An 18-question survey was created regarding the exposure to the LGBTQ+ population and healthcare education before and after attending osteopathic medical schools. The anonymous survey was electronically distributed at Western University of Health Sciences College of Osteopathic Medicine Pacific and Pacific Northwest, Idaho College of Osteopathic Medicine, Touro University, Philadelphia College of Osteopathic Medicine, Rocky Vista University College of Osteopathic Medicine, and Michigan State University College of Osteopathic Medicine between 1/6/21 and 5/8/21. The survey information was statistically analyzed via SAS University edition. Results The survey had 441 responses: 63% were female, 34% were male, and 3% selected other gender identities. From 441 responses to the survey, 378 responses were analyzed using a logistics regression model to comprehensively model a binary-dependent variable for the students’ preparedness. Students knowing the meaning of the acronym LGBTQ+ (p =0.04) and actively engaging in extracurricular activities for the LGBTQ+ population (p =0.01) showed the strongest correlation based on the logistic regression analysis. Additionally, Chi-square results identified 6 independent variables associated with students’ preparedness to care for the LGBTQ+ population: being a second year or a third year osteopathic medical student (p &amp;lt;0.01), having opportunities to learn about the LGBTQ+ population in college (p &amp;lt;0.01), having a formal presentation about LGBTQ+ health in medical school (p &amp;lt;0.01), the medical school offering extracurricular activities about the LGBTQ+ population (p &amp;lt;0.01), knowing what the LGBTQ+ acronym stands for (p =0.01), and actively being involved in extracurricular activities concerning the LGBTQ+ community (p=0.03). Conclusions Our study indicates that medical students’ educational exposure through college and medical school is a more correlating influencing factor for their preparedness to care for the LGBTQ+ population in comparison with student’s gender, hometown size, or socioeconomic, geographical, and religious background. Future studies to objectively identify medical students’ preparedness and experience with LGBTQ+ patients, as well as studying effective curricula for filling in knowledge gaps, will be necessary.

Judge rules against former professor

Case name: Bartell, et al. v. Community College of Philadelphia, et al., No. 2:19‐cv‐6056, No. 2:19‐cv‐6057, No. 2:20‐cv‐1659, No. 2:20‐cv‐1666 (E.D. Pa. 02/24/22).

Regulatory learnings for the next wave of cellular immuno-oncology agents

Dr Pietrusko currently serves as Chief Regulatory and Quality Officer at Vor Biopharma in Cambridge, MA and leads the Regulatory strategy for engineered hematopoietic stem cell therapy for hematologic malignancies including AML. He has directed the worldwide approval of more than 30 new products in multiple therapeutic areas. As an early team member at Voyager Therapeutics, Dr Pietrusko pioneered regulatory strategies to translate gene therapies from research into the clinic. Prior to Voyager, he was Vice President of Global Regulatory Affairs &amp; Quality and Executive Officer at ViroPharma, Inc. He also served as Senior Vice President of Regulatory Affairs at Millennium Pharmaceuticals, spearheading the accelerated approval of Velcade&#174;&#160;in the US and in more than 90 countries worldwide. Earlier in his career, he was Vice President of Regulatory Affairs at SmithKline Beecham (now GSK). He has played a key role in shaping US regulatory policy for cutting edge medicines, such as recently pioneering the concept of an expedited pathway to approval for cell and gene therapies that led to the Regenerative Medicine Advanced Therapy (RMAT) designation process that was included in the United States 21st Century Cures Act. He currently serves as Chair of the Regulatory Affairs Committee of the Alliance for Regenerative Medicine (ARM) and is an appointed member of the Regulatory Affairs Committee of the American Society of Gene and Cell Therapies (ASGCT). Dr Pietrusko holds a Bachelor of Science degree in biology, a Bachelor of Pharmacy degree from Rutgers University, and a Doctor of Pharmacy degree from the Philadelphia College of Pharmacy and Science. He completed his residency training in hospital pharmacy at Thomas Jefferson University Hospital and is the author or co-author of over 50 scientific publications.

Judge rules against former professor

Case name: Bartell, et al. v. Community College of Philadelphia, et al., No. 2:19‐cv‐6056, No. 2:19‐cv‐6057, No. 2:20‐cv‐1659, No. 2:20‐cv‐1666 (E.D. Pa. 02/24/22).