Edward J Caterson

Harvard University, Cambridge, Massachusetts, United States

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Publications (70)198.57 Total impact

  • 05/2015; DOI:10.1097/GOX.0000000000000345
  • 05/2015; DOI:10.1097/GOX.0000000000000343
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    ABSTRACT: The skin wound microenvironment can be divided into two main components that influence healing: the external wound microenvironment, which is outside the wound surface; and the internal wound microenvironment, underneath the surface, to which the cells within the wound are exposed. Treatment methods that directly alter the features of the external wound microenvironment indirectly affect the internal wound microenvironment due to the exchange between the two compartments. In this review, we focus on the effects of temperature, pressure (positive and negative), hydration, gases (oxygen and carbon dioxide), pH, and anti-microbial treatment on the wound. These factors are well described in the literature and can be modified with treatment methods available in the clinic. Understanding the roles of these factors in wound pathophysiology is of central importance in wound treatment. This article is protected by copyright. All rights reserved. © 2015 by the Wound Healing Society.
    Wound Repair and Regeneration 04/2015; DOI:10.1111/wrr.12303 · 2.77 Impact Factor
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    ABSTRACT: American Board of Plastic Surgery (ABPS) recently celebrated its 75 anniversary as an established specialty board. This historical article provides an outline of the events that led to the formation of the ABPS and gives insight into the personalities and achievements of the key individuals whose unique talents coalesced into a common vision of making plastic surgery the diverse and well respected specialty that it is today. This is a historical literature review outlining the circumstances leading to the formation of ABPS. The emphasis on the role of founding fathers of ABPS is reviewed and detailed in the manuscript. The founding figures of ABPS continue to inspire us, through their unrelenting dedication to the field of Plastic Surgery. Over the past 75 years, the field of plastic surgery has been very well served by their successors and these founding figures of the ABPS have fostered a surgical specialty of great repute.
    Plastic &amp Reconstructive Surgery 02/2015; DOI:10.1097/PRS.0000000000001313 · 3.33 Impact Factor
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    ABSTRACT: Large facial tissue defects are traditionally treated with staged conventional reconstruction. Facial allograft transplantation has emerged as a treatment modality. Facial allografts are procured from a dead donor and transplanted to the recipient. Recipients are then subjected to lifelong global immunosuppression to prevent immunologic rejection. This study analyzes the cost of facial allograft transplantation in comparison with conventional reconstruction. Hospital billing records from facial allograft transplantation (2009 to 2011) and conventional reconstruction (2000 to 2010) patients were compiled. Comparative 1-year costs were calculated, segregated by physician, hospital, and hospital's department costs. Because most conventional reconstruction patients had smaller facial deficits than their facial allograft transplantation counterparts, regression models were used to estimate costs of conventional reconstruction for full facial defects, mirroring the facial transplantation cohort. All costs were adjusted using the medical consumer price index. One-year costs for facial allograft transplantation were significantly higher than those for conventional reconstruction (mean/median, $337,360/$313,068 versus $70,230/$64,451, respectively). One-year costs for a hypothetical full-face conventional reconstruction were $184,061 (95 percent CI, $89,358 to $278,763). The per-patient cost in a hypothetical cohort of conventional reconstruction patients with deficits identical to four facial allograft transplantation recipients was $155,475 (95 percent CI, $69,021 to $241,929). Initial cost comparison portrays facial allograft transplantation as significantly more costly than conventional reconstruction. However, after adjustments for case severity, the cost profiles are similar. Gains in efficiency and experience are expected to lower costs. Additional unmeasured benefits may also positively influence the cost-to-benefit ratio of facial allograft transplantation.
    Plastic &amp Reconstructive Surgery 01/2015; 135(1):260-7. DOI:10.1097/PRS.0000000000000799 · 3.33 Impact Factor
  • Radiographics 01/2015; In Press. · 2.73 Impact Factor
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    ABSTRACT: Injury to the skin can predispose individuals to invasive infection. The standard of care for infected wounds is treatment with intravenous antibiotics. However, antibiotics delivered intravenously may have poor tissue penetration and be dose limited by systemic side effects. Topical delivery of antibiotics reduces systemic complications and delivers increased drug concentrations directly to the wound. Porcine full-thickness wounds infected with Staphylococcus aureus were treated with ultrahigh concentrations (over 1000 times the minimum inhibitory concentration) of gentamicin using an incubator-like wound healing platform. The aim of the present study was to evaluate clearance of infection and reduction in inflammation following treatment. Gentamicin cytotoxicity was evaluated by in vitro assays. Application of 2000 μg/ml gentamicin decreased bacterial counts in wound tissue from 7.2 ± 0.3 log colony-forming units/g to 2.6 ± 0.6 log colony-forming units/g in 6 hours, with no reduction observed in saline controls (p < 0.005). Bacterial counts in wound fluid decreased from 5.7 ± 0.9 log colony-forming units/ml to 0.0 ± 0 log colony-forming units/ml in 1 hour, with no reduction observed in saline controls (p < 0.005). Levels of interleukin-1β were significantly reduced in gentamicin-treated wounds compared with saline controls (p < 0.005). In vitro, keratinocyte migration and proliferation were reduced at gentamicin concentrations between 100 and 1000 μg/ml. Topical delivery of ultrahigh concentrations of gentamicin rapidly decontaminates acutely infected wounds and maintains safe systemic levels. Treatment of infected wounds using the proposed methodology protects the wound and establishes a favorable baseline for subsequent treatment.
    Plastic &amp Reconstructive Surgery 01/2015; 135(1):151-9. DOI:10.1097/PRS.0000000000000801 · 3.33 Impact Factor
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    ABSTRACT: CONCLUSION Based on this data, 3D printing is now a mandatory step in surgical planning for face transplantation and it is very likely to be implemented in the other VCA and complex surgeries in the near future. Background The role of 3D printing in surgical planning has been assessed in some studies; however, to date there is only sparse data to assess clinical impact. Vascular CTA is performed for surgical planning before face transplantation, a large scale Vascularized Composite Allotransplantation (VCA). The purpose of this study is to assess the clinical impact of 3D printing in face transplantation. Evaluation This study was approved by the institutional human research committee. Four face transplantation patients from a single, large, urban teaching hospital prospectively underwent pre-procedure 320 x 0.5 mm detector row CT (Aquilion One , CITY, Japan) with 3D visualization (Vitrea, Vital Images, Minnetonka, MN, USA). For 3D printing, DICOM images were segmented and processed using customized software (Mimics, Materialise, Leuven, Belgium) and the STL files were created. The models were printed subsequently ( SLA 7000 ,3D Systems, Rock Hill, SC) from the STL outputs. The clinical impact of the 3D models was assessed by consensus between one senior surgeon and one senior radiologist. Discussion 3D printed models provide superior pre-operative data for face transplantation surgical planning when compared to 2D visualization. Complex anatomy and bony defects from either injury, prior surgeries, or both was better appreciated with 3D models. It was felt that the total procedure time was reduced with the prospective use of 3D models.
    Radiological Society of North America (RSNA); 12/2014
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    ABSTRACT: BACKGROUND: Severe facial injuries can compromise the upper airway by reducing airway volume, obstructing or obliterating the nasal passage, and interfering with oral airflow. Besides the significant impact on quality of life, upper airway impairments can have life-threatening or life-altering consequences. The authors evaluated improvements in functional airway after face transplantation. METHODS: Between 2009 and 2011, four patients underwent face transplantation at the authors' institution, the Brigham and Women's Hospital. Patients were examined preoperatively and postoperatively and their records reviewed for upper airway infections and sleeping disorders. The nasal mucosa was biopsied after face transplantation and analyzed using scanning electron microscopy. Volumetric imaging software was used to evaluate computed tomographic scans of the upper airway and assess airway volume changes before and after transplantation. RESULTS: Before transplantation, two patients presented an exposed naked nasal cavity and two suffered from occlusion of the nasal passage. Two patients required tracheostomy tubes and one had a prosthetic nose. Sleeping disorders were seen in three patients, and chronic cough was diagnosed in one. After transplantation, there was no significant improvement in sleeping disorders. The incidence of sinusitis increased because of mechanical interference of the donor septum and disappeared after surgical correction. All patients were decannulated after transplantation and were capable of nose breathing. Scanning electron micrographs of the respiratory mucosa revealed viable tissue capable of mucin production. Airway volume significantly increased in all patients. CONCLUSIONS: Face transplantation successfully restored the upper airway in four patients. Unhindered nasal breathing, viable respiratory mucosa, and a significant increase in airway volume contributed to tracheostomy decannulation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
    Plastic &amp Reconstructive Surgery 12/2014; 134:946e-54e. DOI:10.1097/PRS.0000000000000752 · 3.33 Impact Factor
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    ABSTRACT: TEACHING POINTS Perforator flaps offer cosmetically superior results with significantly less morbidity than TRAM flaps. Choice of flap is dependent on patient anatomy and quality of vasculature. Pre-operative CTA effectively maps perforators, decreases operative time, and decreases morbidity/complications. Post-processing may also help to determine exact tissue volume to be harvested for more targeted reconstruction. TABLE OF CONTENTS/OUTLINE 1. Autologous breast reconstruction basics (patient selection, aim, timing of surgery, advantages over breast implants). 2. Overview and evolution of flap options with focus on deep inferior epigastric perforator (DIEP) and superior gluteal artery perforator (SGAP) flaps. 3. Overview of pre-operative imaging including Doppler ultrasound, CTA, and MRA. Brief review of literature demonstrating the advantages of CTA with regard to duration of surgery, length of hospitalization, and complication rates. 4. Importance of angiosomes in perforator flap surgery. Alteration of imaging protocols to better determine flap vascular supply and reduce likelihood of fat necrosis. 5. Future directions include 3D printing of perforator flaps for more customized pre-operative planning.
    Radiological Society of North America (2014 Annual meeting), Chicago, IL.; 12/2014
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    ABSTRACT: High energy tibial plafond (pilon) fractures are known to have a high rate of complication, particularly wound dehiscence and infection. Wound infection, requiring debridement of both soft tissue and bone can be especially challenging to reconstruct due to the combination of high load-bearing requirements within a thin soft tissue envelope.Method We present a case of a pilon fracture with a post-operative complication of wound dehiscence and infection necessitating bone debridement, ultimately resulting in chronic osteomyelitis. We used a medial femoral osteocutaneous free flap to provide vascularized structure to the defect. Included is a comprehensive literature review for the use of the MFC osteocutaneous free flaps in lower extremities.ResultsThis flap provided restoration of the medial column of the ankle. The use of vascularized bone resulted in rapid post-operative bony union. The vascularized bone flap was press fit into the defect ruling out the potential for further hardware related infections. We report follow up of over one year.Conclusion The MFC free osteocutaneous flap is a good option for small bone and soft tissue defects of lower extremities, especially in setting of chronic osteomyelitis. It can be custom fabricated and either fixated or press fit into a chronic pilon fracture cavity to obliterate dead space with vascularized bone.Level of Evidence: Level IV, Retrospective case study
    Injury 11/2014; 46(2). DOI:10.1016/j.injury.2014.11.008 · 2.46 Impact Factor
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    ABSTRACT: Occult submucous cleft palate is a congenital deformity characterized by deficient union of the muscles that normally cross the velum and aid in elevation of the soft palate. Despite this insufficient muscle coverage, occult submucous cleft palate by definition lacks clear external anatomic landmarks. This absence of anatomic signs makes diagnosis of occult submucous cleft less obvious, more dependent on ancillary tests, and potentially missed entirely. Current diagnostic methodologies are limited and often are unrevealing in the presurgical patient; however, a missed diagnosis of occult submucous cleft palate can result in velopharyngeal insufficiency and major functional impairment in patients after surgery on the oropharynx. By accurately and easily diagnosing occult submucous cleft palate, it is possible to defer or modify pharyngeal surgical intervention that may further impair velopharyngeal function in susceptible patients. In this report, we introduce transillumination of the soft palate using a transnasal or transoral flexible endoscope as an inexpensive and simple technique for identification of submucous cleft palate. The use of transillumination of an occult submucous cleft palate is illustrated in a patient case and is compared to other current diagnostic methodologies.
    Journal of Craniofacial Surgery 10/2014; 25(6). DOI:10.1097/SCS.0000000000001159 · 0.68 Impact Factor
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    ABSTRACT: Purpose Submucous cleft palate is a congenital deformity characterized by deficient union of the muscles that normally cross the velum and aid in elevation of the soft palate. Unlike overt submucous cleft palate, occult submucous cleft palate lacks clear external anatomic landmarks while still exhibiting insufficient median muscle interdigitation and abnormal function (Figure 1). This absence of anatomic markers makes the diagnosis of occult submucous cleft less obvious, more dependent on ancillary tests, and potentially missed entirely. Current diagnostic methodologies are limited and often are unrevealing in the pre-surgical patient, however a missed diagnosis of occult submucous cleft palate can result in velopharyngeal insufficiency (VPI) and major functional impairment in patients following surgery on the oropharynx. By accurately and easily diagnosing occult submucous cleft palate, it is possible to defer or modify pharyngeal surgical intervention that may further impair velopharyngeal function in susceptible patients. Methods and Materials In this report, we introduce transillumination of the soft palate as a simple diagnostic technique for submucous cleft palate identification, illustrate its facile use in the pre-operative patient work-up in comparison to other diagnostic methods, and describe its utility in a patient case. As part of a thorough assessment of patients undergoing oropharyngeal surgery, a flexible fiberoptic nasopharyngoscope is routinely used to examine the velum, oropharynx and hypopharynx. We propose that the same scope be used to improve diagnosis of occult submucous cleft palate through transillumination. Following introduction of the scope through the nose or mouth, the lighted distal end of the scope should be directed anteriorly as to provide a backlight for the soft palate (Figure 2). Conclusions Occult submucous cleft palate is a frequently missed diagnosis that is often not recognized until a patient develops symptoms of VPI, sometimes secondary to surgery on the oropharynx. As illustrated in our patient, the appearance of VPI symptoms following routine surgery can be debilitating for the patient and defeating for the surgeon in cases of missed occult submucous cleft. In patients undergoing oropharyngeal surgery, transillumination of the palate is an inexpensive, quick, and easily incorporated technique that can screen for undiagnosed occult submucous cleft palate and decrease the incidence of iatrogenic VPI post-operatively. Figures Figure 1: Abnormal muscular attachments of submucous cleft palate. Figure 2: Appearance of submucous cleft palate on transillumination.
    Plastic Surgery: The Meeting 2014; 10/2014
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    ABSTRACT: Humanitarian cleft surgery has long been provided by teams from resource-rich countries traveling for short-term missions to resource-poor countries. After identifying an area of durable unmet need through surgical missions, Operation Smile constructed a permanent center for cleft care in Northeast India. The Operation Smile Guwahati Comprehensive Cleft Care Center (GCCCC) uses a high-volume subspecialized institution to provide safe, quality, comprehensive, and cost-effective cleft care to a highly vulnerable patient population in Assam, India. The purpose of this study was to profile the expenses of several cleft missions carried out in Assam and to compare these to the expenditures of the permanent comprehensive cleft care center. We reviewed financial data from 4 Operation Smile missions in Assam between December 2009 and February 2011 and from the GCCCC for the 2012-2013 fiscal year. Expenses from the 2 models were categorized and compared. In the studied period, 33% of the mission expenses were spent locally compared to 94% of those of the center. The largest expenses in the mission model were air travel (48.8%) and hotel expenses (21.6%) for the team, whereas salaries (46.3%) and infrastructure costs (19.8%) made up the largest fractions of expenses in the center model. The evolution from mission-based care to a specialty hospital model in Guwahati incorporated a transition from vertical inputs to investments in infrastructure and human capital to create a sustainable local care delivery system.
    Journal of Craniofacial Surgery 08/2014; 25(5). DOI:10.1097/SCS.0000000000001133 · 0.68 Impact Factor
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    ABSTRACT: Reconstruction of the ascending portion of the mandible, including the angle, ramus, and condyle, can be a challenging surgical problem. Many treatment options are available, but no single procedure has been able to restore long-term form and function in every case. Currently, autologous nonvascularized bone grafts are the most common treatment, with the costochondral graft as the historic leader. Nonvascularized grafts can often restore vertical height and normal function but may face the challenge of long-term durability secondary to bone resorption. Emerging techniques in microvascular surgery may offer an alternative approach with the benefits of resistance to resorption and infection by maintaining a viable blood supply to the graft. Vascularized grafts may thus be used to full advantage in cases where prior surgery, scarring, disrupted vasculature, or radiation damage may compromise the long-term surgical success of a nonvascularized graft. This article reviews the literature and summarizes key points regarding nonvascularized and vascularized treatment modalities for reconstruction of the ascending mandible. In addition, we present the use of the femoral medial epicondyle free flap based on the descending genicular vascular pedicle as a novel reconstruction of the ascending portion of the mandible with minimal donor-site morbidity. Knowledge of all available options will aid the surgeon in achieving the optimal reconstruction for their patient and improve long-term outcomes.
    Journal of Craniofacial Surgery 08/2014; 25(5). DOI:10.1097/SCS.0000000000001192 · 0.68 Impact Factor
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    ABSTRACT: Significance: Fibroblasts play a critical role in normal wound healing. Various extracellular matrix (ECM) components, including collagens, fibrin, fibronectin, proteoglycans, glycosaminoglycans, and matricellular proteins, can be considered potent protagonists of fibroblast survival, migration, and metabolism. Recent Advances: Advances in tissue culture, tissue engineering, and ex vivo models have made the examination and precise measurements of ECM components in wound healing possible. Likewise, the development of specific transgenic animal models has created the opportunity to characterize the role of various ECM molecules in healing wounds. In addition, the recent characterization of new ECM molecules, including matricellular proteins, dermatopontin, and FACIT collagens (Fibril-Associated Collagens with Interrupted Triple helices), further demonstrates our cursory knowledge of the ECM in coordinated wound healing. Critical Issues: The manipulation and augmentation of ECM components in the healing wound is emerging in patient care, as demonstrated by the use of acellular dermal matrices, tissue scaffolds, and wound dressings or topical products bearing ECM proteins such as collagen, hyaluronan (HA), or elastin. Once thought of as neutral structural proteins, these molecules are now known to directly influence many aspects of cellular wound healing. Future Directions: The role that ECM molecules, such as CCN2, osteopontin, and secreted protein, acidic and rich in cysteine, play in signaling homing of fibroblast progenitor cells to sites of injury invites future research as we continue investigating the heterotopic origin of certain populations of fibroblasts in a healing wound. Likewise, research into differently sized fragments of the same polymeric ECM molecule is warranted as we learn that fragments of molecules such as HA and tenascin-C can have opposing effects on dermal fibroblasts.
    08/2014; DOI:10.1089/wound.2014.0561
  • E J Caterson, Margarita S Ramos
    Journal of Craniofacial Surgery 08/2014; 25(5). DOI:10.1097/SCS.0000000000001211 · 0.68 Impact Factor
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    ABSTRACT: Objective: In the United States, around 50% of all musculoskeletal injuries are soft tissue injuries including ligaments and tendons. The objective of this study is to assess the role of amnion-derived cellular cytokine solution (ACCS) in carboxy-methyl cellulose (CMC) gel in the healing of Achilles tendon in a rat model, and to examine its effects on mechanical properties and collagen content. Methods: Achilles tendons of Sprague-Dawley rats were exposed and transected. The distal and proximal ends were injected with either saline or ACCS in CMC, in a standardized fashion, and then sutured using a Kessler technique. Tendons from both groups were collected at 1, 2, 4, 6, and 8 weeks postoperatively and assessed for material properties. Collagen studies were performed, including collagen content, collagen cross-linking, tendon hydration, and immunohistochemistry. Tendons were also evaluated histologically for cross-sectional area. Results: Mechanical testing demonstrated that treatment with ACCS in CMC significantly enhances breaking strength, ultimate tensile strength, yield strength, and Young's modulus in the tendon repair at early time points. In context, collagen content, as well as collagen cross-linking, was also significantly affected by the treatment. Conclusion: The application of ACCS in CMC has a positive effect on healing tendons by improving mechanical properties at early time points. Previous studies on onetime application of ACCS (not in CMC) did not show significant improvement on tendon healing at any time point. Therefore, the delivery in a slow release media like CMC seems to be essential for the effects of ACCS demonstrated in this study.
    Eplasty 08/2014; 14:e29.
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    ABSTRACT: Cell migration requires spatiotemporal integration of signals that regulate cytoskeletal dynamics. In response to a migration-promoting agent, cells begin to polarise and extend protrusions in the direction of migration. These cytoskeletal rearrangements are orchestrated by a variety of proteins, including focal adhesion kinase (FAK) and the Rho family of GTPases. CCN2, also known as connective tissue growth factor, has emerged as a regulator of cell migration but the mechanism by which CCN2 regulates keratinocyte function is not well understood. In this article, we sought to elucidate the basic mechanism of CCN2-induced cell migration in human keratinocytes. Immunohistochemical staining was used to demonstrate that treatment with CCN2 induces a migratory phenotype through actin disassembly, spreading of lamellipodia and re-orientation of the Golgi. In vitro assays were used to show that CCN2-induced cell migration is dependent on FAK, RhoA and Cdc42, but independent of Rac1. CCN2-treated keratinocytes displayed increased Cdc42 activity and decreased RhoA activity up to 12 hours post-treatment, with upregulation of p190RhoGAP. An improved understanding of how CCN2 regulates cell migration may establish the foundation for future therapeutics in fibrotic and neoplastic diseases.
    International Wound Journal 08/2014; DOI:10.1111/iwj.12315 · 2.02 Impact Factor
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    ABSTRACT: Skeletal muscle injury is common in everyday physical activity and athletics, as well as in orthopedic trauma and disease. The overall functional disability resulting from muscle injury is directly related to the intrinsic healing properties of muscle and extrinsic treatment options designed to maximize repair and/or regeneration of muscle tissue all while minimizing pathologic healing pathways. It is important to understand the injury and repair pathways in order to improve the speed and quality of recovery. Recent military conflicts in Iraq and Afghanistan have highlighted the importance of successfully addressing muscular injury and showed the need for novel treatment options that will maximize functional regeneration of the damaged tissue. These severe, wartime injuries, when juxtaposed to peacetime, sports-related injuries, provide us with interesting case examples of the two extreme forms of muscular damage. Comparing and contrasting the differences in these healing pathways will likely provide helpful cues that will help physicians recapitulate the near complete repair and regeneration in less traumatic injuries in addition to more severe cases.
    Wound Repair and Regeneration 05/2014; 22(S1). DOI:10.1111/wrr.12163 · 2.77 Impact Factor

Publication Stats

2k Citations
198.57 Total Impact Points

Institutions

  • 2011–2015
    • Harvard University
      Cambridge, Massachusetts, United States
  • 2013–2014
    • Brigham and Women's Hospital
      Boston, Massachusetts, United States
  • 2007–2014
    • Harvard Medical School
      • Department of Surgery
      Boston, Massachusetts, United States
  • 2012–2013
    • NYU Langone Medical Center
      New York, New York, United States
  • 2002
    • Thomas Jefferson University
      • Department of Orthopaedic Surgery
      Philadelphia, PA, United States
    • National Institute of Arthritis and Musculoskeletal and Skin Diseases
      베서스다, Maryland, United States
  • 2001
    • Thomas Jefferson University Hospitals
      Philadelphia, Pennsylvania, United States