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Closed-Loop Stimulation Of Temporal Cortex Rescues Functional Networks And Improves Memory., Youssef Ezzyat, Paul A. Wanda, Deborah F. Levy, Allison Kadel, Ada Aka, Isaac Pedisich, Michael R. Sperling, Ashwini Sharan, Bradley C. Lega, Alexis Burks, Robert E. Gross, Cory S. Inman, Barbara C. Jobst, Mark A. Gorenstein, Kathryn A. Davis, Gregory A. Worrell, Michal T. Kucewicz, Joel M. Stein, Richard Gorniak, Sandhitsu R. Das, Daniel S. Rizzuto, Michael J. Kahana 2018 University of Pennsylvania

Closed-Loop Stimulation Of Temporal Cortex Rescues Functional Networks And Improves Memory., Youssef Ezzyat, Paul A. Wanda, Deborah F. Levy, Allison Kadel, Ada Aka, Isaac Pedisich, Michael R. Sperling, Ashwini Sharan, Bradley C. Lega, Alexis Burks, Robert E. Gross, Cory S. Inman, Barbara C. Jobst, Mark A. Gorenstein, Kathryn A. Davis, Gregory A. Worrell, Michal T. Kucewicz, Joel M. Stein, Richard Gorniak, Sandhitsu R. Das, Daniel S. Rizzuto, Michael J. Kahana

Department of Neurology Faculty Papers

Memory failures are frustrating and often the result of ineffective encoding. One approach to improving memory outcomes is through direct modulation of brain activity with electrical stimulation. Previous efforts, however, have reported inconsistent effects when using open-loop stimulation and often target the hippocampus and medial temporal lobes. Here we use a closed-loop system to monitor and decode neural activity from direct brain recordings in humans. We apply targeted stimulation to lateral temporal cortex and report that this stimulation rescues periods of poor memory encoding. This system also improves later recall, revealing that the lateral temporal cortex is a reliable target ...


Improving Outcomes Of Emergency Bowel Surgery Using Nela Model, Rizwan Sultan, Hasnain Zafar 2018 Aga Khan University

Improving Outcomes Of Emergency Bowel Surgery Using Nela Model, Rizwan Sultan, Hasnain Zafar

Section of General Surgery

Abstract

OBJECTIVE:

To find outcomes of emergency bowel surgery and review the processes involved in the care of these patients on the same template used in National Emergency Laparotomy Audit (NELA).

STUDY DESIGN:

An audit.

PLACE AND DURATION OF STUDY:

Surgery Department, The Aga Khan University Hospital, Karachi, from December 2013 to November 2014.

METHODOLOGY:

Patients undergone emergency bowel surgery during the review period were included. Demographic data, type of admission, ASA grade, urgency of surgery, P-POSSUM score, indication of surgery, length of stay and outcome was recorded. Data was then compared with the data published by NELA team in ...


Department Of Surgery Update, January 2018, Wright State University Department of Surgery 2018 Wright State University

Department Of Surgery Update, January 2018, Wright State University Department Of Surgery

Department of Surgery Updates

A three page newsletter created by the Department of Surgery documenting changes to the department. This issue contains a message from the chair, a list of important dates, committee meetings, and more.


A Case Review Of A Morel Lavellee Lesion With Delayed Presentation, Ammar Qureshi, Pradeep Monoot 2018 Marshall University

A Case Review Of A Morel Lavellee Lesion With Delayed Presentation, Ammar Qureshi, Pradeep Monoot

Marshall Journal of Medicine

A Morel Lavellee lesion is a relatively rare post traumatic condition which is missed at the time of early presentation. It involves a closed internal degloving injury where the subcutaneous tissue is torn away from the underlying fascia and thus creating a cavity containing hematoma and necrotic fat. It occurs most commonly over the greater trochanter. The lesion can be treated conservatively and surgically. Here we report an unusually delayed presentation of a Morel Lavellee lesion that was treated by incisions, drainage and primary closure.


Development Of An Objective Assessment Tool For Total Laparoscopic Hysterectomy: A Delphi Method Among Experts And Evaluation On A Virtual Reality Simulator., Sophie Knight, Rajesh Aggarwal, MD, PhD, FRCS, FACS, Aubert Agostini, Anderson Loundou, Stéphane Berdah, Patrice Crochet 2018 Aix Marseille Université

Development Of An Objective Assessment Tool For Total Laparoscopic Hysterectomy: A Delphi Method Among Experts And Evaluation On A Virtual Reality Simulator., Sophie Knight, Rajesh Aggarwal, Md, Phd, Frcs, Facs, Aubert Agostini, Anderson Loundou, Stéphane Berdah, Patrice Crochet

Department of Surgery Faculty Papers

INTRODUCTION: Total Laparoscopic hysterectomy (LH) requires an advanced level of operative skills and training. The aim of this study was to develop an objective scale specific for the assessment of technical skills for LH (H-OSATS) and to demonstrate feasibility of use and validity in a virtual reality setting.

MATERIAL AND METHODS: The scale was developed using a hierarchical task analysis and a panel of international experts. A Delphi method obtained consensus among experts on relevant steps that should be included into the H-OSATS scale for assessment of operative performances. Feasibility of use and validity of the scale were evaluated by ...


Role Of Multi-Parametric (Mp) Mri In Prostate Cancer, Syed Muhammad Nazim, Hammad Ather, Basit Salam 2018 Aga Khan University

Role Of Multi-Parametric (Mp) Mri In Prostate Cancer, Syed Muhammad Nazim, Hammad Ather, Basit Salam

Section of Neurosurgery

Abstract

Multi-parametric magnetic resonance imaging is increasingly being recommended as standard imaging modality for prostate cancer diagnosis and staging. It comprises structural T2 and T1 sequences supplemented by functional imaging techniques, i.e. diffusion-weighted, dynamic contrast enhanced and spectroscopic imaging. Pre-biopsy multi-parametric magnetic resonance imaging is recommended for both detection and staging as it avoids biopsy artefact, and when normal, has a negative predictive value of 95% for significant cancer. Magnetic resonance imaging-guided prostate biopsy targets only area(s) considered to be suspicious for prostate cancer, hence resulting in improved accuracy. Dynamic contrast enhancing helps in the detection of cancer ...


Vital Signs, Winter 2018, Boonshoft School of Medicine 2018 Wright State University

Vital Signs, Winter 2018, Boonshoft School Of Medicine

Vital Signs

A thirty-six page newsletter created by the Boonshoft School of Medicine to document the current affairs of the school. This issue includes a variety of feature articles, alumni profiles, class notes, and more.


Spatial Distribution Of Road Traffic Crash Fatalities In Karachi: Perspective From 2008-2012, Rashid Jooma, Mir Shabbar Ali, Masood Ali Shaikh 2018 Aga Khan University

Spatial Distribution Of Road Traffic Crash Fatalities In Karachi: Perspective From 2008-2012, Rashid Jooma, Mir Shabbar Ali, Masood Ali Shaikh

Section of Neurosurgery

Abstract

Road Traffic Crash (RTC) mortality and morbidity is one of the major public health problems in Karachi. In this study we used geographic information systems (GIS) to visualize and quantify the spatial distribution of RTC mortality and yearly trend from 2008 to 2012, for all 24 administrative subdivisions of Karachi, using Road Traffic Injury Research and Prevention Center's (RTIRPC) data. Cumulatively, 6040 deaths were recorded by RTIRPC, out of which we were able to map 4657 (77.1%) deaths based on location information available in the database. During the 5-year period, highest number of cumulative RTC fatalities were ...


Outcomes Of Cataract Surgery At Teaching Hospital In Karachi, Shaukat Ali Chhipa, Mustafa Kamal Junejo 2018 Aga Khan University

Outcomes Of Cataract Surgery At Teaching Hospital In Karachi, Shaukat Ali Chhipa, Mustafa Kamal Junejo

Section of Ophthalmology

Abstract

OBJECTIVE:

To assess outcomes of cataract surgery at a tertiary care hospital in Karachi.

METHODS:

This retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised data of patients who underwent cataract surgery from January 2011 to December 2015. The data was collected using guidelines based on World Health Organisation systems for quality monitoring. Postoperative follow-up was done at 1 day, 1 week, 4 weeks and after 12 weeks. Visual acuity was recorded as good (6/6-6/18), borderline (6/18-6/60) and poor (<6/60). Intraoperative and postoperative complications were also noted.

RESULTS:

Of the 570 patient charts reviewed, 527(92.45%) were included in ...


Situational Awareness Within Objective Structured Clinical Examination Stations In Undergraduate Medical Training - A Literature Search., Markus A. Fischer, Kieran M. Kennedy, Steven Durning, Marlies P. Schijven, Jean Ker, Paul O'Connor, Eva M. Doherty, Thomas JB Kropmans 2017 National University Ireland Galway

Situational Awareness Within Objective Structured Clinical Examination Stations In Undergraduate Medical Training - A Literature Search., Markus A. Fischer, Kieran M. Kennedy, Steven Durning, Marlies P. Schijven, Jean Ker, Paul O'Connor, Eva M. Doherty, Thomas Jb Kropmans

Surgery (The Colles Institute) Articles

BACKGROUND: Medical students may not be able to identify the essential elements of situational awareness (SA) necessary for clinical reasoning. Recent studies suggest that students have little insight into cognitive processing and SA in clinical scenarios. Objective Structured Clinical Examinations (OSCEs) could be used to assess certain elements of situational awareness. The purpose of this paper is to review the literature with a view to identifying whether levels of SA based on Endsley's model can be assessed utilising OSCEs during undergraduate medical training.

METHODS: A systematic search was performed pertaining to SA and OSCEs, to identify studies published between ...


Ependymomas Overexpress Chemoresistance And Dna Repairrelated Proteins, Sherise D. Ferguson, Shouhao Zhou, Joanne Xiu, Yuuri Hashimoto, Nader Sanai, Lyndon Kim, Santosh Kesari, John de Groot, David Spetzler, Amy B. Heimberger 2017 The University of Texas MD Anderson Cancer Center

Ependymomas Overexpress Chemoresistance And Dna Repairrelated Proteins, Sherise D. Ferguson, Shouhao Zhou, Joanne Xiu, Yuuri Hashimoto, Nader Sanai, Lyndon Kim, Santosh Kesari, John De Groot, David Spetzler, Amy B. Heimberger

Department of Neurosurgery Faculty Papers

Background: After surgery and radiation, treatment options for ependymoma are few making recurrence a challenging issue. Specifically, the efficacy of chemotherapy at recurrence is limited. We performed molecular profiling on a cohort of ependymoma cases in order to uncover therapeutic targets and to elucidate the molecular mechanisms contributing to treatment resistance. Results: This ependymoma cohort showed minimal alterations in gene amplifications and mutations but had high expression rates of DNA synthesis and repair enzymes such as RRM1 (47%), ERCC1 (48%), TOPO1 (62%) and class III β-tublin (TUBB3) (57%), which are also all associated with chemoresistance. This cohort also had high ...


Telesurgery: Surgery In The Digital Age, Dylan J. Cahill 2017 Dartmouth

Telesurgery: Surgery In The Digital Age, Dylan J. Cahill

Dartmouth Undergraduate Journal of Science

The dawn of the digital age has transformed the way we now receive and provide healthcare. Today, providers have instant access to all of their patients’ information, just as patients can connect with their providers on their smartphones in minutes from nearly anywhere in the world.


Silent Sentence Completion Shows Superiority Localizing Wernicke's Area And Activation Patterns Of Distinct Language Paradigms Correlate With Genomics: Prospective Study., Kamel El Salek, Islam S. Hassan, Aikaterini Kotrotsou, Srishti Abrol, Scott H. Faro, Feroze B. Mohamed, Pascal O. Zinn, Wei Wei, Nan Li, Ashok J. Kumar, Jeffrey S. Weinberg, Jeffrey S. Wefel, Shelli R. Kesler, Ho-Ling Anthony Liu, Ping Hou, R. Jason Stafford, Sujit Prabhu, Raymond Sawaya, Rivka R. Colen 2017 University of Texas MD Anderson Cancer Center

Silent Sentence Completion Shows Superiority Localizing Wernicke's Area And Activation Patterns Of Distinct Language Paradigms Correlate With Genomics: Prospective Study., Kamel El Salek, Islam S. Hassan, Aikaterini Kotrotsou, Srishti Abrol, Scott H. Faro, Feroze B. Mohamed, Pascal O. Zinn, Wei Wei, Nan Li, Ashok J. Kumar, Jeffrey S. Weinberg, Jeffrey S. Wefel, Shelli R. Kesler, Ho-Ling Anthony Liu, Ping Hou, R. Jason Stafford, Sujit Prabhu, Raymond Sawaya, Rivka R. Colen

Department of Radiology Faculty Papers

Preoperative mapping of language areas using fMRI greatly depends on the paradigms used, as different tasks harness distinct capabilities to activate speech processing areas. In this study, we compared the ability of 3 covert speech paradigms: Silent Sentence Completion (SSC), category naming (CAT) and verbal fluency (FAS), in localizing the Wernicke's area and studied the association between genomic markers and functional activation. Fifteen right-handed healthy volunteers and 35 mixed-handed patients were included. We focused on the anatomical areas of posterosuperior, middle temporal and angular gyri corresponding to Wernicke's area. Activity was deemed significant in a region of interest ...


Widespread Theta Synchrony And High-Frequency Desynchronization Underlies Enhanced Cognition., E. A. Solomon, J. E. Kragel, Michael R. Sperling, Ashwini Sharan, G. Worrell, M. Kucewicz, C. S. Inman, B. Lega, K. A. Davis, J. M. Stein, B. C. Jobst, K. A. Zaghloul, S. A. Sheth, D. S. Rizzuto, M. J. Kahana 2017 University of Pennsylvania

Widespread Theta Synchrony And High-Frequency Desynchronization Underlies Enhanced Cognition., E. A. Solomon, J. E. Kragel, Michael R. Sperling, Ashwini Sharan, G. Worrell, M. Kucewicz, C. S. Inman, B. Lega, K. A. Davis, J. M. Stein, B. C. Jobst, K. A. Zaghloul, S. A. Sheth, D. S. Rizzuto, M. J. Kahana

Department of Neurology Faculty Papers

The idea that synchronous neural activity underlies cognition has driven an extensive body of research in human and animal neuroscience. Yet, insufficient data on intracranial electrical connectivity has precluded a direct test of this hypothesis in a whole-brain setting. Through the lens of memory encoding and retrieval processes, we construct whole-brain connectivity maps of fast gamma (30-100 Hz) and slow theta (3-8 Hz) spectral neural activity, based on data from 294 neurosurgical patients fitted with indwelling electrodes. Here we report that gamma networks desynchronize and theta networks synchronize during encoding and retrieval. Furthermore, for nearly all brain regions we studied ...


A Case Report Of Successful Management Of Clostridium Difficile Colitis With Antegrade Fidaxomicin Through A Mucous Fistula Obviating The Need For Subtotal Colectomy., Suzanne Arnott, Matthew Skancke, Sheena Chen, Bruce Abell 2017 George Washington University

A Case Report Of Successful Management Of Clostridium Difficile Colitis With Antegrade Fidaxomicin Through A Mucous Fistula Obviating The Need For Subtotal Colectomy., Suzanne Arnott, Matthew Skancke, Sheena Chen, Bruce Abell

Surgery Faculty Publications

Introduction

Clostridium difficile is the most common cause of healthcare-associated infections and can have devastating morbidity and mortality. Traditional treatment algorithms involve intravenous metronidazole and enteric metronidazole or vancomycin. Fidaxomicin (DificidR) targets “switch regions” within RNA polymerases and effectively kills clostridium difficile bacteria and is typically administered orally primarily or through a naso/oro-gastric conduit.

Presentation of case

55-year-old with a recent elective surgical procedure was hospitalized with multifocal pneumonia and subsequently developed clostridium difficile colitis. This patient failed the standard medical therapy for clostridium difficile colitis, decompensated and required surgical exploration, partial colectomy and mucous fistula creation. Following her ...


Transcriptional Alterations In Hereditary And Sporadic Nonfunctioning Pancreatic Neuroendocrine Tumors According To Genotype., Xavier M Keutgen, Suresh Kumar, Sudheer Gara, Myriem Boufraqech, Sunita Agarwal, Ralph H Hruban, Naris Nilubol, Martha Quezado, Richard Finney, Maggie Cam, Electron Kebebew 2017 George Washington University

Transcriptional Alterations In Hereditary And Sporadic Nonfunctioning Pancreatic Neuroendocrine Tumors According To Genotype., Xavier M Keutgen, Suresh Kumar, Sudheer Gara, Myriem Boufraqech, Sunita Agarwal, Ralph H Hruban, Naris Nilubol, Martha Quezado, Richard Finney, Maggie Cam, Electron Kebebew

Surgery Faculty Publications

BACKGROUND

Nonfunctioning pancreatic neuroendocrine tumors (NFPanNETs) may be sporadic or inherited because of germline mutations associated with von Hippel-Lindau disease (VHL) or multiple endocrine neoplasia type 1 (MEN1). The clinical behavior of NFPanNETs is difficult to predict, even in tumors of the same stage and grade. The authors analyzed genotype-specific patterns of transcriptional messenger RNA (mRNA) levels of NFPanNETs to understand the molecular features that determine PanNET phenotype.

METHODS

Thirty-two samples were included for genome-wide mRNA gene expression analysis (9 VHL-associated, 10 MEN1-associated, and 9 sporadic NFPanNETs and 4 purified normal islet cell [NIC] samples). Validation of genes was performed ...


Genetic And Genomic Characterization Of 462 Melanoma Patient-Derived Xenografts, Tumor Biopsies, And Cell Lines., Bradley Garman, Ioannis N. Anastopoulos, Clemens Krepler, Patricia Brafford, Katrin Sproesser, Yuchao Jiang, Bradley Wubbenhorst, Ravi Amaravadi, Joseph Bennett, Marilda Beqiri, David Elder, Keith T. Flaherty, Dennie T. Frederick, Tara C. Gangadhar, Michael Guarino, David Hoon, Giorgos Karakousis, Qin Liu, Nandita Mitra, Nicholas J. Petrelli, Lynn Schuchter, Batool Shannan, Carol L. Shields, Jennifer Wargo, Brandon Wenz, Melissa A. Wilson, Min Xiao, Wei Xu, Xaiowei Xu, Xiangfan Yin, Nancy R. Zhang, Michael A. Davies, Meenhard Herlyn, Katherine L. Nathanson 2017 University of Pennsylvania

Genetic And Genomic Characterization Of 462 Melanoma Patient-Derived Xenografts, Tumor Biopsies, And Cell Lines., Bradley Garman, Ioannis N. Anastopoulos, Clemens Krepler, Patricia Brafford, Katrin Sproesser, Yuchao Jiang, Bradley Wubbenhorst, Ravi Amaravadi, Joseph Bennett, Marilda Beqiri, David Elder, Keith T. Flaherty, Dennie T. Frederick, Tara C. Gangadhar, Michael Guarino, David Hoon, Giorgos Karakousis, Qin Liu, Nandita Mitra, Nicholas J. Petrelli, Lynn Schuchter, Batool Shannan, Carol L. Shields, Jennifer Wargo, Brandon Wenz, Melissa A. Wilson, Min Xiao, Wei Xu, Xaiowei Xu, Xiangfan Yin, Nancy R. Zhang, Michael A. Davies, Meenhard Herlyn, Katherine L. Nathanson

Wills Eye Institute Papers

Tumor-sequencing studies have revealed the widespread genetic diversity of melanoma. Sequencing of 108 genes previously implicated in melanomagenesis was performed on 462 patient-derived xenografts (PDXs), cell lines, and tumors to identify mutational and copy number aberrations. Samples came from 371 unique individuals: 263 were naive to treatment, and 108 were previously treated with targeted therapy (34), immunotherapy (54), or both (20). Models of all previously reported major melanoma subtypes (BRAF, NRAS, NF1, KIT, and WT/WT/WT) were identified. Multiple minor melanoma subtypes were also recapitulated, including melanomas with multiple activating mutations in the MAPK-signaling pathway and chromatin-remodeling gene mutations ...


Diverticulitis Resulting In Brain Abscess: A Case Report (Poster)., Sean J. Wallace MD, David Deisher DO, Thomas Daniel Harrison DO 2017 Lehigh Valley Hospital

Diverticulitis Resulting In Brain Abscess: A Case Report (Poster)., Sean J. Wallace Md, David Deisher Do, Thomas Daniel Harrison Do

Department of Surgery

No abstract provided.


Extra-Pleural Dermal Solitary Fibrous Tumor On The Posterior Shoulder: A Case Report., Sean J. Wallace MD, Robert Teixeira MD, Nathan F. Miller, Hina A. Sheikh, Genevieve Guzman, Rohit Sharma MD 2017 Lehigh Valley Hospital

Extra-Pleural Dermal Solitary Fibrous Tumor On The Posterior Shoulder: A Case Report., Sean J. Wallace Md, Robert Teixeira Md, Nathan F. Miller, Hina A. Sheikh, Genevieve Guzman, Rohit Sharma Md

Department of Surgery

No abstract provided.


Differential Impact Of Serial Measurement Of Nonplatelet Thromboxane Generation On Long-Term Outcome After Cardiac Surgery, Nikolaos Kakouros, Tyler J. Gluckman, John V. Conte, Thomas S. Kickler, Katherine Laws, Bruce A. Barton, Jeffrey J. Rade 2017 University of Massachusetts Medical School

Differential Impact Of Serial Measurement Of Nonplatelet Thromboxane Generation On Long-Term Outcome After Cardiac Surgery, Nikolaos Kakouros, Tyler J. Gluckman, John V. Conte, Thomas S. Kickler, Katherine Laws, Bruce A. Barton, Jeffrey J. Rade

University of Massachusetts Medical School Faculty Publications

BACKGROUND: Systemic thromboxane generation, not suppressible by standard aspirin therapy and likely arising from nonplatelet sources, increases the risk of atherothrombosis and death in patients with cardiovascular disease. In the RIGOR (Reduction in Graft Occlusion Rates) study, greater nonplatelet thromboxane generation occurred early compared with late after coronary artery bypass graft surgery, although only the latter correlated with graft failure. We hypothesize that a similar differential association exists between nonplatelet thromboxane generation and long-term clinical outcome.

METHODS AND RESULTS: Five-year outcome data were analyzed for 290 RIGOR subjects taking aspirin with suppressed platelet thromboxane generation. Multivariable modeling was performed to ...


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