Digital Commons Network^™

Bilateral Germ Cell Tumor Of The Testis: Biological And Clinical Implications For A Stem Versus Genetic Origin Of Cancers, Jamaal C Jackson, Darren Sanchez, Aron Y Joon, Marcos R Estecio, Andrew C Johns, Amishi Y Shah, Matthew Campbell, John F Ward, Louis L Pisters, Charles C Guo, Miao Zhang, Niki M Zacharias, Shi-Ming Tu

Faculty, Staff and Student Publications

Germ cell tumors of the testis (GCTs) provide an ideal tumor model to investigate the cellular versus genetic origin of cancers. In this single institutional study, we evaluated 38 patients with bilateral GCT, including tumors that occurred simultaneously (synchronous) and those occurring at different times (metachronous). For nine of these patients, DNA was isolated from the right and left GCT to determine the genomic and epigenetic differences between tissues using whole-exome sequencing (WES) and reduced representation bisulfite sequencing (RRBS). We found that seminomas and non-seminomas are molecularly distinct based on DNA methylation and not due to synchronous or metachronous disease. …

Cognitive Outcomes In Prostate Cancer Treatment: Insights From The Odenza Trial And Future Considerations, Bryan J Neth, Jeffrey S Wefel, Kevin T Nead

Faculty, Staff and Student Publications

No abstract provided.

Trends In Medicare Payments Within The First Year Of Cervical Cancer Diagnosis, 2010–2019, Mohammad A Karim, Ning Zhang, Hui Zhao, Ya-Chen Tina Shih, Lakshmi S M Kodali, Sharon H Giordano, Sanjay Shete

Faculty, Staff and Student Publications

Assessing Medicare payment trends for cervical cancer care is important to mitigate the financial impact on Medicare. This multiyear cross-sectional study included 65 years and older cervical cancer patients in SEER registries diagnosed between 2010 and 2019 who had continuous Part A and B Medicare coverage at least 6 months before diagnosis and at least within the first year of diagnosis and were not enrolled in any Health Maintenance Organization (HMO) in this duration. The main outcomes were trends in total and service-specific mean monthly Medicare payments within the first year of a cervical cancer diagnosis. This study included 2147 …

Network-Based Clustering Unveils Interconnected Landscapes Of Genomic And Clinical Features Across Myeloid Malignancies, Fritz Bayer, Marco Roncador, Giusi Moffa, Kiyomi Morita, Koichi Takahashi, Niko Beerenwinkel, Jack Kuipers

Faculty, Staff and Student Publications

Myeloid malignancies exhibit considerable heterogeneity with overlapping clinical and genetic features among subtypes. We present a data-driven approach that integrates mutational features and clinical covariates at diagnosis within networks of their probabilistic relationships, enabling the discovery of patient subgroups. A key strength is its ability to include presumed causal directions in the edges linking clinical and mutational features, and account for them aptly in the clustering. In a cohort of 1323 patients, we identify subgroups that outperform established risk classifications in prognostic accuracy. Our approach generalises well to unseen cohorts with classification based on our subgroups similarly offering advantages in …

Myth Of The Pentad: Approaching Thrombotic Thrombocytopenic Purpura, Nidhi Patel, Md, Meera Jain, Natasha Edwin, Md

Providence Pharmacy PGY2 Program at Providence Medical Group 2025

Introduction: •Thrombotic Thrombocytopenic Purpura (TTP) is a thrombotic microangiopathy that leads to microthrombi formation. •Immune thrombocytopenic purpura (ITP) is an acquired autoimmune disorder characterized by a low platelet count due to both increased platelet destruction and impaired platelet production. •Though both involving thrombocytopenia, prompt recognition of TTP is critical, as it has a high mortality rate if left untreated Case Presentation: •42-year-old female with rheumatoid arthritis (RA) who was started on tocilizumab three months prior to presentation •Platelet counts dropped to 30,000 (Figure 1). Her rheumatologist presumed that it was ITP and treated her with steroids •Presented to outside emergency …

Endocarditis Prophylaxis In Vulnerable Valve; Antibiotic Stewardship Or Suboptimal Care?, Zachary Taylor, Andrea Roast, Michael Layoun

Providence Portland Medical Center Internal Medicine 2025

Introduction Infective endocarditis (IE) is a relatively uncommon disease with an annual incidence of 5 per 100,000 people in the U.S.. Dental procedures are an exceptionally rare cause of IE. Amidst a global emphasis on antibiotic stewardship, U.S. and European guidelines only recommend antibiotic prophylaxis for dental procedures in high-risk groups. Having a bicuspid aortic valve (BAV) confers an 11-fold risk of endocarditis compared to the general public, and yet, is not classified as high-risk per AHA/IDSA guidelines. We present a patient with BAV who developed IE following a noninvasive dental procedure and review whether patients with BAV are under-classified …

Development Of A Reference Standard To Assign Bacterial Versus Viral Infection Etiology Using An All-Inclusive Methodology For Comparison Of Novel Diagnostic Tool Performance, Coburn Allen, J Kate Deanehan, Yaniv Dotan, Matthew A Eisenberg, Andrew M Fine, Jonathan Isenberg, Ann Kane, Dani Kirshner, Todd W Lyons, Yasmin Maor, Ami Neuberger, Daniel G Ostermayer, Sharona Paz, Oded Scheuerman, Shachaf Shiber, Victoria A Statler, Michal Stein, Renata Yakubov, Shirly Yanai, Roy Navon, Lior Kellerman, Tanya M Gottlieb, Eran Eden

Faculty, Staff and Student Publications

Background: Diagnostic test evaluation requires a reference standard. We describe an approach for creating a reference standard for acute infection using unrestricted adjudication and apply it to compare biomarker tools.

Methods: Adults and children with suspected acute infection enrolled in three prospective studies at emergency departments and urgent cares were included. Adjudicators, blinded to C-reactive protein, procalcitonin, and MeMed BV (MMBV), labeled each case (bacterial/viral/non-infectious/indeterminate). Initial adjudication involved 3 adjudicators. Reference standard cohorts were defined: Microbiologically confirmed (3/3 adjudicators concur with high confidence and a concordant microbiological finding), unanimous (3/3 adjudicators concur with high confidence), suspected (3/3 adjudicators concur with …

Clinicians’ Perspectives Concerning Treatment Initiation And Escalation Strategies For Digital Ulcers In Patients With Systemic Sclerosis, Giulia Campanaro, Giulia Bandini, Alessia Alunno, Stefano Di Donato, Begonya Alcacer-Pitarch, Ilaria Galetti, Barbara Ruaro, Silvia Bellando Randone, Alberto Moggi Pignone, Marco Matucci-Cerinic, Zsuzsanna H Mcmahan, Michael Hughes

Faculty, Staff and Student Publications

Objectives: Digital ulcers (DUs) are a major cause of pain and disability in systemic sclerosis (SSc) patients and remain a major treatment challenge. Our aim was to explore clinicians' perspectives towards treatment initiation and escalation, akin to a 'Treat to Target' (T2T) strategy.

Methods: SSc clinicians were invited to participate in an online survey.

Results: A total of 173 responses (75% rheumatologists) were obtained from 33 countries. When initiating a change in oral drug therapy for SSc-DUs, most (80%) respondents would consider adding new medication to existing treatment, and 50% would increase existing treatment dose. Time to assess the impact …

The Effects Of Prescribed Medications On Depressive Symptoms And Neurocognitive Performance In People With Hiv, Asante R Kamkwalala, Avery Matthews, Ankita Garg, Upal Roy, Qing Ma, Maile Karris, Erin Sundermann, Ronald J Ellis, Patricia K Riggs, Mattia Trunfio, Jennifer Blanchard, David J Moore, Leah H Rubin, Scott L Letendre

Faculty, Staff and Student Publications

Background: Alterations in brain function and structure, such as depression and neurocognitive impairment, continue to occur in people with human immunodeficiency virus (HIV, PWH) taking suppressive antiretroviral therapy (ART). The lifespan of PWH has improved but the healthspan remains worse than people without HIV, in part because of aging-related diseases. As a result, polypharmacy is common and increases the risk of drug-drug interactions and adverse reactions.

Methods: This cross-sectional project investigated the relationship between 7 medication-related metrics (including anticholinergic burden), depressive symptoms, and neurocognitive performance in 491 PWH at a single center in the United States. All participants were taking …

Nutrition Provision In Pediatric Extracorporeal Membrane Oxygenation: Evidence, Challenges, And Clinical Considerations, Marwa Mansour, Nicole Knebusch, Andrea Ontaneda, Stephanie Vazquez, Jennifer Daughtry, Katri Typpo, Jorge A Coss-Bu

Faculty, Staff and Students Publications

Background/objectives: Nutritional support is a critical yet challenging aspect of care for pediatric patients requiring extracorporeal membrane oxygenation (ECMO). Malnutrition is prevalent in this population and is associated with worse clinical outcomes. This review synthesizes current evidence on nutritional strategies for pediatric ECMO patients, emphasizing assessment methods, feeding routes, challenges, and clinical outcomes.

Methods: A literature review was conducted using PubMed, Scopus, and Web of Science to identify relevant studies published between January 2010 and 2025. Keywords included "pediatric ECMO", "nutrition", "enteral feeding", and "parenteral nutrition". Studies addressing nutritional assessment, enteral and parenteral feeding practices, and their impact on clinical …

Assessing The Efficacy Of Tranexamic Acid In Adjunct To Oxytocin In Reducing Blood Loss During Cesarean Deliveries: A Scoping Review, Hilary Clair Ray Bsn, Rn, Shelbie Freeman Hendrix Bsn, Rn, Lauren Elizabeth Hubbard Bsn, Rn, Helen Maisen Conley Bsn, Rn, Dwayne Accardo Dnp, Ccrn, Faana

Doctor of Nursing Practice Projects

Purpose/Background

Globally, postpartum hemorrhage (PPH) is the leading cause of morbidity and mortality during the peripartum and postpartum period in delivering people. Emerging evidence suggests that combining second-line uterotonics with tranexamic acid (TXA) improves maternal outcomes, reduces blood loss, and lowers morbidity and mortality related to PPH (Jones et al., 2023; Al-dardery et al., 2023). TXA, an antifibrinolytic, enhances clotting, reduces blood loss, transfusion needs, hemoglobin drop, and the use of additional uterotonics (Bellos & Pergialiotis, 2021). This review highlights the benefits of TXA.

Methods

A scoping review required a literature search conducted from August 2023 to February 2024 using …

Comparing The Effectiveness Of Digital 3d Pdf Vs. 3d-Printed Heart Models As Learning Aids For Echocardiography In Medical Students, Kunaal S. Sarnaik, Vishnu Ramasamy, Kelli Qua, Robert A. Jones, Susanne Wish-Baratz

Student Scholarship

Background: Reconciling echocardiographic images with heart anatomy in sonographic cross-sections is challenging. We compared use of 3D-printed heart models to 3D Portable Document Format (PDFs) heart models as learning aids in understanding echocardiography. Methods: 3D heart models were printed in five echocardiographic cross-sections: parasternal long axis, parasternal base short axis, parasternal ventricular short axis, apical four-chamber, and bicaval. Models were also reproduced as 3D PDFs on handheld tablets. Medical students were assigned to use 3D PDFs (control) or 3D-printed models (experimental) while performing transthoracic echocardiograms on standardized patients. Students were given immediate (after one session) and delayed (after four sessions …

Evaluation Of Depression Screening Tools For Utilization In Adolescents: A Scoping Review, Helen Whitaker Bsn, Rn, Jade Bray Bsn, Rn, Tracy Mcclinton Dnp, Aprn, Agacnp-Bc, Hget-C, Ebp-C, Jacqueline Sharp Dnp, Aprn, Pmhp-Bc, Sharon Little Dnp, Fnp-Bc

Doctor of Nursing Practice Projects

Purpose/Background

Anxiety and depression are prevalent mood disorders among the adolescent population with significant impacts on academic performance, social interactions, and mental well-being. With depression rates continuing to rise and suicide among the leading causes of death in adolescents, there is an urgent need for effective screening and intervention. While depression screening is recommended in the primary care setting, many adolescents do not have regular access to healthcare, complicating early identification and treatment. The purpose of this scoping review is to compare the effectiveness of two depression screening tools, the Patient Health Questionnaire (PHQ-9) and the Beck Depression Inventory (BDI), …

Utility And Safety Of Romiplostim As An Alternative To Platelet Transfusion For Neonates, Rachel N. Zeno, Sara Awad, Harry Lesmana

Student Scholarship

Thrombocytopenia is a common challenge in the neonatal intensive care unit, traditionally managed with platelet transfusions. However, transfusions are associated with significant risks, including increased mortality and neurodevelopmental impairment. This case series highlights the use of romiplostim, a thrombopoietin receptor agonist, in three neonates with thrombocytopenia. Each case demonstrated notable improvements in platelet counts without adverse events, reducing dependency on transfusions. These findings underscore romiplostim's potential as a safer alternative for managing neonatal thrombocytopenia. This report advocates for further research to explore romiplostim's efficacy and safety in this vulnerable population, emphasizing its promise in improving neonatal outcomes.

Optimizing The Well-Being Of Residents Diagnosed With Dementia: An Activities Calendar And Guide For Cognitive And Physical Engagement, Kaylex L. Monteagudo Parra

Undergraduate Theses

This thesis explores the critical role of structured activities in enhancing the cognitive, emotional, and physical well-being of individuals with dementia. Drawing on evidence-based research and practical experience as an Activities Assistant, it emphasizes how engaging, person-centered activities can mitigate symptoms, improve quality of life, and promote social interaction across the stages of disease progression. The research culminates in the development of an ideal activities calendar tailored to patients with dementia, accompanied by a comprehensive guide detailing activity benefits, implementation strategies, and required resources. This framework addresses the unique challenges of dementia care, offering practical tools for caregivers to adapt …

Effect Of A Digital Health Exercise Program On The Intention For Spinal Surgery In Adult Spinal Deformity: Exploratory Cross-Sectional Survey, Marsalis Christian Brown, Christopher Quincy Lin, Christopher Jin, Matthew Rohde, Brett Rocos, Jonathan Belding, Barrett I. Woods, Stacey J. Ackerman

Rothman Institute Papers

BACKGROUND: Adult spinal deformity (ASD) is a prevalent condition estimated at 38%. Symptomatic ASD is associated with substantial health care costs. The role of nonoperative interventions in the management of ASD remains elusive. The National Scoliosis Clinic's (NSC) scoliosis realignment therapy (SRT) is a personalized digital health exercise program for the nonoperative management of ASD.

OBJECTIVE: This exploratory study had two objectives: (1) to evaluate the effect of the SRT program on users' intention of having spinal fusion; and (2) from a US payer perspective, to estimate the annual cost savings per 100,000 beneficiaries by averting spinal surgery.

METHODS: Individuals …

Incidence And Risk Factors Of Surgical Site Infection After Lower Transverse Incision In Cesarean Section, Ahmed M. Salman, Suzan Z Mohammed, Fatma M. Sayed, Soha A. Fawaz, Ahmed A. Kassab, Sherif Abd El-Mordy, Mohammed I. Elazab, Heba M. Khattab

Journal of Medicine in Scientific Research

Background Cesarean sections are frequently performed every day, and the rate of cesarean deliveries in Egypt is rapidly escalating. Surgical site infection is a complication of cesarean sections associated with numerous risk factors, elevating maternal morbidity and potentially resulting in maternal mortality. Several strategies are followed to minimize SSI risk after CS, which can improve both the mother's and the newborn's health. Patient and methods This prospective case-control study was carried out throughout 12-month from November 2023 to November 2024, at the obstetrics and gynecology department of the EL-Sahel Teaching Hospital in Cairo, Egypt. In the study 947 CS were …

Correction Of Post Keratoplasty Refractive Error By Two Step Femto-Lasik Approach, Hazem Abdallah Elnashar

Journal of Medicine in Scientific Research

Background: Vision rehabilitation following a successful keratoplasty remains difficult. Occasionally, Post Keratoplasty Refractive Error cannot be corrected with eyeglasses or contact lenses. In such situations, refractive surgery may be the answer. It has been demonstrated that Femto-LASIK is a safe and effective procedure for reducing postoperative refractive error in keratoplasty patients. Aim: To assess the visual and refractive effect of using two step Femto-LASIK approach for correction of post keratoplasty refractive error. Methods: Prospective interventional study involved 12 patients with high refractive error after keratoplasty that a Two-step Femto-LASIK procedure was performed on after corrective lenses (contacts or glasses) failed …

Effect Of Mirror-Based Lateral Walking Training On Balance In Children With Hemiparesis: A Randomized Controlled Trial, Mohamed I. Elsepaee, Eman I. Elhadidy, Samia A. Abd Elrahman, Hesham A.E. Elghaiaty, Seham M. Abd El-Moghny

Journal of Medicine in Scientific Research

Background: Cerebral palsy children with hemiparesis manifest impaired balance during static and dynamic activities which impact gait, functional activities, and quality of life. Purpose: To determine the effect of mirror-based lateral walking training on balance in cerebral palsy children with hemiparesis. Methods: The study included 60 children of both sexes with hemiparesis between the ages of five and seven who met the following inclusion criteria: they able to walk independently at level II on the Gross Motor Function Classification System (GMFCS), with spasticity at grade 1+ to 2 on the modified Ashworth scale. Results: Following training, both groups showed statistically …

Comparison Of Outcomes Among Neurovascular Patients Managed In Dedicated Neurological Intensive Care Units Vs. General Intensive Care Units, Joanna Roy, Basel Musmar, Nassos Tziviskos, Saarang Patel, Roberto Deleon, Ashley Thommana, Shady Mina, Stavropoula Tjoumakaris, Michael Gooch, Robert Rosenwasswer, Pascal Jabbour

Department of Neurosurgery Faculty Papers

Background/Objectives: Patients with neurovascular conditions often require multidisciplinary management to optimize recovery. Our systematic review identifies literature comparing outcomes among neurovascular patients managed at dedicated neurological intensive care units (ICUs) compared to general ICUs. Methods: PubMed was searched to identify articles that reported outcomes among patients managed at dedicated neurological ICUs versus general ICUs. Articles that reported outcomes among patients with neurovascular conditions were included. Articles that reported outcomes among patients managed at stroke units were excluded. The Newcastle Ottawa Scale (NOS) was used to assess for risk of bias across individual studies. Results: After a title and abstract screen …

Interactive Module For Medical Student Education In Type I Renal Tubular Acidosis, Het Patel, Emelie-Jo Nappo, Akshata Naik, Suzan Elsayed

Posters

No abstract provided.

Survey Of Medical Student Attitudes Regarding Uterine Transplant For Cisgender And Transgender Women, Oakland University William Beaumont School Of Medicine Medical School Medical Student, Deidre Hurse, Abram Brummett

Posters

No abstract provided.

One Pulse At A Time: Exploring Spinal Cord Stimulator Anatomy To Enhance M1 Medical Education, Matthew Tufts, Sruthi Shriram, Arush Rao, Ariel Banks, Ragad Almsaddi, Gabrielle Abdelmessih, Varna Taranikanti

Posters

No abstract provided.

Green Prescription: Analyzing And Encouraging Plant-Based Eating For Student Physicians In A Four Week Seminar, Deena Sukhon, Kaithlyn Duong, Corinne Bowditch, Tai Metzger, Jessica Eibling, Amy Lin, Cindy Tran, Jackie Kraft, Maya Jaradi, Vicky Lu, Sophie Fisher, Jacob Keeley, Fanny Huang, Virginia Uhley

Posters

No abstract provided.

Publication Trends Among Integrated Plastic Surgery Residency Applicants After The Elimination Of Numeric Step 1 Scores, Forrest Bohler, James Burmeister, Ethan Dimock, Ava Harvey, Zachary Koenig, Kongkrit Chaiyasate, Cameron Davidson

Posters

No abstract provided.

Eye Dissection Video Guide: An Innovative Approach To Anatomy Education Of The Orbit, Eye, And Intraocular Lens, Jack Dryden, Malli Barremkala

Posters

No abstract provided.

Interactive Module Ror Medical Student Education In Type I Renal Tubular Acidosis, Het Patel, Emelie-Jo Nappo, Akshata Naik, Suzan Elsayed

Posters

No abstract provided.

Overcoming Barriers To Human Papillomavirus Vaccination In Guangdong Province, China, Shuaijing Zhang, Shiqi Li, Jingtai Ma, Guiyuan Ji, Zhifeng Li, Siyi Chen, Fenglin Zhang, Xingfen Yang, Jianpeng Xiao, Rong Cao, Chenggang Wu, Wei Wu

Faculty, Staff and Student Publications

Human papillomavirus (HPV) infection remains a critical public health challenge in China, particularly in Guangdong Province, where HPV-52, 16, and 58 genotypes predominate, and male infection rates exceed 40%. Despite the successful implementation of a government-funded school-based program that has achieved 88% HPV vaccine coverage among adolescent girls, several persistent barriers, including genotype mismatch (the free HPV vaccine covers < 50% of high-risk local strains), regional disparities (80% vs. 60% for first-dose coverage), and exclusion of males, thwart progress toward herd immunity. Financial sustainability risks pose an even more significant threat to the expansion of HPV vaccination programs, especially in Guangdong province where annual expenditures exceed CNY 200 million. This review delves into Guangdong's pioneering efforts and proposes practical solutions: accelerating domestic multivalent HPV vaccine development, adopting gender-neutral vaccination policies, and leveraging mobile clinics for remote populations. These strategies not only provide a roadmap for China but also serve as valuable insight for other LMICs striving to overcome HPV-related inequalities.

Lung Cancer Risk Prediction In Patients With Persistent Pulmonary Nodules Using The Brock Model And Sybil Model, Hui Li, Morteza Salehjahromi, Myrna C B Godoy, Kang Qin, Courtney M Plummer, Zheng Zhang, Lingzhi Hong, Simon Heeke, Xiuning Le, Natalie Vokes, Bingnan Zhang, Haniel A Araujo, Mehmet Altan, Carol C Wu, Mara B Antonoff, Edwin J Ostrin, Don L Gibbons, John V Heymach, J Jack Lee, David E Gerber, Jia Wu, Jianjun Zhang

Faculty, Staff and Student Publications

Background/objectives: Persistent pulmonary nodules are at higher risk of developing into lung cancers. Assessing their future cancer risk is essential for successful interception. We evaluated the performance of two risk prediction models for persistent nodules in hospital-based cohorts: the Brock model, based on clinical and radiological characteristics, and the Sybil model, a novel deep learning model for lung cancer risk prediction.

Methods: Patients with persistent pulmonary nodules-defined as nodules detected on at least two computed tomography (CT) scans, three months apart, without evidence of shrinkage-were included in the retrospective (n = 130) and prospective (n = 301) cohorts. …

Percutaneous Transluminal Angioplasty And Stenting (Ptas) In Patients With Symptomatic Intracranial Vertebrobasilar Artery Stenosis (Ivbs), Ramtin Pourahmad, Kiarash Saleki, Sina Zoghi, Ramtin Hajibeygi, Hamed Ghorani, Amin Javanbakht, Sina Goodarzi, Parsa Alijanizadeh, Kelly Trinh, Ravi Shastri, Mohammad Ghasemi-Rad

Faculty, Staff and Students Publications

Background: Approximately 20% of all transient ischaemic attacks (TIAs) and ischaemic strokes occur within the posterior circulation, with vertebrobasilar stenosis identified as the cause in roughly 25% of the cases. Studies have shown that about a quarter of these patients have atherosclerotic stenosis of at least 50% of the vertebrobasilar artery. Stenosis has been shown to be associated with an increased risk of 90-day recurrent vertebrobasilar stroke, particularly in the first few weeks, which is significantly higher when compared with patients with stenosis of the anterior circulation. Therefore, aggressive treatment is important for the patient's prognosis. Stenting is emerging as …