Digital Commons Network^™

Refractory Thrombocytopenia During Liver Transplantation Requiring Splenectomy, Ivana Wrobleski Wilder, Alexander Reskallah, Catherine M Pivalizza, John S Bynon, Evan G Pivalizza

Faculty, Staff and Student Publications

Although thrombocytopenia is common in end-stage liver disease, severe, refractory thrombocytopenia during liver transplantation is rare, and if immune based, usually presents months or years later. This case describes an adult woman in whom preoperative evaluation had not determined an immune-related cause of thrombocytopenia. Clot strength was dramatically impaired as measured by thrombelastography during the transplant. Following a lack of response to repeat platelet transfusions, splenectomy was performed after graft reperfusion with rapid temporal restoration of clot strength. This case shows a severe manifestation of perioperative thrombocytopenia during liver transplantation and clinically guided management when measured clot strength is too …

Hypofibrinogenemia Following Injury In 186 Children And Adolescents: Identification Of The Phenotype, Current Outcomes, And Potential For Intervention, Justin Gerard, Jan-Michael Van Gent, Jessica Cardenas, Christian Gage, David E Meyer, Charles Cox, Charles E Wade, Bryan A Cotton

Faculty, Staff and Student Publications

OBJECTIVES: Recent studies evaluating fibrinogen replacement in trauma, along with newly available fibrinogen-based products, has led to an increase in debate on where products such as cryoprecipitate belong in our resuscitation strategies. We set out to define the phenotype and outcomes of those with hypofibrinogenemia and evaluate whether fibrinogen replacement should have a role in the initial administration of massive transfusion.

METHODS: All patients/17-4/21 were reviewed. We then evaluated all patients who received emergency-release and massive transfusion protocol (MTP) products. Patients were defined as hypofibrinogenemic (HYPOFIB) if admission fibrinogen(r-TEG) angleHYPOFIB, the impact on outcomes, and whether early replacement improved mortality. …

Fascial Defect Closure During Ventral Hernia Repair: A Systematic Review Of Randomized Controlled Trials, Shin Jeong, Tunmi A Anwoju, Oscar A Olavarria, Natalia Cavagnaro, Naila H Dhanani, Nicole B Lyons, Zuhair Ali, Mike K Liang

Faculty, Staff and Student Publications

Background: During minimally invasive ventral hernia repair (VHR) it is unknown if a fascial defect closure, as opposed to a bridged repair (current care), is beneficial for patients. We sought to systematically review the published literature on the role of fascial defect closure during minimally invasive VHR.

Methods: PubMed, Embase, Scopus, Cochrane, and Clinicaltrials.gov were reviewed for randomized controlled trials (RCTs) that compared fascial defect closure with bridged repair. The primary outcome was major complications defined as deep/organ-space surgical site infections (SSIs), reoperations, hernia recurrences, or deaths. Secondary outcomes included SSI, seroma, eventration, hernia recurrence, post-operative pain, and quality of …

Quadricuspid Aortic Valve With Guarded Left Coronary Artery Ostium In An Infant With Myocardial Infarction, Anne Aurelie Tedga, Frank Pigula, Latasha Lewis, Thomas Richard Kimball

Faculty, Staff and Student Publications

• Anatomical variations of the aortic valve include unicuspid, bicuspid, and quadricuspid.
• The bicuspid aortic valve is most common and affects 1%-2% of the general population.
• QAV is generally an isolated malformation, and adults most commonly present with AR.
• Coronary anomalies have been reported in up to 10% of patients with QAV.
• Prompt and accurate imaging will lead to corrective surgery.

Non-Pharmacologic Approaches To Treatment Of Pediatric Functional Abdominal Pain Disorders, Partha Sarathi Chakraborty, Rhea Daniel, Fernando A Navarro

Faculty, Staff and Student Publications

Functional abdominal pain disorders (FAPDs) affect up to 25% of children in the United States. These disorders are more recently known as disorders of "brain-gut" interaction. The diagnosis is based on the ROME IV criteria, and requires the absence of an organic condition to explain the symptoms. Although these disorders are not completely understood, several factors have been involved in the pathophysiology including disordered gut motility, visceral hypersensitivity, allergies, anxiety/stress, gastrointestinal infection/inflammation, as well dysbiosis of the gut microbiome. The pharmacologic and non-pharmacologic treatments for FAPDs are directed to modifying these pathophysiologic mechanisms. This review aims to summarize the non-pharmacologic …

A Deep Learning Approach To Predict Collateral Flow In Stroke Patients Using Radiomic Features From Perfusion Images, Giles Tetteh, Fernando Navarro, Raphael Meier, Johannes Kaesmacher, Johannes C Paetzold, Jan S Kirschke, Claus Zimmer, Roland Wiest, Bjoern H Menze

Faculty, Staff and Student Publications

Collateral circulation results from specialized anastomotic channels which are capable of providing oxygenated blood to regions with compromised blood flow caused by arterial obstruction. The quality of collateral circulation has been established as a key factor in determining the likelihood of a favorable clinical outcome and goes a long way to determining the choice of a stroke care model. Though many imaging and grading methods exist for quantifying collateral blood flow, the actual grading is mostly done through manual inspection. This approach is associated with a number of challenges. First, it is time-consuming. Second, there is a high tendency for …

The Economic Case For Hospital Discharge Services For People Experiencing Homelessness In England: An In-Depth Analysis With Different Service Configurations Providing Specialist Care, Joshua X Samuels, Jonathan J-M Calede, Robert M Hunt

Faculty, Staff and Student Publications

Dipodomyine heteromyids (kangaroo rats and mice) are a diverse group of arid-adapted ricochetal rodents of North America. Here, a new genus and species of a large dipodomyine is reported from early Miocene-aged deposits of the John Day Formation in Oregon that represents the earliest record of the subfamily. The taxon is known from a single specimen consisting of a nearly complete skull, dentary, partial pes, and caudal vertebra. The specimen is characterized by a mosaic of ancestral and highly derived cranial features of heteromyids. Specifically, the dental morphology and some cranial characteristics are similar to early heteromyids, but other aspects …

Novel Psychiatric Disorder 6 Months After Traumatic Brain Injury In Children And Adolescents, Jeffrey E Max, Imogen Drake, Florin Vaida, John R Hesselink, Linda Ewing-Cobbs, Russell J Schachar, Sandra B Chapman, Erin D Bigler, Elisabeth A Wilde, Ann E Saunders, Tony T Yang, Olga Tymofiyeva, Harvey S Levin

Faculty, Staff and Student Publications

OBJECTIVE: To investigate the factors predictive of novel psychiatric disorders in the interval 0-6 months following traumatic brain injury (TBI).

METHODS: Children ages 5-14 years consecutively hospitalized for mild to severe TBI at five hospitals were recruited. Participants were evaluated at baseline (soon after injury) for pre-injury characteristics including psychiatric disorders, socioeconomic status (SES), psychosocial adversity, family function, family psychiatric history, and adaptive function. In addition to the psychosocial variables, injury severity and lesion location detected with acquisition of a research MRI were measured to develop a biopsychosocial predictive model for development of novel psychiatric disorders. Psychiatric outcome, including occurrence …

An Individual Data-Driven Virtual Resection Model Based On Epileptic Network Dynamics In Children With Intractable Epilepsy: A Magnetoencephalography Interictal Activity Application, Pablo Cuesta, Ricardo Bruña, Ekta Shah, Christopher Laohathai, Stephanie Garcia-Tarodo, Michael Funke, Gretchen Von Allmen, Fernando Maestú

Faculty, Staff and Student Publications

Epilepsy surgery continues to be a recommended treatment for intractable (medication-resistant) epilepsy; however, 30-70% of epilepsy surgery patients can continue to have seizures. Surgical failures are often associated with incomplete resection or inaccurate localization of the epileptogenic zone. This retrospective study aims to improve surgical outcome through in silico testing of surgical hypotheses through a personalized computational neurosurgery model created from individualized patient's magnetoencephalography recording and MRI. The framework assesses the extent of the epileptic network and evaluates underlying spike dynamics, resulting in identification of one single brain volume as a candidate for resection. Dynamic-locked networks were utilized for virtual …

Delayed Presentation Of Berardinelli-Siep Lipodystrophy In An Adolescent Female, Courtney Cleary, Nadine Gordon, Sheela Gavvala

Faculty, Staff and Student Publications

Berardinelli-Siep syndrome (BSS) is a form of congenital generalized lipodystrophy that disrupts the pathways of lipid metabolism. It presents with physical exam findings, including muscular hypertrophy and lipoatrophy as well as serious metabolic consequences such as diabetes mellitus, hypertriglyceridemia, acute pancreatitis, hepatomegaly, and hepatic steatosis. Diagnosis generally occurs soon after birth or in childhood. The case presented is significant for a delayed diagnosis of suspected BSS Type 1 which is rather uncommon in a developed country. Due to the detrimental complications of BSS, such as hypertrophic cardiomyopathy, pancreatitis, and liver disease, early diagnosis and intervention are crucial. Pediatric providers must …

Total Reconstruction Of Lower Lip And Chin Following Firework Injury Using Composite Bilateral Radial Forearm-Fascia Lata Flaps: A Case Report, Michael M Talanker, Kasra N Fallah, Cassie A Hartline, Daniel J Freet

Faculty, Staff and Student Publications

BACKGROUND: Primary explosion injuries with fireworks can lead to devastating and geometrically complex facial traumas that present a challenge to the reconstructive surgeon. Our patient, a woman in her early thirties, was hit directly in her chin by a large artillery shell firework. This caused complete soft tissue loss of the lower lip and chin beyond the oral commissures, complicated further by a comminuted mandible fracture.

METHODS: After external fixation, our patient underwent a 2-stage reconstruction with a novel composite flap arrangement. Soft tissue coverage and lip reconstruction were performed with opposing bilateral radial forearm free flaps. The outer flap …

Pregnancy And Diabetic Ketoacidosis: Fetal Jeopardy And Windows Of Opportunity, Ankia Coetzee, David R Hall, Eduard J Langenegger, Mari Van De Vyver, Magda Conradie

Faculty, Staff and Student Publications

BACKGROUND: Diabetic ketoacidosis (DKA) during pregnancy poses significant risks to both the mother and fetus, with an increased risk of fetal demise. Although more prevalent in women with Type I diabetes (T1D); those with Type 2 diabetes (T2D) and gestational diabetes mellitus (GDM) can also develop DKA. A lack of information about DKA during pregnancy exists worldwide, including in South Africa.

OBJECTIVE: This study examined the characteristics and outcomes associated with DKA during pregnancy.

METHODS: The study took place between 1 April 2020 and 1 October 2022. Pregnant women with DKA, admitted to Tygerberg Hospital's Obstetric Critical Care Unit (OCCU) …

Rates And Risk Factors For Anastomotic Leak Following Blunt Trauma-Associated Bucket Handle Intestinal Injuries: A Multicenter Study, Holly Grossman, Chathurka Samudani Dhanasekara, Kripa Shrestha, Brianna Marschke, Erin Morris, Robyn Richmond, Ara Ko, Lakshika Tennakoon, Eric M Campion, Frank C Wood, Maggie Brandt, Grace Ng, Justin L Regner, Stacey L Keith, Michelle K Mcnutt, Heather Kregel, Rajesh R Gandhi, Thomas J Schroeppel, Daniel R Margulies, Yassar M Hashim, Joseph Herrold, Mallory Goetz, Lerone Simpson, Xuan-Lan Doan, Sharmila Dissanaike

Faculty, Staff and Student Publications

OBJECTIVES: The risk factors for anastomotic leak (AL) after resection and primary anastomosis for traumatic bucket handle injury (BHI) have not been previously defined. This multicenter study was conducted to address this knowledge gap.

METHODS: This is a multicenter retrospective study on small intestine and colonic BHIs from blunt trauma between 2010 and 2021. Baseline patient characteristics, risk factors, presence of shock and transfusion, operative details, and clinical outcomes were compared using R.

RESULTS: Data on 395 subjects were submitted by 12 trauma centers, of whom 33 (8.1%) patients developed AL. Baseline details were similar, except for a higher proportion …

The Development Of Tumour Vascular Networks, Cassandra B Iroz, Willemijn L A Schäfer, Julie K Johnson, Meagan S Ager, Reiping Huang, Salva N Balbale, Jonah J Stulberg

Faculty, Staff and Student Publications

BACKGROUND: Opioids prescribed to treat postsurgical pain have contributed to the ongoing opioid epidemic. While opioid prescribing practices have improved, most patients do not use all their pills and do not safely dispose of leftovers, which creates a risk for unsafe use and diversion. We aimed to generate consensus on the content of a "safe opioid use agreement" for the perioperative settings to improve patients' safe use, storage, and disposal of opioids.

METHODS: We conducted a modified three-round Delphi study with clinicians across surgical specialties, quality improvement (QI) experts, and patients. In Round 1, participants completed a survey rating the …

Association Between Surgical Technical Skills And Clinical Outcomes: A Systematic Literature Review And Meta-Analysis, Michael S Woods, Joshua N Liberman, Pinyao Rui, Emily Wiggins, Joan White, Bruce Ramshaw, Jonah J Stulberg

Faculty, Staff and Student Publications

BACKGROUND: A systematic literature review and meta-analysis was conducted to assess the association between intraoperative surgical skill and clinical outcomes.

METHODS: Peer-reviewed, original research articles published through August 31, 2021 were identified from PubMed and Embase. From the 1,513 potential articles, seven met eligibility requirements, reporting on 151 surgeons and 17,932 procedures. All included retrospective assessment of operative videos. Associations between surgical skill and outcomes were assessed by pooling odds ratios (OR) using random-effects models with the inverse variance method. Eligible studies included pancreaticoduodenectomy, gastric bypass, laparoscopic gastrectomy, prostatectomy, colorectal, and hemicolectomy procedures.

RESULTS: Meta-analytic pooling identified significant associations between …

Hiatal Hernia Repair With Transoral Incisionless Fundoplication Versus Nissen Fundoplication For Gastroesophageal Reflux Disease: A Retrospective Study, Veeravich K Jaruvongvanich, Reem Matar, Janani Reisenauer, Peter Janu, Peter Mavrelis, Glenn Ihde, Michael Murray, Sneha Singh, Jennifer Kolb, Ninh T Nguyen, Nirav Thosani, Erik B Wilson, Rasa Zarnegar, Kenneth Chang, Marcia I Canto, Barham K Abu Dayyeh

Faculty, Staff and Student Publications

Background and study aims  Concomitant hiatal hernia (HH) repair with transoral incisionless fundoplication (TIF) is a therapeutic option for patients with HH > 2 cm and gastroesophageal reflux disease (GERD). Data comparing this approach with laparoscopic Nissen fundoplication (LNF) are lacking. We performed an exploratory analysis to compare these two approaches' adverse events (AEs) and clinical outcomes.

Patients and methods  This was a multicenter retrospective cohort study of HH repair followed by LNF versus HH repair followed by TIF in patients with GERD and moderate HH (2–5 cm). AEs were assessed using the Clavien-Dindo classification. Symptoms (heartburn/regurgitation, bloating, and dysphagia) were …

Peripheral Eosinophil Trends And Clinical Outcomes After Non-Traumatic Subarachnoid Hemorrhage, Hugo Gonzalez Gomez, Jude P J Savarraj, Atzhiry S Paz, Xuefang Ren, Hua Chen, Louise D Mccullough, Huimahn A Choi, Aaron M Gusdon

Faculty, Staff and Student Publications

Background/objective

Uncontrolled systemic inflammation after non-traumatic subarachnoid hemorrhage (SAH) is associated with worse outcomes. Changes in the peripheral eosinophil count have been linked to worse clinical outcomes after ischemic stroke, intracerebral hemorrhage, and traumatic brain injury. We aimed to investigate the association of eosinophil counts with clinical outcomes after SAH.

Methods

This retrospective observational study included patients with SAH admitted from January 2009 to July 2016. Variables included demographics, modified Fisher scale (mFS), Hunt–Hess Scale (HHS), global cerebral edema (GCE), and the presence of any infection. Peripheral eosinophil counts were examined as part of routine clinical care on admission and …

An F-Ratio-Based Method For Estimating The Number Of Active Sources In Meg, Amita Giri, John C Mosher, Amir Adler, Dimitrios Pantazis

Faculty, Staff and Student Publications

INTRODUCTION: Magnetoencephalography (MEG) is a powerful technique for studying the human brain function. However, accurately estimating the number of sources that contribute to the MEG recordings remains a challenging problem due to the low signal-to-noise ratio (SNR), the presence of correlated sources, inaccuracies in head modeling, and variations in individual anatomy.

METHODS: To address these issues, our study introduces a robust method for accurately estimating the number of active sources in the brain based on the F-ratio statistical approach, which allows for a comparison between a full model with a higher number of sources and a reduced model with fewer …

A Phase 3b Study For Management Of Ocular Side Effects In Patients With Epidermal Growth Factor Receptor-Amplified Glioblastoma Receiving Depatuxizumab Mafodotin, Colin J Vize, Stella K Kim, Tim Matthews, Marian Macsai, Ryan Merrell, Sigmund Hsu, Madan Gopal Kundu, Jennifer Yoon, Emma Kennedy, Madhavi Pai, Earle Bain, Andrew B Lassman, Golnaz Moazami

Faculty, Staff and Student Publications

INTRODUCTION: The Understanding New Interventions with GBM ThErapy (UNITE) study was designed to assess the effect of prophylaxis for ocular side effects (OSEs) in patients with glioblastoma receiving the antibody-drug conjugate (ADC) depatuxizumab mafodotin. UNITE (NCT03419403) was a phase 3b, open-label, randomized, exploratory study performed at 18 research sites in 5 countries.

METHODS: The study enrolled adult patients with epidermal growth factor receptor-amplified, histologically confirmed, newly diagnosed supratentorial glioblastoma or grade IV gliosarcoma, and a Karnofsky Performance Status ≥70, receiving depatuxizumab mafodotin. All patients were administered depatuxizumab mafodotin during concurrent radiotherapy and temozolomide and with adjuvant temozolomide. Ninety patients were …

Dye Coupling Of Horizontal Cells In The Primate Retina, Feng Pan, Stephen C Massey

Faculty, Staff and Student Publications

In the monkey retina, there are two distinct types of axon-bearing horizontal cells, known as H1 and H2 horizontal cells (HCs). In this study, cell bodies were prelabled using 4',6-diamidino-2-phenylindole (DAPI), and both H1 and H2 horizontal cells were filled with Neurobiotin™ to reveal their coupling, cellular details, and photoreceptor contacts. The confocal analysis of H1 and H2 HCs was used to assess the colocalization of terminal dendrites with glutamate receptors at cone pedicles. After filling H1 somas, a large coupled mosaic of H1 cells was labeled. The dendritic terminals of H1 cells contacted red/green cone pedicles, with the occasional …

Multimethod Process Evaluation Of A Community Paramedic Delivered Care Transitions Intervention For Older Emergency Department Patients, Gwen Costa Jacobsohn, Apoorva P Maru, Rebecca K Green, Angela N Gifford, Matthew D Lukasik, Tikiri Bandara, Thomas V Caprio, Amy L Cochran, Jeremy T Cushman, Courtney M C Jones, Amy J H Kind, Michael Lohmeier, Manish N Shah

Faculty, Staff and Student Publications

OBJECTIVE: We assessed fidelity of delivery and participant engagement in the implementation of a community paramedic coach-led Care Transitions Intervention (CTI) program adapted for use following emergency department (ED) visits.

METHODS: The adapted CTI for ED-to-home transitions was implemented at three university-affiliated hospitals in two cities from 2016 to 2019. Participants were aged ≥60 years old and discharged from the ED within 24 hours of arrival. In the current analysis, participants had to have received the CTI. Community paramedic coaches collected data on program delivery and participant characteristics at each transition contact via inventories and assessments. Participants provided commentary on …

Reading-To-Writing Mediation Model Of Higher-Order Literacy, Yusra Ahmed, Shawn C Kent, Milena Keller-Margulis

Faculty, Staff and Student Publications

INTRODUCTION: Writing difficulties frequently manifest comorbidly with reading challenges, and reading is implicated in particular acts of writing, such as reviewing and editing. Despite what is known, however, there remain significant barriers to understanding the nature of reading-writing relations, as few studies are comprehensive in the number and types of literacy skills evaluated. This study consists of a secondary data analysis of two studies employing structural equation modeling (SEM) to evaluate relations among reading and writing components skills independently, using the Direct and Inferential Mediation Model (DIME) of reading comprehension and Not-so-Simple View of Writing (NSVW) as theoretical frameworks.

METHODS: …

Frequentist Model Averaging For Analysis Of Dose-Response In Epidemiologic Studies With Complex Exposure Uncertainty, Deukwoo Kwon, Steven L Simon, F Owen Hoffman, Ruth M Pfeiffer

Faculty, Staff and Student Publications

In epidemiologic studies, association estimates of an exposure with disease outcomes are often biased when the uncertainties of exposure are ignored. Consequently, corresponding confidence intervals (CIs) will not have correct coverage. This issue is particularly problematic when exposures must be reconstructed from physical measurements, for example, for environmental or occupational radiation doses that were received by a study population for which radiation doses cannot be measured directly. To incorporate complex uncertainties in reconstructed exposures, the two-dimensional Monte Carlo (2DMC) dose estimation method has been proposed and used in various dose reconstruction efforts. The 2DMC method generates multiple exposure realizations from …

Association Of Vitamin D Polygenic Risk Scores And Disease Outcome In People With Multiple Sclerosis, Eleni S Vasileiou, Chen Hu, Charles N Bernstein, Fred Lublin, Jerry S Wolinsky, Gary R Cutter, Elias S Sotirchos, Kaarina Kowalec, Amber Salter, Shiv Saidha, Ellen M Mowry, Peter A Calabresi, Ruth Ann Marrie, Kathryn C Fitzgerald

Faculty, Staff and Student Publications

Background and objectives: Observational studies suggest low levels of 25-hydroxyvitamin D (25[OH]D) may be associated with increased disease activity in people with multiple sclerosis (PwMS). Large-scale genome-wide association studies (GWAS) suggest 25(OH)D levels are partly genetically determined. The resultant polygenic scores (PGSs) could serve as a proxy for 25(OH)D levels, minimizing potential confounding and reverse causation in analyses with outcomes. Herein, we assess the association of genetically determined 25(OH)D and disease outcomes in MS.

Methods: We generated 25(OH)D PGS for 1,924 PwMS with available genotyping data pooled from 3 studies: the CombiRx trial (n = 575), Johns Hopkins MS Center …

In Utero Ethanol Exposure Induces Mitochondrial Dna Damage And Inhibits Mtdna Repair In Developing Brain, Nune Darbinian, Armine Darbinyan, Nana Merabova, Myrna Kassem, Gabriel Tatevosian, Shohreh Amini, Laura Goetzl, Michael E Selzer

Faculty, Staff and Student Publications

Introduction

Mitochondrial dysfunction is postulated to be a central event in fetal alcohol spectrum disorders (FASD). People with the most severe form of FASD, fetal alcohol syndrome (FAS) are estimated to live only 34 years (95% confidence interval, 31 to 37 years), and adults who were born with any form of FASD often develop early aging. Mitochondrial dysfunction and mitochondrial DNA (mtDNA) damage, hallmarks of aging, are postulated central events in FASD. Ethanol (EtOH) can cause mtDNA damage, consequent increased oxidative stress, and changes in the mtDNA repair protein 8-oxoguanine DNA glycosylase-1 (OGG1). Studies of molecular mechanisms are limited by …

Return To Sport Following Acl Reconstruction With Slope-Correcting High Tibial Osteotomy In The Elite Athlete, Walter R Lowe, Alfred Mansour, Steven Higbie, Connor Galloway, Jacquelyn Kleihege, Lane Bailey

Faculty, Staff and Student Publications

Background: Increased posterior tibial slope is a strong predictor of anterior cruciate ligament (ACL) graft re-injury. A concomitant slope-reducing high tibial osteotomy (HTO) has been suggested to decrease re-tear risk in these cases although little is known regarding outcomes following ACL reconstruction with HTO, especially in elite athletic patients.

Indications: A 19-year-old National Collegiate Athletics Association (NCAA) Division 1 running back presented with an ACL tear, lateral meniscus tear, and posterior tibial slope of 19° (case 1). A 19-year-old NCAA Division 1 soccer forward presented with an ACL graft re-tear and posterior tibial slope of 21° (case 2).

Technique: Anterior …

Increasing Rates Of Ulnar Collateral Ligament Repair Outpace Reconstruction In Isolated Injuries: Review Of A Texas Surgical Database, Taylor J Willenbring, Eden C Epner, Ryan J Warth, James M Gregory

Faculty, Staff and Student Publications

BACKGROUND: The gold standard of treatment for ulnar collateral ligament (UCL) injuries has been reconstruction. Despite early repair studies yielding less than satisfactory results, there has been recent renewed interest in UCL repair due to improved outcomes and new technologies. Data regarding clinical use of these procedures are lacking. The purpose of this study was to define the epidemiological trends of UCL repair and reconstruction surgery from 2010 to 2019, compare demographic characteristics of patients undergoing either procedure, and determine incidence of concomitant procedures in each surgical group as well as comparing respective patient-level charges.

METHODS: A retrospective database analysis …

Self-Administered Transcranial Direct Current Stimulation Treatment Of Knee Osteoarthritis Alters Pain-Related Fnirs Connectivity Networks, Samuel Montero-Hernandez, Luca Pollonini, Lindsey Park, Geraldine Martorella, Hongyu Miao, Kenneth B Mathis, Hyochol Ahn

Faculty, Staff and Student Publications

SIGNIFICANCE: Knee osteoarthritis (OA) is a disease that causes chronic pain in the elderly population. Currently, OA is mainly treated pharmacologically with analgesics, although research has shown that neuromodulation via transcranial direct current stimulation (tDCS) may be beneficial in reducing pain in clinical settings. However, no studies have reported the effects of home-based self-administered tDCS on functional brain networks in older adults with knee OA.

AIM: We used functional near-infrared spectroscopy (fNIRS) to investigate the functional connectivity effects of tDCS on underlying pain processing mechanisms at the central nervous level in older adults with knee OA.

APPROACH: Pain-related brain connectivity …

A Steadier Hand: The First Human Clinical Trial Of A Single-Use Robotic-Assisted Surgical Device For Cochlear Implant Electrode Array Insertion, Jay A Gantz, Bruce J Gantz, Christopher R Kaufmann, Allan M Henslee, Camille C Dunn, Xiaoyang Hua, Marlan R Hansen

Faculty, Staff and Student Publications

OBJECTIVE: To evaluate the safety and utility of an investigational robotic-assisted cochlear implant insertion system.

STUDY DESIGN: Prospective, single-arm, open-label study under abbreviated Investigational Device Exemption requirements.

SETTING: All procedures were performed, and all data were collected, at a single tertiary referral center.

PATIENTS: Twenty-one postlingually deafened adult subjects that met Food and Drug Administration indication criteria for cochlear implantation.

INTERVENTION: All patients underwent standard-of-care surgery for unilateral cochlear implantation with the addition of a single-use robotic-assisted insertion device during cochlear electrode insertion.

MAIN OUTCOME MEASURES: Successful insertion of cochlear implant electrode array, electrode array insertion time, postoperative implant function. …

Target Recognition By Rnase E Rna-Binding Domain Ar2 Drives Srna Decay In The Absence Of Pnpase, Pranathi Gullapalli, Nicoletta Fossati, Dusica Stamenkovic, Muhammad Haque, Davide Cattano

Faculty, Staff and Student Publications

The human brain contributes 2% of the body weight yet receives 15% of cardiac output and demands a constant supply of oxygen (O 2) and nutrients to meet its metabolic needs. Cerebral autoregulation is responsible for maintaining a constant cerebral blood flow that provides the supply of oxygen and maintains the energy storage capacity. We selected oxygen administration-related studies published between 1975-2021 that included meta-analysis, original research, commentaries, editorial, and review articles. In the present narrative review, several important aspects of the oxygen effects on brain tissues and cerebral autoregulation are discussed, as well the role of exogenous O 2 …