Medicine and Health Sciences Commons^™

Super-Resolution And Segmentation Deep Learning For Breast Cancer Histopathology Image Analysis, Aniwat Juhong, Bo Li, Cheng-You Yao, Chia-Wei Yang, Dalen W Agnew, Yu Leo Lei, Xuefei Huang, Wibool Piyawattanametha, Zhen Qiu

Faculty, Staff and Student Publications

Traditionally, a high-performance microscope with a large numerical aperture is required to acquire high-resolution images. However, the images' size is typically tremendous. Therefore, they are not conveniently managed and transferred across a computer network or stored in a limited computer storage system. As a result, image compression is commonly used to reduce image size resulting in poor image resolution. Here, we demonstrate custom convolution neural networks (CNNs) for both super-resolution image enhancement from low-resolution images and characterization of both cells and nuclei from hematoxylin and eosin (H&E) stained breast cancer histopathological images by using a combination of generator and discriminator …

Easycelltype: Marker-Based Cell-Type Annotation By Automatically Querying Multiple Databases, Ruoxing Li, Jianjun Zhang, Ziyi Li

Faculty, Staff and Student Publications

MOTIVATION: Cell label annotation is a challenging step in the analysis of single-cell RNA sequencing (scRNA-seq) data, especially for tissue types that are less commonly studied. The accumulation of scRNA-seq studies and biological knowledge leads to several well-maintained cell marker databases. Manually examining the cell marker lists against these databases can be difficult due to the large amount of available information. Additionally, simply overlapping the two lists without considering gene ranking might lead to unreliable results. Thus, an automated method with careful statistical testing is needed to facilitate the usage of these databases.

RESULTS: We develop a user-friendly computational tool, …

Estimating Causal Effects With Hidden Confounding Using Instrumental Variables And Environments, James P Long, Hongxu Zhu, Kim-Anh Do, Min Jin Ha

Faculty, Staff and Student Publications

Recent works have proposed regression models which are invariant across data collection environments [24, 20, 11, 16, 8]. These estimators often have a causal interpretation under conditions on the environments and type of invariance imposed. One recent example, the Causal Dantzig (CD), is consistent under hidden confounding and represents an alternative to classical instrumental variable estimators such as Two Stage Least Squares (TSLS). In this work we derive the CD as a generalized method of moments (GMM) estimator. The GMM representation leads to several practical results, including 1) creation of the Generalized Causal Dantzig (GCD) estimator which can be applied …

Pain Experience And Sensory Changes In Astronauts During And After Short-Lasting Commercial Spaceflight: A Proof-Of-Concept Study, Andrea K Sauer, Marie Vigouroux, Patrick M Dougherty, Juan Pablo Cata, Pablo M Ingelmo

Faculty, Staff and Student Publications

Space travel has been associated with musculoskeletal pain, yet little is known about the nociceptive changes and pain experience during spaceflight. This preliminary study aims to investigate the pain experience and sensory alterations in astronauts following a 17-day mission to the International Space Station (ISS) on Axiom Space's AX-1 commercial space flight. Two participants were enrolled, and data were collected pre-flight, in-flight, post-flight, and three-month post-flight. Validated pain questionnaires assessed anxiety, catastrophizing, impact on physical and mental health, disability, and overall pain experience. Qualitative interviews were conducted post-landing and conditioned pain modulation (CPM) and quantitative sensory testing (QST) were performed. …

Multi-Organ Spatial Stratification Of 3-D Dose Distributions Improves Risk Prediction Of Long-Term Self-Reported Severe Symptoms In Oropharyngeal Cancer Patients Receiving Radiotherapy: Development Of A Pre-Treatment Decision Support Tool, Andrew Wentzel, Abdallah S R Mohamed, Mohamed A Naser, Lisanne V Van Dijk, Katherine Hutcheson, Amy M Moreno, Clifton D Fuller, Guadalupe Canahuate, G Elisabeta Marai

Faculty, Staff and Student Publications

Purpose: Identify Oropharyngeal cancer (OPC) patients at high-risk of developing long-term severe radiation-associated symptoms using dose volume histograms for organs-at-risk, via unsupervised clustering.

Material and methods: All patients were treated using radiation therapy for OPC. Dose-volume histograms of organs-at-risk were extracted from patients' treatment plans. Symptom ratings were collected via the MD Anderson Symptom Inventory (MDASI) given weekly during, and 6 months post-treatment. Drymouth, trouble swallowing, mucus, and vocal dysfunction were selected for analysis in this study. Patient stratifications were obtained by applying Bayesian Mixture Models with three components to patient's dose histograms for relevant organs. The clusters with the …

Overview Of The Hecktor Challenge At Miccai 2022: Automatic Head And Neck Tumor Segmentation And Outcome Prediction In Pet/Ct, Vincent Andrearczyk, Valentin Oreiller, Moamen Abobakr, Azadeh Akhavanallaf, Panagiotis Balermpas, Sarah Boughdad, Leo Capriotti, Joel Castelli, Catherine Cheze Le Rest, Pierre Decazes, Ricardo Correia, Dina El-Habashy, Hesham Elhalawani, Clifton D Fuller, Mario Jreige, Yornna Khamis, Agustina La Greca, Abdallah Mohamed, Mohamed Naser, John O Prior, Su Ruan, Stephanie Tanadini-Lang, Olena Tankyevych, Yazdan Salimi, Martin Vallières, Pierre Vera, Dimitris Visvikis, Kareem Wahid, Habib Zaidi, Mathieu Hatt, Adrien Depeursinge

Faculty, Staff and Student Publications

This paper presents an overview of the third edition of the HEad and neCK TumOR segmentation and outcome prediction (HECKTOR) challenge, organized as a satellite event of the 25th International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI) 2022. The challenge comprises two tasks related to the automatic analysis of FDG-PET/CT images for patients with Head and Neck cancer (H&N), focusing on the oropharynx region. Task 1 is the fully automatic segmentation of H&N primary Gross Tumor Volume (GTVp) and metastatic lymph nodes (GTVn) from FDG-PET/CT images. Task 2 is the fully automatic prediction of Recurrence-Free Survival (RFS) …

The Contemporary Management Of Cancers Of The Sinonasal Tract In Adults, Rajat Thawani, Myung Sun Kim, Asad Arastu, Zizhen Feng, Malinda T West, Nicholas F Taflin, Kyaw Zin Thein, Ryan Li, Mathew Geltzeiler, Nancy Lee, Clifton David Fuller, Jennifer R Grandis, Charalampos S Floudas, Michael C Heinrich, Ehab Hanna, Ravi A Chandra

Faculty, Staff and Student Publications

Sinonasal malignancies make up <5% of all head and neck neoplasms, with an incidence of 0.5-1.0 per 100,000. The outcome of these rare malignancies has been poor, whereas significant progress has been made in the management of other cancers. The objective of the current review was to describe the incidence, causes, presentation, diagnosis, treatment, and recent developments of malignancies of the sinonasal tract. The diagnoses covered in this review included sinonasal undifferentiated carcinoma, sinonasal adenocarcinoma, sinonasal squamous cell carcinoma, and esthesioneuroblastoma, which are exclusive to the sinonasal tract. In addition, the authors covered malignances that are likely to be encountered in the sinonasal tract-primary mucosal melanoma, NUT (nuclear protein of the testis) carcinoma, and extranodal natural killer cell/T-cell lymphoma. For the purpose of keeping this review as concise and focused as possible, sarcomas and malignancies that can be classified as salivary gland neoplasms were excluded.

Head And Neck Cancer Predictive Risk Estimator To Determine Control And Therapeutic Outcomes Of Radiotherapy (Hnc-Predictor): Development, International Multi-Institutional Validation, And Web Implementation Of Clinic-Ready Model-Based Risk Stratification For Head And Neck Cancer, Lisanne V Van Dijk, Abdallah Sr Mohamed, Sara Ahmed, Nafiul Nipu, G Elisabeta Marai, Kareem Wahid, Nanna M Sijtsema, Brandon Gunn, Adam S Garden, Amy Moreno, Andrew J Hope, Johannes A Langendijk, Clifton D Fuller

Faculty, Staff and Student Publications

Background: Personalised radiotherapy can improve treatment outcomes of patients with head and neck cancer (HNC), where currently a 'one-dose-fits-all' approach is the standard. The aim was to establish individualised outcome prediction based on multi-institutional international 'big-data' to facilitate risk-based stratification of patients with HNC.

Methods: The data of 4611 HNC radiotherapy patients from three academic cancer centres were split into four cohorts: a training (n = 2241), independent test (n = 786), and external validation cohorts 1 (n = 1087) and 2 (n = 497). Tumour- and patient-related clinical variables were considered in a machine learning pipeline to predict overall …

The History Of Oral Decitabine/Cedazuridine And Its Potential Role In Acute Myeloid Leukemia, Robert Briski, Guillermo Garcia-Manero, Hagop Kantarjian, Farhad Ravandi

Faculty, Staff and Student Publications

Decitabine, a member of the 5-azanucleosides, has a dose-dependent mechanism of action in vitro: termination of DNA replication at high doses, and inhibition of DNA methyltransferase at low doses. The alteration of DNA methylation patterns by low-dose decitabine is hypothesized to upregulate genes, which promote myeloblast differentiation. In a phase III clinical trial, low-dose decitabine achieved a superior overall response rate (ORR) when compared with 'treatment choice' [consisting of low-dose cytarabine (80%) and supportive care (20%)] as a frontline treatment for elderly patients with acute myeloid leukemia (AML). Despite an improved ORR, the median overall survival (OS) for elderly …

Benchmarking Outcomes For Molecularly Characterized Synchronous Oligometastatic Non-Small-Cell Lung Cancer Reveal, Brian De, Ahsan S Farooqi, Kyle G Mitchell, Ethan B Ludmir, Jeff Lewis, Waree Rinsurongkawong, Vadeerat Rinsurongkawong, J Jack Lee, Stephen G Swisher, Don L Gibbons, Jianjun Zhang, Xiuning Le, Yasir Y Elamin, Daniel R Gomez, Matthew S Ning, Steven H Lin, Zhongxing Liao, Joe Y Chang, Ara A Vaporciyan, John V Heymach, Mara B Antonoff, Saumil J Gandhi

Faculty, Staff and Student Publications

Purpose: Local consolidative therapy (LCT) for patients with synchronous oligometastatic non-small-cell lung cancer is an evolving treatment strategy, but outcomes following LCT stratified by genetic mutations have not been reported. We sought to identify genomic associations with overall survival (OS) and progression-free survival (PFS) for these patients.

Methods: We identified all patients presenting between 2000 and 2017 with stage IV non-small-cell lung cancer and ≤ 3 synchronous metastatic sites. Patients were grouped according to mutational statuses. Primary outcomes included OS and PFS following initial diagnosis.

Results: Of 194 included patients, 121 received comprehensive LCT to all sites of disease with …

Construction Of The Interaction Network Of Hub Genes In The Progression Of Barrett's Esophagus To Esophageal Adenocarcinoma, Kai Li, Peipei Duan, Haifa He, Ruijuan Du, Qian Wang, Pengju Gong, Hua Bian

Faculty, Staff and Student Publications

Introduction: Esophageal adenocarcinoma (EAC) is one of the histologic types of esophageal cancer with a poor prognosis. The majority of EAC originate from Barrett's esophagus (BE). There are few studies focusing on the dynamic progression of BE to EAC.

Methods: R software was used to analyze differentially expressed genes (DEGs) based on RNA-seq data of 94 normal esophageal squamous epithelial (NE) tissues, 113 BE tissues and 147 EAC tissues. The overlapping genes of DEGs between BE and EAC were analyzed by Venn diagram tool. The hub genes were selected by Cytoscape software based on the protein-protein interaction network of the …

Performance Benchmark Metrics And Clinicopathologic Outcomes Of Mri-Guided Breast Biopsies: A Systematic Review And Meta-Analysis, Berat Bersu Özcan, Justin Yan, Yin Xi, Serine Baydoun, Marion E Scoggins, Başak E Doğan

Faculty, Staff and Student Publications

OBJECTIVE: To determine key performance metrics of magnetic resonance imaging (MRI)-guided breast biopsies (MRGB) to help identify reference benchmarks.

MATERIALS AND METHODS: We identified studies reporting MRGB results up to 04.01.2021 in the Embase database, Ovid Medline (R) Process, Other Non-Indexed Citations, Ovid Medline (R) and completed a PRISMA checklist and sources of bias (QUADAS-2). The inclusion criteria were English language, available histopathological outcomes, or at least one imaging follow-up after biopsy. A random intercept logistic regression model was used to pool rates. Between-study heterogeneity was quantified by the I2 statistic.

RESULTS: A total of 11,215 lesions in 50 articles …

Contemporaneous Symptom Networks Of Multidimensional Symptom Experiences In Cancer Survivors: A Network Analysis, Zheng Zhu, Yanling Sun, Yi Kuang, Xiaoyi Yuan, Haiyan Gu, Jing Zhu, Weijie Xing

Faculty, Staff and Student Publications

Background: Symptom networks can provide empirical evidence for the development of personalized and precise symptom management strategies. However, few studies have explored the symptom networks of multidimensional symptom experiences in cancer survivors. The objectives of this study were to generate symptom networks of multidimensional symptom experiences in cancer survivors and explore the centrality indices and density in these symptom networks METHODS: Data from 1065 cancer survivors were obtained from the Shanghai CANcer Survivor (SCANS) Report. The MD Anderson Symptom Inventory was used to assess the prevalence and severity of 13 cancer-related symptoms. We constructed contemporaneous networks with all 13 symptoms …

A Bayesian Piecewise Exponential Phase Ii Design For Monitoring A Time-To-Event Endpoint, Yun Qing, Peter F Thall, Ying Yuan

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A robust Bayesian design is presented for a single-arm phase II trial with an early stopping rule to monitor a time to event endpoint. The assumed model is a piecewise exponential distribution with non-informative gamma priors on the hazard parameters in subintervals of a fixed follow up interval. As an additional comparator, we also define and evaluate a version of the design based on an assumed Weibull distribution. Except for the assumed models, the piecewise exponential and Weibull model based designs are identical to an established design that assumes an exponential event time distribution with an inverse gamma prior on …

A Bibliometric And Visual Analysis Of Cancer-Associated Fibroblasts, Wei-Chen Yuan, Jie-Xiang Zhang, Hai-Bin Chen, Ying Yuan, Yu-Pei Zhuang, Hong-Li Zhou, Mu-Han Li, Wen-Li Qiu, Hong-Guang Zhou

Faculty, Staff and Student Publications

Background: Cancer-associated fibroblasts (CAFs) represent the predominant stromal component within the tumour microenvironment (TME), exhibiting considerable heterogeneity and plasticity that significantly impact immune response and metabolic reprogramming within the TME, thereby influencing tumour progression. Consequently, investigating CAFs is of utmost importance. The objective of this study is to employ bibliometric analysis in order to evaluate the current state of research on CAFs and predict future areas of research and emerging trends.

Methods: Conduct a comprehensive search for scholarly publications within the Web of Science Core Collection database, encompassing the time period from January 1, 2001, to December 31, 2022. Apply …

Survival Outcomes In Patients With Relapsed/Refractory Or Mrd-Positive B-Cell Acute Lymphoblastic Leukemia Treated With Blinatumomab, Hagop M Kantarjian, Aaron C Logan, Faraz Zaman, Nicola Gökbuget, Ralf C Bargou, Yi Zeng, Gerhard Zugmaier, Franco Locatelli

Faculty, Staff and Student Publications

Blinatumomab has demonstrated significant efficacy in adult and pediatric patients with relapsed/refractory B-cell acute lymphoblastic leukemia (R/R B-cell ALL) and patients with measurable residual disease (MRD). This review aimed to compare median relapse-free survival (RFS) and median overall survival (OS) in adult and pediatric patients with R/R or MRD-positive B-cell ALL from pivotal studies [MT-103-211 and TOWER for adults with Philadelphia chromosome (Ph)-negative R/R B-cell ALL, ALCANTARA for adults with Ph-positive R/R B-cell ALL, MT-103-203 for adults with MRD-positive B-cell ALL, and MT-103-205 for pediatric patients with R/R B-cell ALL], with the median RFS and OS from retrospective analyses, country …

Targeted Therapy For Intractable Cancer On The Basis Of Molecular Profiles: An Open-Label, Phase Ii Basket Trial (Long March Pathway), Xiao-Dong Jiao, Bao-Dong Qin, Zhan Wang, Ke Liu, Ying Wu, Yan Ling, Wen-Xing Qin, Miao-Miao Wang, Ling-Yan Yuan, Savio George Barreto, Anthony W Kim, Kimberley Mak, Hao Li, Yuan-Yuan Xu, Xiao-Ming Qiu, Min Wu, Min Jin, Li-Chao Xu, Yi Zhong, Hui Yang, Xue-Qin Chen, Yu Zeng, Jun Shi, Wen-Yu Zhu, Qing-Qing Ding, Wei Jia, Su-Fen Liu, Jun-Jing Zhou, Hong Shen, Shi-Hua Yao, Zhao-Ji Guo, Ting Li, Pei-Juan Zhou, Xue-Wei Dong, Wen-Feng Lu, Robert L Coleman, Mehmet Akce, Chérif Akladios, Francesco Puccetti, Yuan-Sheng Zang

Faculty, Staff and Student Publications

Purpose: We evaluated he effects of molecular guided-targeted therapy for intractable cancer. Also, the epidemiology of druggable gene alterations in Chinese population was investigated.

Materials and methods: The Long March Pathway (ClinicalTrials.gov identifier: NCT03239015) is a non-randomized, open-label, phase II trial consisting of several basket studies examining the molecular profiles of intractable cancers in the Chinese population. The trial aimed to 1) evaluate the efficacy of targeted therapy for intractable cancer and 2) identify the molecular epidemiology of the tier II gene alterations among Chinese pan-cancer patients.

Results: In the first stage, molecular profiles of 520 intractable pan-cancer patients …

Intracranial Mesenchymal Tumor, Fet::Creb Fusion-Positive In The Lateral Ventricle, Hanim I Ozkizilkaya, Jason M Johnson, Barbara J O'Brien, Ian E Mccutcheon, Sujit S Prabhu, Amol J Ghia, Gregory N Fuller, Jason T Huse, Leomar Y Ballester

Faculty, Staff and Student Publications

No abstract provided.

The Mediating Effect Of Resilience On The Relationship Between Symptom Burden And Anxiety/Depression Among Chinese Patients With Primary Liver Cancer After Liver Resection, Xue Zhang, Haoran Zhang, Zonghao Zhang, Hua Fan, Shuwen Li

Faculty, Staff and Student Publications

Purpose: Primary liver cancer (PLC) is a common cancer of the digestive system. Patients with PLC often experience a heavy symptom burden and along with a significant levels of anxiety and depression after liver resection. High levels of symptom burden can lead to increased anxiety and depression, whereas high levels of resilience can alleviate these conditions. Therefore, we aimed to explore the relationships among symptom burden, resilience, and anxiety/depression in Chinese patients with PLC after liver resection and to determine whether resilience mediates the relationship between symptom burden and anxiety/depression.

Patients and methods: A total of 223 postoperative PLC patients …

One Patient With 4 Different Primary Cancers: A Case Report, Dung Thi Nguyen, Lan Mai Nguyen, Thang Le Phan, Quang Vinh Bui

Faculty, Staff and Student Publications

BACKGROUND: The development of medicine, especially in oncology, has been helping prolong the cancer patients' survival, but also leads to increasing the possibility of getting multiple cancers. However, the possibility of getting 4 primary cancers in 4 different sites is extremely rare.

CASE PRESENTATION: A 63-year-old female patient was diagnosed with thyroid cancer in 2018, and then with right colon cancer in 2019. In 2020, this patient was diagnosed with left renal pelvis cancer, and most recently, in April 2022, she was hospitalized with bladder cancer diagnosis. Thanks to being closely and regularly followed-up, her malignancies had been detected early …

Timing Of Invasive Mechanical Ventilation And Death In Critically Ill Adults With Covid-19: A Multicenter Cohort Study, Adam Green, Jean-Sebastien Rachoin, Christa Schorr, Phil Dellinger, Jonathan D Casey, Isabel Park, Shruti Gupta, Rebecca M Baron, Shahzad Shaefi, Krystal Hunter, David E Leaf

Faculty, Staff and Student Publications

PURPOSE: To investigate if the timing of initiation of invasive mechanical ventilation (IMV) for critically ill patients with COVID-19 is associated with mortality.

MATERIALS AND METHODS: The data for this study were derived from a multicenter cohort study of critically ill adults with COVID-19 admitted to ICUs at 68 hospitals across the US from March 1 to July 1, 2020. We examined the association between early (ICU days 1-2) versus late (ICU days 3-7) initiation of IMV and time-to-death. Patients were followed until the first of hospital discharge, death, or 90 days. We adjusted for confounding using a multivariable Cox …

Cancer-Associated Pyroptosis: A New License To Kill Tumor, Qing Kong, Zhibin Zhang

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Pyroptosis is a programmed necrotic cell death mediated by pore-forming Gasdermin (GSDM) proteins. After being unleashed from the C-terminal auto-inhibitory domains by proteolytic cleavage, the N-terminal domains of GSDMs oligomerize and perforate on the plasma membrane to induce cytolytic pyroptosis, releasing immune mediators and alarming the immune system. Upon infection or danger signal perception, GSDMD that functions downstream of the inflammasome, a supramolecular complex for inflammatory caspase activation, is cleaved and activated by inflammasome-activated caspase-1/4/5/11 in immune cells and epithelial cells to trigger pyroptosis and exert anti-infection protection. Unlike this inflammasome-activated pyroptosis (IAP), recent studies also suggest an emerging role …

Combining Small Angle X-Ray Scattering (Saxs) With Protein Structure Predictions To Characterize Conformations In Solution, Naga Babu Chinnam, Aleem Syed, Greg L Hura, Michal Hammel, John A Tainer, Susan E Tsutakawa

Faculty, Staff and Student Publications

Accurate protein structure predictions, enabled by recent advances in machine learning algorithms, provide an entry point to probing structural mechanisms and to integrating and querying many types of biochemical and biophysical results. Limitations in such protein structure predictions can be reduced and addressed through comparison to experimental Small Angle X-ray Scattering (SAXS) data that provides protein structural information in solution. SAXS data can not only validate computational predictions, but can improve conformational and assembly prediction to produce atomic models that are consistent with solution data and biologically relevant states. Here, we describe how to obtain protein structure predictions, compare them …

Unveiling The Noncanonical Activation Mechanism Of Cdks: Insights From Recent Structural Studies, Tao Li, Hui-Chi Tang, Kuang-Lei Tsai

Faculty, Staff and Student Publications

The Cyclin-dependent kinases (CDKs) play crucial roles in a range of essential cellular processes. While the classical two-step activation mechanism is generally applicable to cell cycle-related CDKs, both CDK7 and CDK8, involved in transcriptional regulation, adopt distinct mechanisms for kinase activation. In both cases, binding to their respective cyclin partners results in only partial activity, while their full activation requires the presence of an additional subunit. Recent structural studies of these two noncanonical kinases have provided unprecedented insights into their activation mechanisms, enabling us to understand how the third subunit coordinates the T-loop stabilization and enhances kinase activity. In this …

Radiotherapy Reimagined: Integrating Nanomedicines Into Radiotherapy Clinical Trials, Allison N Duross, Jack Phan, Alexander J Lazar, Joshua M Walker, Alexander R Guimaraes, Carole Baas, Sunil Krishnan, Charles R Thomas, Conroy Sun, Alexander F Bagley

Faculty, Staff and Student Publications

Radioenhancing nanoparticles (NPs) are being evaluated in ongoing clinical trials for various cancers including head and neck, lung, esophagus, pancreas, prostate, and soft tissue sarcoma. Supported by decades of preclinical investigation and recent randomized trial data establishing clinical activity, these agents are poised to influence future multimodality treatment paradigms involving radiotherapy. Although the physical interactions between NPs and ionizing radiation are well characterized, less is known about how these agents modify the tumor microenvironment, particularly regarding tumor immunogenicity. In this review, we describe the key multidisciplinary considerations related to radiation, surgery, immunology, and pathology for designing radioenhancing NP clinical trials. …

Robot-Assisted Resection Of Left Ventricular Papillary Fibroelastoma Arising From The Mitral Chordal Apparatus, Kyle G Mitchell, Blaz Podgorsek, Diego E Fiorito, Juan A Abreu, Danny Ramzy

Faculty, Staff and Student Publications

The application of robot-assisted thoracoscopy to cardiac surgery affords an opportunity to leverage the exceptional intraoperative exposure, visualization, and dexterity of the robotic platform. Here, we report the case of a 72-year-old woman who presented to our institution for evaluation of a left ventricular mass that was identified following workup for an embolic event. We present an intraoperative video that provides technical details of the robot-assisted resection of the lesion, which was found to be a left ventricular papillary fibroelastoma arising from the mitral chordal apparatus. This case highlights the advantages provided by the robotic platform, which permitted complete, minimally …

Open Treatments For Thoracoabdominal Aortic Aneurysm Repair, Akiko Tanaka, Holly N Smith, Hazim J Safi, Anthony L Estrera

Faculty, Staff and Student Publications

Thoracoabdominal aortic aneurysms (TAAA) represent a unique pathology that is associated with considerable mortality if untreated. While the advent of endovascular technologies has introduced new modalities for consideration, the mainstay of TAAA treatment remains open surgical repair. However, the optimal conduct of open TAAA repair requires careful consideration of patient risk factors and a collaborative team effort to mitigate the risk of perioperative complications. In this chapter, we briefly outline the history of treating TAAA, preoperative preparation and postoperative care, and our operative techniques for treatment.

Addition Of Aspirin To Venous Thromboembolism Chemoprophylaxis Safely Decreases Venous Thromboembolism Rates In Trauma Patients, Daniel Lammers, Michelle Scerbo, Annamaria Davidson, Matthew Pommerening, Jeffrey Tomasek, Charles E Wade, Jessica Cardenas, Jan Jansen, Charles C Miller, John B Holcomb

Faculty, Staff and Student Publications

Background: Trauma patients exhibit a multifactorial hypercoagulable state and have increased risk of venous thromboembolism (VTE). Despite early and aggressive chemoprophylaxis (CP) with various heparin compounds ("standard" CP; sCP), VTE rates remain high. In high-quality studies, aspirin has been shown to decrease VTE in postoperative elective surgical and orthopedic trauma patients. We hypothesized that inhibiting platelet function with aspirin as an adjunct to sCP would reduce the risk of VTE in trauma patients.

Methods: We performed a retrospective observational study of prospectively collected data from all adult patients admitted to an American College of Surgeons Level I Trauma center from …

Initial Thoracic Endovascular Aortic Repair Vs Medical Therapy For Acute Uncomplicated Type B Aortic Dissection, E Hope Weissler, Oyomoare L Osazuwa-Peters, Melissa A Greiner, N Chantelle Hardy, Panagiotis Kougias, Sean M O'Brien, Daniel B Mark, W Schuyler Jones, Eric A Secemsky, Andrew M Vekstein, Sherene Shalhub, Firas F Mussa, Manesh R Patel, Sreekanth Vemulapalli

Faculty, Staff and Student Publications

IMPORTANCE: Thoracic endovascular aortic repair (TEVAR) has increasingly been used for uncomplicated type B aortic dissection (uTBAD) despite limited supporting data.

OBJECTIVE: To assess whether initial TEVAR following uTBAD is associated with reduced mortality or morbidity compared with medical therapy alone.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study included Centers for Medicare & Medicaid Services inpatient claims data for adults aged 65 years or older with index admissions for acute uTBAD from January 1, 2011, to December 31, 2018, with follow-up available through December 31, 2019.

EXPOSURES: Initial TEVAR was defined as TEVAR within 30 days of admission for acute …

Diagnostic Challenges And Prognostic Implications Of Extranodal Extension In Head And Neck Cancer: A State Of The Art Review And Gap Analysis, Christina E Henson, Ahmad K Abou-Foul, Daniel J Morton, Lachlan Mcdowell, Sujith Baliga, James Bates, Anna Lee, Pierluigi Bonomo, Petr Szturz, Paul Nankivell, Shao Hui Huang, William M Lydiatt, Brian O'Sullivan, Hisham Mehanna

Faculty, Staff and Student Publications

Extranodal extension (ENE) is a pattern of cancer growth from within the lymph node (LN) outward into perinodal tissues, critically defined by disruption and penetration of the tumor through the entire thickness of the LN capsule. The presence of ENE is often associated with an aggressive cancer phenotype in various malignancies including head and neck squamous cell carcinoma (HNSCC). In HNSCC, ENE is associated with increased risk of distant metastasis and lower rates of locoregional control. ENE detected on histopathology (pathologic ENE; pENE) is now incorporated as a risk-stratification factor in human papillomavirus (HPV)-negative HNSCC in the eighth edition of …