Medicine and Health Sciences Commons^™

Progression Of Gestational Subclinical Hypothyroidism And Hypothyroxinemia To Overt Hypothyroidism After Pregnancy: Pooled Analysis Of Data From Two Randomized Controlled Trials, Michael W Varner, Lisa Mele, Brian M Casey, Alan M Peaceman, Uma M Reddy, Ronald J Wapner, John M Thorp, George R Saade, Alan T N Tita, Dwight J Rouse, Baha M Sibai, Maged M Costantine, Brian M Mercer, Steve N Caritis, Eunice Kennedy Shriver National Institute Of Child Health And Human Development Maternal-Fetal Medicine Units Network, Bethesda, Md, Usa

Faculty, Staff and Student Publications

Background: To examine the incidence of overt hypothyroidism 1 and 5 years after pregnancies where screening before 21 weeks identified subclinical hypothyroidism (SH) or hypothyroxinemia (HT). Methods: Secondary analysis of two multicenter treatment trials for either SH or HT diagnosed between 8 and 20 weeks gestation. Current analyses focus only on individuals randomized to the placebo groups in the two parallel studies. SH was diagnosed with thyrotropin (TSH) ≥4.0 mU/L and normal free T4 (fT4) (0.86-1.9 ng/dL). HT was diagnosed with normal TSH (0.08-3.99 mU/L) but fT4 < 0.86 ng/dL. Serum from initial testing was stored for later thyroid peroxidase (TPO) antibody assay; results were not returned for clinical management. At 1 and 5 years after delivery, participants were asked whether they had either been diagnosed with or were being treated for a thyroid condition. Maternal serum was collected at these visits and thyroid function measured. Subsequent overt hypothyroidism was defined as TSH ≥4.0 mU/L with fT4 < 0.86 ng/dL. Results: Data for 1- and 5-year follow-up were available in 307 of the …

Distal Metaphyseal Ulnar Shortening Osteotomy Fixation: A Biomechanical Analysis, Christopher S Frey, Joanne Y Zhou, Kalpit N Shah, Calvin K Chan, Lauren Joseph, Hunter Storaci, Nicole Segovia, Jeffrey Yao

Faculty, Staff and Student Publications

Purpose: Ulnar shortening osteotomy can be used to treat ulnar impaction syndrome and other causes of ulnar wrist pain. Distal metaphyseal ulnar shortening osteotomy (DMUSO) is one technique that has been proposed to reduce the complications seen with a diaphyseal USO or a wafer resection. However, to our knowledge, the optimal fixation construct for DMUSO has not been studied. We sought to characterize the biomechanical stiffness and rotational stability of different DMUSO constructs.

Methods: A DMUSO was performed on 40 human cadaveric ulnas using 4 different fixation constructs (10 specimens per group): one 3.0 mm antegrade screw; two 2.2 mm …

Characteristics Of Medically Attended Influenza Infection Across Age Groups Before The Covid-19 Pandemic In Lebanon, Amani Haddara, Zeina Houry, Nada Zahreddine, Mark Atallah, Celina F Boutros, Joseph Tannous, Christian Sadaka, Sarah Wehbe, Tamara Kadi, Ahmad Ibrahim, Rihab Ahmadieh, Tala Kardas, Nadia Soudani, Habib Al Kalamouni, Youssef Zgheib, Noha El Yaman, Sarah Khafaja, Mireille Lteif, Rouba Shaker, Aia Assaf Casals, Yolla Youssef, Nour Youssef, Zeinab El Zein, Sarah Chamseddine, Ahmad Chmaisse, Magda Haj, Danielle Fayad, Shereen Kiblawi, Imad Isaac, Hind Anan, Najwa Radwan, Rima Hanna Wakim, Hassan Zaraket, Souha S Kanj, Ghassan S Dbaibo

Faculty, Staff and Student Publications

Background: Influenza represents a significant global health burden for individuals and society. This study assessed the burden of medically attended influenza at a tertiary medical center in Lebanon to describe the demographics, risk factors, and outcomes prior to the COVID-19 pandemic.

Methods: This was a retrospective review of patients who tested positive for the influenza virus during three seasons between July 1, 2016 to June 30, 2019, at the American University of Beirut Medical Center.

Results: A total of 2049 patients who tested positive for influenza were analyzed. Influenza A accounted for 79.6 % of cases, and influenza B for …

Biomechanical Analysis Of Age-Dependent Changes In Fontan Power Loss, A Sahni, L Marshall, M A Cetatoiu, J Davee, N Schulz, E R Eickhoff, N St Clair, S Ghelani, A Prakash, P E Hammer, D M Hoganson, P J Del Nido, R H Rathod, Vijay Govindarajan

Faculty, Staff and Student Publications

The hemodynamics in Fontan patients with single ventricles rely on favorable flow and energetics, especially in the absence of a subpulmonary ventricle. Age-related changes in energetics for extracardiac and lateral tunnel Fontan procedures are not well understood. Vorticity (VOR) and viscous dissipation rate (VDR) are two descriptors that can provide insights into flow dynamics and dissipative areas in Fontan pathways, potentially contributing to power loss. This study examined power loss and its correlation with spatio-temporal flow descriptors (vorticity and VDR). Data from 414 Fontan patients were used to establish a relationship between the superior vena cava (SVC) to inferior vena …

The Geriatric Trauma Hospitalist Service: An Analysis Of A Management Strategy For Injured Older Adults, Heather R Kregel, Claudia Pedroza, Fatimah Sunez, Gina Khraish, Ezenwa Onyema, David E Meyer, Sasha D Adams, Lillian S Kao, Laura J Moore, Thaddeus J Puzio

Faculty, Staff and Student Publications

Background: Management of geriatric trauma patients requires balancing chronic comorbidities with acute injuries. We developed a care model in which patients are managed by hospitalists with trauma-centered education and hypothesized that clinical outcomes would be similar to outcomes in patients primarily managed by trauma surgeons.

Methods: This was a retrospective study of trauma patients aged ≥65 from January 2020 to December 2021. Groups were defined by admitting service: trauma surgery service (TSS) or geriatric trauma hospitalist service (GTHS). The primary outcome was in-hospital mortality. Regression analyses and inverse probability treatment weighted (IPTW) propensity score (PS) analyses were performed to determine …

Four Important Questions About Between-Hospital Differences In Care At <25 Weeks' Gestation, Matthew A Rysavy, Ashley N Battarbee, Kelly S Gibson

Faculty, Staff and Student Publications

No abstract provided.

Standardized Therapies After Ecmo Program (Step); A Novel Approach To Pediatric Post-Ecmo Care, Rebekah K H Shappley, Christen M Holder, Constance E Poplos, Pilar Anton-Martin, Thomas Spentzas, Toni M Whitaker, Swati Karmarkar, Samir H Shah, Hitesh S Sandhu

Faculty, Staff and Student Publications

Background: The study objective was to characterize compliance with Standardized Therapy after ECMO Program (STEP), an intentional discharge pathway for extracorporeal membrane oxygenation (ECMO) survivors in a US pediatric hospital.

Methods: The program identified pediatric ECMO survivors before discharge, appropriate consultations were reviewed and requested, families were educated on ECMO sequelae, and ECMO summaries were sent to pediatricians. Compliance with institutional post-ECMO guidelines was evaluated before and after STEP implementation.

Results: We identified 77 ECMO survivors to hospital discharge (36 [46.8%] before and 41 [53.2%] after STEP implementation). There was a significant increase in complete (38.8% vs. 74.2%, p < 0.001) and time-appropriate neurodevelopmental testing (71.4% vs. 95.6%, p = 0.03). Significant increase in inpatient evaluations by neurology (52.7% vs. 75.6%, p = 0.03) and audiology (66.7% vs. 87.8%, p = 0.02), and in referrals for outpatient audiology (66.6 vs. 95.1%, p = 0.002), physical therapy (P.T.) (63.8% vs. 95.1%, p = 0.001), occupational therapy (O.T.) (63.8% vs. 95.1%, p = 0.001) and speech-language pathology (S.L.P.) (55.5% vs. 95.1%, p < 0.001) were noted.

Conclusion: …

Surgical Necrotizing Enterocolitis And Spontaneous Intestinal Perforation Lead To Severe Growth Failure In Infants, Allison L Speer, Kevin P Lally, Claudia Pedroza, Yuxin Zhang, Brenda B Poindexter, Walter J Chwals, Susan R Hintz, Gail E Besner, David K Stevenson, Robin K Ohls, William E Truog, Barbara J Stoll, Matthew A Rysavy, Abhik Das, Jon E Tyson, Martin L Blakely

Faculty, Staff and Student Publications

Objective: We aimed to determine the incidence of growth failure in infants with necrotizing enterocolitis (NEC) or spontaneous intestinal perforation (SIP) and whether initial laparotomy versus peritoneal drainage (PD) impacted the likelihood of growth failure.

Summary background data: Infants with surgical NEC and SIP have high mortality, and most have neurodevelopmental impairment and poor growth. Existing literature on growth outcomes for these infants is limited.

Methods: This is a preplanned secondary study of the Necrotizing Enterocolitis Surgery Trial dataset. The primary outcome was growth failure (Z-score for weight < -2.0) at 18 to 22 months. We used logistic regression, including diagnosis and treatment, as covariates. Secondary outcomes were analyzed using the Fisher exact or Pearson χ2 test for categorical variables and the Wilcoxon rank sum test or one-way ANOVA for continuous variables.

Results: Among 217 survivors, 207 infants (95%) had primary outcome data. Growth …

Bioengineering Of Intestinal Grafts, Madushani Herath, Allison L Speer

Faculty, Staff and Student Publications

Intestinal failure manifests as an impaired capacity of the intestine to sufficiently absorb vital nutrients and electrolytes essential for growth and well-being in pediatric and adult populations. Although parenteral nutrition remains the mainstay therapeutic approach, the pursuit of a definitive and curative strategy, such as regenerative medicine, is imperative. Substantial advancements in the field of engineered intestinal tissues present a promising avenue for addressing intestinal failure; nevertheless, extensive research is still necessary for effective translation from experimental benchwork to clinical bedside applications.

Concordance Of Her2 Expression In Paired Primary And Metastatic Sites Of Endometrial Serous Carcinoma And The Effect Of Intratumoral Heterogeneity, Francis Hong Xin Yap, Yancey Wilson, Joanne Peverall, Benhur Amanuel, Ben Allanson, Sukeerat Ruba

Research outputs 2022 to 2026

Primary endometrial serous carcinoma, known for its aggressive nature and poor prognosis, shares similarities with breast and gastric cancers in terms of potential HER2 overexpression as a therapeutic target. Assessing HER expression is complicated by tumor heterogeneity and discrepancies between primary and metastatic sites. In this study, we retrospectively analyzed HER amplification and expression in 16 pairs of primary endometrial serous carcinoma resections and corresponding metastases. HER2 status was determined using immunohistochemistry (IHC), with criteria based on the percentage and intensity of tumor cell staining. Confirmatory techniques, such as dual in situ hybridization (DISH) and fluorescence in situ hybridization (FISH), …

The Influence Of Individual Factors On The Career Preferences And Specialty Choices Of Final-Year Nursing Students, Edah Anyango, Irene Ngune, Janie Brown, Esther Adama

Research outputs 2022 to 2026

Background: Statistical evidence shows that nursing students prefer a professional career in hospital settings, leading to a lack of career interest in non-hospital settings such as community and residential aged care facilities. The lack of preference for non-hospital settings has persisted over several decades and presents a need for different approaches that may reveal new information to better understand the individual factors that influence specialty choices and preferences from the students' viewpoints. Purpose: The aims of this study were to (1) explore individual factors that impact the nursing specialty choices of final-year nursing students and (2) explore how these factors …

Preliminary Assessment Of Tunic Off-Gassing After Wildland Firefighting Exposure, Kiam Padamsey, Adelle Liebenberg, Ruth Wallace, Jacques Oosthuizen

Research outputs 2022 to 2026

Evidence has previously shown that outer tunics (turnout coats) worn by firefighters at structural fires are contaminated with harmful chemicals which subsequently off-gas from the material. However, there is limited research on whether this phenomenon extends to wildland firefighter uniforms. This pilot study aimed to explore if the tunics of volunteer bushfire and forestry firefighters in Western Australia off-gas any contaminants after exposure to prescribed burns or bushfires, and whether there is a need to explore this further. Nine tunics were collected from firefighters following nine bushfire and prescribed burn events, with a set of unused tunics serving as a …

Decoding The Molecular Symphony: Interactions Between The M6a And P53 Signaling Pathways In Cancer, Rachel Shoemaker, Mo-Fan Huang, Ying-Si Wu, Cheng-Shuo Huang, Dung-Fang Lee

Faculty, Staff and Student Publications

The p53 tumor suppressor gene governs a multitude of complex cellular processes that are essential for anti-cancer function and whose dysregulation leads to aberrant gene transcription, activation of oncogenic signaling and cancer development. Although mutations can occur at any point in the genetic sequence, missense mutations comprise the majority of observed p53 mutations in cancers regardless of whether the mutation is germline or somatic. One biological process involved in both mutant and wild-type p53 signaling is the N6-methyladenosine (m6A) epitranscriptomic network, a type of post-transcriptional modification involved in over half of all eukaryotic mRNAs. Recently, a significant number of …

An Exploration Of Low Back Beliefs Of Male Pre-Professional And Professional Dancers, Isaac Campbell, Robyn Fary, Luke Hopper, Danica Hendry

Research outputs 2022 to 2026

Background: Globally, male dancers are affected by low back pain (LBP) up to 2.5 times more than female dancers. While female dancers’ beliefs around LBP and dance-specific low back movements exist, no research has explored male dancers’ beliefs. This study aimed to (1) examine the low back beliefs of Australian male professional and pre-professional dancers, and (2) determine if beliefs toward common low back movements and lifting differed when current LBP or history of disabling LBP (DLBP) were considered. Methods: 40 male dancers (mean age [SD] 26.9 years [7.9]) from a range of dance backgrounds (all participating in ballet) were …

Clinician's Perspectives On The Feasibility Of Patient Controlled Analgesia In Emergency Departments: A Qualitative Descriptive Study, Natasya Raja Azlan, Caroline Bulsara, Leanne Monterosso, Max Bulsara, Gail Ross-Adjie

Research outputs 2022 to 2026

Background: Despite pain being the most common reason for patients to visit the emergency department (ED), conventional pain management methods are often inadequate. Patient controlled analgesia (PCA), which allows patients to self-administer intravenous analgesia, is widely used across many hospital wards, however, is not routinely used in ED. We aimed to identify clinicians’ perceptions of PCA use in the ED setting. Methods: A qualitative descriptive approach was employed using semi-structured individual interviews conducted with ED clinicians from two hospitals in Western Australia. Interviews were recorded and transcribed. Data was analysed using qualitative content analysis. Results: Data saturation was achieved after …

Effect Of Maternal Prebiotic Supplementation On Human Milk Immunological Composition: Insights From The Symba Study, Nivedithaa Divakara, Zac Dempsey, Chitra Saraswati, Johan Garssen, Desiree Silva, Jeffrey A. Keelan, Claus T. Christophersen, Matthew N. Cooper, Susan L. Prescott, Debra J. Palmer, Valerie Verhasselt, Patricia Macchiaverni

Research outputs 2022 to 2026

Background: Immunomodulatory proteins in human milk (HM) can shape infant immune development. However, strategies to modulate their levels are currently unknown. This study investigated whether maternal prebiotic supplementation alters the levels of immunomodulatory proteins in HM.

Methods: The study was nested within the SYMBA double-blind randomized controlled trial (ACTRN12615001075572), which investigated the effects of maternal prebiotic (short-chain galacto-oligosaccharides/long-chain fructo-oligosaccharides) supplementation from <21 weeks gestation during pregnancy until 6 months postnatal during lactation on child allergic disease risk. Mother–child dyads receiving prebiotics (n = 46) or placebo (n = 54) were included in this study. We measured the levels of 24 immunomodulatory proteins in HM collected at 2, 4, and 6 months.

Results: Cluster analysis showed that the overall immunomodulatory protein composition of milk samples from both groups was similar. At 2 months, HM of prebiotic-supplemented women had decreased levels of TGF-β1 and TSLP (95% CI: −17.4 [−29.68, −2.28] and −57.32 …

Hla-A01 And Hla-B27 Supertypes, But Not Hla Homozygocity, Correlate With Clinical Outcome Among Patients With Non-Small Cell Lung Cancer Treated With Pembrolizumab In Combination With Chemotherapy, Afaf Abed, Anna Reid, Ngie Law, Michael Millward, Elin S. Gray

Research outputs 2022 to 2026

Introduction: Maximal heterozygosity on the human leukocyte antigen (HLA) loci has been found to be associated with improved survival and development of immune-related adverse events (irAEs) among NSCLC patients treated with immunotherapy. Here, we investigated the effect of germline HLA-I/-II on clinical outcomes among NSCLC patients treated with first-line pembrolizumab in combination with chemotherapy. Method: We prospectively recruited patients with NSCLC who were commencing first-line pembrolizumab in combination with chemotherapy. DNA from white blood cells was used for high-resolution HLA-I/II typing. Results: Of the 65 patients recruited, 53 complied with the inclusion criteria. We did not find an association between …

Avoiding The Pitfalls Of The Dsm-5: A Primer For Health Professionals, Darren Haywood, David J. Castle, Nicolas H. Hart

Research outputs 2022 to 2026

The Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5), is the leading system guiding the diagnosis of mental disorders. Accurate diagnoses of mental disorders are fundamental to guiding treatment and supportive care and have potential impacts on resources available to individuals. However, the DSM has the allure of ‘tick box’ diagnosis rather than biopsychosocial formulation and treatment planning, as well as multiple limitations impacting validity. Further, even with accurate diagnosis, there are strong concerns related to the reliability and validity of DSM diagnoses for clinical practice and research efforts. Understanding these limitations can help reduce errors and sub-optimal clinical decisions, …

Effects Of Increased Nitrate Intake From Beetroot Juice On Blood Markers Of Oxidative Stress And Inflammation In Older Adults With Hypertension, Rebeka Fejes, Nina Pilat, Martin Lutnik, Stefan Weisshaar, Anna M. Weijler, Karsten Krüger, Agnes Draxler, Laura Bragagna, Jonathan M. Peake, Richard J. Woodman, Kevin D. Croft, Catherine P. Bondonno, Jonathan M. Hodgson, Karl Heinz Wagner, Michael Wolzt, Oliver Neubauer

Research outputs 2022 to 2026

Background: Vascular oxidative stress and low-grade inflammation are important in the pathology of cardiovascular disorders, including hypertension. Cell culture and animal studies suggest that inorganic dietary nitrate may attenuate oxidative stress and inflammation through nitric oxide (NO), and there is a need to investigate whether this translates to humans. Aim: In this randomised, placebo-controlled crossover study, by measuring a combination of multiple blood biomarkers, we evaluated whether previously reported benefits of dietary nitrate translate to a reduced oxidative stress and an improved inflammation status in 15 men and women (age range: 56–71 years) with treated hypertension. Methods: We investigated the …

Recruitment Of Cxcr4+Type 1 Innate Lymphoid Cells Distinguishes Sarcoidosis From Other Skin Granulomatous Diseases, S. Sati, J. Huang, A.E. Kersh, P. Jones, O. Ahart, C. Murphy, S.M. Prouty, M.L. Hedberg, V. Jain, S.G. Gregory, Leung, Denis H. Y., J.T. Seykora, M. Rosenbach, T.H. Leung

Research Collection School Of Economics

Sarcoidosis is a multiorgan granulomatous disease that lacks diagnostic biomarkers and targeted treatments. Using blood and skin from patients with sarcoid and non-sarcoid skin granulomas, we discovered that skin granulomas from different diseases exhibit unique immune cell recruitment and molecular signatures. Sarcoid skin granulomas were specifically enriched for type 1 innate lymphoid cells (ILC1s) and B cells and exhibited molecular programs associated with formation of mature tertiary lymphoid structures (TLSs), including increased CXCL12/CXCR4 signaling. Lung sarcoidosis granulomas also displayed similar immune cell recruitment. Thus, granuloma formation was not a generic molecular response. In addition to tissue-specific effects, patients with sarcoidosis …

Impact Of Sars-Cov-2 (Covid-19) Infections On Mental Health Diagnoses In Youth With Chronic Illness, Molly Mcvoy, Rina Hung, Irina Bransteter, David W. Miller, Jeffrey A. Dusek, Martha Sajatovic

Faculty Scholarship

Objective: Stressors from the COVID-19 pandemic and limited availability of mental health care services have negatively impacted youth mental health in a significant way. In the first year of the pandemic, global prevalence of anxiety and depression increased by roughly 25% in pediatric populations. While the general trend is clear, this research aimed to explore the added mental health burden of acute COVID-19 on pediatric patients with chronic conditions and describe the differences in mental health outcomes between pediatric patients with 2 common chronic conditions (asthma and diabetes) to better understand specific factors that may increase susceptibility to mental health …

Trifarotene Alleviates Skin Photoaging Injury By Inhibition Of Jnk/C-Jun/Mmps, Xuan Fei, Lele Zixin Yang, Jingjing Zhang, Xiang Li, Mengtian Pan, Guangchen Xu, Cuixia Zhang, Fei Liu, Weirong Fang

Student Papers, Posters & Projects

Long-term exposure to ultraviolet (UV) radiation induces skin photoaging, which manifests as oxidative stress, inflammation, and collagen degradation. Multiple approaches (topical or systemic retinoids, antioxidants, alpha-hydroxy acids, laser, surgery) are used in the treatment of photoaged skin, and the use of topical retinoids is currently a primary clinical treatment. Previous studies revealed that retinoic acid promotes keratinocyte proliferation and reduces melanin deposition and matrix metalloproteinase (MMP) secretion; it also causes potential allergic and inflammatory damage to the skin. This study aimed to investigate the therapeutic effects and mechanisms of trifarotene, a functional retinoic acid analog, on UV-irradiated photoaging ICR and …

Spatio-Temporal Patterns Of Heat Index And Heat-Related Emergency Medical Services (Ems), Kijin Seong, Junfeng Jiao, Akhil Mandalapu, Dev Niyogi

Research Collection College of Integrative Studies

Despite growing concerns about heat waves due to climate change and their health impacts, there has been limited research on patterns of extreme heat during summertime and their association with heat-related Emergency Medical Services (EMS) incidents. This study examines spatiotemporal patterns of the heat index (HI) and its relationship to heat-related EMS incidents in Austin-Travis County, Texas, focusing on the summers of 2020 and 2021. Collecting 47,838 heat-related EMS incidence cases and aggregating them at the tract level (N = 290), the research employs spatiotemporal analysis, spatial autocorrelation, K-means clustering, and geographically weighted Poisson regression to identify disparities in heat-related …

A Visit To The U.P.: The 106th Annual Upper Peninsula Dental Meeting, Elizabeth Knudsen Dds

The Journal of the Michigan Dental Association

The Cloverland District Dental Society hosted its 106th annual meeting in Gladstone, Michigan. The event included continuing education, guest speakers, a business meeting, and social activities. The meeting also featured student involvement and discussions about rural dentistry. The next meeting will be held on Mackinac Island in June 2025.

U-M School Of Dentistry: Collaborating With Michigan’S Dentists To Move The Profession Always Forward, Jacques E. Nör Dds, Ms, Phd

The Journal of the Michigan Dental Association

Completing his first year as dean of the University of Michigan School of Dentistry Dr. Nor highlights the importance of community-based learning in dental education. Students gain valuable experience through rotations at various clinics across Michigan, including those serving underserved populations. The dean emphasizes the generosity of dentists who mentor students and the importance of the Oath of Aspiring Dentists. The Commission on Dental Accreditation completed its site visit at our school in March. Its findings identified numerous strengths during the formal review that American dental schools must complete every seven years. Demographic data on the incoming class of 2028 …

Exploit The Potential Clinical Benefit Of Using Proton Arc Therapy For Esophageal Cancer, Peilin Liu, Xiaoda Cong, Raymond Dalfsen, Martin Soukup, James E. Dolan, Shupeng Chen, Craig Stevens, Rohan Deroniyagala, Xiaoqiang Li, Xuanfeng Ding

Conference Presentation Abstracts

No abstract provided.

Quantitative Evaluation Of Gantry Rotation Perturbation Effects On Spot-Scanning Arc Therapy (Sparc), Peilin Liu, Lewei Zhao, Gang Liu, Xiaoda Cong, Xiaoqiang Li, Xuanfeng Ding

Conference Presentation Abstracts

Purpose: To quantitatively assess the impact of random gantry rotation perturbations on spot-scanning arc (SPArc) therapy.

Methods:

To simulate random gantry rotation perturbations, the initial gantry angle of SPArc treatment plans was modified using an in-house script. Four cases from different disease sites include brain, lung, liver and prostate were selected to evaluate. Original SPArc plans (SPArc_org) were developed through iterative processes, including control point re-sampling, redistribution of control points & energy layers, energy layer filtration, and re-sampling. Considering potential limitations, rotation perturbations of 1mm and 2mm were applied to al SPArc_org plans to generate perturbed SPArc …

Complex Multi-Site Stereotactic Body Re-Irradiation With Ct-Guided Online Adaptive Radiotherapy, Domenic Sievert, Alden D'Souza, Xiaodong Zhao, Michael T. Prusator, Tom Mazur, Hyun Kim, Dean Hobbis

2020-Current year OA Pubs

Online adaptive radiotherapy optimizes a patient's treatment plan to their daily anatomy to account for inter-fraction motion. Daily target and organ-at-risk (OAR) delineation allows for optimized treatments and has been shown to have favorable outcomes in the abdominal region. Adaptive radiotherapy also has the potential to support fine control of dose in re-irradiation to OARs. Herein, we describe a complex multi-site re-irradiation case utilizing CT-guided adaptive radiotherapy. A 46-year-old man with metastatic hepatocellular carcinoma presented for re-irradiation of four metastatic lesions to the right acetabulum, T11, S2, and a gastrosplenic lymph node (gsLN). The right acetabulum, T11, and S2 lesions …

Single-Isocenter, Multiple-Target Abdominal Cone-Beam Computed Tomography (Cbct)-Guided Online Adaptive Stereotactic Body Radiotherapy (Sbrt), Chipo Raranje, Thomas R. Mazur, Allen Mo, Eric Laugeman

2020-Current year OA Pubs

Stereotactic body radiotherapy (SBRT) is increasingly being prescribed for treating patients with multiple metastases, especially in the setting of oligometastatic disease. Treating multiple targets presents unique challenges in radiotherapy planning and delivery, including practical considerations relating to treatment time, resource allocation, and treatment planning complexity. Treating targets in a common isocenter reduces the time required for treatment and simplifies planning, but historically, it has often not been feasible due to inter- and intra-fractional variation in relative target positions. With online adaptation, individual targets can be re-contoured on each treatment fraction to obviate inter-fractional variation, and with appropriate margin selection intra-fractional …

Manifested U-Waves Prior To Seizure Attacks In A Patient Who Had Remote Subarachnoid Hemorrhage: A Case Report, Nao Kaneko, Masao Watanabe, Shusuke Mori, Isik Turker, Ken Okamoto, Takao Urabe, Tomohiko Ai

2020-Current year OA Pubs

Sudden unexpected death in epilepsy (SUDEP) refers to unpredictable demise of a person following a seizure. Electroencephalograms can directly measure electrical activity in the brain; however, it cannot predict when seizures will occur. The use of electrocardiograms (ECGs) to monitor changes in brain electrical activity has gained attention, recently. In this case report, we retrospectively reviewed ECGs taken before and after seizure activity in a 75-year-old male who had a remote subarachnoid hemorrhage. Interestingly, U-waves appeared prior to his seizures and disappeared afterward, which suggests ECGs can be used to predict epilepsy in a certain population.