Medical Specialties Commons^™

Patient Experience Of Head And Neck Surgery With Free Flap Reconstruction., Lillian W. Dattilo, Trinity I. Russell, Chloe B. Warinner, Heather Starmer, Donald J. Annino, Laura A. Goguen, Rosh K. V. Sethi, Ravindra Uppaluri, Melina Windon, Regan W. Bergmark, Eleni M. Rettig

Markey Cancer Center Faculty Publications

IMPORTANCE: Major head and neck surgery with microvascular free tissue transfer reconstruction is complex, with considerable risk of morbidity. Little is known about patients' experiences, including decision-making prior to, and regret following, free flap surgery.

OBJECTIVE: To characterize patient experiences and decision regret of patients undergoing head and neck reconstructive free flap surgery.

DESIGN, SETTING, AND PARTICIPANTS: This mixed-methods cohort study comprising semistructured interviews was conducted June to August 2021 at a single tertiary academic cancer center. Participants underwent head and neck reconstructive surgery with microvascular free tissue transfer (flap) more than 3 months before recruitment (range, 3 months to …

Decoding Implant-Related Sickness: Unraveling The Complexities Of Breast Implant Illness, Madison M. Stewart

Senior Theses

This thesis investigates the phenomenon of breast implant illness (BII), examining its potential correlation with individual factors such as obesity and poor lifestyle habits. BII, characterized by nonspecific symptoms, is often self-diagnosed by patients influenced by social media and internet sources, leading to requests for implant removal. Conducting a comprehensive meta-analysis, the study scrutinizes existing literature to evaluate the association between BII, obesity, and lifestyle choices. Employing inclusion criteria, peer-reviewed publications are analyzed through systematic review methodology to offer insights into the interplay between BII and adiposity, exploring inflammatory mechanisms and patient behaviors like exercise and smoking. The research aims …

The Design Of A Quality Improvement Dashboard For Monitoring Spinal Cord And Column Injuries, Zahra Azadmanjir, Mohsen Sadeghi-Naini, Mohammad Dashtkoohi, Maziar Moradi-Lakeh, Jalil Arabkheradmand, James Harrop, Vafa Rahimi-Movaghar

Department of Neurosurgery Faculty Papers

Background: Interactive dashboards are a powerful tool for dynamic visualization and monitoring of patient performance and serve as a useful to for optimal decision-making. The National Spinal Column and Cord Injury Registry of Iran (NSCIR-IR) was designed to efficiently display and broadcast important patient care data. This has been achieved through an electronic dashboard display (graph and visual displays), rather than traditional static paper reports (text). Objectives: The objective of this study was to design and develop an electronic visual dashboard as a display system to monitor the quality of care in the NSCIR-IR collaborating centers. Methods: The indicators chosen …

How Territoriality And Sociality Influence The Habitat Selection And Movements Of A Large Carnivore, K Whitney Hansen, Nathan Ranc, John Morgan, Neil R Jordan, J Weldon Mcnutt, Alan Wilson, Christopher C Wilmers

Faculty, Staff and Student Publications

While territoriality is one of the key mechanisms influencing carnivore space use, most studies quantify resource selection and movement in the absence of conspecific influence or territorial structure. Our analysis incorporated social information in a resource selection framework to investigate mechanisms of territoriality and intra‐specific competition on the habitat selection of a large, social carnivore. We fit integrated step selection functions to 3‐h GPS data from 12 collared African wild dog packs in the Okavango Delta and estimated selection coefficients using a conditional Poisson likelihood with random effects. Packs selected for their neighbors' 30‐day boundary (defined as their 95% kernel …

Identifying Age-Specific Risk Factors For Poor Outcomes After Trauma With Machine Learning, Heather R Kregel, Gabrielle E Hatton, John A Harvin, Thaddeus J Puzio, Charles E Wade, Lillian S Kao

Faculty, Staff and Student Publications

Introduction: Risk stratification for poor outcomes is not currently age-specific. Risk stratification of older patients based on observational cohorts primarily composed of young patients may result in suboptimal clinical care and inaccurate quality benchmarking. We assessed two hypotheses. First, we hypothesized that risk factors for poor outcomes after trauma are age-dependent and, second, that the relative importance of various risk factors are also age-dependent.

Methods: A cohort study of severely injured adult trauma patients admitted to the intensive care unit 2014-2018 was performed using trauma registry data. Random forest algorithms predicting poor outcomes (death or complication) were built and validated …

Cytokine Release By Microglia Exposed To Neurologic Injury Is Amplified By Lipopolysaccharide, Michael C Scott, Olivia Leblanc, Harper Day, Candice Haase, Scott D Olson, Charles S Cox

Faculty, Staff and Student Publications

Introduction: Traumatic brain injury (TBI) is a leading cause of death and morbidity in the trauma population. Microglia drive the secondary neuroinflammatory response after TBI. We sought to determine if the microglial response to neurologic injury was exacerbated by a second stimulus after exposure to neurologic injury.

Methods: Sprague-Dawley rats (age 2-3 wk) were divided into injured and noninjured groups. Injured rats underwent a controlled cortical impact injury; noninjured rats remained naïve to any injury and served as the control group. Primary rat microglia were isolated and applied to in vitro cultures. After incubation for 24 h, the microglia were …

Presentation Acuity And Surgical Outcomes For Patients With Health Insurance Living In Highly Deprived Neighborhoods, Susanne Schmidt, Michael A Jacobs, Jeongsoo Kim, Daniel E Hall, Karyn B Stitzenberg, Lillian S Kao, Bradley B Brimhall, Chen-Pin Wang, Laura S Manuel, Hoah-Der Su, Jonathan C Silverstein, Paula K Shireman

Faculty, Staff and Student Publications

Importance: Insurance coverage expansion has been proposed as a solution to improving health disparities, but insurance expansion alone may be insufficient to alleviate care access barriers.

Objective: To assess the association of Area Deprivation Index (ADI) with postsurgical textbook outcomes (TO) and presentation acuity for individuals with private insurance or Medicare.

Design, setting, and participants: This cohort study used data from the National Surgical Quality Improvement Program (2013-2019) merged with electronic health record data from 3 academic health care systems. Data were analyzed from June 2022 to August 2023.

Exposure: Living in a neighborhood with an ADI greater than 85. …

Open Repair With Latissimus Muscle Flap Coverage For Treatment Of Infected Thoracic Endovascular Aneurysm Repair, Lucas Ribé Bernal, Rana O Afifi, Anthony L Estrera

Faculty, Staff and Student Publications

A male patient, 70 years of age, was evaluated for an infected thoracic endovascular aneurysm repair (TEVAR). After presenting with persistent fever, a positron emission tomography scan found an infected aortic stent graft. The patient underwent open repair with explantation of the infected TEVAR, extensive periaortic debridement, graft replacement with a Dacron graft, and complete coverage with a latissimus dorsi muscle flap. Tissue culture revealed

Risk Factors For In-Hospital Seizure And New-Onset Epilepsy In Coiling And Clipping Treatment Of Aneurysmal Subarachnoid Hemorrhage, Viet-Thang Le, Anh Minh Nguyen, Phuc Long Nguyen

Faculty, Staff and Student Publications

OBJECTIVE: To identify risk factors associated with in-hospital seizures and new-onset epilepsy in patients with aneurysmal subarachnoid hemorrhage (SAH) who underwent coiling embolization or clipping surgery.

METHODS: This retrospective descriptive study included 195 patients diagnosed with aneurysmal SAH and treated with coiling embolization or clipping surgery between January 2018 and June 2022.

RESULTS: Among the 195 patients meeting inclusion criteria, 9 experienced an onset seizure at the time of SAH. In-hospital seizures were observed in 33 patients, of which 24 were electrographic seizures detected in 24 patients with suspected subclinical seizures. After 12 months of follow-up, 11 patients met criteria …

Effect Of Perioperative Stroke On Survival After Carotid Intervention, Tommaso Cambiaghi, Alexander Mills, Samuel Leonard, Regina Husman, Syed T Zaidi, Ezra Y Koh, Kourosh Keyhani, S Keisin Wang

Faculty, Staff and Student Publications

OBJECTIVES: Perioperative stroke is the most dreaded complication of carotid artery interventions and can severely affect patients' quality of life. This study evaluated the impact of this event on mortality for patients undergoing interventional treatment of carotid artery stenosis with three different modalities.

METHODS: Patients undergoing carotid revascularization at participating Memorial Hermann Health System facilities were captured from 2003-2022. These patients were treated with either carotid endarterectomy (CEA), transfemoral carotid stenting (TF-CAS), or transcarotid artery revascularization (TCAR). Perioperative outcomes, including stroke and mortality, as well as follow-up survival data at 6-month intervals, were analyzed and stratified per treatment modality.

RESULTS: …

Transcatheter Electrosurgical Septotomy Technique For Chronic Postdissection Aortic Aneurysms, Aidin Baghbani-Oskouei, Safa Savadi, Thomas Mesnard, Titia Sulzer, Aleem K Mirza, Shadman Baig, Carlos H Timaran, Gustavo S Oderich

Faculty, Staff and Student Publications

Aortic dissection often results in chronic aneurysmal degeneration due to progressive false lumen expansion. Thoracic endovascular aortic repair and other techniques of vessel incorporation such as fenestrated-branched or parallel grafts have been increasingly used to treat chronic postdissection aneurysms. True lumen compression or a vessel origin from the false lumen can present considerable technical challenges. In these cases, the limited true lumen space can result in inadequate stent graft expansion or restrict the ability to reposition the device or manipulate catheters. Reentrance techniques can be used selectively to assist with target vessel catheterization. Transcatheter electrosurgical septotomy is a novel technique …

Machine Learning-Enabled Maternal Risk Assessment For Women With Pre-Eclampsia (The Piers-Ml Model): A Modelling Study, Tünde Montgomery-Csobán, Kimberley Kavanagh, Paul Murray, Chris Robertson, Sarah J E Barry, U Vivian Ukah, Beth A Payne, Kypros H Nicolaides, Argyro Syngelaki, Olivia Ionescu, Ranjit Akolekar, Jennifer A Hutcheon, Laura A Magee, Peter Von Dadelszen, Piers Consortium

Faculty, Staff and Student Publications

BACKGROUND: Affecting 2-4% of pregnancies, pre-eclampsia is a leading cause of maternal death and morbidity worldwide. Using routinely available data, we aimed to develop and validate a novel machine learning-based and clinical setting-responsive time-of-disease model to rule out and rule in adverse maternal outcomes in women presenting with pre-eclampsia.

METHODS: We used health system, demographic, and clinical data from the day of first assessment with pre-eclampsia to predict a Delphi-derived composite outcome of maternal mortality or severe morbidity within 2 days. Machine learning methods, multiple imputation, and ten-fold cross-validation were used to fit models on a development dataset (75% of …

Toward Electrical Impedance Sensing Surgical Drill For Tissue Boundary Detection, Harshavardhan Devaraj

Dartmouth College Ph.D Dissertations

Dental implantation is an increasingly common procedure used to treat missing teeth. However, surgical drilling to place the implant poses a high risk of injury to critical anatomy, such as inferior alveolar nerve injury or maxillary sinus perforation. A real-time surgical feedback system sensing proximity of these critical anatomy could reduce injury risks. This dissertation investigates the development of such a system that incorporates an electrical impedance sensor into the tip of a surgical drill.

A simulation framework based on finite element method (FEM) was developed to optimize the sensor as it approached a high impedance boundary. The accuracy of …

Sphingosine-1-Phosphate Inhibition Increases Endoplasmic Reticulum Stress To Enhance Oxaliplatin Sensitivity In Pancreatic Cancer, Zachary Gao, Harinarayanan Janakiraman, Yang Xiao, Sung Wook Kang, Jiangling Dong, Jasmine Choi, Besim Ogretmen, Hyun-Sung Lee, Ernest Ramsay Camp

Faculty, Staff and Students Publications

BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) is an aggressive cancer resistant to current therapies, including oxaliplatin (Oxa). Growing evidence supports the ability of cancers to harness sphingolipid metabolism for survival. Sphingosine-1-phosphate (S1P) is an anti-apoptotic, pro-survival mediator that can influence cellular functions such as endoplasmic reticulum (ER) stress. We hypothesize that PDAC drives dysregulated sphingolipid metabolism and that S1P inhibition can enhance ER stress to improve therapeutic response to Oxa in PDAC.

METHODS: RNA sequencing data of sphingolipid mediators from The Cancer Genome Atlas (TCGA) and Genotype-Tissue Expression Project (GTEx) datasets were analyzed. Murine and human PDAC cell lines were treated …

Endovascular Covered Stent Graft Repair By Through-And-Through Snaring Of An Acute Traumatic Femoral-Femoral Arteriovenous Fistula Following A Gunshot Wound., Anthony N Rizzo, Krishna Patel, Jordyn Perdue, Jon C Henry

Trauma and Acute Care Articles

Arteriovenous fistula (AVF) formation after penetrating injury underscores a rare and challenging complication of vascular trauma. Traumatic AVFs have various clinical presentations and reported methods of repair. Although open surgical repair is the most frequently used method of repair, the advancement of endovascular techniques has been increasingly used during the past 3 decades. We report a case of an acute traumatic AVF of the superficial femoral artery and superficial femoral vein from a gunshot wound repaired with a unique endovascular technique involving snaring to establish through-and-through access to allow deployment of a covered stent graft.

Myocardial Edema, Inflammation, And Injury In Human Heart Donated After Circulatory Death Are Sensitive To Warm Ischemia And Subsequent Cold Storage, Nandan K Mondal, Shiyi Li, Abdussalam E Elsenousi, Aladdein Mattar, Camila Hochman-Mendez, Todd K Rosengart, Kenneth K Liao

Faculty, Staff and Students Publications

Background: Single-dose del Nido solution was recently used in human donation after circulatory death (DCD) heart procurement. We compared the effect of del Nido cardioplegia on myocardial edema, inflammatory response, and injury in human DCD hearts and human donation after brain death (DBD) hearts with different warm ischemic times (WIT) and subsequent cold saline storage times (CST).

Methods: A total of 24 human hearts, including 6 in the DBD group and 18 in the DCD group-were procured for the research study. The DCD group was divided into 3 subgroups based on WIT: 20, 40, and ≥60 minutes. All hearts received …

Proteoglycan Dysfunction: A Common Link Between Intervertebral Disc Degeneration And Skeletal Dysplasia, Kimheak Sao, Makarand V. Risbud

Department of Orthopaedic Surgery Faculty Papers

Proteoglycans through their sulfated glycosaminoglycans regulate cell-matrix signaling during tissue development, regeneration, and degeneration processes. Large extracellular proteoglycans such as aggrecan, versican, and perlecan are especially important for the structural integrity of the intervertebral disc and cartilage during development. In these tissues, proteoglycans are responsible for hydration, joint flexibility, and the absorption of mechanical loads. Loss or reduction of these molecules can lead to disc degeneration and skeletal dysplasia, evident from loss of disc height or defects in skeletal development respectively. In this review, we discuss the common proteoglycans found in the disc and cartilage and elaborate on various murine …

Vascular In-Person For Students In The Match Trial: An Investigation Of Postinterview Site Visits To Address The Limitations Of Virtual Interviews, David Rigberg, Brigitte K. Smith, Ting Sun, Benjamin Pearce, Misty Humphries, Malachi Sheahan, Dawn Coleman, Jason Lee

School of Medicine Faculty Publications

PURPOSE: The graduate medical education community implemented virtual residency interviews in response to travel restrictions during the COVID-19 pandemic, and this approach has persisted. Although many residency applicants wish to visit in-person prospective training sites, such opportunities could bias programs toward those who are able to meet this financial burden, exacerbating equity concerns. One proposed solution is to offer applicants the opportunity to visit only after a program's rank list is "locked," avoiding favoritism to applicants who visit, but allowing applicants to experience some of the camaraderie, geography, and local effects of an in-person visit. As debate about the optimal …

Randomized Controlled Trial Of The Cmr Immersive Virtual Reality (Ivr) Headset Training Compared To E-Learning For Operating Room Configuration Of The Cmr Versius Robot, Catherine L Eley, Varun Palaniappan, Abbie Carter, Opeyemi Sogaolu, James Horwood, Michael Davies, Jared Torkington, James Ansell

Faculty, Staff and Student Publications

Robotic surgery offers potential advantages over laparoscopic procedures, but the training for configuring robotic systems in the operating room remains underexplored. This study seeks to validate immersive virtual reality (IVR) headset training for setting up the CMR Versius in the operating room. This single-blinded randomized control trial randomised medical students with no prior robotic experience using an online randomiser. The intervention group received IVR headset training, and the control group, e-learning modules. Assessors were blinded to participant group. Primary endpoint was overall score (OS): Likert-scale 1-5: 1 reflecting independent performance, with increasing verbal prompts to a maximum score of 5, …

Reinforced Tissue Matrix To Strengthen The Abdominal Wall Following Reversal Of Temporary Ostomies Or To Treat Incisional Hernias, Spencer P Lake, Corey R Deeken, Amit K Agarwal

Faculty, Staff and Student Publications

BACKGROUND: Abdominal wall deficiencies or weakness are a common complication of temporary ostomies, and incisional hernias frequently develop after colostomy or ileostomy takedown. The use of synthetic meshes to reinforce the abdominal wall has reduced hernia occurrence. Biologic meshes have also been used to enhance healing, particularly in contaminated conditions. Reinforced tissue matrices (RTMs), which include a biologic scaffold of native extracellular matrix and a synthetic component for added strength/durability, are designed to take advantage of aspects of both synthetic and biologic materials. To date, RTMs have not been reported to reinforce the abdominal wall following stoma reversal.

AIM: To …

A Clinical Practice Guideline For The Management Of Patients With Acute Spinal Cord Injury: Recommendations On Hemodynamic Management, Brian K. Kwon, Lindsay A. Tetreault, Allan R. Martin, Paul M. Arnold, Rex A.W. Marco, Virginia F.J Newcombe, Carl M. Zipser, Stephen L. Mckenna, Radha Korupolu, Chris J. Neal, Rajiv Saigal, Nina E. Glass, Sam Douglas, Mario Ganau, Vafa Rahimi-Movaghar, James S. Harrop, Bizhan Aarabi, Jefferson R. Wilson, Nathan Evaniew, Andrea C. Skelly, Michael G. Fehlings

Department of Neurosurgery Faculty Papers

STUDY DESIGN: Clinical practice guideline development following the GRADE process.

OBJECTIVES: Hemodynamic management is one of the only available treatment options that likely improves neurologic outcomes in patients with acute traumatic spinal cord injury (SCI). Augmenting mean arterial pressure (MAP) aims to improve blood perfusion and oxygen delivery to the injured spinal cord in order to minimize secondary ischemic damage to neural tissue. The objective of this guideline was to update the 2013 AANS/CNS recommendations on the hemodynamic management of patients with acute traumatic SCI, acknowledging that much has been published in this area since its publication. Specifically, we sought …

Highlights Of The 2023 Brano Heart Failure Forum, Bela Merkely, Rajko Radovancevic, Bojan Vrtovec, Igor D. Gregoric

The VAD Journal

Since 2007, the Branislav “Brano” Radovancevic Heart Failure Forum (BHFF) has been held annually to provide a venue for experts to present and discuss “Innovations and New Treatment Strategies in Heart Failure.” Clinicians and researchers gather yearly in a different Eastern European city to discuss the latest in heart failure diagnostics and therapeutics. The 2023 BHHF forum was held on the 13^th thru 15^th of September 2023 in Budapest, Hungary. It was attended by over 100 faculty from 16 countries. In addition, participation through online streaming was available. Throughout the forum, 16 sessions focused on challenges and solutions …

Preoperative Warming To Improve Patient Outcomes: Implementation Of A Warming Protocol, Tiara Switzer-Houston

Student Scholarly Projects

Practice Problem: Inadvertent perioperative hypothermia (IPH) is noted to be the most common surgical complication. IPH is associated with a variety of complications which are known to impact the well-being of the patient, family, and healthcare system.

PICOT: The PICOT question that guided this scholarly project was scheduled for total hip and knee arthroplasty surgical procedures under general or neuraxial anesthesia greater than 60 minutes (P), how effective is the implementation of an evidence-based pre-surgical warming protocol including forced-air warming (FAW) (I) compared to current practices (C) in improving normothermia readings within 15 minutes of arriving to the PACU, …

The Association Between Robotic Lung Cancer Resection And Esophagectomy Outcomes: A Facility-Level Analysis, Micaela L. Collins, Gregory L. Whitehorn, Shale J. Mack, Brian M. Till, Hamza Rshaidat, Tyler Grenda, Nathaniel R. Evans Iii, Karen A. Chojnacki, Olugbenga T. Okusanya

Department of Neurosurgery Faculty Papers

Background: Within the field of robotic thoracic surgery, the association between facility surgical volume, conversion rates, and patient outcomes across multiple procedures has not been explored. This study aims to examine the potential association between robotic lung cancer resection surgical volume and conversion rates for robotic-assisted minimally invasive esophagectomy (RAMIE). Methods: A retrospective analysis of the National Cancer Database, between the years 2010–2018 was conducted. Facility-years were categorized into one of four groups based on a combination of robotic lung cancer resection surgical volume and RAMIE volumes. Cutoffs were based on previously identified surgical volume thresholds. Results: A total of …

Comparative Effectiveness Of Endovascular Vs Surgical Arteriovenous Fistulas: A Preliminary Analysis, Melissa M. Cruz, James J. Fitzgibbon, Patrick Heindel, Mohamad Hussain

Research Symposium

Purpose: The objective of this study was to compare the efficacy and safety of endovascular arteriovenous fistula (endoAVF) creation versus open surgical AVF (openAVF) for hemodialysis access across centers participating in the Dialysis Access Learning and Innovation Collaborative (DiAL-In Collaborative) in the United States. In this preliminary analysis, we report the baseline characteristics and clinical profile of patients enrolled at a single center.

Materials and Methods: A retrospective cohort study was conducted in chronic kidney disease patients who underwent creation of an upper arm autogenous vascular access for hemodialysis (2018-2022) at the Brigham and Women’s Hospital in Boston, MA. Data …

Use Of Flow-Through Free Flaps In Head And Neck Reconstruction, Mark A. Maier, Patrick A. Palines, Richard F. Guidry, Mark W. Stalder

School of Medicine Faculty Publications

Background: Reconstructive obstacles in composite head and neck defects are compounded in reoperated, traumatized, irradiated, and vessel-depleted surgical fields. In cases that require multiple free flaps, recipient vessel accessibility and inset logistics become challenging. Strategic flow-through flap configurations mitigate these issues by supplying arterial inflow and venous outflow to a second flap in a contiguous fashion. This approach (1) permits the use of a singular native recipient vessel, (2) increases the reach of the vascular pedicle, avoiding the need for arteriovenous grafting, and (3) allows for a greater three-dimensional flexibility in configuring soft tissue and bony flap inset. Methods: To …

Outcomes Of Hepatic Artery-Based Therapies And Systemic Multiagent Chemotherapy In Unresectable Colorectal Liver Metastases: A Systematic Review And Meta-Analysis, Henry Stitzel, Victoria Wu, David Bajor, Sakti Chakrabarti, Madison Conces, Lauren Henke, Melissa Lumish, Amit Mahipal, Amr Mohamed, Jordan M. Winter, Jeffrey M. Hardacre, John B. Ammori, Jennifer E. Selfridge, Lee M. Ocuin

Faculty Scholarship

Background: Treatment of unresectable colorectal liver metastases (UCRLM) includes locoregional and systemic therapy. A comprehensive analysis capturing long-term outcomes of these treatment options has not been performed. Objective: A systematic review and meta-analysis was performed to calculate pooled outcomes of hepatic artery infusion with systemic chemotherapy (HAI-S), transarterial chemoembolization with systemic chemotherapy (TACE-S), transarterial radioembolization with systemic chemotherapy (TARE-S), doublet (FOLFOX, FOLFIRI), and triplet chemotherapy (FOLFOXIRI). Methods: Outcomes included overall survival (OS), progression-free survival (PFS), rate of conversion to resection (CTR), and response rate (RR). Results: A total of 32, 7, 9, and 14 publications were included in the HAI-S, …

Delayed Diagnosis Of Mycobacterium Bovis Bacillus Calmette-Guérin Periprosthetic Joint Infection Following Total Knee Arthroplasty, Christopher E. Pelt, Salika Shakir, Michael J. Cahill, Jakrapun Pupaibool, Barbara C. Cahill

SKMC Student Presentations and Publications

Periprosthetic joint infection (PJI) can present challenges in diagnosis and treatment, particularly in the setting of atypical causative organisms such as fungi and mycobacteria. Herein, we present a case and provide a review of the diagnosis and treatment of an unusual PJI caused by bacillus Calmette-Guérin, administered during the treatment of bladder cancer 3 years prior to total knee arthroplasty and subsequent PJI. Although the patient's history of bladder cancer was known, neither his Bacillus Calmette-Guérin treatment nor its potential for distant site spread that could lead to PJI were appreciated, leading to a prolonged diagnostic evaluation and treatment course.

Viscosity Flow Curves Of Agar And The Bounded Ripening Growth Model Of The Gelation Onset, Vincenzo Villani

Faculty, Staff and Student Publications

The gelation kinetics of agar aqueous solutions were studied by means of the viscosity flow curves using a coaxial Couette cylinder viscometer. The viscosity curves show an unusual sigmoidal trend or an exponential decay to a viscous steady state. An original theory of gelation kinetics was developed considering the coarsening of increasingly larger and more stable clusters due to Ostwald ripening and the breakup of clusters that were too large due to the instability of rotating large particles induced by the shear rate. The developed

The Impact Of Robotic Assistance For Lumbar Fusion Surgery On 90-Day Surgical Outcomes And 1-Year Revisions, Jeremy Heard, Yunsoo Lee, Nicholas D D'Antonio, Rajkishen Narayanan, Mark Lambrechts, John Bodnar, Caroline Purtill, Joshua Pezzulo, Dominic Farronato, Pat Fitzgerald, Jose Canseco, Ian Kaye, Alan Hilibrand, Alex Vaccaro, Christopher Kepler, Gregory Schroeder

Department of Orthopaedic Surgery Faculty Papers

Objectives: To evaluate the (1) 90-day surgical outcomes and (2) 1-year revision rate of robotic versus nonrobotic lumbar fusion surgery. Methods: Patients >18 years of age who underwent primary lumbar fusion surgery at our institution were identified and propensity-matched in a 1:1 fashion based on robotic assistance during surgery. Patient demographics, surgical characteristics, and surgical outcomes, including 90-day surgical complications and 1-year revisions, were collected. Multivariable regression analysis was performed. Significance was set to P < 0.05. Results: Four hundred and fifteen patients were identified as having robotic lumbar fusion and were matched to a control group. Bivariant analysis revealed no significant difference in total 90-day surgical complications (P = 0.193) or 1-year revisions (P = 0.178). The operative duration was longer in robotic surgery (287 + 123 vs. 205 + 88.3, P ≤ 0.001). Multivariable analysis revealed that robotic fusion was not a significant predictor of 90-day surgical complications (odds ratio [OR] = 0.76 [0.32-1.67], P = 0.499) or 1-year revisions (OR = 0.58 [0.28-1.18], P = 0.142). Other variables identified as the positive predictors of 1-year revisions included levels fused (OR = 1.26 [1.08-1.48], P = 0.004) and current smokers (OR = 3.51 [1.46-8.15], P = 0.004). Conclusion: Our study suggests that robotic-assisted and nonrobotic-assisted lumbar fusions are associated with a similar risk of 90-day surgical complications and 1-year revision rates; however, robotic surgery does increase time under anesthesia.