Medical Specialties Commons^™

Multi-Institutional Modified Delphi For Genomics In Expert Consensus Survey Of Genomic Testing For Anterior Skull Base Malignancies, Anirudh Saraswathula, Shreya Sriram, Corinna Levine, Nyall R London, Shirley Y Su, Mathew Geltzeiler, Sanjeet V Rangarajan, Ian Witterick, Brian Thorp, Kathleen Kelly Gallagher, Kenneth Byrd, Ricardo Carrau, Waleed Abuzeid, Eric Wang, Carl Snyderman, Erin L Mckean

Faculty, Staff and Students Publications

Objectives: The use of genomic testing for patients with anterior skull base malignancies has grown dramatically. There are no clear guidelines on indications for testing. As the literature on the subject is still in early stages, there is a need for expert consensus. We conducted a modified Delphi expert consensus process with high-volume North American cranial base surgical programs.

Design setting participants: A modified Delphi consensus approach was used, following the method laid out by the American Academy of Otolaryngology-Head and Neck Surgery, and included 13 high-volume care centers. An otolaryngologist was appointed at each location to serve as the …

The Influence Of Preoperative Bowel Preparation On Surgical Site Infection In Pediatric Colorectal Surgery., Katlyn G. Mckay, Naomi-Liza Denning, Rebecca M. Rentea, Eunice Y. Huang

Manuscripts, Articles, Book Chapters and Other Papers

Surgical site infection (SSI) is one of the most common nosocomial infections that occur in pediatric patients in the United States, with colorectal procedures consistently demonstrating the highest rates of SSI. Strategies to reduce SSI in colorectal surgery include standardized perioperative colorectal care bundles, which commonly incorporate preoperative bowel preparation. Robust adult literature exists supporting the use of mechanical bowel preparation in combination with oral antibiotics to mitigate SSI; however, pediatric evidence remains less definitive. Current pediatric literature shows heterogeneity of bowel preparation use amongst surgeons, with existing literature consisting primarily of small retrospective studies. A well-designed pediatric randomized controlled …

The 2025 Accra Declaration On Upskilling And Cost-Effective Cardiac Surgery In Africa, Charles Yankah, Jonathan Nwiloh, Carlos Mestres, Abdelmalek Bouzid, Tom Mwambu, Andrew Duncan, Mohamed Debieche, Samuel Omokhodion, Uvie Onakpoya, Matthias Angres

General Surgery, East Africa

The Pan-African Society for Cardiothoracic Surgery (PASCaTS) organized the 1st Pan-African Cardiothoracic Surgery Summit on 21 to 24 February 2025 in Accra, Ghana. The summit brought together leading specialists from across Africa, China, Europe, South America and the USA to address the growing burden of cardiovascular disease, to share their vision for the fight against cardiovascular disease, to raise standards in the diagnosis, treatment, and recovery of patients thereby improving procedural safety and clinical outcomes in Africa. The experts agreed on the need for cost effectiveness in cardiac surgery, simulation skills training, an African regional cardiothoracic surgery database, African heart …

The Global Cancer Crisis: A Review Of Growing Burden, Deepening Inequality And Initiatives For Prevention And Early Detection, Charles Yankah, Jonathan Nwiloh, Carlos Mestres, Abdelmalek Bouzid, Tom Mwambu, Andrew Duncan, Mohamed Debieche, Samuel Omokhodion, Uvie Onakpoya, Matthias Angres

General Surgery, East Africa

Cancer constitutes one of the most urgent global health crises, with over 20 million new cases diagnosed annually worldwide, claiming 10 million lives. This devastating burden disproportionately affects vulnerable populations: 75% of cancer deaths occur in low- and middle-income countries despite these regions having lower reported incidence rates. Lung cancer leads the global toll, representing 12% of all cases but 19% of deaths, followed by breast cancer (12% of cases) and colorectal cancer (9.6%). A stark geographical inequity defines the cancer landscape—while wealthy regions such as North America, Northern Europe and Australia report the highest incidence rates, Africa and Latin …

Preoperative Malnutrition Is Associated With Increased Postoperative Complications Following Lumbar Fusion: A Propensity-Matched Analysis, Ali Mehaidli, Muaaz Wajahath, Jad Lawand, Omar Abdalla, Lorenzo Deveza, Noah Hodson, Ryan J Berger, Kevin Taliaferro

Faculty, Staff and Students Publications

Background: Lumbar fusion (LF) is a common surgical intervention for degenerative spinal conditions but carries significant short- and long-term risks. Preoperative malnutrition, characterized by low serum albumin or leukocyte counts, impairs wound healing and increases susceptibility to infection, yet its influence on LF outcomes remains underexplored. This study evaluates the association between preoperative malnutrition and long-term postoperative outcomes following LF.

Methods: Adult patients undergoing LF between 2003 and 2023 were identified in the TriNetX US Collaborative Network. Malnutrition was defined as serum albumin < 3.5 g/dL or leukocyte count < 1,500/mm3 within 1 year preoperatively. A 1:1 propensity score match was performed for demographics, comorbidities, surgical approach, and body mass index (BMI), yielding two cohorts (n=20,693 each). Ninety-day and 5‑year postoperative outcomes were compared using hazard ratios (HRs) with 95% confidence intervals (CIs).

Results: Malnourished patients experienced significantly higher 90‑day rates of transfusion (8.4% vs. 4.5%; HR 1.87, 95% CI: …

Factors Associated With Upstaging In Patients With Resectable Non-Small Cell Lung Cancer: A Modern Institutional Sample, Sneha Alaparthi, Hamza Rshaidat, Luke Meredith, Scott H. Koeneman, Christina Grindley, Jacob Heilizer, Purab Kothari, Prarthna Chandar, Tyler Grenda, Nathaniel R. Evans Iii, Olugbenga T. Okusanya

Department of Surgery Faculty Papers

BACKGROUND: There is significant value in predicting and better assessing patients who are at risk of post-surgery upstaging in lung cancer. The objective of this study is to review patients who were upstaged following resection and evaluate their clinical and demographic data to elucidate which factors portend an increased risk of pathologic upstaging at our institution (the Thomas Jefferson University Hospital).

METHODS: A retrospective review of institutional data was performed between 2011 and 2023. Patients with stage I-II non-small cell lung cancer (NSCLC) were included. Patients were excluded if they received neoadjuvant systemic therapy, including chemotherapy and/or immunotherapy, and were …

Development Of Dirofilaria Immitis Adult Worms In Nsg Mice, Detection Of Parasite-Derived Microrna And Comparative Analysis Of Laboratory Isolates, Mohini Nakhale, Jessica A. Hess, Ellie Oliver, Nathan M. Ryan, Kirsten Mallon, Omair Sultan, Elinor Willis, Esha Banerjee, Enrico Radaelli, Charles-Antoine Assenmacher, Michael Povelones, Duncan Wells, Russ Morphew, Jennifer Willingham-Lane, Christine Henderson, John Harrington, Paul Mcveigh, David Abraham

Department of Surgery Faculty Papers

Global efforts to control heartworm disease are challenged by increasing drug resistance and inadequate early detection methods, which hinder the effective diagnosis and treatment of Dirofilaria immitis infection. This study presents an in vivo model for investigating D. immitis development and host-parasite interactions. The growth and migration of the D. immitis JYD-34 isolate were analyzed in immunodeficient NSG mice over 177 days, revealing parasite migration to the heart and lungs, which mirrors infection dynamics in the natural canine host. Pathophysiological examination of host tissues revealed early adult-stage worms elicited minimal inflammation. However, with chronicity, mild pulmonary hemosiderin accumulation was observed. …

Factors Influencing Match Success In Integrated Vascular Surgery Residency Programs From 2019 To 2023, Antony A. Fuleihan, Melissa C. Xu, Scott H. Koeneman, Paul J. Dimuzio, Babak Abai, Michael Nooromid

Department of Surgery Faculty Papers

INTRODUCTION: Integrated vascular surgery residency (IVSR) programs have grown increasingly competitive. However, the factors influencing successful matching remain unclear. This study evaluates the impact of medical school and applicant characteristics on IVSR match outcomes.

METHODS: A list of ACGME-accredited IVSRs was obtained from the Society for Vascular Surgery, and resident data from the 2019-2023 match cycles were collected from publicly available sources. Applicant characteristics consisted of additional graduate degrees, Alpha Omega Alpha (AOA) status, and research productivity. Medical school characteristics consisted of ranking, research funding, vascular surgery interest group (VSIG) presence, and vascular surgery faculty size. Logistic regression models were …

Upper Hemisternotomy Vs. Full Sternotomy For Hemiarch And Proximal Aortic Replacement, Jeffrey A. Zucker, Vishal N. Shah, Joshua R. Chen, Christopher Pritting, Colin King, Jacqueline Mcgee, Megary Mccoy, Konstadinos A. Plestis

Department of Surgery Faculty Papers

Introduction: Hemiarch replacement with proximal aortic replacement is seldom performed via upper hemisternotomy (UHS). We report our surgical technique and postoperative outcomes in 11 patients who underwent UHS for hemiarch and proximal aortic replacement, compared with 15 patients who underwent the procedure via full sternotomy (FS).

Methods: A UHS was performed at the right third or fourth intercostal space. Cardiopulmonary bypass (CPB) was established via the distal ascending aorta or right axillary artery and right common femoral vein. After aortic cross-clamping (ACC), the heart was arrested with single-dose antegrade crystalloid cardioplegia. After proximal aortic replacement, hypothermic circulatory arrest (HCA) between …

Comparing Educational Pathways For Denturists To Become Maxillofacial Prosthetic Specialists In The Us And The Uk, Minseok Kim

Oral Health

Abstract

In the absence of formal training, licensure, and professionalism, this scientific literature review will seek to include denturists in the American maxillofacial prosthetics industry. Denturists are oral health professionals who perform oral examination, design, manufacture, and place removable oral prostheses. In other regions of the world, they are also known as clinical dental technologists and dental prosthetists. This practice is not widespread in the US. The review can also be assessed on the model mediated by PRISMA, which is concentrated on the experiences of international education in the United Kingdom, Canada, and Australia, where the concentration further revolves around …

Post-Traumatic Rupture Of Primary Solid Pseudopapillary Epithelial Neoplasm (Spen) Of The Pancreas In A Male Adolescent: A Case Report, Paulo Castro, Heather Hartman, Yashasvi Shukla, Michael Moore, Dennis Drehner, Harish Lavu

Department of Surgery Faculty Papers

Introduction Solid pseudopapillary epithelial neoplasm (SPEN) is a rare pancreatic tumor that typically presents in adult women and is usually asymptomatic. Case presentation A 12-year-old male presented to the emergency department with worsening abdominal pain one day after suffering mild abdominal trauma during a soccer match. Physical exam showed diffuse abdominal tenderness and guarding. CT abdomen with IV contrast showed a heterogeneous, round structure adjacent to the pancreatic tail with mass effect upon the spleen. MRI abdomen revealed a “claw sign” of pancreatic tissue surrounding the structure, suggesting a an underlying pancreatic mass with capsular rupture measuring 8.3 x 8.1 …

B Lymphocytes Impede Tregs To Erode Islet Tolerance In Type 1 Diabetes, Christopher S Wilson, Blair T Stocks, Alexander C Falk, Daniel J Moore

Faculty, Staff and Students Publications

B lymphocytes are thought to drive β-cell destruction in type 1 diabetes (T1D) by activating anti-islet T cells. However, the observation that autoreactive T-cell activation and disease progression can occur without B cells challenges this view. Still, preclinical and clinical studies have shown that B-cell depletion alleviates β-cell destruction, suggesting a critical role for B cells in T1D. Our findings propose an alternative function for B cells, impairing regulatory T cells (Tregs) that would otherwise protect islets. In the NOD islet transplant model, we show that B-cell absence enables transplant tolerance, allowing Tregs to become responsive to immune therapy and …

Real-Time Hemodynamic Deterioration Following Polymorphic Ventricular Tachycardia In A Patient With Preexisting Aicd Implanted With Lvad, Dhruvil Patel, Maya Guglin, Deepa Iyer, Chonyang Albert, Jagpreet Grewal, Kenneth Dulnuan

The VAD Journal

Ventricular arrhythmias (VAs) are common in patients with a left ventricular assist device (LVAD), but the literature remains inconclusive regarding the benefits of an automatic implantable cardioverter-defibrillator (AICD) in this population, especially in those with a preexisting device before LVAD implantation. Here, we report the acute hemodynamic consequences of polymorphic ventricular tachycardia in a patient with a preexisting biventricular AICD who was implanted with an LVAD (HeartMate 3). This case underscores the importance of considering AICD placement on a case-by-case basis and highlights the need for a well-designed study to establish its benefit in this population.

Real-World Multicenter Assessment Of Sustained Clinical Outcomes After Digital Deep Brain Stimulation, Alireza Gharabaghi, Sergiu Groppa, Elena Casas, Alfons Schnitzler, Laura Muñoz-Delgado, Vicky L. Marshall, Jessica Karl, Lin Zhang, Ramiro Alvarez, Mary S. Feldman, Michael J. Soileau, Lan Luo, Benjamin L. Walter, Chengyuan Wu, Hong Lei, Damian M. Herz, Devyani Nanduri, Claudia A. Salazar, Corneliu Luca, Daniel Weiss

Department of Neurosurgery Faculty Papers

Remote, internet-based deep brain stimulation programming for Parkinson's disease accelerates clinical benefits postoperatively by improving access to therapy adjustments compared to in-clinic optimization. After completion of the initial digital programming phase, we show that clinical outcomes, quality of life, and safety remain sustained over at least twelve months under routine care conditions. Embedding a randomized trial within a larger cohort study enables long-term, real-world evaluation, offering a scalable and pragmatic model for assessing complex digital interventions in routine clinical care. (NCT05269862 registered on 2022-03-08 and NCT04071847 registered on 2019-08-28).

Perioperative Fluid Management In Pancreaticoduodenectomy In The Era Of Goal-Directed Fluid Therapy: A Review Of The Literature, Meghan D Grim, Richard Zheng, Nader Hanna, Harish Lavu, Charles J. Yeo, Avinoam Nevler

Department of Surgery Faculty Papers

BACKGROUND: Pancreaticoduodenectomy (PD) is the only curative option for localized pancreatic head and periampullary malignancies. However, PD is associated with significant perioperative morbidity. Perioperative fluid management has emerged as an important modifiable factor influencing surgical outcomes in PD.

METHODS: In this qualitative review, PubMed/Medline searches were performed between March and August 2025 to review the terms "pancreaticoduodenectomy," "fluid management," "Enhanced Recovery After Surgery," "complications," and related terms.

RESULTS: Historically, liberal fluid administration was favored to compensate for third-space losses, but contemporary evidence has linked excessive fluid volumes to complications, such as postoperative pancreatic fistula, anastomotic edema, and increased inflammatory responses. …

High-Dose Oral Pyrophosphate Inhibits Connective Tissue Calcification In Abcc6 Null Mice But May Affect Bone Structure, Ibtesam Rajpar, Nicholas Yancy, Jacob Beiriger, Christina Shao, Syed Naqvi, Deana Mancuso, Fatemeh Niaziorimi, Ryan E Tomlinson, Koen Van De Wetering

Department of Orthopaedic Surgery Faculty Papers

Pseudoxanthoma elasticum (PXE) is a rare inherited disorder marked by abnormal calcium phosphate deposition in soft connective tissues, particularly the skin, arteries, and eyes. It is caused by inactivating mutations in the ABCC6 gene, which encodes a hepatic efflux transporter. Loss of ABCC6 function leads to reduced plasma levels of pyrophosphate (PPi), a key inhibitor of calcification, thereby promoting ectopic mineralization. Oral PPi therapy has emerged as a potential treatment, but its effectiveness is uncertain. Most ingested PPi is hydrolyzed in the gut to inorganic phosphate, which may worsen calcification. Moreover, its impact on mineralized tissues remains largely unexplored. Abcc6−/− …

Regional Anesthesia Utilizing Liposomal Bupivacaine, With Or Without Dexamethasone, Provides Excellent Pain Control And Minimizes Opioid Consumption Following Anterior Cruciate Ligament Reconstruction, William L. Johns, Armen Voskeridjian, Benjamin Miltenberg, Rahul Muchintala, Christopher C. Dodson, Steven B. Cohen, John Salvo, Matthew Sherman, Michael G. Ciccotti, Sommer Hammoud

Rothman Institute Papers

BACKGROUND: Perioperative nerve blocks are commonly used for regional analgesia with anterior cruciate ligament (ACL) reconstruction (ACLR). Liposomal bupivacaine (LB) is a long-acting anesthetic agent providing up to 72 hours of nerve blockade. It is theorized that the addition of dexamethasone to LB (LB+dex) may prolong the analgesic duration.

PURPOSE: To characterize pain control and opioid consumption with adductor canal block (ACB), interspace between the popliteal artery and capsule of the posterior knee (iPACK), and suprasartorial infiltration (SSI) regional anesthetic techniques utilizing LB after ACLR and to compare LB versus LB+dex.

STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. …

Optimal Timing Of Cranioplasty Post-Decompressive Craniectomy In Traumatic Brain Injury: A Systematic Review, Meta-Analysis, And Overview Of Ongoing Trials, Ashviniy Thamilmaran, Shaan Patel, Shiva A. Nischal, Honey Panchal, Kush Kale, Pious D. Patel, Jack Jallo, James S. Harrop

Department of Neurosurgery Faculty Papers

BACKGROUND: The optimal timing of cranioplasty (CP) following decompressive craniectomy (DC) for the management of traumatic brain injury (TBI) remains debated. Prior studies comparing early CP (EC) and late CP (LC) report conflicting outcomes, compounded by inconsistent timing thresholds and limited attention to effect modifiers such as implant material.

OBJECTIVE: To perform a systematic review and meta-analysis comparing outcomes of EC (≤ 90 days) versus LC (> 90 days) after DC for TBI, with particular evaluation of ultra-EC (<  35 days) and implant material.

METHODS: MEDLINE, Embase, and CENTRAL were electronically searched from inception to April 2025, supplemented by manual screening of references and grey …

The Vascular Density/Angiogenesis Marker Cd31/Pecam1 Does Not Correlate With Overall Survival In Neuroendocrine Tumors, Nicholas J. Skill, Kenneth Avanzino, Yvette Bren-Mattison, J. Philip Boudreaux, Ramcharan Thiagarajan, Mary Maluccio

School of Medicine Faculty Publications

Abstract: Neuroendocrine neoplasms (NENs) are rare cancers. CD31/PECAM1 is an adhesion molecule that modulates endothelial cell-to-cell contact. Increased CD31 expression is a marker for tumor growth, and cancer aggressiveness. The purpose of this study was to better understand the prognostic value of CD31 expression in primary and metastatic NEN tumors in terms of correlations with overall survival and pathological metrics, tumor grade, and tumor primary/metastatic location. As NENs are highly vascular tumors, the hypothesis is that CD31 staining is an important prognostic biomarker and target. This is based on prior correlations between CD31 staining and 3-year recurrence-free survival in pancreas …

Spatially Resolved Integrative Analysis Of Transcriptomic And Metabolomic Changes In Tissue Injury Studies, Eleanor C Williams, Lovisa Franzén, Martina Olsson Lindvall, Gregory Hamm, Steven Oag, Muntasir Mamun Majumder, James Denholm, Azam Hamidinekoo, Javier Escudero Morlanes, Marco Vicari, Joakim Lundeberg, Laura Setyo, Trevor M Godfrey, Livia S Eberlin, Aleksandr Zakirov, Jorrit J Hornberg, Marianna Stamou, Patrik L Ståhl, Anna Ollerstam, Jennifer Y Tan, Irina Mohorianu

Faculty, Staff and Students Publications

Recent developments in spatially resolved -omics have enabled the joint study of gene expression, metabolite levels and tissue morphology, offering greater insights into biological pathways. Integrating these modalities from matched tissue sections to probe spatially-coordinated processes, however, remains challenging. Here we introduce MAGPIE, a framework for co-registering spatially resolved transcriptomics, metabolomics, and tissue morphology from the same or consecutive sections. We show MAGPIE's generalisability and scalability on spatial multi-omics data from multiple tissues, combining Visium with MALDI and DESI mass spectrometry imaging. MAGPIE was also applied to new multi-modal datasets generated with a specialised sampling strategy to characterise the metabolic …

The Efficacy And Safety Of Laparoscopic Cholecystectomy For Acute Cholecystitis: A Descriptive Study, Michael Lawenko, Marie Abigail Dumlao

The Lasallian Journal of Health

Objectives: Laparoscopic Cholecystectomy (LC) is gaining traction to become a safe and effective surgical option for Acute Cholecystitis (AC). In our institution, the trend toward laparoscopic management of AC has only recently gained traction. The objective of this study is to describe the early experience of our institu tion utilizing LC. Methods: This descriptive study involved a retrospec tive analysis of early institutional cases of LC. Included were cases with both pre- and post-operative diagnoses of AC, as well as cases admitted for non-AC conditions but found to have incidental AC postoperatively. Cases were further categorized into severe (SAC) and …

The Five-Step Teaching Method Vs Demo-Return Demo Of Laparoscopic Camera Manipulation On Medical Students: A Randomized Controlled Trial In A Philippine Medical School Curriculum, Michael Lawenko

The Lasallian Journal of Health

Objectives: This study aims to examine if laparoscopic camera manipulation, using the five-step teaching method, is more effective than the traditional demoreturn demo method in developing psychomotor and visuospatial skills in fourth year medical students. Methods: Randomization was done to create two groups (n = 129). One group, (n = 70), received training using the five-step method: (1) conceptualization, (2) visualization, (3) verbalization by the preceptor, (4) verbalization by the student, and (5) practice. The other group, (n = 59), followed the traditional demo-return demo method. Psychomotor and visuospatial skills of the students were assessed using a rubric. The subjective …

Predicting Sepsis In Heart Failure Patients Supported By Left Ventricular Assist Devices: The Role Of Ve-Cadherin And Adam10, Shiyi Li, Iván Murrieta-Álvarez, Ismael Garcia, Katherine V Nordick, Rishav Bhattacharya, Shreyo Ghosh, Ronald A Shaju, Adel M Hassan, Carl P Walther, Camila Hochman-Mendez, Alexis E Shafii, Kenneth K Liao, Nandan K Mondal

Faculty, Staff and Students Publications

Vascular endothelial cadherin (VE-Cadherin) is a major endothelial adhesion molecule and can be cleaved explicitly by metalloproteinase domain-containing protein 10 (ADAM10). Vascular hyperpermeability may contribute to a greater susceptibility to sepsis in left ventricular assist device (LVAD) support patients. We aim to evaluate the efficacy of VE-Cadherin and ADAM10 for predicting sepsis in LVAD patients. We prospectively recruited 50 patients with advanced heart failure receiving LVAD therapy. Baseline and weekly postoperative blood samples (weeks 1-4) were collected, and plasma VE-cadherin and ADAM10 levels were measured. Sepsis occurred in 9 of 50 patients (18.0%). Across all sampling points, plasma VE-cadherin and …

Medicaid Expansion And Breast Cancer Care And Outcomes-What Lies Ahead?, Meghan H. Maceyko, Oluwadamilola M. Fayanju

Department of Surgery Faculty Papers

No abstract provided.

Another Gastric Band Complication: Acute Appendicitis, Dustin Williamson, Naveed Ismail, John Weaver

Continental and Mountain Divisions GME Resarch Day 2026

No abstract provided.

Reducing Healthcare Spending With Pharmacist Driven Icg Allocation, Rachel W. Wong, Calvin Le, Vanessa Sifuentes, Faith Rutherford, Grace Desrochers, Zuhair Ali, Mike K. Liang

Gulf Coast Division GME Research Day 2026

No abstract provided.

Spontaneous Pneumoperitoneum Presenting As An Acute Abdomen, Madison Mcinnis, Megan Tierney, Kaysie Banton

Continental and Mountain Divisions GME Resarch Day 2026

No abstract provided.

Cecal Volvulus In The Setting Of Situs Inversus Totalis: A Rare Case Report, Alexandra Moody, Josie Bjorklund

Continental and Mountain Divisions GME Resarch Day 2026

No abstract provided.

Bilateral Pseudoangiomatous Stromal Hyperplasia In A Twelve-Year-Old Female: A Case Report, Alexandra Mcmillan, Taylor Sullivan, Joyce Moore, Robert M. Pride

Continental and Mountain Divisions GME Resarch Day 2026

No abstract provided.

A Predictive Tool Using The Society Of Thoracic Surgeons Risk Calculator For Safe Operating Room Extubation After Coronary Bypass Surgery, John G. Byrne, Farhaan Chaugle, Thomas Kessinger, Prince Thommen, Ali Asghar, Shahistha Hyder, Curtis Dickey, Nicole Blatt, Hannan Chaugle

Gulf Coast Division GME Research Day 2026

No abstract provided.