Medical Specialties Commons^™

Novel Repair Of Costal Margin Rupture With Preoperative 3d Planning, Casey T. Walk, Gregory Semon

Department of Surgery Faculty Publications

WHAT WOULD YOU DO? This is a 32-year-old man involved in a motor vehicle crash in 2019 with chronic left-sided rib pain since. He was initially treated with physical therapy and medical management with no improvement. CT imaging in 2021 noted displaced left lateral seventh and eighth ribs, noted chest wall deformity, and when three-dimensional (3D) reconstruction of his ribs was created, this noted a left- sided costal margin rupture at the sixth and seventh ribs.

Variability And Outcomes Of Medical And Lifestyle Management Of Peripheral Arterial Disease At The Time Of Lower Extremity Bypass, Ryan Howard, Jeremy Albright, Matthew Corriere, Nicholas Osborne, Eugene Laveroni, Peter Henke

Conference Presentation Abstracts

Background: First-line treatment of peripheral arterial disease (PAD) involves medical therapy and lifestyle modification. Specifically, the 2016 American Heart Association/American College of Cardiology guidelines for the management of PAD make Class I recommendations for antiplatelet therapy, statin therapy, antihypertensive therapy, and cilostazol therapy, as well as exercise therapy and smoking cessation. Although evidence supports medical and lifestyle management of PAD before surgical intervention, it is currently unclear whether clinical practice reflects this. Moreover, it is also unknown whether variability in medical and lifestyle optimization before revascularization affects short- and long-term outcomes. This study was conducted to determine the proportion of …

Loss Of Smad4 Is Associated With Poor Tumor Immunogenicity And Reduced Pd-L1 Expression In Pancreatic Cancer, Daniel R. Principe, Patrick W. Underwood, Sandeep Kumar, Kaytlin E. Timbers, Regina M. Koch, Jose G. Trevino, Hidayatullah G. Munshi, Ajay Rana

Surgery Publications

Transforming Growth Factor β (TGFβ) is a key mediator of immune evasion in pancreatic ductal adenocarcinoma (PDAC), and the addition of TGFβ inhibitors in select immunotherapy regimens shows early promise. Though the TGFβ target SMAD4 is deleted in approximately 55% of PDAC tumors, the effects of SMAD4 loss on tumor immunity have yet to be fully explored. Using a combination of genomic databases and PDAC specimens, we found that tumors with loss of SMAD4 have a comparatively poor T-cell infiltrate. SMAD4 loss was also associated with a reduction in several chemokines with known roles in T-cell recruitment, which was recapitulated …

Role Of Micrornas In Non-Functioning Pituitary Adenoma, Mehak Ismail Rajani, Yumna Mirza, Rohan Advani, Syed Muhammad Adnan Ali, Ather Enam

Centre for Innovation in Medical Education

Non-functioning pituitary adenomas account for 30% of anterior pituitary tumours. Based on their inability to secrete hormones, these are often diagnosed incidentally or due to pressure symptoms. Understanding the pathogenesis of these adenomas can provide insight into factors leading to its progression and serving as biomarkers for early recognition. A literature search was performed in the current narrative review for articles published in PubMed for the last 10 years till January 2020 on micro-ribonucleic acid involved in the pathogenesis of non-functioning pituitary adenomas. Of the 478 articles found, 21(4.4%) were filtered. In total, 106 micro-ribonucleic acids were identified, 25(23.5%) of …

Hernia Prevention Utilizing Mesh And/Or Small Bites: A 2x2 Factorial Randomized Controlled Trial, Rainna Coelho, Naila Dhanani, Erik Askenasy, Stefanos Millas, Karla Bernardi, Zuhair Ali, Lillian S. Kao, Mike Liang

Gulf Coast Division GME Research Day 2022

No abstract provided.

Undertriage Of Elderly Trauma Patients With Comorbid Conditions, Taylor Locklear, Heather Rhodes, Nasser Mohammad, Nicole Pascarella, Rudy Flores, Antonio Pepe

South Atlantic Division GME Research Day 2022

No abstract provided.

Primary Retroperitoneal Mucinous Tumor – A Cyst That Is Not So Simple, Scott Cruise, Aaron Dan Pinnola, Abhishek Srivastava

South Atlantic Division GME Research Day 2022

No abstract provided.

Isolated Hip Fractures: Factors Beyond 48 Hours, Evelyn Coile, Heather Rhodes, Nassar Mohammad, Nicole Pascarella, Tatiana Eversley Kelso, Christa Zino, Summer Rabon, Saptarshi Biswas, James Dunne, Antonio Pepe

South Atlantic Division GME Research Day 2022

No abstract provided.

Congenital Non-Union Of C1 Leading To Quadriplegia Following A Roller Coaster Ride, Kelly Champlin, Saptarshi Biswas

South Atlantic Division GME Research Day 2022

No abstract provided.

Bilateral Renal Infarcts From Blunt Trauma In A Healthy Young Female Patient. Clinical Dilemmas, Diagnostic Conundrum And Management., Kelly Champlin, Austin Mccrea, Saptarshi Biswas

South Atlantic Division GME Research Day 2022

No abstract provided.

Eagle Syndrome: Efficacies Of Medical And Surgical Treatments, Kirklin Mitchell

Capstone Showcase

Eagle Syndrome is a rare syndrome caused by elongation of the styloid process of the temporal bone or calcification of the stylohyoid ligament occurring in a very small percentage of the population that can cause a wide range of common symptoms, leading to it being often misdiagnosed. While there are no set standards for treating Eagle Syndrome, both pharmaceutical and surgical options exist. Pharmaceutical options are often ineffective in long term treatment so surgery is usually required for full symptom resolution. Transoral and Transcervical surgeries have similar efficacies but each come with important drawbacks when considering which type of surgery …

Percutaneous Coronary Intervention Using Second Generation Drug-Eluting Stents Vs Coronary Artery Bypass Graft In Left Main Coronary Artery And Multivessel Coronary Artery Disease, Eric Kim

Capstone Showcase

Many of the studies that are used in reference to the clinical decision making between PCI vs CABG use BMS or first-generation DES as a comparison. With the advancement of stent technology, second-generation DES have emerged with improved efficacy and overall outcome rates compared to BMS and first-generation DES. Some of the newer studies such as EXCEL1-2 , demonstrated noninferiority of second-generation DES to CABG but there are limited studies that support this conclusion. Currently, the studies remain divided in the impact of newer-generation PCIs, and 10-year follow up studies may be required to further validate noninferiority before it can …

Single-Incision Laparoscopic Splenectomy In Children With Massive Splenomegaly: A Prospective, Monocentric Pilot Study, Congjun Wang, Cheng Su, Chao Chen, Xianming Tang, Hong Wang, Wei Li, Yanqiang Li, Qiang Liu, Peng Chen, Yong Li, Yige Luo

Faculty, Staff and Student Publications

BACKGROUND: Single-incision laparoscopic splenectomy (SILS) remains a challenging procedure because of the technical difficulty. In this prospective study, we aimed to evaluate the efficacy and safety of SILS in children with massive splenomegaly.

METHODS: Pediatric patients with massive splenomegaly were recruited for SILS in a university-affiliated hospital. The data on patient demographics, clinical features, operative variables, and perioperative outcomes were collected prospectively and analyzed. According to the different surgical instruments, the patients were randomly assigned into two groups: the SILS with straight surgical instrument (SILS-S) group and the SILS with curved surgical instrument (SILS-C) group. A two-group comparative analysis was …

Cross-Mentorship: A Unique Lens Into The Realities And Challenges Of Diversity In Surgery., Marina Affi Koprowski, Karen J Dickinson, Crystal N Johnson-Mann, Martha Godfrey, Emilia J Diego, Marie Crandall, Kevin Y. Pei Md, Mhsed

Other Specialties

Mentorship in surgery is a perennial topic of interest, as successful mentoring relationships are associated with improved career satisfaction, academic promotion, research productivity, and overall well-being. While it is true that certain minority groups in surgery find great personal and professional benefit in receiving and providing mentorship among “their own” (ie, a female academic surgeon mentoring a female resident), it is important to recognize that many mentoring relationships, whether intentionally or otherwise, extend across gender, sexuality, generations, race, ethnicity, and other differences. Lived examples of these include an Asian man hailing from the Northeast with no children mentoring a White …

Bibliometric Study On The Literature Related To Dental Research And Education Published In Journal Of Pakistan Medical Association, Samira Adnan, Kamil Zafar, Farhan Raza Khan, Rizwan Ullah

Section of Dental-Oral Maxillofacial Surgery

Objective: To analyse characteristics of literature related to dental research and education published in a single medical journal, The Journal of Pakistan Medical Association.
Method: The bibliometric study was conducted at the Sindh Institute of Oral Health Sciences, Jinnah Sindh Medical University from March till May 2020, and comprised electronic and hand search of scientific literature relevant to dentistry published in the Journal of Pakistan Medical Association from the first issue published in 1953 till March 2020. The selected articles were analysed for year of publication, field of study, type of article, institute and country of first author, number of …

Comparison Of Surface Defects In Protaper Next And Hyflex Edm Files After Single Clinical Use: A Stereoscopic Evaluation, Faizan Javed, Momina Anis Motiwala, Farhan Raza Khan, Rabia Ghafoor

Section of Dental-Oral Maxillofacial Surgery

Objective: To compare the surface defects created on the ProTaper Next files versus HyFlex Electrical Discharge Machining files after single clinical use in molars.
Methods: The cross-sectional study was conducted in the dental department of the Aga Khan University Hospital, Karachi, from December 2018 to June 2019, and comprised Nickel-Titanium files belonging to HyFlex Electrical Discharge Machining and ProTaper Next to perform complete root canal treatment of molar teeth. The files were first visually examined and then analysed under 25.6x magnification using a stereomicroscope for the evaluation of surface defects. A photographic record was maintained and studied. Data was analysed …

Kidney Disease After Heart And Lung Transplantation, Carlos M Zapata, Hassan N Ibrahim

Faculty, Staff and Student Publications

Chronic kidney disease (CKD) is not only common after lung and heart transplantation but also is associated with increased morbidity and mortality due to multiple pre-, peri- and post-transplant factors. While the exact incidence of CKD in this population is not well-defined, it seems to have gradually increased over the years as older recipients are more frequently considered. The increasing success of the procedure and expanding transplant candidate pool has allowed many with comorbid conditions to receive a transplant, which was considered prohibitive in the past. This review presents risk factors that have been linked to CKD as well as …

Small Bowel Stomas Are Associated With Higher Risk Of Circulating Food-Specific-Igg Than Patients With Organic Gastrointestinal Conditions And Colostomies, Walker K. Carson, Joseph L. Baumert, Jennifer Clarke, Jacques Izard

Department of Food Science and Technology: Faculty Publications

Objective The effects of food sensitivity can easily be masked by other digestive symptoms in ostomates and are unknown. We investigated food-specific-IgG presence in ostomates relative to participants affected by other digestive diseases.

Design Food-specific-IgG was evaluated for 198 participants with a panel of 109 foods. Immunocompetency status was also tested. Jejunostomates, ileostomates, and colostomates were compared with individuals with digestive tract diseases with inflammatory components (periodontitis, eosinophilic esophagitis, duodenitis, ulcerative colitis, Crohn’s disease, and appendicitis), as well as food malabsorption due to intolerance. A logistic regression model with covariates was used to estimate the effect of the experimental data …

A Proposed Method To Verify Physician Visual Estimation Of Intraoperative Corneal Edema From Refractive Measurement Images During Cataract Surgery, Karalee Corley

CMC Senior Theses

A patient’s resultant vision quality in a restorative Femtosecond Laser Assisted Cataract Surgery (FLACS) can be fine tuned via an intraoperative measurement of refractive power and axis of astigmatism in the aphakic state. Standard preoperative measurements often disagree with intraoperative measurements (Optiwave Refractive Analysis; Alcon, Inc.) on account of the inclusion or exclusion of posterior corneal curvature, leaving the ultimate lens selection to physician discretion. One additional suggested cause of disagreement is swelling at the corneal incision site (Corley and Carmack 2020).The following proposes a method to verify visual estimation of intraoperative corneal swelling from 2D gray-scale images collected during …

The Relationship Between First Case On-Time Starts, Turnover Times, And Operating Room Productivity, Rhafia Bucoy

Walden Dissertations and Doctoral Studies

Operating room (OR) managers struggle to manage day-to-day surgical operations while meeting and exceeding organizational productivity amid the COVID-19 pandemic. The deferral of surgeries contributes to millions of backlogs of surgical case volume and unintended negative consequences. Grounded in the proposition that first-case on-time starts (FCOTS) and turnover time (TOT) are correlates of OR productivity, the purpose of this quantitative correlational study was to examine the relationship between FCOTS, TOT, and OR productivity. Archival data from 136 electronic surgical records were collected from two free-standing ambulatory surgery centers and analyzed using multiple regression. The results of the one-service, eye-specialized, ambulatory …

Effectiveness Of Stabilized Hypochlorous Acid In Acute Peritonitis Treatment: A Murine Surgical Study, Benjamin Michael Pomeroy

Graduate Theses/Dissertations

Peritonitis is an inflammatory condition affecting the mesothelial cells that line the peritoneal cavity and is commonly induced by bowel perforations. This medical emergency is treated through antibiotic therapy and surgical intervention followed by tissue irrigation (lavage). Acute treatments aim to remove the bacterial burden, however recurring peritoneal infections occur at high rates and contribute to patient morbidity. These recurring infections are likely due to the inability of lavage solutions to remove the entire massive intra-abdominal bacterial load due to intestinal perforation. Numerous antiseptic solutions and antibiotic additives have been evaluated in their ability to improve source control by abdominal …

Severity Assessment Of Impairment In Spinal Cord Injury; A Systematic Review On Challenging Points About International Standards For Neurological Classification Of Spinal Cord Injury, Mahmoud Yousefifard, Mostafa Hosseini, Alireza Oraii, Alex R. Vaccaro, Vafa Rahimi-Movaghar

Department of Orthopaedic Surgery Faculty Papers

Objective: Assessment of spinal cord injuries (SCI) severity is usually done according to the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). However, a limitation of ISNCSCI has not been thoroughly evaluate; therefore, a systematic review was performed to gather current evidence on the limitations of the ISNCSCI for assessing SCI. Methods: An extensive literature search was performed using Medline, Embase, Web of Science, Cochrane library, and Scopus for all articles up until the end of 2017 and then was updated to the end of 2020. Data was summarized by two independent reviewers and limitations of the ISNCSCI …

Diagnostic Accuracy Of Computed Tomography In Adults With Suspected Acute Appendicitis At The Emergency Department In A Private Tertiary Hospital In Tanzania, Nyamuryekun'ge Miten, Miten Wr Patel, Ahmed Jusabani, Ali Akbar Zehri, Athar Ali

General Surgery, East Africa

Introduction: The increasing incidence of acute appendicitis in sub-Saharan Africa emphasizes the need for accurate and reliable diagnostic tools. However, the variability in the diagnostic performance of computed tomography for suspected acute appendicitis coupled with comparatively higher negative appendectomy rates in this setting highlight a possible concern regarding the diagnostic accuracy. This study evaluated the diagnostic accuracy of a computed tomography scan for suspected acute appendicitis at the emergency department in Tanzania.

Methods: A retrospective diagnostic accuracy study was conducted from July to October 2020. All patients above 14 years of age who presented at the emergency department with …

Authorship Equity And Gender Representation In Global Oncology Publications, Paula Hornstein, Hubert Tuyishime, Miriam Mutebi, Nwamaka Lasebikan, Fidel Rubagumya, Temidayo Fadelu

General Surgery, East Africa

Purpose: Authorship gender disparities persist across academic disciplines, including oncology. However, little is known about global variation in authorship gender distribution.

Methods: This retrospective cross-sectional study describes the distribution of author gender as determined from the first name across variables such as authorship position (first, middle, and last), country region, and country income level. The 608 articles with 5,302 authors included in this analysis were published in the Journal of Clinical Oncology Global Oncology, from its inception in October 2015 through March 2020. Primary outcome measure was author gender on the basis of first name probabilities assessed by …

The Impact Of Preoperative Neurological Symptom Severity On Postoperative Outcomes In Cervical Spondylotic Myelopathy, Gregory R Toci, Jose A Canseco, Brian A Karamian, Michael Chang, Giovanni Grasso, Kristen Nicholson, Emily M Pflug, Glenn S Russo, Daniel Tarazona, I David Kaye, Mark Kurd, Alan S. Hilibrand, Barrett I. Woods, Jeffrey A Rihn, D Greg Anderson, Kris E Radcliff, Christopher K Kepler, Alex R. Vaccaro, Gregory D. Schroeder

Department of Orthopaedic Surgery Faculty Papers

Study design: The study design is a retrospective cohort study.

Objective: To compare patient-reported outcomes between patients with mild versus moderate-to-severe myelopathy following surgery for cervical spondylotic myelopathy (CSM).

Summary of background data: Recent studies have demonstrated that decompression for CSM leads to improved quality of life when measured by patient-reported outcomes. However, it is unknown if preoperative myelopathy classification is predictive of superior postoperative improvements.

Materials and methods: A retrospective review of patients treated surgically for CSM at a single institution from 2014 to 2015 was performed. Preoperative myelopathy severity was classified according to the modified Japanese Orthopaedic Association …

National Trends And Survival Outcomes Of Performing Immediate Breast Reconstruction For Male Breast Cancer Patients, Neha Sarvepalli, Nayana Dekhne, Mohamad Sebai, Patrick Karabon

Conference Presentation Abstracts

INTRODUCTION: Immediate breast reconstruction after a mastectomy was reported in 43.3% of female patients in 2014; and has been associated with improved quality of life and adherence to adjuvant therapies. While there are many studies regarding immediate breast reconstruction in women, little has been reported about reconstruction rates and outcomes in male breast cancer. The purpose of this study is to examine the trends and outcomes of performing Immediate Breast Reconstruction (IBR) in male breast cancer (MBC) patients following a mastectomy. METHODS: The National Cancer Database (NCDB) registry from 2004 to 2014 was used to identify non-metastatic MBC patients who …

Load Sharing Assessment Of Osseoligamentous Structures Within A Thoracic Spine Segment During Surgical Release, Michael Polanco, James Bennett, Austin Tapp, Michel Audette, Stacie Ringleb, Sebastian Bawab

Electrical & Computer Engineering Faculty Publications

Spinal surgical procedures often require release of intervertebral discs and ligaments to optimally achieve postural correction on a patient-specific basis. In this paper, a T7-T8 Finite Element (FE) model is utilized to examine internal load sharing during resection steps performed in a Ponte osteotomy. The FE model was rotated bidirectionally along three anatomical planes using an externally applied moment. In each step, the Ranges of Motion (RoM), Instantaneous Centers of Rotation (ICR), and forces from ligaments, discs, facet, and costovertebral joints were calculated. The product of each component’s force and the distance between the ICR and their position were used …

Enhancing Mesenchymal Stromal Cell Potency: Inflammatory Licensing Via Mechanotransduction, Max A Skibber, Scott D Olson, Karthik S Prabhakara, Brijesh S Gill, Charles S Cox

Faculty, Staff and Student Publications

Mesenchymal stromal cells (MSC) undergo functional maturation upon their migration from bone marrow and introduction to a site of injury. This inflammatory licensing leads to heightened immune regulation via cell-to-cell interaction and the secretion of immunomodulatory molecules, such as anti-inflammatory mediators and antioxidants. Pro-inflammatory cytokines are a recognized catalyst of inflammatory licensing; however, biomechanical forces, such as fluid shear stress, are a second, distinct class of stimuli that incite functional maturation. Here we show mechanotransduction, achieved by exposing MSC to various grades of wall shear stress (WSS) within a scalable conditioning platform, enhances the immunomodulatory potential of MSC independent of …

Incidence Of Readmission Following Pediatric Hand Surgery: An Analysis Of 6600 Patients, Christopher J Goodenough, Cassie A Hartline, Shuyan Wei, Joseph K Moffitt, Alfredo Cepeda, Phuong D Nguyen, Matthew R Greives

Faculty, Staff and Student Publications

BACKGROUND: Quality in surgical outcomes is frequently assessed by the 30-day readmission rate. There are limited data available in the published literature regarding readmission rates following pediatric hand surgery. This study aims to identify factors associated with an increased risk of readmission following hand surgery in a pediatric population.

METHODS: The 2012-2017 National Surgical Quality Improvement Project - Pediatric (NSQIP-P) databases were queried for pediatric patients who underwent procedures with hand-specific current procedural terminology (CPT) codes. The primary outcome was readmission.

RESULTS: A total of 6600 pediatric patients were identified and included in the analysis. There were 45 patients who …

Dysphagia Is Associated With Worse Clinical Outcomes In Geriatric Trauma Patients, Heather R Kregel, Mina Attia, Claudia Pedroza, David E Meyer, Michael W Wandling, Shah-Jahan M Dodwad, Charles E Wade, John A Harvin, Lillian S Kao, Thaddeus J Puzio

Faculty, Staff and Student Publications

INTRODUCTION: Dysphagia is associated with increased morbidity, mortality, and resource utilization in hospitalized patients, but studies on outcomes in geriatric trauma patients with dysphagia are limited. We hypothesized that geriatric trauma patients with dysphagia would have worse clinical outcomes compared with those without dysphagia.

METHODS: Patients with and without dysphagia were compared in a single-center retrospective cohort study of trauma patients aged ≥65 years admitted in 2019. The primary outcome was mortality. Secondary outcomes included intensive care unit (ICU) length of stay (LOS), hospital LOS, discharge destination, and unplanned ICU admission. Multivariable regression analyses and Bayesian analyses adjusted for age, …