Medical Specialties Commons^™

Roi In Geriatric Emergency Departments: It's More Than Just Money, Lauren Cameron-Comasco

Conference Presentation Abstracts

Curious about the return on investment from accredited geriatric emergency departments? Want to learn more about potential key impact areas? This conference explores the measurable key impact areas of hospitals, systems, patients and more. Join us to hear these impressive results and learn actionable information for these questions and more.

Disentangling Sex Differences In Ptsd Risk Factors: A Systematic Overview And Multiple Mediation Analysis The The Aurora Study, Stephanie Haering, Antonia V. Seligowski, Sarah Linnstaedt, Vasiliki Michopoulos, Stacey L. House, Francesca Beaudoin, Xinming An, Thomas C. Neylan, Gari Clifford, Robert A. Swor

Articles

No abstract provided.

Assessment Of Portal System Hemodynamics For The Prediction Of Portal-Vein Thrombosis In Cirrhosis - A Systematic Review And Meta-Analysis, Marko Kozyk, Suprabhat Giri, Ankita Singh, Kailash Kolhe, Akash Roy, Kateryna Strubchevska

Conference Presentation Abstracts

Background: The pathogenesis of portal vein thrombosis (PVT) in cirrhosis is multifactorial, with altered hemodynamics being proposed as a possible contributor. The present systematic review was conducted to study the role of assessment of portal hemodynamics for the prediction of PVT in patients with cirrhosis. Methods: Three databases (Medline, Embase, and Scopus) were searched from inception to February 2023 for studies comparing portal venous system parameters in patients with cirrhosis developing PVT with those not. Results were presented as mean difference (MD) or odds ratio (OR) with their 95% confidence intervals (CI). Results: A total of 31 studies (patients with …

Deletion Of Interleukin-17a Augments Portal Fibrosis In A Mouse Model Of Cholestatic Liver Injury, Takashi Kitagataya, Kirsta Olson, Michelle Baez-Faria, Nazli Begum Ozturk, Kaiyel Cutshaw, Anuradha Krshnan, Maria Eugenia Guicciardi, Kevin D. Pavelko, Gregory J. Gores

Conference Presentation Abstracts

Background: The underlying mechanism contributing to cholestatic liver injury remains unclear. The proinflammatory cytokine interleukin-17A (IL-17A) has been implicated in human cholestatic liver injury. However, mechanistic insights on how IL-17A modulates cholestatic liver injury are lacking and require further exploration in preclinical models. Herein, we examined the effects of IL-17A genetic deletion in a mouse model of cholestasis. Methods: Ageand gender-matched littermate WT and Il-17a-/- were fed intermittently on 0.1% 3,5-diethoxycarbonyl-1,4-dihydrocollidine (DDC) diet or control diet (n=10, each) and standard diet for 21 days to induce cholestatic liver injury. We assessed liver inflammation, ductular reaction, and fibrosis using complementary approaches. …

A Single Center Analysis Of Patients Undergoing Liver Resection For Intrahepatic Cholangiocarcinoma, Nazli Begum Ozturk, Laith H. Jamil

Conference Presentation Abstracts

Background: Intrahepatic cholangiocarcinoma (iCCA) is the second most common primary liver cancer with increasing rates of incidence and mortality. Surgical resection with negative margins and regional lymphadenectomy is the mainstay of the treatment for patients with resectable-iCCA. Because of its rarity and low resectability rate of iCCA, prognostic markers and outcomes of patients who undergo liver resection are not well defined. We aimed to evaluate the characteristics of patients undergoing liver resection for iCCA at our institution over ten years. Methods: All patients with iCCA who had liver resection between 3/2013-3/2023 at our institution were included in the study. An …

The Global Survey Of Disease Burden And Stigma Among Patients With Nafld And Their Healthcare Providers, Zobair M. Younossi, Yusuf Yilmaz, Jian-Gao Fan, Ming-Hua Zheng, Khalid Aida Alswat, Saleh A. Alqahtani, Mohamed El-Kassas, Laurent Castera, Jesus Funuyet-Salas, Stuart C. Gordon

Conference Presentation Abstracts

Background: NAFLD can be associated with disease burden and stigma to patients and providers. Aims: To understand the disease burden and stigma related to NAFLD. Methods: Members of the Global NASH Council created two surveys (68-item patient and 41- items provider survey) about experiences and attitudes toward NAFLD and related terms. Results: The surveys were completed by 895 NAFLD patients (19 countries) and 629 providers (64% GI/hepatologists, 23 countries). Of all patients, 64% ever disclosed having NAFLD to family/friends; the main term used was “fatty liver” (82%) while “metabolic disease” or “MAFLD” were rarely used (never by 88%). 35% of …

Persistent Pruritus Associated With Worse Quality Of Life In Patients With Chronic Hepatitis, Mei Lu, Lora Rupp, Christina Melkonian, Sheri Trudeau, Yihe G. Daida, Mark A. Schmidt, Stuart C. Gordon

Conference Presentation Abstracts

Background: Pruritus—itching—is common with liver disease, but its prevalence and severity among US patients with chronic hepatitis B and C (HBV, HCV) are not well-documented. A subset of patients from the Chronic Hepatitis Cohort Study (CHeCS) were surveyed to examine pruritus prevalence, persistence, and management, and the impact on patients’ quality of life (QoL). Methods: The validated Pruritus Numeric Rating Scale (NRS) was used to assess pruritus intensity; patients who reported a score ≥ 3 in the last 30 days were invited to participate in a 6-month study using the validated SF-36 questionnaire. A general regression model (univariate followed by …

Efficacy And Safety Of Transjugular Intrahepatic Portosystemic Shunt In Patients With Hepatocelluar Carcinoma - A Systematic Review And Meta-Analysis, Marko Kozyk, Suprabhat Giri, Ankit Singh, Akash Roy, Kateryna Strubchevska, Taraprasad Tripathi, Ranjan Kumar Patel

Conference Presentation Abstracts

Background: Patients with hepatocellular carcinoma (HCC) and cirrhosis can present with features of severe portal hypertension, which can be worsened further with associated portal vein tumoral thrombosis (PVTT). Due to the technical difficulties and short survival of these patients, HCC was traditionally considered a relative contraindication for transjugular intrahepatic portosystemic shunt (TIPS). However, there is an increasing body of evidence supporting the use of TIPS in HCC. The present study aimed to analyze the efficacy and safety of TIPS in patients with HCC. Methods: A literature search of MEDLINE, Embase, and Scopus was conducted from 2000 to October 2022 for …

Pelvic Fracture Urethral Trauma– Going With The Flow, Frank Burks

Website/Multimedia Contributions

No abstract provided.

Massive Transfusion In Trauma– The Basics And Beyond, Kristina Davis

Website/Multimedia Contributions

No abstract provided.

Structurally Competent Healthcare And Health Inequities, James Meza

Conference Presentation Abstracts

No abstract provided.

Laparoscopic Repair Of Pediatric Femoral Hernias: A Scoping Review, Alex Chen, Spencer Wilhelm, Michael Sobolic, Begum Akay, Pavan Brahmamdam, Nathan Novotny

Conference Presentation Abstracts

No abstract provided.

Malignant Tumors Arising From Adult Polycystic Kidney Disease, Yazan Al-Othman, Mai Elzieny, Christopher Thorburn, John D. Schwartz, Susan I. Daraiseh, Hassan D. Kanaan, Zhenhong H. Qu, Ping L. Zhang

Conference Presentation Abstracts

Context: The prevalence of renal tumors arising from adult polycystic kidney disease (APKD) has been rarely reported in the pathology literature. We report our findings of various renal tumors in APKD nephrectomy specimens.

Design: We searched our database for APKD during the past 11 years and identified various primary malignant tumors within the kidneys of APKD.

Results: Forty-eight nephrectomies with APKD were evaluated. Ten malignant tumors were identified in the APKD kidneys, indicating a prevalence of 20.8% (10/48; Table). These included 4 clear cell (CC) renal cell carcinomas (RCCs) ranging from 1 mm to 6.7 cm, 3 papillary RCCs …

Evaluation Of A Novel Lupus Anticoagulant Assay Designed To Reduce False Positive Results Due To Anticoagulation: A Retrospective Study At A Single Health System, Jessica D. Anderson, Tamara Sabih, Yuying Xing, Lili Zhao, Marc D. Smith

Conference Presentation Abstracts

Introduction: Lupus anticoagulants (LA) are antibodies directed against phospholipids/phospholipid-protein complexes involved in coagulation and are associated with thrombotic events and recurrent fetal loss. There is no gold standard test for LA, therefore at least two LA-specific tests are recommended before excluding LA. Potential testing methods involve dilute Russell viper venom time (dRVVT) and hexagonal phase phospholipid assays (HPPA); however, many of these tests are susceptible to interference with anticoagulant therapy which can lead to false positive results. In this study, we compared the performance of our current HPPA, StaClot LA (SCLA), with a novel assay reported to have relatively minimal …

Serum Tests For Donor-Derived Cell-Free Dna Are Well Correlated With Renal Transplant Rejection In Renal Biopsies: Our Preliminary Experience Of New Surveillance For Monitoring Rejection, Reenal Patel, Brandon Metcalf, Dilip Samarapungavan, Hassan D. Kanaan, Wei Li, Sarah T. Suliman, Atul Singh, Ping L. Zhang

Conference Presentation Abstracts

Context: Noninvasive serum test for donor-derived cell-free DNA (dd-cfDNA) has been found useful for monitoring acute cellular rejection (ACR) and antibody-mediated rejection (AMR) since 2018, and the accepted threshold to indicate rejection is 1%. The goal of this pilot study was to determine if this test can correlate with renal biopsy results during a 1-year period when the dd-cfDNA test was initiated in our medical center.

Design: Renal transplant biopsies were evaluated for various rejection and nonrejection etiologies. Their corresponding dd-cfDNA percentages were identified. The biopsy data and dd-cfDNA results were correlated.

Results: During a year, we noticed a trend …

Renal Cell Carcinoma With Fibromyomatous Stroma Has A Distinctive Staining Pattern With Gata3 And Cd133 From Clear Cell Rcc And Clear Cell Papillary Rcc (Ccp-Rcc), Brandon Metcalf, Jining Feng, Leilei Chen, Vaishali Pansare, Ping L. Zhang

Conference Presentation Abstracts

Context: Renal cell carcinoma with fibromyomatous stroma (RCC-FMS) is a provisional entity of renal cell neoplasm that can be difficult to distinguish from low-grade clear cell RCC and clear cell papillary renal cell carcinoma (CCP-RCC) owing to its fibromyomatous stroma, low-grade nuclei, and clear cell cytoplasm.

Design: In this pilot study, we evaluated the utility of GATA3 and CD133 (a stem cell marker) as immunostain markers for the standard panel of cytokeratin 7 (CK7), CD10, and CAIX in distinguishing RCC-FMS from clear cell RCC and CCP-RCC. We stained 6 RCC-FMSs, 5 clear cell RCCs, and 5 CCP-RCC samples for all …

Monoclonal Immunoglobulin-Associated Glomerulopathy: Single Health Center Experience With 16 Cases, Brandon Metcalf, Yazan A. Al-Othman, James Huang, Wei Li, Hassan D. Kanaan, Ping L. Zhang

Conference Presentation Abstracts

Context: In addition to monoclonal cryoglobulinemic glomerulopathy, nonorganized monoclonal immunoglobulin (Ig) can deposit in glomeruli, causing either proliferative glomerulonephritis or membranous glomerulopathy. We present our experience related to this phenomenon.

Design: Sixteen cases of monoclonal immunoglobulin-associated glomerulopathy (MIAGN) from 14 patients were identified during the past 13 years and their pathologic and clinical features were collected and presented.

Results: One case of membranous glomerulopathy with monoclonal immunoglobulin deposits (MGNMID) (also called membranous glomerulopathy with light-chain–restricted deposits) was found. The patient was a 71-year-old woman with serum creatinine at 0.7 mg/dL and nephrotic syndrome (urine protein to creatinine ratio at 5.41), …

Igm-Dominant Immune Complex-Mediated Glomerulonephritis Should Be Classified As Membranoproliferative Glomerulonephritis, Igm Subtype, Sarang Khan, Brandon Metcalf, Wei Li, Hassan Kanaan, Ping L. Zhang

Conference Presentation Abstracts

Context: Immunoglobulin M (IgM) glomerulopathy usually presents as drug-resistant nephrotic syndrome and is characterized by diffuse effacement of foot processes and scattered mesangial IgM deposits, which is considered within the spectrum of minimal change disease and primary focal segmental glomerulosclerosis. However, IgM-dominant immune complex–mediated glomerulonephritis (IgM-ICMGN) is a rare renal entity and usually characterized by a membranoproliferative pattern with light microscopy; dominant IgM staining by immunofluorescent staining; and subendothelial, mesangial, and occasional subepithelial deposits by electron microscopy.

Design: We report our experience of 5 IgM-ICMGN cases with their pathologic phenotypes and clinical scenarios.

Results: Patient ages ranged from 47 to …

Combined Smad4 And Imp3 Immunohistochemical Stains To Increase The Probability Of Diagnosing Pancreatic Adenocarcinomas In Fine-Needle Biopsies, Reenal Patel, Ashbita Pokharel, Ping L. Zhang, Zhenhong H. Qu

Conference Presentation Abstracts

Context: SMAD4 and IMP3 are useful stains in diagnosing pancreatic cancer but not perfect to reach that goal individually. We attempted to determine if using both SMAD4 and IMP3 can increase the diagnostic specificity of fine-needle biopsies (FNBs) for pancreatic adenocarcinomas, as FNBs often showed limited tissue for the morphologic evaluation.

Design: Fifteen FNBs with or without prior cytology were evaluated with both SMAD4 and IMP3 stains. Nuclear loss of SMAD4 was graded as 0 (no loss), 1–2+ (partial loss), and 3+ (total loss), whereas IMP3 was graded 0–3+ by staining intensity. Staining results were correlated with morphologic changes for …

Doac Therapy Associated With Macroscopic Hematuria: Investigation Of The Underlying Urologic Etiologies, Catherine Xie, Mary Wyrzykowski, Subhash Edupuganti, Ming Xie

Conference Presentation Abstracts

Context: Direct oral anticoagulants (DOACs) have gained wide use in prevention and treatment of thromboembolic diseases. Both major and nonmajor bleeding events have been reported. Hematuria is a common bleeding complication in patients receiving DOACs.

Design: This study retrospectively investigates the underlying urologic etiologies responsible for DOAC therapy–related macroscopic hematuria. During a 1-year period, hospitalized patients with prolonged PTT and DOAC therapy–related hemorrhage were identified. Medical chart review focused on urology consult and related laboratory and imaging findings.

Results: Among 93 patients with DOAC therapy–related hemorrhage, 15 had macroscopic hematuria (16%), including 11 men and 4 women with a median …

Using An Artificial Intelligence (Ai) Tool (Chatgpt) To Identify The Main Indications And Side Effects Of Drugs In Patient Medical Records, Mai Elzieny, Zhenhong Qu

Conference Presentation Abstracts

Context: Drug history is important clinical information for the correct histologic diagnosis of a wide variety of nonneoplastic diseases, such as hepatitis, gastritis, and colitis. As pathologists, however, keeping a strong knowledge of all drugs (and variations of drug names) can be challenging. Using online databases to find relevant drug information one at a time is very time-consuming.

Design: Sixty-seven drugs were collected from the medical records of 5 randomly selected patients. ChatGPT (https://chat.openai.com/chat) was instructed to identify (1) the main clinical indications, and (2) the major side effects of each drug, using the prompt “List the major indications and …

Audit Tumor Reports In Pathology For Completeness And Compliance By An Artificial Intelligence Tool, Chatgpt, Ashbita Pokharel, Keran Zhao, Reenal Patel, Jack W. Qu, Zhenhong Qu

Conference Presentation Abstracts

Context: A tumor synoptic report (TSR) audit is an important quality control tool for compliance with reporting requirements; however, no simple audit tool is readily available to most pathologists. ChatGPT (https://chat.openai.com/chat) is an emerging artificial intelligence tool with wide applications. Its ability to extract data from text content has been widely reported but lacks evidence-based validation for its application in medicine. We assess the effectiveness of ChatGPT to identify and extract key data elements of TSRs and detect missing elements.

Design: Forty synoptic reports of malignant tumors of the lung, kidney, colon, and uterus were collected randomly. Key data elements …

Enhancing Pathology Report Analysis With Artificial Intelligence: A Validation Study Of Chatgpt's Effectiveness In 444 Cases, Zhenhong Qu, Megan Wang, Christian Santiago, Jack W. Qu, Ping Zhang

Conference Presentation Abstracts

Context: Despite years of efforts, the pathology report lacks standardization for its gross description. This inevitably leads to the occasional omission of key data elements, and difficulty to identify key elements in a lengthy unstructured report. A novel artificial intelligence (AI) tool, ChatGPT by OpenAI (San Francisco, California), was reportedly proficient in extracting keywords from text content. We assess the effectiveness of ChatGPT to quickly find multiple data elements in reports and detect missing data elements.

Design: Gross description of 444 pathology reports of several common organ types was submitted to ChatGPT (https://chat.openai.com/chat) that extracted and listed key data elements …

Refractive Outcomes Of Phacoemulsification Wtih Endocyclophotocoagulation Vs. Phacoemulsification Alone, Truman Silvasi

Conference Presentation Abstracts

No abstract provided.

Richter Syndrome And The Retina, Sahal Saleh

Conference Presentation Abstracts

No abstract provided.

Growth Hormone Deficiency: When Is Mri Imaging Indicated?, Haya Azouz, Kurt Tech, M Bassem Dekelbab

Conference Presentation Abstracts

Objectives The diagnosis of Growth Hormone Deficiency (GHD) is made with a combination of clinical assessment, measurement of insulin-like growth factor 1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) levels, and GH stimulation tests. Provocative (stimulation) GH testing is indicated for most patients to confirm a diagnosis of GHD. Traditionally, most pediatric endocrinologists defined a "normal" response by a serum GH concentration of >10 ng/ml. After the clinical and biochemical diagnosis of GHD is made, it is typical to obtain an MRI of the brain with narrow cuts through the hypothalamic-pituitary area. The aim of our study is to …

Calculating Differences In Surrogate Lung Perfusion Measurements Between Smokers And Nonsmokers As A Biomarker To Assess Their Potentials For Developing Chronic Obstructive Pulmonary Disease, A Prakash, A Nowacki, Y K. Liu, J Cisneros-Paz, Girish Nair, E Castillo

Conference Presentation Abstracts

Purpose: COPD (chronic obstructive pulmonary disease) is a collection of lung diseases that complicates breathing and causes irreversible lung damage. Given that it is a progressive disease, early detection is crucial for managing its symptoms. We recently developed a method for calculating pulmonary blood mass change (PBMC) apparent on paired inhale/exhale non-contrast computed tomography (CT) scans as a quantitative surrogate for lung perfusion. Our long term objective is to develop a PBMC biomarker for predicting COPD progression. As a first step, we hypothesize that PBMC is significantly lower for non-COPD smokers versus non-COPD non-smokers. Methods: CT scans from 77 healthy …

Rethinking Resilience Using The R-Factor: Neurobiological Mechanisms Of Static And Dynamic Components Of Resilience Following Trauma, Sanne Van Rooij, Justin Santos, Cecilia A. Hinojosa, Timothy Ely, Nathaniel Harnett, Vishnu P. Murty, Lauren Lebois, Tanja Jovanovic, Stacey House, Robert A. Swor

Articles

Resilience is a dynamic process of recovery after trauma, but in most studies it is conceptualized as the absence of specific psychopathology following trauma. Using the large emergency department AURORA study (n=1,865, 63% women), we took a longitudinal, dynamic and transdiagnostic approach to define a static resilience (r) factor, that could explain >50% of variance in mental wellbeing 6-months following trauma, and a dynamic r-factor, which represented recovery from initial symptoms. We assessed its neurobiological profile across threat, inhibition, and reward processes using fMRI collected 2-weeks post-trauma. Our neuroimaging results suggest that resilience is promoted by activation of higher-level cognitive …

57 Yo Man With High Grade Astrocytoma With Piloid Features And 2 Other Cns Lesions, Joseph Fullmer

Conference Presentation Abstracts

Patient is a 57 yo man who presented with periodic headaches and lower back pain, initially attributed to lifting heavy weights but symptoms persisted. Eventual imaging was performed and revealed a 4 cm heterogeneously enhancing left cerebellar mass, 1 cm enhancing lateral right frontal subcortical lesion, and enhancing T12-L1 spinal cord lesion and multiple smaller spinal cord lesions suggestive of drop metastasis. The cerebellar lesion was first resected and final results, including methylome profiling, were consistent with high grade astrocytoma with piloid features (HGAP). The T12-L1 spinal lesion was later resected and had somewhat distinct histology although intraoperatively surgeon felt …

Does Proton Arc Therapy Has Potential Clinical Benefits For Hepatocellular Carcinoma?, Peilin Liu, R Dalfsen, M Soukup, Shupeng Chen, Lewei Zhao, Z Wang, X S. Gao, Thomas Quinn, Craig Stevens, Rohan Deraniyagala, Xiaoqiang Li, Xuanfeng Ding

Conference Presentation Abstracts

Purpose: To investigate the potential clinical benefits and dose-averaged Linear Energy Transfer (LETd) sparing, utilizing proton arc plan for Hepatocellular carcinoma (HCC) patients in comparison with Intensity Modulated Proton Therapy (IMPT). Methods: Ten HCC patients have been retrospectively selected. Two planning groups were created: Proton Arc plans using Monaco ver. 6 and the clinical IMPT plan. Both planning groups used the same robustness parameters. The prescription dose is 67.5 Gy (RBE) in 15 fractions/ 66 GyE in 10 fractions of the Clinical Target Volume (CTV) following clinical IMPT plan. Robustness evaluations were performed to ensure target dose coverage. Normal Tissue …