Medical Specialties Commons^™

Secondary Syphilis Mimicking Marginal Zone B-Cell Lymphoma In A 70-Year-Old Man., Hannah Gier, Shannon Trotter

Ambulatory and Primary Care Articles

No abstract provided.

Plastic Deformation Of The Pediatric Forearm: Recognition, Radiographic Measurement, And Management., Caitlin Wetzel, Matthew Rohl, Taylor Manes, Allen Kadado

Ambulatory and Primary Care Articles

Pediatric forearm bowing fractures, also known as plastic deformation fractures, are a clinically important but often underdiagnosed injury pattern. These fractures usually occur from longitudinal compressive forces such as falls on an outstretched hand, causing plastic deformation that exceeds the elastic limit of pediatric bone. Patients often present with nonspecific symptoms like pain, swelling, and limited pronation-supination, and these injuries can be subtle on radiographs. Using standardized measurement methods, such as the percentage of radial bowing relative to total bone length, can improve diagnosis; values over approximately 10% of radial length are considered suggestive of pathological bowing. Missing or delaying …

Impact Of Depression And Anxiety On Outcomes Following Muscle-Preserving Transforaminal Lumbar Interbody And Fusion., Sahil Garg, Sean M Muir, Kyle Jamar, Alexa Dietrich, Patrick Young, Sonny Gill

Surgery Articles

Background: The impact of concurrent diagnoses of anxiety and depression has not been extensively studied in spine surgery. We hypothesize that a muscle-sparing technique may be associated with decreased postoperative pain and improved strength postoperatively compared to open techniques, decreasing the stress of the postoperative recovery process. Therefore, this study aims to assess the benefits that a modified muscle-preserving lumbar fusion technique (Wiltse transforaminal lumbar interbody and fusion (W-TLIF)) would have on this subset of patients.

Methods: One hundred twenty subjects who underwent a single-level W-TLIF were identified with a recorded diagnosis status associated with mental health. The subjects underwent …

Current State And Needs Of Clinical Laboratories In Latin America: A Cross-Country Assessment., Alejandro R Molinelli, Elizabeth L Palavecino, José C Jara-Aguirre, Kerry Cosby, Allison Targowski, Barbara M Goldsmith, Rosa Sierra-Amor, Juan D García, Alicia Algeciras-Schimnich, Eugenio H Zabaleta, Veronica I Luzzi, Jessica M Colón-Franco

Ambulatory and Primary Care Articles

The Association for Diagnostics & Laboratory Medicine (ADLM) aims to improve health by providing education to laboratory scientists worldwide. Different regions of the world face unique challenges shaped by their national and regional contexts. However, the needs of clinical laboratories worldwide remain largely understudied. To address this gap, we conducted a comprehensive needs assessment survey among laboratory professionals in the Latin American region. The survey was distributed to over 2708 individuals across Latin American countries and yielded 148 responses. Most respondents were from urban areas (74%) and worked in private hospital laboratories (45%), with microbiology (25%) and chemistry (23%) identified …

Clinical And Economic Impact Of Vascular Access Teams Utilizing An Ic-Ecg-Based Tip Confirmation System For Peripherally Inserted Central Catheters., Gustavo Rc De Freitas, Sanjay A Patel, Shigeki Fujitani, Yusuke Terasaka, Angel A Sarabia Collazo, Andrew Barton, Leanne Ruegg, Amanda Griffin, Matthew O'Brien, Idal Beer

Heart and Vascular Articles

INTRODUCTION: Peripherally inserted central catheters (PICCs) are commonly used in clinical practice. Historical PICC placement methods (e.g. fluoroscopy-guided placement or blind insertion with confirmatory chest X-ray) have many limitations and are associated with longer wait times, treatment delays, and potential risks to patient safety. One such way of addressing some of these issues is the use of dedicated systems that integrate ultrasound vessel selection and PICC insertion, magnetic catheter tip navigation, and intracavitary electrocardiogram-based tip confirmation (IC-ECG). The uptake of these systems has been slow in some parts of the world. This narrative review aims to assess the clinical and …

Manufacturing And Clinical Applications Of Non-Car-T Immune Effector Cells., Thane Kubik, Theodros Mamo, David H Mckenna

Oncology Articles

No abstract provided.

Comparison Of Integrated 3d Electroanatomic Mapping And Conventional Mapping Systems For Pentaspline Pulsed Field Ablation Of Atrial Fibrillation., Auroa Badin, Andrea K Robinson, Allyson Farrah, Saanvi Billakanty, David M Nemer, Ankur N Shah, Jaret D Tyler, Eugene Y Fu, Nagesh Chopra, Anish K Amin

Heart and Vascular Articles

INTRODUCTION: Pulsed field ablation (PFA) is an established therapy for atrial fibrillation (AF), yet optimal mapping strategies during pentaspline PFA remain uncertain. We compared procedural characteristics and material costs of an integrated 3D electroanatomic mapping (EAM) platform with conventional mapping systems.

METHODS AND RESULTS: In a multicenter observational study of 448 consecutive AF ablations done using pentaspline catheter (62 integrated mapping; 386 conventional mapping) performed between February 2024 and August 2025, baseline characteristics were similar between groups. Compared with conventional mapping, the integrated platform was associated with shorter total procedure time (49 ± 16 vs. 66 ± 26 min, p …

Soft Skills For Medical Physicists: Evolving A Profession., Tomas Kron, Julie Raffi, Shada Wadi-Ramahi, Abdelkader Toutaoui, Bilal Jalal, Peter A Sandwall, Graciela Velez, Dario Sanz, Godfrey Azangwe

Oncology Articles

PURPOSE: Medical physicists are essential healthcare professionals who bridge the gap between technology and patient care, particularly in radiation oncology and medical imaging. With the profession expanding its clinical and global roles, the need for competencies beyond technical expertise-such as communication, leadership, and cultural awareness-is increasingly evident. These competencies, commonly referred to as soft skills, are critical for patient-centered care but remain insufficiently integrated into formal education and training pathways. The aim of the present work was to identify soft skills relevant to medical physics practice and investigate where in a career they are acquired and used.

METHODS: This paper …

Feasibility And Outcomes Of Perirectal Spacer Implantation In Previously Treated Prostate Cancer Patients Undergoing Salvage Proton Therapy Radiation., Irini Yacoub, Keyur Mehta, Daniel Gorovets, Shaakir Hasan, J Isabelle Choi, Arpit M Chhabra, Stanislav Lazarev, Madhur Garg, Charles B Simone

Oncology Articles

PURPOSE: Treatment of recurrent prostate cancer following prior therapy is challenging due to the risk of toxicities to previously irradiated normal tissues, particularly the rectum. Proton therapy offers a conformal approach that may reduce this risk. Perirectal spacers have been shown to further minimize rectal dose in primary treatment, but the ability to be placed and their value in the retreatment setting have not been thoroughly evaluated to date. The purpose of this study was to evaluate feasibility of rectal spacer placement after prior pelvic radiation or other local treatments for prostate cancer.

METHODS AND MATERIALS: We conducted a retrospective …

Navigation-Assisted Percutaneous Fixation Of An Anterior Column And Posterior Hemitransverse Fracture In An Elderly Patient: A Case Report., Matthew Rohl, Taylor J Manes, Nate Rodriguez, Kevin Monahan, Joseph P Scheschuk

Surgery Articles

INTRODUCTION: Acetabular fractures in elderly patients are often the result of low-energy trauma and are complicated by osteopenia, comorbidities, and limited physiologic reserve. Minimally invasive approaches, such as percutaneous fixation have emerged as viable alternatives to open reduction in selected fracture patterns.

CASE REPORT: We report the case of a 76-year-old male with a history of coronary artery disease, hypertension, hyperlipidemia, and osteopenia who sustained a comminuted right anterior column and posterior hemitransverse acetabular fracture following a ground-level fall. His hospital course was complicated by rhabdomyolysis and elevated troponin levels, necessitating cardiac evaluation, which demonstrated normal left ventricular function and …

Acute Schistosomiasis In A Traveler Returning From St. Croix, United States Virgin Islands: A Case Report., John Weis, Mackenzie Caruthers, Megan Buller

Ambulatory and Primary Care Articles

In this case report, we describe a patient who presented to their primary care provider with abdominal pain after returning from travel to the Caribbean island of St. Croix. The patient reported two weeks of epigastric abdominal pain, dyspepsia, nausea, and night sweats. Following an initial evaluation that revealed eosinophilia with unclear etiology, they were referred to an infectious disease clinic. Through a targeted infectious evaluation and workup, the patient was diagnosed with acute schistosomiasis syndrome and was treated with praziquantel. Treatment resulted in the complete resolution of her symptoms, and follow-up laboratory evaluation showed complete resolution of her eosinophilia. …

Six-Year Outcomes After Transcatheter Vs Surgical Aortic Valve Replacement In Low-Risk Patients With Aortic Stenosis., John K Forrest, Steven J Yakubov, G Michael Deeb, Michael J Reardon

Heart and Vascular Articles

BACKGROUND: The Evolut Low Risk trial enrolled patients with severe aortic stenosis at low surgical risk. Annual follow-up is planned for 10 years, evaluating the composite of all-cause mortality or disabling stroke and key secondary endpoints.

OBJECTIVES: Our prespecified objective was to report the 6-year clinical outcomes of transcatheter aortic valve replacement (TAVR) vs surgery from the Evolut Low Risk trial. Given an increase in reintervention rates at 6 years, we performed additional analyses in available 7-year data.

METHODS: Low-risk patients with severe symptomatic aortic stenosis were randomized to TAVR or surgery from 2016-2019. Prespecified analyses at 6 years included …

Postdilation Of Evolut Transcatheter Heart Valves: Insights From Bench Testing., Ole De Backer, Ryan Stublaski, Hatem Tadros, Arif Khokhar, Gintautas Bieliauskas, Steven J Yakubov, Michael Deeb, Kendra J Grubb, John K Forrest, Michael J Reardon

Heart and Vascular Articles

No abstract provided.

Right Ventricular Thrombus Presenting With Right Ventricular Failure In Septic Shock: A Case Report., Micah Harris

Heart and Vascular Articles

We present a case report of refractory multifactorial shock initially managed as septic shock, requiring multidisciplinary collaboration when the diagnostic pathway was limited by acute kidney injury; the primary learning objective is to highlight clinical decision-making in shock when standard contrast imaging is contraindicated. Echocardiography revealed right ventricular failure with right ventricular thrombus, and pulmonary embolism was strongly suspected but could not be confirmed due to the inability to obtain contrast imaging. Persistent shock prompted a transition from a septic shock-directed strategy to cardiogenic and obstructive shock management. The patient was treated with anticoagulation but was not a candidate for …

Glomerular Disease In Patients With Acute Kidney Injury After Vancomycin Treatment-Need For Kidney Biopsy., Mineaki Kitamura, Pooya Zardoost, Anjali A Satoskar

Ambulatory and Primary Care Articles

No abstract provided.

Design And Implementation Of An Aapm Volunteer Database For Advancing Global Medical Physics Initiatives., Teh Lin, Minsun Kim, Courtney Morrison, Jiahan Zhang, Kevin Little, Yan-Hong Xin, Michael Woodward, Peter Sandwall, Eun Young Han

Oncology Articles

PURPOSE: The purpose of this study is to assess American Association of Physicists in Medicine (AAPM) members' availability to volunteer, share their expertise, and promote global collaboration in medical physics by partnering with international colleagues who seek support in strengthening their medical physics practice.

METHODS: The questionnaire was administered to AAPM members to assess their willingness to volunteer, preferred engagement modalities, and availability for different types of volunteer activities. The questionnaire was integrated into the AAPM member profile and covered therapy, diagnostic, and nuclear medicine disciplines, capturing participants' visiting preferences and expertise in teaching and training. Respondents were categorized based …

Ischemic Stroke As The Initial Presentation Of Advanced Pancreatic Adenocarcinoma: A Case Of Marantic Endocarditis., Micah Harris

Ambulatory and Primary Care Articles

Nonbacterial thrombotic endocarditis (NBTE), formerly known as marantic endocarditis, is a rare condition characterized by sterile vegetations on cardiac valves and is often associated with hypercoagulable states such as adenocarcinoma. We describe a patient who presented with multiple embolic cerebrovascular accidents, ultimately found to be secondary to NBTE, which served as the initial manifestation of previously undiagnosed advanced pancreatic adenocarcinoma. This case underscores the importance of considering NBTE in patients with multifocal embolic infarcts, particularly when blood cultures are negative, echocardiography reveals valvular abnormalities without evidence of infection, and clinical suspicion for an underlying malignancy is present.

Annals Journal Club: How Patients Value Visits, Taylor Drew, Michael E Johansen

Medical Education Articles

No abstract provided.

Hepatitis C Virus Treatment Outcomes Using A Family Medicine Interdisciplinary Team., Megan Hull

Ambulatory and Primary Care Articles

No abstract provided.

Health Plan-Based Atherosclerosis Imaging For Members With Diabetics: Utilization And Impact On Subsequent Episodes Of Care., Subha V Raman, Alexander V Smolensky, Juhi Ramchandani, Purva Patel, Xin He, Tarek Aridi, John Salvas, Wasi Khatri, Jack Tiahnybik, Nihanth Damera, Keyur Vora, Rohan Dharmakumar

Heart and Vascular Articles

BACKGROUND: Quantitative coronary CT angiography plaque analysis (QCCTA) is a novel tool for atherosclerosis detection.

OBJECTIVES: The authors examined utilization of a health plan offering of QCCTA to diabetic members and the impact of utilization on health plan costs.

METHODS: Diabetic health plan members ≥40 years without prior myocardial infarction were offered QCCTA as a pilot benefit. Benefit utilizers were compared to eligible nonutilizers for incident cardiovascular episodes of care post-notification of eligibility.

RESULTS: Over 14 months, 2,064 of 38,079 health plan members were identified as eligible. Utilizers (19.1%) were predominantly White (76.4%) and female (72.6%) residing in communities with …

A Review Of 3d-Printed Medical Devices For Cancer Radiation Therapy., Radiah Pinckney, Santosh Kumar Parupelli, Peter Sandwall, Sha Chang, Salil Desai

Oncology Articles

This review explores the transformative role of three-dimensional (3D) printing in radiation therapy for cancer treatment, emphasizing its potential to deliver patient-specific, cost-effective, and sustainable medical devices. The integration of 3D printing enables rapid fabrication of customized boluses, compensators, immobilization devices, and GRID collimators tailored to individual anatomical and clinical requirements. Comparative analysis reveals that additive manufacturing surpasses conventional machining in design flexibility, lead time reduction, and material efficiency, while offering significant cost savings and recyclability benefits. Case studies demonstrate that 3D-printed GRID collimators achieve comparable dosimetric performance to traditional devices, with peak-to-valley dose ratios optimized for spatially fractionated radiation …

Leadless Versus Transvenous Dual-Chamber Pacemakers: Real-World Evidence From Aveir Dr Coverage With Evidence Development Study., Monica Lo, Anish K Amin, Marcin Kowalski, Anne Kroman, Dilip Mathew, Valay Parikh, Stanislav Weiner, Jennifer M Joseph, Leonard Ganz, Mohammed Mortada

Heart and Vascular Articles

BACKGROUND: AVEIR DR, an industry-first dual-chamber leadless pacemaker (LP), provides continuous atrioventricular synchrony through implant-to-implant (i2i) communication between atrial and ventricular LP devices. It is important to evaluate the early real-world comparative safety of AVEIR DR LP.

OBJECTIVE: To compare complications and mortality between AVEIR DR LP and dual-chamber transvenous pacemakers (TP).

METHODS: De novo LP and TP patients were identified in Medicare Fee-for-Service claims (October 2023 and December 2024). Outcomes were 30-day and 6-month complications, reinterventions, heart failure hospitalizations, and all-cause mortality. Comparisons were adjusted for demographics, comorbidities, and hospital encounter characteristics.

RESULTS: Compared to TP (N = 77 …

Deliver Us From Evil., Ethan Schimmoeller

Ambulatory and Primary Care Articles

No abstract provided.

Deep-Learning Serial Ct Prediction Of Survival In Immunotherapy-Treated Non-Small Cell Lung Cancer., Chiharu Sako, Brenda F Kurland, Taly G Schmidt, Jing He, Marius De Groot, Arpan A Patel, Dwight H Owen, Arya Amini, Brendan D Curti, Ronan J Kelly, Ray D Page, Aurelie Swalduz, Jean-Paul Beregi, Jan Chrusciel, Stephane Sanchez, Jakob Weiss, An Liu, Olivier Gevaert, Alma Hart, George R Simon, Ravi B Parikh, Jasper Van Der Aart, Petr Jordan

Oncology Articles

IMPORTANCE: Reliable early response biomarkers for overall survival (OS) are lacking for patients receiving immune checkpoint inhibitor (ICI) therapy for advanced non-small cell lung cancer (NSCLC). Existing imaging-based measures, such as Response Evaluation Criteria in Solid Tumors (RECIST) and tumor volume change (TVC), have limited predictive value for long-term outcomes, and advanced imaging-based biomarkers may enhance decision-making in clinical practice and clinical trials.

OBJECTIVE: To develop and validate a fully automated deep-learning imaging-based biomarker using pretherapy and 12-week follow-up computed tomography (CT) scans.

DESIGN, SETTING, AND PARTICIPANTS: This prognostic study used retrospectively collected HER data from routine clinical practice (RCP) …

Seasonal And Geographic Trends In Photodynamic Therapy And Cryosurgery Use In The United States: A Cross-Sectional Study From 2015-2022., Dawn Merritt, Jon Lyons, Mouna Mikati, Christian Geils, Todd Schlesinger

Ambulatory and Primary Care Articles

BACKGROUND: Photodynamic therapy (PDT) is an effective field treatment for actinic keratoses (AKs). It is an ideal option for patients who prefer a minimally invasive procedure conveniently administered in their physician's office. Anecdotal clinician insights suggest that it may not be used at the same rate year-round.

OBJECTIVE: This study investigates whether PDT and cryosurgery usage is affected by season and geographic location in the United States.

METHODS: The data source is an aggregate of closed and open United States medical procedural claims (

RESULTS: PDT utilization is affected by season and geographic location. Procedural claims peak during cooler months …

Lost Fractures: Prevalence And Risk Factors For Missed Costosternal And Costal Cartilage Fractures Among Patients With Radiologic Chest Wall Injury., Joseph D Forrester, Mohamad Abou Chaar, Andrew T Barnes, Zachary M Bauman, Samy Bendjemil, Nizama N Betts, Benjamin Christie, Raaga Dasari, Devoe Wb, Michelle J Earley, Bradley Faliks, Tracy J Johns, Connie Johnson, Michelle S Junker, Brian D Kim, Jonathan M King, Ariel Whitney Knight, Alexis A Schweibinz, Daniel Stephens, Mary Stuever, Simeng Wang

Trauma and Acute Care Articles

BACKGROUND: Costosternal cartilages and the costal margin, collectively termed costal cartilage, are hyaline cartilage connecting ribs to the sternum and to adjacent ribs, respectively. Presence of intact costal cartilage is essential for elasticity of the chest wall. Anecdotally, costal cartilage injuries are underdiagnosed on trauma CT scan in patients with rib fractures. Our aim was to determine a baseline frequency of acute costal cartilage injury among patients presenting with rib fractures.

METHODS: We performed a retrospective cohort study of injured adult patients admitted to Level I/II trauma centers with rib fractures from January 2020 to July 2024. CT images obtained …

Ex Vivo Assessment Of Keratinocytic Carcinomas Using A Fast Mid-Infrared Probe., Maria G Vazquez De Vasquez, Rebecca C Bradley, Charles L Hitchcock, Angela S Casey, Austin Cusick, James V Coe, Ronald Siegle

Ambulatory and Primary Care Articles

A fast mid-infrared spectral probe was used to record infrared (IR) spectra of fresh skin tissue removed from patients with biopsy-proven keratinocytic cancer (KC) during Mohs surgery. A 150-patient library of IR spectral data was obtained to see if KC on the epidermal side (outside) of tissue samples can be differentiated from adjacent nonmalignant tissue and normal skin. A linear support vector machine model minimized overtraining predicting the contributions to decisions at each step in the spectrum. Training with an equal cost for KC and nontumor cases samples demonstrated a KC sensitivity of 93% ± 5% and specificity 82% ± …

Acute Correction Of Acquired Genu Valgum Secondary To Post-Traumatic Growth Arrest At The Time Of Distal Femur Fracture., Josiah Wolf, Nicholas Pelz, Adam Mansour, Christopher Iobst, Allen Kadado

Surgery Articles

A 14-year-old male patient sustained a distal femur fracture after a ground-level fall. His history was notable for severe acquired genu valgum secondary to a childhood lawnmower accident, which had required multiple limb salvage procedures including a Syme amputation and soft-tissue skin grafting. Acute correction of the limb deformity was performed concurrently with fracture fixation using a retrograde intramedullary nail and poller blocking screws. Retrograde intramedullary nailing represents a viable treatment option for simultaneous acute correction of acquired genu valgum and stabilization of distal femur fractures.

Trends In Dermatologic Biologic Prescribing: A Medicare Part D Public Use File Analysis From 2018 To 2023., Cathleen V D'Angelo, Patricia Wilberger, Chase Merritt, Joshua Burshtein, Dawn Merritt

Ambulatory and Primary Care Articles

No abstract provided.

Sequential Tav-In-Tav Resolves Lvot Pseudoaneurysm-Related Paravalvular Leak., Zeryab A Khan, Steven J Yakubov, Laura D Flannery, Carlos E Sanchez

Heart and Vascular Articles

No abstract provided.