Medical Specialties Commons^™

Failure Rates Of Nonoperative Management Of Low-Grade Splenic Injuries With Active Extravasation: An Eastern Association For The Surgery Of Trauma Multicenter Study., Kristen Spoor, John David Cull, Banan W Otaibi, Joshua P Hazelton, John Chipko, Jessica Reynolds, Sam Fugate, Claire Pederson, Linda B Zier, Lewis E Jacobson, Jamie M Williams, Thomas S Easterday, Saskya Byerly, Caleb Mentzer, Edward Hawke, Daniel C Cullinane, Julianne B Ontengco, Nikolay Bugaev, Madison Leclair, Pascal Udekwu, Cooper Josephs, Matthew Noorbaksh, James Babowice, Catherine Garrison Velopulos, Shane Urban, Anna Goldenberg, Gaby Ghobrial, John M Pickering, Steven D Quarfordt, Alia F Aunchman, Aimee K Lariccia, Chance Spalding, Richard D Catalano, Jordan E Basham, Philip M Edmundson, Jeffry Nahmias, Erika Tay, Scott H Norwood, Katelyn Meadows, Yee Wong, Claire Hardman

Trauma and Acute Care Articles

OBJECTIVES: There is little evidence guiding the management of grade I-II traumatic splenic injuries with contrast blush (CB). We aimed to analyze the failure rate of nonoperative management (NOM) of grade I-II splenic injuries with CB in hemodynamically stable patients.

METHODS: A multicenter, retrospective cohort study examining all grade I-II splenic injuries with CB was performed at 21 institutions from January 1, 2014, to October 31, 2019. Patients >18 years old with grade I or II splenic injury due to blunt trauma with CB on CT were included. The primary outcome was the failure of NOM requiring angioembolization/operation. We determined …

Advancing The Practice Of Trauma: Utilizing Advanced Practice Providers To Improve Patient Outcomes Through A Collaborative Team Approach., Alaina M Lasinski, Allysen Shaughnessy, Benjamin Reynolds, Raquel Forsythe, Annika B Kay, Brian K Yorkgitis, Brandy N Younge, Ashley B Christmas, Jeffrey A Claridge

Trauma and Acute Care Articles

Advanced practice providers (APPs) have become essential to trauma teams in the United States during the last few decades. The optimal utilization of APPs is not yet known and is likely highly variable secondary to many factors. We discuss three aspects of the multidisciplinary approach to caring for trauma patients. First, a review of the literature demonstrates that APPs in trauma improve quality of care, patient throughput, and decrease cost. We then report on models of APP utilization by comparing five trauma centers across the country, concluding that utilization remains highly variable due to several system and provider factors. The …

2024 Canadian Surgery Forum: Sept. 25-28, 2024., Christine Li, Michael Guo, Ahmer Karimuddin, Michael Guo, Christine Li, Ahmer Karimuddin, Jason Sutherland, Bright Huo, Tyler Mckechnie, Monica Ortenzi, Yung Lee, Stavros Antoniou, Julio Mayol, Hassaan Ahmed, Vanessa Boudreau, Karim Ramji, Cagla Eskicioglu, Pieter De Jager, David Urbach, Meredith Poole, Aghiles Abbad, Hussain Al-Shamali, Zainab Al-Faraj, Chuck Wen, Radu Pescarus, Robert Bechara, Dennis Hong, Lily J Park, Maura Marcucci, Sandra Ofori, Jessica Bogach, Pablo E Serrano, Marko Simunovic, Ilun Yang, Margherita Cadeddu, Michael J Marcaccio, Flavia K Borges, Rahima Nenshi, P J Devereaux, Peter Urbanellis, Joanne Douglas, Evan Nemeth, James Ellsmere, Richard Spence, Joshua Cunningham, Ryan Falk, Tom Skinner, Nicole Ebert, Lauren Galbraith, Mark Prins, Shahrzad Joharifard, Emilie Joos, Adele Orovec, Lynn Lethbridge, Richard Spence, Marius Hoogerboord, Heather Stuart, Anne-Marie Bergeron, Ilun Yang, Jessica Bogach, Laura Nguyen, Clare Reade, Lua Eiriksson, Michelle Morais, Gillian Hanley, Sarah Mah, Karanbir Brar, Keri A Seymour, Shaina R Eckhouse, Ranjan Sudan, Jacob A Greenberg, Dana Portenier, James J Jung, Anne Light, Brittany Dingley, Megan Delisle, Sameer Apte, Ranjeeta Mallick, Trevor Hamilton, Heather Stuart, Martha Talbot, Gregory Mckinnon, Evan Jost, Eve Thiboutot, Carolyn Nessim, Neha Katote, Ashley Drohan, Richard Spence, Katerina Neumann, Ge Shi, Regina Leung, Christina Lim, Matthew Van Oirschot, Aaron Grant, Sarah Knowles, Julie Ann Van Koughnett, Karine Brousseau, Leah Monette, Daniel Mcisaac, Christopher Wherrett, Ranjeeta Mallick, Aklile Workneh, Tim Ramsay, Alan Tinmouth, Julie Shaw, François Martin Carrier, Dean Fergusson, Guillaume Martel, Matthew Cornacchia, Victoria Ivankovic, Shahad Abdulkhaleq Mamalchi, Dexter Choi, Peter Glen, Maher Matar, Fady Balaa, Natasha Caminsky, Sarah Mashal, Nathalie Boulanger, Larry Watt, Jonathon Campbell, Jeremy Grushka, Paola Fata, Evan Wong, Michael Guo, Ahmer Karimuddin, Jason Sutherland, Christine Li, Wenjie Lin, Ahmer Karimuddin, Bright Huo, Elisa Calabrese, Sunjay Kumar, Bethany Slater, Danielle S Walsh, Wesley Vosburg, Uzair Jogiat, Simon Turner, Vickie Baracos, Dean Eurich, Heather Filafilo, Eric Bedard, Sam Khan, Tom Waddell, Kazuhiro Yasufuku, Andrew Pierre, Shaf Keshavjee, Elliot Wakeam, Laura Donahoe, Marcelo Cypel, Najib Safieddine, Michael Ko, Natasha Leighl, Jamie Feng, Jonathan Yeung, Marc De Perrot, Alexandra Salvarrey, Negar Ahmadi, Carmine Simone, Gazala Sayf, David Parente, Victoria Cheung, Mary R Rabey, Michael Cabanero, Lisa W Le, Christodoulos Pipinikas, Amber Chevalier, Richard Chaulk, David Sahai, Richard Malthaner, Mehdi Qiabi, Dalilah Fortin, Richard Inculet, Rahul Nayak, John Campbell, Peter White, Adam Bograd, Alexander Farivar, Brian Louie, Geraint Berger, Daniel French, Simon Houston, Flyn Gallardo, Bryce Macek, Richard Liu, Biniam Kidane, Nader M Hanna, Yogita S Patel, Ikennah Browne, Esther Provost, Forough Farrokhyar, Ehsan Haider, Waël C Hanna, Garrett Johnson, George Okoli, Nicole Askin, Ahmed Abou-Setta, Harminder Singh, Alexandra Coxon-Meggy, Julie Cornish, Lars Icat Study Management Group, Sahil Sharma, Jigish Khamar, Jo-Anne Petropolous, Amandeep Ghuman, Wenjie Lin, Christine Li, Carl Brown, Terry Phang, Manoj Raval, Amandeep Ghuman, Elizabeth Clement, Ahmer Karimuddin, Tyler Mckechnie, Jigish Khamar, Christopher Chu, Amin Hatamnejad, Ghazal Jessani, Yung Lee, Aristithes Doumouras, Dennis Hong, Cagla Eskicioglu, Giancarlo Sticca, Madeleine Poirier, Jean-François Tremblay, Jean-François Latulippe, Yves Bendavid, Jean-Sébastien Trépanier, Ariane Lacaille-Ranger, Margaret Henri, Tyler Mckechnie, Tania Kazi, Victoria Shi, Shan Grewal, Ahmed Aldarraji, Kelly Brennan, Sunil Patel, Nalin Amin, Aristithes Doumouras, Sameer Parpia, Cagla Eskicioglu, Mohit Bhandari, Gaurav Talwar, Tyler Mckechnie, Jigish Khamar, Luke Heimann, Swati Anant, Cagla Eskicioglu, Victoria Shi, Tyler Mckechnie, Swati Anant, Moeiz Ahmed, Sahil Sharma, Gaurav Talwar, Dennis Hong, Cagla Eskicioglu, Tania Kazi, Tyler Mckechnie, Yung Lee, Rehab Alsayari, Gaurav Talwar, Aristithes Doumouras, Dennis Hong, Cagla Eskicioglu, Lily J Park, Husein Moloo, Tim Ramsay, Kednapa Thavorn, Justin Presseau, Terry Zwiep, Guillaume Martel, P J Devereaux, Robert Talarico, Daniel I Mcisaac, Madeline Lemke, Wenjie Lin, Carl Brown, Elizabeth Clement, Anu Ghuman, Terry Phang, Manoj Raval, Ahmer Karimuddin, Christine Li, Wenjie Lin, Elizabeth Clement, Amandeep Ghuman, Cameron Hague, Ahmer Karimuddin, P Terry Phang, Manoj Raval, Pari Tiwari, Patrick Vos, Carl Brown, Alessandro Ricci, Ameer Farooq, Sunil Patel, Kelly Brennan, Vanessa Wiseman, Tyler Mckechnie, Allison Keeping, Paul Johnson, Heidi Bentley, Karim Messak, Jessica Bogach, Gregory Pond, Shawn Forbes, Vanja Grubac, Scott Tsai, Christian Van Der Pol, Marko Simunovic, Adom Bondzi-Simpson, Ramy Behman, Tiago Ribeiro, Sheron Perera, Aisha Lofters, Rinku Sutradhar, Rebecca Snyder, Callisia Clarke, Natalie Coburn, Julie Hallet, Natasha Caminsky, Alex Chen, Jeongyoon Moon, Paul Brassard, Daniel Marinescu, Teodora Dumitra, Ebram Salama, Carol-Ann Vasilevsky, Marylise Boutros, Kelly Brennan, Tyler Mckechnie, Vanessa Wiseman, Alessandro Ricci, Ameer Farooq, Sunil Patel, Tania Kazi, Tyler Mckechnie, Ghazal Jessani, Victoria Shi, Niv Sne, Aristithes Doumouras, Dennis Hong, Cagla Eskicioglu, Manisha Jogendran, Jennifer Flemming, Maya Djerboua, Martin Korzeniowski, Brooke Wilson, Shaila Merchant, Sean Bennett, Kala Hickey, Stephanie Gill, Zoë Breen, Kaitlyn Harding, Hannah Yaremko, Patti Power, Alex Mathieson, David Pace, Joannie Neveu, Sean Bennett, Brooke Wilson, Nan Chen, Weidong Kong, Sunil Patel, Christopher Booth, Shaila Merchant, Sean Bennett, Georgia Nelson, Nouf Almarzooqi, Manisha Jogendran, Maya Djerboua, Brooke Wilson, Jennifer Flemming, Shaila Merchant, Lily J Park, Carol Wang, Vicki Archer, Tyler Mckechnie, Dan Cohen, Jessica Bogach, Marko Simunovic, Pablo E Serrano, Rodney H Breau, Paul Karanicolas, P J Devereaux, Georgia Nelson, Nouf Almarzooqi, Shaila Merchant, Sean Bennett, Janyssa Charbonneau, Mai-Kim Gervais, Alexandre Brind'amour, Narcisse Singbo, Mikaël Lefebvre Soucisse, Lucas Sidéris, Guy Leblanc, Jean-François Tremblay, Pierre Dubé, Ekaterina Kouzmina, Matthew Castelo, Nicole Look Hong, Julie Hallet, Natalie Coburn, Frances Write, Lena Nguyen, Sonal Gandhi, Katarzyna Jerzak, Andrea Eisen, Amanda Roberts, Dejan Vidovic, Brianne Cruickshank, Lucy Helyer, Carman Giacomantonio, Zuhaib Mir, Matheus Faleiro, Stephanie Hiebert, Scott Livingstone, Mark Walsh, Boris Gala-Lopez, Sukhdeep Jatana, Daniel Krys, Uzair Jogiat, Janice Kung, Kevin Verhoeff, Tori Lenet, François Martin Carrier, Karine Brousseau, Franck Vandenbroucke-Menu, Yves Collin, Richard W D Gilbert, Maja Segedi, Jad Abou Khalil, Kimberly A Bertens, Fady Balaa, Dean A Fergusson, Guillaume Martel, Christopher Wherrett, Katlin Mallette, Leah Monette, Aklile Workneh, Monique Ruel, Elham Sabri, Heather Maddison, Melanie Tokessym, Patrick B Y Wong, Luc Massicotte, Michaël Chassé, Michel-Antoine Perrault, Élodie Hamel-Perreault, Jeieung Park, Shirley Lim, Véronique Maltais, Philemon Leung, Timothy Ramsay, Alan Tinmouth, Zofia Czarnecka, Nidheesh Dadheeech, Rena Pawlick, Haide Razavy, James Shapiro, Panthea Pouramin, Susan Allen, Boris Gala-Lopez, Nawal Amhis, Rachel Liu Hennessey, Yuwei Yang, Rochelle Guan, Yolanda Zhang, Adam Meneghetti, Chieh Chiu, Dhuvaraha Srikrishnaraj, Jeffrey Hawel, Christopher Schlachta, Ahmad Elnahas, Ayse Yilbas, Marguerite Mainprize, Anton Svendrovski, Christoph Paasch, Fernando Spencer Netto, Jigish Khamar, Tyler Mckechnie, Amin Hatamnejad, Yung Lee, Bright Huo, Edward Passos, Niv Sne, Cagla Eskicioglu, Dennis Hong, Sean Bennett, Jennifer Flemming, Maya Djerboua, Vanessa Wiseman, Jonah Moore, Peter Szasz, Sulaiman Nanji, Jonah Moore, Vanessa Wiseman, Peter Szasz, Isis Lunsky, Sulaiman Nanji, Jennifer A Flemming, Sean Bennett, Sandra Mckeown, Omar Mouhammed, Colton Gibb, Kevin Verhoeff, Michael Kim, Matt Strickland, Ram Anantha, Ilinca Georgescu, Yung Lee, Thomas Shin, Lea Tessier, Arshia Javidan, James Jung, Dennis Hong, Tyler Mckechnie, Andrew Strong, Matthew Kroh, Jerry Dang, Muhammad Faran, Tyler Mckechnie, Emma O'Callaghan, Sama Anvari, Taylor Hughes, Mark Crowther, Mehran Anvari, Aristithes Doumouras, Amin Andalib, Ali Safar, Philippe Bouchard, Sebastian Demyttenaere, Olivier Court, Simran Parmar, Brianna Brand, Noah Switzer, Richdeep Gil, Sunawer Aujla, Morgan Schellenberg, Natthida Owattanapanich, Brent Emigh, Jan-Michael Van Gent, Tanya Egodage, Patrick B Murphy, Chad Ball, Audrey L Spencer, Kelly N Vogt, Jessica A Keeley, Stephanie Doris, Kenji Inaba, Jordan Nantais, Nancy Baxter, Refik Saskin, Andrew Calzavara, David Gomez, Alex Le, Philip Dawe, Morad Hameed, Amir Hassanpour, Eran Shlomovitz, David Gomez, Eisar Al-Sukhni, Vanessa Wiseman, Sunil Patel, Sean Bennett, Zuhaib Mir, Stephanie Roberts, Harvey Hawes, Khalil Merali, Rachel Morris, Marc De Moya, Todd Neideen, Andrew Kastenmeier, Lewis Somberg, Dan Holena, Patrick Murphy, Jordan Nantais, Nancy Baxter, Refik Saskin, Andrew Calzavara, David Gomez, Asad Naveed, Umang Deshpande, David Gomez, Joao Rezende-Neto, Najma Ahmed, Andrew Beckett

Surgery Articles

No abstract provided.

Chestfeeding For Lactating People Living With Hiv., Bailey White, Bryce Ringwald, Emily Gorman

Women’s Health Articles

No abstract provided.

Agreement Between Published Reference Resources For Neurofilament Light Chain Levels In People With Multiple Sclerosis., Elias S Sotirchos, Chen Hu, Matthew D Smith, Hannah-Noelle Lord, Anna L Duval, Georgina Arrambide, Xavier Montalban, Katja Akgün, Tjalf Ziemssen, Robert T Naismith, Carrie M Hersh, Megan Hyland, Lauren B Krupp, Jacqueline A Nicholas, Robert A Bermel, Ellen M Mowry, Peter A Calabresi, Kathryn C Fitzgerald

Neuroscience Articles

OBJECTIVES: To examine the agreement between published reference resources for neurofilament light chain (NfL) applied to a large population of people with multiple sclerosis (MS).

METHODS: Six published reference resources were used to classify NfL in participants in the Multiple Sclerosis Partners Advancing Technology and Health Solutions (MS PATHS) network as elevated or normal and to derive age-specific NfL

RESULTS: NfL measurements were assessed from 12,855 visits of 6,687 people with MS (median 2 samples per individual [range 1-7]). The mean ± SD age was 47.1 ± 11.7 years, 72.1% of participants were female, disease duration was 15.0 ± 10.6 …

Randomized Phase Ii Trial Of Dendritic Cell/Myeloma Fusion Vaccine With Lenalidomide Maintenance After Upfront Autologous Hematopoietic Cell Transplantation For Multiple Myeloma: Bmt Ctn 1401., David J Chung, Nina Shah, Juan Wu, Brent Logan, Lina Bisharat, Natalie Callander, Giulia Cheloni, Kenneth Anderson, Thinle Chodon, Binod Dhakal, Steve Devine, Poorvi Somaiya Dutt, Yvonne Efebera, Nancy Geller, Haider Ghiasuddin, Peiman Hematti, Leona Holmberg, Alan Howard, Bryon Johnson, Dimitra Karagkouni, Hillard M Lazarus, Ehsan Malek, Philip Mccarthy, David Mckenna, Adam Mendizabal, Ajay Nooka, Nikhil Munshi, Lynn O'Donnell, Aaron P Rapoport, Jane Reese, Jacalyn Rosenblatt, Robert Soiffer, Dina Stroopinsky, Lynne Uhl, Ioannis S Vlachos, Edmund K Waller, James W Young, Marcelo C Pasquini, David Avigan

Oncology Articles

PURPOSE: Vaccination with dendritic cell (DC)/multiple myeloma (MM) fusions has been shown to induce the expansion of circulating multiple myeloma-reactive lymphocytes and consolidation of clinical response following autologous hematopoietic cell transplant (auto-HCT).

PATIENTS AND METHODS: In this randomized phase II trial (NCT02728102), we assessed the effect of DC/MM fusion vaccination, GM-CSF, and lenalidomide maintenance as compared with control arms of GM-CSF and lenalidomide or lenalidomide maintenance alone on clinical response rates and induction of multiple myeloma-specific immunity at 1-year posttransplant.

RESULTS: The study enrolled 203 patients, with 140 randomized posttransplantation. Vaccine production was successful in 63 of 68 patients. At …

Use Of Interleukin-12/23 Inhibitor For The Management Of Acne Fulminans., Hannah Gier, Alexa Israeli, Austin Cusick, Dawn Merritt

Ambulatory and Primary Care Articles

Acne fulminans (AF) is a rare disorder marked by severe eruptions of inflamed nodules, hemorrhagic crusts, and ulcers accompanied by systemic symptoms and often laboratory abnormalities. Commonly affecting adolescent males with pre-existing acne, AF has been associated with isotretinoin therapy and elevated testosterone levels. With unknown pathogenesis, lesions frequently involve the trunk and face and are managed standardly with corticosteroids and isotretinoin. Uncontrolled or recurrent cases pose challenges due to prolonged high-dose corticosteroid use with increased scarring. In this study, we present a case of AF in a 17-year-old male unresponsive to corticosteroid and isotretinoin therapy, successfully treated with ustekinumab, …

Implementing In-House Compounding Of Nimodipine Oral Syringes For Aneurysmal Subarachnoid Hemorrhage Patients., Keaton S Smetana, Kerri J Wilcox, Aaron M Cook

Neuroscience Articles

No abstract provided.

Randomized Controlled Trial Of Mechanical Thrombectomy Vs Catheter-Directed Thrombolysis For Acute Hemodynamically Stable Pulmonary Embolism: Rationale And Design Of The Peerless Study., Carin F Gonsalves, C Michael Gibson, Stefan Stortecky, Roger A Alvarez, Daren M Beam, James M Horowitz, Mitchell J Silver, Catalin Toma, John H Rundback, Stuart P Rosenberg, Craig D Markovitz, Thomas Tu, Wissam A Jaber

Heart and Vascular Articles

BACKGROUND: The identification of hemodynamically stable pulmonary embolism (PE) patients who may benefit from advanced treatment beyond anticoagulation is unclear. However, when intervention is deemed necessary by the PE patient's care team, data to select the most advantageous interventional treatment option are lacking. Limiting factors include major bleeding risks with systemic and locally delivered thrombolytics and the overall lack of randomized controlled trial (RCT) data for interventional treatment strategies. Considering the expansion of the pulmonary embolism response team (PERT) model, corresponding rise in interventional treatment, and number of thrombolytic and nonthrombolytic catheter-directed devices coming to market, robust evidence is needed …

Use Of Interleukin-12/23 Inhibitor For The Management Of Acne Fulminans., Hannah Gier, Alexa Israeli, Austin Cusick, Dawn Merritt

Ambulatory and Primary Care Articles

Acne fulminans (AF) is a rare disorder marked by severe eruptions of inflamed nodules, hemorrhagic crusts, and ulcers accompanied by systemic symptoms and often laboratory abnormalities. Commonly affecting adolescent males with pre-existing acne, AF has been associated with isotretinoin therapy and elevated testosterone levels. With unknown pathogenesis, lesions frequently involve the trunk and face and are managed standardly with corticosteroids and isotretinoin. Uncontrolled or recurrent cases pose challenges due to prolonged high-dose corticosteroid use with increased scarring. In this study, we present a case of AF in a 17-year-old male unresponsive to corticosteroid and isotretinoin therapy, successfully treated with ustekinumab, …

A Case Report: Kikuchi Disease Associated With A Positive Auto-Immune Panel Triggered By Covid-19 Infection., Andrew Graef, Aimee Willett, Andrew-Huy Dang, Jayalakshmi Balakrishna, Charles Nicely, Robert Baiocchi

Ambulatory and Primary Care Articles

Kikuchi disease (KD) is a rare, benign inflammatory condition characterized by fever and cervical lymphadenopathy. While the pathogenesis is largely unknown, Kikuchi disease onset has strong associations with various infections and autoimmune conditions. There are few reported cases of Kikuchi disease triggered by coronavirus disease 2019 (COVID-19) infection or vaccination. A 43-year-old Filipina female with a history of anemia and recent uncomplicated COVID-19 infection one month prior presented with a one-month history of progressive weakness, fatigue, anorexia with 30-pound weight loss, fevers, odynophagia, and new-onset hematemesis. Initial laboratory findings were most significant for a markedly elevated ferritin level prompting initial …

A Case Report: Kikuchi Disease Associated With A Positive Auto-Immune Panel Triggered By Covid-19 Infection., Andrew Graef, Aimee Willett, Andrew-Huy Dang, Jayalakshmi Balakrishna, Charles Nicely, Robert Baiocchi

Ambulatory and Primary Care Articles

Kikuchi disease (KD) is a rare, benign inflammatory condition characterized by fever and cervical lymphadenopathy. While the pathogenesis is largely unknown, Kikuchi disease onset has strong associations with various infections and autoimmune conditions. There are few reported cases of Kikuchi disease triggered by coronavirus disease 2019 (COVID-19) infection or vaccination. A 43-year-old Filipina female with a history of anemia and recent uncomplicated COVID-19 infection one month prior presented with a one-month history of progressive weakness, fatigue, anorexia with 30-pound weight loss, fevers, odynophagia, and new-onset hematemesis. Initial laboratory findings were most significant for a markedly elevated ferritin level prompting initial …

Neutrophil To Lymphocyte Ratio (Ntlr) Predicts Local Control And Overall Survival After Stereotactic Body Radiotherapy (Sbrt) In Metastatic Sarcoma., Eashwar Somasundaram, Peter M Anderson, Timothy D Smile, Ahmed Halima, James B Broughman, Chandana A Reddy, Shireen Parsai, Jacob G Scott, Timothy Chan, Shauna Campbell, Lilyana Angelov, Stacey Zahler, Matteo Trucco, Stefanie M Thomas, Shavaughn Johnson, Peng Qi, Anthony Magnelli, Erin S Murphy

Oncology Articles

The neutrophil to lymphocyte ratio (NTLR) and absolute lymphocyte count (ALC) recovery are prognostic across many cancers. We investigated whether NLTR predicts SBRT success or survival in a metastatic sarcoma cohort treated with SBRT from 2014 and 2020 (N = 42). Wilcox Signed Rank Test and Friedman Test compare NTLR changes with local failure vs. local control (N = 138 lesions). Cox analyses identified factors associated with overall survival. If local control was successful, NLTR change was not significant (p = 0.30). However, NLTR significantly changed in patients with local failure (p = 0.027). The multivariable Cox model demonstrated higher …

A Phase Ii Study Of Bevacizumab And Temsirolimus In Advanced Extra-Pancreatic Neuroendocrine Tumors., Sonia M Abuzakhm, Vineeth Sukrithan, Briant Fruth, Rui Qin, Jonathan Strosberg, Timothy J Hobday, Thomas Semrad, Diane Reidy-Lagunes, Hedy Lee Kindler, George P Kim, Jennifer J Knox, Andreas Kaubisch, Miguel Villalona-Calero, Helen Chen, Charles Erlichman, Manisha H Shah

Oncology Articles

We assessed the efficacy and safety of combining bevacizumab with temsirolimus in patients with advanced extra-pancreatic neuroendocrine tumors. This NCI-sponsored multicenter, open-label, phase II study (NCT01010126) enrolled patients with advanced, recurrent, or metastatic extra-pancreatic neuroendocrine tumors. All patients were treated with temsirolimus and bevacizumab until disease progression or unacceptable toxicity. Temsirolimus 25 mg was administered i.v. on days 1, 8, 15, and 22 and bevacizumab 10 mg/kg i.v. on days 1 and 15 of a 4-week cycle. Discontinuation of temsirolimus or bevacizumab did not require discontinuation of the other agent. The primary endpoints were objective response rate and 6-month progression-free …

Large Vessel Occlusion Prediction Scale Thresholds That Are Sensitive For Dawn Trial Patients., Kevin J Keenan, Wade S Smith, Ashutosh P Jadhav, Diogo C Haussen, Ronald F Budzik, Alain Bonafé, Parita Bhuva, Dileep R Yavagal, Marc Ribò, Christophe Cognard, Ricardo A Hanel, Ameer E Hassan, Cathy A Sila, Jeffrey L Saver, David S Liebeskind, Tudor G Jovin, Raul G Nogueira

Neuroscience Articles

BACKGROUND: Large vessel occlusion (LVO) prediction scales are used to triage prehospital suspected stroke patients with a high probability of LVO stroke to endovascular therapy centers. The sensitivities of these scales in the 6-to-24-h time window are unknown. Higher scale score thresholds are typically less sensitive and more specific. Knowing the highest scale score thresholds that remain sensitive could inform threshold selection for clinical use. Sensitivities may also vary between left and right-sided LVOs.

METHODS: LVO prediction scale scores were retrospectively calculated using the National Institutes of Health Stroke Scale (NIHSS) scores of patients enrolled in the DAWN Trial. All …

Supraventricular Tachycardia Associated With Repeat Cesarean Section Under Spinal Anesthesia., Mihir Patel, Matthias Franzen, Camille D Hawkins, Matthew Brown, Samir Patel

Heart and Vascular Articles

Supraventricular tachycardia (SVT) is the most common tachyarrhythmia of pregnancy. Catecholamine surges, the use of vasoactive agents during delivery, and increased cardiac output during pregnancy are the most common contributing factors to developing SVT. SVT is usually benign in presentation but can lead to more serious arrhythmias in patients with a history of mitral stenosis secondary to rheumatic heart disease. When an SVT is detected, organic heart causes should be ruled out first. Symptoms of SVT include shortness of breath, palpitations, syncope, sweating, chest pain, and dizziness. In patients who are refractory to pharmacologic management and hemodynamically unstable, electrical cardioversion …

Captive Samples Are Not The Answer To Survey Response Rates., Bryce A Ringwald

Medical Education Articles

No abstract provided.

Inflammation And Fibrosis In Orbital Inflammatory Disease: A Histopathologic Analysis., Rohan Verma, Allison J Chen, Dongseok Choi, David J Wilson, Hans E Grossniklaus, Roger A Dailey, John D Ng, Eric A Steele, Stephen R Planck, Craig N Czyz, Bobby S Korn, Don O Kikkawa, Jill A Foster, Michael Kazim, Gerald J Harris, Deepak P Edward, Azza Al Maktabi, James T Rosenbaum

Surgery Articles

PURPOSE: The purpose of this study was to compare the histopathologic inflammation and fibrosis of orbital adipose tissue in orbital inflammatory disease (OID) specimens.

METHODS: In this retrospective cohort study, inflammation, and fibrosis in orbital adipose tissue from patients with thyroid-associated orbitopathy (TAO), granulomatosis with polyangiitis (GPA), sarcoidosis, nonspecific orbital inflammation (NSOI), and healthy controls were scored by 2 masked ocular pathologists. Both categories were scored on a scale of 0 to 3 with scoring criteria based on the percentage of specimens containing inflammation or fibrosis, respectively. Tissue specimens were collected from oculoplastic surgeons at 8 international centers representing 4 …

Real-World Utilization Of An Intrauterine, Vacuum-Induced, Hemorrhage-Control Device., Dena Goffman, Kara M Rood, Angela Bianco, Joseph R Biggio, Paul Dietz, Kelly Drake, Erica Heilman, Maeve Hopkins, Monique De Four Jones, Tyler Katz, Courtney Martin, Mona Prasad, Marcela C Smid, Kathryn D Wine, Robert Ryan, Candice Yong, Patricia I Carney, Hyagriv N Simhan

Women’s Health Articles

OBJECTIVE: To assess the real-world effectiveness and safety of a U.S. Food and Drug Administration (FDA)-cleared intrauterine vacuum-induced-hemorrhage control device for postpartum hemorrhage (PPH) management.

METHODS: Sixteen centers in the United States participated in this observational, postmarket registry medical record review (October 2020 through March 2022). The primary effectiveness outcome was treatment success , defined as bleeding control after insertion with no treatment escalation or bleeding recurrence. Additional outcomes included blood loss, time to device insertion, indwelling time, bleeding recurrence, and time to bleeding control. Treatment success and severe maternal morbidity measures (transfusion of 4 or more units of red …

The Clinicopathologic Significance Of Npm1 Mutation And Ability To Detect Mutated Npm1 By Immunohistochemistry In Non-Aml Myeloid Neoplasms., Hatem Kaseb, Valeria Visconte, Daniel S Socha, Genevieve M Crane, Lisa Durkin, James R Cook, Jaroslaw P Maciejewski, Eric D Hsi, Heesun J Rogers

Oncology Articles

NPM1 mutated non-AML myeloid neoplasms (MN; T p. L287F; 65%) than frameshift insertion/duplication (35%) with median variant allele frequency (VAF; 9.7%, range 5.1%-49.8%). Mutated NPM1 by IHC showed cytoplasmic positivity in 48% and positivity was associated with higher VAF. The median overall survival (OS) in this cohort was 70 months. Nine patients (26%) progressed to AML. OS in patients who progressed to AML was significantly shorter than the one of patients without progression to AML (OS 20 vs. 128 months, respectively, log rank p = 0.05). NPM1 mutated non-AML MN patients commonly had cytopenias, dysplasia, normal karyotype, mutations in multiple …

Transcarotid Versus Transaxillary Access For Transcatheter Aortic Valve Replacement With A Self-Expanding Valve: A Propensity-Matched Analysis., Keith B Allen, Daniel Watson, Amit N Vora, Paul Mahoney, Adnan K Chhatriwalla, Jonathan G Schwartz, Antoine Keller, Nishtha Sodhi, Daniel Haugan, Michael Caskey

Heart and Vascular Articles

UNLABELLED: Transaxillary access has been the most frequently used nonfemoral access route for transcatheter aortic valve replacement (TAVR) with a self-expanding valve. Use of transcarotid TAVR is increasing; however, comparative data on these methods are limited. We compared outcomes following transcarotid or transaxillary TAVR with a self-expanding, supra-annular valve.

METHODS: The Transcatheter Valve Therapy Registry was queried for TAVR procedures using transaxillary and transcarotid access between July 2015 and June 2021. Patients received a self-expanding Evolut R, PRO, or PRO + valve (Medtronic) and had 1-year follow-up. Thirty-day and 1-year outcomes were compared in transcarotid and transaxillary groups after 1:2 …

Outcomes In High-Risk Pulmonary Embolism Patients Undergoing Flowtriever Mechanical Thrombectomy Or Other Contemporary Therapies: Results From The Flame Study., Mitchell J Silver, C Michael Gibson, Jay Giri, Sameer Khandhar, Wissam Jaber, Catalin Toma, Bushra Mina, Terry Bowers, Lee Greenspon, Herman Kado, David M Zlotnick, Mithun Chakravarthy, Aaron R Ducoffe, Paul Butros, James M Horowitz

Heart and Vascular Articles

BACKGROUND: Hemodynamically unstable high-risk, or massive, pulmonary embolism (PE) has a reported in-hospital mortality of over 25%. Systemic thrombolysis is the guideline-recommended treatment despite limited evidence. The FLAME study (FlowTriever for Acute Massive PE) was designed to generate evidence for interventional treatments in high-risk PE.

METHODS: The FLAME study was a prospective, multicenter, nonrandomized, parallel group, observational study of high-risk PE. Eligible patients were treated with FlowTriever mechanical thrombectomy (FlowTriever Arm) or with other contemporary therapies (Context Arm). The primary end point was an in-hospital composite of all-cause mortality, bailout to an alternate thrombus removal strategy, clinical deterioration, and major …

Response To "Point-Of-Care Ultrasound And Procedural Instruction In The Family Medicine Clerkship: A Cera Study"., Kennedy Ovenseri

Medical Education Articles

No abstract provided.

Operative Technique For A Successful Laparoscopic En-Bloc Resection Of Gastrogastric Fistula Following Roux-En-Y Gastric Bypass., Krishna Patel, Jordyn Perdue, Jaya Varre, Vinnie Serapiglia, Anthony Rizzo, Thomas Sonnanstine

Surgery Articles

Gastrogastric fistulas are rare complications following Roux-en-Y gastric bypass surgery and are characterized by a fistulous connection between the gastric pouch and the remnant stomach. The presentation is often variable and a high-index of suspicion must be maintained for accurate and timely diagnosis. In this case report, we provide a detailed review of the technical steps taken to successfully resect a gastrogastric fistula en-bloc laparoscopically with an unremarkable post-operative course.

Mild Biceps Tendonitis May Be Managed Nonoperatively During Shoulder Arthroscopy., Jonathan J Light, Wihan Du Plessis, Matthew H Adsit, Alexander T Eckstrom, Amanda B Firoved, Justin W Griffin, Kevin F Bonner

Surgery Articles

PURPOSE: The purposes of this study were to determine whether patients with mild biceps tendonitis required revision surgery after the biceps tendon was not surgically treated, while addressing concomitant pathology, and to evaluate whether preoperative groove pain affected patient-reported outcomes.

METHODS: Patients who underwent shoulder arthroscopy between 2015 and 2018 by a single surgeon for rotator cuff pathology, debridement, and distal clavicular excision (DCE), with or without subacromial decompression (SAD), and where the biceps tendon was not surgically addressed were retrospectively identified. Inclusion criteria were mild LS (< 50% hyperemic appearing biceps tendon arthroscopically), and a minimum 2-year follow-up. The primary outcome measure was the incidence of revision surgery. Secondary outcomes included American Shoulder and Elbow Surgeons (ASES) score, simple shoulder test (SST), pain level, and satisfaction scores. Two sample

RESULTS: Sixty-four of 69 eligible subjects (93%) were evaluated at a minimum …

A Paradoxical Internal Hernia At Brolin's Anti-Obstruction Stitch Following Roux-En-Y Gastric Bypass: A Case Report., Krishna Patel, Vinnie Serapiglia, Anthony N Rizzo, Jaya Varre, Thomas Sonnanstine

Surgery Articles

Internal hernias are a rare but morbid complication following Roux-en-Y gastric bypass surgery. The incorporation of Brolin's anti-obstruction stitch has historically demonstrated a significant reduction in the incidence of internal hernias following Roux-en-Y gastric bypass. We present an ironic and unique case of a patient with small bowel herniation into a defect between Brolin's stitch and the stapled closed common enterotomy of the jejunojejunostomy and technical considerations to decrease internal hernias at this site in the future.

Prediction Of Rapid Early Progression And Survival Risk With Pre-Radiation Mri In Who Grade 4 Glioma Patients., Walia Farzana, Mustafa M Basree, Norou Diawara, Zeina A Shboul, Sagel Dubey, Marie M Lockhart, Mohamed Hamza, Joshua D Palmer, Khan M Iftekharuddin

Oncology Articles

Recent clinical research describes a subset of glioblastoma patients that exhibit REP prior to the start of radiation therapy. Current literature has thus far described this population using clinicopathologic features. To our knowledge, this study is the first to investigate the potential of conventional radiomics, sophisticated multi-resolution fractal texture features, and different molecular features (MGMT, IDH mutations) as a diagnostic and prognostic tool for prediction of REP from non-REP cases using computational and statistical modeling methods. The radiation-planning T1 post-contrast (T1C) MRI sequences of 70 patients are analyzed. An ensemble method with 5-fold cross-validation over 1000 iterations offers an AUC …

Surgical Management Of Congenital Malrotation Presenting In Adulthood., Jacob Holzemer, Krishna Patel, Oscar Ruiz, Jodi Oostra

Surgery Articles

Intestinal malrotation is characterised by positional and congenital fixation abnormalities resulting from a failure in embryonic development in the normal 270° rotation around the axis of the superior mesenteric artery. Intestinal malrotation is primarily thought to affect neonates with an incidence of 1 in 500, however, only 1 in 6000 live births are symptomatic, and these usually present within the first month of life in 40% of cases and within the first year in over 5% of cases as an obstructive pathology or volvulus. In adults, however, the incidence has been documented at 0.2%. These patients usually present with postprandial …

Diabetic Ketoacidosis Diagnosis In A Hospital Setting., Amber M Healy, Mallory Faherty, Zeryab Khan, Naveen Emara, Cody Carter, Andrew Scheidemantel, Musa Abu-Jubara, Robert Young

OhioHealth Research Institute Articles

CONTEXT: Diabetic ketoacidosis (DKA) is an endocrine emergency that can occur in people with diabetes. Its incidence is estimated to be 220,340 hospital admissions each year. Treatment algorithms include fluid resuscitation, intravenous (IV) insulin infusion, and scheduled electrolyte and glucose monitoring. The misdiagnosis of DKA in the setting of hyperglycemic emergencies results in overtreatment and unnecessary increases in healthcare utilization and costs.

OBJECTIVES: The aims of this study were to determine how often DKA is overdiagnosed in the context of other acute hyperglycemic emergencies, to describe the baseline characteristics of patients, to determine the hospital treatments for DKA, and to …

Stress-Dose Steroids: A Potential Therapeutic Option For Refractory Hyperkalemia., Pooya Zardoost, Zeryab Khan, Rachel Kim, Kelsey Scott, Henry L Wehrum

Ambulatory and Primary Care Articles

Hyperkalemia refractory to standard temporization measures can be life-threatening, and urgent hemodialysis is often utilized as a final resort. Our patient presented with hyperkalemia that was multifactorial in etiology, with acute kidney injury complicated by adrenal insufficiency. Her hyperkalemia was refractory to temporization and excretion agents, and hemodialysis was being considered. Given a recent infection, surgery, and borderline hypotension with low adrenocorticotropic hormone, there was a concern for adrenal insufficiency. However, a full investigation for secondary adrenal insufficiency via magnetic resonance imaging could not be conducted as the patient suffered from claustrophobia. Continued concern for adrenal insufficiency prompted the initiation …