Medical Specialties Commons^™

The Breakdown Of Neurovascular Barriers: Molecular Mechanisms Of Tight Junction Dysfunction, Sowmya Shree Gopal, Mandeep Kaur, Sophie Lanzkron, Amit K. Srivastava

Department of Medicine Faculty Papers

The central nervous system (CNS) relies on tightly regulated barriers to maintain homeostasis and protect neural tissue from blood-borne toxins, pathogens, and inflammatory mediators. Tight junctions (TJs) are critical components of the blood-brain barrier (BBB) and blood-spinal cord barrier (BSCB), forming selective paracellular seals that regulate molecular trafficking. These structures comprise transmembrane proteins and cytoplasmic scaffolding proteins, which anchor TJs to the actin cytoskeleton. The spatial organization and function of TJs are dynamically regulated by calcium-dependent signaling, phosphorylation events, and G-protein-mediated pathways, which govern their assembly, disassembly, and response to physiological and pathological stimuli. The integrity of TJ complexes is …

Using Mean Airway Pressure (Map) As An Indicator To Help Predict Successful Extubationof Preterm And Term Infants In A Neonatal Intensive Care Unit, William F. Bucher, Rrt-Nps, Eliza C. Desantis, Md

Division of Pulmonary, Allergy, and Critical Care Medicine Posters

Background
Extubation of preterm and term infants in a neonatal intensive care setting has always proven to be a challenge often resulting in failure. One of the challenges to a successful extubation in this vulnerable patient population is maintaining proper lung inflation at the time of extubation. We often rely on the use of the mean airway pressure (MAP) as an indicator to help predict patient readiness to extubate these patients.

Methods
23 patients ranging from 24 weeks to 41 weeks corrected gestational age were extubated from either conventional mechanical ventilation (CMV) or high frequency ventilation (HFV) using their mean …

Characterization Of Peg-Modified Composite Membranes For Microfluidic Oxygenator Applications, Nicholas C. Higgins, David G. Blauvelt, Shuvo Roy

Department of Pediatrics Faculty Papers

Microfluidic oxygenators promise to advance extracorporeal membrane oxygenation (ECMO) devices with enhanced hemodynamics and low prime volume. We are developing a silicon-based membrane oxygenator that will offer improved gas transfer and fluid flow control. Polyethylene glycol (PEG) has been used to improve hemocompatibility by providing excellent resistance to protein adsorption. Here, we characterized a polyethylene glycol surface modification of composite silicon–PDMS membranes to evaluate their effects on microfluidic oxygenator properties. X-ray photoelectron spectroscopy (XPS) and water contact angle goniometry confirmed successful PEG attachment, evidenced by the presence of characteristic C-O bonds and increased hydrophilicity, which was stable for 2 weeks. …

Outcomes After Ulnar Collateral Ligament Reconstruction And Repair In Nonthrowing Athletes, William L. Johns, Neel K. Patel, Benjamin Miltenberg, Ryan W. Paul, Adeeb J. Hanna, Michael C. Ciccotti, Steven B. Cohen, Michael G. Ciccotti, Christopher C. Dodson

Rothman Institute Papers

BACKGROUND: Surgical management of ulnar collateral ligament (UCL) tears in nonthrowing athletes is less commonly performed, and the outcomes of that management have not been thoroughly described.

PURPOSE: To describe the clinical outcomes of surgical management of UCL injury in nonthrowing athletes.

STUDY DESIGN: Case series; Level of evidence, 4.

METHODS: A retrospective review was conducted on all patients who underwent UCL reconstruction or repair across a 10-year period (2010-2020), with nonthrowing athletes who had >2-year follow-up being specifically identified. Demographic variables such as age, sport participation, concomitant procedures, and graft type, as well as postoperative outcomes such as complications, …

A Case Of The Blue Blues: The Safety Issue Of Recognizing And Avoiding The Retinal Toxicity Of Methylene Blue Compared To Brilliant Blue And Trypan Blue, Sidra Zafar, Jose S. Pulido, Samir N. Patel, Yoshihiro Yonekawa, Jordan D. Deaner

Wills Eye Hospital Papers

While blue vital dyes remain indispensable in ophthalmic surgery, medication errors, particularly the inadvertent use of methylene blue instead of trypan blue and brilliant blue, pose a significant risk to patient safety. Methylene blue has been reported to cause damage to anterior segment structures, We reported a case of inner retinal toxicity from injection of methylene blue into the vitreous cavity resulting in profound vision loss. Standardization, vigilant verification, and safer packaging are critical to preventing these never events.

Radiation-Induced Brachial Plexopathy: Current Understanding, Diagnosis, And Treatment Options, Alex G. Lambi, Tomas Holly, Ryan E. Tomlinson, Mary F. Barbe

Department of Orthopaedic Surgery Faculty Papers

Radiation-induced brachial plexopathy (RIBP) is a gruesome complication of cancers treated with radiation therapy around the lung and chest wall, head and neck, and breast and axilla. It can occur in an early-onset (transient) or a late-onset (chronic) fashion. The diagnosis involves exclusion of a compressive neoplastic process, either new or recurrent, and relies largely on patient symptomatology without well-validated, objective scoring systems. Treatment options remain limited as no major advances have been made to prevent or halt disease progression. This article reviews the background incidence, pathophysiology, and diagnosis of RIBP. In addition to surgical treatment options, nonsurgical modalities, often …

Model For Calculating Impact Force For Individualized Hip Fracture Prediction During A Fall, Alisha Agarwal, Daniel Kargilis, Nishtha Gupta, Michael Chang, Rui Feng, Gregory Chang, Chamith S. Rajapakse

Student Papers, Posters & Projects

Osteoporotic-related weakening of bone is a common cause of hip fractures. The standard of care for the diagnosis and management of osteoporosis is the dual-energy x-ray absorptiometry bone mineral density T-scores. Many individuals considered nonosteoporotic, however, still sustain fractures since these tools do not incorporate vital bone parameters and subject-specific characteristics. The purpose of this work was to (1) develop a simple analytical model for estimating the force exerted on the femur during a fall (i.e., impact force) based on measurable patient metrics and (2) define a quantifiable fracture risk index by comparing finite-element-derived bone strength and impact force, which …

Urgent Radiotherapy For Superior Vena Cava Syndrome In Metastatic Non-Small Cell Lung Cancer: A Case Report, Arpeet Patel, Nilanjan Haldar, Ida Micaily, Michael Greenberg, Evan Nardone, John A. Lippert, Christopher Fundakowski, Adam C. Mueller

Department of Radiation Oncology Faculty Papers

Superior vena cava (SVC) syndrome is a life-threatening complication of thoracic malignancies, requiring rapid management in the setting of airway compromise or hemodynamic instability. We present a 59-year-old male with metastatic non-small cell lung cancer (NSCLC) who developed superior vena cava syndrome (SVCS) due to compression from a large mediastinal mass identified as metastatic lung adenocarcinoma. His declining respiratory status progressed rapidly, necessitating intensive care. After extensive multidisciplinary collaboration, the patient was determined fit for inpatient radiation therapy and 10 fractions of 300 cGy external beam radiotherapy to the obstructing lesion was planned. However, the patient was unable to lay …

Laboratory Monitoring In Patients With Moderate To Severe Plaque Psoriasis, Jonathan M. Fenkel, John A. Osborne, April W. Armstrong, Bruce Strober, Linda Stein Gold, Michael Cameron, Mark Lebwohl

Department of Medicine Faculty Papers

OBJECTIVES: Plaque psoriasis is a common immune-mediated disease associated with various comorbidities, including cardiovascular disease, diabetes, psoriatic arthritis, liver disease, and mood disorders. Biologic and small-molecule therapies are efficacious and well tolerated in adults with moderate to severe plaque psoriasis. However, dermatologists may be uncertain about appropriate laboratory monitoring in patients treated with these therapies, especially those with comorbidities.

METHODS: This review summarizes prescribing information and provides expert recommendations based on real-world experience in the monitoring of concerning laboratory values in patients with psoriasis.

RESULTS: Individualized monitoring is essential for maximizing the benefits and minimizing the risks associated with biologic …

Discovery Of A Small Molecule Tlr3 Agonist Adjuvant, Branden Lee, Danica Dong, Etsuro Nanishi, John Mark Awad, Kimia Abedi, Yoshine Saito, Francesco Borriello, Soumik Barman, Byron Brook, Aisling Kelly, Manisha Menon, Constance Marques-Mourlet, Maansi Gupta, Ida Lister, Chiwoo Oh, Kevin Lyskawa, Morgan Goetz, Kristina Walker, Wing Ki Cheng, Spencer Brightman, Pankaj Sharma, Timothy O'Meara, Katherine Chew, Daniel Vieira, Kevin Ryff, Cali Sweitzer, Sanya Thomas, Simon Van Haren, Matthew Pettengill, Hyuk-Soo Seo, Sirano Dhe-Paganon, Wei Zhang, Ofer Levy, David Dowling

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Pattern-recognition receptor (PRR) agonists are valuable agents across multiple medical applications, from vaccinology to immune-oncology. However, well-defined and potent small molecule agonists for many PRRs still await discovery and development. Screening of chemical libraries of ~200,000 small molecules for maturation of human monocytic cells by quantifying NF-κB activation and cell adherence was completed. From this screen, we selected a thiazole benzamide derivative, PVP-057, for its robust immunomodulatory properties, low toxicity profile, and concentration-dependent activity. In vitro investigation of pathway and receptor activation reveals that PVP-057 is a Toll-like receptor 3 (TLR3) agonist. As a single-component adjuvant, administered intramuscularly or intradermally …

Methylene Blue Associated Retinal Toxicity, Sidra Zafar, Martin Calotti, Timothy T. Xu, Justin Muste, Theodore Bowe, Luis Acaba-Berrocal, Brian Cheng, Samir Patel, Yoshihiro Yonekawa, Jose S. Pulido, Jordan D. Deaner

Wills Eye Hospital Papers

BACKGROUND: To describe a case of inadvertent methylene blue use during pars plana vitrectomy (PPV) for an epiretinal membrane (ERM).

CASE: A 69-year-old man presented with 1 day of severe vision loss in his left eye. Two days prior to presentation, he had undergone PPV that was complicated by accidental methylene blue use. Visual acuity (VA) at presentation to our institution was CF from his baseline VA of 20/60. Optical coherence tomography (OCT) demonstrated diffuse hyperreflectivity and thickening of the inner retinal layers. The patient was started on oral prednisone with no improvement. On postoperative month 1, VA was HM. …

Factors Influencing Immediate Post-Angiographic Occlusion Outcomes In Intracranial Aneurysms Treated With The Woven Endobridge Device: A Multi-Center Analysis And Predictive Model From The Worldwideweb Consortium, Muhammed Amir Essibayi, Mohamed Sobhi Jabal, Hasan Jamil, Hamza Adel Salim, Basel Musmar, Nimer Adeeb, Mahmoud Dibas, Nicole M. Cancelliere, Jose Danilo Bengzon Diestro, Oktay Algin, Sherief Ghozy, Sovann V. Lay, Adrien Guenego, Leonardo Renieri, Joseph Carnevale, Guillaume Saliou, Panagiotis Mastorakos, Kareem El Naamani, Arbaz A. Momin, Eimad Shotar, Markus Möhlenbruch, Michael Kral, Charlotte Chung, Mohamed M. Salem, Ivan Lylyk, Paul M. Foreman, Hamza Shaikh, Vedran Župančić, Muhammad U. Hafeez, Joshua Catapano, Muhammad Waqas, Muhammed Said Besler, Yasin Celal Gunes, James D. Rabinov, Julian Maingard, Clemens M. Schirmer, Mariangela Piano, Anna L. Kühn, Caterina Michelozzi, Robert M. Starke, Ameer Hassan, Mark Ogilvie, Anh Nguyen, Jesse Jones, Waleed Brinjikji, Marie T. Nawka, Marios Psychogios, Christian Ulfert, Bryan Pukenas, Jan-Karl Burkhardt, Thien Huynh, Juan Carlos Martinez-Gutierrez, Sunil A. Sheth, Diana Slawski, Rabih Tawk, Benjamin Pulli, Boris Lubicz, Pietro Panni, Ajit S. Puri, Guglielmo Pero, Eytan Raz, Christoph J. Griessenauer, Hamed Asadi, Adnan Siddiqui, Elad I. Levy, Deepak Khatri, Neil Haranhalli, Andrew F. Ducruet, Felipe C. Albuquerque, Robert W. Regenhardt, Christopher J. Stapleton, Peter Kan, Vladimir Kalousek, Pedro Lylyk, Srikanth Boddu, Jared Knopman, Stavropoula I. Tjoumakaris, Hugo H. Cuellar-Saenz, Pascal M. Jabbour, Frédéric Clarençon, Nicola Limbucci, Vitor Mendes Pereira, Aman B. Patel, David J Altschul, Adam A. Dmytriw, Worldwideweb Consortium Collaborators

Jefferson Hospital Staff Papers and Presentations

The Woven EndoBridge (WEB) device treats wide-necked bifurcation aneurysms, but occlusion rates vary. This study aims to identify factors associated with immediate WEB device occlusion. Data from patients treated with WEB devices across 36 sites were analyzed. Machine learning algorithms and ordinal regression models were developed to predict immediate incomplete occlusion for ruptured and unruptured aneurysms. The study included 1565 patients, with 436 ruptured and 1129 unruptured aneurysms. Immediate complete occlusion was achieved in 38.3% of ruptured and 32.8% of unruptured aneurysms. For ruptured aneurysms, the CatBoost classifier achieved an AUROC of 0.69. Key predictors of incomplete occlusion included pretreatment …

Reducing Storage-Related Bias In Reproductive Vitamin D Research: Towards A Stable And Reliable Biomarker Of Ovarian Vitamin D Status, Evelin E Lara-Molina, Jason M. Franasiak, Almudena Devesa-Peiro, Marina López-Nogueroles, Alberto Vázquez, David Amorós, Agustín Ballesteros, Antonio Pellicer, Patricia Sebastian-Leon, Patricia Diaz-Gimeno

SKMC Student Presentations and Publications

Background/Objectives: One of the main reasons for discrepancies in the role of vitamin D in ART could be the measurement of the conventional biomarker 25(OH)D₃. It is known that this value is affected by multiple factors, such as tissue origin, assay variability, classification criteria, and potential storage-related degradation. In this study, we investigate 24,25(OH)₂D₃ as a new biomarker to improve vitamin D assessment in women’s reproductive health, particularly regarding oocyte development. Methods: A prospective cohort study including 35 oocyte donors undergoing controlled ovarian stimulation, who were recruited between October and November 2017, was conducted. Vitamin …

The Right Kind Of Rarefaction: Coronary Microvascular Remodeling In Right Ventricle Failure, Cyrus Vahdatpour, Katharine Clapham, Steven M. Kawut, Kirk Jones, John J. Ryan, Danielle Petty, Shannon Talbot, Kimberly Dumoff, Ellen C. Keeley, Priti Lal, Andrew J. Bryant, Alex M. Parker, Jeremy A. Mazurek, Leonid Mirson, Andrew Murphy, Andrew Baird, Megan Schwietert, Alissa F. Schurr, Andrew Stein, Scott M. Hansen, Zhining Ou, Angela P. Presson, Dylan Miller

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

BACKGROUND: Right ventricular failure (RVF) is the primary determinant of outcomes in pulmonary hypertension (PH). Coronary microvascular dysfunction (CMD), defined by capillary rarefaction and endothelial dysfunction, may contribute to RVF but remains poorly characterized. CMD, defined by capillary rarefaction and endothelial dysfunction, may contribute to RVF through impaired myocardial oxygen delivery and fibrotic remodeling.

OBJECTIVES: To characterize right ventricle (RV) CMD and myocardial fibrosis in explanted human hearts and examine associations with echocardiographic and hemodynamic indices of RVF across PH subtypes.

METHODS: We retrospectively analyzed 57 adult patients who underwent orthotopic heart transplantation at 3 institutions (2023-2024). Explanted hearts were …

A Double-Edged Sword: Ethical And Psychological Implications Of Apoe Genotype Disclosure Across The Lifespan, Diego Iacono

Department of Neurology Faculty Papers

The apolipoprotein E (APOE) gene is the strongest genetic risk factor for sporadic Alzheimer’s disease (AD), with the ε4 allele increasing risk and decreasing the average age of onset. While APOE genotyping is primarily used in research or clinical settings for patients with memory concerns, interest in disclosing APOE status to asymptomatic individuals—particularly during early adulthood—is growing. This trend is fueled by the rise of direct-to-consumer genetic testing and emerging prevention-focused clinical trials. However, ethical debates remain unresolved about the potential harms of early disclosure, including anxiety, stigma, and misunderstanding of probabilistic risk. Conversely, some argue that knowledge of APOE …

The Nature Of Nasal Discharge In Chronic Rhinosinusitis: A Systematic Review And Meta-Analysis Using Patient-Reported Outcomes, Ethan M. Kallenberger, Asher T. Ripp, Shaun A. Nguyen, Erin Briggs, Alexander N. Duffy, Isabella V. Schafer, Jess C. Mace, Timothy L. Smith, Zachary M. Soler, Rodney J. Schlosser

SKMC Student Presentations and Publications

OBJECTIVE: The objective of this study is to answer the question "What is the most common and severe type of nasal discharge in patients with chronic rhinosinusitis (CRS) at baseline as measured by patient-reported outcomes?".

METHODOLOGY: Two independent reviewers evaluated studies for inclusion, extracted data from included studies, and performed critical appraisal of studies. Data on the four Sino-Nasal Outcome Test 22 (SNOT22) discharge questions, demographic, and comorbidity data was collected. Meta-analysis of single means and proportions was performed for demographic, comorbidity, severity, and prevalence data.

RESULTS: A total of 53 studies (n = 6584) were included for analysis. Postnasal …

Integrating Spot-Scanning Proton Arc Therapy With Functional Avoidance Strategies To Reduce Pulmonary Toxicity, Yingxuan Chen, Peilin Liu, Xiaoda Cong, Edward Castillo, Richard Castillo, Inga Grills, Craig Stevens, Xiangkun Xu, Xiaoqiang Li, Yevgeniy Vinogradskiy, Xuanfeng Ding

Department of Radiation Oncology Faculty Papers

Background and purpose: Functional avoidance radiotherapy has emerged as a promising technique using functional imaging to minimize pulmonary toxicity by reducing doses to functional lung. This study aims to investigate the potential dose-volume advantages of a novel spot-scanning proton arc (SPArc) therapy for functional avoidance radiotherapy with four-dimensional computed tomography (4DCT)-based ventilation imaging.

Material and methods: Twenty-five patients from a prospective functional avoidance clinical trial treated with intensity-modulated photon radiotherapy were included. Robustly optimized intensity modulated proton therapy (IMPT) and SPArc plans were generated in RayStation. Functional lung contour was derived from the 4DCT-based ventilation imaging and utilized as an …

Incidence And Management Of Adverse Events Associated With Tebentafusp Treatment In Metastatic Uveal Melanoma: Pooled Safety Analysis Of 410 Patients, Takami Sato, Marcus O. Butler, Sophie Piperno-Neumann, Jessica C. Hassel, Paul Nathan, Alexander N. Shoushtari, Piotr Rutkowski, Richard D. Carvajal, Jean-Francois Baurain, Max Schlaak, Josep M. Piulats, Ryan J. Sullivan, Sebastian Ochsenreither, Reinhard Dummer, John M. Kirkwood, Alexandra Ikeguchi, Anthony M. Joshua, Mark R. Middleton, Ramakrishna Edukulla, Constance Pfeiffer, Joseph J. Sacco

Kimmel Cancer Center Papers, Presentations, and Grand Rounds

PURPOSE: We conducted an integrated safety analysis from three clinical studies of tebentafusp, a first-in-class ImmTAC bispecific T-cell engager, which can redirect T cells to target glycoprotein 100-positive cells, in metastatic uveal melanoma.

EXPERIMENTAL DESIGN: HLA-A*02:01-positive patients with unresectable or metastatic uveal melanoma enrolled in three clinical trials (IMCgp100-01, IMCgp100-102, and IMCgp100-202) who received ≥1 dose of tebentafusp were included. Safety data were pooled to evaluate the profile, onset, and management of treatment-related adverse events (TRAE). Adverse events of special interest included cytokine release syndrome (CRS), acute skin reactions (ASR), and liver function test elevations. Primary prophylaxis with medications was …

Impact Of Intravenous Drug Use On Neck Abscess Outcomes: 30-Day Readmission & 5-Year Survival Rates, Elliott Sina, Bryce Hambach, Eric Mastrolonardo, Sruti Tekumalla, Meghan Crippen, Richard A. Goldman

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

OBJECTIVES: Injection drug use (IDU) is a known risk factor for neck abscesses, often requiring urgent surgical intervention by acute-care Otolaryngologists. However, data on the prevalence and long-term outcomes of IDU-related neck abscesses are limited. This study investigates differences in 30-day readmission rates and 5-year all-cause mortality between patients with and without a history of IDU hospitalized for neck abscesses.

METHODS: This is a retrospective cohort study utilizing the TriNetX national clinical database. Patients hospitalized for neck abscesses (ICD-10: L02.11) were categorized into two cohorts: IDU (current/previous) and non-IDU. Demographics, 30-day readmission rates, and 5-year survival were analyzed. 1:1 Propensity …

A Feasibility Study Of Sexual Organ-Dose Sparing Volumetric Modulated Arc Therapy In Female Low Rectal Cancer Patients Treated With Three-Dimensional Conformal Radiation Therapy, Margaret Downes, Victoria Olsen, Andre Williams, Rendi Sheu, Maria Thor, Lucy Greenwald, Vishruta Dumane, Kristin Hsieh, Ayesha Ali, Orly Morgan, Michael Buckstein, Deborah Marshall

Department of Radiation Oncology Faculty Papers

BACKGROUND: Sexual dysfunction is a significant toxicity of pelvic radiation therapy (RT) for female rectal cancer patients and may be more common with intensity-modulated techniques compared to three-dimensional conformal radiation therapy (3D-CRT). However, limited research has evaluated dose sparing of female sexual organs at risk (OARs), particularly erectile tissues that are critical for sexual function.

PURPOSE: This feasibility study aimed to demonstrate the practicality of contouring and sparing female sexual OARs in rectal cancer RT by generating sexual organ-sparing volumetric modulated arc therapy (SO-VMAT) plans from a small 3D-CRT cohort and comparing dose distributions to guide future planning.

METHODS: Nine …

Dual-Level Pattern Tree For Visual Field Improves Glaucoma Progression And Polygenic Risk Prediction, Luo Song, Lucy Q. Shen, Louis R. Pasquale, Michael V. Boland, Sarah R. Wellik, Carlos Gustavo De Moraes, Ayellet Segre, Janey L. Wiggs, Constance Turman, Jonathan S. Myers, Tobias Elze, Nazlee Zebardast, David S. Friedman, Jae H. Kang, Mengyu Wang

Wills Eye Hospital Papers

PURPOSE: To develop a dual-level pattern tree to characterize visual field (VF) loss subtypes that can be used to better predict glaucoma progression and glaucoma polygenic risk scores (PRSs).

METHODS: This study included 113,030 patients from three datasets, each used for a specific purpose: (1) model training, (2) progression forecasting, and (3) PRS correlations. We applied archetypal analysis to cluster 24-2 VFs into trunk patterns and their branch patterns. The Cox regression model was used to forecast VF progression using mean deviation (MD) slope, MD-fast slope, total deviation (TD) pointwise slope, and visual field index (VFI) slope. Multivariable regression analyses …

Endoscopic Retrograde Cholangiopancreatography And Primary Sclerosing Cholangitis: A Retrospective Study Of A High-Volume Program, Kristel Leung, Michael Youssef, Yasi Xiao, Catherine Streutker, Aliya Gulamhusein, Bettina Hansen, Natalia Calo, Gary May, Jeffrey Mosko, Gideon Hirschfield

Division of Gastroenterology and Hepatology Faculty Papers

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is valuable in management of primary sclerosing cholangitis (PSC). Herein, we characterize individuals with PSC who underwent ERCP on-demand at a high-volume quaternary centre, with evaluation of pathology results and short-term postprocedural outcomes.

METHODS: This retrospective cohort study evaluated patients with PSC who underwent ERCP at St Michael's Hospital between April 2011 and July 2021. Chart review was conducted to collect clinical, procedural, and pathology data, and reported post-ERCP complications within 90 days. Logistic regression analyses were conducted to evaluate factors associated with post-ERCP complications and placement of a biliary stent.

RESULTS: One hundred and …

Comparative Value Of Echocardiography Vs. Right Heart Catheterization In Heart Failure With Preserved Ejection Fraction, Nathanael Tran, Mohammad Shaar, Hussein Al-Sudani, Ramy Sedhom, Hamza Akhtar, Kevin Bryan Lo, Gregg S. Pressman

Einstein Health Papers

BACKGROUND: Echocardiography and right heart catheterization (RHC) are useful in the evaluation of heart failure with preserved ejection fraction (HFpEF). We compared the two among decompensated HFpEF patients to determine their relative value in predicting all-cause mortality and a composite of cardiovascular (CV) death and heart failure (HF) readmission at 1 year.

METHODS: One hundred seventy-eight decompensated HFpEF patients who underwent both procedures and survived to hospital discharge were retrospectively identified. Hospital records and the National Death Index were queried to determine outcomes. Echocardiographic and invasive parameters were tested for significant associations with each outcome. Additionally, three predictive models were …

Decorin Deficiency Promotes D-Galactose-Induced Skeletal Muscle Atrophy And Fibrosis By Regulating Itgb1/Akt/Mtor Signalling Pathway, Xiaoqin Luo, Mengxue Zhang, Lili Chen, Ruichang Wang, Jiabing Lian, Zhe Yang, Renato V. Iozzo, Jin Wang, Yan Zhang, Xiuli Bi

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

BACKGROUND: Primary sarcopenia is an age-associated disorder with progressive and generalised loss of skeletal muscle strength and mass. Skeletal muscle fibrosis is one of the significant pathological manifestations of age-associated sarcopenia. Decorin, a small dermatan-sulfate proteoglycan, participates in extracellular matrix assembly. In numerous studies, the involvement of decorin is not restricted to matrix structural proteins, and it also affects a diverse variety of biological functions like cell growth, adhesion, migration, proliferation and differentiation. Additionally, it modulates the process of inflammation and fibrillogenesis. Based on these preclinical evidences, we hypothesised that decorin may potentially play an important role in skeletal muscles …

Do Patient-Important Outcomes Differ By Care Setting? Findings From Semi-Structured Interviews With Individuals With Diabetes, Amy Cunningham, Alexzandra Gentsch, Pouya Arefi, Judd E. Hollander, Marianna D Lanoue, Amanda M. B. Doty, Geoffrey Mills, Brendan Carr, Kristin L. Rising

Department of Emergency Medicine Faculty Papers

Background: Patient-important outcomes (PIOs) reflect patient values and preferences. Prior studies have elicited a variety of PIOs for diabetes. However, no studies have examined whether, or how, PIOs differ across diabetes care settings. The purpose of this study was to compare the frequencies of PIOs derived from patients with diabetes in primary care (PC), acute care (emergency department (ED)), and post-acute care (post-hospital discharge (PHD)) settings within a large delivery system. Methods: This study was an analysis of 89 interviews with patients in PC, ED, and PHD settings. Participants had moderately to poorly controlled diabetes, defined as follows: presented to …

Applying Entrustable Professional Activities Across Emergency Medicine Medical Education Fellowships: A Cross-Institutional Commentary, Carrie Maupin, Ambika Anand, Danielle Nesbit, Casey Morrone, Danielle Sultan

Department of Emergency Medicine Faculty Papers

No abstract provided.

Short-Term Preeclampsia Prediction: Cutoff Variations For Sflt-1/Plgf In U.S. Patients With Or Without Hypertensive Disorders, Yaxin Li, Kristen Cagino, Jim Yee, Caroline Andy, Dajana Borova, Ayush Shah, Isla Racine, Tracy Grossman, Zhen Zhao

Student Papers, Posters & Projects

BACKGROUND: Preeclampsia (PE) is a complex disorder with significant maternal and fetal risks. The soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) ratio shows promise as a diagnostic tool, but its adoption in the U.S. remains limited due to the lack of accessible testing platforms, U.S.-based studies, and evidence-based implementation guidelines.

PATIENTS/MATERIALS AND METHODS: We conducted a cohort study to evaluate the sFlt-1/PlGF ratio for predicting PE within two weeks among pregnant individuals ≥18 years, ≥20 weeks gestation. Serum samples were obtained from routine prenatal visits or triage evaluations. sFlt-1/PlGF ratios were measured using Roche Elecsys assays, and …

Detection Of Phase-Binning And Interpolation Artifacts In 4-Dimensional Computed Tomography Imaging Using Deep Learning And Rule-Based Approaches, Jorge Cisneros, Nathan H. Feldt, Yevgeniy Vinogradskiy, Richard Castillo, Edward Castillo

Department of Radiation Oncology Faculty Papers

BACKGROUND: Four-dimensional computed tomography (4DCT) imaging is a crucial component to lung cancer radiotherapy planning and enables CT-ventilation-based functional avoidance planning to mitigate radiation toxicity. However, 4DCT scans are frequently impaired by acquisition artifacts that corrupt downstream analyses that depend on lung segmentation and deformable image registration, such as CT-ventilation and dose accumulation.

PURPOSE: This study develops 3D deep learning models to identify phase-binning artifacts at the voxel level and a heuristic, rule-based method to identify interpolation slices within 4DCT images.

METHODS: We introduce a generator that systematically inserts synthetic phase-binning and interpolation artifacts into any artifact-free breathing phase obtained …

The Association Between Gestational Body Mass Index Change, Cesarean Section, And Other Pregnancy Outcomes: Research Protocol: Retrospective Cohort Analysis, Kirsten I. Black, Owen Streeter, Arianne Sweeting, Pejman Adily, Mark Lauer, Adrienne Gordon, Vincenzo Berghella, Belinda R. Bruce, Lauren Ferris, Bradley De Vries

Department of Obstetrics and Gynecology Faculty Papers

Increasingly the value of gestational weight gain (GWG) as a useful measure to predict obstetric outcomes including cesarean section is being questioned. We will undertake a retrospective cohort study of recorded births in 2023 from 24 to 42 weeks' gestation for women aged from 16 to 49 years in the United States. Using multivariable Robust Poisson Regression, maternal body mass index (BMI) and BMI gain will be modelled on the primary outcome of cesarean delivery. The primary analysis will be restricted to nulliparous women if there is interaction between parity and BMI or BMI gain. A sample of 716,392 births …

A Contemporary Guide To An International Aortic Super-Fellowship For Surgical Trainees And Surgeons In The United States, Roberto G. Aru, Adam W. Beck, Stéphan Haulon

Department of Surgery Faculty Papers

Fenestrated and branched technology for endovascular aortic repair of the thoracoabdominal aorta and aortic arch has evolved significantly over the last decade. The spectrum of these devices is largely available outside the United States (US), while patient-specific company manufactured devices are limited to ten sites in the US, with ongoing expanding use of market-approved off-the-shelf devices. The necessary environment for appropriate education to ensure safe dissemination of these technologies is limited, and the current centralization of both device availability and skillsets affects trainee education. In order to refine their endovascular treatment algorithm and planning/implantation skillsets at these multidisciplinary aortic centers, …