Medical Specialties Commons^™

The Effects Of Synovial Fluid And Inflammatory Cells On Orthopaedic Implant Alloys, Lisa Phan

Theses and Dissertations (ETD)

Introduction. Total knee arthroplasty (TKA) is a common surgical procedure used to treat end-stage osteoarthritis. The implants used in TKA typically consist of a Cobalt Chromium Molybdenum (CoCrMo) femoral component and a Titanium Aluminum Vanadium (TiAlV) alloy baseplate. These metal alloys are chosen for their mechanical properties, corrosion resistance, high affinity for bone, and biocompatibility. However, they can be susceptible to mechanical and electrochemical wear, leading to the release of metal ions. Osteoarthritis and inflammation can alter the composition of Synovial Fluid (SF), potentially causing implant corrosion and the release of metal ions into the surrounding tissue. These metal ions …

A Seven-Year Review Of Hospital- Onset Clostridioides Difficile Infection Reduction And The Case For A Multidisciplinary Taskforce Approach, Peggy Brown Mph, Cic, Michelle Charles Msn, Rn-Bc, Brittany S. Thorp Mph, Kristin Sims Mph Cic Cpps Fapic, R. Scott Stienecker Md

Infection Control

Presented at the 2023 APIC Annual Conference

Background: Hospital-onset Clostridioides difficile infection is a life-threatening disease that can prolong and complicate a patient's hospitalization. To reduce HO-CDIs and ensure positive health outcomes with reduced cost, utilization of a multi-disciplinary taskforce (MDT) is key to identify gaps, develop action plans, and implement and review interventions in the most efficient and effective manner.

Methods: Over the course of seven years, two rounds of interventions were executed consecutively across a nine-hospital healthcare system to reduce HO-CDI events. The first round (Round 1) driven solely by the Infection Prevention (IP) department spanned four years …

Candida Auris Screening In The Acute Care Setting: An Infection Control Partnership Between Hospitals And Skilled Nursing Facilities, Brittany S. Thorp Mph, Peggy Brown Mph, Cic, R. Scott Stienecker Md

Infection Control

Presented at 2023 APIC Annual Conference

Background: Candida auris (C. auris) is a drug-resistant fungus that can spread easily between hospitalized patients and nursing home residents. To mitigate risk of C. auris spread, a nine-hospital healthcare system developed a C. auris screening tool in January 2020. Infection Preventionists (IPs) use the screening tool to determine which patients qualify for C. auris screening, looking specifically at the facility type where the patient came from. The IP then initiates the isolation and testing protocol with the bedside nurse and provider.

Methods: Over the course of three years, the hospital epidemiologist collected data …

Methicillin-Resistant Staphylococcus Aureus Screening Of Neonatal Intensive Care Unit Staff In An Outbreak Setting, R. Scott Stienecker Md, Fidsa, Fshea, Cic, Brittany S. Thorp Mph

Infection Control

Presented at 2023 APIC Annual Conference

In December 2020, our infection prevention (IP) department noted an increase in Methicillin-resistant Staphylococcus aureus (MRSA) isolates over baseline in the Neonatal Intensive Care Unit (NICU). Our hospital sees a steady influx of parents colonized with MRSA and our weekly screening process regularly discovers neonates that subsequently become colonized with MRSA. A doubling of the number of cases per month led to deeper investigation. Epidemiologic data were collected on the neonates and matched to their mother’s screening cultures (when obtained). Sensitivity patterns were matched, and staff noted that a single sensitivity pattern predominated

Sinus Tract Vs. Fistula: There Is A Difference, Mea Weinberg Dmd, Msd, Rph, Stuart Segelnick Dds, Ms, Christine Chu Dds, Asgeir Sigurdsson Dds, Ms

The New York State Dental Journal

The terms sinus and fistula have been used interchangeably in clinical dentistry, but it may be inconsistent with past and current literature. The primary difference between the two is the number of anatomic spaces or openings involved. There is often confusion regarding the lining of a sinus tract and of a fistula. This article will review the clinical and histological features of a sinus and a fistula in both dentistry and medicine.

Long-Term Outcomes Of Dual Vs Single Her2-Directed Neoadjuvant Therapy In Nsabp B-41., Priya Rastogi, Gong Tang, Saima Hassan, Charles E Geyer, Catherine A Azar, Gustav C Magrinat, J Marie Suga, Harry D Bear, Luis Baez-Diaz, Shakir Sarwar, Jean-Francois Boileau, Adam M Brufsky, Henry R Shibata, Hanna Bandos, Soonmyung Paik, Greg Yothers, Sandra M Swain, Eleftherios P Mamounas, Norman Wolmark

Oncology Articles

BACKGROUND: The primary aim of this randomized neoadjuvant trial in operable, HER2-positive breast cancer, was to determine the efficacy on pathologic complete response (pCR) of substituting lapatinib (L) for trastuzumab (T) or adding L to T, in combination with weekly paclitaxel (WP) following AC. Results on pCR were previously reported. Here, we report data on planned secondary endpoints, recurrence-free interval (RFI) post-surgery, and overall survival (OS).

METHODS: All patients received standard AC q3 weeks × 4 cycles followed by WP (80 mg/m

RESULTS: RFI at 4.5 years was 87.2%, 79.4% (p = 0.34; HR = 1.37; 95% CI 0.80, 2.34), …

Resident Perspectives On The Value Of Rural General Surgery Rotations: It's Not Just About The Cases, Dorothy Hughes, Rebekah Wood, Randy Woods, Michael Sarap

Department of Surgery Faculty Publications

Purpose: Understand the scope of cases that residents participate in during rural general surgery rotations and the value residents and program directors find in such rotations. In turn, our goal is to add to the ongoing conversation the value exposure to rural surgery brings to surgery training. Methods: Qualitative study analyzed reviews of residents' self-reported case lists and field notes from exit interviews with the site director. Results: Trainees participated in an average of 105 cases during the rotation, including basic and advanced endoscopy along with exposure to a wide array of surgical cases. Residents had exposure to the rural …

Endometriosis Eras, Children's Mercy Kansas City

Clinical Pathways (Formally Known As Care Process Models)

No abstract provided.

Ethical Perspectives On Surgical Video Recording For Patients, Surgeons And Society: Systematic Review, Ross Walsh, Emma C. Kearns, Alice Moynihan, Sara Gerke, Mindy Duffourc, Marcelo Corrales Compagnucci, Timo Minssen, Ronan A. Cahill

Faculty Scholarly Works

Background

Operating-room audiovisual recording is increasingly proposed, although its ethical implications need elucidation. The aim of this systematic review was to examine the published literature on ethical aspects regarding operating-room recording.

Methods

MEDLINE (via PubMed), Embase, and Cochrane databases were systematically searched for articles describing ethical aspects regarding surgical (both intracorporeal and operating room) recording from database inception to the present (the last search was undertaken in July 2022). Medical subject headings used in the search included ‘operating room’, ‘surgery’, ‘video recording’, ‘black box’, ‘ethics’, ‘consent’, ‘confidentiality’, ‘privacy’, and more. Title, abstract, and full-text screening determined relevance. The quality of …

A Shared Decision-Making Process Utilizing A Decision Coach In Pediatric Epilepsy Surgery, Michelle Kregel, Natalie Evans, Bonnie Wooten, Craig Campbell, Sandrine De Ribaupierre, Andrea Andrade

Paediatrics Publications

BACKGROUND & RATIONALE: The process to evaluate candidacy for epilepsy surgery is lengthy and stressful for caregivers, therefore the decision can be challenging. There is not a lot of information in regard to how families of a child living with epilepsy navigate the stressful decision during surgical candidacy evaluation. With difficult decisions comes the possibility of increased decisional conflict in both the child and the family.

METHODS: A project designed to provide greater knowledge to the family was conducted utilizing the shared decision-making (SDM) process to assist families in the decision-making during surgical candidacy evaluation; this was done using a …

The Role Of Geography And Distance On Physician Follow-Up After A First Hospitalization With A Diagnosis Of A Schizophrenia Spectrum Disorder: A Retrospective Population-Based Cohort Study In Ontario, Canada, Kelly Anderson, Martin Rotenberg, Peter Gozdyra, Paul Kurdyak

Data and Test Instruments

No abstract provided.

Bronchiolitis, Children's Mercy Kansas City

Clinical Pathways (Formally Known As Clinical Practice Guidelines)

No abstract provided.

3rd Jakarta Annual Surgical Symposia: Comprehensive Surgical Update Proceeding Abstracts, Scientific Committee Jass

The New Ropanasuri Journal of Surgery

Introduction. The need for arteriovenous fistula (AVF) as access to hemodialysis is increasing, but the failure rate of AVF maturity is also relatively high. Umbilical cord mesenchymal stem cells (MSCs) have anti-inflammatory properties that can occur in homeostasis, repair, and regeneration in pathological responses caused by vascular injury. This study aims to determine how administering cord mesenchymal stem cells (MSC) affects vascular maturity based on Doppler ultrasound examination in AVF rabbit models.

Method. An experimental study proceeded using a local male rabbit (Lepus Domestica). The administration of umbilical cord mesenchymal stem cells was applied in situ on AVF and intravenously. …

Elevated Inos And 3'-Nitrotyrosine In Kaposi's Sarcoma Tumors And Mouse Model, Olga Vladimirova, Samantha Soldan, Chenhe Su, Andrew Kossenkov, Owen Ngalamika, For Yue Tso, John T. West, Charles Wood, Paul M. Lieberman

LSU-LCMC Cancer Center Faculty Publications

Kaposi's Sarcoma (KS) is a heterogenous, multifocal vascular malignancy caused by the human herpesvirus 8 (HHV8), also known as Kaposi's Sarcoma-Associated Herpesvirus (KSHV). Here, we show that KS lesions express iNOS/NOS2 broadly throughout KS lesions, with enrichment in LANA positive spindle cells. The iNOS byproduct 3-nitrotyrosine is also enriched in LANA positive tumor cells and colocalizes with a fraction of LANA-nuclear bodies. We show that iNOS is highly expressed in the L1T3/mSLK tumor model of KS. iNOS expression correlated with KSHV lytic cycle gene expression, which was elevated in late-stage tumors (>4 weeks) but to a lesser degree in …

Intravenous Thrombolytic Therapies In The Management Of Unknown Onset And Wakeup Strokes: A Scoping Review, Saima Nazish

Pakistan Journal of Neurological Sciences (PJNS)

ABSTRACT Background: The efficacy and safety of intravenous recombinant tissue plasminogen activator (IV rt-PA) for the management of unknown time onset stroke (UTOS) and wake-up stroke (WUS) are in a debate. Objective:The objective of this review is to discuss the UTOS and its management with intravenous thrombolytic therapies. Data Sources: Databases searched included PubMed and Cochrane electronic databases and manual search. Study Selection and Data Extraction: 45 articles of potential relevance were selected. Results: 14 relevant papers were included. Most of studies including recent trials using Magnetic resonance imaging diffusion-weighted imaging fluid-attenuated inversion recovery (MRIDWI FLAIR) mismatch or Computed tomography …

Fibromyalgia: The Misunderstood Victim, Wajid Jawaid

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

County Incidence And Geospatial Trends Of Early-Onset Hypertensive Disorders Of Pregnancy In Kentucky, 2008-2017, Courtney J. Walker, Anna Kucharska-Newton, Steven R. Browning, W. Jay Christian

UK CARES Faculty Publications

Background Early‑onset hypertensive disorders of pregnancy (eHDP) are associated with more severe maternal and infant outcomes than later‑onset disease. However, little has been done to evaluate population‑level trends. Therefore, in this paper, we seek to address this understudied area by describing the geospatial and temporal patterns of county‑level incidence of eHDP and assessing county‑level demographics that may be associated with an increased incidence of eHDP.

Methods Employing Kentucky certificates of live and stillbirth from 2008–2017, this ecological study detected county‑level clusters of early‑onset hypertensive disorders of pregnancy using SaTScan, calculated average annual percent change (AAPC) with a join point analysis, …

Quantifying Disease Progression In Copd Patients By Forecasting Pft Scores Using Extracted Features From Non-Contrast Ct, A T. Luong, C J. Herrera, E Young, Y K. Liu, A Nowacki, J Cisneros-Paz, Girish Nair, E Castillo

Conference Presentation Abstracts

Purpose: Currently there is no validated method for quantifying risk of disease progression in chronic obstructive pulmonary disease (COPD). We aim to address this by predicting whether a patient will worsen using a machine learning model trained on basic patient information, current pulmonary function values, FEV1 and FVC, and extracted features from a non-contrast CT scan. Disease severity is characterized by these pulmonary function values, and by extension disease progression can be determined by the change in these values between future timepoints. Methods: XGBoost, a popular classification library that utilizes gradient boosted trees, was used to define an ensemble model …

Quantifying Disease Progression In Copd Patients By Forecasting Pft Scores Using Extracted Features From Non-Contrast Ct, A T. Luong, C J. Herrera, E Young, Y K. Liu, A Nowacki, J Cisneros-Paz, Girish Nair, E Castillo

Conference Presentation Abstracts

Purpose: Currently there is no validated method for quantifying risk of disease progression in chronic obstructive pulmonary disease (COPD). We aim to address this by predicting whether a patient will worsen using a machine learning model trained on basic patient information, current pulmonary function values, FEV1 and FVC, and extracted features from a non-contrast CT scan. Disease severity is characterized by these pulmonary function values, and by extension disease progression can be determined by the change in these values between future timepoints. Methods: XGBoost, a popular classification library that utilizes gradient boosted trees, was used to define an ensemble model …

The Clinical Usability, Efficiency, And Accuracy Of Combining Deep-Learning-Based Synthetic Ct And Auto-Contouring For Daily Cbct-Based Online Adaptive Radiation Therapy, An Qin, J Xu, N O'Connell, Xuanfeng Ding, Shupeng Chen, D Thill

Conference Presentation Abstracts

Purpose: To evaluate the feasibility of deep-learning and CBCT-based online adaptive radiotherapy(ART) in thorax, Head&Neck, and pelvic regions. Methods: The study utilized ADMIRE(Advanced Medical Image Registration Engine), a research software designed to enable fast online ART through: (1)synthetic CT(sCT) generation from CBCT, (2)automatic segmentation of critical organs(OARs), and(3)deformable image registration(DIR) to transfer the target volume. ADMIRE trained a modified Cycle-Generative-Adversarial-Networks with Structural Similarity Index Map(SSIM) loss term to generate sCT, while the auto-segmentation model was based on a 3D-ResUnet with modification. Site-specific models were trained for three anatomic sites: thorax, pelvic, and head&neck, and for both networks. The study included …

Unilateral Agenesis Of Adnexa, Srinidhi Govindarajan, Poornima M Associate Professor, Rashmi H.S., Aishwarya Bhat

Digital Journal of Clinical Medicine

No abstract provided.

Development Of A Definition Of Postacute Sequelae Of Sars-Cov-2 Infection, Tanayott Thaweethai, Sarah E. Jolley, Elizabeth W. Karlson, Emily B. Levitan, Bruce Levy, Grace A. Mccomsey, Lisa Mccorkell, Girish N. Nadkarni, Sairam Parthasarathy, Upinder Singh, Tiffany A. Walker, Caitlin A. Selvaggi, Daniel J. Shinnick, Carolin C. M. Schulte, Rachel Atchley-Challenner, Recover Consortium Authors, Leora I. Horwitz, Andrea S. Foulkes

Saha Cardiovascular Research Center Faculty Publications

IMPORTANCE SARS-CoV-2 infection is associated with persistent, relapsing, or new symptoms or other health effects occurring after acute infection, termed postacute sequelae of SARS-CoV-2 infection (PASC), also known as long COVID. Characterizing PASC requires analysis of prospectively and uniformly collected data from diverse uninfected and infected individuals.

OBJECTIVE To develop a definition of PASC using self-reported symptoms and describe PASC frequencies across cohorts, vaccination status, and number of infections.

DESIGN, SETTING, AND PARTICIPANTS Prospective observational cohort study of adults with and without SARS-CoV-2 infection at 85 enrolling sites (hospitals, health centers, community organizations) located in 33 states plus Washington, DC, …

Impact Of An Expanded Definition Of Family History On Outcomes Of Active Surveillance For Prostate Cancer, Adam C. Schneider, Thenappan Chandrasekar, Nicholas Bowler, Ryan Fogg, Joon Yau Leong, Andrew Gusev, Linda H. Rodgers, Shelley R. Mccormick, Douglas M. Dahl, Jason A. Efstathiou, Michael L. Blute, Anthony L. Zietman, Chin-Lee Wu, Matthew R. Smith, Eliezer M. Van Allen, Adam S. Feldman, Keyan Salari

Department of Urology Faculty Papers

PURPOSE: Despite family history being an established risk factor for prostate cancer, the role of a broader definition of family history inclusive of not just prostate cancer but other genetically related malignancies has not been investigated in the active surveillance population. Here, we evaluate the impact of an expanded definition of family history on active surveillance outcomes.

MATERIALS AND METHODS: Patients undergoing active surveillance for prostate cancer at Massachusetts General Hospital from 1997-2019 with detailed data available on family cancer history were identified. Primary outcome was biopsy progression-free survival, and secondary outcomes were treatment-free survival, adverse pathological features at prostatectomy, …

Clinical Characteristics, Management, And 5-Year Survival Compared Between No Standard Modifiable Risk Factor (Smurfless) And ≥ 1 Smurf Acs Cases: An Analysis Of 15,051 Cases From Pakistan, Sana Sheikh, Ghazal Peerwani, Bashir Hanif, Salim S. Virani

Section of Cardiology

Background: There has been an increase in Acute Coronary Syndrome (ACS) patients without standard modifiable risk factors i.e. hypertension, diabetes, dyslipidemia, and tobacco use (SMuRFless) compared to the patients with ≥ 1 SMuRF but this has not been studied in South Asia despite them being a high-risk population. We conducted a comparative analysis of first episodes of ACS cases admitted to a tertiary cardiac center in Pakistan between SMuRFless and ≥ 1 SMuRF patients for clinical presentation, management, in-hospital, and 5-year mortality.
Methods: We undertook a retrospective study and data of 15,051 patients admitted at Tabba Heart Institute (THI) with …

What Is The Prevalence Of Temporomandibular Joint (Tmj) Condylar Osteoarthritis In An Asymptomatic Oral And Maxillofacial Surgery Department Population?, John Vorrasi Dds, Laura Mendomo Mvomo

The New York State Dental Journal

The aim of the present study is to determine the prevalence and demographics of temporomandibular joint (TMJ) condylar changes in the asymptomatic general population of a hospital based Oral and Maxillofacial Surgery (OMFS) practice. We retrospectively reviewed cone beam computed tomography (CBCT) scans of 272 TMJs from 136 consecutive patients to detect osteophyte, subchondral cyst, sclerosis, cortical erosions, and flattening. While gender did not appear to play a significant role in TMJ pathology, age was positively correlated with prevalence of condylar changes. Patients 78 years and older were significantly more likely to have osteophyte, cyst, sclerosis, and breakdown than were …

Beyond The Treatment: The Role Of Race, Sex, And Education In Health Trajectories Between Cancer Survivors And Noncancer Older Adults, Minzhi Ye, Eva Kahana, Gary Deimling, Adam Perzynski, Kurt Stange

School of Social Work Faculty Publications

Introduction:

The number of older, long-term cancer survivors is increasing. However, little is known about how cancer and aging affect the health trajectories of older adults differently. In addition, the impact of race, sex, and education on the processes of aging and the cancer experience needs further investigation. The current study aims to address this knowledge gap by combining two National Cancer Institute (NIC)-funded longitudinal studies conducted in Cleveland from 1998 to 2010.

Materials and Methods:

The unique cross-sequential design facilitates a comparison between the health changes in long-term (five years +) older cancer survivors (breast, prostate, and colorectal cancer) …

A Qualitative Inquiry Of Experiences Of Hiv-Related Stigma And Its Effects Among People Living With Hiv On Treatment In Rural Kilifi, Kenya, Stanley Wechuli Wanjala, Moses Nyongesa, Rachael Mapenzi, Stanley Luchters, Amina Abubakar

Institute for Human Development, East Africa

Background: The pervasiveness of HIV-related stigma and discrimination, and its consequences on HIV prevention and treatment, have been well documented. However, little is known about the lived experiences of HIV-related stigma and its effects among the general adult population living with HIV in rural African settings. This study set out to explore this knowledge gap.

Methods: From April to June 2018, we conducted in-depth interviews with a convenience sample of 40 adults living with HIV aged 18–58 years in Kilifi, Kenya. A semi-structured interview guide was used to explore experiences of HIV-related stigma and its impact on these adults. …

Caregivers Of Youth In Foster Care In Texas And Their Role In Contraception Decision-Making For Adolescents In Care, Shelby Edmondson, Ana Belen Conrado, Hilda Loria, Jill Mcleigh, Jasmin Tiro, Simon Lee, Jenny Francis

Caregiver Needs and Supports

Few studies address the experiences of caregivers of adolescents in foster care. This study highlights a range of caregiver attitudes about contraception for adolescents in care. Provider training regarding contraception should include strategies to manage caregiver beliefs and extreme reactions to contraception use among youth in care.

For questions about this study or others, please email [email protected]

childrens.com/fostercare

Effects Of Atrioventricular Optimization On Left Ventricular Reverse Remodeling With Cardiac Resynchronization Therapy: Results Of The Smart-Crt Trial., Michael R Gold, Kenneth A Ellenbogen, Christophe Leclercq, Jonathan Lowy, Seth J Rials, Morio Shoda, Gery Tomassoni, Ziad Issa, Jean-Francois Sarrazin, John M Jennings, Devi G Nair, Nicholas Wold, Patrick Yong, Michelle M Harbin, Kenneth M Stein, Angelo Auricchio

Heart and Vascular Articles

BACKGROUND: The role of atrioventricular optimization (AVO) to improve cardiac resynchronization therapy outcomes remains controversial. Previous post hoc analyses of a multicenter trial showed that measures of electrical dyssynchrony (right ventricular-left ventricular [LV] or LV electrical delay durations) are associated with patients who benefit from AVO.

METHODS: This was a global, multicenter, prospective, randomized trial of de novo cardiac resynchronization therapy implant patients with an right ventricular-LV duration ≥70 ms to determine whether AVO results in greater reverse remodeling. Patients were randomized 1:1 for either an AVO algorithm (SmartDelay) that determines atrioventricular delay and pacing chamber, biventricular or LV only, …

Case Report: Large Left Ventricular Aneurysm With Contained Rupture And Haemopericardium., Aimee Willett, Zachary Glenn, Madison Rose-Malkamäki, Arash Arshi

Heart and Vascular Articles

BACKGROUND: Recent advancements in cardiology have significantly decreased the incidence of post-myocardial infarction mechanical complications. When these sequelae occur, they can have high morbidity and mortality and may require aggressive intervention.

CASE SUMMARY: We describe a case of contained rupture of a large left ventricular aneurysm (LVA) presenting with syncope in a 60-year-old male with late presentation myocardial infarction (MI) 6 weeks prior on home triple antithrombotic therapy (TAT). Urgent pericardiocentesis along with imaging techniques including ultrasound, computed tomography angiography (CTA), and cardiac magnetic resonance imaging (MRI) were used for initial diagnosis. Definitive treatment was achieved with excision and repair …