Medical Specialties Commons^™

Transplantation And Mortality As Competing Outcomes Among Patients On Dialysis With Newly Diagnosed Cancer: A Longitudinal Cohort Study, Ryan Gately, Eric A. Engels, Dharshana Sabanayagam, Armando Teixeira-Pinto, Scott Campbell, Carmel Hawley, Wai Lim, Germaine Wong

Research outputs 2022 to 2026

Rationale & Objective: A cancer diagnosis is associated with complex risks for patients that may influence survival and access to transplantation. This study characterized the probability and timing of cancer-related death, noncancer death, and transplantation among patients with an incident cancer diagnosis after dialysis initiation. Study Design: Longitudinal cohort study. Setting & Participants: In Australia and New Zealand, 2000-2021, 3,052 patients receiving dialysis, identified via the Australia and New Zealand Dialysis and Transplant Registry, with cancer diagnosed after they had started dialysis. Exposure: Cancer, categorized by type and stage. Outcome: Transplantation as well as cancer-related death and noncancer death for …

Association Between Stress Mindset, Psychological Symptoms, And Psychosocial Risk In Liver Transplant Patients, Sarah Kay Brill

Dissertations

Psychosocial functioning is a central component of liver transplant evaluation, yet less is known about how cognitive factors, such as stress mindset, relate to transplant readiness. The present study examined the association between stress mindset and psychosocial risk, as well as its relationship with depressive symptoms, anxiety, and perceived stress among patients undergoing liver transplant evaluation. Patients included 62 adults completing standard pre-transplant assessment measures, including the Stress Mindset Measure–Specific (SMM-S), Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Perceived Stress Scale (PSS). Hierarchical logistic regression analyses indicated that stress mindset was …

The Effect Of Elevated Blood Pressure And Stage One Hypertension On Perinatal Outcomes In Appalachian Gravidas: A Retrospective Cohort Study, Caroline Briggs, Austin L. Loop, Grace E. Montgomery, David G. Chaffin, Jesse Cottrell

Marshall Journal of Medicine

Introduction:  There is literature in the obstetric population that suggests any degree of hypertension (blood pressures greater than or equal to 120 systolic or 80 diastolic) can lead to adverse maternal and fetal outcomes.  We sought to determine if pregnant patients in our Appalachian population with elevated blood pressure or stage 1 hypertension have an increased risk of gestational hypertension and preeclampsia.

Methods:  A retrospective chart review was performed on patients who received obstetric care with the Marshall University OB/GYN department and delivered at Cabell Huntington Hospital.  Delivery outcomes were obtained for 233 deliveries from March 30, 2020 to September …

A Prospective Study Of Hyperspectral Imaging For Lower Extremity Tissue Assessment In Normative And At-Risk Populations, Jessica Sima, Mariana Rodriguez, Stephanie Campbell, Amanda Killeen

School of Podiatric Medicine - Student Research

Introduction:  Diabetic foot ulceration and peripheral vascular disease remain major causes of morbidity and limb loss, yet early identification of tissue compromise can be challenging, particularly across diverse skin tones. Hyperspectral imaging (HSI) is a non-invasive technology that quantifies tissue oxygenation by measuring the absorption and reflection of near-infrared light.

The objective of this study is to evaluate the relationship between oxygenation, skin tone, skin temperature, and ambient skin temperature in adults with and without risks of foot ulcers.

Method: This ongoing prospective observational study recruits English- and Spanish-speaking adults aged 18 and over from campus, clinics, and community outreach …

Comparative Effectiveness Of Antiseptic And Antibiotic Irrigation Versus Normal Saline In Infected Total Ankle Arthroplasty: A Systematic Review, Madelaine Adkins, Yahan Wei, Amanda Killeen

School of Podiatric Medicine - Student Research

Introduction: Periprosthetic joint infection (PJI) is a rare but devastating complication following total ankle arthroplasty (TAA). Acute infections are commonly managed with debridement, antibiotics, and implant retention (DAIR), in which irrigation plays a critical role in reducing bacterial burden. Although irrigation protocols have been investigated in total hip and total knee arthroplasty, evidence specific to infected TAA remains unclear. This systematic review evaluated the available literature regarding irrigation practices in the surgical management of infected TAA.

Methods: A systematic review was conducted in accordance with PRISMA guidelines. PubMed and Scopus were search for English-language studies published between December 2005 and …

Select Plasma Oxylipins As Potential Biomarkers Of Effective Indomethacin Treatment Response In Preterm Infants With Patent Ductus Arteriosus., Khanh C K Nguyen, Cindy H T Yeung, Allison Scott, Thomas J. Velenosi, Tamorah Lewis

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVES: Patent ductus arteriosus (PDA) is one of the most common heart conditions in preterm infants, and indomethacin treatment is used for PDA closure. However, its efficacy varies among patients. This pilot study aimed to identify novel metabolic biomarkers to predict effective indomethacin response in infants with PDA.

METHODS: Preterm infants with PDA <  34 weeks gestational age were recruited and treated with indomethacin. Plasma and urine samples were collected before and 2-7 days after initial treatment. Longitudinal targeted oxylipin and untargeted metabolomics analysis were performed on plasma and urine samples.

RESULTS: Among 17 infants, 12 were responders and 5 non-responders to indomethacin treatment. Before the treatment, four plasma oxylipins: 12,13-DiHOME, 9,10-DiHOME, 15,16-DiHODE, and 9,10-DiHODE were significantly higher in responders compared to non-responders (P <  0.05). Following treatment, these oxylipins decreased in responders but remained stable in non-responders. Urinary 12,13-DiHOME showed an opposite trend, with lower baseline concentrations in the responders.

CONCLUSIONS: Pre-treatment plasma levels of four oxylipins were associated with effective PDA response to …

The Role Of Mitochondria In The Pathogenesis Of Parkinson’S Disease, Oyinkansola Mudasiru, Vivian Etugbo, Bhuvana Lakkasetter, Claudia Biguetti, Reginald Adiele

School of Podiatric Medicine - Student Research

Introduction: Parkinson’s disease (PD) is a progressive neurodegenerative disorder characterized by the degeneration of the dopaminergic neurons of the substantia nigra that leads to motor and non-motor dysfunctions. Emerging evidence highlights mitochondrial dysfunction as a key factor in PD pathogenesis. This project aims to investigate the pathophysiology of PD, highlighting the involvement of oxidative stress, and examining current and emerging therapeutic approaches aimed at restoring mitochondrial function.

Methodology: A systematic literature review was conducted using PubMed and Google Scholar within the 2004-2024 date range. Keywords included “Parkinson’s disease”, “mitochondrial dysfunction", “oxidative stress”, and neurodegeneration”. Data was extracted regarding …

Extracorporeal Rescue In Massive Pulmonary Embolism: A Case Of Chronic Thromboembolic Pulmonary Hypertension Unveiled, Kenzo Ramos, Kari Gorder

Journal of Shock and Hemodynamics

Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare yet curable cause of pulmonary hypertension from unresolved pulmonary emboli. We present the case of a 48-year-old man with progressive dyspnea and leg swelling, who was found to have bilateral pulmonary emboli with right heart strain. He developed cardiac arrest during thrombectomy, requiring emergent veno-arterial extracorporeal membrane oxygenation (V-A ECMO). Further evaluation revealed acute emboli superimposed on CTEPH. After incomplete thrombectomy and persistent instability, he underwent successful pulmonary endarterectomy with ECMO decannulation, leading to recovery of right ventricular function and discharge in stable condition. This case illustrates that previously unrecognized CTEPH may …

The Legacy, Importance, & Impact Of Lend: Evidence And Personal Stories, Emily Zalimeni, Emma Stone, Alexa Fortier, Leia Getchell, Nataliya Kloyzner, Asha Abdullahi, Elizabeth Barkoudah, Meghan Chapman, Meredith Close, Heather Engholm, Melissa Levin, Aanchal Sharma, Sarah Sparks, Patricia Rissmiller, Amy Szarkowski, Jason M. Fogler

Developmental Disabilities Network Journal

Leadership Education in Neurodevelopmental and related Disabilities (LEND) programs offer an interdisciplinary/interprofessional training opportunity for medical and allied health professionals, and individuals impacted by disability, including family members and self-advocates. Toward the aim of advocating for the enduring need of LEND and similar training programs, this article centers the voices of a subset of our alumni who have advanced the rights and improved the lives of persons with intellectual and developmental disabilities. These stories are intended to illustrate the key lessons and principles of LEND training, including attending to disability issues in education, growing skills within and between individuals working …

Dosimetric Impact Of Eclipse’S Entrance Avoidance Tool On Salivary Gland Sparing In Head And Neck Vmat Plans, Shannon Diederichs

Masters Projects

Medical dosimetry is constantly evolving as new techniques emerge to improve plan quality. The Eclipse treatment planning system (TPS) is equipped with the entrance and exit dose avoidance tool commonly used to prevent beam interaction with implanted metals or steer the beam away from anatomical regions. Current literature shows this tool has not been thoroughly investigated for more fundamental applications such as routine organ at risk (OAR) sparing. Xerostomia remains a lasting side effect for head-and-neck cancer (HNC) patients after the salivary glands receive substantial radiation. This study takes a more detailed look at the tool’s effectiveness when applied to …

A Perfect Storm In Advanced Aids: Severe Acute Respiratory Distress Syndrome From Pneumocystis Jirovecii And Mycobacterium Avium Complex Coinfection, Abdel Martinez, Abelardo Rodriguez, Conrad Chouinard, Fatimah Bello

School of Medicine Publications

Advanced HIV infection is associated with profound immunosuppression, predisposing patients to opportunistic infections such as Pneumocystis jirovecii pneumonia (PJP) and Mycobacterium avium complex (MAC). PJP can cause severe respiratory disease, including acute respiratory distress syndrome (ARDS), while disseminated MAC may contribute to systemic illness and pulmonary complications. Concurrent infection with both pathogens is uncommon but may precipitate severe pulmonary failure. A man in his 40s presented with unintentional weight loss, fatigue, oral thrush, and progressive dyspnea. On arrival, oxygen saturation was 86% on room air, requiring high-flow nasal cannula. Laboratory evaluation revealed profound immunosuppression (CD4 7 cells/mm3, HIV RNA 123,000 …

Craniospinal Irradiation Volumetric Modulated Arc Therapy (Vmat) Planning: A Dosimetric Contrast Utilizing Anterior Avoidance Sectors, Ashleigh M. Sammataro

Masters Projects

Purpose: Craniospinal irradiation (CSI) is essential for treating pediatric and adult central nervous system malignancies, yet it exposes large volumes of normal tissue to low‑dose radiation, contributing to significant long‑term toxicity. This study evaluated whether incorporating anterior‑avoidance sectors (AVD) into volumetric modulated arc therapy (VMAT) planning would improve normal tissue sparing while maintaining target coverage and plan quality.

Materials and Methods: 8 previously treated CSI patients were retrospectively replanned using two VMAT techniques: Full Arc and AVD. All patients were simulated supine with standardized immobilization and planned in Eclipse. Identical target volumes, optimization structures, and planning objectives were used for …

"It Doesn't Matter Where Ocd Comes From," Or Does It?, Caitlin M Pinciotti, Ryan J Mccarty, Gabriella T Ponzini

Faculty, Staff and Students Publications

Purpose of review: This review critically evaluates the claim that etiology is not relevant to cognitive behavioral therapy (CBT) for obsessive-compulsive disorder (OCD). Research on the clinical presentation and treatment outcomes associated with traumatic/stressor and biological etiologies is presented.

Recent findings: The extant literature demonstrates varying clinical utility across the reviewed etiologies. Traumatic/stressor etiologies show the most consistent and robust evidence of clinical utility, demonstrating compelling associations with clinical presentation and treatment outcomes, while also being amenable to existing evidence-based approaches. Medical conditions (e.g., Pediatric Acute onset Neuropsychiatric Syndrome) and neurobiological factors also demonstrate considerable associations with OCD presentation, yet …

Intermembrane Coupling Between Bcl-Xl And The Ip3 Receptor Supports Local Ca2+ Transfer At Er-Mitochondrial Contacts, Arijita Ghosh, David Weaver, Chi Li, György Hajnóczky

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Bcl-xL, an anti-apoptotic Bcl-2 family protein, engages laterally with Bak/Bax in the outer mitochondrial membrane (OMM) to inhibit apoptosis and interacts with the IP₃ receptor Ca²⁺ channels (IP3Rs) in the endoplasmic reticulum (ER) membrane to control Ca²⁺ release. It is unknown if OMM-localized Bcl-xL can also interact in trans with IP3Rs at ER-mitochondrial contacts to form a tethering complex that supports IP3R-mediated local Ca²⁺ transfer from ER to mitochondria. We establish that IP3R-mitochondria Ca²⁺ signal propagation depends on Bcl-xL. By targeting Bcl-xL specifically to different subcellular compartments, we find that OMM-localized Bcl-xL increases the efficacy …

Comment On: Managing Sickle Cell Disease And Related Complications In Pregnancy: Results Of An International Delphi Panel, Deva Sharma, Ilknur Pamuk, Kenneth I. Ataga, Alexandra Benachi, Selim Büyükkurt, Sophie Lanzkron, Hakan Ozdogu, Shivan Pancham, Lydia H. Pecker, Susan E. Robinson, Safak Yilmaz Baran

Cardeza Foundation for Hematologic Research

Consensus-based recommendations on managing sickle cell disease in pregnancy were recently published in a hematology journal. As this topic is also of great interest to obstetricians and gynecologists, we summarize some of these recommendations, while highlighting the challenges of providing evidence-based medical care to pregnant individuals with sickle cell disease.

Clinicopathologic Spectrum Of Renal Disease In Sars-Cov-2 Infection And Post-Covid-19 Vaccination, Naya Williams, Mohammed S. Razzaque

School of Medicine Publications

Both SARS-CoV-2 infection and COVID-19 vaccination have been associated with renal complications. In the context of SARS-CoV-2 infection, kidney injury is primarily attributed to a complex interplay of systemic immune dysregulation and vascular damage. Severe infection triggers a cytokine-mediated inflammatory response characterized by elevated levels of pro-inflammatory mediators, resulting in systemic hemodynamic instability, increased capillary permeability, and renal hypoperfusion, ultimately leading to acute tubular injury. In addition, virus-induced endothelial activation promotes a prothrombotic state, microvascular injury, and further impairment of renal perfusion. Collectively, these processes converge to produce acute kidney injury (AKI) and, in severe or prolonged cases, may contribute …

Ophthoevidence Report: Comparative Effects Of Prophylactic Strategies For Post-Intravitreal Injection Endophthalmitis: Protocol For A Systematic Review And Network Meta-Analysis, Maryam Ghadimi, Dena Zeraatkar, João Pedro Lima, Jinhui Ma, Sunir J. Garg, Peter Kaiser, David Steel, Tien Yin Wong, Sobha Sivaprasad, Charles Wykoff, Varun Chaudhary

Wills Eye Hospital Papers

BACKGROUND: Endophthalmitis is a rare but serious complication of intravitreal injections (IVI). To mitigate the risk of post-injection endophthalmitis (PIE), retinal specialists use different strategies, combining various prophylactic measures. However, existing systematic reviews have evaluated the effects of these measures in isolation, which does not consider their concurrent use in practice. A trustworthy systematic review with network meta-analysis (NMA) by providing a framework for simultaneous comparisons of different prophylactic combinations is essential to guide decision-making.

OBJECTIVES: To present a protocol for addressing the comparative effects of different strategies for the prevention of PIE.

METHODS: We will search Medline, EMBASE, Cochrane …

Metastatic Large Cell Neuroendocrine Carcinoma: A Rare Cause Of Hypopituitarism, Smriti Nair, Taskeen Ahmed, Jessica Watari

Division of Internal Medicine Faculty Papers & Presentations

Pituitary metastases from pulmonary large cell neuroendocrine carcinoma (LCNEC) are exceedingly rare but should be considered in patients presenting with arginine vasopressin deficiency and panhypopituitarism in the context of known or suspected metastatic lung cancer. Early recognition and prompt initiation of hormonal replacement therapy are essential to prevent life-threatening endocrine crises and to improve symptom burden. We describe a case of a 43-year-old male who presented with dyspnea, weight loss, and weakness who was found to have metastatic LCNEC involving the liver. Endocrine evaluation revealed central hypothyroidism, central adrenal insufficiency, and later arginine vasopressin deficiency manifested by polyuria and hypernatremia. …

Benefits Of Regional Anesthesia Versus Opioids In The Management Of Postoperative Pain Following Excision Of A Peripheral Nerve Sheath Tumor., Duveen Nalamothu, Mauricio Arce Villalobos, Joseph D Tobias

Ambulatory and Primary Care Articles

Postoperative opioid exposure in opioid-naive patients may carry a risk of persistent opioid use. We present the case of a 16-year-old female with no significant family history who was recently diagnosed with neurofibromatosis type 1 and found to have a rapidly enlarging mass in her left upper extremity. She was scheduled for excisional biopsy. To minimize the need for postoperative opioids, analgesia via a continuous peripheral nerve catheter was employed following resection of the malignant peripheral nerve sheath tumor. This case report reviews the clinical applications of multimodal analgesia via a continuous peripheral nerve catheter in pediatric patients, including placement …

Study On The Accuracy Of Varian Eclipse Mlc Modeling When Mlcs Are Open Beyond The Jaw In Breast Cancer Patient Planning Using Aaa And Acuros With Both Dual-Isocentric Technique And Mono-Isocentric Technique., Amy Rogers

Masters Projects

Accurate dose delivery at the chest wall-supraclavicular (CW-SCV) junction remains an important challenge in breast irradiation, especially when multileaf collimator (MLC) leaves are intentionally opened beyond the collimator jaws to improve junction coverage. This study evaluated the dosimetric accuracy of the Varian Eclipse treatment planning system (TPS) at the CW-SCV junction using the Anisotropic Analytical Algorithm (AAA) and Acuros XB calculation algorithms with mono-isocentric and dual-isocentric treatment techniques. A prospective phantom-based study was performed using a solid water phantom and a Varian TrueBeam linear accelerator. Twenty-four unique three-dimensional conformal treatment plan configurations were created using combinations of beam energy (6 …

Genetic Associations With Pulmonary Embolism Among Those With A Deep Vein Thrombosis: The International Network Against Venous Thrombosis Consortium, Susana Lozano-Esparza, Gabrielle E Shakt, Jennifer A Brody, Angel Martinez-Perez, Matthew P Conomos, Marine Germain, Katharine R Clapham, Maris Teder-Laving, Astrid Van Hylckama Vlieg, Anni Kauko, Florian Thibord, Ohanna C L Bezerra, Girish N Nadkarni, Gaëlle Munsch, Therese Haugdahl Nøst, Ellen L Goode, Yuekai Ji, Daniel I Chasman, Alexander P Reiner, Constance Turman, Kerri L Wiggins, Colleen M Sitlani, Juan Carlos Souto, Pamela L Lutsey, Tiffany Bellomo, Estonian Biobank, Million Veteran Program, Ruifang Li-Gao, Aleksi Kristian Winstén, Ming-Huei Chen, Ron Do, Lénaick Gourhant, Kristian Hveem, Sebastian M Armasu, Noémie Saut, Nathan Pankratz, Franco Giulianini, Jeffrey Haessler, Mingyang Song, Robert Olaso, Eric Boerwinkle, Daniel Dochtermann, Jose Manuel Soria, Stephen S Rich, David Smadja, Satoshi Koyama, Frits R Rosendaal, Teemu Niiranen, France Gagnon, Ha My T Vy, Neil Zakai, Catherine Lemarie, Anne Heidi Skogholt, Jean-François Deleuze, James S Pankow, Paul M Ridker, Yuxi Liu, Kenneth M Rice, Saiju Pyarajan, Mary Cushman, Jospeh Emmerich, Bruce M Psaty, Pradeep Natarajan, Andrew D Johnson, Marc A Rodger, Pierre Suchon, Francis Couturaud, Pierre-Emmanuel Morange, Weihong Tang, Charles Kooperberg, Christopher Kabrhel, Maria Sabater-Lleal, David-Alexandre Trégouët, Alisa S Wolberg, Scott M Damrauer, Nicholas L Smith

Children’s Nutrition Research Center Staff Publications

Background: Venous thromboembolism (VTE) includes deep vein thrombosis (DVT) and pulmonary embolism (PE), the latter of which often originates from DVT and can be fatal.

Objectives: The aim of this study was to identify causal genetic factors that alter risk of PE among those with a presumed DVT.

Methods: Using a case-only design of VTE, we conducted meta-analyses of genome-wide association studies (GWASs) in the International Network Against Venous Thrombosis Consortium. Among participants diagnosed with VTE, each study identified those who had a clinically reported PE, with or without a clinically reported DVT; those remaining had isolated DVT. Logistic regression …

The Biological Response Of Human Np Cells To Soluble Collagen Vi, Jonathan Dalton, Srikanth N. Divi, Yasmine Eichbaum, Panya Luksanapruksa, Mitchell K. Ng, Rachel Huang, Alan S. Hilibrand, Alex R. Vaccaro, Dessislava Z. Markova, Christopher K. Kepler

Department of Orthopaedic Surgery Faculty Papers

Extracellular matrix (ECM) dysregulation plays a significant role in the development of intervertebral disc disease (IVDD). The ECM around the chondrocytes in the nucleus pulposus (NP) is unique in that it contains ColVI. While linked to chondrocyte proliferation in cartilage, ColVI's specific role in IVD degeneration is less clear. Our aim was to determine the expression of ColVI in NP cells from degenerative IVDs, along with the effects of soluble ColVI on NP cells. Thus, we compared the expression levels of ColVI in human degenerated IVD samples, along with the effect of soluble ColVI on primary human NP cells. A …

Improving Provider Adherence To Adolescent Depression Screening: Implementation Of A Standardized Phq-A Workflow In Pediatric Primary Care, Taylor P. H. Wamser

Student Scholarly Projects

Practice Problem: Adolescent depression is frequently under identified in pediatric primary care because of inconsistent implementation of routine depression screening despite national recommendations. This practice gap may delay diagnosis and treatment which may increase the risk of adverse mental health outcomes.

PICOT: The PICOT question that guided this project was: In pediatric primary care providers, how does the implementation of a standardized PHQ-A (Patient Health Questionnaire for Adolescents) workflow compared to informal screening practices affect provider adherence to depression screening guidelines over 12 weeks?

Evidence: Current evidence and national clinical practice guidelines support routine adolescent depression screening using validated tools …

Clinical Corner: Pearls From Local Dentists

West Michigan District Dental Society Bulletin

"Clinical Corner: Pearls from Local Dentists" is a section of the WMDDS Bulletin where local dentists share clinical wisdom for fellow practitioners. This edition discusses Caring for Patients with Cleft Lip and Palate.

Higher Mortality And Distinct Complications After Anterior Cervical Discectomy And Fusion In Dialysis Patients, Despite Improvements Over Prior Decade: A National Inpatient Study, Mitchell K. Ng, Leonidas E. Mastrokostas, Paul G. Mastrokostas, William A. Green, Joshua Mathew, Gregorio Baek, Yasmine Eichbaum, Yulia Lee, Morgan Hitchner, Jonathan Dalton, Adam Fano, Alec Giakas, Rajendra Singh, Brendan Reitman, Afshin E. Razi, Daniel R. Fassett, Alan S. Hilibrand, Alex R. Vaccaro, Christopher K. Kepler, Gregory D. Schroeder, Andrew P. Alvarez

Rothman Institute Papers

Introduction: Dialysis patients undergoing anterior cervical discectomy and fusion (ACDF) face elevated perioperative risk due to complex comorbidities. This study aimed to (1) identify associations between dialysis status and perioperative complications after ACDF, (2) quantify differences in length of stay (LOS), hospitalization costs, and discharge disposition, and (3) provide a contemporary national benchmark for outcomes in this high-risk population. Materials and Methods: The 2016–2022 National Inpatient Sample was queried for adult elective ACDF cases. Dialysis dependence was identified through International Classification of Diseases-10 codes for end-stage renal disease with hemodialysis or peritoneal dialysis. Demographics, comorbidities, complications, LOS, costs, and discharge …

Safety Of Early Discharge And Abbreviated Nimodipine Course In Patients With Good-Grade Aneurysmal Subarachnoid Hemorrhage, Patrick R. Toyota, Alexander D. Rebchuk, Michael A. Rizzuto, Hugh Mchugh, Kelsey Cruz, Charles S. Haw, Gary J. Redekop, Peter Gooderham

Department of Neurosurgery Faculty Papers

Aneurysmal subarachnoid hemorrhage (aSAH) remains a devastating cerebrovascular emergency associated with substantial morbidity and mortality. Current guidelines recommend 14-21 days of inpatient monitoring and a 21-day course of nimodipine following aSAH. This retrospective study evaluates early outcomes early discharge (≤14 days post-ictus) and an abbreviated nimodipine course in highly selected patients with good-grade aSAH managed under a standardized institutional protocol. Consecutive patients enrolled in the Vancouver Ruptured Aneurysm Database (VRAD) at Vancouver General Hospital between 2022 and 2025 were included. Inclusion criteria were good-grade aSAH (WFNS Grade I-III) and discharge home within 14 days of ictus. The primary outcome was …

Locoregional Therapy Pressure-Enabled Drug Delivery For Liver Cancers, Thomas Eggleston, Bassem Fayek, Jacqueline Kowalke, Mina Makary

Student Papers, Posters & Projects

Hepatic malignancies account for a substantial portion of global cancer mortality, with hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (IHC), and metastatic liver disease representing the most common diagnoses. While surgical resection and liver transplantation remain curative options for eligible patients, most patients are diagnosed at stages unsuitable for surgery. This has shifted medical management towards locoregional therapies (LRTs) which are often catheter-directed. Of these interventions, the use of conventional end-hole catheters for therapeutic infusion has been a mainstay of treatment, but this method is constrained by retrograde particle escape and elevated tumoral interstitial fluid pressure. Together, these factors limit drug penetration …

When Should You Worry About Pediatric Snoring?, Sarah Gubara, Samira Naime

Pediatrics in Practice: A CME Podcast

My child snores — when is it a problem? Snoring and obstructive sleep apnea are the focus here. Samira Naime, MD, Pediatric Pulmonologist and Sleep Medicine Physician at Children's Mercy, explains how to spot worrying signs, when to try allergy treatment or nasal steroid and when to consider a sleep study. She also covers which labs allow outside ordering and when referral to sleep medicine is appropriate.

Click here to stream the podcast episode.

Personalizing Modern Heart Failure Therapy In Hfref: Bridging Evidence, Clinical Practice, And Future Perspectives, Ehsan Shahverdi, Amin Shahverdi, Sendooran Shahi, Carsten Schneider, Mathias Lange, Shadi Kamali

Journal of the Saudi Heart Association

Background

Heart failure with reduced ejection fraction (HFrEF) remains a major cause of morbidity, mortality, and healthcare utilization worldwide despite substantial therapeutic advances. Over the past three decades, randomized clinical trials have established four foundational pharmacologic pillars of guideline-directed medical therapy (GDMT): renin–angiotensin system inhibition or angiotensin receptor–neprilysin inhibition, evidence-based beta-blockers, mineralocorticoid receptor antagonists, and sodium–glucose cotransporter 2 inhibitors. However, real-world implementation of these therapies remains suboptimal.

Objectives

To provide a contemporary state-of-the-art review of current evidence supporting GDMT in HFrEF, examine unresolved challenges in sequencing and optimization, and propose a practical phenotype-based framework to support individualized treatment decisions

. …

What Factors Do Patients Consider When Choosing A Hand Surgeon?, Monik Debkowska, Jeremy Ruskin, Brian Lynch, Samuel Caradonna, David Komatsu, Edward Wang, Samantha Muhlrad

Stony Brook Orthopaedic and Musculoskeletal Journal

Introduction: Many patients find themselves frustrated wasting time and money when searching for the right hand specialist, only to be referred to a different one. There has been little research evaluating patient decision making when choosing a hand surgeon. Specialists would benefit from learning how to optimize their practice to reach their appropriate patient population for maximum benefit and minimum resource waste, both for the patients and physicians. We therefore conducted a survey study to evaluate which factors patients consider important when choosing a hand surgeon, and if these factors differ based on patient demographics. Our hypothesis is that patients …