Surgery Commons^™

Injury And Illness: An Analysis Of Team Usa Athletes At The 2024 Winter Youth Olympic Games, Ashley N Triplett, Eric G Post, Travis Anderson, Olivia Samson, Alexis D Gidley, Francisco Silva, Lea Thomann, Amber T Donaldson, Jonathan T Finnoff, Eric L Dugan, Jeffrey S Shilt, William M Adams

Faculty, Staff and Students Publications

Background: Injury and illness surveillance is essential for understanding the relative risks of sports participation to develop effective strategies to optimize athlete health, wellness, and performance. Epidemiological studies examining injuries and illnesses among Team USA youth athletes are limited, particularly among athletes competing in Winter sports. The purpose of this study was to characterize the injury and illness incidence rate among Team USA athletes participating in the 2024 Winter Youth Olympic Games (YOG).

Methods: Injuries and illnesses among 101 Team USA youth athletes (40.6% female; age, 17 ± 1 years) were prospectively documented. Injury and illness prevalence, and incidence rate …

Testosterone Deficiency And Treatments: Common Misconceptions And Practical Guidance For Patient Care, Mohit Khera, James M Hotaling, Martin Miner

Faculty, Staff and Students Publications

Introduction: Misconceptions about testosterone therapy are prevalent and there is an unmet need for a review of current literature that can be leveraged by physicians to deliver safe and effective care for men with hypogonadism.

Objectives: This review aims to address common misconceptions about testosterone therapy using current literature and synthesize practical guidance for clinicians with patients who are starting testosterone therapy.

Methods: A literature search of PubMed, Embase, CINAHL was carried out to identify associations between testosterone therapy and prostate cancer, cardiovascular risk, and hepatic toxicity; definitions of hypogonadism; and practical guidance for clinician with patients starting testosterone therapy. …

Predictors Of Failure To Rescue After Fenestrated-Branched Endovascular Aortic Repair Of Thoracoabdominal Aortic Aneurysms: Presented At The Thirty-Seventh Annual Meeting Of The European Society Of Vascular Surgery, Belfast, Northern Ireland, September 26-29, 2023, Andrea Vacirca, Thomas Mesnard, Ying Huang, Bernardo C Mendes, Tomasz Jakimowicz, Darren B Schneider, Stéphan Haulon, Jonathan Sobocinski, Adam W Beck, Andres Schanzer, Mark A Farber, Carlos Timaran, Andrea Kahlberg, Tilo Kölbel, Warren J Gasper, Barend M E Mees, Mauro Gargiulo, Nuno V Dias, Anthony Lee Woongchae, Matthew P Sweet, Kevin Mani, Matthew Eagleton, Luis Mendes Pedro, Hence Verhagen, Kak Khee Yeung, Nikolaos Tsilimparis, Timothy Resch, Luca Bertoglio, Emília Ferreira, Manar Khashram, Titia Sulzer, Marina Dias-Neto, Emanuel R Tenorio, Lucas Ruiter Kanamori, Katarzyna Jama, Ezequiel Parodi, Vivian Gomes, Jesus Porras Colon, Roberto Chiesa, Giuseppe Panuccio, Geert Willem Schurink, Charlotte Lemmens, Enrico Gallitto, Gianluca Faggioli, Angelos Karelis, Anders Wanhainen, Mohammed Habib, Ryan Gouveia E Melo, Kaj Olav Kappe, Samira Elize Mariko Van Knippenberg, Bichlan Tran, Sean Crawford, Marco Panagrosso, Andrea Melloni, Stefano Bonardelli, Rita Garcia, Tiago Ribeiro, Sinead Gormley, Steven Maximus, Gustavo S Oderich, International Multicenter Aortic Research Group

Faculty, Staff and Students Publications

No abstract provided.

Ad-Sge-Dkk3 Gene Therapy Overcomes Resistance To Immune Checkpoint Blockade In Pleural Mesothelioma, Hee-Jin Jang, Meera Patel, Daniel Y Wang, Sung Wook Kang, Jong Min Choi, Claire Lee, Monica Vilchis, Ji Seon Shim, Sonali Mitra, Priyanka Ranchod, Allen Kuncheria, William Hudson, Peter Jindra, Veronica Lenge De Rosen, Maheshwari Ramineni, Ernest Ramsay Camp, Farrah Kheradmand, R Taylor Ripley, Shawn S Groth, Hyun-Sung Lee, Bryan M Burt

Faculty, Staff and Students Publications

Purpose: Immune checkpoint inhibitors (ICI) have limited efficacy in pleural mesothelioma. We investigated the role of Dickkopf WNT signaling pathway inhibitor 3 (DKK3) in overcoming treatment resistance.

Patients and methods: We performed preclinical studies to elucidate DKK3's role in ICI-resistant mouse mesothelioma. Based on these findings, we conducted a single-arm, phase II clinical trial of a combination of Ad-SGE-DKK3 and nivolumab for chemotherapy-refractory epithelioid pleural mesothelioma, with the objective response rate as the primary outcome.

Results: DKK3 was significantly reduced in human epithelioid mesothelioma. Overexpression of DKK3 in cancer cells activated the p53 pathway, enhanced glycolysis, increased surface PD-L1, and …

Role Of Kctd13 In Modulating Ar And Sox9 Expression In Different Penile Cell Populations, Carolina J Jorgez, Ahmed Chahdi, Hunter Flores, Marisol O'Neill, Abhishek Seth

Faculty, Staff and Students Publications

Objective: Micropenis is a condition with significant physical and psychological implications caused mainly by decreased androgen action in penile development. Kctd13-knockout (Kctd13-KO) mice have micropenis, cryptorchidism, and fertility defects because of reduced levels of androgen receptor (AR) and SOX9. We hypothesized that normalizing the levels of AR and SOX9 in the Kctd13-KO penis could help us to understand the mechanism of action of these signaling pathways on penile development.

Methods: We generated transgenic mice lacking Kctd13 and conditionally expressing AR in the urethral mesenchyme after Cre activation with Twist2cre (Kctd13-KO; AR-CMV; Twist2cre; herein called AR+), and Sox9 in the urethral …

Mass Spectrometry Imaging Reveals Alterations In Protein And N-Glycan Molecular Signatures In Endometriosis Tissues, Monica Lin, Erin H Seeley, Suzanne Ledet, Christina Salazar, Michael T Breen, Livia S Eberlin

Faculty, Staff and Students Publications

Endometriosis is a gynecological condition characterized by the uncontrolled growth of endometrial-like tissue outside the uterine cavity. Although highly prevalent, the biological mechanisms of endometriosis are poorly understood, and the disease is often misdiagnosed due to the unavailability of pre-operative diagnostic methods. Thus, better characterization of molecular markers of endometriosis are critical to improve our understanding of the disease and management of patients. Here, we used matrix-assisted laser desorption ionization mass spectrometry (MALDI MS) imaging to investigate protein and N-glycan molecular signatures in eutopic endometrium and endometriosis lesions from tissues prospectively collected from patients. MALDI MS imaging of intact proteins …

Arterial Anastomosis To Injured Vessels: Outcomes In Lower Extremity Trauma Reconstruction, Ellen Wang, Jessica R Nye, Imran Rizvi, Kylie R Swiekatowski, Bora Kahramangil, Paul Won, Noa G Kopplin, Stephen F Parlamas, Jeffrey G Trost, Mohin A Bhadkamkar

Faculty, Staff and Student Publications

Background: Although traditional teaching advocates that microsurgical anastomoses should be performed to uninjured vessels outside the zone of injury (ZOI), there is no defined way to assess the extent of the ZOI, and uninjured vessels may not be available. To evaluate the complications ascribed to the ZOI and injured vessels, outcomes between arterial anastomoses fashioned from within the ZOI versus noninjured recipient vessels were compared.

Methods: A retrospective review was conducted of adult patients who required lower extremity free flap (FF) reconstruction from 2016 to 2024. Injury to the recipient artery (transection, avulsion, or thrombosis) was determined by intraoperative assessment …

The Landmark Series: Therapeutic Cancer Vaccine Strategies For Cold Tumors, Alex B Blair, Lei Zheng, Kevin C Soares

Faculty, Staff and Student Publications

Immunologically cold tumors present a significant challenge in cancer treatment due to their limited baseline immune infiltration and resistance to immunotherapy. Cancer vaccines offer a promising strategy to overcome this barrier by introducing high-quality, tumor-relevant antigens that can stimulate an effective anti-tumor immune response. Therapeutic cancer vaccines are being explored in the neoadjuvant, adjuvant, and minimal residual disease contexts to enhance immune activation and promote immune cell infiltration and function, with the goal to eradicate malignant cells and improve patient survival. Critical hurdles remain in optimizing antigen selection, determining the most effective vaccine formulations, and defining the ideal clinical setting …

Histologic- And Genomic-Directed Adjuvant Therapy For Ampullary Adenocarcinoma: A Hidden Genome-Derived Analysis, Brett L Ecker, Kenneth Seier, Ankur Choubey, Austin M Eckhoff, Gabriella N Tortorello, Vinod P Balachandran, Nicola Blackburn, Michael I D'Angelica, Ronald P Dematteo, Daniel G Blazer, Jeffrey A Drebin, William E Fisher, Anthony J Gill, Marie-Claude Gingras, T Peter Kingham, Major K Lee, Michael E Lidsky, Daniel P Nussbaum, Michael J Overman, Jaswinder S Samra, Ronglai Shen, Carlie S Sigel, Charles M Vollmer, Alice C Wei, Sabino Zani, Australian Pancreatic Genome Initiative, Robert E Roses, Mithat Gonen, William R Jarnagin

Faculty, Staff and Students Publications

Background: The benefit of adjuvant chemotherapy (AC) for ampullary adenocarcinoma is unclear. The Hidden Genome model classifies prognostic subtypes with greater accuracy than standard histologic classification (intestinal [INT] vs pancreatobiliary [PB]), but its predictive capacity to guide the use of AC remains unstudied.

Methods: We applied the Hidden Genome model to an international cohort of 183 patients with resected ampullary adenocarcinoma who underwent genomic sequencing. The model quantified the predicted cell of origin (colorectal vs pancreas/distal bile duct) in all specimens. Overall survival (OS) was compared using Kaplan-Meier estimates, stratified by AC use versus surgery alone (SA).

Results: Most patients …

"Touch&Play" Wood Typification By The Masspec Pen, Adriano Reis, Caroline Pais Carvalho, Iasmim Lopes De Lima, Felipe R P Mansoldo, Alane Beatriz Vermelho, Rosineide Costa Simas, Livia S Eberlin, Marcos N Eberlin

Faculty, Staff and Students Publications

We have investigated the ability of a MasSpec Pen (MSPen) "three-in-one" (extraction, transfer, and ionization) device coupled to a mass spectrometer to provide instantaneous chemical profiles that could promptly characterize wood samples from the mahogany (Meliaceae) family. For that, we selected a set of five representative wood species, that is, Brazilian mahogany (Swietenia macrophylla, also known as Honduran mahogany), two African mahoganies (Khaya ivorensis and Khaya senegalensis), and two "nongenuine" ("fake") mahogany woods: cedar (Cedrela odorata) and andiroba (Carapa guianensis). By simply touching the superficially polished wood surface and after 3 s of automatic extraction, profiles of highly characteristic markers …

New Frontiers: The Intern Experience In A Newly Established Integrated Plastic Surgery Program, Hendrik Lintel, Imran Rizvi, Michael Haydon, Erik S Marques, Matthew R Greives, Mohin A Bhadkamkar

Faculty, Staff and Student Publications

The plastic surgery residency pathway has undergone many changes since its inception. The advent of integrated training has largely taken over as the predominant residency model with the addition of a few new programs every year. There is currently a paucity of literature describing the experiences of first-year interns in a new integrated residency program transitioning from the independent model. In this article, we seek to elucidate some of the advantages and difficulties encountered by the initial residents of a newly established integrated program and the steps taken to pave the way for future matched integrated trainees.

Time To Weight Plateau With Tirzepatide Treatment In The Surmount-1 And Surmount-4 Clinical Trials, Deborah B Horn, Scott Kahan, Rachel L Batterham, Dachuang Cao, Clare J Lee, Madhumita Murphy, Sylvia Gonsahn-Bollie, Farai Chigutsa, Adam Stefanski, Julia P Dunn

Faculty, Staff and Student Publications

The rate of weight reduction during obesity treatment declines over time and eventually reaches a weight plateau. We investigated factors associated with time to weight plateau (TTWP) in tirzepatide-treated participants with obesity or overweight in a post-hoc analysis of SURMOUNT-1 and SURMOUNT-4 trials. Participants adherent to tirzepatide treatment and achieving ≥5% weight loss by primary endpoint (week 72 SURMOUNT-1; week 88 SURMOUNT-4) were included. Weight plateau was defined as a weight change < 5% over a 12-week interval and all subsequent 12-week intervals. TTWP was time from randomization to the start of the first 12-week interval. Association between baseline characteristics and TTWP was assessed. Overall, 1438 participants in SURMOUNT-1 and 259 in SURMOUNT-4 were included. Across BMI categories (overweight, class I, II, and III), median TTWP in SURMOUNT-1 was 24.3, 26.0, 36.1, and 36.1 weeks, respectively (p < .05, class II and III vs. overweight). By week 72, 90.2%, 88.9%, 87.6%, and 87.8% of participants in SURMOUNT-1 had reached a weight plateau across respective BMI categories [Correction added on 22 January 2025, after first online publication: The "72%" has been changed to "72" in this version.]. Higher doses of tirzepatide (10/15 mg), younger age, and female sex were more likely to reach a weight plateau later. Results in SURMOUNT-4 were similar. In this post-hoc analysis, most participants reached a weight plateau by week 72. Higher doses of tirzepatide, younger age, and female sex were associated with a longer TTWP. Further research into modifiers of weight reduction phases with tirzepatide may inform treatment decisions for its use in chronic weight management. Clinical Trial Registration: ClinicalTrials.gov, identifiers NCT04184622 (SURMOUNT-1) and NCT04660643 (SURMOUNT-4), available at http://www.clinicaltrials.gov/.

Association Between Timing Of Angiotensin Ii Administration And Outcomes In Vasoplegia After Cardiac Surgery, Travis J Miles, Michael T Guinn, Orlando R Suero, Todd K Rosengart, Marc R Moon, Joseph S Coselli, Ravi K Ghanta, Subhasis Chatterjee

Faculty, Staff and Students Publications

Objective: Vasoplegic shock after cardiopulmonary bypass (CPB) is a highly morbid condition. The novel vasopressor angiotensin II is increasingly being used for catecholamine-resistant vasoplegia. Although early intervention with adjunctive therapies such as methylene blue can improve outcomes of vasoplegia, the optimal timing for escalation with angiotensin II is unknown.

Methods: Pharmacologic data were extracted from electronic health records for patients who underwent surgery with CPB during 2017-2022. Patients were identified who received angiotensin II intraoperatively or postoperatively (ie, early or late). Multivariable logistic regression was used to determine the risk-adjusted effects of earlier angiotensin II administration on postoperative major adverse …

When The Right Ventricle Fails After Left Ventricular Assist Device Implantation: Prediction Tools, Recognition Strategies, And Support Options, Juan Jose Rodriguez Arias, James Schurr, Phyllis Billia, Joyce W. Wald

Journal of Shock and Hemodynamics

The incidence of right heart failure (RHF) during durable left ventricular assist device (LVAD) surgery ranges from 9% to 42%, depending on the definition. RHF can be divided into three peri-implantation categories: early acute, early, and late. Despite many available risk models, predicting RHF before durable LVAD implantation has been difficult. Preemptive right-sided temporary mechanical circulatory support can improve outcomes; however, if intraoperative RHF is not suspected, early recognition and appropriate intervention after surgery are important.

Artificial Intelligence-Based Virtual Staining Platform For Identifying Tumor-Associated Macrophages From Hematoxylin And Eosin-Stained Images, Arpit Aggarwal, Mayukhmala Jana, Amritpal Singh, Tanmoy Dam, Himanshu Maurya, Tilak Pathak, Sandra Orsulic, Kailin Yang, Deborah Chute, Justin A Bishop, Farhoud Faraji, Wade M Thorstad, Shlomo Koyfman, Scott Steward, Qiuying Shi, Vlad Sandulache, Nabil F Saba, James S Lewis, Germán Corredor, Anant Madabhushi

Faculty, Staff and Students Publications

Background: Virtual staining is an artificial intelligence-based approach that transforms pathology images between stain types, such as hematoxylin and eosin (H&E) to immunohistochemistry (IHC), providing a tissue-preserving and efficient alternative to traditional IHC staining. However, existing methods for translating H&E to virtual IHC often fail to generate images of sufficient quality for accurately delineating cell nuclei and IHC+ regions. To address these limitations, we introduce VISTA, an artificial intelligence-based virtual staining platform designed to translate H&E into virtual IHC.

Methods: We applied VISTA to identify M2-subtype tumor-associated macrophages (M2-TAMs) in H&E images from 968 patients with HPV+ oropharyngeal squamous cell …

Expert Consensus For Key Components Of A High-Quality Ventral Hernia Repair Operative Note, Jonathan S Lall, Said Maldonado, Nicole B Lyons, Gina Adrales, Karla Bernardi, Anne P Ehlers, Hobart Harris, Julie Holihan, William Hope, Jeffrey E Janis, Michele Loor, Clayton Petro, Luke Putnam, Caroline E Reinke, John Scott Roth, Christopher Senkowski, Kendell Sowards, Shirin Towfigh, Daniel Dante Yeh, Zuhair Ali, Mike K Liang

Faculty, Staff and Students Publications

Background: Ventral hernia repair (VHR) is one of the most commonly performed procedures by surgeons; however, there remains a lack of consensus for key components of operative reporting. Prior literature has identified several key elements that are recommended for inclusion in ventral hernia repair operative notes, but it is unclear whether these details alone make for a high-quality operative note. This study sought to determine whether experts agree on what factors make a ventral hernia repair operative note high-quality.

Study design: A prospective exploratory sequential survey-based mixed-methods design was used for round 1. Conclusions via thematic analysis from survey responses …

Multidisciplinary Team Care In Plastic Surgery: Vascular Anomalies, Josephine L Schmidt, Vamsi C Mohan, Richard Appel, Tara L Rosenberg, Jessica A Ching

Faculty, Staff and Students Publications

Vascular anomalies consist of a wide range of diagnoses relating to abnormal vasculature. These lesions can affect a variety of anatomical structures, requiring the expertise of numerous specialists. Over the past few decades, the formation of multidisciplinary vascular anomalies clinics has allowed patients to meet multiple providers within the same clinic visit, leading to improved communication between patients and providers. Furthermore, diagnostic and treatment plans are discussed in multidisciplinary conferences allowing for enhanced diagnostic accuracy and more comprehensive management plans. The purpose of this article is to provide an overview of the multidisciplinary management of vascular anomalies, including descriptions of …

Surgical Specimen Management Protocols In The Pre-Analytical Phase, Jordan L. Hall

Doctor of Nursing Practice Final Project Abstract

Purpose

This quality improvement (QI) project aimed to decrease surgical specimen errors during the pre-analytical phase at the target institution by 50% by January 2025 by developing best practices for specimen labeling and documentation.

Background

The QI project was implemented within a level two trauma center with a 24-suite operating room (OR) in The Woodlands, Texas, which provides care across all surgical specialties except ophthalmology.

Methodology

The target institution changed from nurse-hand-written specimen labels and requisition sheets to electronic medical record (EMR) generated specimen labels and requisition sheets. The change was congruent with the target institution’s shift to a new …

Impact Of Perioperative Organ Injury On Morbidity And Mortality In 28 Million Surgical Patients, Felix Kork, Yafen Liang, Adit A Ginde, Xiaoyi Yuan, Rolf Rossaint, Hongfang Liu, Alex S Evers, Holger K Eltzschig

Faculty, Staff and Student Publications

Perioperative organ injury contributes to morbidity and mortality of surgical patients. This cohort study included all elective and emergent surgeries in Germany over 4 years to address the impact of perioperative organ injuries on outcomes. We analyzed 28,350,953 cases. In-hospital mortality was 1.4% (n = 393,157), and 4.4% of cases (n = 1,245,898) experienced perioperative organ injury. Perioperative organ injury was associated with 9-fold higher odds of death and prolonged hospital stay by 11.2 days. Acute kidney injury had the highest incidence (2.0%) and was associated with 25.0% mortality. While delirium had the second highest incidence (1.5%), it was associated …

Optimal Restoration Of Spermatogenesis After Testosterone Therapy Using Human Chorionic Gonadotropin And Follicle-Stimulating Hormone, Blair T Stocks, Amelia G Oppenheimer, Kevin J Campbell, John P Lindsey, Taylor P Kohn, Juliet M Alexander, Jason B Huang, Larry I Lipshultz

Faculty, Staff and Students Publications

Objective: To study improvements in spermatogenesis in men with a history of testosterone therapy using a novel fertility treatment regimen.

Design: A single-center retrospective cohort analysis.

Subjects: Seventy-seven men with previous testosterone use seeking fertility treatment from January 2020 to March 2024.

Exposure: A treatment regimen of 3,000 IU of human chorionic gonadotropin (hCG) and 75 IU of follicle-stimulating hormone (FSH) three times a week was used.

Main outcome measures: The primary outcome measured was change in sperm concentration during hCG/FSH therapy. The secondary outcome measured was whether concurrent testosterone therapy during hCG/FSH therapy affected recovery of spermatogenesis.

Results: Within …

Obesity And Outcomes After Elective Thoracoabdominal Aortic Aneurysm Repair, Sanford Zeigler, Kyle W Blackburn, Ahmad Tabatabaeishoorijeh, Veronica A Glover, Susan Y Green, Marc R Moon, Scott A Lemaire, Joseph S Coselli

Faculty, Staff and Students Publications

Objective: Obesity can complicate surgical repair, but its relationship to outcomes after open thoracoabdominal aortic aneurysm (TAAA) repair remains uncertain. Therefore, we examined whether obesity is associated with greater operative risk after elective TAAA repair.

Methods: We retrospectively evaluated data from 2517 open, elective, single-practice TAAA repairs (from 1986 to 2023) and compared patients without obesity or underweight (body mass index [BMI] 18.6-29.9; n = 1977) with patients with obesity (BMI ≥30; n = 540 [21.5%]). Multivariable logistic regression modeling identified predictors of operative mortality in patients with obesity. We created propensity-matched cohorts (n = 540 pairs) and compared their …

Fruits Of The Professional Educator Appreciation And Recognition (Pear) Awards: Learning What Students Value In Their Medical Educators, Madeline Tomlinson, Kristiana Nasto, Kevin Gosselin, Ellen M Friedman, Anne Gill, Stacey Rose

Faculty, Staff and Students Publications

Purpose: The Professional Educator Appreciation and Recognition (PEAR) awards program was created by students at Baylor College of Medicine (BCM) in 2020 to recognize exemplary educators. We reviewed our 3-year experience of this initiative to identify characteristics of award-winning educators, and to assess the award's impact.

Materials and methods: We reviewed the title, department, and clinical affiliation of award winners. Using ChatGPT, we qualitatively analyzed de-identified nomination narratives to identify themes of educator characteristics most valued by students. Following refinement by the study team, each award was then assigned one or more themes. Unsolicited thank-you emails were reviewed to consider …

International Multispecialty Expert Physician Preoperative Identification Of Extranodal Extension In Patients With Oropharyngeal Cancer Using Computed Tomography: Prospective Blinded Human Inter-Observer Performance Evaluation, Onur Sahin, Serageldin Kamel, Kareem A Wahid, Cem Dede, Nicolette Taku, Renjie He, Mohamed A Naser, Christina S Sharafi, Antti Mäkitie, Benjamin H Kann, Kimmo Kaski, Jaakko Sahlsten, Joel Jaskari, Moran Amit, Gregory M Chronowski, Eduardo M Diaz, Adam S Garden, Ryan P Goepfert, Jeffrey P Guenette, G Brandon Gunn, Jussi Hirvonen, Frank Hoebers, Katherine A Hutcheson, Nandita Guha-Thakurta, Jason Johnson, Diana Kaya, Shekhar D Khanpara, Kristofer Nyman, Stephen Y Lai, Miriam Lango, Kim O Learned, Anna Lee, Carol M Lewis, Anastasios Maniakas, Amy C Moreno, Jeffrey N Myers, Jack Phan, Kristen B Pytynia, David I Rosenthal, Vlad C Sandulache, Dawid Schellingerhout, Shalin J Shah, Andrew G Sikora, Abdallah S R Mohamed, Melissa M Chen, Clifton D Fuller, Multidisciplinary Oropharyngeal Cancer Extra‐Nodal Extension (Opc Ene) Assessment Working Group

Faculty, Staff and Students Publications

Background: Pathologic extranodal extension (pENE) is a crucial prognostic factor in oropharyngeal cancer (OPC), but determining pENE from imaging has high inter-observer variability. The role of clinician specialty in the accuracy of imaging-detected extranodal extension (iENE) remains unclear. The purpose of this study is to assess the influence of clinician specialty on the accuracy of preoperative iENE detection in human papillomavirus (HPV)-positive OPC using computed tomography (CT) imaging.

Methods: This prospective observational study evaluated pretherapy CT images from 24 HPV-positive OPC patients (30 scans, including duplicates). Thirty-four expert observers (11 radiologists, 12 surgeons, 11 radiation oncologists) assessed iENE and reported …

A Workflow Enabling The Automated Synthesis, Chain-End Degradation, And Rapid Mass Spectrometry Analysis For Molecular Information Storage In Sequence-Defined Oligourethanes, Julia R Shuluk, Christopher D Wight, James R Howard, Mary E King, Sarah R Moor, Rachel J Dehoog, Samuel D Dahlhauser, Livia S Eberlin, Eric V Anslyn

Faculty, Staff and Students Publications

The field of molecular information storage has recently expanded to include abiotic sequence-defined polymers. While robust methods have been developed, there is a current bottleneck in the throughput of this work as information density is increased. Herein, we introduce an automated workflow in which a commercial peptide synthesizer composed of a single XYZ liquid-handling robot was adapted to both synthesize and sequence sequence-defined oligourethanes. Our sequencing method was improved to cut down the number of samples required for each oligomer from 13 to one. Additionally, we introduce the use of desorption electrospray ionization mass spectrometry as our analysis method for …

Preoperative Brain Volume Loss Is Associated With Postoperative Delirium In Advanced Heart Failure Patients Supported By Left Ventricular Assist Device, Iván Murrieta-Álvarez, Jacob P Scioscia, José M Benítez-Salazar, Jason Uwaeze, Zicheng Xu, Guangyao Zheng, Shiyi Li, Vladimir Braverman, Carl P Walther, Alexis E Shafii, Camila Hochman-Mendez, Todd K Rosengart, Kenneth K Liao, Nandan K Mondal

Faculty, Staff and Students Publications

Delirium is a common neurological complication in patients with advanced heart failure (ADHF) following left ventricular assist device (LVAD) implantation, significantly impacting recovery. This study aimed to analyze non-contrast computed tomography (CT) scans of the brain in ADHF patients undergoing LVAD implantation to determine the association between pre-existing brain atrophy and postoperative delirium. A study involving 166 ADHF patients was conducted from March 2020 to July 2023. Non-contrast CT scans were analyzed using advanced quantitative neuroimaging techniques before implantation. The primary marker assessed was the lateral ventricle fraction (LVF), with secondary markers including cortical gray matter fraction (cGMF), white matter …

Every Jump Is A Leap Of Faith-Just Ask Evel Knievel!, Vicente Orozco-Sevilla, Joseph S Coselli

Faculty, Staff and Students Publications

No abstract provided.

Space Flight Missions Over 6 Months Significantly Increase The Risk Of Shoulder Pathology And Rotator Cuff Tears, Benjamin Fiedler, Meghana Jami, Srikhar V Chilukuri, Abdullah Ghali, Todd Phillips, Adil Shahzad Ahmed

Faculty, Staff and Students Publications

Background: The purpose of this study was to determine risk of shoulder injury in astronauts returning from space flight and highlight the need for further exploration of risk factors and preventative strategies.

Methods: Using The Lifetime Surveillance of Astronaut Health epidemiology database at National Aeronautics and Space Administration, a retrospective cohort study was conducted to assess the effect of space flight mission duration on rate of shoulder injury among astronauts. Inclusion criteria were all astronauts who participated in space flight regardless of age or space flight mission time. Exclusion criteria were all injuries occurring greater than 5 years following return …

Which Systemic Responses Should We Evolve To Help Surgeons Navigate Their Regret Experiences?, Ryan X Lam, Ruhi Thapar, Eric J Silberfein, Lorenzo R Deveza

Faculty, Staff and Students Publications

Regret in surgical practice is typically construed as resulting from the commission or the omission of a specific action at a specific decision point, which leads to a deleterious outcome. This article suggests a need to expand this conception of surgical regret to better account for surgeons' regret experiences arising from factors beyond their control. The commentary accompanying the case investigates these external sources of regret, such as resource limitations or professional interpersonal dynamics that prevent a desired outcome from being realized. It also discusses the normative value of addressing surgeons' experiences of regret, especially as a catalyst to facilitate …

Open-Hybrid Aortic Stent Placement For Recurrent Coarctation In Complex Single Ventricles, Andrew K Morse, Blaz Podgorsek, Julija Dobrila, Zachary A Cerra, Kiran K Mallula, Muhammad S Khan, Christopher E Greenleaf, Jorge D Salazar, Damien J Lapar, Peter C Chen

Faculty, Staff and Student Publications

Recurrent coarctation of the aorta in patients with hypoplastic left heart syndrome requires timely intervention to limit ventricular dysfunction and atrioventricular valve regurgitation. Current strategies include catheter-based intervention in adequately sized patients or surgical arch augmentation at the time of a concomitant operation. We report an open-hybrid surgical technique with placement of a balloon-expandable stent that can later be expanded to an adult size as the patient grows. Limiting the arch dissection reduces the risk to the left recurrent laryngeal nerve and shortens anterograde cerebral perfusion time.

Androgen Receptor Ubiquitination Links Kctd13 To Genitourinary Tract Defects, Ahmed Chahdi, Carolina Jorgez, Jill A Rosenfeld, Neetu Neetu, Abhishek Seth

Faculty, Staff and Students Publications

The potassium channel tetramerization domain containing 13 (KCTD13) protein is a substrate-specific adapter for cullin3-based E3 ubiquitin ligase. Patients with copy number variants at this locus exhibit genitourinary tract anomalies. In this study, we show that decreased androgen receptor (AR) protein level correlated with increased AR ubiquitination in the testis of Kctd13-deficient mice, suggesting that KCTD13 inhibits AR ubiquitination. KCTD13 increased CUL3-dependent AR ubiquitination but had no effect on CUL3 binding to AR, confirming the role of KCTD13 as an adaptor of CUL3 ligase. Recombinant KCTD13 directly binds to recombinant AR, and the BTB domain of KCTD13 is critical for …