Diagnosis Commons^™

A Comparative Evaluation Of Two Subharmonic-Aided Pressure Estimation (Shape) Analysis Methods, Hailee Mayer, Priscilla Machado, Trang Vu, Annalisa Berzigotti, Jaume Bosch, Elton Dajti, Antonina Antonenko, Kirk Wallace, Flemming Forsberg

Department of Radiology Faculty Papers

Pressure measurement in clinical practice is a valuable tool for diagnostic evaluation, especially in diseases such as portal hypertension. Currently, portal pressures are measured by invasive hepatic vein catheterization, posing risks to patients, and limiting how often measurements can be obtained. Subharmonic-aided pressure estimation (SHAPE) is an ultrasound-based technique that leverages ultrasound contrast agents (UCAs) to estimate changes in hydrostatic pressure. UCAs act as nonlinear oscillators when exposed to high enough acoustic pressures (typically > 200 kPa) and produce significant energy components ranging from subharmonics to higher harmonics. Tissues do not generate significant subharmonic components, thus making it the optimal component …

Association Of Estimated Plasma Volume Status With Invasive Hemodynamics And Adverse Clinical Outcomes In Patients With Pulmonary Hypertension And Chronic Kidney Disease, Andrew Geller, Jose Manuel Martinez Manzano, Esteban Kosak Lopez, Phuuwadith Wattanachayakul, John Malin, Raul Leguizamon, Tara John, Rasha Khan, Ian Mclaren, Alexander Prendergast, Simone Jarrett, Kevin Bryan Lo, Christian Witzke

Einstein Health Papers

Identifying noninvasive measures to assess intravascular volume status and risk stratify patients with pulmonary hypertension (PH) and chronic kidney disease (CKD) is needed. We assessed the predictive value of estimated plasma volume status (ePVS) using the Strauss-derived Duarte formula in PH-CKD patients. This single-center retrospective cohort analysis included patients with PH and CKD Stage 3b (CKD3b), Stage 4 (CKD4), or Stage 5 (CKD5) who underwent right heart catheterization from 2018 to 2023. Patients were categorized into low ePVS (< 6.2) and high ePVS (≥ 6.2) using Youden's J statistics. We used the Cox-proportional hazards model, adjusting for age, sex, and body mass index, to investigate the association between …

Outcomes Of The Modified Cabrol Technique In Aortic Root Replacement: Early And Midterm Experience, Nayeem Nasher, Joshua R. Chen, Purab Kothari, Colin King, Jacqueline Mcgee, Vishal Shah, Saarah Khairi, Konstadinos A. Plestis

Department of Surgery Faculty Papers

OBJECTIVES: The modified Cabrol technique has been associated with excellent graft patency. However, prior studies were limited to patients largely on long-term anticoagulation. We sought to analyze outcomes in patients primarily managed without mechanical prostheses.

METHODS: We retrospectively analyzed all patients who underwent aortic root replacement by a single surgeon from 2014 to 2024. Patients who underwent reimplantation of one or both coronary ostia using the modified Cabrol technique with separate interposition grafts were identified. Baseline characteristics and postoperative outcomes were reported. Predictors of mortality were analyzed using Cox proportional hazards, and overall survival was reported using Kaplan-Meier analysis.

RESULTS: …

Non-Invasive Detection Of Choroidal Melanoma Via Tear-Derived Protein Corona On Gold Nanoparticles: A Machine Learning Approach, Hakimeh Rakhshandeh, Ahmad Nasiraei, Hamid Riazi-Esfahani, Babak Masoomian, Fariba Ghassemi, Mojtaba Arjmand, Saeed Heidari Keshel, Fatemeh Atyabi, Rassoul Dinarvand

Wills Eye Hospital Papers

This study investigates the feasibility of using tear sample analysis, based on protein corona formation on gold nanoparticles combined with electrospray ionization mass spectrometry (ESI-MS) and machine learning techniques, as a non-invasive approach for the detection of choroidal melanoma. The aim is to assess whether protein-nanoparticle interactions can support early and reliable identification of this ocular condition. Tear samples were collected using Schirmer strips from six healthy individuals and six patients diagnosed with choroidal melanoma, with subsequent augmentation to 18 samples per group. Gold nanoparticles (AuNPs, ~ 20 nm) were synthesized via citrate reduction and incubated with tear samples to …

Inflammation And Detection: Rethinking The Biomarker Landscape In Gastric Cancer, Keykavous Parang, Koosha Paydary

Pharmacy Faculty Articles and Research

Gastric carcinoma is a leading cause of cancer-related mortality worldwide, yet reliable noninvasive biomarkers for its early detection remain limited. As research continues to elucidate the inflammatory underpinnings of tumor initiation and progression, it has become increasingly clear that pro-inflammatory cytokines may hold promise as diagnostic adjuncts. Serum cytokines such as interleukin (IL)-1β, IL-6, IL-8, and interferon-gamma have been frequently reported as elevated in gastric cancer patients compared to healthy individuals. These molecules, known for their roles in modulating tumor-promoting inflammation, angiogenesis, and immune evasion, may serve as accessible indicators of disease presence or progression. Several studies have shown that …

Monitoring The Hematologic Markers In Patients Undergoing Single-Stage Exchange Arthroplasty For Periprosthetic Joint Infection, Wenbo Mu, Juan D. Lizcano, Boyong Xu, Wentao Guo, Abudousaimi Aimaiti, Xiaogang Zhang, Javad Parvizi, Li Cao

Rothman Institute Papers

BACKGROUND: Periprosthetic joint infection (PJI) is a serious complication that necessitates a complex treatment strategy. Single-stage exchange arthroplasty, combined with intravenous and intra-articular antibiotic infusions, has shown high efficacy in treating complex PJIs. However, the impact of this approach on hematologic parameters remains underexplored. This study aims to evaluate the postoperative trends in blood platelet count, white blood cell (WBC) count, and neutrophil count in patients undergoing single-stage exchange arthroplasty.

METHODS: A retrospective analysis was conducted on 313 patients who underwent single-stage revision for PJI between June 2010 and October 2022. Hematologic parameters were monitored for the first seven postoperative …

Artificial Intelligence In The Management Of Leukemia, Stephanie Koo, Austin P. Runde, Melvin Speisman

School of Medicine

BACKGROUND: Recently, given the demonstrated ability of AI to accurately characterize complex pathologies, AI has been proposed to be of use in the diagnosis, treatment, and monitoring of leukemias given their genetic complexity and subtype heterogeneity, array of treatments, and need for relapse detection. AI has several potential applications in the management of leukemia. First, it can be used to detect leukemia; using AI to detect nuances in lab values can ensure these deadly cancers are never missed. Second, AI can be used to risk-stratify patients and personalize treatments; leukemias are among the most genetically complex cancers with well-characterized risk …

Comparison Of Cytology And Histology Diagnosis Methods In Metastatic Anaplastic Thyroid Cancer, Phyllis Yang, John Nicholas Cauba, Shizue Mito

Research Colloquium

Background: Anaplastic thyroid cancer (ATC) is a rare and extremely aggressive form of thyroid cancer that presents as a rapidly enlarging neck mass with compressive symptoms. Its malignancy and mortality rates approach nearly 90% and is a feared transformation of papillary thyroid cancer (PTC). A contributor to its increased mortality is its predilection for metastasis, which by nature, is less documented in medical literature. The study of ATC’s diagnostic algorithm, which classically utilizes cytological and histological confirmation, is crucial in enhancing early recognition and atypical presentations.

Methods: This systematic review catalogs the diagnosis, clinical properties, and metastasis sites of anaplastic …

Differences In Emergency Department Imaging Modalities For Femur Fractures Based On Insurance And Demographics, Patrick De La Torre Schutz, Bryce M. Bellon, Daniel Salinas, Kelsey Baker, Hamaad Gohar

Research Colloquium

Insurance status and race have been significant predictors of delayed care and reduced imaging utilization in emergency settings, particularly among minority and Medicaid-insured populations (Moser, Shan). The reasoning for the disparities in treatment for these underserved populations is still not well understood. To further analyze these claims, this study examined whether demographic factors such as ethnicity, sex, age, insurance type, and fracture classification were associated with differences in imaging modality among patients with femur fractures. Data from the Texas Department of State Health Services Trauma Registry (2018–2022) was analyzed using logistic regression to determine the odds ratios of receiving CT, …

Wernicke’S Encephalopathy With Classic Triad And Normal Mri In A Young Woman Following Rapid-Sequence Bariatric And Biliary Surgery, Hugo Zamarron, Nina Mourao, Roberto A. Cruz Saldana

Research Colloquium

Background: Wernicke’s encephalopathy is a life-threatening neurological disorder caused by thiamine deficiency, most commonly associated with alcoholism. However, postoperative nutritional deficiencies in young patients undergoing bariatric procedures are increasingly recognized. This case is unique due to the rapid succession of bariatric and cholecystectomy surgeries, development of classic Wernicke’s symptoms with a normal MRI, and diagnostic delay due to overlapping differential diagnoses including intracranial hypotension and myelopathy.

Case Presentation: A 22-year-old woman with class III obesity underwent sleeve gastrectomy in July 2022, followed by significant weight loss and persistent intractable vomiting. Due to suspected gallbladder disease, she underwent a cholecystectomy in …

Corticobasal Syndrome With Mixed Pathology In The Absence Of Grn Mutation: A Clinico-Pathological Case Of Ftld-Tdp With Coexisting Alzheimer’S And Lewy Body Pathology, Hugo Zamarron, David Irwin, Jeffery Phillips, Edward Lee, Matthew Tisdall, Corey Mcmillan

Research Colloquium

Background: Corticobasal syndrome (CBS) is a neurodegenerative disorder characterized by often asymmetric fronto-pariteal and extra-pyramidal features that is traditionally associated with tauopathy, but pathological findings are heterogenous, including other forms of frontotemporal lobar degeneration (FTLD) and mixed pathologies of aging. We present clinical, radiographic, and histopathologic features of asymmetry in a unique patient with CBS and underlying FTLD with TDP-43 pathology (FTLD-TDP), co-occurring with other age-related pathologies.

Case Presentation: A 76-year-old man presented with progressive cognitive and motor dysfunction including asymmetric parkinsonism, left-sided dystonia and rigidity, apraxia, visuospatial impairment, and a subtle social disorder including apathy and social withdrawal. The …

Bilateral Small Vessel Strokes In A Young Male With Coccidioidal Meningitis And Suspected Cns Vasculitis, Hugo Zamarron, Ahsan Ali

Research Colloquium

Background: Cerebral small vessel strokes in young, otherwise healthy adults without traditional vascular risk factors are rare and warrant further investigation. Central nervous system (CNS) vasculitis is an uncommon etiology that may be triggered by infections, including fungal pathogens. This case is notable for a suspected primary CNS vasculitis manifesting as bilateral deep infarcts in the setting of Coccidioidal meningitis. It highlights the importance of considering fungal infections and vasculitis in the differential diagnosis of stroke in younger patients.

Case Presentation: A 32-year-old previously healthy male presented with fever, headache, and was diagnosed with aseptic meningitis. He was later readmitted …

Rapid Mapping Of Spinal And Supraspinal Connectome Via Self-Targeting Glucose-Based Carbon Dots, Yasin B. Seven, Elif S. Seven, Emel Kirbas Cilingir, Komal Parikh, Mehmet Aydin, Edward K. Luca, Jayakrishnan Nair, Roger M. Leblanc

Department of Physical Therapy Faculty Papers

The spinal cord is a highly dynamic network, playing significant roles in the vital functions of the brain. Disorders of the spinal cord, such as spinal cord injury and amyotrophic lateral sclerosis (ALS), are associated with neurodegeneration, often resulting in morbidity and mortality. The blood-brain barrier (BBB) poses a major challenge to imaging and therapeutic agents because less than 2% of small-molecule drugs and almost no large-molecule drugs can cross the BBB. Furthermore, spatial spectroscopy studies have shown highly heterogeneous BBB crossing with significant accumulation at the unintended brain regions. Thus, targeting systems that can cross the BBB at the …

Early Blood Pressure Targets In Acute Spinal Cord Injury: A Randomized Clinical Trial, Ruba Sajdeya, N. David Yanez, Michael Kampp, Michael D. Goodman, David Zonies, Brandon Togioka, Andrew Nunn, Robert D. Winfield, Niels D. Martin, Anirudh Kohli, Toan T. Huynh, David O. Okonkwo, Roy A. Poblete, Emily J. Gilmore, Randall M. Chesnut, Aaron E. Bunnell, Tetsu Ohnuma, Mona Hashemaghaie, Miriam M. Treggiari

Department of Surgery Faculty Papers

IMPORTANCE: Early blood pressure management is central to neurologic resuscitation of spinal cord injury; however, the role of augmented blood pressure is unclear.

OBJECTIVE: To compare the efficacy and safety of augmented vs conventional blood pressure on 6-month neurologic outcomes after acute spinal cord injury.

DESIGN, SETTING, AND PARTICIPANTS: This multicenter randomized clinical trial took place from October 3, 2017, to July 26, 2023, and assessed patients 18 years or older with spinal cord injury followed up for 6 months at 13 large US trauma centers.

INTERVENTIONS: Patients were equally randomized to augmented (>85-90 mm Hg) or conventional ( …

A Single Center Study Of The Symbol Digit Modalities Test As A Screening Tool For Cognitive Impairment In Parkinson’S Disease, Daniyell Thomason, Morganne Manuel, Shannin Moody, Jesus Lovera, Brain Copeland, Deidre Devier

School of Medicine Faculty Publications

Background: Parkinson’s Disease (PD) can include physical signs and possibly cognitive impairment, resulting from the convergence of pathologicalprocesses involving dopaminergic dysfunction, accumulation ofalpha-synuclein, cholinergic deficits, and disruption of otherneurotransmitter systems. We used screening tests to evaluate thecharacteristics of cognitive performance in patients with PD and to assess their validity compared tothe Montreal Cognitive Assessment (MoCA). Methods: This is a natural history study of participants with PD and controls screened for possible cognitive impairment using the MoCA, Symbol Digit Modalities Test (SDMT), and King-Devick (KD). The groups were compared on performance and then factors associated with cognitive performance (age, diagnosis, and …

Redefining The Albumin-Bilirubin Score: Predictive Modeling And Multidimensional Integration In Liver And Systemic Disease, Berkay Demirors, Ramin Shekouhi, Paola Berrios Jimenez, Anjali Yadav, Guido Chiriboga, Vishal A. Mahesh, Harsheen K. Manaise, Jade Bowers, Angel Aguayo Merly, Emmanuel Gabriel

School of Medicine Faculty Publications

This editorial comment is on the article by Xu et al. It offers an in-depth analysis of liver function assessment tools and their prognostic roles in non-malignant liver diseases, with a focus on the albumin-bilirubin (ALBI) score. ALBI’s components, grading system, and clinical relevance across various liver conditions are reviewed and compared with traditional models such as the Child-Pugh and model for end-stage liver disease scores. We included recent studies evaluating ALBI’s role in estimating liver function, suggesting it may help differentiate patients who appear similar under other staging systems, and assist in guiding clinical decisions. Although ALBI is primarily …

Intelligence Architectures And Machine Learning Applications In Contemporary Spine Care, Rahul Kumar, Conor Dougherty, Kyle Sporn, Akshay Khanna, Puja Ravi, Pranay Prabhakar, Nasif Zaman

SKMC Student Presentations and Publications

The rapid evolution of artificial intelligence (AI) and machine learning (ML) technologies has initiated a paradigm shift in contemporary spine care. This narrative review synthesizes advances across imaging-based diagnostics, surgical planning, genomic risk stratification, and post-operative outcome prediction. We critically assess high-performing AI tools, such as convolutional neural networks for vertebral fracture detection, robotic guidance platforms like Mazor X and ExcelsiusGPS, and deep learning-based morphometric analysis systems. In parallel, we examine the emergence of ambient clinical intelligence and precision pharmacogenomics as enablers of personalized spine care. Notably, genome-wide association studies (GWAS) and polygenic risk scores are enabling a shift from …

Diagnostic Journey In The Recognition Of Oncogenic Osteomalacia, Steven B. Nagelberg, Mihaela Biscoveanu, Barbara Bix, Carrie Andrews, Srinivas Prasad

Jefferson Health - Northeast Papers (formerly Aria Health Papers)

A 73-year-old woman with a remote history of successfully treated primary hyperparathyroidism was referred to our office because of multiple skeletal fractures and proximal muscle weakness. Prior laboratory evaluation demonstrated hypocalcemia, vitamin D deficiency, elevated PTH, and elevated alkaline phosphatase. Updated evaluation in our clinic additionally showed hypophosphatemia prompting measurement of serum fibroblast growth factor 23 (FGF23). FGF23 proved to be markedly elevated prompting consideration of tumor-induced osteomalacia. Positron emission tomography with Cu-64 oxodotreotide revealed an enhancing focus in the left thoracic spine that was confirmed on magnetic resonance imaging to be a 1.5-cm extradural mass. The patient underwent surgical …

Parent Needs, Recommendations, And Systemic Challenges Affecting Pediatric Hypertension Detection, Abbas H. Zaidi, Erica D. Sood, Sarah De Ferranti, Samuel Gidding, Varsha Zadokar, Jonathan M. Miller, Anne E Kazak

Department of Pediatrics Faculty Papers

Pediatric hypertension (HTN) affects 3%-5% of children in the United States, yet only 25% are diagnosed and 60% lack recommended follow-up care. Skepticism about elevated blood pressure (BP) readings and reluctance to use antihypertensive medications by parents and clinicians highlight the need for stakeholder-informed strategies to address these challenges. This study examined parents' perceived needs, their recommended strategies to improve HTN detection, and contextual health system challenges. Parents and clinicians from 10 pediatric primary care clinics participated in semi-structured qualitative interviews. Only parents of children with documented stage 2 BP readings and a HTN diagnosis, but with gaps in care …

Automated Instance Segmentation And Registration Of Spinal Vertebrae From Ct-Scans With An Improved 3d U-Net Neural Network And Corner Point Registration, James Hill, Muhammad Rizwan Khokher, Chuong Nguyen, Matt Adcock, Ron Li, Stuart Anderson, Thomas Morrell, Tim Diprose, Olivier Salvado, Dadong Wang, Guan K. Tay

Research outputs 2022 to 2026

This paper presents a rapid and robust approach for 3D volumetric segmentation, labelling, and registration of human spinal vertebrae from CT scans using an optimised and improved 3D U-Net neural network architecture. The network is designed by incorporating residual and dense interconnections, followed by an extensive evaluation of different network setups by optimising the network components like activation functions, optimisers, and pooling operations. In addition, the network architecture is optimised for varying numbers of convolution layers per block and U-Net levels with fixed and cascading numbers of filters. For 3D virtual reality visualisation, the segmentation output of the improved 3D …