Surgery Commons^™

Tak1 Is A Key Regulator Of Oncogenic Signaling And Differentiation Blockade In Rhabdomyosarcoma, Anh Tuan Vuong, Aniket S Joshi, Anirban Roy, Kavya Mathukumalli, Phuong T Ho, Raksha Bhat, Meiricris Tomaz Da Silva, Tagari Samanta, Meghana V Trivedi, Bin Guo, Benny A Kaipparettu, Ashok Kumar

Faculty, Staff and Students Publications

Rhabdomyosarcoma (RMS) is a malignant soft tissue sarcoma with a skeletal muscle phenotype, accounting for approximately 50% of all pediatric soft tissue sarcomas and 8% of all childhood cancers. Although RMS cells express myogenic regulatory factors, they fail to undergo terminal differentiation into mature muscle cells. Transforming growth factor β-activated kinase 1 (TAK1) is a key signaling mediator that activates multiple intracellular pathways, yet its role in RMS has remained unknown. Here, we show that TAK1 expression and activity are markedly elevated in RMS cell lines and patient tumor specimens. RNA-Seq and reverse phase protein array (RPPA) analyses revealed that …

Congenital Aromatase Deficiency In An Adult Male: A Case Report Of Clinical Course And Symptom Reversal With Estrogen Supplementation, Peyton Coady, Arnaav Walia, Beatriz Hernandez, David E Hinojosa-Gonzalez, Adnan El-Achkar, Mohit Khera

Faculty, Staff and Students Publications

Congenital aromatase deficiency is an autosomal recessive CYP19A1 loss-of-function disorder that blocks conversion of androgens to estrogens. A man with homozygous CYP19A1 c.628G > A (exon 5) presented with longstanding fatigue, low libido, and desire to maintain fertility. Physiologic estrogen replacement was started with transdermal estradiol 0.0375 mg. After three months of estrogen therapy, the patient reported markedly improved energy and libido. Follow-up evaluation showed a rise in serum estradiol with normalization of gonadotropins, while maintaining spermatogenesis. This case illustrates the essential role of estrogen in male physiology, sexual function, and fertility. Estradiol replacement can alleviate hypoestrogenic symptoms with preservation of …

Opioid-Free Hernia Repair Protocol Reduces Pediatric Opioid Exposure Without Compromising Pain Control, Abigail Teitelbaum, Kristin E. Lemarbe, Diane Studzinski, Corey Shafer, Antonela Muca, Emanuela Peshel, Randall Hilleary, Anthony Stallion, Nathan M. Novotny, Pavan Brahmamdam, Begum Akay

Conference Presentation Abstracts

Abstract: Purpose: Protocolizing perioperative pain management may reduce opioid exposure in children. We designed a multimodal pain management protocol for pediatric ambulatory hernia surgery with the goal of reducing opioid use. This study evaluates the impact of this protocol on opioid use, pain control, and patient/proxy satisfaction. Methods: Our protocol utilized child life services, regional anesthesia, and non-opioid analgesic adjuncts in the perioperative period. We reviewed all pediatric ambulatory hernia cases two years before and after protocol implementation. Protocol adherence was stratified by level of opioid use: high (no opioid use), medium (opioids used intraoperatively or postoperatively), and low adherence …

Operative Versus Non-Operative Management Of Infant Perianal Abscesses: A Pediatric Surgery Research Collaborative Prospective Quality Improvement Study, Leigh Selesner, Chakshu Soni, Romeo C. Ignacio, Rimla Khan, Robert Wright, Alicia Mcintire, Bethany J. Slater, Nathan M. Novotny, Ryan T. Davis, Artem F. Dadamyan

Conference Presentation Abstracts

Abstract: Purpose Treatment of infant perianal abscesses (IPA) remains controversial, with ongoing debate between operative and non-operative management. Recurrence is common and prospective data to guide care are lacking. We performed the first multi-institutional prospective quality improvement (QI) study comparing non-operative to operative IPA management. Methods The primary endpoint was time to complete abscess resolution. Secondary endpoints included surgical intervention (incision and drainage ± fistulotomy) and abscess recurrence. Institutions were recruited through a national research collaborative. IRB approval was obtained individually. Between 2022 and 2025, we prospectively enrolled patients < 1 year of age with an abscess ≤2 cm from the anal verge. Patients with predisposing conditions (e.g. inflammatory bowel disease) were excluded. Management was determined by the treating provider, with either upfront surgical intervention (control group) or non-operative care per our QI protocol (protocol group, Figure 1). Data were collected on management prior to surgical evaluation, presentation, subsequent treatment and outcomes. Statistical analyses were performed using STATA, with p < 0.05 considered significant. Endpoints were compared between groups by non-parametric methods, with denominators based on available data. Results Fourteen institutions participated across the U.S., with a total of 288 patients (108 control, 180 protocol) enrolled. Median follow-up was 0.99 (interquartile range 0.23-3.93) and 1 (0.16-4.56) months for control and protocol groups. Abscess resolution occurred in 155 patients during follow-up (36/71 (51%) control, 119/134 (89%) protocol, p < 0.01). Median time to abscess resolution was 1.21 (0.33-4) and 1.13 (0.57-3.83) months for control and protocol groups (p=0.64). Recurrences were frequent in both cohorts (34/93 (37%) control, 62/153 (41%) protocol). Surgical intervention was significantly more common in the control group: incision and drainage were performed in 61/107 (57%) versus 19/166 (11%) and exam under anesthesia with fistulotomy in 31/106 (29%) versus 20/166 (12%) (both p< 0.01). Conclusions Time to abscess resolution was similar between patients treated with upfront surgical intervention and non-operative management according to our QI protocol. Significantly more patients underwent surgical intervention in the control group, without an impact on time to resolution. Our data support initial non-operative management of infant perianal abscesses, emphasizing antibiotics at initial presentation, sitz baths and family reassurance. Abbreviations: IPA - infant perianal abscess; QI - quality improvement; IRB - institutional review board

Impact Of Obesity On Complication Rates After Treatment Of Slipped Capital Femoral Epiphysis: A Retrospective Cohort Database Study, Holden Archer, Scott B Rosenfeld, Pablo Castañeda, Jessica A Mcgraw-Heinrich, Simon P Kelley

Faculty, Staff and Students Publications

Background: While obesity is a well-established risk factor for slipped capital femoral epiphysis (SCFE), limited data exist regarding its impact on postoperative complication rates. This study aimed to evaluate the association between obesity and complications following SCFE treatment.

Methods: We queried a large national database for pediatric patients who underwent treatment for SCFE between June 2005 and June 2025. We divided this cohort into patients with obesity and patients without obesity. We matched the cohorts with a propensity scoring algorithm on a one-to-one basis, resulting in 1,175 patients in each group. We tracked outcomes including infection, pulmonary embolism (PE), chondrolysis, …

Protecting Minors From Medical Malpractice Act: Implications For Otolaryngology-Head & Neck Surgery, Shiven Sharma, Margo K Mckenna, Julina Ongkasuwan, Michael J Brenner

Faculty, Staff and Students Publications

No abstract provided.

Optical Coherence Tomography As An Emerging Technique For Identifying Pediatric Middle Ear Effusion, Roger Neuberger, Jeffrey Carter, Adriana Dives, Ana Sofia C Ibarrola, Maritsa Ixba, Elton Lambert, Yi-Chun Liu, Anna H Messner

Faculty, Staff and Students Publications

Objective: Acute otitis media (AOM) and otitis media with effusion (OME) rely on accurate characterization of middle ear effusion (MEE). Optical coherence tomography (OCT) is a potential modality for noninvasive analysis of MEE, thereby assisting with otitis media diagnosis. This study aims to compare the diagnostic performance of OCT with otoscopy and tympanometry in pediatric patients.

Methods: A prospective convenience sample of 164 pediatric patients aged 6 months to 12 years was recruited from two tertiary care pediatric otolaryngology clinics. During their visit, each child underwent otoscopy, tympanometry, and OCT evaluation. Scans were reviewed by both a fellowship-trained pediatric otolaryngologist …

The Role Of Simulation In General Surgery Residency: Advancing Technical Proficiency And Clinical Confidence, Matthew A. Daniel, Alyssa Mcmandon, Rachel Daley, Andrew Gustetic, Alexis Howarth, Meghana Jacob, Holden Lewis, Kushali Patel, Taylor Locklear, Saptarshi Biswas

HCA Healthcare Journal of Medicine

Surgical training has changed significantly over the past several decades, largely due to advances in technology. After the introduction of laparoscopic and robotic surgery into residency programs, simulation-based training (SBT) has become an important addition to surgical education. Simulation-based training offers a safe and structured environment to practice skills, receive feedback, and develop technical and non-technical abilities. While its benefits are well recognized, wider use of SBT continues to face challenges, including high costs, limited faculty availability, and time constraints within residency schedules. New technologies such as artificial intelligence, virtual and augmented reality, and standardized simulation frameworks may help address …

Enhancing Resident Preparedness For The American Board Of Surgery Certifying Exam Through Low-Stakes Mock Oral Sessions, Camila R. Guetter, Taylor Locklear, Omar Haque, P Nina Scalise, Saptarshi Biswas, R. Wesley Vosburg

HCA Healthcare Journal of Medicine

Background

The American Board of Surgery (ABS) requires trainees to pass both a written qualifying examination (ABSQE) and oral certifying examination (ABSCE) to achieve board certification. The high-stakes nature of the ABSCE, which assesses knowledge, clinical judgment, and decision-making, necessitates extensive preparation. To address the challenges of the ABSCE format and associated trainee stress, structured mock oral programs have been developed. Here we evaluate the impact of structured mock oral sessions on residents' comfort levels and familiarity with the ABSCE at a single institution.

Methods

A mixed-methods survey was given to 50 general surgery residents in different training years who …

Cyanosis-Associated Coagulopathy In Neonates Undergoing Cardiopulmonary Bypass: A Scoping Review, Lily Crickmar

Student Works

2. Structured summary:

A. Background: Patients with cyanotic congenital heart disease exhibit coagulation abnormalities related to chronic hypoxemia, which may increase the risk of bleeding and thrombosis, particularly during cardiopulmonary bypass.

B. Objective: This scoping review mapped the existing literature on coagulation disturbances and perioperative hemostatic outcomes in pediatric patients with cyanotic congenital heart disease.

C. Methods: 14 studies meeting the inclusion criteria were identified through structured database searching. The data were collected and synthesized descriptively due to heterogeneity in study design, patient populations, and coagulation assessment methods.

D. Results: Across studies, cyanotic patient physiology was associated with platelet dysfunction, …

Indicators Of Fontan Circulatory Failure In Pediatric Patients: A Scoping Review Of Early Clinical And Hemodynamic Factors, Marina Mcmahon

Student Works

Structured Summary

a. Background/Introduction:

For patients with single ventricle congenital heart disease, the Fontan procedure is the definitive palliative procedure. Although advancements have been made in the surgical technique and management, the Fontan circulation is inefficient and prone to progressive dysfunction. Elevated central venous pressure, non-pulsatile pulmonary blood flow, and reduced cardiac output can lead to many complications, and eventual failure. These conditions can lead to protein losing enteropathy, plastic bronchitis, and hepatic fibrosis which often indicate advanced decline. Though a known problem, there is a lack of standardized criteria to guide optimal intervention timing of Fontan revision prior to …

All-Inside Endoscopic Zone 1 Flexor Hallucis Longus Transfer: A Cadaveric Feasibility Study., Kevin D Martin, Yi Wei, Adam G F Smith, Franco Piscitani, Luke M Martin, Brian Steginsky, Brian Tscholl, Nathaniel A Bates

Surgery Articles

BACKGROUND: Endoscopic flexor hallucis longus (FHL) tendon transfer addresses chronic Achilles tendon ruptures. Traditional percutaneous plantar incisions gain FHL length but risk neurovascular injury. This study evaluated the feasibility of an all-inside endoscopic FHL zone 1 tenotomy and transfer technique, which avoids plantar incisions by using zone 1 of the FHL tendon. We hypothesized that this technique would (1) provide sufficient tendon length, (2) avoid neurovascular damage, and (3) securely anchor the FHL tendon without tunnel blowout.

METHODS: Ten cadaveric all-inside endoscopic zone 1 FHL tendon transfers were performed without fluoroscopic guidance. Specimens were independently assessed post hoc by 2 …

Disordered Differentiation And Cellular Senescence In Pediatric Hodgkin Reed-Sternberg Cells, Jennifer E Agrusa, Elmoataz Abdel Fattah, Howard Lin, Jessica Velazquez, Sandra Andrea Salinas, Harshal A Abhyankar, Brooks P Scull, Ryan Fleischmann, M Tarek Elghetany, Andrea N Marcogliese, Choladda V Curry, Jyotinder N Punia, Nmazuo W Ozuah, Olive S Eckstein, Nader K El-Mallawany, Nitya Gulati, Joseph Lubega, Terzah M Horton, Kala Y Kamdar, Kenneth L Mcclain, Tsz-Kwong Man, Carl E Allen

Faculty, Staff and Students Publications

Hodgkin lymphoma (HL) is characterized by inflammatory lesions with relatively few (typically < 1%) pathogenic Hodgkin Reed-Sternberg (HRS) cells. The scarcity of malignant HRS cells in HL has historically limited characterization of these disease drivers, and pathogenic mechanisms underlying HL are incompletely defined. Using multiparameter flow cytometry to purify HRS cells and immune cell populations from pediatric HL lesions and control tonsils, we sought to define transcriptional programs in pediatric HRS cells. HRS cells are thought to arise from transformed germinal center B cells. Interestingly, transcriptomic analysis of HRS cells compared to control tonsil CD30+ cells revealed disordered differentiation with multilineage gene expression patterns, and primary HRS cells had distinct transcriptomes compared to HL cell lines. Further, transcriptomic analysis revealed increased expression of senescence-related genes and downregulation of proapoptotic/mitosis-related genes. Gene expression findings were validated by immunohistochemistry and single-cell imaging. In vitro treatment of primary HRS cells with B-cell lymphoma 2 inhibitor, venetoclax, augmented the induction of apoptosis in HRS cells and other cells of the HL immune microenvironment. These findings support the further study of targeting apoptosis resistance as a potential approach to eliminate malignant HRS cells and dismantle inflammatory lesion formation in pediatric HL.

Pharmacologic Interventions To Reduce Cardiopulmonary Bypass Induced Inflammation In Cardiac Surgery: A Scoping Review, Wyatt Anderson

Student Works

ABSTRACT

1. Structured summary

Background

Cardiopulmonary bypass (CPB) is essential in cardiac surgery but can trigger a systemic inflammatory response that contributes to postoperative complications. The scoping review conducted has a purpose to map the existing literature on pharmacologic interventions to mitigate CPB related inflammation. While several interventions demonstrated potential anti-inflammatory effects, findings were inconsistent, and no standardized pharmacologic approach is currently agreed upon.

Methods

This scoping review followed PRISMA-ScR guidelines.Both PubMed, and CINAHL were screened for studies published between 2000 and 2024 that evaluated pharmacologic interventions aimed at reducing CPB related inflammation. After screening and duplicate removal, 10 studies met …

Addition Of Prg4 To Optimize The Anti‑Adhesive Properties Of Tissue Barrier Sepraflm®, Ava J. Marks, Khaled A. Elsaid, Ling X. Zhang, Timmy Lin, Janette Baird, Tannin A. Schmidt, Gregory D. Jay

Pharmacy Faculty Articles and Research

Purpose

Postsurgical adhesion remains a significant clinical challenge. Seprafilm^® is widely used as a barrier to reduce adhesion formation, however its efficacy may be inconsistent. Recombinant human proteoglycan-4 (rhPRG4), a surface-active, anti-inflammatory glycoprotein found in synovial fluid inhibits cell and protein adhesion. This study investigated whether coating Seprafilm with rhPRG4 could enhance its anti-adhesive potential.

Methods

Macrophages (J774), human fibroblast-like synoviocytes (HFLS), and melanoma (A375) cells were cultured on tissue culture wells treated with rhPRG4 or bovine submaxillary mucin (BSM) to determine optimal seeding density. Seprafilm sheets were coated with rhPRG4 or BSM (0.78–200 µg/mL). Cell adhesion was quantified …

Chemotherapy-Induced Activation Of Caspase-1 And Il-1Α Release By Cancer Cells Remotely Skews Myelopoiesis To Drive Pro Tumorigenic Systemic Neutrophil-Dominant Inflammation, Stephen Qr Wong, Kazukuni Hayashi, Ethan J Subel, Yung Hsing Huang, Hongbo Gao, Haley E Garcia, Sophie J Porter, Mustafa Karabicici, Xen Ping Hoi, Mark D Alonzo, Armine Kasabyan, Efrosini Tsouko, Crystal S Shin, Lisa Bouchier-Hayes, Dimitrios Korentzelos, Chen Chen, Michael Brooks, Zheng Yin, Renil S Titus, Lan Zhou, Yinan Gong, Yulin Li, Stephen Tc Wong, Ziad El-Zaatari, Dharam Kaushik, Raj Satkunasivam, Fotis Nikolos, Keith S Chan

Faculty, Staff and Students Publications

While chemotherapy-induced tumor cell death is known to modulate the local immune landscape, its systemic impact on distant bone marrow—a site essential for immune cell maturation—remains underexplored. Here, we show that gemcitabine chemotherapy induces inflammatory caspase-1-dependent pyroptosis in epithelial cancer cells (epiCaspase-1). Despite its inflammatory nature, epiCaspase-1-mediated cell death is non-immunogenic. Clinically, elevated expression of an epiCaspase-1 gene signature correlates with worse patient outcomes. Mechanistically, epiCaspase-1 triggers the noncanonical release of IL-1α through NINJ1 lytic pores, remotely skewing bone marrow hematopoiesis towards granulocyte-monocyte progenitors and mature neutrophil output. This systemic reprogramming elevates the neutrophil-to-lymphocyte ratio (NLR) in both peripheral blood …

A Rare Presentation Of Extra-Appendiceal Mucinous Neoplasm Of The Anus, Pincus Joshua, Marianne Estrada, Lance Horner University Of Nevada, Las Vegas

School of Medicine Research Poster Showcase

Introduction: Mucinous neoplasm of the anus is an uncommon malignancy, representing less than 3% of all anal cancers. Even more rare is extra-appendiceal mucinous neoplasm. As a result, limited literature exists to define diagnostic strategies and optimal management. Our case report details the presentation and management of a patient with recurrent mucinous neoplasm of the anus. Methods: A retrospective chart review was performed which includes clinic documentation., operative notes, pathology reports. Results: The patient is a 76-year-old male with a history of T3N0M0 anal mucinous carcinoma diagnosed in 2015 and treated with neoadjuvant chemoradiation with complete pathological response. In 2024, …

Hydatid Cyst In The Right Ventricle Leading To Tricuspid Stenosis And Heart Failure: A Case Report, Muhammad Sheraz Hameed, Syed Rafay Hussain Zaidi, Shafaq Saleem, Muhammad Ahsan, Sarah Rahman, Azeen Razzaq, Ali Iqbal, Muhammad Sohaib Alvi, Muhammad Usama Naveed

Department of Medicine Faculty Papers

BACKGROUND: Cystic hydatid infection is a parasitic disease caused by the larval stages of Echinococcus granulosus, most commonly involving the liver and lungs. Cardiac involvement is rare, accounting for less than 2% of cases, with the left ventricle being the most commonly affected site. Involvement of the right ventricle is extremely uncommon and may lead to life-threatening complications such as tricuspid valve obstruction and hemodynamic compromise.

CASE PRESENTATION: We report a rare case of a 42-year-old patient who presented to the emergency department with exertional dyspnea, hemoptysis, chest pain, syncope, peripheral edema, and signs of right-sided heart failure. The patient …

Mitochondrial Translation Is A Targetable Dependency Of Chemo-Refractory Triple Negative Breast Cancer, Mariah J Berner, Steven W Wall, Mokryun L Baek, Audra Lane, Allison S Greer, Karen Wang, Lacey E Dobrolecki, Ivy Strope, Qian Zhu, Bing Zhang, Jonathan T Lei, Michael T Lewis, Gloria V Echeverria

Faculty, Staff and Students Publications

Triple negative breast cancer (TNBC) patients harboring residual cancer burden following completion of conventional neoadjuvant chemo-immunotherapy regimens have poor relapse-free and overall survival rates and limited therapeutic options. We and others have demonstrated that mitochondrial function is required for the survival of chemo-refractory TNBC. Here, we define the mitochondrial translation machinery as a critical and targetable dependency underlying chemo-refractory TNBC. Analyses of human and orthotopic patient-derived xenograft (PDX) mass spectrometry proteomics datasets revealed that mitochondrial protein translation-related signatures were among the top associated with chemoresistance. These signatures included core mitoribosome components and the mitoribosome-associated factor Oxidase (Cytochrome C) Assembly 1-Like …

Horseshoe Kidneys In Transplantation: Underutilization Despite Comparable Quality And Favorable Outcomes: Unos Registry Analysis (2007-2023), Abigail W. Cheng, Samrawi Misiker, Roberto Sagaribay, Kavita Batra

School of Medicine Research Poster Showcase

Introduction: Horseshoe kidneys (HSKs) are the most common renal fusion anomaly, occurring in approximately 1 in 500 individuals and often discovered incidentally. Historically excluded from transplantation due to complex anatomy, advances in surgical techniques have made HSK transplantation increasingly feasible. Although successful procurement and transplantation have been described in case reports, national-level data comparing donor characteristics and organ utilization between HSK and non-HSK donors remain limited. This study characterizes donor demographics, clinical profiles, and organ utilization of HSK donors using the United Network for Organ Sharing (UNOS) database.

Methods: A retrospective analysis of the UNOS kidney transplant registry was performed, …