Scholarly Works, Virginia Tech Carilion School of Medicine (VTCSOM)

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Endothelial deletion of EPH receptor A4 alters single-cell profile and Tie2/Akap12 signaling to preserve blood-brain barrier integrity
Cash, Alison; de Jager, Caroline; Brickler, Thomas; Soliman, Eman; Ladner, Liliana; Kaloss, Alexandra M.; Zhu, Yumeng; Pridham, Kevin J.; Mills, Jatia; Ju, Jing; Basso, Erwin Kristobal Gudenschwager; Chen, Michael; Johnson, Zachary; Sotiropoulos, Yianni; Wang, Xia; Xie, Hehuang; Matson, John B.; Marvin, Eric A.; Theus, Michelle H. (National Academy of Sciences, 2023-10-10)
Neurobiological consequences of traumatic brain injury (TBI) result from a complex interplay of secondary injury responses and sequela that mediates chronic disability. Endothelial cells are important regulators of the cerebrovascular response to TBI. Our work demonstrates that genetic deletion of endothelial cell (EC)-specific EPH receptor A4 (EphA4) using conditional EphA4f/f/Tie2-Cre and EphA4f/f/VE-Cadherin-CreERT2 knockout (KO) mice promotes blood–brain barrier (BBB) integrity and tissue protection, which correlates with improved motor function and cerebral blood flow recovery following controlled cortical impact (CCI) injury. scRNAseq of capillary-derived KO ECs showed increased differential gene expression of BBB-related junctional and actin cytoskeletal regulators, namely, A-kinase anchor protein 12, Akap12, whose presence at Tie2 clustering domains is enhanced in KO microvessels. Transcript and protein analysis of CCI-injured whole cortical tissue or cortical-derived ECs suggests that EphA4 limits the expression of Cldn5, Akt, and Akap12 and promotes Ang2. Blocking Tie2 using sTie2-Fc attenuated protection and reversed Akap12 mRNA and protein levels cortical-derived ECs. Direct stimulation of Tie2 using Vasculotide, angiopoietin-1 memetic peptide, phenocopied the neuroprotection. Finally, we report a noteworthy rise in soluble Ang2 in the sera of individuals with acute TBI, highlighting its promising role as a vascular biomarker for early detection of BBB disruption. These findings describe a contribution of the axon guidance molecule, EphA4, in mediating TBI microvascular dysfunction through negative regulation of Tie2/Akap12 signaling.
SYNGAP1 Syndrome and the Brain Gene Registry
Greco, Melissa R.; Chatterjee, Maya; Taylor, Alexa M.; Gropman, Andrea L. (MDPI, 2025-03-30)
Background: The human brain relies on complex synaptic communication regulated by key genes such as SYNGAP1. SYNGAP1 encodes the GTPase-Activating Protein (SYNGAP), a critical synaptic plasticity and neuronal excitability regulator. Impaired SYNGAP1 function leads to neurodevelopmental disorders (NDDs) characterized by intellectual disability (ID), epilepsy, and behavioral abnormalities. These variants disrupt Ras signaling, altering AMPA receptor transport and synaptic plasticity and contributing to cognitive and motor difficulties. Despite advancements, challenges remain in defining genotype–phenotype correlations and distinguishing SYNGAP1-related disorders from other NDDs, which could improve underdiagnosis and misdiagnosis. Brain Gene Registry: The Brain Gene Registry (BGR) was established as a collaborative initiative, consolidating genomic and phenotypic data across multiple research centers. This database allows for extensive analyses, facilitating improved diagnostic accuracy, earlier interventions, and targeted therapeutic strategies. The BGR enhances our understanding of rare genetic conditions and is critical for advancing research on SYNGAP1-related disorders. Conclusions: While no FDA-approved treatments exist for SYNGAP1-related disorders, several therapeutic approaches are being investigated. These include taurine supplementation, ketogenic diets, and molecular strategies such as antisense oligonucleotide therapy to restore SYNGAP1 expression. Behavioral and rehabilitative interventions remain key for managing developmental and cognitive symptoms. Advancing research through initiatives like the BGR is crucial for refining genotype–phenotype associations and developing precision medicine approaches. A comprehensive understanding of SYNGAP1-related disorders will improve clinical outcomes and patient care, underscoring the need for continued interdisciplinary collaboration in neurodevelopmental genetics.
Pulsed Electromagnetic Field Therapy Alters the Genomic Profile of Bladder Cancer Cell Line HT-1197
Sandberg, Maxwell; Whitman, Wyatt; Bissette, Randall; Ross, Christina; Tsivian, Matvey; Walker, Stephen J. (MDPI, 2025-04-04)
Background/Objectives: Pulsed electromagnetic field (PEMF) therapy involves the use of magnetic waveform energy for targeted treatment delivery. This technique has shown promising results in the treatment of various cancers. Currently, treatment of bladder cancer is highly invasive, involving intravesical chemotherapy or radical cystectomy. The potential therapeutic effects of PEMF therapy on bladder cancer are a relatively new and understudied area; therefore, the goal of this investigation was to gain mechanistic insight by examining the effects of PEMF therapy on a bladder cancer cell line in vitro. Methods: Cells from the bladder cancer cell line HT-1197 were cultured and incubated with (treatment group) or without (control group) PEMF therapy for one hour each day for five days. Cell counts were compared using Incucyte^® data to determine proliferation rates. At days 1 and 5, total RNA was isolated from cells, and following quantity and quality checks, gene expression was compared between the two groups. Proliferation rates from cell line HT-1197 were compared to prior published results on the bladder cancer cell line HT-1376. Results: HT-1197 cells treated with PEMF therapy had slower proliferation rates compared to controls (p < 0.05), but HT-1376 cells did not (p > 0.05). Principal component analysis showed complete separation of treated and untreated cells, with PEMF treatment accounting for 76% of the variation between the groups. Expression of numerous genes and cancer-related pathways was altered in the treated cells relative to the controls. Conclusions: Bladder cancer HT-1197 cells treated with PEMF therapy had slower proliferation and corresponding changes in gene expression. Several cancer-relevant pathways were differentially regulated following PEMF treatment. The conclusions are limited by the lack of a control healthy urothelial cell line in the experiments. Despite this shortcoming, our results suggest that PEMF therapy may be a promising avenue for further research in the treatment of bladder cancer.
Comparing National Institute of Health Funding for Cancer Survivorship: A Spotlight on Breast and Gynecologic Cancers
White, Payden; Greer, Heather; Armbruster, Shannon (Lippincott, Williams & Wilkins, 2025)
Objective: To evaluate the distribution of National Institutes of Health (NIH) funding for breast and gynecologic cancer survivorship research in relation to survivor populations. Methods: A retrospective cohort study was conducted on NIH-funded grants for breast and gynecologic cancer survivorship from fiscal years (FY) 2017–2021 using an existing dataset from the NIH Office of Cancer Survivorship. Grant characteristics, including funding amount, study design, and research focus, were extracted from NIH Reporter and ClinicalTrials.gov. Total funding and per-survivor funding were calculated using prevalence data from the Surveillance, Epidemiology, and End Results (SEER) program. Descriptive statistics were applied to compare funding disparities between breast and gynecologic cancer survivorship research. Results: Among 160 NIH-funded grants on cancer survivorship, 144 (90%) focused on breast cancer, and 16 (10%) on gynecologic cancers. Breast cancer survivorship research received significantly more funding ($188.35 million) compared to gynecologic cancer survivorship research ($15.41 million). Per-survivor funding was also higher for breast cancer ($9.69 per survivor) than for gynecologic cancers ($2.15 per survivor). Most survivorship studies were interventional (60%), with randomized controlled trials as the predominant design. The primary study focus was on late and long-term effects of cancer treatment (53%), followed by health promotion (21%) and care delivery (16%). Conclusion: NIH funding for gynecologic cancer survivorship research is significantly lower than that for breast cancer, even when accounting for survivor prevalence. The findings highlight the need for equitable resource allocation to ensure comprehensive survivorship support for gynecologic cancer survivors. Increased funding and research efforts are necessary to address the unique challenges faced by this population and to optimize long-term outcomes.
The Cardiovascular Effects of Interleukin-6 Inhibition in Patients with Severe Coronavirus-19 Infection
Binder, Michael S.; Timmerman, Clinton; Marof, Biwar; Wu, Yingxing; Bankole, Adegbenga; Heletz, Ido (SAGE Publishing, 2025-04-02)
Objective: The coronavirus disease 2019 (COVID-19) pandemic illustrated the relationship between cardiac arrhythmias and pro-inflammatory states. Pro-inflammatory cytokines, including interleukin-6 (IL-6), have significant effects on cardiac conduction. Atrial or ventricular arrhythmias occurring while infected results in a doubling of mortality. Tocilizumab, a monoclonal antibody that blocks the IL-6 receptor, is associated with improved mortality and is believed to be related to immune modulation of the COVID-19–related hyperinflammatory state. Methods: A single-center retrospective review of all patients with severe COVID-19, defined as admission to an intensive care unit or requirement of respiratory or circulatory support, from March 2020 through March 2022, was conducted. Patients who received or did not receive tocilizumab were grouped into the treatment and control groups, respectively. Results: Four hundred seventy-three patients were reviewed and 400 met the criteria for inclusion in our study. There were 305 patients (age, 63 ± 13 years, 58% male) in the control group and 95 (age, 57 ± 15 years, 51% male) in the treatment group. In-hospital mortality was greatly reduced with tocilizumab compared with controls (44.2% vs 85.9%, p < 0.001) and new-onset atrial fibrillation (AF) showed a statistically significant reduction (17.8% vs 29.5%, p = 0.019). New-onset wall motion abnormalities, potentially related to myocarditis or acute coronary syndrome, also trended toward significance with tocilizumab (7.7% vs 15.7%, p = 0.10). Deep vein thrombosis, pulmonary embolism, stroke, and sustained ventricular arrhythmias did not meet statistical significance. Conclusion: As expected, tocilizumab did show significant improvement in mortality. Tocilizumab also showed a significant reduction of new-onset AF. Other cardiac structural endpoints did not reach statistical significance.
Risk factors for vulvar dysplasia recurrence in patients from southwestern Virginia and surrounding states: A retrospective cohort study
Greer, Heather O.; Metz, Kallie; Locklear, Tonja M.; Armbruster, Shannon D. (Springer, 2025)
Objective. To determine whether distance to a tertiary care center is an independent risk factor for recurrence of VIN 2/3 or invasive vulvar cancer. Methods. A retrospective chart review included individuals with VIN 2/3 from southwest Virginia and surrounding states treated at a single institution. The patients were treated from 1/1/2010 to 12/31/2020. Medical records were reviewed for demographics, risks factors, distance to care determined by a geographic information system (GIS) software, treatment modality, and recurrent disease. Results. We identified 251 patients. Most patients were Caucasian (92%) and had history of tobacco use (current [49%] and former [27.5%] tobacco users). Patients traveled an average of 20 miles for care (range: 0.3-113.9 miles). Most commonly, VIN 2/3 was treated with excision (n=136), excision and ablation (n=59), or ablation alone (n=31). The average lesion size was 20 mm (range: 2, 100 mm). Thirty-five percent of patients (n=88) developed recurrent VIN 2/3, on average, 9.6 months (range: 0.1, 7.8 years) following treatment. Recurrences were associated with increased body mass index (p=0.049), immunocompromised status (p=0.039), steroid use (p=0.024), and positive margins (p=0.0003). No subsequent diagnoses of cancer were made. Logistic regression showed that margin status was the only field impacting recurrence (p=0.0075; OR=2.63, 95% CI: 1.30-5.35). Distance to care was not related to recurrence risk (p>0.05). Conclusions. Our findings confirm known risk factors for current disease, while indicating that distance to care does not impact their recurrence. Further research is merited to investigate other recurrence risk factors that were not included in our model.
Ticam2 ablation facilitates monocyte exhaustion recovery after sepsis
Caldwell, Blake A.; Ie, Susanti; Lucas, Amy; Li, Liwu (Nature Portfolio, 2025-01-15)
Sepsis is a leading cause of death worldwide, with most patient mortality stemming from lingering immunosuppression in sepsis survivors. This is due in part to immune dysfunction resulting from monocyte exhaustion, a phenotype of reduced antigen presentation, altered CD14/CD16 inflammatory subtypes, and disrupted cytokine production. Whereas previous research demonstrated improved sepsis survival in Ticam2-/- mice, the contribution of TICAM2 to long-term exhaustion memory remained unknown. Using a cecal slurry injection sepsis model, we monitored the establishment and recovery of monocyte exhaustion in Ticam2-/- mice. After one week of recovery, we profiled bone marrow and splenic reservoir monocytes in Ticam2-/- mice and found that, in contrast to the persistent exhaustion observed in wild-type monocytes, Ticam2-/- monocytes largely resembled healthy controls. To determine the impact of TICAM2 ablation on innate epigenetic memory in sepsis, we measured genome-wide DNA methylation in bone marrow monocytes and found that Ticam2-/- cells exhibit a unique profile of altered methylation at CEBPE binding sites and regulatory features for key immune genes such as Dmkn and Btg1. Bearing human translational relevance, a case study of time course blood samples collected from a sepsis patient presenting with SIRS and a positive qSOFA revealed a similar effect in human monocytes, which steadily transition into an exhausted memory characterized by a CD38high; CX3CR1low; HLA-DRlow state within four days of hospital admittance. Together, our data reveal the chronic preservation of monocyte exhaustion, partially controlled by TICAM2.
Elementary school compliance with a state recess minimum requirement by racial and geographic factors: a cross-sectional study
Howie, Erin K.; Harden, Samantha M.; Barr-Anderson, Daheia J.; Long, Christopher R. (2025-03-28)
Background: Recess is a part of school-based physical activity promotion offered worldwide with equitable recess access a social justice issue. From a policy perspective, in the U.S. few states currently require elementary school recess and little is known about its implementation. The purpose of this study was to determine the current implementation of one state system as a case study to investigate minimum recess requirement and to compare the implementation between school geographic and racial factors. Methods: A cross-sectional, observational study of the implementation of one state’s minimum daily recess requirement of 40-minutes recess was conducted during the 2023–2024 academic year. A school audit of provided recess time was conducted of all public elementary schools in Arkansas through an online search of bell schedules, a survey sent to principals and physical education teachers, and phone call surveys to school offices. Key demographic and geographic features of the schools included enrollment data (e.g., race, grade, and % Free-and-Reduced Lunch composition), rurality, and region. Results: Recess information was obtained from 384 (73%) of 526 eligible schools with an average student enrollment of 398 students (SD 154), 19.8% (SD 27.9) Black student enrollment, and 63.8% (SD 20.0%) students receiving free-and-reduced lunch. 306 (85.5%) schools met recess requirements. There were no differences in meeting recess requirements by rurality. Of schools with higher Black student enrollment (≥ 25% Black enrollment), 75.3% met recess requirements compared to 89.5% in schools with lower Black enrollment (< 25% Black enrollment, OR 0.36, 95%CI: 0.16, 0.78, p =.010). There were differences in survey-reported available playground spaces and equipment between by meeting recess requirements and Black student enrollment (p <.05). Conclusions: Schools in a state with a 40-minute daily recess requirement reported high compliance with the state policy. However, students in schools with higher Black student enrollment were less likely to meet the 40-minute recess requirement, and thus strategies are needed to ensure all students have access to recess opportunities. Ensuring equal access to recess through wide-reaching place-based and policy-based strategies may be a step in reducing health and education disparities, especially among populations where disparities are greatest.
Implementation and Utility of the Da Vinci SP (Single Port) in Pediatric Urology
Arney, Lucas A.; Bissette, Randall G.; Smith, Jordan M.; Bayne, Christopher E. (Springer, 2024-10-03)
Purpose of Review: Detail the evolution, utility, and future directions of the da Vinci SP® in pediatric urology, focusing on perioperative outcomes and intraoperative details. Recent Findings: The SP has been safely and successfully utilized in various pediatric urological procedures, from pyeloplasty to nephroureterectomy to appendicovesicostomy. Reports indicate mixed operative times but similar hospital stays and postoperative outcomes compared to multiport (MP) robotic surgery. The learning curve for transitioning from MP to SP systems in pediatric patients appears manageable, though the smaller abdominal circumference in children poses a notable challenge. This review assumes that SP systems will primarily be acquired for adult services, not considering initial and ongoing costs to hospital systems. Summary: The SP serves as a complementary option, rather than a replacement, for MP robotic surgery in pediatric urology, offering potential advantages in specific scenarios. Cosmetic outcomes with the SP appear at least as favorable as MP surgery, but further research is needed. Future research should focus on patient-centered outcomes to optimize SP robotic surgery use in pediatric patients.
Diagnosis and Management of Pediatric Varicocele: A Modern Update for the Practicing Pediatrician
Bissette, Randall G.; Edelson, Mia P.; Campbell, Kevin J.; Bayne, Christopher E. (Springer, 2024-12-16)
Purpose of Review: Pediatric varicoceles are common, yet the paucity of data on long-term fertility outcomes does not establish recommendations for conservative management and reassurance versus pediatric urology referral for consideration of surgical intervention. This review incorporates recent literature to generate pragmatic, objective methodology for the evaluation and management of pediatric varicoceles. Recent Findings: The initial evaluation of pediatric varicoceles includes focused history, physical exam, and use of an orchidometer or ultrasound for volume assessment. In early puberty, asynchronous testicular growth may be transient and monitored serially via ultrasound. Further workup may include semen analysis (SA), ultrasound of spermatic veins to determine peak retrograde flow (PRF), and hormonal analysis. Pediatric varicoceles may be managed with observation and reassurance or referral to pediatric urology for consideration of surgical intervention. In patients presenting before Tanner V stage, management is typically expectant, with pain warranting referral. Definitive indications for referral once Tanner V is reached include pain, undesirable appearance, bilateral varicoceles, persistent testicular atrophy, low total testicular volume (TTV), elevated peak retrograde flow on Doppler ultrasonography, persistently low total mobile sperm count (TMSC) on repeat SA, or infertility. Summary: Most pediatric and adolescent patients with varicocele may be reassured and monitored serially. Straightforward and objective assessment tools should be used when further workup is warranted, providing clear guidance on elevation of care from pediatricians to pediatric urologists.
Gun Violence in the COVID-19 Era: Using Multiple Databases to Describe the Experience in Buffalo, NY
L'Huillier, Joseph C.; Nordin, Andrew B.; Nair, Veer V.; Cantor, Brittany L.; Tadlock, Bryan; Friend, Brianna; Boccardo, Joseph D.; Yu, Jihnhee; Lukan, James; Lillvis, Denise F.; Bass, Kathryn D. (Sage, 2024-12-24)
Objectives: In 2020, the public health crises of gun violence and novel coronavirus (COVID-19) collided and interventions to decrease COVID-19 transmission displaced millions of Americans from normal activity. We analyzed the effects of COVID-19 and its resultant shutdowns on gun violence in Buffalo, NY. Methods: We queried the Gun Violence Archive (GVA) and the hospital databases from the 2 level 1 trauma centers which serve Buffalo firearm victims between March 15th and June 24th, 2020 ("COVID") and the same time period for years 2013 (hospital data)/2014 (GVA data) through 2019 ("pre-COVID") and 2021 through 2022 ("post-COVID"). Data points collected included number of daily victims, victim age, gender, and morbidity/mortality. Bivariate and multivariate analyses were used to compare gun violence in these 3 periods. Results: There were 518 and 913 victims in the GVA and hospital data sets, respectively. Bivariate analyses showed fewer incidents on Saturdays during the pandemic in both data sets (P < 0.05). Multivariate analyses demonstrated no association between number of gun violence victims and time period in either data set (P > 0.05). Conclusions: There was no change in number of gun violence victims during the COVID-19 shutdowns compared to pre-COVID and post-COVID periods in Buffalo, NY. However, there was a change in the weekly temporality of gun violence during the COVID pandemic. Multiple databases are needed to accurately capture gun violence from an epidemiologic perspective.
Cobalt Protoporphyrin IX Attenuates Antibody-Mediated, Complement-Dependent Podocyte Injury: Role of Cobalt and Porphyrin Moieties
Lianos, Elias A.; Phung, Gia Nghi; Zhou, Jianping; Sharma, Mukut (MDPI, 2025-02-23)
Metalloporphyrins (MPs) that induce heme oxygenase (HO)-1 were shown to attenuate complement-mediated glomerular injury, with cobalt protoporphyrin IX (CoPPIX) being the most effective. To decipher the efficacy between CoPPIX and its constituents (Co, PPIX), we compared the outcomes of treatment with each in a rat model of complement-dependent immune injury of glomerular epithelial cells (podocytes). Outcomes were correlated with HO-1 induction and expression levels of complement C3 and of the complement activation regulators (CARs) cluster of differentiation (CD)55, CD59, and CR1-related gene y protein product (Crry). Podocyte injury was induced in rats following a single injection of the complement-fixing antibody against the podocyte antigen, Fx1A. CoPPIX or its constituents, cobaltous chloride (CoCl₂) and protoporphyrin IX (PPIX), were injected prior to and on alternate days thereafter. Urine was assessed for protein excretion and kidney cortex samples were processed for histopathology and assessment of target gene mRNA and protein levels using digital polymerase Chain Reaction (dPCR) and capillary-based Western blot analysis. The anti-Fx1A antibody caused proteinuria and podocyte injury. Treatment with the full CoPPIX chelate reduced proteinuria but treatment with either CoCl₂ or PPIX did not. CoPPIX treatment potently induced HO-1 and reduced tissue C3 mRNA and protein levels. It also increased CD55, CD59, and Crry mRNA, with an inconsistent effect on protein levels. The Co moiety was required for HO-1 induction but not for the decrease in C3. This decrease did not significantly correlate with the effects of CoPPIX treatment on CD55 protein levels. Chelation of cobalt to PPIX enhanced its potency to induce HO-1 but reduced that on CD55 induction. These observations distinguish between the effects of CoPPIX and its constituents on proteinuria consequent to complement-mediated podocyte injury and underlying mediators and identify this MP as a potential disease-modifying agent.
Training School-Based Health Clinicians in New Mexico Regarding Adverse Childhood Experiences
Katzman, Joanna G.; Tomedi, Laura E.; Chari, Krishna; Pandey, Navin; Del Fabbro, Anilla; Ramos, Mary; Kazhe-Dominguez, Briana (MDPI, 2025-03-14)
Background: Adverse childhood experiences (ACEs) are potentially traumatic experiences that may promote poor mental health, including substance use and suicidality, as well as chronic pain. Telementoring may be used to provide education to school-based health center (SBHC) clinicians and other health professionals in the community to identify and support youth with ACEs. Methods: This study was an evaluation of the novel ACEs ECHO telementoring program, which incorporates didactics, case-based learning, and a community of practice to serve school-based health clinicians in New Mexico, a rural state with a high prevalence of ACEs. Results: In the program’s first two years, there were 704 unique participants, including SBHC clinicians from 25 of New Mexico’s 33 counties. The pre/post survey demonstrated that the participants reported increases in knowledge in identifying children that experienced ACEs (4.3 versus 3.7, p = 0.001) and confidence in supporting children who may be at high risk (4.1 versus 3.3, p = 0.001) compared with before they began attending the ACEs ECHO program. The participants also reported that they felt more hopeful that they could help youth with ACEs (4.2 versus 3.3, p = 0.001). Conclusions: The ACEs ECHO telementoring program may be considered for other rural states and globally as a capacity-building model to educate SBHC clinicians and other health professionals to identify youth at risk for adverse childhood experiences.
Building a health systems science bridge between medical school and the clinical learning environment via a pilot faculty development cohort program
Harendt, Sarah M.; Allison-Jones, Lisa; Rudd, Mariah J.; Karp, Natalie E.; Parker, Sarah H.; Whicker, Shari A. (2025-03-18)
Background: Clinical faculty development focused on Health Systems Science (HSS) is crucial for integrating HSS concepts into medical education. The 2021 HSSIP Faculty Development program was created to support faculty in effectively creating and incorporating comprehensive HSS content into the clerkship experience. Methods: Nine clinical champions, selected for their diverse backgrounds and interest in HSS, participated from November 2021 through October 2022 in monthly day-long, in-person workshops, and bi-monthly self-directed sessions, covering both HSS domains and foundational learning in curriculum development. Using a community of practice model, clinical champions gained expertise in HSS domains and developed curricula throughout the year-long program. Evaluation methods included surveys and feedback, focusing on satisfaction, self-efficacy, and curricular content creation. Results: Post-engagement surveys showed increased comfort in teaching HSS content, with significant improvement in specific areas. Participants valued learning from experts and collaborating with peers but found virtual sessions challenging. Despite systemic challenges and time constraints, clinical champions successfully created and implemented HSS-focused curricular content. They also contributed to broader HSS education efforts, presenting scholarly work and integrating HSS into various educational activities. Conclusions: This study showcases an innovative approach to preparing faculty to integrate HSS into clinical education. Key lessons included the value of subject matter experts, community engagement, and the challenges of virtual participation. Despite limitations such as low response numbers and context-specific results, the program demonstrated the potential for broad HSS integration. Further research with more participants and more rigorous data collection protocols is needed to more fully understand the generalizability of such an innovation. The initiative serves as a model for other academic health centers.
A unique case of herpetic keratitis manifesting as recurrent preseptal cellulitis
Miller, Emily; Ward, Maxwell; Fazili, Tasaduq; Bansal, Ekta (Elsevier, 2025-02-09)
Preseptal cellulitis is typically caused by nasopharyngeal bacteria and can usually be treated with empiric antibiotics. We present a case of herpes simplex virus (HSV) 1 keratitis manifesting as recurrent and treatment refractory preseptal cellulitis. This is a rare presentation that is infrequently reported in the literature. Due to the potential for permanent vision loss, it is important to consider herpes viruses as an etiology in immunocompromised patients with preseptal cellulitis not responding to standard treatment.
Extent of Myometrial Resection With Various Surgical Methods for Endometrial Polypectomy Procedures
Evans-Hoeker, Emily; Millner, Adrienne; Lee, Grace; Perry, Ryan; Perry, Ryan; Kar, Ayesha; Swaroop, Meyha; Locklear, Tonja; Newman, Brian; Casey, James (Wolters Kluwer Health, Inc., 2024-09)
OBJECTIVE: To assess whether the frequency and extent of myometrial resection differs among surgical methods commonly used for endometrial polypectomy. METHODS: We conducted a retrospective cohort study of pathology samples from polypectomy procedures performed on patients 18–50 years of age. Samples were reevaluated by a blinded pathologist to assess the following primary outcome measures: presence and percentage of myometrium on the pathology sample, prevalence of isolated myometrium, and depth of myometrial resection. Data were evaluated using Fisher exact test and Kruskal-Wallis test, followed by multiple comparisons analysis. To maintain a familywise error rate of 5% across all four primary analyses, the Bonferroni correction method was applied. RESULTS: Of 458 pathology samples, 21.8% were obtained using hysteroscopic morcellators, 11.1% were obtained with hysteroscopic scissors, and 67.0% were obtained with hysteroscopy with dilation and curettage (D&C). Hysteroscopic morcellation demonstrated a higher prevalence of myometrium (58.0% vs 9.8% and 15.3%, for hysteroscopic scissors and hysteroscopy with D&C, respectively; P,.001), a larger percentage of pathology samples with more than 25% myometrium (26.0% vs 4.0% and 0.6%, respectively; P,.001), and a higher prevalence of isolated myometrium compared with hysteroscopy with D&C (11.0% vs 0.7%; P,.001). CONCLUSION: The presence and proportion of myometrium in polypectomy samples obtained using hysteroscopic morcellators was significantly higher compared with hysteroscopic scissors and hysteroscopy with D&C.
Diabetes Performance Improvement Program With Continuous Glucose Monitoring, Pharmacist Intervention, and Team Management
Behnke, Andrew; Christopher G. Parkin (Elmer Press, 2024-10-31)
The growing prevalence of diabetes in the USA continues to be a significant public health concern. A significant proportion of patients with type 2 diabetes (T2D) have elevated glucose levels, as evidenced by a glycated hemoglobin (HbA1c) level > 9.0%. Persistent hyperglycemia results in the development of chronic macrovascular and microvascular complications. Previous strategies to assist this high-risk population in achieving optimal glycemic control have not been as successful as desired. As the demand for healthcare providers and services continues to grow at an unprecedented pace, the USA is facing a national deficit in physicians, nurse practitioners, and physician assistants. Conversely, the number of pharmacists is projected to increase at a rate of 3% annually over the next three decades. Studies have demonstrated that pharmacist involvement in diabetes patient management has resulted in improvements in HbA1c, lowering of low-density lipoprotein (LDL)-cholesterol levels, and achievement of blood pressure targets. This suggests the potential for pharmacists to play a key role in narrowing the gap. We implemented a Diabetes Performance Improvement Program (DPIP) that facilitates a comprehensive lifestyle intervention designed to improve diabetes management and outcomes. The DPIP care team comprises endocrinologists, certified diabetes educators, pharmacists, and supporting staff. The intervention includes utilizing continuous glucose monitoring (CGM) supported by diabetes self-management training (DSMT) and medical nutrition therapy (MNT) delivered by a certified diabetes education specialist (CDES) and registered dietitian (RD). This article reviews the evidence supporting the use of an interdisciplinary team-based approach to diabetes care, describes the DPIP components, and provides guidance for implementing the program in clinic-community settings.
Effectiveness of Intraoperative Ketorolac in Outpatient Breast Surgery: A Double-blinded Prospective Randomized Controlled Trial
Choi, Joowon M.; Rodriguez, Jose D.; Saccocci, Michael A.; Shafer, Robert P.; Feldmann, Mark E.; Moyer, Kurtis E.; Thompson, James T. (Wolters Kluwer Health, 2025-02-17)
Background: The use of nonnarcotic analgesics, such as ketorolac, has been shown to reduce postoperative pain and opioid consumption. This double-blinded randomized trial is designed to assess the efficacy of intraoperative ketorolac in reducing postoperative narcotic use in outpatient breast reconstruction and reduction procedures. Methods: This study is a prospective double-blinded randomized controlled trial. Adult patients, 18-64 years of age, undergoing breast surgery were randomized to receive 15 mg of ketorolac, 30 mg of ketorolac, or a placebo dose of saline. Patients' opioid requirements in the postoperative anesthesia care unit and postoperative opioid utilization and pain scores were collected through a daily survey. Postoperative hematomas were assessed before discharge and at subsequent follow-up visits for a period of 14 days. Results: Of the 63 patients included in the study, 31 patients underwent delayed reconstruction following mastectomy and 35 patients underwent breast reduction surgery. Patients who received 30 mg of ketorolac had the fastest pain resolution (P<0.05). The rate of opioid discontinuance was the fastest overall in patients who received 15 mg of ketorolac (rate = -0.072) when compared with the 30-mg ketorolac group (rate = -0.071) and the placebo group (rate = -0.065). Total opioid usage in the postoperative anesthesia care unit was not statistically different across the 3 groups. Only 1 patient developed a hematoma in the 15-mg ketorolac group. Conclusions: This study demonstrates that a single dose of intraoperative ketorolac was associated with reduced opioid usage and postoperative pain. However, due to the study size, the difference in hematoma rate was not statistically significant.
Point-of-Care Ultrasound Transmission for Remote Interpretation in Austere Environments
Haines, Carver M.; Waasdorp, Christopher P.; Lockhart, Ellen R.; Lareau, Stephanie A. (Sage, 2023-06-29)
Introduction: Point–of-care ultrasound (POCUS) is used in wilderness medicine and could potentially be the only imaging modality available. Cellular and data coverage is often lacking in remote areas, limiting image transmission. This study evaluates the viability of transmitting POCUS images from austere environments using slow-scan television (SSTV) image transmission methods over very-high-frequency (VHF) hand-held radio units for remote interpretation. Methods: Fifteen deidentified POCUS images were selected and encoded into an SSTV audio stream by a smartphone and transmitted over a VHF radio. A second radio and smartphone 1 to 5 mi away received and decoded the signals back into images. The original images and transmitted images were randomized into a survey graded by emergency medicine physicians using a standardized ultrasound quality assurance scoring scale (1–5 points). Results: The difference in mean scores between the original image and transmitted image showed a 3.9% decrease in transmitted image scores, with P <0.05 on a paired t test; however, this is not likely a clinically significant decrease. Comparing transmitted images using different SSTV encodings and distances ranging up to 5 mi, 100% of survey respondents determined the images to be clinically usable. This dropped to 75% when significant artifacts were introduced. Conclusions: Slow-scan television image transmission is a viable option for transmitting ultrasound images in remote areas where more modern forms of communication are unavailable or not practical. Slow-scan television may have potential as another data transmission option in the wilderness, such as electrocardiogram tracings.
Timing and Predictors of Upper Extremity Peripheral Nerve Reconstruction
Gray, Kelsey M.; Burkat, Andrzej J.; Arney, Lucas A.; Peterman, Nicholas J.; Mandala, Sahith R.; Capito, Anthony E. (Elsevier, 2025-02)
Primary neurorrhaphy is the preferred reconstruction modality over nerve grafting, especially for motor nerves. The main limitation to primary repair is often dictated by tension secondary to increased nerve defect length. A retrospective review was conducted of sharp transections of mixed motor and purely sensory nerves in the upper extremity to assess factors influencing defect length. Two groups of either primary repair or nerve graft/conduit were created for comparison. 71 injured mixed motor nerves and 224 injured sensory nerves were included for analysis. There were no significant differences in patient demographics between groups. The primary repair group had a significantly shorter time interval between injury and surgical fixation when compared to the conduit/graft group. Conduit or graft technique was associated with a significantly larger tissue gap after preparation of the nerve ends. Our data suggest the best chance of primary repair is within 3 days for mixed nerves and within 7 days for purely sensory. A total of 167 nerve reconstructions were included in a random forest plot, which demonstrated nerve defect size to be influenced by days from injury, type of nerve injured, age, and hypertension. A publicly available 4-feature calculator, NERVE (Nerve Evaluation and Retraction Variability Estimator), was developed from the forest plot to predict a patient's nerve deficit ± 3.78 mm on average, R2 = 0.89. This calculator could aid surgeons with surgical planning for the potential need of grafts or conduits for reconstruction.

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