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  Trends and Outcomes During Rollout Phase of Non-Primary PCI at Sites Without Surgery On-Site: The Michigan Experience

  Majed Afana, Gerald C Koenig, Milan Seth, Kathleen M Frazier, Sheryl Fielding, Andrea Jensen, and Hitinder S Gurm

  Objectives: This study sought to compare outcomes of patients undergoing non-primary percutaneous coronary intervention (non-PPCI) at centers with and without surgery on-site (SoS) in Michigan during the introductory phase.Background: Non-PPCI recently received certificate of need approval in the state of Michigan to be performed at sites without SoS. This requires mandatory participation in the BMC2 registry, which involves rigorous quality oversight. Methods: Consecutive patients who underwent non-PPCI at 47... Read More

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  Does Kidney Transplant Increase the Risk of Ipsilateral Lower Extremity Deep Venous Thrombosis?

  Shahnur Ahmed, Dean Y. Kim, Lauren E. Malinzak, Ziad Al Adas, Abigail Chatfield, Timothy J Nypaver, Mitchell R Weaver, Alexander D. Shepard, and Loay S Kabbani

  Introduction: There is limited information on the development and laterality of symptomatic deep vein thrombosis (DVT) following kidney transplantation. In this study, we want to define the incidence of DVT in this population and determine if the side of DVT corresponds to the side of the transplanted kidney. Methods: We performed a retrospective review of all kidney transplant recipients from January, 2004 to August, 2014 at our institution and... Read More

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  Lack of Alloimmunization to the D Antigen in D- Liver Transplant Recipients Receiving D+ RBCs Perioperatively

  Beena U. Ahsan, Lindsey Wlosinski, Jaber El-Bashir, Shunji Nagai, Atsushi Yoshida, Marwan Abouljoud, and Zaher K. Otrock

  Background: D negative (D-) patients are routinely transfused with D- red blood cells (RBCs) due to the increased immunogenicity of the D antigen. The rate of alloimmunization to the D antigen following transfusion can be as high as 80%; however, immunosuppressed patients may be less likely to become alloimmunized. Some D- patients undergoing liver transplant may require a large number of RBC units which can risk the inventory of... Read More

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  Feasibility of Omitting Outer Renorrhaphy During Robotic Partial Nephrectomy

  Sohrab Arora, Chandler Bronkema, James R. Porter, Alexander Mottrie, Mani Menon, Craig G. Rogers, Wooju Jeong, Prokar Dasgupta, Mahendra Bhandari, and Firas Abdollah

  Introduction: Reconstruction technique after robotic partial nephrectomy (RPN) is a modifiable factor with possible impact on ischemia time, bleeding, renal function, and incidence of pseudoaneurysms. We sought to evaluate the feasibility of omitting cortical (outer) renorrhaphy (CR) in a multi-institutional setting.Methods: We analyzed 1453 patients undergoing RPN, from 2006-2018, within the Vattikuti Collective Quality Initiative database, which captures that data from 14 centers in 9 countries. Patients having surgery... Read More

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  The Efficacy of Fascia Iliaca Blocks After Total Hip Arthroplasty

  Kamil Bober, Allen Kadado, Wayne T North, and Michael A. Charters

  Introduction: Pain control after THA is an essential component of patient satisfaction. Published studies suggest postoperative fascia iliaca blocks provide additional benefit when used in conjunction with a multi modal pain regimen; however, there have been no studies that describe single shot fascia iliaca blocks after a mini-posterior surgical approach to the hip and their impact on postoperative function and pain. The purpose of this randomized trial was to... Read More

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  Impact of positive surgical margins on overall mortality in localized neuroendocrine carcinoma of prostate treated with radical prostatectomy

  Chandler Bronkema, Sohrab Arora, Jacob Keeley, Deepansh Dalela, Akshay Sood, Alex Borchert, Lee Baumgarten, Craig G. Rogers, James O Peabody, Mani Menon, and Firas Abdollah

  Background: Neuroendocrine (NEC) carcinoma is a rare variant of prostate adenocarcinoma (PCa) associated with advanced local stage, high incidence of metastatic disease, and poor survival. It is also associated with marked enlargement of prostate, for which some men with localized disease get local therapy in the form of radical prostatectomy (RP). The prognostic significance of positive surgical margin (PSM) after RP in this scenario is unknown. Our aim was... Read More

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  Impact of T2 Candida Panel on Species Specific Anti-fungal De-escalation

  Zohra Chaudhry, Amit Vahia, Sally Askar, Noman Hussain, Mujtaba Hameed, and George J. Alangaden

  Background: Candidemia is associated with a 30-day mortality of 20-40%, with likelihood of death increasing by 50% for each day therapy is delayed. T2 Candida is approved by the FDA for the diagnosis of candidemia with a sensitivity of 90% and specificity of 98%. The mean time to Candida detection is estimated to be 4.4 hours. Standard blood culture turnaround time is 3 days. Prompt diagnosis is essential to... Read More

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  Firearm Injury in Detroit: Examining Seasonal Variability and Outcomes

  Kendra J. Colbert, Ursula Barghouth, David A Moore, and Jeffrey Johnson

  Background: Firearm injuries contribute substantially each year to premature death, illness, and disability nationally. Previous studies have suggested seasonal variability in total trauma admissions, however there is limited data that specifically examines firearm injury. We hypothesize that when compared to all other trauma, firearm injury demonstrates seasonal variation with increased incidence in summer. Additionally, we anticipate poorer outcomes for firearm injury as measured by length of stay, days in... Read More

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  HPV immunization rates in student athletes depending on venue of pre-participation evaluation: a pilot study

  Andrew Cunningham, Meaghan Rourke, James Moeller, and Melissa Nayak

  HPV Immunization in student athletes receiving pre-participation physical evaluation at mass event versus other venues: a pilot studyBackground: The preparticipation physical evaluation (PPE) is required for high school sports participation in 49 of 50 states and represents a potential opportunity to provide recommended preventive health services such as immunizations. PPE can be completed in the primary care setting but is often done at mass participation events or retail medical... Read More

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  Unique Risk Factors for Thiamine Deficiency in ED Patients without Alcohol Dependence

  Jad Dandashi, Kaleem Chaudhry, Sam Tirgari, Daniel Hrabec, Abraham Markin, Jacob Ross, John France, JoAnn Rammal, and Joseph B. Miller MD

  Background: Thiamine (vitamin B1) is a crucial component in multiple essential biochemical pathways, andB1deficiency is increasingly recognized as a treatment target in sepsis and other critical illnesses. Our objective was to determine risk factors for B1 deficiency in severely ill ED patients without a history of alcohol dependence. Methods: This was a multi-pronged, prospective observational study that assessed B1 levels in ED patients with diabetic ketoacidosis, severe sepsis, and... Read More

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  The Impact of Age on Outcomes and Mode of Transport in Trauma

  Maritza D. Essis, Ursula Barghouth, David A Moore, and Jeffrey Johnson

  Introduction: Current data suggest that trauma patients arriving via private vehicle transport (PVT) have improved outcomes compared to patients arriving via EMS. Additionally, age has been demonstrated to impact patient outcomes in trauma. This study hypothesizes older patients will be more likely to utilize EMS transportation over PVT to the hospital in trauma. Additionally, this study hypothesizes that improved outcomes in PVT will be demonstrated across pediatric, adult, and... Read More

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  Markers of Mineral Homeostasis and Bone Turnover in Patients with Acute Hip Fractures

  Kathleen Estrada, Mahalakshi Honasoge, Arti Bhan, and Sudhaker D Rao

  Markers of Mineral Homeostasis and Bone Turnover in Patients Presenting with Acute Hip Fractures. It is generally assumed that bone turnover increases soon after a fracture, particularly after a major fracture such as hip. However, very little data exists on bone turnover markers (BTM) immediately after a hip fracture. In addition, it is unclear if the BTMs are related to prevailing VDN and parathyroid function. As part of ongoing... Read More

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  Prostate and Prostate Cancer Segmentation Using a Deep Learning-Based Object Detection Algorithm

  Aharon Feldman, Zhenzhen Dai, Eric Carver, Chang Liu, Joon K. Lee, Milan Pantelic, Mohamed A. Elshaikh, and Ning Wen

  Purpose: Mask-RCNN has been proposed in other industries for structure mapping and recognition. We attempted to use this platform for normal prostate segmentation and dominant intraprostatic lesion (DIL) segmentation and localization on multi-parametric MRI (Mp-MRI). This can potentially aid in diagnosis and therapeutic planning, as precise localization of the site of disease can guide targeted surgical resection or radiation boost volumes.

  Methods: A total of 78 patients with biopsy... Read More

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  Psoas Muscle Area Predicts Acute Respiratory Distress Syndrome in Acute Pancreatitis

  Charles Fisher, Pridvi Kandagatla, Arielle H Gupta, Daniyal Abbas, Beatrice Knisely, Rachel Cho, Nathan Schmoekel, and Jerry Stassinopoulos

  Introduction: Acute Respiratory Distress Syndrome (ARDS) is a serious complication of acute pancreatitis. However, limited literature exists pertaining to patient characteristics that can help predict the development of ARDS among patients with acute pancreatitis. Sarcopenia, based on psoas muscle area on imaging, has been predictive of outcomes after surgery. We hypothesized that sarcopenia would correlate with development of ARDS in patients admitted for acute pancreatitis. Methods: We performed a... Read More

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  Emergency Department Visit Within One Year Prior to Elective Total Hip Arthroplasty is Predictive of Post-Operative Return to Emergency Department within 90 Days

  Michael D. Gabbard, Michael A. Charters, Sean P Mahoney, and Wayne T North

  Background: Bundled care payment models, such as the Comprehensive Care for Joint Replacement Model, developed by Centers for Medicare and Medicaid Services, aim to improve the quality of joint replacement. Metrics, including emergency room visit rates after Primary Total Knee and Total Hip Arthroplasty (TKA and THA) are of particular interest. The purpose of this study was to determine if pre-operative Emergency Department (ED) visits are predictive of post-operative... Read More

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  Stimulant formulations for the treatment of ADHD

  Mohan Gautam and Deepak Prabhakar

  Objective: Clinicians have access to a variety of formulations of methylphenidate and amphetamine to treat attention-deficit hyperactivity disorder (ADHD). However, due to new emerging formulations clinicians may lack up-to-date knowledge about all available stimulant formulations. We present a comprehensive guide of 13 formulations of methylphenidate and 10 formulations of amphetamine that have U.S. Food and Drug Administration (FDA) approval to treat ADHD. Methods: A systematic review was completed through... Read More

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  Long-Term Outcomes after Robotic-Assisted Ivor-Lewis Esophagectomy

  Ali Ghandour, Pridvi Kandagatla, Ali Amro, Andrew Popoff, and Zane Hammoud

  Purpose: Robotic assistance has gained a measure of acceptance in thoracic procedures, including esophagectomy. However, there is a paucity of data regarding long-term outcomes for robotic esophagectomy. We have previously reported our initial series of robot assisted Ivor-Lewis (RAIL) esophagectomy. We report long-term outcomes to assess the efficacy of the procedure.Methods : We performed a retrospective review of 112 consecutive patients who underwent a RAIL at our institution. Patient... Read More

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  Robotic Assistance in Ventral Hernia Repair May Decrease the Incidence of Hernia Recurrence

  Mitchell Goettman, Margaret Riccardi, Lucky Vang, Chadi Faraj, and Moe Dughayli

  Background: Since the advent of laparoscopic surgery, many studies have shown advantages of laparoscopic surgery over open surgery for ventral hernia repair. As robotic surgery is gaining popularity, we sought to compare the outcomes of this newer robotic assisted technique to the outcomes of established open and laparoscopic techniques to assess for any additional benefit.Methods: A meta-analysis research design was employed. Multiple databases were queried for publications over the... Read More

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  Trauma Patients Still Use Private Vehicle Transport Despite Improvement in EMS Response Times

  Joseph Gosnell, Ursula Barghouth, Megan McNitt, David A Moore, and Jeffrey Johnson

  Introduction: Recently, Detroit has seen a gradual improvement in Emergency Medical Service (EMS) response times. The historically long response times have been implicated in contributing to the high rates of private vehicle transportation (PVT) in Detroit, up to 3 times higher than the national average. This study tests the hypothesis that as EMS arrival times improve, the utilization of PVT in Detroit would decrease. Methods: This is a retrospective... Read More

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  Success Rate of Embolization for Type II Endoleaks at a Major Tertiary Referral Center

  Garret Greer, Brian Sullivan, Ziad Al Adas, Mitchell R Weaver, David W McVinnie, Timothy J Nypaver, Alexander D. Shepard, and Loay S Kabbani

  Objective: The rise of endovascular aneurysm repair (EVAR) as the preferred treatment for abdominal aortic aneurysm (AAA) has introduced endoleaks as a major complication following AAA repair. The objective of this study is to assess the outcomes associated with endovascular embolization of type II endoleaks after EVAR. Methods: The institutional Radiology database at our tertiary referral hospital was queried for type II endoleak during the period 2006-2018. A retrospective... Read More

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  Lack of Association Between Tidal Volume and Postoperative Pulmonary Complications in Morbidly Obese Patients

  Carlos E Guerra, Donald Penning, Xiaoxia Han, and David Boy

  Background: Current evidence suggests that a low tidal volume (TV) intraoperative ventilation strategy reduces the risk of postoperative pulmonary complications (PPCs). Morbidly obese patients have not only been underrepresented in these trials, but low-tidal volumes have not been formally tested in this population. The aim of this study was to explore the relationship between TV adjusted for ideal body weight (IBW) and the occurrence PPCs in morbidly obese patients... Read More

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  Treatment and Outcomes of Daptomycin-Nonsusceptible MRSA Bloodstream Infection

  Hind Hadid, Mary Perry, Erica Herc, Ana C Bardossy, Helina Misikir, and Marcus J. Zervos

  Introduction: Daptomycin (dap) is approved as an alternative to vancomycin (van) for therapy of MRSA bloodstream infection (BSI). Cases of therapy failure associated with the emergence of daptomycin-nonsusceptible (DNS) MRSA strains have been documented. Information on the treatment and outcome of DNS MRSA BSI is scarce. This study describes the treatment and outcome of patients (pts) with DNS MRSA BSI at our healthcare center. Methods: This is a retrospective... Read More

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  Changing Trends in US Hospitalizations with Sphincter of Oddi Dysfunction: Insights from the National Inpatient Sample Database

  Khwaja F. Haq, Raja C. Chakinala, Mohammad A. Siddiqui, Shantanu Solanki, Muhammad Ali, Zubair Khan, Abhishek Bhurwal, Khawaja S. Haq, Anam S. Burney, and Faiza Bhatti

  Introduction: Sphincter of Oddi plays an important physiologic role by controlling the flow of biliary and pancreatic secretions through the ampulla of Vater into the duodenum. Sphincter of Oddi dysfunction (SOD), either from stenosis or dyskinesis, has been associated with complications such as biliary pain, idiopathic recurrent pancreatitis, and post-ERCP pancreatitis. Limited epidemiological data exists on the number of hospitalizations, demographic variations, cost of care, and comorbidity measures associated... Read More

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  Tangled: A Pictorial Review of Ultrasound and Angiography of Postpartum Hemorrhage due to Uterine Arteriovenous Malformations and Sub-Involution of the Placental Bed

  Daniel Hillman, Giordano Mitchell, Brian Craig, and John Fallucca

  Background: PPH can occur in up to 6% of deliveries and is a major cause of maternal mortality. UAE is preferred for PPH after failure of conservative treatment, as UAE can be performed in an emergent manner and can be repeated if necessary. UAE is effective for multiple types of PPH, and 24 hours after delivery, AVMs are the most common type to require UAE. Sub-involution of the placenta... Read More

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  Aurora-A and Polo-Like Kinases are Important Diagnostic and Therapeutic Markers in Hodgkin Lymphoma and Mimics

  Kathryn Hogan, Carlos Murga-Zamalloa, Girish Venkataraman, Daniel Schultz, Madhu P Menon, Juan Gomez-Gelvez, Jie Yan, and Kedar Inamdar

  Background: Aurora-A (AA) and Polo-like kinases (PLK) are mitotic kinases that regulate the G2/M phase of the cell cycle. It has been demonstrated that AA acts as an upstream regulator of PLK, mediating its phosphorylation in the presence of a cofactor named Bora. PLK is activated by AA to promote checkpoint recovery in mitosis. AA and PLK are implicated in the tumorigenesis of solid tumors, and, recently, in B-... Read More