Clinical Research

Factors Influencing Reintubation in Self Extubated Pediatric Intensive Care Unit Patients

Ahmed Naseem, B.S.¹, Ameer Al-Hadidi, M.D.², Morta Lapkus M.D.², Patrick
Karabon M.S.¹, Begum Akay M.D.3, Paras Khandhar M.D.³

¹Oakland University William Beaumont School of Medicine

²Department of General Surgery, Beaumont Hospital-Royal Oak

³Department of Pediatric Critical Care Medicine, Beaumont Hospital-Royal Oak

INTRODUCTION
Intubated pediatric patients that self-extubate may be particularly susceptible to reintubation. Identifying factors that increase risk of reintubation allows for better monitoring and response in cases of self-extubation and can potentially identify patients needing reintubation.

METHODS
Retrospective, single center, chart review of intubated patients in the pediatric intensive care unit (PICU) between January 2010-December 2017. Baseline demographics, reasons for intubation, length of intubation, use of rescue respiratory modalities, need for re-intubation after initial extubation, and PICU and hospital length were analyzed. T-Tests and chi-square tests were used for continuous and categorical variables.

RESULTS
A total of 502 patients were identified, of which 14 (2.8%) self-extubated. Of those 14 patients, 6 (42.9%) patients required reintubation. Five of seven patients who were intubated due to hypoxia required reintubation (p-value=0.0308). Furthermore, none of the 4 patients intubated for surgery required reintubated (p-value=0.0404). Average hospital LOS was 25.83 days in patients reintubated versus 7.38 days in patients not reintubated (p-value=0.0359). Average PICU LOS was 25.67 days in patients reintubated versus 4.13 days in patients not reintubated (p-value=0.0148).

CONCLUSIONS
It is crucial to identify factors that can predict self-extubated patients requiring reintubation. The study demonstrates that patients who are intubated due to hypoxia have a significantly increased risk of requiring reintubation. Additionally, patients intubated for surgery were significantly less likely to be reintubated. Patients
requiring reintubation had a significantly longer LOS in both the PICU and hospital overall. Additional studies involving larger retrospective reviews are needed to corroborate these findings further.

VIEW POSTER

Identification of Aggressive Variants of Mantle Cell Lymphoma Based on Flow Cytometry

Alan Nguyen, B.S.¹, Alia Gupta, M.D.², Marc Smith, M.D.², James Huang, M.D.²

¹Oakland University William Beaumont School of Medicine, Rochester, Michigan

²Department of Anesthesiology and Perioperative Medicine, Beaumont Health, Royal Oak, Michigan

INTRODUCTION
Mantle cell lymphoma (MCL) is a rare subtype of B-cell non-Hodgkin lymphoma characterized by a (1,14) translocation resulting in overexpression of cyclin D1.1 MCL variants and a heterogenous disease presentation make this a challenging diagnosis with a highly variable outcome. Pleomorphic and blastic variants have an aggressive clinical course and shorter survival than the classical type.2 The pleomorphic variant shows a marked variation in nuclear size, shape, and mitotic index.3 The blastic variant appears small and immature with fine chromatin mimicking acute leukemia.3 The aim of our study is to explore if flow cytometry analysis can help with the identification of aggressive MCL variants.

METHODS
67 cases of Mantle Cell Lymphoma diagnosed at William Beaumont Hospital from 2010-2021 were identified and the flow cytometry data were reanalyzed. The forward scatter intensity (FSC INT) of all neoplastic B-cells and reactive T-cells were collected which included: median (Med), arithmetic mean (Amean), geometric mean (Gmean), standard deviation (StDev). Numerical data and graphical histograms for flow cytometry data were correlated with clinical and pathological features on patient derived H&E slides.

RESULTS
Compared to classical MCL, blastic and pleomorphic variants show a right-shift or bimodal distribution on FSC INT. Cases with atypical FSC patterns revealed a significantly higher FSC median and standard deviation than typical FSC patterns.

CONCLUSIONS
MCL with increased FSC intensity and atypical histogram patterns are likely to be blastic of pleomorphic variants, requiring careful histopathological evaluation for accurate sub-classification.

VIEW POSTER

Effect of SARS-COV2 on Adolescent PHQ-9 Screening Result

Anisah Hashmi, B.A.¹, Aimee Pollak, M.D.², Leah Ludwig, M.D.², Kerry Mychaliska, M.D.², Mara Rubenstein, M.D.², Olufunke Adeyemo, M.D.², S. Shubeck², L. Qu3, M. Coffey³

¹Oakland University William Beaumont School of Medicine, Rochester, Michigan

²Department of Pediatrics, Beaumont Hospital, Royal Oak, Michigan

³Biostatistics, Beaumont Health, Royal Oak, Michigan

INTRODUCTION
The SARS-COV2 pandemic created numerous stressors for adolescents including financial insecurities, family illness or death, home schooling, discontinuation of group activities, and decreased peer interaction. Prior studies have shown an increased risk for self-reported depression symptoms in pediatric patients following traumatic events. The purpose of this study is to compare rates of newly diagnosed depression in adolescents and self-reported depression symptoms prior to and during the pandemic.

METHODS
A retrospective chart review was conducted for adolescents aged 12-17 who attended Beaumont Hospital between January 1, 2018 and March 22, 2020. Included patients completed a PHQ-9 questionnaire without a previously established diagnosis of mood disorder. Charts were reviewed for age, gender, race, questionnaire results and a new diagnosis of depression. The pandemic data was collected between March 23, 2020 and June 2, 2021 during the Michigan shelter in place order.

RESULTS
381 patient charts were reviewed with 250 meeting inclusion criteria from 233 distinct patients (53.6% female; 55.4% African American; 24.9% Caucasian, and mean age 14.4 years). During the pre-pandemic period, 29.6% of the patients had a PHQ-9 score positive for depression. Depression severity among these patients was: 68.9% mild, 21.3% moderate, 8.2% moderate-severe, 1.6% severe. During the pandemic period, 29.6% had a PHQ-9 score positive for depression. Depression severity among these was: 77% mild, 15% moderate and 8% severe. Among teens who screened positive for depression and completed questions assessing symptom severity, 56.6% in the pre-pandemic and 90.9% in the pandemic period reported symptoms causing difficulty in daily activities.

CONCLUSIONS
This study did not show an increased incidence of new onset depression amongst adolescents when comparing pre-pandemic and pandemic PHQ-9 scores. However, those who screened positive for depression during the pandemic period reported more difficulty in performing daily activities.

VIEW POSTER

Relationship Between Smoking and Triple-Negative Breast Cancer: A Retrospective Analysis

Anna Jahshan, B.S.¹, Mariam Aoun, B.S.¹, Nayana Dekhne, M.D.², Varna Taranikanti, M.D./Ph.D.³

¹Oakland University William Beaumont School of Medicine, Rochester, Michigan
²Department of Breast Surgery, Beaumont Hospital, Royal Oak, Michigan
³Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan

INTRODUCTION
Breast cancer is currently the most common cancer by incidence among women in the United States with high mortality. Compared to other specific types, triple-negative breast cancer (TNBC) is considered to be an aggressive cancer with poor prognosis. Hence, it is important to study the risk factors associated with it. Smoking has been implicated in many cancers, including breast cancer. However, there is no evidence in literature that has shown a relationship between smoking and a specific type of breast cancer. The goal of this study is to analyze the relationship between smoking and TNBC so that we may improve the understanding of the risk factors related to this type of breast cancer.

METHODS
Retrospective data was obtained from the Beaumont Health System of women who were diagnosed with TNBC within the past 10 years and who received breast conserving therapy with at least two years of follow-up. 107 patients were found to meet the inclusion criteria. The study compared smokers and non-smokers with TNBC. The statistical analysis was conducted using ANOVA F-test, Chi-Square, and Fisher exact test.

RESULTS
Of the 107 patients in the dataset, 56% of female patients with TNBC were smokers. Of that population, 50% had a greater than 11.5-pack-year smoking history. The study revealed that there was no significant difference between smokers and nonsmokers with regard to the prognostic factors, including tumor stage (p = 0.85), nodal stage (p = 0.95), and pathologic grade (p = 0.24).

CONCLUSIONS
The study did not demonstrate an association between smoking status and prognosis of TNBC, but the sample size was a limitation to the power of the study. Therefore, more studies analyzing associations between smoking and TNBC are warranted.

VIEW POSTER

Insufficient Sleep Following Pediatric Mild Traumatic Brain Injury Correlates With Neurocognitive Dysfunction

Bailey Hull, B.S.¹, Patrick Karabon, M.S.¹, Neal Alpiner, M.D.²

¹Oakland University William Beaumont School of Medicine, Rochester, Michigan

²Department of Physical Medicine and Rehabilitation, Beaumont Health, Royal Oak, Michigan

INTRODUCTION
Sleep disturbance of any nature is reported in more than half of all mild traumatic brain injury (mTBI) patients. The pathophysiology of sleep disturbance following an mTBI is associated with structural and functional disruptions of sleep circuitry and circadian rhythm. Specifically, in the pediatric population, untreated sleep disturbance has been shown to delay mTBI recovery and compound other morbidities including neurocognitive dysfunction. It was our goal to further analyze the impact sleep disturbance has on neurocognitive function in children recovering from an mTBI.

METHODS
A retrospective chart review of 118 pediatric patients (mean age = 14.56 +/- 2.03 years) recovering from mTBI was performed. Epworth Sleepiness Scale (SF-8) results were analyzed alongside CNS Vital Signs (CNSVS) neurocognitive test outcomes. SF-8 is a subjective estimation of a patient’s daytime sleepiness. CNSVS uses a multitude of domains to objectively evaluate the overall neurocognitive status of a patient. Pearson correlations were calculated using a type I error of P<0.05.

RESULTS
Epworth Sleepiness Scale (SF-8) results showed 28.82% of participants experienced excessive daytime sleepiness sufficient to recommend medical attention. There was a significant negative correlation between SF-8 and CNSVS neurocognitive test outcomes including complex attention (r=-0.37; P=0.0004), cognitive flexibility (r=-0.24; P=0.0151), executive function (r=-0.21; P=0.0350), and simple attention (r=-0.36; P=0.0003) scores. This means as SF-8 scores increased (participants defined as excessively sleepy), neurocognitive function scores in these domains decreased. There was not enough evidence to conclude a significant correlation between other CNSVS domains and SF-8 (all P>0.05).

CONCLUSIONS
Our findings support the concern of neurocognitive dysfunction among pediatric mTBI patients with sleep disturbance. Further analysis is needed to determine if mTBI is the primary source or an exacerbating factor of sleep disturbance within this population. Nonetheless, these findings suggest a need for thorough evaluation when treating sleep concerns, irrespective of a history of childhood mTBI.

VIEW POSTER

Resistance in Gram-Negative Bacteria in the Pediatric Patient Population by Age and Sex

Benjamin Malamet, B.S.¹, Matthew Sims, M.D./Ph.D.^2,3

¹Oakland University William Beaumont School of Medicine, Rochester, Michigan
²Department of Internal Medicine, Section of Infectious Diseases and International Medicine, Beaumont Hospital, Royal Oak, MI
³Departments of Internal Medicine and Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan

INTRODUCTION
Previous research within the Beaumont Infectious Diseases Research Program found an increase in antibiotic resistance in adult males versus females. Furthermore, there is a peak in resistance in 18-29-year-old males, not seen in females. The origin of this early peak of antibiotic resistance in adults is unclear. This study examines these trends in the pediatric patient population.

METHODS
Resistance data for all Gram-negative bacterial clinical isolates from Beaumont Health’s clinical microbiology lab between October 1st, 2010 and December 31st, 2014 was analyzed. The pediatric isolates were categorized into sextiles (0-2, 3-5, 6-8, 9-11, 12-14, 15-17) and the sensitivities for each antibiotic were compared based on gender and age and separated by urine isolates vs. non-urine isolates to account for potential bias based on abundance of urine samples in females.

RESULTS
There were 7878 pediatric Gram-negative bacterial isolates, and 96 duplicate samples were removed, leaving 7782 isolates to be analyzed. There were more female isolates (n=6888) than male isolates (n=890) due to the preponderance of urine cultures in females. At most age ranges, antibiotic resistance was significantly higher in males than females. In males, antibiotic resistance was highest between 12-14 and 15-17 years old. When analyzing the cultures based on sample type, the peak in resistance in males is seen in urine isolates, but the patterns of resistance are chaotic in non-urine isolates. This is likely attributable to a low number of isolates.

CONCLUSIONS
Sex is an important factor in determining antibiotic resistance in the pediatric patient population, as males exhibit higher resistance. The peak in antibiotic resistance noted in 18-29-year-old males in previous research originates in the pediatric age group between 12-17 years old. Further research is needed to determine the cause of the observed gender bias, to ascertain if it is modifiable in order to reduce antibiotic resistance.

VIEW POSTER

Intraoperative MAP, Vasopressors, and Opioids in TF-TAVR patients undergoing Conscious Sedation vs General Anesthesia

Brett J. Friedman, MPH¹, Patrick Karabon, M.S.¹, Wei C. Lau, M.D.²

¹Oakland University William Beaumont School of Medicine, Rochester, Michigan
²Beaumont Hospital - Department of Anesthesia, Royal Oak, Michigan

INTRODUCTION
Aortic stenosis is a progressive narrowing of the aortic valve that can cause serious cardiovascular harm such as syncope, heart failure, and death if left untreated. Transfemoral-transcatheter aortic valve replacement (TF-TAVR) emerged in the last 10 years as an alternative for previously inoperable, high-risk patients. Studies suggest that monitored anesthesia for TF-TAVR using minimalist conscious sedation results in better outcomes (e.g., shorter length of stay, lower 30-day mortality) when compared to general anesthesia. However, there is a gap in knowledge of why conscious sedation is more successful. Recent studies have demonstrated the association of intraoperative mean arterial pressure (MAP) variables including MAP variability (MAPV) and time-weighted average MAP (TWA-MAP) with 30-day mortality in non-cardiac surgery. We compared intraoperative variables for TF-TAVR patients that underwent conscious sedation versus general anesthesia.

METHODS
A retrospective chart review was performed on patients receiving elective TF-TAVR between 2013-2017 at a single institution and propensity-matched 2:1 using baseline clinical characteristics. Primary endpoints were intraoperative MAP, MAPV, and TWA-MAP. Secondary endpoints were intraoperative opioid and vasopressor administration. Univariate analysis was performed with independent two-sample T-tests and Chi-Square tests.

RESULTS
Initial data collection yielded 285 patients; propensity matched 144 (96 conscious sedation, 48 general anesthesia). Conscious sedation was strongly associated with lower total intraoperative concentrations (micrograms) of fentanyl administered (78.5 ± 51.9 vs 112.5 ± 68.5, p = 0.008) and higher TWA-MAP (89.4 ± 11.8 vs 85.0 ± 7.0, p = 0.006). Intraoperative MAP, MAPV, and vasopressor administered were similar between patients who received conscious sedation versus general anesthesia.

CONCLUSIONS
There is increased intraoperative TWA-MAP and decreased administration of opioids for conscious sedation patients. When choosing anesthesia for older adults receiving TF-TAVR, the benefits of conscious sedation’s higher perfusion and lower opioid use should be considered.

VIEW POSTER

Hearing Durability and Trajectory after Radiosurgery for Vestibular Schwannoma

Christian G. Fritz, M.D.^1,2, Dennis I. Bojrab II, M.D.^2,3, Nathan C. Tu, M.D.^2,3, Christopher A. Schutt, M.D. ^2,3, Dennis I. Bojrab, M.D. ^2,3, Seilesh C. Babu, M.D.^2,3

¹Oakland University William Beaumont School of Medicine, Rochester, Michigan
²Michigan Ear Institute, Farmington Hills, Michigan
³Department of Surgery, Beaumont Health, Royal Oak, Michigan

INTRODUCTION
Vestibular schwannomas (VS) are benign skull base tumors arising from the eighth cranial nerve. Stereotactic radiosurgery (SRS) is emerging as treatment for smaller sized tumors with the intent being to prevent further tumor growth, thus avoiding mass-effect symptoms. Hearing outcomes are commonly presented as preservation of class A/B hearing (defined as Pure Tone Average (PTA) ≤50 dB with Word Recognition Score (WRS) ≥50 dB). Long-term follow-up data on hearing outcomes and hearing trajectory trends are limited.

METHODS
This retrospective case series assessed patients treated with SRS for VS between March 2007 to March 2017. Exclusion criteria included pre-treatment class C/D hearing level, NF type II, history of previous surgical resection, and follow-up less than 1 year. The main outcome measure was hearing function assessed both by maintenance of serviceable hearing (class A/B) and by maintenance of baseline hearing (≤20 dB change PTA) after SRS.

RESULTS
A total of 93 patients were included in this study. Patients with pre-treatment class A hearing status maintained serviceable hearing for a longer duration in the post-treatment period (p=0.005) yet did not maintain PTA to within 20 dB of baseline for a longer duration than patients with class B hearing (p=0.294), according to Kaplan-Meier analysis. Analysis of changes in PTA after radiosurgery revealed a common hearing trajectory comprised of an acute, rapid decline in function, followed by stabilization, and then a delayed phase of slow hearing decline after 36 months.

CONCLUSIONS
Normalization to baseline hearing using the quantitative PTA-based outcome measure afforded a more precise description of hearing trends as compared to the categorical serviceable hearing (class A/B) assessment. An understanding of year-by-year hearing trajectories could prove useful for counseling patients on hearing expectations after radiosurgical treatment of VS.

VIEW POSTER

Impact of polycystic ovary syndrome on cardiovascular disease in obese female youth

Collin R. Walentine, B.A.¹, Michael R. Brennan , D.O.¹, Kristen J. Nadeau, M.D./Ph.D.², Melanie Cree-Green, M.D./ Ph.D.²

¹Oakland University William Beaumont School of Medicine, Rochester, Michigan
²Department of Pediatric Endocrinology, University of Colorado Anchutz Medical Campus, Aurora, Colorado

INTRODUCTION
17% of youth in the United States are obese and the incidence is rising. Among obese adolescents, girls with polycystic ovary syndrome (PCOS) represent a vulnerable and understudied group. PCOS is strongly associated with dyslipidemia and cardiovascular disease (CVD) in adulthood, but studies of CVD in youth are limited. We hypothesized that obese youth with PCOS would show evidence of vascular dysfunction relative to girls with obesity without PCOS.

METHODS
Girls with obesity with or without PCOS were enrolled in prospective cross-sectional research trials between 08/2014-08/2019 at Children’s Hospital Colorado. Participants underwent a physical exam, fasting labs, an oral glucose tolerance test (OGTT) and vascular measures with an EndoPAT-2000. Primary analysis compared participants with PCOS to controls. Subgroup analysis compared participants designated as high cardiovascular risk (HCVR) to those with low cardiovascular risk (LCVR) based on EndoPAT-2000 measurements.

RESULTS
68 girls with obesity, consisting of 44 with PCOS (age 16.0±1.9 years; BMI 36.1±6.3 kg/m2) and 24 without PCOS (age 15.3±1.6 years; BMI 34.5±6.3 kg/m2) were enrolled. There were no differences in endothelial function or systolic blood pressure (SBP) between groups. Subgroup analysis of HCVR (N=15, BMI 35.5±4.6 kg/m2, 80% PCOS) and LCVR (N=16, BMI 34.2±6.3 kg/m2, 69% PCOS) demonstrated elevated SBP in the HCVR group (HCVR = 132 mmHg±11, LCVR = 122 mmHg±11, p<0.01). Peak insulin concentrations from the OGTT were higher in HCVR participants (HCVR = 479 µU/mL±341, LCVR = 269 ±146, p<0.04).

CONCLUSIONS
PCOS in adolescents with obesity was not associated with vascular dysfunction or elevated SBP compared to similarly obese girls without PCOS. However, HCVR participants demonstrated hypertension and hyperinsulinemia relative to LCVR. This suggests vascular dysfunction can be observed as early as adolescence in girls with obesity, and that early intervention to prevent or reduce hyperinsulinemia could be potentially targeted to reduce CVD risk.

VIEW POSTER

Fluoroscopic Demonstration of Thoracic Tumor Immobilization with High Frequency Percussive Ventilation

Cristian Solano, B.S.¹, Ina M. Sala, Ph.D.², Beverly Maurer³, Ronald Levin, M.D.³, Thomas M. Guerrero, M.D./Ph.D.^1,3

¹Oakland University William Beaumont School of Medicine, Rochester, Michigan
²Yale University School of Medicine, Department of Therapeutic Radiology, New Haven, Connecticut
³William Beaumont Hospital, Royal Oak, Michigan

INTRODUCTION
High frequency percussive ventilation (HFPV) is a novel immobilization technique that utilizes high frequency low tidal volume ventilation to produce endotracheal percussion. In a previous departmental study of chest wall motion immobilization, it was found that volunteers were able to tolerate HFPV for varying lengths of time – from a few to tens of minutes. By investigating a novel process to immobilize the chest wall, and thus thoracic tumors, it can allow for more localized radiation delivery and reduction of healthy tissue irradiation.

METHODS
We screened patients with conspicuous lung tumors that exhibited motion >10 mm to undergo kV fluoroscopy with HFPV. Two sets of consecutive AP (anterior posterior) fluoroscopy frames were acquired during multiple breathing cycles for free- and HFPV- breathing. Percussions were delivered via the intrapulmonary percussive ventilation device (IPV-2C) and phasitron. The baseline settings for the IPV-2C (pressure, frequency, CPAP and inspiration time) were set during an initial training session, but minor adjustments were made prior to imaging at the direction and comfort of the patient.

RESULTS
Patient recruited was a 69 y.o. female with stage IB (cT2a, cN0, cM0) adenocarcinoma of the LLL with lepidic and acinar growth pattern. She experienced slight discomfort lying flat on the treatment table, however successfully completed HFPV. Peak-to-peak tumor motion during 4DCT sim was 11.0 mm, however patient had already received 4x 10Gy fractions of SBRT when enrolled in the study, and therefore peak-to-peak motion during free-breathing measured with fluoroscopy, at the time of the study, was 6.2 mm. Subsequently, peak-to-peak motion measured with fluoroscopy during HFPV was at 2.7 mm. This resulted in a 57% tumor motion reduction.

CONCLUSIONS
In this first-in-man study, we have shown that HFPV is a novel respiratory motion technique that can significantly reduce tumor motion.

VIEW POSTER

Post-Concussive Visual Symptoms in Teens Undergoing Rehabilitation

Daniel Ludema, B.S.¹, Neal Alpiner, M.D.²

¹Oakland University William Beaumont School of Medicine, Rochester, Michigan
²Pediatric Physical Medicine and Rehabilitation, Beaumont Health, Royal Oak, Michigan

INTRODUCTION
Visual symptoms are commonly reported in those who have experienced mild TBI. However, there has not been much research on other types of visual disturbances commonly seen in the post-concussive period. The goal of this study was to identify novel visual symptoms seen in post-concussive teens.

METHODS
This study is a retrospective chart review utilizing electronic medical record data of teenage patients, between the ages of 13 and 18, from a physical medicine and rehabilitation center. Measured outcomes were near point convergence, diplopia, visual tracking, suppression of vision, block pattern matching, and size discrimination. The data was subjected to chi-squared analysis.

RESULTS
Data was gathered from 77 patient’s charts. The most common visual symptom seen was difficulty with size discrimination (52.11%), followed by failed near point convergence (49.35%), diplopia (43.42%), block pattern matching difficulty (42.86%), suppression of vision (40.26%), and difficulty with visual tracking (30.26%). There was no significant difference in symptoms between the age groups. The only significantly different symptom between sexes was difficulty with block pattern matching, seen more in females, X2(1, N=70) = 5.1, p = 0.023.

CONCLUSIONS
Visual disturbances can be underestimated in their impact on adolescents following concussion. There are a wide range of visual irregularities amongst our population, but one that is commonly unrecognized and underreported in the literature, is estimation of size and size discrimination. The frequency to which these symptoms are seen could explain some of the difficulty with academics many post-concussive teens have. Acknowledged limitations with our data relates to absence of a comparison control group. Further research should focus on controlled studies to see how common these symptoms are compared to a healthy population. Perhaps, in the future, the presence of these symptoms could aid in the diagnosis of post-concussion academic and cognitive decline.

VIEW POSTER

Irreversible Electroporation for Recurrent Pelvic Metastases: Case Series and Literature Review

Duncan A. Stevens, B.S.¹, Jeffrey H. Savin, M.D.², Brett J. Friedman¹, Michael A. Savin, M.D.²

¹Oakland University William Beaumont School of Medicine, Rochester, Michigan
²Beaumont Health, Royal Oak, Michigan

INTRODUCTION
Irreversible electroporation (IRE) is a nonthermal ablative technique that has potential safety advantages over thermal ablation in the treatment of tumors near critical structures. It creates an electrical field which forms permanent nanopores in the membranes of cells and triggers apoptosis. This case series reviews three patients with pelvic metastases from colorectal cancer treated with IRE.

METHODS
Two patients had rectal cancer and one sigmoid colon cancer. The mean age was 55 years and there were two males and one female. Thermal ablation was contraindicated due to proximity to ureter, bladder, bowel, and/or sciatic or lumbosacral nerves. Every patient was referred to interventional radiology due to progression after primary tumor resection, FOLFOX chemotherapy, and pelvic radiation. All patients were treated with NanoKnife IRE (AngioDynamics, Latham, New York).

RESULTS
To reduce IRE risk, hydrodissection was performed. In each case, either four or five IRE probes were used with up to two pull back treatments. Probe exposure length was either 1.5 cm or 1 cm. One patient had no recurrence after last follow-up at 23 months. Two patients had recurrence, one after 6 months (retreated with IRE) and the other after 17 months. Complications included partially reversible lower extremity sensory and motor deficits, contained colon perforation, and ureteral injury requiring stent placement.

CONCLUSIONS
IRE is a promising tool for local treatment of recurrent pelvic metastases when other local treatments are contraindicated. IRE leaves supporting tissue largely unaffected, so that blood vessels and intestines are relatively preserved, and damaged axons may regenerate. This is important in the pelvis where sensitive structures include bladder, ureters, bowel, lumbar and sacral nerve roots, and the sciatic nerve. For these patients, IRE was selected over thermal ablation due to decreased risk of complications. Complete ablation is possible for smaller lesions, while symptom control should be the focus of larger lesions.

VIEW POSTER

Acute Post-Operative Pain Following Anterior Cruciate Ligament Reconstruction: A comparison of Patellar Tendon vs Hamstring Autograft

Dustin Randall, B.S.¹, Denise Koueiter, M.S.², Brandon Luczak, M.D.², Kyle Anderson, M.D.²

¹Oakland University William Beaumont School of Medicine, Rochester, Michigan
²Department of Orthopaedic Surgery, Beaumont Health, Royal Oak, Michigan

INTRODUCTION
Choosing between a bone-patellar tendon-bone (BTB) or hamstring tendon (HS) graft for primary anterior cruciate ligament (ACL) reconstruction has long been a topic of debate and discrepancy in orthopaedic literature, with many factors contributing to the decision process. The purpose of this study is to analyze acute post-operative pain scores of patients who underwent ACL reconstruction and compare the results between BTB autograft and the HS autograft techniques.

METHODS
The study retrospectively reviewed a sports medicine outcomes registry for all patients that had a primary ACL reconstruction between August 2014 and April 2017. All reconstructions were performed by a single surgeon (the senior author) and all reconstructions were done with either a BTB autograft or a hamstring autograft. Pain scores were collected for all patients pre-operatively. Patients were asked to follow-up post-operatively at 2 weeks, 1 month, and 3 months. Pain scores were also collected at each follow-up visit and were compared between groups pre-operatively and at each post-operative time point using a Mann-Whitney Rank Test.

RESULTS
Preoperative pain in the BTB group was 3.41 ± 2.04 and was not significantly different from preoperative pain in the HS group (3.74 ± 2.32, P=0.439). There was no difference in mean pain scores for BTB patients and HS patients at 2-week follow-up, 1-month follow-up, and 3-month follow-up (Table 2). Improvement in pain score from preoperative to postoperative also did not vary between groups at any time point.

CONCLUSIONS
There was no statistical difference found between the acute post-operative pain scores of the BTB autograft and the HS autograft cohorts. An HS autograft may be selected for some individuals undergoing ACLR based on alignment, personalized rehabilitation and activity demands among other reasons, but should not be selected on the perception of less pain in the acute post-operative period.

VIEW POSTER

Functional Lung Segmentation from Computed Tomography Images using Deep Learning

Duyen Quach, B.A.¹, Evan Porter, B.S.², Thomas Guerrero, M.D./Ph.D.^1,3

¹Oakland University William Beaumont School of Medicine, Rochester, Michigan
²Department of Medical Physics, Wayne State University, Detroit, Michigan
³Department of Radiation Oncology, Beaumont Health, Royal Oak, Michigan

INTRODUCTION
Functional avoidance treatment planning allows radiation oncologists to intentionally minimize radiation dose to higher-functioning lung areas while favoring radiation dose towards lower-functioning regions. This treatment planning method has been shown to reduce pulmonary toxicity for patients receiving radiation therapy. Functional lung information, traditionally ventilation or perfusion SPECT scans, is required to plan for functional avoidance.

METHODS
The proposed study identified 51 pre- and post-radiotherapy 99mTc-labeled MAA-SPECT perfusion images of lungs from 24 patients in a retrospective clinical data set. For each SPECT perfusion image, a 4DCT image of the lung was also collected in the course of normal radiation treatment planning. The inhale and exhale phases of a 4DCT image were used to generate a synthetic perfusion image with the MAA-SPECT as ground truth. The 51 4DCT images were separated into 41 images for the training set and 10 images for the testing set. From the pre-treatment cases, 50th-percentile contours of well perfused lung were generated from both the clinical and synthetic perfusion images and the agreement was quantified.

RESULTS
The statistical analyses using 95% Hausdorff distance and Dice similarity coefficient metrics were used to compare deep-learning generated contours and manually generated contours. Across the 51 imaging studies, pre- and post-treatment cases performed similarly. The agreement of the functional avoidance contour pairs was: Dice of 78.0% (IQR: 76.2 – 81.2) and average surface distance of 6.23mm 38 (IQR: 5.13 – 8.70).

CONCLUSIONS
The results supported the hypothesis that a functional avoidance contour derived from 4DCT images of the lungs correlate well and warrant further investigations into the application in functional avoidance treatment planning.

VIEW POSTER

VBAC Success in Women with Diabetes Mellitus Types I + II: A Pilot Study

Emma Randall, B.S.¹, Rachel Taylor, M.D.², Sarah Becker, B.S.¹, Zeynep Alpay-Savasan, M.D.³

¹Oakland University William Beaumont School of Medicine, Rochester, Michigan
²Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
³Beaumont Health System, Royal Oak, Michigan

INTRODUCTION
Due to a rise in cesarean sections since the 1970s, the American College of Gynecology has acted to reduce unnecessary cesarean deliveries. In 2017, ACOG released clinical management guidelines for vaginal birth after cesarean delivery (VBAC), including a nomogram to predict VBAC success. This nomogram, developed by Grobman et al. (2007), explored factors impacting VBAC success for delivery at term for a singleton pregnancy. While the presence of diabetes was evaluated in the study, it was not found to be a significant factor in predicting outcome. This study will take a more detailed look at if pre-existing diabetes impacts a woman’s VBAC success.

METHODS
A retrospective chart review was used to identify patients who received prenatal care from the Beaumont - Royal Oak outpatient OB/GYN clinic between January 1, 2012 and December 31, 2017. Patients with a history of one cesarean section who delivered at RO Beaumont were divided into experimental and control groups based on the presence of a diabetes diagnosis.

RESULTS
We identified five patient encounters where women met inclusion criteria and had a diagnosis of Type 1 or Type 2 Diabetes Mellitus. Of this group of five, only one underwent TOLAC with successful VBAC, while four had a repeat cesarean section. Three of the C-sections were planned due to health concerns or trouble with prior delivery, while one was described as an “elective repeat.”

CONCLUSIONS
The small number of patients fitting criteria hindered us from drawing a conclusion regarding the difference in VBAC success rate in women with pre-existing diabetes. Next steps for this study include expanding data collection to look at how TOLAC in recent years compares to the data from 2012-2017, with the hopes of being able to draw conclusions regarding significance of success as well as identify any trends that have developed over time.

VIEW POSTER

Correlations between Symptoms of Post-Concussion Syndrome and Anxiety & Depression in Athletes

Grace Peterson, B.S.¹, Rachel Saban, M.D.¹, Aimen Vanood, M.D.¹, Gustavo Patino, M.D./Ph.D.²

¹Oakland University William Beaumont School of Medicine, Rochester, Michigan
²Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan

INTRODUCTION
Post-concussion syndrome (PCS) is defined as concussion symptoms persisting 3 months beyond traumatic head injury. For the general population, diagnosis of pre-concussion mood disorders is a positive predictor for post-concussion depression and anxiety. Identifying correlating demographics and symptoms might allow for better screening for post-concussion psychiatric diagnoses and therapeutic interventions in athletes. The primary goal of this project was to determine which demographics and PCS symptoms correlate with reported depression and anxiety in adult athletes with and without a history of psychiatric diagnoses.

METHODS
A scoping review was performed using PubMed to identify studies reporting the frequency of symptoms in sport-related PCS, including depression, sadness, and anxiety. Inclusion criteria included subjects 18 years of age or older who sustained a sports-related concussion reporting symptoms ≥3 months after injury. Monte Carlo simulations of the data were used to simulate the symptom combinations of individual patients, which were then used to calculate odds ratios between PCS symptoms or patient demographics and depression/sadness or anxiety.

RESULTS
Athletes reporting restlessness ≥3 months after concussion had significantly higher odds that they would also report depression/sadness or anxiety. Women had lower odds of reporting depression and anxiety ≥3 months after concussion than men. There was no significant difference in the odds of reporting depression, sadness, or anxiety ≥3 months after concussion when comparing those with or without a psychiatric history.

CONCLUSIONS
In adult athletes suffering from concussion symptoms ≥3 months after injury, the presence of restlessness and male gender revealed increased odds of reporting depression/sadness or anxiety. Unlike studies in the general population, this analysis did not show any significant relationship between prior psychiatric diagnosis and reporting depression, sadness, or anxiety ≥3 months after concussion. The outcomes of this review may help healthcare professionals more effectively screen for mood disorders in athletes with PCS and provide necessary support.

VIEW POSTER

Evaluating Taper Junction Fretting and Corrosion in Reverse Total Shoulder Arthroplasty

Ian R. Penvose, B.S.¹, Erin A. Baker, Ph.D.², J. Michael Wiater, M.D,², Corinn K. Gehrke, M.S.², Jon O. Wright, M.D.², Omar N. Khatib, M.D.², Brett P. Wiater, M.D.²

¹Oakland University William Beaumont School of Medicine, Rochester, Michigan
²Beaumont Health Orthopaedic Department, Royal Oak, Michigan

INTRODUCTION
Taper junction fretting and corrosion (F&C) has been identified in total hip arthroplasty (THA) as an implant failure mode. Studies have reported taper F&C in in anatomic total shoulder arthroplasty (ATSA) implants, but limited literature has described comparable analyses in reverse shoulder arthroplasty (RTSA) implants. In this study, taper junction F&C in retrieved RTSA implants was assessed and analyzed.

METHODS
Fifty-seven retrieved RTSA implants were identified via database query. A medical records review was performed to analyze patient and surgical factors. Implant components were graded for standard damage modes and fretting corrosion with a modified Goldberg-Cusick classification system. Using a 22 factorial model, subgroup analyses assessed damage based on implant characteristics - taper size, taper geometry, and bolt-reinforced.

RESULTS
No significant differences in ages, sex, BMI, laterality, or duration of implantation between subgroups. Baseplates showed greater moderate-to-severe fretting (43%) and corrosion (27%) damage than matched glenospheres (fretting, 9%; corrosion, 13%). Humeral stems showed greater moderate-to-severe fretting (28%) and corrosion (30%) of implants than matched humeral trays/spacers (fretting, 14%; corrosion, 17%). Small-tapered glenospheres and baseplates had significantly greater F&C grades compared to large-tapered implants (glenospheres, p≤0.001; baseplates, p=0.031). Unbolted glenospeheres had significantly greater corrosion grades compared to bolted tapered implants (p≤0.001). F&C grades on glenospheres with trunnions (male) were significantly greater than glenospheres with bores (female) (both p≤0.001). Factorial analysis showed taper size, component engagement, and their interactions were associated with in vivo F&C damage on RTSA implants.

CONCLUSIONS
In this series, F&C damage predominantly occurred on the taper surface of the baseplate (vs. glenosphere) as well as on the humeral stem (vs. tray/spacer). Large-tapered implants showed less F&C damage. Bolted glenospheres showed less corrosion than unbolted glenospheres. Designs with bores (female), rather than trunnions (male), showed less F&C damage. Factorial analysis further elucidated the influence of F&C damage.

VIEW POSTER

Applying the Periprosthetic Joint Infection Consensus Definition to Ankle Implant-Associated and Infection-Suspected Procedures to Assess Diagnosis

Jackson Harley, B.S.¹, Erin Baker, Ph.D.², Corinn Gehrke, M.S.², David Ciufo, M.D.², Zachary Vaupel, M.D.³, Paul T Fortin, M.D.³

¹Oakland University William Beaumont School of Medicine, Rochester, Michigan
²Department of Orthopedic Surgery, Beaumont Health System, Royal Oak, Michigan
³Oakland Orthopedic Surgeons, Royal Oak, Michigan

INTRODUCTION
Periprosthetic joint infection (PJI) affects 2-3% of all total joint replacement cases. In 10-30% of these cases, the organism is unidentifiable, which may impact treatment planning and outcomes. In this study, suspected periprosthetic infections of foot and ankle procedures treated by four foot and ankle-trained orthopedic surgeons were retrospectively reviewed to determine culture status and applicability of the 2018 International Consensus Meeting on Orthopedic Infections (ICM) classification system.

METHODS
Under an IRB-approved protocol, cases of suspected infection, based on ICD-9/10 codes, from cases performed at a Level 1, private, academic hospital from October 2014 to November 2019 were reviewed for demographic, surgical, and infection-related data. Data was analyzed using ANOVA modeling (Dunn’s post-hoc test) and Spearman correlation tests (α=0.05).

RESULTS
Of the 210 revision cases coded for infection, 81 met the inclusion criteria of the study; cases included removal of an implant and were not wound infection-related only. Comparing cases that met vs. did not meet the 2018 ICM definition of infection, there were no significant differences between age (p=0.522), BMI (p=0.747), sex (p=0.514), laterality (p=0.323), prior revision status (p=0.457), or CCI score (p=0.511). Length of stay was significantly greater in cases defined as infected by the 2018 ICM classification system (p≤0.001; averages, 9.3 vs. 4.7). There were also no significant differences between cases not meeting threshold vs. infected cases in preoperative positive culture status (p=1.000), intraoperative positive culture status (p=0.235), pre-culture administration of antibiotics (p=0.496), cases readmitted within 30 days (p=0.232), or cases readmitted for PJI (p=0.502).

CONCLUSIONS
This study reviewed and identified culture status and infection using the 2018 ICM classification system. Length of stay was significantly greater in patients that met the ICM infection diagnosis definition.

VIEW POSTER

Comparative Analysis and Quantitative Rupture Risk Assessment of Intracranial Aneurysms

Jeremy F. Santamaria¹, Madan Krishnamurthy, Ph.D.², Fakhare Alam, Ph.D.², Khalid M. Malik, Ph.D.², Hesham Zakaria, M.D.³, Ghaus M. Malik, M.D.³

¹Oakland University William Beaumont School of Medicine, Rochester, Michigan
²Department of Computer Science and Engineering, Oakland University, Rochester, Michigan
³Department of Neurosurgery, Henry Ford Hospital

INTRODUCTION
Six million people in the United States, or 1 in 50 people, are afflicted with an unruptured intracranial aneurysm (IA). Existing statistical and traditional approaches does not provide accurate rupture prediction nor offer quantitative comparison among a group of risk factors. This study proposes a novel risk assessment methodology, Rupture Criticality index (RCI), that would fill this knowledge gap.

METHODS
Retrospectively analyzed 915 patient records involving treatment for intracranial aneurysms in the last 30 years in the Henry Ford Hospital System. We outline 50 risk factors (RF) in 11 unique intracranial vessel locations out of the dataset. Multivariable analysis was performed on RF combinations, which were defined by size, location, and a third variable from the study design. Frequency distribution methods were applied to define the RCI of each RF combination. Relative Risk and traditional PHASES (n=895) and UIATS (n=215) score performances were evaluated on our dataset for comparison.

RESULTS
Notable RF combinations with the greatest risk for rupture were: Small (4.8 - 8.2 mm) or Medium (8.3 - 14.5 mm) ACoA aneurysms in male patients (RCI=9.87 - 10), Large (14.6 - 22.5 mm) Basilar Tip aneurysms in Caucasian patients (RCI=9.25) or in Generation X (38 - 55 years) patients (RCI=9.35)., and Tiny (< 4.7 mm) PICA aneurysms in Baby Boomer (56 - 73 years) patients (RCI=8.51).

CONCLUSIONS
PHASES and UIATS scores provide weak assistance in the clinical decision-making process of aneurysm management. RCI allows understanding how a group of risk factors contribute towards lifetime rupture risk. This IA rupture risk assessment is a novel approach that identifies high risk clinical presentations and potentially can be used as a guide in treatment management in patients with nontraditional IA presentations.

VIEW POSTER

Comparing Radiological characteristics of Neck Pain in Younger versus Older Patients: A retrospective analysis

Jnana Aditya Challa, B.A.¹, Abdul Majid Khan, M.D.², Varna Taranikanti, M.D./Ph.D.³

¹Oakland University William Beaumont School of Medicine, Rochester, Michigan
²Department of Radiology, Beaumont Health, Royal Oak, Michigan
³Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan

INTRODUCTION
Neck pain commonly occurs during the fifth or sixth decade of life due to degenerative changes in the spine. With increased usage of digital technology from a very young age we hypothesized an earlier age of onset of these degenerative changes. There have been no recent epidemiologic studies that investigated difference in radiological changes seen in older versus younger patients presenting with neck pain. Hence, this study is undertaken to analyze the variability in radiological changes seen in the cervical vertebrae between older (>50) versus younger (≤50) patients presenting with the chief complaint of neck pain.

METHODS
We queried the PACS database at Beaumont Royal Oak and analyzed the data of 110 eligible patients (770 cervical levels). We then constructed various heat maps and graphs to identify the underlying characteristics of neck pain based on age.

RESULTS
C3 to C6 vertebral levels were found to be the most affected across all age groups and foraminal narrowing was the most frequent degenerative change seen, followed by disc spurs. Our study showed that the incidence of foraminal narrowing and disc spurs is much higher in patients >50 as compared to patients ≤50 (P=0.0007, P= 0.006 respectively).

CONCLUSIONS
Our study shows that in younger patients (≤50) with neck pain, no significant degenerative changes are observed radiologically as compared to the older patients. However, a greater number of patients across various hospitals should be analyzed in order to understand the impact of digital technology on the cervical vertebrae of the younger population.

VIEW POSTER

Evaluation of TrenGuard Patient Positioning System

Joshua Volin, B.S.¹, Patrick Herndon, B.S.¹, Michelle Jankowski¹, Deborah Hasenau, RN², Jason Hafron, M.D.^1,2,3

¹Oakland University William Beaumont School of Medicine, Rochester, Michigan
²Michigan Institute of Urology, Troy, Michigan
³Beaumont Hospital, Royal Oak, Michigan

INTRODUCTION
The TrenGuard™ patient positioning device is a comprehensive patient restraint system for patient positioning when in Trendelenburg position during robotic surgery. This study aims to compare patient migration with the TrenGuard™ patient restraint system (TGPRS) to traditional patient restraint with surgical tape and egg crate foam bolsters (STECFB).

METHODS
Patient migration was evaluated by marking the location of the tragus before and after the patient was moved into Trendelenburg position. Trendelenburg position was defined as greater than or equal to 15 degrees of decline. The distance of migration was measured and recorded. The distance of migration was compared between the TGPRS and STECFB. Gender, and Body Mass Index (BMI) was also recorded and evaluated. A two-sample t-test for the continuous measures or a Fisher's exact test for the categorical measures was used for analysis.

RESULTS
43 robotic cases were evaluated. 34 patients (8 robotic hysterectomies, 17 robotic inguinal hernia repairs, and 9 robotic radical prostatectomies) were compared to 9 patients’ robotic inguinal cases with STECFB. The significant associations with shift were type of procedure and gender. Positive shift was defined at 15mm or greater. None of the hysterectomies had shift while 12% of the inguinal hernias and 67% of the prostates had shift (p=0.003). Migration with the TGPRS was not significantly different when compared with STECFB (p=0.403).

CONCLUSIONS
Based on the current results, the TGPRS compared to STECFB did not significantly differ with patient migration. Other advantages like prep time stabilizing the patient, safety and cost should be considered.

VIEW POSTER

Ventricular assist device association in improving outcomes in patients resuscitated from out of hospital cardiac arrest

Julie Tram, B.S.¹, Andrew Pressman, M.D.², Nai-Wei Chen, Ph.D.², David Berger, M.D.², Joseph Miller, M.D.², Robert Welch, M.D.², Joshua Reynolds, MD², James Pribble, MD², Robert Swor, DO², CARES Surveillance Group²

¹Oakland University William Beaumont School of Medicine, Rochester, Michigan
²Beaumont Hospital, Royal Oak Michigan

INTRODUCTION
There has been continued debate on the efficacy of ventricular assist devices (VAD) on improving survival outcomes in post cardiac arrest patients.
The objective of this study is to assess whether the use of VAD is associated with improved survival outcome in patients resuscitated from out-of-hospital cardiac arrest in Michigan.

METHODS
We matched cardiac arrest cases from 2014-2017 in the Michigan CARES Registry (CARES) and the Michigan Inpatient Database (MIDB) using probabilistic linkage.VAD are defined as either IABP or Impella device identified using ICD-9 or 10 procedure codes. Multilevel, multivariable regression analyses were employed to evaluate the impact of device use on survival, adjusting for variables normally predictive of cardiac arrest survival (age, location, witnessed, shockable rhythm).

RESULTS
A total of 3,790 CARES cases were matched with MIDB of which 183 (4.8%) received IABP, 50 (1.3%) Impella, and 1,131 (29.8%) survived to discharge. VAD use was associated with improved survival to discharge (OR=2.07, 95% CI 1.55, 2.77). IABP were used more frequently and associated with an improved outcome (OR=2.16, 95%CI 1.59, 2.93) compared to Impella (OR=1.72, 95% CI 0.96, 3.06). In a multivariable model, however, VAD was no longer associated with an improved outcome (aOR =0.95, 95% CI 0.69, 1.31). In the subset of patients with cardiogenic shock (n=725) we identified an improved survival with VAD (OR= 1.84 95% CI 1.24, 2.73). IABP use was more frequent and associated with an improved outcome (OR=1.98, 95% CI 1.32, 2.98). After adjusting for patient characteristics, VAD increased odds of improved outcome by 14% but was not statistically significant (aOR = 1.14, 95% CI 0.74, 1.77 ).

CONCLUSIONS
Although limited by low frequency of use, VAD or IABP alone was associated with improved outcomes for post arrest care. However, in a multivariable analysis, VAD use was not associated with an independent improvement in post arrest survival.

VIEW POSTER

Spontaneous Pneumomediastinum in Children is Not Associated with Esophageal Perforation

Kevin Roby, M.S.¹, Catherine Barkach, M.S.¹, Diane Studzinski, B.S.², Nathan Novotny, M.D.^1,2, Begum Akay, M.D.^1,2, Pavan Brahmamdam, M.D.^1,2

¹Oakland University William Beaumont School of Medicine, Rochester, Michigan
²Department of Surgery, Beaumont Health, Royal Oak, Michigan

INTRODUCTION
We hypothesize that esophageal perforation is not a common etiology for spontaneous pneumomediastinum (SPM), and that SPM is a self-limited disease not requiring routine admission.

METHODS
We performed a retrospective review of patients, ages 0 to 21 years, diagnosed with SPM in one hospital system (five hospitals) from 2009 – 2019. Cases were identified using ICD-9 and 10 codes and confirmed through chart review. Cases were excluded for trauma, severe infections, or subsequent development of SPM after admission for a separate diagnosis. Data regarding patient characteristics, diagnostic tests, and outcomes were collected, and summary statistics were performed.

RESULTS
We identified 179 cases for inclusion and analysis. The median age at diagnosis was 16 years, and 66% were male. The most common presenting symptoms were chest pain (59%), cough (45%), shortness of breath (44%), vomiting (22%) and neck pain (20%). Only 14 patients (7.8%) complained of difficulty swallowing. Asthma was the most common underlying condition noted (33%). Chest radiography was performed in 97% of patients, chest computed tomography (CT) in 33%, and esophagram in 46 (26%). There were no esophageal perforations noted in this cohort and no interventions specifically for pneumomediastinum. A patient required intubation for asthma exacerbation and underwent a tube thoracostomy for a pneumothorax post-intubation. 121 patients were admitted; the overall median length of stay was 1.14 days. Outpatient follow-up imaging showed resolution in 83% (17.2 days) and improvement in 16% (8.9 days).

CONCLUSIONS
In our series, SPM was not associated with esophageal perforation and did not require specific intervention. We recommend avoiding CT scans and esophagrams unless there is a discrete concern about the esophagus due to the history. Admission for SPM should be based on symptomatology and patient status, rather than the presence of SPM alone.

VIEW POSTER

Elimination Of Postoperative Narcotics In Infant Robotic Pyeloplasty Using Caudal Anesthesia And A Non-Narcotic Pain Pathway

Kwesi Asantey, B.A.¹, Kristen Meier, M.D.², Zachary Rollins¹, Andrew Banooni, M.D.³, Zachary Liss, M.D.^1,2

¹Oakland University William Beaumont School of Medicine, Rochester, Michigan
²Department of Urology, Beaumont Health, Royal Oak, Michigan
³Department of Anesthesia, Beaumont Health, Royal Oak, Michigan

INTRODUCTION
Research suggests that narcotic pain medications are dramatically overprescribed. We hypothesize that narcotics are unnecessary in the majority of infants for postoperative pain control. In this series, we report our experience combining caudal blocks with a non-narcotic postoperative pathway as a means of completely eliminating postoperative narcotics following infant robotic pyeloplasty.

METHODS
We reviewed 24 consecutive patients who underwent robotic pyeloplasty by a single surgeon treated with an end-procedure caudal block followed by a non-narcotic postoperative pain pathway treated between May 2017 and May 2021. The standardized postoperative pathway consisted of an end procedure caudal block followed by alternating IV acetaminophen and ketorolac. We reviewed demographics, outcomes and unscheduled healthcare encounters within 30 postoperative days.

RESULTS
63% (15/24) patients were male and average age was 12.1 months (range 4-34 months). 58% (9/15) underwent surgery on the left. 16.7% (4/24) of patients received a single postoperative dose of narcotics in the PACU. No patient required narcotic prescriptions at discharge or anytime thereafter. Average length of stay was 1.13 days. There were no pain related unscheduled visits, or phone calls after discharge.

CONCLUSIONS
This series supports the fact that narcotics are not routinely needed for infants following robotic pyeloplasty. Post-procedure caudal block is likely a good addition to a non-narcotic pathway. In the future, we intend to expand these findings to other pediatric urologic procedures in the hope of eliminating unnecessary narcotic use.

VIEW POSTER

Meta-Analysis Reveals Multiple Disease Processes Underlying Genetic Differences in Schizophrenia

Leena Raza, B.A.¹, Jihad Aljabban, M.D.², Dexter Hadley, M.D.³, Gustavo Patino, M.D./Ph.D.⁴

¹Oakland University William Beaumont School of Medicine, Rochester, Michigan
²University of Wisconsin Hospital and Clinics, Madison, Wisconsin
³University of Central Florida College of Medicine, Orlando, Florida
⁴Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan

INTRODUCTION
Schizophrenia is a severe mental illness that results in dysregulation in multiple brain systems. Men and women have different clinical presentations of schizophrenia (age of onset, disease severity, symptoms, treatment response). The etiology is not completely understood, but studies have pointed to different genetic pathways between genders. Our research’s goal is to reveal new differences in pathogenesis between genders that can be further studied for therapeutic purposes.

METHODS
We employed the Search Tag Analyze Resource for GEO platform to access Gene Expression Omnibus database for genomic data. We tagged 76 samples of superior temporal gyrus (STG) tissue (women: 19 cases, 18 control; men: 21 cases, 18 controls) and 171 samples of prefrontal cortex (PF) tissue (female: 28 cases/controls; male: 61 cases, 54 controls). We analyzed the data through Ingenuity Pathway Analysis (IPA) and filtered genes based on significance (p<0.05).

RESULTS
Based on meta-analysis results, both gender STG tissues showed cancer as the top disease network. For PF tissue, seizure was in the top disease networks for men. For STG tissue, in men, SOX2 and TCF7l2 was a top upstream regulator with predicted activation as down-regulated, but not in women.

CONCLUSIONS
There is a higher incidence and mortality of cancer among schizophrenic patients; in our research, the most upregulated genes had a significant overlap with gene patterns in cancer, implying a genetic component to this association. Men showcase lower medical insight than women. SOX2 was an up-regulated enzyme in STG male tissue vs. women and is associated with lower insight. TCF712 is also a strong risk factor for diabetes mellitus 2 (DM2). It was suppressed in STG male tissue, but not women. This correlates with the higher incidence of DM2 among female schizophrenic patients relative to men. SOX2 and TCF712 should be studied further to explore therapeutic or prognostic benefits for schizophrenic patients.

VIEW POSTER

Perioperative Antibiotic Use in Neonatal Surgery

Lior Kopel, B.S.¹, Patrick Karabon, M.S.¹, Nathan Novotny, M.D.², Begum Akay, M.D.², Pavan Brahmamdam, M.D., M.S.²

¹Oakland University William Beaumont School of Medicine, Rochester, Michigan
²Beaumont Children’s Pediatric Surgery, Beaumont Health, Royal Oak, Michigan

INTRODUCTION
The ideal duration of perioperative antibiotic prophylaxis to prevent surgical site infection (SSI) in neonates is undetermined. The aim of this study is to evaluate the association between the duration of perioperative antibiotics and SSIs in the neonatal surgical population.

METHODS
We performed a retrospective review of patients <30 days old who underwent surgery at a single children’s hospital from 2014 through 2019. Patient demographics, duration of antibiotics, and surgical details were collected. The patients were divided into three groups based on antibiotic duration (no antibiotics, <48 hours, >48 hours). The primary outcome was the development of SSI. Continuous variables were compared using one-way analysis of variance (ANOVA) and categorical variables were compared using chi-square tests. Variable importance indices were also done using recursive partitioning.

RESULTS
There were 155 patients who met our study criteria. The mean gestational age was 37.77 weeks with a mean birthweight of 2.96 kg. Of the entire cohort, 12.26% developed an SSI. In the 80 clean cases, 45 did not receive antibiotics, 21 received <48 hours, and 14 received >48 hours of antibiotics. The incidence of SSI in these 3 groups was 4.44%, 14.29%, and 14.29%, respectively (p=0.30). Of the 75 clean-contaminated and contaminated cases, the incidence of SSI in the no antibiotic group was 0%, 19.05% in the <48-hour group, and 18.18% in the >48-hour group (p=0.33). The variables in order of relative importance for SSI development were as follows: gestational age (100%), age at surgery (71.41%), birthweight (62.3%), and length of antibiotics (47.87%).

CONCLUSIONS
Antibiotic prophylaxis greater than 48 hours was not associated with decreased incidence of SSI. Risk factors for SSI development were gestational age, age at surgery, and birthweight. Post-operative antibiotic duration greater than 48 hours likely does not confer additional protection to this special population.

VIEW POSTER

Relationship Between Obesity and Triple-Negative Breast Cancer: A Retrospective Study

Mariam Aoun, B.S.¹, Anna Jahshan, B.S.¹, Nayana Dekhne, M.D.², Varna Taranikanti, M.D./Ph.D.³

¹Oakland University William Beaumont School of Medicine, Rochester, Michigan
²Department of Breast Surgery, Beaumont Hospital, Royal Oak, Michigan
³Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan

INTRODUCTION
Several research studies have identified a positive correlation between obesity and specific receptor statuses in breast cancer, including ER-positive, PR-positive, and HER2-positive breast cancers. However, triple-negative breast cancer (TNBC) in particular has not been studied in relation to body mass index (BMI), which suggests that an analysis of triple-negative breast cancer and its relation to obesity is warranted. This study aims to analyze the association between triple-negative breast cancer and BMI through a retrospective analysis in order to further guide patient counseling about TNBC risk factors.

METHODS
The study is a retrospective review using data from the Beaumont Health System of female patients who were diagnosed with triple-negative breast cancer within the last ten years, and who had at least two years of follow-up. Based on the inclusion criteria, 98 patients were chosen and analyzed to establish a correlation between BMI and TNBC with regard to prognostic factors. The statistical analysis was conducted using unequal variance t-test, Fisher exact test, and Chi-Square test.

RESULTS
Of the 98 patients in the dataset, 67% were in the non-obese group (BMI < 30) and 33% were in the obese group (BMI > 30). There was no significant difference between the two groups with regard to any of the analyzed prognostic factors, including T-stage (p-value = 0.33), nodal stage (p-value = 0.26), and pathologic grade (p-value = 0.67).

CONCLUSIONS
There was no association between BMI classification and prognosis of TNBC. However, this study is a single-institution study that included a small sample size that met the inclusion criteria, and more studies are warranted to further investigate this relationship.

VIEW POSTER

The Recurrent Laryngeal Nerve and Its Vulnerability in Thyroid Surgeries

Michael Kabbash, B.S.¹, Jickssa Gemechu, Ph.D.²

¹Oakland University William Beaumont School of Medicine, Rochester, Michigan
²Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan

INTRODUCTION
Although thyroid surgical procedures are very common, research findings have shown that post-operative complications may affect the patient’s quality of life. To minimize the rate of these occurrences, researchers have studied the branching patterns of the recurrent laryngeal nerve (RLN) to avoid its iatrogenic injury. Awareness of variations and anatomical relationship of RLN’s with the inferior thyroid artery (ITA) is clinically significant to preserve the nerve and minimize associated post-operative symptoms. The normal course and relationship of RLN is superior to the ITA and posterolateral to the ligament of Berry; however, it has been noted that its course can be different, and the identification of different branching patterns is important in thyroid surgeries. Failure to do so increases the possibility of iatrogenic injury, which can lead to hoarseness, loss of voice, or closure of the vocal cords during bilateral RLN damage.

METHODS
In this study, 34 formalin-fixed cadavers were carefully dissected and examined, with the course and relationship of the RLN and ITA evaluated and documented bilaterally. Cadavers with anatomical variations were photographed and the data was analyzed quantitatively.

RESULTS
Our findings indicate that out of 34 cadavers, 55.8% of the RLNs were related superiorly to the respective ITAs, and 44.11 % were related inferiorly. In addition, the branching pattern findings indicate that 50% of the RLNs bifurcated, 41.17 % trifurcated, and 8.82% had four branches. Altogether, the findings show a significant amount of variation in the relationship and branching pattern of the RLN and ITA.

CONCLUSIONS
The different branching patterns of the RLN increases its vulnerability during ligation of the ITA in thyroid surgeries. Knowledge of these variable relationships is critical for identification and isolation of the neurovascular structures in order to preserve the nerve, prevent voice hoarseness, and minimize the risk of voice loss in thyroid surgeries.

VIEW POSTER

Characterization of CD57+ T-cell subset in Blood, Bone Marrow, and Lymphoid Tissue

Michelle Ka Yan Wu, B.S.¹, Xia Chen,M.D.², James Huang,M.D.²

¹Oakland University William Beaumont School of Medicine, Rochester, Michigan
²Department of Pathology, Beaumont Health, Royal Oak, Michigan

INTRODUCTION
A CD57+ T-cell subset has shown to have diagnostic and prognostic significances in some cancers. However, its specific distributions in tissues and specific variations among different diseases are yet to be further defined. This Embark project aims to examine the distributions and antigen expression profiles in the CD57+ T-cell subset in peripheral blood (PB), bone marrow (BM), and lymph node (LN).

METHODS
247 samples were retrospectively studied. The 10 color multi-parameter flow cytometry data with antibody combination including CD2, CD3, CD4, CD5, CD7, CD8, CD16, CD45, CD57 and CD56 were reanalyzed with Kazula software. Patients’ age, gender, tissue specimen types, and pathology diagnosis were retrieved in pathology databases (SoftFlow and Epic). Student T-test was run to identify any statistically significance between different tissue types with or without neoplastic infiltrate.

RESULTS
The numbers of CD57 T-cells were highly variable, ranging from 0.4% to 67.0% of total T-cells among all samples. The average frequency of CD57 T-cells in LN with neoplasms was 17.2% while the frequency in LN without neoplasms was 7.3% (p<0.05). The average frequency of CD4+CD8+ (12.7%), CD16+CD56- (3.0%), and CD16+CD56+ (2.9%) in the LN were significantly different (p<0.05) from that in PB and BM. Both PB and BM showed no difference (p>0.05) in the frequency of CD4+CD8+ (6.4% vs 8.3%), CD16+CD56- (9.7% vs. 5.6%), and CD16+CD56+ (7.8% vs 8.5%).

CONCLUSIONS
The frequency of reactive CD57+ T-cells was statistically lower in LN with neoplasms than those without neoplasms. However, such a difference was not observed in PB and BM. CD57+ T-cells showed similar immunophenotypic profiles in PB and BM. LN samples, however, had higher CD4:CD8 ratios, more CD4+CD8+ subsets, and less CD16+ subsets. Our findings provided a foundation for future investigation of these CD57+ T-cells in cancer immunology.

VIEW POSTER

Prediabetes as a risk factor for major adverse cardiovascular events

Muhammad A. Waheed, B.S.¹, Ramy Mando, M.D.², Adrian Michel, M.D.³, Alexandra Halalau, M.D.³

¹Oakland University William Beaumont School of Medicine, Rochester, Michigan
²Department of Cardiovascular Medicine, Beaumont Health, Royal Oak, MI
³Department of Internal Medicine, Beaumont Health, Royal Oak, MI

INTRODUCTION
Major adverse cardiac events (MACE) have been shown to be associated with Type II diabetes mellitus (DM) as it is a proinflammatory process. Some DM inflammatory markers may be present in prediabetes (pDM). Yet, the clinical relationship between pDM and MACE has not been well studied. Thus, this study’s primary goal is to see if pDM increases one’s risk for MACE.

METHODS
A retrospective chart analysis was performed at Beaumont Health, Michigan between 2006 and 2020. Patients were divided into 5 groups based on hemoglobin A1c (HbA1c) trends over the duration of the study. Patients were stratified based on the following criteria: pDM patients who remained pDM (G1); pDM who progressed into DM (G2); pDM who normalized their HbA1c (G3); patients who maintained a normal HbA1c (G4); patients with HbA1c persistently in the DM range (G5). Univariate and multivariate regression analyses were conducted to compare MACE between the groups.

RESULTS
A total of 119,271 patients were included in the study (G1: N = 13,520, G2: N = 6314, G3: N = 1585, G4: N = 15,018, G5: N = 82,834). Pairwise comparison revealed a statistically significant increase in the odds of MACE in all groups compared to those with normal HbA1c values (G1, G2, G3, G5 vs G4; p < .001). Multivariate regression adjusting for baseline characteristics revealed an elevated adjusted odds ratio of MACE in patients with persistent pDM (G1; aOR = 1.087, p = .002) and diabetes (G2/G5; aOR = 1.25 and aOR = 1.18, p < .001) compared to individuals with normal HbA1c values.

CONCLUSIONS
This study has elucidated that prediabetes is a risk factor for MACE. Patients with elevated pDM should aim to normalize their HbA1c as patients who manage to normalize their HbA1c values appeared to decrease their adjusted risk for MACE.

VIEW POSTER

Differences Within a Health System: Imaging Use for Suspected Pediatric Appendicitis

Nafisa Bhuiyan, B.S.¹, Ryan Nierstedt, B.S.¹, Michelle Jankowski¹, Shanna Jones, M.D.^1,2, Aveh Bastani, M.D.^1,2

¹Oakland University William Beaumont School of Medicine, Rochester, Michigan
²Department of Emergency Medicine, Beaumont Health, Troy, Michigan

INTRODUCTION
Ultrasound (US) is the first line imaging used for suspected pediatric appendicitis. However, following equivocal US findings and its lower negative predictive value for ruling out appendicitis, Computed Tomography (CT) imaging is often performed in children. This study investigates the differences in imaging utilization between a community hospital (Beaumont Troy) and a children’s ED hospital (Beaumont Royal Oak), making it the first study to evaluate suspected pediatric appendicitis in Beaumont Health System. It also aims to further characterize differences in patient outcomes such as surgery, length of hospital stay, complications of appendicitis, and highlight the need to reduce unnecessary CT use due to its radiation exposure.

METHODS
Following IRB approval, this retrospective mixed-methods chart review analyzed patients ages 4-17, who initially received an abdominal US in the ED for abdominal pain associated with suspected appendicitis between January 1st, 2016 – January 1st, 2019 in Beaumont Troy and Royal Oak hospitals. Variables of interests were compared between hospitals using unequal variance two sample t-test, Chi-Square, and Fisher Exact tests. Pathology reports determined a definitive diagnosis of appendicitis.

RESULTS
In the ED, 1,672 patients (1113 from Royal Oak, 559 from Troy) were suspected to have appendicitis. The community hospital performed significantly more CT imaging (P=0.0007), had longer length of stay in the ED (P <.0001), shorter length of surgery, (P= 0.0026), than the children’s hospital. There were no significant differences in complication rates (perforation P=0.5699, Abscess P=0.1060), total hospital length of stay (P=0.0691), percent receiving surgery (P=0.0543) between the hospitals.

CONCLUSIONS
This study confirmed our prediction and prior studies showing the community hospital utilizing more CT imaging for suspected appendicitis than the children’s hospital, despite no difference in surgical interventions or complication rates at the community hospital. Further investigation is necessary to decrease reliance on CT imaging after equivocal US findings in Beaumont Health System.

VIEW POSTER

Identifying Discrepancies in Diagnosis of PCOS with Use of Different Diagnostic Criteria

Naveena Daram, B.S.¹, Sangeeta Kaur, M.D.²

¹Oakland University William Beaumont School of Medicine, Rochester, Michigan
²Department of Obstetrics and Gynecology, Beaumont Hospital, Royal Oak, Michigan

INTRODUCTION
Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. Two main diagnostic criteria are used for PCOS: the Rotterdam and Androgen Excess Society (AES) criteria. Depending on which criteria is used, the diagnosis of PCOS may change. Therefore, our study investigates the discrepancies in the diagnosis of PCOS when using the Rotterdam versus the AES scale in the Beaumont Health System. This is clinically significant because a PCOS diagnosis should not be made lightly as it can come with many lifelong social, emotional, and medical implications.

METHODS
Charts from patients in the Beaumont Health System will be assessed for a variety of inclusion of exclusion criteria, such as age (12<x<51) and gender (female), in the time frame of January 2012 to January 2019. Of those, 100 charts will be chosen for further analysis of variables such as the criteria used to diagnose PCOS and the lifelong implications of that diagnosis. The Fleiss kappa statistic will be used to test the inter-rater reliability. Descriptive statistics such as age, ethnicity, family history, social history, and race will be collected in order to eliminate any confounding variables.

RESULTS
We anticipate that our results will reveal significant discrepancies in the diagnosis of PCOS in patients depending on whether the Rotterdam or AES criteria is used. Specifically, we expect that a greater subset of patients will receive a diagnosis of PCOS with the Rotterdam scale.

CONCLUSIONS
The results are expected to support our hypothesis that misdiagnoses or underdiagnoses of PCOS is possible when using the Rotterdam and AES criteria, respectively. This will provide insight into how future physicians should manage a possible PCOS diagnosis.

VIEW POSTER

Does Aspirin Reduce Risk for Future Cardiovascular Events in Women with Diabetes?

Olivia Hillier, B.A.¹, Amna Zeb, M.D., MPH², Pamela Marcovitz, M.D.²

¹Oakland University William Beaumont School of Medicine, Rochester, Michigan
²Ministrelli Women’s Heart Center, Beaumont Health System, Royal Oak, Michigan

INTRODUCTION
The use of low dose aspirin (LDA) in primary prevention of cardiovascular events (CVE) is no longer recommended due to lack of benefit in prevention of primary outcome and increased bleeding risks. It’s postulated that LDA could still be of benefit in those with very high vascular risk including diabetes mellitus (DM) as it confers a higher risk for future CVE in women as compared to men. We conducted a meta-analysis to determine if use of low dose ASA is beneficial to lower CVE in women with multiple risk factors.

METHODS
A literature review was conducted using key words: “randomized clinical trials”, “aspirin”, “primary prevention”, “cardiovascular events”, “males”, “females”, “hypertension, hyperlipidemia, smoking, and diabetes”. Databases searched were PubMed, Embase and Web of Science. Data was entered and analyzed using RevMan. Analysis for risk of bias was conducted. Random effects model was used to deal with heterogeneity of the data.

RESULTS
Of 309 trials initially identified, 4 studies met the criteria and were included in the meta-analysis. Risk of primary outcome was defined as death from any coronary artery disease or fatal myocardial infarction. The primary outcome in women was 585/10,950 and men was 578/10,300 in aspirin group and 612/10,950 women and 575/10,300 men in placebo group. The risk ratio in women versus men in aspirin group was 1.02 (95% CI: .65-1.60, p=.93) whereas the risk ratio for in women versus men in placebo group was 1.09 (95% CI: .63-1.88, p=.75).
The number of women assigned to LDA with primary outcome was slightly less as compared to women in the placebo group, [1.02(.65-1.60) vs. 1.09(.63-1.88)] particularly in studies that included patients > 65 years of age (not statistically significant).

CONCLUSIONS
Women with multiple cardiovascular risk factors including DM may benefit from LDA to prevent future CVE. Future studies are needed to confirm this hypothesis.

VIEW POSTER

Association of Gut Metabolomic Biomarkers with Sleeve Gastrectomy Weight-Loss Outcomes

Pamela Spicer, B.S.¹, Wendy Miller, M.D.²

¹Oakland University William Beaumont School of Medicine, Rochester, Michigan
²Beaumont Hospital, Royal Oak, Michigan

INTRODUCTION
Obesity is a prevalent health challenge with high morbidity and many associated chronic diseases. Sleeve gastrectomy is currently the predominant intervention for obesity. However, weight loss results are variable. The mechanisms and factors influencing this variability are not well understood. We evaluated the correlation of metabolomic biomarkers with weight-loss

METHODS
48 patients undergoing sleeve gastrectomy (SG) at Beaumont-Royal Oak and Beaumont-Troy Hospitals were recruited from the Royal Oak Weight Control Center (WCC). Serum and stool collections were taken at baseline and at three-months post-surgery. Patients were separated into tertiles based on weight loss outcomes post-surgery. The metabolomic profiles of the feces and serum were evaluated and quantitatively profiled using a combination of 1H NMR and DI-LC-MS/MS (AbsoluteIDQ P180 kit (Biocrates, Innsbruck)).

RESULTS
Percent total weight loss (%TWL) for the lowest versus the highest weight loss tertiles (T1 vs T3) was 11.1 + 0.8% and 17.0 + 1.3%, p<0.001. Patients with successful weight loss (T3) at three months, when compared to all patients at baseline, were found to have significant alterations in arachidonic acid (AA), taurine and hypotaurine metabolism, and bile acid biosynthesis (p<0.05). (Fig 1). Compared to patients at baseline, patients with poor post-op weight loss (T1) at three months had significant alterations in metabolites related to porphyrin metabolism, ammonia recycling, and bile acid biosynthesis, but not AA metabolism (p<0.05). Serum analyses are pending.

CONCLUSIONS
We found that significant alterations in fecal AA metabolism correlates with increased weight loss, while significant alterations in porphyrin metabolism correlates with poor weight loss. AA metabolites have been linked to the pathophysiology of obesity and the initiation and resolution of inflammation. Disorders of porphyrin metabolism have been associated with insulin resistance and metabolic syndrome. Further, we anticipate finding correlations between serum metabolites and weight loss outcomes.

VIEW POSTER

CSF Flow Cytometry in Patients with Leukemia and Lymphoma

Patricia Rusli, B.S.¹, James Huang, M.D.²

¹Oakland University William Beaumont School of Medicine, Rochester, Michigan
²Department of Clinical Pathology, Beaumont Health System, Royal Oak, Michigan

INTRODUCTION
The use of flow cytometric testing in analyzing bodily fluid for hematologic neoplasms is not novel. Flow cytometric immunophenotyping of cerebrospinal fluid (CSF) has previously been demonstrated to have high sensitivity and specificity for the detection of lymphoma and leukemia. They are able to determine definitive diagnostic information from even very low cellularity samples. In this study, we reviewed the experience of our clinical flow cytometry laboratory in evaluating CSF specimens in order to find the disease distribution of positive CSF samples.

METHODS
We retrospectively analyzed 382 cases with CSF samples that previously had been studied with flow cytometry for B-cell lymphoproliferative disorders in the Beaumont Hospital. Their ages ranged from 9-90 (median: 58). The process of case identification requires us to reanalyze archived flow cytometry data using Kaluza software, a software package that is routinely used in the Beaumont Flow cytometry lab. Specifically, CSF samples are reanalyzed to see if they contain any abnormal cells. We separated the cases based on flow cytometry results and these cases were further examined by their age, gender, diagnosis, CSF WBC, CSF lymphocyte, CSF monocytes, CSF neutrophils and CSF proteins.

RESULTS
Acute Myeloid Leukemia (AML) is the most positively associated with CSF involvement, accounting for 70% positive specimens and 80% patients with positive CSF flow cytometry. Compared to the negative flow cytometry, the positive flow cytometry specimens contain a significant increase in white blood cells (WBC) counts (p-value = 0.02).

CONCLUSIONS
The results reinforced the significance of CSF flow cytometry in patients with leukemia and lymphoma. This is especially true for patients with acute myeloid leukemia. A high white blood cells counts in the CSF is statistically significant for positive flow cytometry and we might not need the flow cytometry in patients with low CSF white blood cells.

VIEW POSTER

Let Them Play: A Prospective Study of Postoperative Activity Restrictions in Children

Rachel Harvey, B.S.¹, Begum Akay, M.D.^1,2, Diane Studzinski, B.S.², Nathan Novotny, M.D.^1,2, Anthony Stallion, M.D.^1,2, Pavan Brahmamdam, M.D.^1,2

¹Oakland University William Beaumont School of Medicine, Rochester, Michigan
²Beaumont Health Department of Surgery, Royal Oak, Michigan

INTRODUCTION
We aim to compare time to resume full activity, postoperative outcomes, and describe family preferences of self-directed activity restrictions (SDAR) and physician-directed activity restrictions (PDAR) following routine pediatric surgeries.

METHODS
We conducted a single-institution, clinical trial from January 2020 to February 2022. Patients who presented for an inguinal hernia repair (ages 2-13) or laparoscopic appendectomy (aged ≤ 18) were eligible for participation. Participants chose to enroll in either the control (PDAR) or experimental (SDAR) groups. Control patients were instructed to restrict full activities (including sports, heavy lifting, etc.) for two weeks. For SDAR, patients were instructed to return to full activity when the patient and family felt comfortable enough to do so. Postoperatively, participants were asked to complete a survey to assess time to resume full activity, surgical complications, and patient and caregiver satisfaction.

RESULTS
Eleven patients selected PDAR and 44 selected SDAR. The mean age was 10.4 years. The majority of patients underwent laparoscopic appendectomy (78.2%). The average time to resume full activity was 12 days for PDAR and 9.5 days for SDAR (p = 0.328). There was no difference in parent satisfaction between the study arms. (p >0.999). There was no statistically significant difference in postoperative complications (p >0.999).

CONCLUSIONS
The time to resume full activity was three days shorter for SDAR. While this was not statistically significant, this difference may be clinically relevant. The study is limited by the small sample size and that participating families overwhelmingly preferred SDAR to PDAR. There were no differences in complications between the two groups. Families more frequently chose to guide their own activities postoperatively. There are psychosocial benefits to children resuming normal activities, and SDAR may lessen a family’s societal burden through decreased school absences and missed workdays. Therefore, we propose that SDAR is safe and should be utilized for routine surgery.

VIEW POSTER

Clearance of the Cervical Spine in Obtunded Pediatric Blunt Trauma Patients: Quality Assessment of an Existing Clearance Pathway

Rachel Kalthoff, MS4¹, Elizabeth Boudiab, M.D.², Diane Studzinski, BS², Nathan Novotny, M.D.^1,3, Pavan Brahmamdam, M.D.^1,3, Begum Akay, M.D.^1,3

¹Oakland University William Beaumont School of Medicine, Rochester, Michigan
²Beaumont Health, Royal Oak, Michigan
³Beaumont Children’s, Royal Oak, Michigan

INTRODUCTION
Obtunded patients following blunt trauma need clearance of the cervical spine (c-spine) that cannot depend on a clinical exam. Our center’s current pediatric c-spine evaluation pathway includes both Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). The objective of this study was to review our use of both CT and MRI for obtunded pediatric trauma patients to assess the quality of our pathway and utility of MRI.

METHODS
We performed a retrospective review of pediatric blunt trauma patients at our Level II Pediatric Trauma Center between January 2010 and December 2019. Patients age 0-18 with a Glasgow Coma Score (GCS) <10 were included. Patient charts were reviewed for age, sex, GCS, mode of injury, CT and MRI results, time from admission to CT and MRI, and c-spine treatments.

RESULTS
Forty-six patients met inclusion criteria with a median age of 13.5 (IQR 7-16) and median GCS of 4 (IQR 3-7). Forty-three patients had a normal c-spine CT. Of these, 16 patients received MRI due to persistent neurologic depression. MRI identified 3 injuries (18%). One patient required prolonged cervical collar immobilization and another required surgical immobilization with halo placement.

CONCLUSIONS
In obtunded patients, MRI adds value by identifying injuries needing intervention that were not seen on CT. These findings justify inclusion of MRI in our clinical pathway for pediatric c-spine clearance. This standardized pathway should lower the chance that unstable ligamentous injury is missed.

VIEW POSTER

Comparison of Readmission Rates of Thyroidectomy Based on Surgical Indication, Outpatient vs. Inpatient Surgery, and Comorbidities Present

Rachel Patterson, B.S.¹, Patrick Karabon, M.S.¹

¹Oakland University William Beaumont School of Medicine, Rochester, Michigan

INTRODUCTION
A thyroidectomy is the removal of all or part of the thyroid gland. It is the most common endocrine surgery in the United States and is mostly performed as a total thyroidectomy, which is the removal of the entire organ. With increased awareness of the risks of hospitalization and emphasis on reduction of healthcare costs, there has been rising interest in performing thyroidectomy as an outpatient procedure. This study will compare inpatient and outpatient procedures readmissions. It will also address comorbidities between both groups, which can impact the decision to perform an outpatient thyroidectomy vs. inpatient. This study will also analyze readmission rates according to indication for thyroidectomy to see which indications are at higher risk for complications.

METHODS
This study will use the National Readmissions Database from 2011-2016 in order to do statistical analysis of readmission rates for indications of thyroidectomy (thyroid cancer, goiter, nontoxic nodular goiter, graves disease, thyrotoxicosis, acquired hypothyroidism, and thyroiditis), comorbities present, and outpatient vs. inpatient surgery.

RESULTS
Thyroidectomies with readmissions were 98.38% Inpatient procedures and 1.62% Outpatient procedures compared to thyroidectomies with no readmission which was 97.89% Inpatient and 2.11% Outpatient. 42.51% of readmissions were patients with Cancer of the Thyroid, 5.66% were Goiter, 4.65% Graves Disease, 9.25% Thyrotoxicosis, 12.29% Acquired Hypothyroidism, 4.91% Thyroiditis, and 2.41% Other Disorders of the Thyroid.

CONCLUSIONS
Patients with comorbidities present were more likely to be readmitted following thyroidectomy with no particular comorbidity that stood out with a high degree of correlation. Outpatient procedures had a slightly smaller chance of readmission compared to inpatient procedures, supporting the thought that outpatient procedures are a safe alternative, though these are generally performed on healthier patients. The indication with the highest rate of readmission was thyroid cancer. This was expected since these patients are generally sicker and the surgery can be more difficult to perform.

VIEW POSTER

Aneurysmal Bone Cysts of Craniofacial Bones: A Systematic Review

Rafey Rehman , B.S.¹, Antonio Dekhou, B.S.¹, Muhammad Osto, B.S.², Jacob Agemy, B.S.³, Brian Yuhan, M.D.⁴, Eric Thorpe, M.D.⁴

¹Oakland University William Beaumont School of Medicine, Rochester, Michigan
²Wayne State University School of Medicine, Detroit, Michigan
³Michigan State University College of Human Medicine
⁴Department of Otolaryngology–Head and Neck Surgery, Loyola School of Medicine

INTRODUCTION
Objectives: Aneurysmal bone cysts (ABCs) are blood filled, locally destructive, benign bone tumors. Our objective was to conduct a systematic review outlining patient demographics, clinical characteristics, management, and outcomes of those with aneurysmal bone cysts of the craniofacial bones.

METHODS
Following PRISMA guidelines, a systematic review was conducted. Using PubMed, Cochrane, and Embase databases, 116 studies were included. Data including patient demographics, clinical characteristics, treatment strategies, and patient outcomes were collected.

RESULTS
A total of 125 patients from 116 studies were identified. Age ranged from 10 months to 90 years, with a mean age of 18.8 years. The most commonly affected craniofacial locations were the mandible (n=31, 24.8%), skull base (n=25, 20.0%), and temporal bone (n=20, 16.0%). The most common presenting symptoms included a nontender mass (n=43, 34.4%), a tender mass (n=31, 24.8%), and generalized headache (n=31, 24.8%). Imaging modalities included CT and MRI (n=77, 61.6%), CT alone (n=31, 24.8%), and MRI alone (n=8, 6.4%). All patients underwent surgical resection, with one patient requiring adjuvant radiation in addition to surgery. 119 patients were disease and symptom free without evidence of recurrence (17.4 month mean followup).

CONCLUSIONS
The current literature's characterization of ABCs in craniofacial bones is limited by case reports and case series. Given the rarity of these tumors, head and neck surgeons must rely on systematic reviews such as the present analysis to guide management.

VIEW POSTER

Cardiorespiratory, Hemodynamic, and Perceived Exertion Responses to Seated Chair Exercise

Ryan Khemraj, B.S.¹, Cristian Solano, B.S.¹, Neesirg Patel, B.S.¹, Roger Sacks, B.S.²

¹Oakland William Beaumont School of Medicine, Rochester, Michigan
²Senior Physiologist, Preventive Cardiology and Cardiac Rehabilitation, Beaumont Health, Royal Oak, Michigan

INTRODUCTION
The increasing prevalence of cardiovascular disease (CVD) and its sequelae in the United States population has led to escalating health care expenditures. To favorably modify cardiovascular outcomes, exercise physiologists have developed varied exercise programs that are associated with mortality reduction, symptom relief, improved exercise tolerance, favorable risk factor modification and improved psychosocial well-being. For patients with significant disability and deconditioning, chair-based exercise may provide an alternative method of achieving the relative cardioprotective benefits of traditional exercise.

METHODS
In this study, we will recruit 12-15 previously sedentary, asymptomatic middle-aged and older individuals without known cardiovascular disease. Subjects will have participated in a recent cardiopulmonary exercise stress test (past 4 months), and screened for any recent cardiac event (past six months) or any underlying cardiovascular pathology via an echocardiogram to rule out structural cardiovascular abnormalities. Participants will consent to the study and participate in a 5-8-minute seated exercise routine with ECG and cardiorespiratory monitoring.

RESULTS
Subjects of the pilot study (n=2) were able to achieve average values of energy expenditure expressed as metabolic equivalents (METs) > 3 METs and peak values > 4.5 METs during seated chair exercise.

CONCLUSIONS
The pilot study showed that our subjects were able to achieve a moderate levels of energy expenditure (~3-4.5 METs) during a chair-based exercise routine. The promising results of this study warrant future studies to confirm the acute hemodynamic and cardiorespiratory responses to chair-based exercise. In the setting of cardiac rehabilitation and in physical rehabilitation regimens for the elderly, chair-based exercise may eventually play a significant role in improving cardiovascular outcomes for those patient populations.

VIEW POSTER

Imaging For Suspected Pediatric Appendicitis. Can Ultrasound Alone Be Trusted?

Ryan Nierstedt, B.S.¹, Nafisa Bhuiyan, B.S.¹, Michelle Jankowski, M.S.¹, Lauren DeSantis, B.S.², Aveh Bastani, M.D.^1,2, Shanna Jones , M.D. ^1,2

¹Oakland University William Beaumont School of Medicine, Rochester, Michigan
²Department of Emergency Medicine, Beaumont Hospital, Troy, Michigan

INTRODUCTION
Diagnosis of pediatric appendicitis relies on a combination of laboratory results, diagnostic imaging, and clinician judgement. However, the necessity of CT imaging has been questioned given radiation exposure. Therefore, ultrasound imaging has become a useful diagnostic tool, yet its sensitivity in identifying appendicitis is often lower in comparison to CT. This study aims to determine the sensitivity of US imaging for pediatric appendicitis and if differences exist in the diagnosis of appendicitis utilizing both CT and ultrasound or ultrasound alone.

METHODS
After obtaining IRB approval, patients 4-17 years of age who received an abdominal ultrasound and/or additional abdominal CT imaging at Beaumont Royal Oak and Troy emergency departments between January 1st, 2016 and January 1st, 2019 were reviewed. Radiology reports were reviewed to determine if the appendix was visualized, and if a diagnosis positive or negative for appendicitis was made. Comparisons between imaging modalities were done using Fisher's Exact tests and sensitivity of predicting appendicitis between imaging cohorts were computed using reviewed pathology reports, when present, as the gold standard for appendicitis.

RESULTS
1,672 patients were included in our cohort (1,113 from Royal Oak, 559 from Troy). 77% of patients with suspected appendicitis only received an ultrasound, while 23% underwent additional CT imaging. Of the 1,672 patients imaged for appendicitis, 384 received an appendectomy (23%). For positive ultrasound tests, there was no difference in the rates of appendicitis in those who received CT imaging and ultrasound when compared to those who received ultrasound alone (p>0.99). The sensitivity in determining appendicitis using ultrasound alone was 0.95 for Royal Oak and 0.93 for Troy.

CONCLUSIONS
While the diagnosis of appendicitis in the pediatric population is multifaceted and should be individualized to each patient, our data demonstrates that a positive ultrasound finding alone may be sufficient for diagnosis without further CT imaging.

VIEW POSTER

Dietary supplement use among BRCA1/2 mutation carriers

Ryan Rogers, B.S.¹, Tara Rangarajan, MPH², Virginia Uhley, Ph.D.³, Kristina Ivan, M.S.², Dana Zakalik, M.D.^2,4

¹Oakland University William Beaumont School of Medicine, Rochester, Michigan
²Nancy and James Grosfeld Cancer Genetics Center, Beaumont Health, Royal Oak, Michigan
³Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
⁴Beaumont Cancer Institute, Beaumont Health, Royal Oak, Michigan

INTRODUCTION
Women who carry BRCA1/2 mutations are at significantly increased risk of breast, ovarian, pancreatic and other cancer. Little is known regarding the use of dietary supplements among women harboring BRCA1/2 mutations. This study aims to characterize the utilization of and attitudes toward dietary supplement use in women who carry BRCA1/2 mutations.

METHODS
Patients identified through a cancer genetics clinic as harboring a BRCA1/2 mutation were invited to complete an electronic survey focused on their use of nutritional supplements. Inclusion criteria included female sex, age 21 years or older, confirmed BRCA1/2 mutation status, and no active cancer treatment. Participants answered questions regarding type of supplement, extent of physician involvement with dietary supplement usage, and perceptions toward dietary supplement use.

RESULTS
A total of 208 BRCA1/2 mutation carriers were invited to participate, and 68 surveys were completed. Forty-nine participants (84%) reported using some type of dietary supplement. Twenty-seven patients (59%) reported that the supplements were not prescribed by a physician, however, 38 patients (70%) reported that their physician was aware of their supplement use. All respondents indicated that it is important for physicians to know what supplements they are taking, and the majority felt comfortable discussing this topic with their doctors. Patients reported that the motivating factors included enhancing the body’s immune system, reducing inflammation, and improving mood, stamina, and energy. Lastly, participants expressed an awareness that dietary supplements could be harmful and interact with other medications.

CONCLUSIONS
Our results show a high utilization of dietary supplements in women carrying a BRCA1/2 mutation. While the majority of these supplements were not prescribed by a physician, patients placed high value on physician involvement with their supplement use. The primary motivators for using dietary supplements in this high-risk population include benefit to the body’s immune system and positive impact on mood, stamina, and energy.

VIEW POSTER

Blunt Trauma and Diaphragm Injury in Children: An Analysis of the National Trauma Data Bank

Sammie Lai, B.S.¹, Patrick Karabon, M.S.¹, Robert Modren, M.D.^1,2, Begum Akay, M.D.^1,2, Anthony Stallion, M.D.^1,2, Pavan Brahmamdam, M.D.^1,2

¹Oakland University William Beaumont School of Medicine, Rochester, Michigan
²Department of Pediatric General Surgery, Beaumont Health, Royal Oak, Michigan

INTRODUCTION
Trauma is the leading cause of mortality and morbidity in children. Traumatic diaphragm rupture (TDR) is a rare but serious injury that can be difficult to identify. The current literature includes individual case reports and single center case series only, which limits our ability to generalize those findings. The purpose of this study is to use the National Trauma Data Bank (NTDB) in order to examine the clinical outcomes of blunt TDR in the pediatric population.

METHODS
We included patients from 0 to 18 years of age with blunt TDR using the NTDB from 2007 to 2017. Patient characteristics and demographics, mechanisms of injury, concomitant diagnoses, procedures, and clinical outcomes were extracted from the NTDB.

RESULTS
In this study, we identified a total of 88 pediatric patients with blunt TDR. The most common mechanism of injury was motor vehicle accidents (65%). The majority of these blunt TDR injuries were observed in males (73%) with a mean age of 12. Fractures of the spine and ribs (49%) and lacerations of the lungs (42%) were some of the most prevailing associated injuries. Seventy percent of the patients were admitted to the ICU. In-hospital mortality was 6%.

CONCLUSIONS
Overall, TDR is relatively unusual among the pediatric population, but is associated with significant morbidity and mortality. Any trauma to neighboring organs - spine, ribs, and lungs - should prompt a workup of potential diaphragm rupture.

VIEW POSTER

Evaluating the Impact of Software Distortion Correction on Target Doses in Cranial Stereotactic Radiosurgery

Sharjil Shamim, B.S.¹, Zachary Seymour, M.D.²

¹Oakland University William Beaumont School of Medicine, Rochester, Michigan
²Department of Radiation Oncology, Beaumont Health, Royal Oak, Michigan

INTRODUCTION
Brainlab’s Elements suite proposed a novel MR distortion correction method based on CT imaging. This involves registration of sub-volumes from MR imaging to generate single continuous deformation field maps, creating a corrected MR image set. No literature currently exists studying the impact of software correction on target dose for cranial stereotactic radiosurgery. In this study, we aim to evaluate the impact of Brainlab distortion correction on radiation target dose compared to original treatment plans without distortion correction.

METHODS
To study the impact of distortion correction, we performed retrospective analysis on 24 previously-treated cranial targets, identifying patients treated for brain metastases within the past year with imaging saved. After applying correction, we outlined updated tumor targets on CT. Clinical significance of distortion correction was investigated in terms of target displacement, dose target coverage, and inverse conformity index. Both original and corrected plans were exported and the coordinates plotted onto a dose-volume histogram for comparison.

RESULTS
MR geometric distortion measurements using Brainlab were 0.3 mm ± 0.2 mm, 0.6 mm ± 0.3 mm, and 0.5 mm ± 0.2 mm in axial, sagittal, and coronal planes respectively. Overall, distance from skull centroid has essentially zero impact on these metrics. The corrected volume and treated volumes are not significantly different. The standard 1mm margin miss volumes were significantly smaller than distortion correction miss volumes, implying that simple geometric expansion places less tissue at risk.

CONCLUSIONS
The outcome suggests that distortion correction did not change target dose volume, regardless of location from centroid position. Thus, suppression software on MR works for the majority of high-risk patients. The general presumption should be software distortion correction is essentially ground truth and only a minority of patients will have worsened plan quality. This strengthens evidence that distortion may be present and unaccounted for and aided by software correction.

VIEW POSTER

Using Next Generation Sequencing To Detect Genes Related To Cancer In Women With Hiv

Stephanie Jo, B.S.¹, Alicia Golembieski, M.S.², Dwayne Baxa, Ph.D.^2,3

¹Oakland University William Beaumont School of Medicine, Rochester, Michigan
²Henry Ford Hospital, Detroit, Michigan
³Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan

INTRODUCTION
Next Generation Sequencing (NGS) is a tool used in the clinical setting to detect HIV resistance mutations at a frequency down to 1% of the viral population. DNA sequences not aligning to the viral genome were being detected in the sequence pool and may indicate upregulated host transcripts in the patient plasma. HIV proviral DNA is known to preferentially integrate into actively expressed genes, and people infected with HIV have an increased risk for cancer compared to the general population. The hypothesis of this study is that upregulated plasma RNA relevant to cancer progression may be detected in patient plasma by NGS testing, and the results may further consideration NGS as a screen for cancer development in patients with HIV.

METHODS
Non-HIV aligning DNA sequences from 11 random HIV+ females obtained during routine NGS testing for antiretroviral resistance were analyzed via Basic Local Alignment Search Tool (BLAST) for the presence of human genes. Sequences with 95% homology or greater were considered and evaluated for correlation with malignancy or cell cycle genes related to tumorigenesis.

Patient medical record was reviewed for the following: cancer diagnoses, cancer type, test orders relevant to suspicion of cancer, general demographics, appointments made with oncology and matched with the information from the BLAST data.

RESULTS
BLAST results of patients’ plasma RNA transcripts identified presence of human genes with known roles in cellular proliferation in all 11 patients as well as sequences related to malignancies. Sequences from one patient included genes related to lung cancer and tumorigenesis and were found to have been diagnosed with adenocarcinoma of the lung. While other patients had sequences for tumorigenic genes, the manifestations were less direct.

CONCLUSIONS
A significant number of human genes were detected in the non-aligning sequences from viral NGS. Further analysis is required to test the significance of this correlation.

VIEW POSTER

Effectiveness of Prenatal Screening Tests on Predicting Cardiac Anomalies

Stephanie Y. Wong, B.S.¹, Zeynep Alpay-Savasan, M.D.²

¹Oakland University William Beaumont School of Medicine, Rochester, Michigan
²Department of Obstetrics and Gynecology, Beaumont Health, Royal Oak, Michigan

INTRODUCTION
Congenital heart disease (CHD) is the leading cause of birth defect-associated infant death. With 1 in 111 newborns born with CHD and an elevated infant mortality rate of 30-50%, early detection is imperative. Current prenatal screening mainly focuses on detecting chromosomal anomalies. However, the accuracy of these exams on detecting fetal cardiac abnormalities is not well researched. The primary goal of this study is to compare three prenatal screening tests’ potential, i.e anatomy ultrasound, nuchal translucency (NT), and cell-free DNA (cfDNA), in identifying risk for fetal cardiac anomalies.

METHODS
A retrospective chart review utilized a convenience sample of obstetric patients treated at Beaumont Royal Oak Hospital from January 2017 to January 2018 and had completed at least an anatomy ultrasound, NT, or cfDNA. The results of the tests were compared with the newborn’s postnatal diagnosis. Sensitivity and specificity were calculated.

RESULTS
Total of 2917 patients completed at least one of the tests – 1793 (61.5%) patients had anatomy ultrasound, 478 (16.4%) had NT, and 646 (22.2%) had cfDNA. 132 (4.5%) of the newborns had cardiac anomalies, 47.7% of which had major defects that require follow-ups or surgeries while 52.3% had minor defects that do not affect quality of life. Sensitivities for ultrasound, NT, and cfDNA were 20.0%, 18.8%, and 5.6%, respectively. Specificities for ultrasound, NT, and cfDNA were 99.7%, 98.0%, and 97.4%, respectively.

CONCLUSIONS
The study suggests that anatomy ultrasound is still the most accurate in detecting cardiac anomalies. A study limitation is the small sample population because not every patient had an ultrasound, leading to its low sensitivity. However, the study demonstrates that NT should be encouraged among physicians because the similar sensitivities of the anatomy ultrasound and NT illustrate that NT can be as important as ultrasound, the current gold standard, when screening for cardiac defects.

VIEW POSTER

Prospective Qualitative Analysis of Minimally Invasive Repair of Pectus Excavatum

Timothy Elton, B.S.¹, Diane Studzinski², Robert S. Morden, M.D.^1,2, Pavan Brahmamdam, M.D.^1,2

¹Oakland University William Beaumont School of Medicine, Rochester, Michigan
²Department of Pediatric Surgery, Beaumont Health, Royal Oak, Michigan

INTRODUCTION
Pectus Excavatum is the most common chest wall deformity and is frequently corrected with the Nuss procedure. Although this procedure has existed for several decades, new strategies are being adapted to reduce complications and improve efficiency. The aim of this study is to perform a qualitative review of the patient experience after minimally invasive repair of Pectus Excavatum.

METHODS
Following Internal Review Board approval, pre-operative, post-operative and follow-up interviews were conducted with patients undergoing the procedure between January 2019 and December 2020 at Beaumont Royal Oak. Semi-structured interviews were transcribed and analyzed using an inductive coding method, a group-up approach.

RESULTS
A total of 5 patients were eligible with 4 agreeing to participate in the recorded interview series. Codes for pain management, activity, and aesthetics were some of the key themes that emerged in the inductive coding method. Key points were divided into positives and negatives. On the positive side, all interviewed patients stated that their pain on average was properly managed throughout their hospital stay and at home and the level of activity post-operative was as expected or better. Additionally, all patients were satisfied with their results and would elect to have the procedure done again if needed. For negatives, two participants expressed concerns regarding minor pain/discomfort in the immediate post-sedation time frame. Additionally, several expressed PT/OT visits provided useful techniques but desired additional visits.

CONCLUSIONS
Overall, a qualitative analysis showed that patients’ expectations are consistent with post-procedure outcomes and current peri-operative management practices have resulted in adequate pain management from a patient’s perspective. However, multimodal pain strategies and standardization of post-operative protocols should be considered to improve patient pain in the immediate post-operative period and to try to reduce variables in post-operative pain management. Additional improvements to increase the utilization of PT services in the post-operative period should also be considered.

VIEW POSTER

Defining Functional Shoulder Range of Motion in Middle-Aged to Elderly Populations to Guide Shoulder Surgical Treatment

Tyler Sargent, B.S.¹, Justin Smith, M.D.², Christie Smith, Ph.D.³, John Krauss, Ph.D.³, Michelle Jankowski, M.S.¹, J. Michael Wiater, M.D.²

¹Oakland University William Beaumont School of Medicine, Rochester, Michigan
²Department of Orthopedic Surgery, Beaumont Health System, Royal Oak, Michigan
³Department of Health Sciences, Oakland University, Rochester, Michigan

INTRODUCTION
Functional range of motion (ROM) is defined as the minimal required mobility of a joint to complete activities of daily living (ADL). Defining functional ROM will allow surgeons to decide which aging patients would benefit from surgical intervention aimed at improving shoulder functionality.

METHODS
Prospective, cross-sectional study involving 100 total participants with 25 participants in each cohort, representing middle-aged (50-59y, n=25), youngest-old (60-69y, n=25); middle-old (70-79y, n=25), and oldest-old (>80y, n=25). Participants were recruited from two outpatient physical therapy clinics and completed a compiled patient reported outcome (PRO) questionnaire, including the American Shoulder and Elbow Surgeons (ASES), University of Pennsylvania Shoulder Score (PSS), and Simple Shoulder Test (SST). Comparisons of ROM and PRO values between age groups were then completed using logistic regression and One-Way Analysis of Variance (ANOVA).

RESULTS
Comparison of ROM values between all populations revealed statistically significant difference in shoulder abduction (p<0.01), internal and external rotation with arm at the side (p<0.01; p<0.01), and internal rotation with arms at 90° (p<0.01). Differences between age groups were most prominent between middle-aged and oldest-old participants with shoulder forward flexion (p=0.02), abduction (p<0.01) internal and external rotation with arms at the side (p<0.01), and internal rotation and external rotation with arms at 90° (p<0.01; p=0.02). Middle-aged and young-old populations differed only in external rotation with the arms at the side (p=0.01). ASES scores did not vary significantly with increasing age group despite decreasing ROM. SST scores only varied when comparing middle-aged and oldest-old (p=0.03). PSS sub-scores of satisfaction remained unchanged with increasing age, while pain scores were better in the middle-old (p<0.01).

CONCLUSIONS
Shoulder ROM revealed an overall declining trend as age increases, with corresponding decreases in PSS function sub-scores. PROs largely remained unchanged with age in terms of ASES, PSS satisfaction, and SST suggesting lower patient expectations with age given decreasing function.

VIEW POSTER

Late Outcomes for Patients with Acute Chest Pain and Positive Fractional Flow Reserve by Computed Tomography

Zach Rollins1, Jason Schott, M.D.², Robert Safian, M.D.²

¹Oakland University William Beaumont School of Medicine, Rochester, Michigan
²Department of Cardiovascular Medicine, Beaumont Hospital, Royal Oak, Michigan

INTRODUCTION
Testing with fractional flow reserve derived from computed tomography (FFRCT) can be used to stratify otherwise indeterminate grade stenoses on cardiac computed tomography angiography (CCTA). Long-term clinical outcomes using FFRCT have been reported in stable heart disease but not for acute chest pain (ACP). This study analyzes clinical outcomes in patients with ACP who underwent FFRCT, including the risk of mortality, myocardial infarction (MI), invasive coronary angiography (ICA), and revascularization.

METHODS
389 patients from 2015-2018 presented to Beaumont with ACP and underwent FFRCT. Retrospective review of medical records was used to assess for mortality, MI, revascularization, and ICA over three years of follow-up. Medical records were additionally queried for the following variables: demographics, correlation of FFRCT results to invasive testing, physician rationale for withholding revascularization, and accuracy of FFRCT interpretation. Appropriateness of revascularization was determined by a blinded cardiologist based on established guidelines.

RESULTS
Immediate ICA occurred in 100/124 (81%) positive and 65/265 (25%) negative FFRCT patients with appropriate revascularization in 77 and 4, respectively. Among the 24 positive FFRCT patients without immediate ICA, late cardiovascular events included 1 death of unknown cause, 2 MIs, and 4 appropriately revascularized patients with mean follow-up of 33.7 ±14 months. Of 200 negative FFRCT patients without immediate ICA, no cardiac deaths, 1 MI, and 24 non-urgent ICA occurred in follow-up (mean 41±10 months) with appropriate revascularization in 2. The sensitivity, negative predictive value, specificity, positive predictive value, and accuracy of FFRCT assessing obstructive disease are 0.94, 0.97, 0.89, 0.77, and 0.91, respectively.

CONCLUSIONS
FFRCT can be used to risk stratify patients presenting with ACP accurately. Positive FFRCT is strongly associated with obstructive disease, whereas negative CCTA is associated with an excellent long-term prognosis without intervention. Therefore, FFRCT should be used to triage patients with ACP and reduce unnecessary ICA.

VIEW POSTER