Baylor University Medical Center Proceedings最新文献

{"title":"The impact of chronic total occlusion percutaneous coronary intervention on the coronary physiology of the donor epicardial vessel: a case series.","authors":"Mohammed Salih, Amr Marawan, Ahmed Kazem, Abdallah Assaf, Mohamad Bader Abo Hajar, Imran Baig, Jared L Christensen, Dinesh Reddy Apala, Karthik Anand, Michael Megaly, Salman Allana, Srinivasa Potluri, Karim Al-Azizi","doi":"10.1080/08998280.2026.2735176","DOIUrl":"https://doi.org/10.1080/08998280.2026.2735176","url":null,"abstract":"<p><strong>Background: </strong>In chronic total occlusion (CTO), donor vessels supplying collateral flow to the occluded artery may exhibit altered physiological indices, potentially influencing revascularization decisions. This case series evaluates the impact of successful CTO percutaneous coronary intervention (PCI) on instantaneous wave-free ratio (iFR) measurements in donor vessels with moderate stenosis.</p><p><strong>Methods: </strong>We present a single-center case series (December 2020-September 2024) involving five patients with right coronary artery (RCA) CTO and a moderately diseased mid-left anterior descending artery (LAD) functioning as a collateral donor. All patients underwent ischemia testing and successful RCA CTO PCI. LAD iFR was measured before and after RCA revascularization.</p><p><strong>Results: </strong>Pre-PCI LAD iFR values ranged from 0.73 to 0.89, at or below the ischemic threshold. Post-RCA-PCI iFR improved in all cases (range: 0.87-0.96): in case 1, from 0.82 to 0.93; in case 2, from 0.82 to 0.89; in case 3, from 0.87 to 0.96; in case 4, from 0.73 to 0.87; and in case 5, from 0.89 to 0.96. In all cases, intervention on the LAD was deferred post-PCI, with no adverse clinical events during follow-up.</p><p><strong>Conclusion: </strong>Successful RCA CTO PCI leads to immediate improvement in donor vessel iFR, suggesting that collateral demand may exaggerate ischemia. Staged physiologic assessment may improve decision-making in patients with moderate lesions in donor vessels.</p>","PeriodicalId":8828,"journal":{"name":"Baylor University Medical Center Proceedings","volume":" ","pages":"1-9"},"PeriodicalIF":0.0,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of patient and clinical characteristics with surgical site infections following hysterectomy for oncologic indications: a single-center retrospective study.","authors":"Sahithi P Puvvala, Megan Lopez-Lin, James E Garda, Anthony McDowell, Timothy McCormick, Michael P Hofkamp, Joanna Stacey","doi":"10.1080/08998280.2026.2738516","DOIUrl":"https://doi.org/10.1080/08998280.2026.2738516","url":null,"abstract":"<p><strong>Background: </strong>The primary aim of this study was to identify patient and clinical characteristics associated with surgical site infections (SSI) following hysterectomies performed for oncologic indications.</p><p><strong>Methods: </strong>We conducted a retrospective study of patients with oncologic indications who underwent hysterectomy between July 1, 2022, and June 30, 2023, at our institution. We performed a bivariate analysis between patients who did and did not develop a postoperative SSI. We then performed a multivariate logistic regression with variables of interest to determine which patient and clinical characteristics were independently associated with developing a posthysterectomy SSI.</p><p><strong>Results: </strong>Among 194 patients who underwent hysterectomy for oncologic indications, 182 who identified as Black, Hispanic, or White were included in the bivariate analysis. A total of 14 patients (7.7%) developed SSI. There were 176 patients from the bivariate analysis with complete serum albumin data included in the multivariate logistic regression. Surgical incision time after 3:30 pm was independently associated with developing an SSI (adjusted odds ratio 6.92; 95% confidence interval 1.84-25.97; <i>P</i> = 0.004).</p><p><strong>Conclusion: </strong>Among patients who underwent hysterectomy for oncologic indications, those who had a surgical incision start time of 3:30 pm or later had an approximately sevenfold increase in SSI.</p>","PeriodicalId":8828,"journal":{"name":"Baylor University Medical Center Proceedings","volume":" ","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceived fit and identity alignment as drivers of orthopedic attrition: a cross-sectional survey of medical trainees.","authors":"Manu U Nair, Aleah Frison, Jimmy Garda, Kunal Verma, Colby McClaugherty, Candace Mason","doi":"10.1080/08998280.2026.2740967","DOIUrl":"https://doi.org/10.1080/08998280.2026.2740967","url":null,"abstract":"<p><strong>Background: </strong>Orthopedic surgery remains one of the least diverse medical specialties despite efforts to improve recruitment and representation. While exposure and mentorship influence specialty choice, the contributions of perceived competitiveness, diversity, and personal fit remain incompletely understood.</p><p><strong>Methods: </strong>We conducted a cross-sectional survey of resident and fellow physicians across multiple institutions in Texas assessing demographics, orthopedic exposure, mentorship access, perceived competitiveness, and factors influencing specialty choice.</p><p><strong>Results: </strong>Fifty participants completed the survey, 54% female and 46% male. Half reported prior interest in orthopedic surgery, whereas 18% were currently in orthopedic surgery. Although 84% reported access to orthopedic subspecialty rotations and 78% to orthopedic faculty or mentorship, only 48% completed an orthopedic subspecialty rotation and 54% reported difficulty establishing connections within the field. Only 34% considered orthopedic surgery a diverse field. In gender-stratified analyses, female respondents reported lower perceived gender fit than male respondents (33.3% vs 82.6%, <i>P <</i> 0.001, <i>q</i> = 0.018), the only association that remained significant after correction for multiple comparisons. Perceived personality fit and prior orthopedic interest also differed by gender before adjustment.</p><p><strong>Conclusion: </strong>These exploratory findings suggest that perceptions of identity alignment and accessibility may influence pursuit of orthopedic surgery despite available exposure and mentorship. Larger studies are needed to validate these findings and better characterize barriers to recruitment and inclusion.</p>","PeriodicalId":8828,"journal":{"name":"Baylor University Medical Center Proceedings","volume":" ","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cutaneous squamous cell carcinoma arising in chronic discoid lupus erythematosus treated with Mohs micrographic surgery.","authors":"Connor K Sisk, Umer Nadir, Brigitte Cochran, Emily Limmer, Jorge Roman, George M Jeha, Stanislav N Tolkachjov","doi":"10.1080/08998280.2026.2740410","DOIUrl":"https://doi.org/10.1080/08998280.2026.2740410","url":null,"abstract":"<p><p>Cutaneous squamous cell carcinoma (cSCC) arising within discoid lupus erythematosus (DLE) is a rare but aggressive complication associated with increased rates of recurrence, metastasis, and mortality. Histopathologic overlap between DLE-associated inflammation and cSCC may complicate margin interpretation during Mohs micrographic surgery (MMS). A 63-year-old Hispanic female receiving adalimumab for rheumatoid arthritis, with a longstanding but previously undiagnosed scalp DLE plaque, presented with a progressively enlarging, painful right parietal scalp mass arising at the border of an atrophic alopecic plaque. Histopathologic examination confirmed well-differentiated cSCC arising in a background of DLE. The tumor was successfully treated with MMS and reconstruction using a fish skin substitute. Follow-up demonstrated progressive wound healing without recurrence. This case highlights the malignant potential of chronic DLE lesions and the clinicopathologic challenges encountered during MMS.</p>","PeriodicalId":8828,"journal":{"name":"Baylor University Medical Center Proceedings","volume":" ","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pseudoaneurysm-related gastrointestinal bleed in pancreatitis: a case series and diagnostic challenges.","authors":"Mutaz Kalas, Mohammad Mustafa, M Ammar Kalas, Ahmad Barazi, Sherif E Elhanafi","doi":"10.1080/08998280.2026.2741781","DOIUrl":"https://doi.org/10.1080/08998280.2026.2741781","url":null,"abstract":"<p><p>Vascular complications can occur in up to 25% of pancreatitis patients. These include venous thrombosis, arterial pseudoaneurysms, arterial thrombosis, and pancreato-portal fistula formation. Gastrointestinal bleeding in the context of pancreatitis is a rare but morbid complication that may be misattributed to other common causes. Herein, we present three cases that highlight the importance of clinician awareness, early recognition, and accurate diagnosis of visceral artery pseudoaneurysm in the setting of pancreatitis.</p>","PeriodicalId":8828,"journal":{"name":"Baylor University Medical Center Proceedings","volume":" ","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disentangling the role of obstructive sleep apnea in heart failure with preserved ejection fraction readmissions: a National Readmissions Database analysis.","authors":"Ritvik Peesapati, Katyayani Saripalli","doi":"10.1080/08998280.2026.2735201","DOIUrl":"https://doi.org/10.1080/08998280.2026.2735201","url":null,"abstract":"<p><strong>Background: </strong>Obstructive sleep apnea (OSA) is highly prevalent among patients with heart failure with preserved ejection fraction (HFpEF). The aim of this study was to analyze the poorly characterized independent impact of OSA on short-term readmission and in-hospital outcomes among hospitalizations with HFpEF.</p><p><strong>Methods: </strong>We performed a retrospective cohort study using the 2019 Nationwide Readmission Database. Adult hospitalizations with acute decompensated HFpEF were identified using ICD-10 codes, and OSA was defined using secondary ICD-10 codes during the index hospitalization. The primary outcome was 30-day all-cause readmission following index hospitalization. Secondary outcomes included length of stay, total hospital charges, days to readmission, and in-hospital mortality. Survey-weighted multivariable logistic and linear regression models were utilized.</p><p><strong>Results: </strong>Among 16,614 acute HFpEF admissions, approximately 17% had documented OSA. Hospitalizations with OSA were younger, more often male, and had higher rates of respiratory failure during index hospitalization. Unadjusted 30-day readmission rates were similar between OSA and non-OSA groups (17.0% vs 17.4%, <i>P</i> = 0.82). OSA was not independently associated with readmission after adjustment (adjusted odds ratio 0.92, 95% confidence interval 0.77-1.09). Among readmitted patients, those with OSA had higher renal and respiratory complications, while comorbidity burden, payer mix, income quartile, and hospital characteristics were otherwise comparable. The most common readmission diagnosis in the OSA group was hypertensive heart disease. OSA was also not associated with index length of stay, total charges, time to readmission, or in-hospital mortality. Adverse outcomes were noted to be primarily driven by illness severity and resource intensity.</p><p><strong>Conclusion: </strong>The national prevalence of OSA is approximately 32% and noted to be higher in heart failure patients. Our study depicted a prevalence of 17%, which may be associated with underuse of the code. Readmission risk and resource utilization were driven by acute illness severity and need for organ support, highlighting the importance of targeting inpatient complications to reduce early HFpEF readmissions.</p>","PeriodicalId":8828,"journal":{"name":"Baylor University Medical Center Proceedings","volume":" ","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MASLD risk factors: searching beyond the metabolic syndrome.","authors":"Sameera N Shuaibi, Stevan A Gonzalez","doi":"10.1080/08998280.2026.2740405","DOIUrl":"https://doi.org/10.1080/08998280.2026.2740405","url":null,"abstract":"","PeriodicalId":8828,"journal":{"name":"Baylor University Medical Center Proceedings","volume":" ","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Teaching Millennial and Generation Z learners in graduate medical education: evidence-informed approaches to learning, feedback, and engagement.","authors":"Thomas Cox, Mia Raymond, Julie Higginbotham","doi":"10.1080/08998280.2026.2737037","DOIUrl":"https://doi.org/10.1080/08998280.2026.2737037","url":null,"abstract":"<p><p>Millennials and Generation Z now comprise a substantial proportion of learners in graduate medical education. As educational environments continue to evolve, faculty increasingly encounter differences in communication preferences, expectations, and learning preferences and expectations that may be influenced by generational experiences. The literature has described some Millennial and Generation Z learners as achievement-oriented, technologically fluent, collaborative, and highly motivated by relevance and applicability. Contrary to common stereotypes, many of the differences observed in these generations reflect broader societal, technological, and economic changes rather than deficiencies in professionalism or work ethic. Educational approaches emphasizing structure, active engagement, feedback, collaboration, and relevance may support engagement and learning among contemporary trainees. Understanding generational influences may help educators create learning communities and environments that maximize engagement, retention, and professional development. The Five Rs framework-research-based methods, relevance, rationale, relaxed environment, and rapport-offers a practical model for teaching modern learners.</p>","PeriodicalId":8828,"journal":{"name":"Baylor University Medical Center Proceedings","volume":" ","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence-enabled detection of left ventricular hypertrophy using a single-lead electrocardiogram: a pilot study for wearable-based screening.","authors":"Shahana Nandy, Sneha Nandy, Siddhartha Dalal","doi":"10.1080/08998280.2026.2735142","DOIUrl":"https://doi.org/10.1080/08998280.2026.2735142","url":null,"abstract":"<p><strong>Background: </strong>Left ventricular hypertrophy (LVH) is an independent predictor of cardiovascular morbidity and mortality. Single-lead electrocardiogram (ECG) tracings from consumer wearable devices may enable scalable screening for LVH where standard 12-lead ECG acquisition is not feasible.</p><p><strong>Methods: </strong>We developed a transformer-based deep learning model to detect LVH using single-lead ECG (lead I) combined with demographic variables and benchmarked performance against a 12-lead ECG model within the same framework. The PTB-XL dataset (21,837 cardiologist-annotated ECGs from 18,885 patients) was used. Models were trained on (a) lead I only, (b) lead I plus demographics (age, sex, body mass index), and (c) 12-lead plus demographics. Classification thresholds were selected to achieve ≥90% specificity consistent with a rule-in screening paradigm.</p><p><strong>Results: </strong>The lead I-only model achieved an area under the curve (AUC) of 0.874 ± 0.062 (sensitivity 69.1% ± 18.9%, specificity 90.1% ± 0.1%). Incorporation of demographic variables improved performance to AUC 0.928 ± 0.017 (sensitivity 84.7% ± 4.2%, specificity 90.6% ± 0.7%). The 12-lead model with demographics achieved AUC 0.939 ± 0.007 (sensitivity 85.9% ± 2.0%, specificity 90.1% ± 0.1%).</p><p><strong>Conclusions: </strong>Single-lead ECG combined with demographic variables enables detection of electrocardiographic LVH with performance approaching that of 12-lead ECG models, supporting the feasibility of wearable-based screening pending validation against imaging-confirmed LVH.</p>","PeriodicalId":8828,"journal":{"name":"Baylor University Medical Center Proceedings","volume":" ","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149036241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When a side-locked headache becomes a stroke code: indomethacin-responsive hemicrania continua with transient hemiplegia.","authors":"Deb Mojumder, Xinyi Chen","doi":"10.1080/08998280.2026.2731839","DOIUrl":"https://doi.org/10.1080/08998280.2026.2731839","url":null,"abstract":"<p><p>Hemicrania continua is a primary headache disorder characterized by strictly unilateral pain, cranial autonomic features, and absolute responsiveness to indomethacin. Presentation as an acute stroke mimic with transient focal neurologic deficits is rare. We report a 40-year-old woman with a 4-year history of strictly right-sided headaches who presented with acute right-sided sensory marching and motor weakness, accompanied by ipsilateral facial flushing, sweating, and miosis. Emergent multimodal neuroimaging was negative; intravenous tenecteplase was administered for suspected ischemic stroke. Subsequent brain magnetic resonance imaging revealed no acute infarction. After the postthrombolysis safety window, an oral indomethacin trial led to complete headache resolution and rapid clearing of deficits. This case illustrates that hemicrania continua can manifest with hemiplegic features due to overlapping cortical spreading depression biology and highlights the diagnostic utility of an inpatient indomethacin trial.</p>","PeriodicalId":8828,"journal":{"name":"Baylor University Medical Center Proceedings","volume":" ","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149036218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}