A Comparison of Scar Infiltration, Scar Deactivation, and Standard of Care for Treatment of Chronic, Post-Surgical Pain After Cesarean Section in the Primary Setting: A Comparative Effectiveness Trial

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A Sweet Kick of Relief

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Culturally Tailored Interventions Enhance Diabetes Awareness and Management within the Karen Community

https://digitalcommons.unmc.edu/com_fam_pres/1017/thumbnail.jp

FORTIFY-med: Fostering Ongoing Research Training In First-Year Medical Students

This is an abstract from the Spotlight on Scholarship event in 2025

Brightly Visualizing Pancreatic Cancer Margins in Orthotopic Mouse Models with an Anti-CA19-9 Antibody Conjugated to a Near-Infrared Fluorophore

Background/Purpose: The only potentially curative procedure for pancreatic cancer is R0 resection, which is difficult to achieve due to poorly defined tumor margins. In the present study, we used an anti-CA19-9 antibody conjugated to a near-infrared fluorophore in orthotopic mouse models to target and visualize pancreatic cancer. Methods: Orthotopic models of the human pancreatic cancer cell lines SW1990 and BxPC3 were established by implanting tumor fragments into the pancreas of athymic nude mice. Anti-CA19-9 and control IgG were conjugated with IRDye800CW. Mice received 50 µg of CA19-9-IRDye800CW or IgG-IRDye800CW via tail-vein injection and were imaged after 72 h. MIA PaCa-2, a CA19-9-negative cell line, was used in subcutaneous models to assess targeting specificity. Results: Using the LI-COR Pearl imaging system in the SW1990 model, the tumor-to-pancreas ratio (TPR) was 4.51 (±0.74), and the tumor to the liver ratio (TLR) was 3.05 (±0.60) with CA19-9-IRDye800CW, while the TPR was 1.67 (±0.16) and the TLR was 0.95 (±0.05) for the non-specific control IgG-IRDye800CW. Using a clinically available fluorescence laparoscope, CA19-9-1RDye800CW demonstrated a TPR of 2.34 (±0.44) and a TLR of 2.23 (±0.49), compared to 1.11 (±0.13) and 0.69 (±0.07), respectively, for IgG-IRDye800CW in the SW1990 orthotopic model. In the BxPC3 models, the TPR was 3.82 (±0.55) and the TLR was 4.13 (±0.77) for CA19-9-IRDye800CW compared to 2.40 (±0.31) and 1.49 (±0.23), respectively, for IgG-IRDye800CW. Conclusions: CA19-9-IRDye800CW provided specific in vivo targeting of two human pancreatic cancer cell lines in orthotopic nude mouse models with superior TPRs and TLRs compared to IgG-IRDye800CW. This tumor-specific fluorescent CA19-9 antibody is a promising clinical tool for improved visualization of pancreatic cancer

Dissecting MUC16 in Pancreatic Cancer: Imaging Targetability, Oncogenic Signaling and Immune Suppression

Pancreatic ductal adenocarcinoma (PDAC) accounts for more than 90% of all pancreatic cancers and is extremely lethal. Late-stage presentation increases the need for standard-of-care regimens including gemcitabine/Abraxane or FOLFIRINOX, which have negligible benefit, as evidenced by the five-year overall survival rate of an abysmal 13%. Driver mutations in the KRAS oncogene are a defining feature of this malignancy. KRAS acts, at least in part, by increasing the expression of a cell-surface glycoprotein called Mucin-16 or MUC16. MUC16 (absent in the normal pancreas) is expressed in \u3e65% of PDAC cases and associated with poor survival. MUC16-expressing tumor cells have higher activation of ErbB-1/2/3, PI3K/AKT, MAPK, and NF-κB pathways that promote cancer progression. Chapter 2 of this dissertation focuses on using MUC16 as a tumor-specific biomarker for diagnostic imaging. We show the design and synthesis of a MUC16 -binding antibody-based MRI probe conjugated to a gadolinium-based contrast agent that facilitates the detection of early- and late-stage PDAC lesions in preclinical mouse models. In Chapter 3, we demonstrate that the aberrant glycoforms of MUC16 exacerbate aggressive behavior in PDAC cells and mediate signaling through a4b1 integrins and downstream integrin-linked kinase (ILK) and focal adhesion kinase (FAK) to increase the migratory properties of PDAC cells, fueling metastatic progression. Targeting MUC16 using the antibody AR9.6 perturbs such oncogenic signaling/migration. In Chapter 4, we uncover a novel role for MUC16 in mediating immunosuppression. The PDAC tumor microenvironment has immunosuppressive cells, of which macrophages form the bulk. We demonstrate that loss of MUC16 causes diminished tumor burden. MUC16KO tumors have low numbers of M2-like CD206+ or Ym1/2+ macrophages, compared to the MUC16-competent tumors. We identify CCL2 and Serpin-E1 as mediators of macrophage infiltration. Lastly, we show that sustained clodronate liposome administration facilitates macrophage depletion in the spleen, and influences tumor burden – specifically lowering tumor burden in KPC (MUC16-expressing) tumors. However, splenic regulatory T cell appearance is a possible mechanism of resistance to long-term myeloid depletion. Hence, we discuss the utility of immune reprogramming strategies like CD40 agonists in combination with anti-MUC16 strategies to facilitate long-term tumor regression

Transitions into GME Program Leadership Roles in Neonatal-Perinatal Medicine: Opportunities for Improvement

Introduction: Graduate Medical Education (GME) leadership can be a rewarding and valuable career path. Strong, skilled leadership is critical to the success of any training program. Despite this, there are few requirements and minimal guidance to prepare for GME leadership roles. Aims: Identify pathways into Neonatal-Perinatal Medicine (NPM) GME leadership roles and describe the needs of incoming program leaders. Methods: The Organization of Neonatal-Perinatal Training Program Directors (ONTPD) distributed an annual anonymous survey to all NPM programs in September 2024. Quantitative questions utilized descriptive statistics. For free text responses, thematic qualitative analysis was utilized to summarize the findings. Coding discrepancies were reconciled amongst the 3 independent reviewers. Results: Leadership from 87 out of 105 (83%) of NPM programs responded. The majority of respondents were the program director (PD) 88%, with 65% of PDs having previously served as an Associate PD (APD), with a median of 2 years in the APD role (Table 1). Of program leaders, only half (55%) planned to have a career in GME, with a wide variety of situations leading to the leadership role (Figure 1). Leaders first joined GME leadership a median of 4 years after completing fellowship. Most program leaders had support for transitioning into the role (91%) including: mentoring from other PD/APDs (44%), meetings to review program tasks and timelines (43%), program coordinator assisted in preparing (41%), and previous program leader stayed in another program role (40%). Figure 2 showcases program leadership’s overall satisfaction or dissatisfaction with important elements of the transition. Thematic analysis identified 6 major themes as most helpful in preparing for a role in fellowship program leadership: mentorship, resources, support, experience, planned transition, and national conferences. Local mentorship, resources, and outgoing program director support were most commonly described and national resources and mentorship through ONTPD were frequently cited. Conclusion: NPM program leaders need mentorship, resources, and support both locally and nationally. We identified areas of opportunity to optimize planned transitions for new leaders. We encourage division leaders to define roles, provide appropriate protected time for leadership in GME, and allocate divisional support and resources. These results reiterate the importance of national collaboration as a tool for new and successful GME leaders

Gazing in the Mirror: Reflecting on Student Perspectives in Work-Integrated Learning in Healthcare Education

Abstract: Student engagement is typically woven into the curriculum of healthcare education through hands-on experiences, lectures, discussions, active learning, and lab components. This engagement is critical to developing student confidence, efficacy, and esteem in important skills that will serve them as they enter their profession. In our doctoral program, we are allowed additional engagement opportunities, including belonging to a research project with professionals. Upon reflection, our experience on an interprofessional research team has helped to translate our classroom knowledge to research and professional practice skills. Plain-Language Summary: This paper is a reflection on the value of adding work skills beyond common fieldwork placements. We recommend schools give students an opportunity to try research skills as part of a working team

Universal Adolescent Depression Screening and Implications for Identification of Adolescent Depression and Mental Health Referrals

Background: Throughout the United States, mental health concerns have been steadily increasing, which has created a significant impact for caregivers, overburdened healthcare facilities, and patients. In fact, a large number of those experiencing mental health issues are unidentified and thus more likely to experience mental health crises, suicidal ideation, or suicide attempts. Rural adolescents are significantly more vulnerable than their urban counterparts related to disparities in both mental health services and preventative screening. Coordination with a critical access hospital (CAH) emergency department revealed that there was no universal adolescent depression screening in place, and patients were potentially going undiagnosed and untreated. Objectives: Objectives of this quality improvement project included increasing staff knowledge and competence with administration of the PHQ-2/PHQ-9 through an educational in-service, providing universal adolescent depression screening in a CAH ED through administration of the PHQ-2/PHQ-9 to all presenting patients ages 12-18, and using depression screening results to increase the provision of mental health referrals in this setting. Methods: This quality improvement project was a prospective cohort study design, which was initiated by a rural CAH in the ED setting. Retrospective chart review pre- and post- project implementation involving three months prior to implementation and three months after implementation was conducted. Additionally, staff education related to depression screening was provided prior to project implementation and its effectiveness was measured through pre- and post- test result comparisons. Universal depression screening using PHQ-2/PHQ-9 tools was then completed on patients presenting to the CAH who were within the designated 12-18 year old age range. Results: There were 24 staff members that completed the educational training along with pre- and post- tests. Pre-test scores demonstrated a mean of 71.92 (SD=10.50), and post-test scores had an increased mean of 82.88 (SD=4.76). A paired t-test showed that the mean difference between pre- and post- test scores was -10.96 (CI: -15.22 to -6.70) with a significant t-value of -5.319 (p Conclusion: Universal adolescent depression screening has the potential to increase identification and treatment rates as well as providing the opportunity for mental health referrals. Early intervention has been shown to prevent financially and emotionally costly mental health crises, and universal screening can aid in the identification that leads to early intervention. Although this study was limited by small sample sizes, staff knowledge and adolescent screening rates increased after education and project implementation. This demonstrated that further studies with larger sample sizes and more diverse settings are needed to demonstrate full practice implications

Pearls for Surgical Dermatology: Common Sense Solutions for Common Problems

Introduction: Efficiency and precision in surgical dermatology are crucial for optimizing patient outcomes and procedural success. This study presents a collection of practical surgical pearls designed to address common challenges encountered in dermatologic surgery. By implementing these streamlined techniques, practitioners can improve hemostasis, enhance visualization, and reduce surgical tension while maintaining favorable cosmetic results. Methods & Key Techniques: Several surgical pearls were compiled based on clinical experience and literature review. Key strategies include: Forceps-Assisted Cautery for Hemostasis: A technique that enhances efficiency by directing electrical current through forceps to neutralize bleeding vessels without additional clamps or sutures. Nasal Ala Hemostasis with Q-Tip Support: Utilizing a cotton-tipped applicator within the nares to provide back pressure and improve bleeding control. Plicating Stitch for Linear Closure: A subcutaneous suture placed before wedge removal to minimize scar length and maintain aesthetic outcomes. Towel Clamp & High-Tensile Sutures for Scalp Flaps: Methods to facilitate tension-free closure and expedite wound approximation. Q-Tip-Assisted Punch Biopsy Hemostasis: A simple technique for maintaining hemostasis while preparing sutures. Tragus Displacement for Conchal Bowl Procedures: A method using a rake retractor to improve surgical access and visualization. Conclusion: These surgical pearls offer low-cost, high-impact modifications that can be seamlessly integrated into dermatologic surgery to enhance efficiency and patient outcomes. By incorporating these techniques, clinicians can reduce procedural complexity, improve hemostasis, and optimize cosmetic results while maintaining patient comfort.https://digitalcommons.unmc.edu/emet_posters/1041/thumbnail.jp