University of Nebraska Medical Center Research: DigitalCommons@UNMC

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Berentson, Grace

Bartels, Michaela

Angeletti, Monica

Liu, Jennifer

University of Nebraska Medical Center 
DigitalCommons@UNMC 
Posters and Presentations: Family Medicine Family Medicine 
5-2025 
Assessing Cervical Cancer Health Literacy Among Karen Women 
in the Omaha Area 
Grace Berentson 
University of Nebraska Medical Center, grace.berentson@unmc.edu 
Michaela Bartels 
University of Nebraska Medical Center, mibartels@unmc.edu 
Monica Angeletti 
University of Nebraska Medical Center 
Jennifer Liu 
University of Nebraska Medical Center, jiliu@unmc.edu 
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Recommended Citation 
Berentson, Grace; Bartels, Michaela; Angeletti, Monica; and Liu, Jennifer, "Assessing Cervical Cancer 
Health Literacy Among Karen Women in the Omaha Area" (2025). Posters and Presentations: Family 
Medicine. 37. 
https://digitalcommons.unmc.edu/com_fam_pres/37 
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Assessing Cervical Cancer Health Literacy Among 
Karen Women in the Omaha Area
Grace Berentson, Michaela Bartels, Monica Angeletti, MD, Jennifer Liu, MD
Department of Family Medicine, University of Nebraska Medical Center, Omaha, NE 68198
Methods
Karen Student Association at the University of Nebraska Omaha
• A presentation was given to college students describing the purpose 
of the study and requesting the students' participation in the survey. 
Karen Christian Revival Church in Omaha, NE
• Visited the church on many occasions to introduce ourselves and 
explain the purpose of our study, obtain consent from the church 
leaders, and gather survey responses.
• Surveys were provided in the Karen language and the English 
language with a Karen interpreter present when needed.
• The members of the church completed the survey before or after the 
Karen or English church service.
       Survey QR Code: 
Results Discussion
• The majority of Karen women rated their confidence in understanding 
health terminology as ‘good’, but most women answered the 
knowledge questions incorrectly or as 'I don't know’. 
• This shows the potential discrepancy between presumed health 
literacy and true female reproductive health knowledge.
• Most of the Karen women do not have an OBGYN or visit the doctor 
regularly if they do not have a current concern.
• Only 13.3% of the Karen women have received a pap smear in their 
lifetime compared to 73.9% of women living in the United States in 
2021.
• Only 6.7% of the Karen women have received an HPV vaccination in 
their lifetime compared to 61.4% of women living in the United States 
in 2023.
• These results demonstrate that there is room for growth within 
cervical cancer screening, education, and prevention in the 
Karen population.
• The refugee community in the U.S. has decreased access to health 
care and high rates of morbidity and mortality. These disparities are 
exacerbated by social determinants of health, including limited 
English proficiency and health literacy.1
• As of 2020, there were approximately 5,500 Karen individuals living 
in Nebraska. Omaha is considered to have one of the largest and 
fastest growing Karen populations in the U.S.2
• Cervical cancer remains a leading cause of death among Myanmar 
women. Myanmar has been selected for the United Nations Global 
Joint Program (UNGJP) for cervical cancer prevention and control 
since 2017.3
• There are limited published studies on health literacy and its impact 
on health outcomes – specifically cervical cancer outcomes – in the 
Karen immigrant population.4
The purpose of this study was to evaluate cervical cancer health 
literacy among Karen women and explore potential areas that may 
benefit from an educational intervention in the future.
Objective
Background
1. Feinberg I, O'Connor MH, Owen-Smith A, Ogrodnick MM, Rothenberg R. The Relationship Between Refugee Health 
Status and Language, Literacy, and Time Spent in the United States. Health Lit Res Pract. 2020 Dec 11;4(4):e230-e236. 
doi: 10.3928/24748307-20201109-01. PMID: 33313933; PMCID: PMC7751446.
2. Nebraska Department of Health & Human Services. (2020). Karen Refugee Health Status Report. 
https://dhhs.ne.gov/Reports/Karen%20Refugee%20Health%20Report%202020.pdf
3. Thinn MM, Aung S, Aung A, Tun NM. Current Status of Cervical Cancer Prevention and Screening in Myanmar. South 
Asian J Cancer. 2023 Feb 25;12(1):47-48. doi: 10.1055/s-0043-1764212. PMID: 36851926; PMCID: PMC9966159.
4. Hoffman SJ, Shannon PJ, Horn TL, Letts J, Mathiason MA. Health of war-affected Karen adults 5 years post-resettlement. 
Fam Pract. 2021 Jul 28;38(4):403-409. doi: 10.1093/fampra/cmaa147. PMID: 33480418; PMCID: PMC8317216.
5. Centers for Disease Control and Prevention. (n.d.). National Health Interview Survey. Centers for Disease Control and 
Prevention. https://www.cdc.gov/nchs/nhis/index.html 
6. Centers for Disease Control and Prevention. (2024, September 10). National vaccination coverage among adolescents 
aged 13–17 years - National immunization survey-teen, United States, 2023. Centers for Disease Control and Prevention. 
https://www.cdc.gov/mmwr/volumes/73/wr/mm7333a1.htm?s_cid=mm7333a1_w 
References
Comparison to U.S. Population
Figure 3. Frequency of Karen women visiting the doctor
Figure 6.  Percentage of correct, incorrect, and I don't know responses to 
knowledge questions in the survey. Question numbers are listed below.
Figure 1. Confidence in understanding health 
terminology of the Karen women
Figure 2. Proportion of Karen women with an OBGYN
Figure 4. Rates of a Pap Smear in the lifetime of Karen 
women vs in the last three years (starting from 2021) 
in the U.S population of women5
Figure 5. Rates of Karen women who have ever 
received an HPV vaccine vs adolescents ages 13-17 in 
the U.S. whose HPV vaccine was up to date in 20236
Knowledge questions:
1. What does a Pap smear screen for?
2. Can you identify where the cervix is on this diagram?
3. Which of the following is the recommended age to get Pap smears?
4. Which of the following diseases is caused by the Human Papillomavirus (HPV)?
Future Directions
• Provide educational materials about the female reproductive system 
and cervical cancer to the Karen population at the Karen Christian 
Revival Church and the Karen Student Association at UNO.
• Participants will be re-surveyed after receiving the educational 
materials to evaluate their impact on health literacy in the survey 
participants.
• A manuscript will be developed emphasizing the importance of 
education in promoting health literacy in the Karen population which 
may have a significant impact on their health outcomes.
46.9% 40.6%
6.3%6.3%
18.8%
18.8%
62.5%
28.1%
53.1%
18.8%


English

Assessing Cervical Cancer Health Literacy Among Karen Women in the Omaha Area

Shrestha, Pramod

Graduate Medical Education 
Research Journal 
Volume 7 Issue 1 Article 8 
June 2025 
Red Blood Cell Transfusion Causes Brain Inflammation in Murine 
Pups With Phlebotomy Induced Anemia 
Pramod Shrestha 
University of Nebraska Medical Center 
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Recommended Citation 
Shrestha, P. Red Blood Cell Transfusion Causes Brain Inflammation in Murine Pups With Phlebotomy 
Induced Anemia. Graduate Medical Education Research Journal. 2025 Jun 29; 7(1). 
https://digitalcommons.unmc.edu/gmerj/vol7/iss1/8 
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© 2025 The Authors 
Red Blood Cell Transfusion Causes Brain Inflammation in Murine Pups With 
Phlebotomy Induced Anemia 
Abstract 
NA 
Creative Commons License 
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Graduate Medical Education Research Journal15 Oral Presentations
*Names in bold type indicate presenting author.
Proceedings of the 7th Annual Graduate Medical Education Research Symposium | Oral Presentations
#2 Survey of Current Clinical and Imaging Practices Amongst Regional Obstetric Providers in Nebraska: A 
Discussion of Future Application of Artificial Intelligence in Fetal Echocardiography
Farhath Sulthana1, Alex Foy2, Ling Li3, Jason Christensen2
1Department of Pediatrics, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA 
2Department of Cardiology, Children’s Nebraska, Omaha, NE, USA 
3Department of Internal Medicine, Division of Cardiovascular Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
Program: Pediatrics
Mentor: Alex Foy
Type: Original Research 
Background: Congenital heart disease (CHD) 
is the leading cause of birth defects, with a 
prevalence of 6 to 12 per 1,000 live births. 
Early detection through fetal echocardiog-
raphy improves outcomes, but limitations in 
image quality, equipment, examiner expertise, 
and operator skill often lead to missed diag-
noses. Artificial intelligence (AI), particularly 
deep learning, shows promise in enhancing 
diagnostic accuracy. However, we must 
explore the significant challenges that remain 
in integrating AI as standard care.
Methods: This study utilized a standard ques-
tionnaire to survey the current clinical and 
imaging practices amongst regional obstetric 
providers in Nebraska in obtaining guide-
line-recommended views for fetal cardiac 
anatomy at the 18-22 week ultrasound. 
Results: A total of 51 clinics in Nebraska 
were identified for inclusion in this study, 
and 26 did not respond. Results from the 
remaining 25 clinics were used for the 
following conclusions (Table 1).
Conclusion: It was found that sonographers 
have a strong confidence level in obtaining 
these images. Over 70% of providers 
confirmed that axial sweeps were performed 
during fetal surveys. This is reassuring, as the 
detection of CHD by medical providers and 
AI is highly dependent on the axial sweep of 
the fetal heart. Despite this standardization 
and confidence level, prenatal detection rates 
of CHD in Nebraska are reportedly only 
20-30%. It is evident that practices varied 
significantly in type of equipment and PACs 
with one clinic even reporting the use of a 
paper archiving system. This speaks to the 
disparities in prenatal diagnosis of CHD 
and the lack of access to similar resources 
based on geographic location and population 
density. 
Table 1. Results from Obstetric Ultrasound Sonographer/Provider Questionnaire.
Obstetric Ultrasound Sonographer/Provider Questionnaire
Clinic Participant’s Role in the Clinic
Confidence Level in Obtaining 
Guideline -Recommended Views for 
Fetal Cardiac Anatomy Screening at 
the 18-22-week Ultrasound
Is Cine Imaging 
for Fetal Anatomy 
Scans Stored?
Is Axial Sweep (of the 
Thorax) Performed on 
Fetal Surveys?
Brand of Ultrasound 
Machine Used
Picture Archiving 
and Communication 
System (PACS) Used
A Sonographer 10 Yes Yes GE Voluson E6 Paper
B Director of Radiology n/a Unsure Unsure Philips Epic Merge
C Radiology Manager n/a Yes Yes Philips Affinity 70 McKesson
D Sonographer 7 Yes Yes Canon Aplio McKesson
E Sonographer 8 Yes Yes GE Voluson E10 McKesson
F Ultrasound Supervisor n/a Yes Yes GE Voluson E8 Philips Intellispace
G Ultrasound Tech 10 Yes Yes GE Voluson E10 Philips Intellispace
H Sonographer 8 Yes Yes Philips IU22 Unsure
I Director of Nursing 10 Yes Yes GE Voluson E10 Unsure
J Nurse Practitioner n/a Yes No GE Voluson E6 None
K Imaging Quality Supervisor 8 Yes Yes GE Voluson E10 McKesson
L Sonographer 8 Yes Yes Philips IU22 Unsure
M Sonographer 10 Yes Yes GE Voluson E10 McKesson
N Sonographer 10 Yes Yes GE Voluson E10 McKesson
O Ultrasound Supervisor 10 Yes Yes GE Voluson Expert 20 Study Cast and Intergi
P Sonographer 9 Yes No Philips Epic Elite McKesson
Q Practice Manager, RN 8 Yes Yes GE Voluson E8 Viewpoint
R Practice Manager, RN 10 Yes Unsure GE Voluson E10, E6, E22 Viewpoint
S Sonographer 10 Yes Yes GE Voluson E10 McKesson
T Sonographer 8 Yes Yes GE Voluson E8 Core Sound Imaging
U Manager of Medical Imaging 8 Unsure No GE Logic 10 Spectrum
V Sonographer 9 Yes No GE Voluson E10 Viewpoint and McKesson
W Sonographer 9 Yes Yes Siemens Nova
X Sonographer 10 Yes No GE Voluson E6 Greenway
Y Director of Radiology 7 Yes Yes Canon i700 Nova
June 2025  |  Vol. 7 Iss. 1 Oral Presentations 16
*Names in bold type indicate presenting author.
#3 Langerhans Cell Histiocytosis Masquerading as Refractory Intertriginous Rash 
Nicole Wozny1,2, Hana Niebur1,2, Morgan Zabel3, Nicole Harter3
1Department of Pediatrics, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA 
2Department of Pediatrics, Children’s Nebraska, Omaha, NE, USA 
3Department of Dermatology, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
Mentor: Hana Niebur
Program: Pediatrics
Type: Case Report
Background: Langerhans’s cell histiocytosis 
(LCH) is characterized by infiltration of 
Langerhans cells into various organs of the 
body. Up to 40% of those with LCH have an 
eczematous rash involving intertriginous sites. 
Case: We present the case of a 4-month-old 
male with refractory intertriginous dermatitis 
that did not respond to eczema or antifungal 
therapy. Figure 1 shows the rash in his left 
axilla. Due to concern for chronic mucocu-
taneous candidiasis, Allergy/Immunology 
referral was requested. Additional findings 
included bloody stools leading to a diagnosis 
of milk soy protein intolerance and early tooth 
eruption at 2 months of age with gingival 
friability and immune evaluation showed CD8 
lymphopenia. Skin scraping failed to demon-
strate Candida. Dermatology evaluation was 
requested. A gingival biopsy was obtained, 
ultimately leading to a diagnosis of LCH with 
multisystem involvement. Chemotherapy was 
urgently initiated. 
Conclusion: Erosive oral mucosal changes 
and maceration and erythema of intertrigi-
nous sites seen in LCH can mimic refractory 
cutaneous candidiasis, atopic dermatitis, or 
seborrheic dermatitis. LCH can be divided 
into single system versus multisystem disease, 
with high-risk organ involvement including 
bone marrow, liver, and/or spleen. Intestinal 
involvement can also occur. Diagnosis of 
LCH can be challenging due to rarity of the 
disease and high index of suspicion required 
to diagnose this condition. Biopsy is vital in 
the evaluation of chronic dermatitis that does 
not improve with usual therapy. 
When typical treatment for seborrheic or 
atopic dermatitis fails, concern for LCH 
should be raised. Due to high mortality, a 
strong index of suspicion is vital to expedite 
biopsy, treatment, and increase survival. 
#4 Surgical Outcomes and Decision Making for Bicuspid Aortic Valve
Adam Larsen1, David Danford1, Angela Yetman1
1Department of Pediatrics, Division of Pediatric Cardiology, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
Mentor: Angela Yetman
Program: Pediatrics – Cardiology 
Type: Original Research
Background: Bicuspid aortic valve (BAV) is 
the most common congenital heart lesion and 
is associated with aortic stenosis or regurgi-
tation, endocarditis, and/or ascending aorta 
dilation. Surgical interventions include pulmo-
nary autograft (Ross procedure), aortic valve 
replacement (mechanical or bioprosthetic), 
and aortic valve repair. 
Methods: Single-center cohort study included 
152 adults with BAV who underwent inter-
ventions during childhood. Cohorts were 
defined as those who underwent “non-defin-
itive” intervention only (balloon or surgical 
aortic valvuloplasty) and by first “definitive” 
intervention – Ross procedure, aortic valve 
replacement (mechanical or bioprosthetic), 
and aortic valve repair. Measured outcomes 
included durability of surgical intervention 
and incidence adverse outcome. 
Results: Of the total 152 patients, 62% were 
male. Females were more heavily represented 
in the Ross cohort, with 32 out of 70 patients 
(45%) being women. A total of 35 patients 
underwent “non-definitive” intervention 
only and 117 patients underwent “definitive” 
intervention: Ross procedure (61), mechanical 
aortic valve replacement (27), bioprosthetic 
aortic valve replacement (19), or surgical 
aortic valve repair (17). Patients who under-
went balloon aortic valvuloplasty were more 
likely to undergo mechanical aortic valve 
replacement as first definitive procedure. 
Aortic valve repair and bioprosthetic valve 
replacement were more associated with major 
adverse events and required earlier repeat 
definitive procedure. Ross procedure and 
mechanical aortic valve replacement were 
comparable in freedom from death, transplant, 
or repeat definitive procedure. 
Conclusion: Ross procedure and mechanical 
aortic valve replacement were superior to 
other definitive procedures and have similar 
outcomes. Females were more likely to 
undergo Ross procedure as the first “defini-
tive” procedure than mechanical aortic valve.
Figure 1. Macerated pink plaque in left axilla. 
Graduate Medical Education Research Journal17 Oral Presentations
*Names in bold type indicate presenting author.
#5 Red Blood Cell Transfusion Causes Brain Inflammation in Murine Pups With Phlebotomy Induced 
Anemia
Pramod Shrestha1,2,3, Eric Peeples1,2,3, Balamurugan Ramatchandirin4, Gwenn Skar2,3,5 Mohan Kumar Krishnan1,3,4
1Department of Pediatrics, Division of Neonatology, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA 
2Department of Pediatrics, Children’s Nebraska, Omaha, NE, USA 
3Child Health Research Institute, University of Nebraska Medical Center, Omaha, NE, USA 
4Department of Biochemistry & Molecular Biology, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA 
5Department of Pediatrics, Division of Pediatric Infectious Diseases, College of Medicine, University of Nebraska Medical Center, Omaha, NE
Mentor: Eric Peeples
Program: Pediatrics – Neonatology
Type: Original Research
Background: Anemia is common in prema-
ture infants, with RBC transfusion as the 
treatment for severe cases. Clinical and animal 
studies suggest a link between anemia, blood 
transfusion, and brain inflammation. While 
severe anemia has caused hippocampal injury 
in animals, the impact of RBC transfusion 
on brain inflammation post-anemia remains 
unclear. To identify the inflammatory changes 
in the neonatal mouse brain of phlebotomy 
induced anemia and RBC transfusion.
Methods: C57BL/6 pups were divided into 4 
groups: naïve control, RBC transfused, severe 
anemia, and severe anemia with RBC trans-
fusion. Severe anemia was induced by facial 
vein phlebotomy on days 2, 4, 6, 8, and 10. 
RBC transfusion (20 ml/kg) of leukoreduced, 
stored packed RBC from FVB/NJ donor adult 
mice was administered intravenously on post-
natal day 11 (P11). Brain tissue was collected 
24 hours post-transfusion, and protein 
concentration was measured by bicinchoninic 
acid (BCA) assay. Cytokines and chemokines 
were quantified using Milliplex Map Mouse 
assay. Immunostaining with Ly6c and Iba-1 
antibodies was performed to detect mono-
cyte recruitment and microglial activation. 
Monocyte recruitment in anemic-transfused 
brains was analyzed by flow cytometry.
Results: Inflammatory cytokines IL-1α, 
IL-1β, IL-6, TNF-α, and IL-12p70 were 
higher in brain tissues of anemic-transfused 
mice pups as compared to controls, while 
IL-4 and IL-5 levels remained unchanged. 
Chemokines MCP1, MIP1-α, MIP1-β, 
RANTES, and Eotoxin were also elevated. 
Immunostaining revealed increased 
Ly6C+ monocytes and activated microglia 
(Iba1+) in the anemic-transfused brain. 
Flow cytometry confirmed the presence of 
CD11b+CD45+Ly6C+ monocytes in the 
anemic-transfused brain.
Conclusion: RBC transfusion increases the 
inflammatory response in murine pups’ brains 
with severe anemia.
#6 Characterizing Prostate Cancer Stage Migration and Subsequent Treatment Implications in the PSMA 
PET Era
Joseph Carmicheal1, Madison Bierman2, Chase Jablon2, Tyson Price1, Michael Baine1,2
1Department of Radiation Oncology, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA 
2College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
Mentor: Michael Baine
Program: Radiation Oncology 
Type: Original Research
Background: Until recently, prostate cancer 
staging has been predicated primarily on 
physical exam, CT, MRI, and bone scans. 
Prostate-specific membrane antigen posi-
tron emission tomography (PSMA PET) is 
a more sensitive and specific study for the 
delineation of nodal and distant metastatic 
disease. PSMA PET was added to National 
Comprehensive Cancer Network guidelines 
as the recommended modality for assessment 
of metastatic disease in 2021. The aim of this 
paper is to determine the impact of this new 
imaging modality on prostate cancer staging 
and subsequent treatment decisions compared 
to historical imaging standards in a single 
institution patient cohort. 
Methods: A total of 206 patients with treat-
ment-naïve prostate cancer underwent PSMA 
PET for the detection of metastatic disease 
between January 2021 and March 2024. Scans 
were retrospectively evaluated for PET avid 
lymph nodes and distant metastases. A lymph 
node size cutoff of ≥1cm on CT was used as 
the historical standard for a pathologic lymph 
node. Bony PET avidity was also assessed 
for a CT correlate. (Ethical approval for 
this retrospective study was obtained: IRB 
398-17-EP)
Results: Of the 49 patients with nodal 
involvement on PSMA PET, 24 did not have 
CT-detectable disease. The average size of 
PSMA avid lymph node without pathologic 
node on CT was 6.8mm. 33.3% of all patients 
with 3a/3b disease by MRI had PSMA posi-
tive lymph nodes. Five patients were found to 
have PET avid bony metastases without a CT 
correlate. A total of 29 patients (14.1%) were 
upstaged via PSMA PET imaging. 
Conclusion: PSMA PET may impact prostate 
cancer staging and treatment options that 
could be different from what would have been 
offered in the pre-PSMA PET era.
#7 Double Trouble: Coexistence of Hodgkin and Non-Hodgkin Lymphoma With Chronic ITP and Cryptic 
Brain Metastasis
Durva Masih1, Snegha Ananth1 
1Department of Internal Medicine, Division of Oncology & Hematology, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA 
Mentor: Snegha Ananth 
Program: Internal Medicine – Oncology & 
Hematology 
Type: Case Report 
Background: Hodgkin lymphoma (HL) and 
splenic marginal zone lymphoma (SMZL) can 
be clonally related, sharing identical V gene 
rearrangements, suggesting a potential evolu-
tionary link. Hematological malignancies, 
including HL and SMZL, are associated with 
immune thrombocytopenia (ITP). ITP is rare 
in HL, occurring in 0.29% at presentation 
and 0.7% during follow-up. ITP is more 
common in SMZL, and is often treated with 


Red Blood Cell Transfusion Causes Brain Inflammation in Murine Pups With Phlebotomy Induced Anemia

Lanoux-Nguyen, Arthur

Graduate Medical Education 
Research Journal 
Volume 7 Issue 1 Article 31 
June 2025 
Surgical Denervation of the First Carpometacarpal Joint for 
Osteoarthritis: A Systematic Review 
Arthur Lanoux-Nguyen 
University of Nebraska Medical Center 
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 Part of the Higher Education Commons, and the Medicine and Health Sciences Commons 
Recommended Citation 
Lanoux-Nguyen, A. Surgical Denervation of the First Carpometacarpal Joint for Osteoarthritis: A 
Systematic Review. Graduate Medical Education Research Journal. 2025 Jun 29; 7(1). 
https://digitalcommons.unmc.edu/gmerj/vol7/iss1/31 
This Conference Proceeding is brought to you for free and open access by DigitalCommons@UNMC. It has been 
accepted for inclusion in Graduate Medical Education Research Journal by an authorized editor of 
DigitalCommons@UNMC. For more information, please contact digitalcommons@unmc.edu. 
© 2025 The Authors 
Surgical Denervation of the First Carpometacarpal Joint for Osteoarthritis: A 
Systematic Review 
Abstract 
NA 
Creative Commons License 
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 
License. 
This conference proceeding is available in Graduate Medical Education Research Journal: 
https://digitalcommons.unmc.edu/gmerj/vol7/iss1/31 
June 2025  |  Vol. 7 Iss. 1 Oral Presentations 28
*Names in bold type indicate presenting author.
#33 Simulation as a Tool in Medical Knowledge Retention
Ryan Pavelka1, Kaitlin Dougherty1, Jason Langenfeld1
1Department of Emergency Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
Mentor: Kaitlin Dougherty
Program: Emergency Medicine 
Type: Original Research
Background: One of the most important 
foundations to medical learners’ curriculum is 
the application of simulation-based learning. 
Simulation allows learners to experience 
stressful scenarios within a controlled envi-
ronment. This study evaluated the efficacy 
between standard in-class lecture verses 
simulation-based learning in emergency medi-
cine resident physicians. Our hypothesis is 
that simulation learning will result in greater 
long-term retention compared to in class 
learning.
Methods: The study included a pre- and post-
test as well as alternating investigation groups 
regrading heavy metal toxicity. Residents 
received a 30-minute lecture about heavy 
metal poisoning and then were split into an 
early intervention and late intervention group. 
The early intervention group immediately 
underwent a heavy metal simulation, and the 
late group underwent identical simulation one 
month later.
Results: The study demonstrated a statisti-
cally significant difference in pre and post 
quiz scores who received simulation training 
in the early group (p=0.001). Additionally, 
there was no significant difference in pre and 
post quiz scores for residents who did not 
receive simulation training in the early group.
Conclusion: The most notable limiting factor 
in this study was a low sample size. The 
residency program targeted by this study is 
comprised of a total of 36 residents. As simu-
lation becomes more prevalent in medical 
schools and residency programs, additional 
research will be needed to conclude if simula-
tion increases medical knowledge retention. 
#35 Surgical Denervation of the First Carpometacarpal Joint for Osteoarthritis: A Systematic Review
Arthur S. Lanoux-Nguyen1, Grace E. Kugler2, Jack A. Dunfield3, Jordan M. Rasmussen2, Kai Yang4
1Department of Surgery, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA 
2College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA 
3College of Osteopathic Medicine, Kansas City University, Kansas City, MO, USA 
4Department of Surgery, Division of Plastic & Reconstructive Surgery, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
Mentor: Kai Yang
Program: General Surgery
Type: Review
Background: First carpometacarpal joint 
osteoarthritis (CMCJ-OA) is a progres-
sive condition that impacts quality of life. 
Treatments focus on pain relief and improved 
function. When non-operative measures fail, 
surgery with trapeziectomy with/without 
ligament reconstruction offers durable results. 
Recent literature describes joint denervation 
as a minimally-invasive alternative that 
decreases pain and expedites recovery in first 
CMCJ-OA. We provide a comprehensive 
review of the current literature to assess the 
long-term efficacy and role of denervation 
first CMCJ-OA treatment.
Methods: A literature review identified 
studies with adults undergoing first CMCJ 
denervation for osteoarthritis. The Preferred 
Reporting Items for Systematic Reviews and 
Meta-Analyses guidelines were followed. 
Reviewers performed screening, data collec-
tion/analysis (demographics, technique, and 
post-operative outcomes/complications), 
and quality assessment with the Newcastle-
Ottawa Scale and National Institutes of Health 
Quality Assessment Tools.
Figure 1. Final tracheostomy order set with “per policy” pre-selected to only require one clinical decision for the 
“end-user”.
Graduate Medical Education Research Journal29 Oral Presentations
*Names in bold type indicate presenting author.
Results: Fifteen studies met inclusion criteria 
for a total of 360 patients/372 hands. The 
mean follow-up was 35.5 months (range 
6-125.6 months). First CMCJ denervation 
demonstrated reduced pain and improved 
hand function. Overall pain score reduction 
was 75.3% (PRE: 7.13; POST: 1.77, p<0.001). 
Complications across studies were 18.5% 
with post-operative paresthesia as the most 
common (12.8%). Wound-related compli-
cations/infections were 3%. The conversion 
rate of 16.3% to trapeziectomy with ligament 
reconstruction was reported in seven studies 
with 36.9 month follow-up (range 12-63.5 
months).
Conclusion: Surgical denervation is a prom-
ising, alternative treatment for patients with 
first CMCJ-OA. Long-term studies demon-
strate success in decreasing overall pain, 
post-operative complications, and conversion 
arthroplasty rates. In this study, denervation 
proves to be an effective, lasting treatment for 
first CMCJ-OA.
#36 Targeted Muscle Reinnervation of the Superficial Branch of the Radial Nerve Following Coronary 
Artery Bypass Grafting: A Good Save and Little Victory
Arthur S. Lanoux-Nguyen1, Rebecca D. Williams2, James R. Willcockson3
1Department of Surgery, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA 
2College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA 
3Department of Surgery, Division of Plastic & Reconstructive Surgery, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
Mentor: James R. Willcockson
Program: General Surgery 
Type: Case Report
Background: Targeted muscle reinnervation 
(TMR) has revolutionized pain management. 
Originally described as a nerve transfer tech-
nique to control myoelectric prostheses, TMR 
creates new neurosensory pathways to treat 
neuroma/phantom pain following limb loss. 
We present the story of a good save and little 
victory in a patient successfully treated with 
TMR for persistent, debilitating paresthesias 
from the superficial branch of the radial nerve 
(SBRN) following radial artery harvest for 
coronary artery bypass grafting (CABG).
Case: Our patient had a history of hyper-
tension, hyperlipidemia, tobacco use, and 
poorly-controlled diabetes (A1c 12.9%), 
who presented with chest pain. Workup was 
consistent with non-ST-elevation myocardial 
infarction. Left heart catheterization revealed 
severe multivessel coronary artery disease 
for which CABG was indicated. Following 
surgery, lifestyle modifications were initially 
successful. However, the psychological 
burden of ongoing pain from a near-complete 
SBRN transection from radial artery harvest 
impacted quality of life. This led to a relapse 
into smoking and alcohol use, behaviors 
that previously contributed to the cardiovas-
cular disease. SBRN TMR to extensor carpi 
radialis brevis motor nerve was completed. 
Subsequent follow-ups have demonstrated 
cessation of analgesic use, improved pain, and 
restored ability to work, care for his children, 
and effectively engage in activities of daily 
living.
Conclusion: Applications of TMR have been 
well-described as treating chronic pain in 
amputees and preventing neuroma formation 
following major limb loss. As highlighted 
here, TMR provides a spectrum of benefits to 
amputees experiencing residual limb pain, and 
little victories to those suffering from chronic 
pain sustained in trauma or surgery.
#37 Indocyanine Green and Near-infrared Guided Surgery Publications: An Analysis of Conflict of Interest 
Statements and Industry General Payments 
Paul J. Nguyen-Lee1, Brianna L. Foley2, Collin E. Dougherty3, Tiffany N. Tanner4, Ivy N. Haskins4, Juan A. Santamaria-Barria3 
1Department of Surgery, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA 
2College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA 
3Department of Surgery, Division of Surgical Oncology, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA 
4Department of Surgery, Division of General Surgery, Minimally Invasive Surgery & Bariatrics, College of Medicine, University of Nebraska Medical Center, 
Omaha, NE, USA
Mentor: Juan A. Santamaria-Barria
Program: General Surgery
Type: Original Research
Background: The use of indocyanine green 
and near-infrared (ICG-NIR) guidance in 
surgery is expanding. Medical device compa-
nies provide general (non-research) payments 
to promote their technology, potentially 
influencing conflicts of interest (COI) and 
publication bias.
Methods: We reviewed ICG-NIR articles in 
the top 100 highest impact surgery journals 
between 2018 and 2023 with at least one 
U.S.-affiliated author. Authors were cross-ref-
erenced with the U.S. Centers for Medicare & 
Medicaid Services Open Payments Database 
for industry general payments related to 
ICG-NIR products. The amount, product, 
company, and nature of payments, and COI 
reporting concordance were analyzed.
Results: Of 240 ICG-NIR articles, 46.7% 
(112/240) had discordant COI reporting. 
Among the 158 articles explicitly stating 
no COIs, 43% (68/158) had underreported 
payments, while 53% (44/82) of those 
disclosing COIs still underreported payments 
(Figure 1). Plastic surgery articles had a 
higher concordant COI reporting rate (77.5%, 
62/80, p < 0.05) compared to other surgical 
specialties (41.3%, 66/160, p < 0.05). Industry 
payments totaled $8,089,060, with 31.7% 
($2,567,825) linked to authors underreporting 
COIs. The top paying companies were 
Intuitive ($3,820,538), Stryker ($3,162,591), 
and NOVADAQ ($783,593; later acquired 
by Stryker). SPY/PINPOINT (Stryker/
NOVADAQ) and Da Vinci (Intuitive) were 
the top ICG-NIR products, making up 96% 
of all payments ($7,766,722). The top under-
reported payment categories were consulting 
fees (38.3%), education (21.3%), travel & 
June 2025  |  Vol. 7 Iss. 1 Oral Presentations 30
*Names in bold type indicate presenting author.
lodging (16.5%), and speaker/faculty compen-
sation (8.5%) (Figure 1). 
Conclusion: Between 2018 and 2023, authors 
of ICG-NIR publications underreported indus-
try-related COIs and general payments. While 
industry-surgeon collaborations are essential 
for the advancement of surgery, standardized 
COI disclosures and transparent company 
funding are urgently needed.
#38 Muscle Oxygen Levels in Patients With Claudication: Measurements During Rest, Walking, and 
Temporary Occlusion of Blood Flow
Yuqian Tian1, Cody Anderson2, Ali Hakim1, Prateek Sharma1, Varnica Bajaj1, Holly Despiegelaere3, Sara Myers4, Panagiotis Koutakis5, Song-Young Park2,6, 
Iraklis I. Pipinos1,3 
1Department of Surgery, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA 
2School of Health & Kinesiology, University of Nebraska at Omaha, Omaha, NE, USA 
3Department of Surgery & VA Research Service, VA Nebraska-Western Iowa Health Care System, Omaha, NE, USA 
4Department of Biomechanics, College of Education, Health & Human Sciences, University of Nebraska at Omaha, Omaha, NE, USA 
5Department of Public Health, University of West Florida, Pensacola, FL, USA 
6Department of Cellular & Integrative Physiology, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
Mentor: Iraklis I. Pipinos
Program: General Surgery
Type: Original Research
Background: Walking is the most signifi-
cantly impacted activity for patients with 
peripheral artery disease (PAD), with clau-
dication being the most common symptom. 
Supervised treadmill (TM) exercise is the 
primary recommended treatment for patients 
with claudication. Therefore, it is crucial 
to understand the ischemic stress that leg 
muscles experience during walking in these 
patients.
Methods: This study was approved by the 
Institutional Review Board of VA Nebraska-
Western Iowa Health Care System, and all 
participants provided informed consent. 
Eighteen male claudicating PAD patients 
(mean age 70, Ankle-Brachial Index 0.72) 
underwent both TM and post-occlusive 
reactive hyperemia (PORH) tests, involving a 
5-minute thigh cuff occlusion. Near-infrared 
spectroscopy (NIRS) devices measured 
gastrocnemius muscle oxygenation (StO2) 
in the most symptomatic leg. Data were 
processed in MATLAB to assess StO2 
dynamics.
Results: Representative NIRS outputs from 
PORH and TM are shown in Figure 1. The 
overall drop in StO2 during stress was similar 
between the two tests (p = 0.21); but oxygen-
ation declined faster in TM (time to minimum 
StO2: TM 92s vs PORH 267s; slope: TM 
–1.4 vs PORH –0.3%/s, p < 0.001). During 
recovery, StO2 recovered more slowly after 
the TM (slope, PORH 1.5 vs TM 0.5%/s, p 
< 0.001), while reaching a higher maximum 
StO2 (PORH vs TM 113 vs 136%, p = 0.001) 
and exhibiting a greater hyperemic response 
(PORH 1713 vs TM 18359%*s, p < 0.001). 
Conclusion: In claudicating patients, walking 
produces profound drops in calf muscle 
oxygenation that are faster and larger oxygen 
deficits than those produced by acute occlu-
sion of arterial inflow of similar duration, and 
with slower recovery. These findings shed 
light in the rapid and profound oxygenation 
deficits produced by walking in claudicating 
patients, underscoring the need for improved 
revascularization and tailored exercise 
strategies.
Figure 1. Discrepancies in conflict of interest disclosures and industry payments in indocyanine green and near-
Infrared surgical publications. 


Surgical Denervation of the First Carpometacarpal Joint for Osteoarthritis: A Systematic Review

Torres, Cristina

Graduate Medical Education 
Research Journal 
Volume 7 Issue 1 Article 37 
June 2025 
Unwanted Travel Souvenirs; Parasite Causing Fever in a Returning 
Traveler 
Cristina Torres 
University of Nebraska Medical Center 
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Torres, C. Unwanted Travel Souvenirs; Parasite Causing Fever in a Returning Traveler. Graduate Medical 
Education Research Journal. 2025 Jun 29; 7(1). 
https://digitalcommons.unmc.edu/gmerj/vol7/iss1/37 
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accepted for inclusion in Graduate Medical Education Research Journal by an authorized editor of 
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© 2025 The Authors 
Unwanted Travel Souvenirs; Parasite Causing Fever in a Returning Traveler 
Abstract 
NA 
Creative Commons License 
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 
License. 
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June 2025  |  Vol. 7 Iss. 1 Oral Presentations 30
*Names in bold type indicate presenting author.
lodging (16.5%), and speaker/faculty compen-
sation (8.5%) (Figure 1). 
Conclusion: Between 2018 and 2023, authors 
of ICG-NIR publications underreported indus-
try-related COIs and general payments. While 
industry-surgeon collaborations are essential 
for the advancement of surgery, standardized 
COI disclosures and transparent company 
funding are urgently needed.
#38 Muscle Oxygen Levels in Patients With Claudication: Measurements During Rest, Walking, and 
Temporary Occlusion of Blood Flow
Yuqian Tian1, Cody Anderson2, Ali Hakim1, Prateek Sharma1, Varnica Bajaj1, Holly Despiegelaere3, Sara Myers4, Panagiotis Koutakis5, Song-Young Park2,6, 
Iraklis I. Pipinos1,3 
1Department of Surgery, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA 
2School of Health & Kinesiology, University of Nebraska at Omaha, Omaha, NE, USA 
3Department of Surgery & VA Research Service, VA Nebraska-Western Iowa Health Care System, Omaha, NE, USA 
4Department of Biomechanics, College of Education, Health & Human Sciences, University of Nebraska at Omaha, Omaha, NE, USA 
5Department of Public Health, University of West Florida, Pensacola, FL, USA 
6Department of Cellular & Integrative Physiology, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
Mentor: Iraklis I. Pipinos
Program: General Surgery
Type: Original Research
Background: Walking is the most signifi-
cantly impacted activity for patients with 
peripheral artery disease (PAD), with clau-
dication being the most common symptom. 
Supervised treadmill (TM) exercise is the 
primary recommended treatment for patients 
with claudication. Therefore, it is crucial 
to understand the ischemic stress that leg 
muscles experience during walking in these 
patients.
Methods: This study was approved by the 
Institutional Review Board of VA Nebraska-
Western Iowa Health Care System, and all 
participants provided informed consent. 
Eighteen male claudicating PAD patients 
(mean age 70, Ankle-Brachial Index 0.72) 
underwent both TM and post-occlusive 
reactive hyperemia (PORH) tests, involving a 
5-minute thigh cuff occlusion. Near-infrared 
spectroscopy (NIRS) devices measured 
gastrocnemius muscle oxygenation (StO2) 
in the most symptomatic leg. Data were 
processed in MATLAB to assess StO2 
dynamics.
Results: Representative NIRS outputs from 
PORH and TM are shown in Figure 1. The 
overall drop in StO2 during stress was similar 
between the two tests (p = 0.21); but oxygen-
ation declined faster in TM (time to minimum 
StO2: TM 92s vs PORH 267s; slope: TM 
–1.4 vs PORH –0.3%/s, p < 0.001). During 
recovery, StO2 recovered more slowly after 
the TM (slope, PORH 1.5 vs TM 0.5%/s, p 
< 0.001), while reaching a higher maximum 
StO2 (PORH vs TM 113 vs 136%, p = 0.001) 
and exhibiting a greater hyperemic response 
(PORH 1713 vs TM 18359%*s, p < 0.001). 
Conclusion: In claudicating patients, walking 
produces profound drops in calf muscle 
oxygenation that are faster and larger oxygen 
deficits than those produced by acute occlu-
sion of arterial inflow of similar duration, and 
with slower recovery. These findings shed 
light in the rapid and profound oxygenation 
deficits produced by walking in claudicating 
patients, underscoring the need for improved 
revascularization and tailored exercise 
strategies.
Figure 1. Discrepancies in conflict of interest disclosures and industry payments in indocyanine green and near-
Infrared surgical publications. 
Graduate Medical Education Research Journal31 Oral Presentations
*Names in bold type indicate presenting author.
#39 Subclassification of Peripheral Artery Disease Based on Muscle Force: Leg Failure With Reduced 
Muscle Force and With Preserved Muscle Force 
Yuqian Tian1, Ali H. Hakim1, Farahnaz Fallah Tafti2, Michael J. Moulton1, Panagiotis Koutakis1, Jonathan R. Thompson1, Jason R. Cook1, Julian K.S. Kim1, 
Zhen Zhu1, Holly K. DeSpiegelaere4, Gleb R. Haynatzki3, Sara A. Myers1,4, Iraklis I. Pipinos1,4
1Department of Surgery, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA 
2Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, USA 
3Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA 
4Department of Surgery & VA Research Service, VA Nebraska-Western Iowa Health Care System, Omaha, NE, USA
Mentor: Iraklis I. Pipinos
Program: General Surgery
Type: Original research 
Background: Claudicating patients with 
peripheral artery disease (PAD) experience 
leg failure, as evidenced by distinct walking 
impairment. However, some maintain 
preserved leg muscle strength, while others 
demonstrate reduced strength. This study 
compares the clinical and physiological char-
acteristics of these groups.
Methods: This study was approved by the 
Institutional Review Board of VA Nebraska-
Western Iowa Health Care System, and all 
participants provided informed consent. Fifty-
four claudicating patients were categorized 
into two groups: leg failure with preserved 
muscle force (LEF-PF, N = 19, PT 92 ± 15 
Nm) and leg failure with reduced muscle 
force (LEF-RF, N=35, PT 49±13 Nm), based 
on maximum isometric plantar flexion peak 
torque measured on a Biodex system. All 
patients underwent clinical evaluation, leg 
hemodynamic assessment, walking tests, 
quality of life surveys, and gastrocnemius 
biopsy for histological and biochemical anal-
ysis. Statistical comparisons were made using 
independent sample T-tests and chi-square 
tests.
Results: LEF-PF and LEF-RF had similar 
demographics and comorbidities. Although 
ankle-brachial indices were comparable, 
LEF-RF showed a greater drop in ankle 
pressure (p = 0.021) and slower recovery (p 
= 0.023) during reactive hyperemia. Both 
groups performed similarly on the Gardner 
Treadmill test, but LEF-PF tended to outper-
form on the 6-Minute Walk (p = 0.062). 
Histologically, LEF-PF had larger gastrocne-
mius myofibers, while biochemically, LEF-RF 
exhibited greater complex-II-dependent mito-
chondrial respiratory activity.
Conclusion: This study highlights differ-
ences in muscle strength among claudicating 
patients, despite similar demographics and 
baseline hemodynamics. Stress-induced 
hemodynamics, walking performance, 
muscle histology, and mitochondrial func-
tion distinguish these groups. Such insights 
may enhance our understanding of PAD 
physiology and potentially correlate with 
variations in mortality rates, progression to 
more advanced PAD stages, and responses to 
different therapeutic interventions.
#40 Unmasking Constrictive Pericarditis Through Multimodality Imaging: A Rare Case
Mansi Oberoi1, Mohan Gudiwada1, Adam Burdorf1
1Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
Mentor: Adam Burdorf
Program: Internal Medicine – Cardiology
Type: Case Report
Background: Constrictive pericarditis (CP) is 
an extremely rare cause of heart failure (HF) 
needing a high level of clinical suspicion. We 
discuss a unique case of CP discovered in the 
light of multimodality imaging.
Case: A 76-year-old female with a history of 
monoclonal gammopathy of undetermined 
significance, heart failure with preserved 
ejection fraction, atrial fibrillation, COPD, 
DM type II, and squamous cell carcinoma 
was admitted to the hospital for worsening 
shortness of breath, swelling in legs, hypo-
natremia, and UTI/pyelonephritis. HF team 
was consulted for her decompensated HF. 
She had no prior history of irradiation. CT 
chest showed diffuse pericardial calcifica-
tions (Figure 1A-B). Subsequent right heart 
catheterization showed elevated right and left 
Figure 1. Representative NIRS output from the same participant 
for both TM (red) and PORH (black) tests. 
June 2025  |  Vol. 7 Iss. 1 Oral Presentations 32
*Names in bold type indicate presenting author.
sided filling pressures with diastolic equaliza-
tion and positive right ventricle square root 
sign and ventricular interdependence; these 
findings were consistent with CP (Figure 
1C). Cardiac MRI (Figure 1D) was obtained, 
which revealed diastolic septal flattening with 
deep inspiration and septal bounce suggestive 
of interventricular dependence and constric-
tive physiology. Cardiothoracic surgery team 
was consulted for the possibility of pericar-
diectomy. Following a thorough discussion of 
risks and benefits, it was concluded that the 
patient was not a good candidate for this high-
risk surgical procedure due to her advanced 
age, frailty, and comorbidities. Consequently, 
the patient opted for medical management.
Conclusion: This case underscores the impor-
tance of maintaining a high index of suspicion 
for CP, given its rarity and non-specific 
clinical features. The utility of multimo-
dality imaging in the diagnostic process is 
highlighted in guiding patient management 
decisions.
#41 Unwanted Travel Souvenirs; Parasite Causing Fever in a Returning Traveler 
Cristina Torres1, Daniel Brailita1 Chunyi Zhou2, Nosakhare Edogun3, Jana Broadhurst2, David Brett-Major1,4, Angela Hewlett1, Mackenzie R. Keintz1, Bryan 
Alexander5, Jennifer M. Davis1 
1Department of Internal Medicine, Division of Infectious Diseases, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA 
2Department of Pathology, Microbiology & Immunology, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA 
3Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA 
4Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA 
5Department of Pharmaceutical & Nutrition Care, Nebraska Medicine, Omaha, NE, USA 
Mentor: Jennifer M. Davis
Program: Internal Medicine – Infectious 
Diseases
Type: Case Report
Background: Fever in returning international 
travelers should prompt consideration for 
endemic and emerging infectious diseases. 
Early symptoms of malaria are often nonspe-
cific. If diagnosis and therapy are delayed, 
patients can experience high parasite burden 
leading to severe disease. 
Case: A 61-year-old man with no chronic 
medical conditions presented to the emer-
gency department with 2 days of fever, 
myalgias, and night sweats after returning 
from a 2-week trip to Uganda. The patient 
had gone on safari, went white water rafting, 
and stayed in hostels. He did not receive 
any travel-focused vaccines or antimalarial 
chemoprophylaxis. Laboratory abnormalities 
included platelet count 35 U/L, white blood 
count 6.4 U/L with 0% eosinophils, AST 100 
U/L, ALT 114 U/L, alkaline phosphatase 139 
U/L, total bilirubin 4.1 mg/dL. Peripheral 
blood smear (Figure 1) and BioFire® Global 
Fever Panel were positive for P. falciparum, 
with initial parasite burden >5%. Given the 
severity of disease, he was started on IV 
artesunate. Acquisition of IV artesunate was 
delayed requiring use of oral therapy. He 
completed 1.5 doses of IV artesunate and 5 
days of artemether-lumefantrine. On follow 
up, night sweats and urinary frequency 
prompted testing and subsequent treatment of 
Schistosoma coinfection. 
Conclusion: Travelers can be exposed to 
multiple infectious threats in tropical areas, 
and patients should be evaluated for co-infec-
tions. Pre-travel counseling should include 
offering antimalarial chemoprophylaxis to 
patients traveling to areas of risk. If IV artesu-
nate is not available for management of severe 
malaria, treatment with oral antimalarials 
should be initiated until IV therapy can be 
obtained. 
Figure 1. (A & B) CT Chest showing pericardial calcifications, (C) RHC and (D) MRI showing ventricular 
interdependence.
Figure 1. Peripheral blood smear with intracellular 
ring trophozoites of P. falciparum.


Unwanted Travel Souvenirs; Parasite Causing Fever in a Returning Traveler

Meyers, Hunter

Graduate Medical Education 
Research Journal 
Volume 7 Issue 1 Article 44 
June 2025 
When Milk is Not Taken Out to Pasteur: A Case Study on Brucella 
in an Otherwise Healthy Child 
Hunter Meyers 
University of Nebraska Medical Center 
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 Part of the Higher Education Commons, and the Medicine and Health Sciences Commons 
Recommended Citation 
Meyers, H. When Milk is Not Taken Out to Pasteur: A Case Study on Brucella in an Otherwise Healthy 
Child. Graduate Medical Education Research Journal. 2025 Jun 29; 7(1). 
https://digitalcommons.unmc.edu/gmerj/vol7/iss1/44 
This Conference Proceeding is brought to you for free and open access by DigitalCommons@UNMC. It has been 
accepted for inclusion in Graduate Medical Education Research Journal by an authorized editor of 
DigitalCommons@UNMC. For more information, please contact digitalcommons@unmc.edu. 
© 2025 The Authors 
When Milk is Not Taken Out to Pasteur: A Case Study on Brucella in an Otherwise 
Healthy Child 
Abstract 
NA 
Creative Commons License 
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 
License. 
This conference proceeding is available in Graduate Medical Education Research Journal: 
https://digitalcommons.unmc.edu/gmerj/vol7/iss1/44 
Graduate Medical Education Research Journal35 Poster Presentations
*Names in bold type indicate presenting author.
Proceedings of the 7th Annual Graduate Medical Education Research Symposium | Poster Presentations
#48 Correlation of Serial Lung Ultrasound Scores and Sonographic Measurements of Diaphragmatic 
Excursion With Extubation Success in Intubated NICU Patients Receiving a Dexamethasone Taper
Caleb Cave1, Ann L. Anderson Berry1, Courtney K. McLean1, Abhineet M. Sharma1, Lisa Wheelock2, Zahi Zeidan1
1Department of Pediatrics, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA 
2Department of Radiology, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
Mentor: Abhineet Sharma
Program: Pediatrics – Neonatal-Perinatal 
Medicine
Type: Original Research
Background: Semiquantitative lung ultra-
sound scores (LUS) can help predict the 
development of bronchopulmonary dysplasia 
(BPD). Sonographic measurement of 
diaphragmatic excursion (DE) may predict the 
success of preterm neonates extubating from 
conventional invasive mechanical ventilation 
(IMV) (Figure 1). Although steroids are often 
given to preterm neonates to facilitate extu-
bation in the prevention of BPD, the success 
of individual steroid courses is difficult to 
predict. We hypothesize that the combined 
sonographic measurements of LUS and DE 
may serve as a novel tool to predict an intu-
bated preterm neonate’s clinical response to a 
steroid taper.
Methods: Eligible subjects include 
infants with birth gestational age < 29 
weeks receiving IMV and starting on a 
dexamethasone taper per the 2006 DART 
(Dexamethasone a Randomized Trial) 
protocol. Serial LUS and DE ultrasounds 
will be obtained during the taper. To quantify 
ventilatory support, a Respiratory Severity 
Score (RSS) [RSS = MAP × FiO2] will be 
calculated on the days that ultrasounds are 
performed. Primary outcome will be libera-
tion from IMV at 72 hours post-extubation. 
Secondary outcome will be a reduction in 
RSS.
Results: Ten subjects have been enrolled. Of 
the 5 subjects who successfully extubated, the 
average LUS was 13.9, average RSS 4.00, 
and average DE 0.63. Of the 5 subjects who 
did not extubate, the average LUS was 14.7, 
average RSS 3.63, and average DE 0.94.
Conclusion: While preliminary results 
suggest that lower LUS and DE values are 
associated with extubation success during 
a steroid taper, our sample size remains 
inadequately powered to suggest statistical 
significance. Further enrollment must be 
completed before analyzing results for poten-
tial confounding factors.
#49 The Advanced Practice Provider’s Role in Fellow Medical Education and Training: A Mixed Methods 
Survey Study to Evaluate Current Educational Interactions, Perspectives, and Models
Jennifer Berger1,2, Sushmitha Chandrasekaran3, Alexandra Comfort4, Marieka Helou5, Nathan Gollehon1,2
1Department of Pediatrics, Division of Neonatology, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA 
2Department of Neonatology, Children’s Nebraska, Omaha, NE, USA 
3Creighton University, Omaha, NE, USA 
4Department of Pediatrics, University of Utah Health, Salt Lake City, UT, USA 
5Department of Pediatrics, Division of Hematology/Oncology, Virginia Commonwealth University, Richmond, VA, USA
Mentor: Nathan Gollehon
Program: Pediatrics – Neonatology 
Type: Original Research
Background: Due to an ongoing paucity 
of doctors, physician preceptor shortages 
exist. Advanced practice providers (APPs) 
are members of the multidisciplinary team 
working to bridge physician care gaps and 
assist with the provider’s role in medicine. 
The APP role in medical learning has not 
been defined or formally evaluated. As APP 
numbers grow, there is a need to understand 
the APP and physician-learner interaction and 
define the APP role in physician education, 
if one exists. The Liaison Committee for 
Medical Education and the Accreditation 
Council for Graduate Medical Education 
do not provide guidance on the APP/trainee 
interaction or instruction to APPs teaching 
learners. Clarity for learners and educators 
is lacking regarding who is teaching, super-
vising, and evaluating trainees. 
Methods: This is a survey study with 
a mixed-methods research design. We 
developed incentivized pediatric fellow 
and fellowship program director surveys to 
distribute on the Association of Pediatric 
Program Directors email listserv. Questions 
focus on the current fellow/APP interaction 
and fellow/PD opinions on the APP role in 
fellowship education. Each survey tool was 
vetted by pilots who provided informal and 
structured feedback via cognitive interviews 
analyzing every survey question. Each survey 
was evaluated by a qualitative statistician to 
optimize data collection. Surveys are awaiting 
dispersal. With results, we will perform a 
mixed methods analysis utilizing a thematic 
approach for qualitative data integrated with 
a quantitative statistical review. Study is 
IRB-exempt. 
Results: Pending. The project completion 
timeline is enclosed in Table 1.
Conclusion: Pending. 
Figure 1. Diaphragmatic excursion measured using 
M-mode ultrasonography. 
June 2025  |  Vol. 7 Iss. 1 Poster Presentations 36
*Names in bold type indicate presenting author.
#50 When Milk is Not Taken Out to Pasteur: A Case Study on Brucella in an Otherwise Healthy Child
Hunter Meyers1, Andrea Green Hines1,2
1Department of Pediatrics, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA 
2Department of Pediatrics, Division of Infectious Diseases, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
Mentor: Andrea Green Hines
Program: Pediatrics
Type: Case Report
Background: Brucellosis is a zoonotic 
disease that highlights several diagnostic 
challenges. Brucella is a slow-growing, 
gram-negative coccobacilli found in wild 
and domestic animals. Typically, history 
entails contact with fluids, tissue, or fetuses 
of infected animals; thus, the associated risk 
of consuming unpasteurized dairy products 
or caring for domestic animals. Diagnosis 
of an infection can be arduous with vague 
symptoms, such as fever, fatigue, myalgia or 
arthralgia, abdominal pain, and anorexia.
Case: A 5-year-old male presented to a 
pediatric emergency department with a 5-day 
history of fever, fatigue, and cough; diag-
nosed as a viral illness and discharged with 
supportive cares. His family brought him back 
to the Emergency Department on day #9 of 
illness for persistent fever, fatigue, and new 
abdominal pain and right ankle arthralgia. 
A repeat examination was significant for 
tachycardia and hepatosplenomegaly. Further 
workup was pursued, and his blood culture 
became positive for Brucella melitensis. 
The patient was hospitalized and initiated 
on trimethoprim-sulfamethoxazole and 
rifampin. Abdominal and cardiac imaging did 
not demonstrate metastatic complications of 
the infection. His mother reported travel to 
Mexico within 4 months prior to admission, 
where the patient consumed dairy products, 
though none known to be unpasteurized 
and no known direct exposure to livestock. 
He improved clinically, and he completed a 
7-week course of dual antibiotic therapy.
Conclusion: The case emphasizes the impor-
tance of thorough history taking, clinical 
vigilance, and follow-up care to identify 
rare conditions like brucellosis. Early recog-
nition and appropriate treatment prevented 
severe complications, reinforcing the need 
for provider diligence and effective family 
communication.
#51 From Paralysis to Heart Block: A Diagnostic Challenge in Andersen-Tawil Syndrome
Andrew Nguyen1,2, Danita Velasco1,3, Jeffrey Robinson1,2
1Department of Pediatrics, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA 
2Pediatric Cardiology, Children’s Nebraska, Omaha, NE, USA 
3Pediatric Genetics, Children’s Nebraska, Omaha, NE, USA
Mentor: Jeffrey Robinson
Program: Pediatrics – Cardiology
Type: Case Report
Background: Andersen-Tawil Syndrome 
(ATS) is a rare genetic disorder caused by 
mutations in the KCNJ2 gene, which encodes 
Kir2.1 potassium channels, resulting in the 
triad of cardiac arrhythmias, craniofacial 
dysmorphisms, and periodic paralysis. 
Case: A 13-year-old previously healthy 
male presented with acute lower extremity 
weakness after participating in strength 
training. Returning home, he collapsed and 
was unable to stand, prompting evaluation. 
Further history detailed a recent camping trip 
with possible tick exposure. Examination 
showed retrognathia, hypertelorism, and 3/5 
knee extension strength. Diagnostics revealed 
persistent hypokalemia, elevated creatinine 
kinase, and negative inflammatory markers. 
Electrocardiogram demonstrated a second-de-
gree Mobitz Type I atrioventricular block. 
Given the constellation of findings, a broad 
differential including cardiogenic, infectious, 
genetic, rheumatologic, and neuromuscular 
causes were considered. Further evaluation 
yielded a normal echocardiogram, infectious, 
and rheumatologic results. During hospital-
ization, he subsequently developed ventricular 
ectopy and escape ventricular tachycardia, and 
was managed with isoproterenol to promote 
conduction through the AV node. Potassium 
supplementation corrected his hypokalemia 
with concurrent improvement in his weak-
ness. As he progressed, his isoproterenol 
was discontinued with only intermittent 
second-degree heart block. Genetic testing 
was pursued, which revealed a variant of 
uncertain significance in KCNJ2 (c.659 G>A; 
p.Ser220Asn).
Conclusion: This is the first report of the 
Ser220Asn missense variant in KCNJ2 in 
someone satisfying clinical diagnostic criteria 
for ATS; however, a variant in the same codon 
has been previously published with cardiac 
features alone. This case highlights the impor-
tance of maintaining a broad differential and 
comprehensive approach in pediatric patients 
who present with an atypical presentation of 
heart block.
Table 1. Project timeline table.
Completed
 • Literature Review and Annotated Bibliography: Complete 
(knowledge gap in current literature identified)
 • Written Study Proposal: Complete 
(including study aims, hypotheses, & research methodology)
 • IRB Exemption Documentation: Complete
 • Survey Tool Development: Complete
 • Budget Development: Grant Support Obtained for Survey Incentive: Complete 
($2500)
 • Survey Tools submitted to APPD for evaluation of dispersal on listserv: Complete
Nov 2024 – Spring 2025  • Data Collection: APPD Approved, survey dispersal and incentive dispersal pending 
Spring 2025  • Quantitative and Qualitative Data Analysis: per plan developed with statistician
Summer 2025  • Manuscript Writing


When Milk is Not Taken Out to Pasteur: A Case Study on Brucella in an Otherwise Healthy Child

Stone, Jeremy

Graduate Medical Education 
Research Journal 
Volume 7 Issue 1 Article 66 
June 2025 
Percutaneous Transhepatic Cholangioscopy: New Horizons for 
Challenging Biliary Interventions 
Jeremy Stone 
University of Nebraska Medical Center 
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© 2025 The Authors 
Percutaneous Transhepatic Cholangioscopy: New Horizons for Challenging 
Biliary Interventions 
Abstract 
NA 
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License. 
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Graduate Medical Education Research Journal47 Poster Presentations
*Names in bold type indicate presenting author.
#78 Percutaneous Transhepatic Cholangioscopy: New Horizons for Challenging Biliary Interventions 
Jeremy Stone1, Neal Kucera1, Lei Yu1 
1Department of Radiology, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
Mentor: Lei Yu
Program: Interventional Radiology 
Type: Case Report 
Background: Percutaneous Transhepatic 
Cholangioscopy (PTCS) is an innovative 
approach for challenging biliary pathologies. 
It allows direct visualization of the biliary 
system for diagnostic and therapeutic inter-
ventions, including biopsy, biliary stone 
retrieval, lithotripsy, foreign body removal, 
and laser treatment of biliary strictures. In 
patients with altered anatomy following 
surgery and those who have failed Endoscopic 
Retrograde Cholangiopancreatography 
(ERCP), PTCS provides an alternative 
approach to manage biliary issues. We present 
a case of challenging biliary intervention 
aided by cholangioscopic guidance. 
Case: Patient is a 74 y/o male with a history 
of gastric adenocarcinoma status post total 
gastrectomy and roux-en-y esophago-
jejunostomy. He has a long history of 
choledocholithiasis, which has resulted in 
multiple prior episodes of cholangitis. ERCP 
was attempted for stone removal, however, 
it was unsuccessful due to the inability to 
reach the jejunojejunostomy anastomosis. 
Interventional Radiology was consulted for 
percutaneous transhepatic stone removal. 
Percutaneous transhepatic access to the biliary 
tree was obtained, and cholangiogram demon-
strated multiple biliary stones and severe 
narrowing of distal common bile duct. A 
biliary catheter was placed for drainage while 
the fistula tract matured. The patient was 
brought back 4 weeks later for cholangios-
copy. PTCS system was introduced through 
the access, and multiple 1-2 cm biliary stones 
were visualized directly. The stones were 
fragmented using electrohydraulic lithotripsy. 
Balloon sweep was performed to push stone 
fragments into the small bowel. The structure 
was dilated with an 8mm balloon. The biliary 
drain was replaced and successfully removed 
at a follow up visit. 
Conclusion: PTCS is a safe and effective 
treatment option for challenging biliary cases, 
especially in patients with post-surgical 
anatomy when traditional ERCP is unfeasible. 
#79 Is Generative AI Being Used in the Creation of Personal Statements in Emergency Medicine Residency 
Applicants? 
Caleb Heder1, Chad Branecki2, Wesley Zeger3
1Department of Emergency Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
Mentor: Wesley Zeger 
Program: Emergency Medicine
Type: Original Research
Background: A significant component of 
Emergency Medicine (EM) residency appli-
cation is the Personal Statement , assessing 
experiences, motives, and ability to communi-
cate in a written format. Artificial intelligence 
(AI) writing aids have gained notoriety in 
the last 6 years as programs such as the GPT 
series demonstrated capabilities for generating 
human-like writing samples. The primary 
objective of this study was to investigate the 
potential use of AI in creating the PS for EM 
residency applications. 
Methods: Retrospective review of applicant’s 
personal statements submitted to an academic 
EM residency program, between Sept of 
2018-Jan 2023. AI detectors GPTZERO, 
Winston AI, and ContentAtScale were used 
for this purpose. Descriptive statistics summa-
rized the data. Continuous measures were 
compared between groups using ANOVA. 
Chi-square looked at associations of categor-
ical variables with AI classification groups. 
The correlation of readability from GPT and 
Winston was evaluated using Pearson correla-
tion coefficient.
Results: There was a strong correlation 
between GPTZERO and Winston readability 
(r = 0.81; p < 0.0001). Only ContentAtScale 
identified different groups related to potential 
AI detection, therefore was used to compare 
other AI measurements and demographic 
groupings. No statistically significant interac-
tions of gender, region, or race/ethnicity were 
identified between groups.
Conclusion: Our findings suggest that no 
consistent AI use was detected. AI tools 
may help enhance EM residency personal 
statements without introducing demographic 
biases. However, the findings also raise 
questions about the accuracy of AI detectors 
and the ethical considerations of using AI in 
personal narratives.
#81 Mycoplasma Genitalium: An Under-Diagnosed Sexually Transmitted Infection 
Melissa Davison1
1Clarkson Family Medicine, Nebraska Medicine, Omaha, NE, USA
Mentor: Kelsey Noble
Program: Clarkson Family Medicine
Type: Case Report
Background: This is a case of delayed diag-
nosis of a symptomatic sexually transmitted 
infection (STI) of Mycoplasma genitalium.
Case: A 25-year-old male presented to a 
primary care clinic complaining of scant 
urethral discharge and urethral irritation 
that was worse after urination. Medical 
history included hypertension and migraines. 
Symptoms had been present for approxi-
mately six weeks. He had presented for care 
twice previously. At his first clinic encounter, 
he tested negative for gonorrhea and chla-
mydia from throat and urine samples but was 
treated empirically with a weeklong course of 
doxycycline, which provided an improvement 
in symptoms but incomplete resolution. In his 
second clinic encounter, he tested negative for 
urine gonorrhea and chlamydia and negative 
for serum HIV and syphilis antibodies. His 
sexual partner was also reportedly negative. 
At this follow up appointment, testing was 
expanded to include a urinalysis, urine 
culture, urine trichomonas, and Mycoplasma 
and Ureaplasma PCR genital swab. The 
physical exam was normal. Results were 
notable for positive leukocyte esterase and 
positive Mycoplasma genitalium. Symptoms 
responded well to treatment with one-week 
course of doxycycline followed by one-week 
course of moxifloxacin. 
June 2025  |  Vol. 7 Iss. 1 Poster Presentations 48
*Names in bold type indicate presenting author.
Conclusion: M. genitalium is a sexually 
transmitted bacterial infection that has similar 
incidence rates to Neisseria gonorrhea and 
Chlamydia trachomatis, however, it is not 
routinely included in STI testing. It also 
requires a different treatment course than 
other STIs. Therefore, patients with this infec-
tion are at risk of missed or delayed diagnosis, 
which may increase the incidence of compli-
cations from this infection and contribute to 
the increasing prevalence of the organism.
 
#82 Investigating the Efficacy and Safety of a Dose-Dense Paclitaxel, Cyclophosphamide With 
Trastuzumab in Stage I-II Human Epidermal Growth Factor Receptor 2 (HER2) Positive Breast Cancer
Lina Elsayed1,2, Elizabeth Reed1, Shivani Modi1, Pavan K Tandra1, Mehmet S Copur3, Kaeli Samson4, Jairam Krishnamurthy1
1Department of Internal Medicine, Division of Oncology & Hematology, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA 
2Clarkson Family Medicine, Nebraska Medicine, Omaha, NE, USA 
3Morrison Cancer Center, Mary Lanning Healthcare, Hastings, NE, USA 
4Department of Biostatistics, College of Public Medicine, University of Nebraska Medical Center, Omaha, NE, USA
Mentor: Jairam Krishnamurthy
Program: Clarkson Family Medicine
Type: Original Research
Background: The evolution of systemic 
therapies has improved outcomes for 
patients with human epidermal growth factor 
receptor 2-positive (HER2+) breast cancer. 
Nonetheless, the tolerability and safety profile 
of systemic therapies represent an area for 
further improvement. Here, we report the 
results of a phase II trial evaluating a non-an-
thracycline, non-platinum adjuvant treatment 
regimen for patients following initial surgical 
resection.
Method: The study was approved by the 
Institutional Review Board (IRB) (IRB#318-
15). We enrolled patients with stage I or II 
HER2+ breast cancer who underwent upfront 
surgery to receive adjuvant treatment with 6 
cycles of dose-dense Paclitaxel, cyclophos-
phamide and Trastuzumab (PC-H) every 2 
weeks, followed by 13 cycles of maintenance 
trastuzumab every 3 weeks to complete 52 
weeks of treatment (comprising 19 cycles). 
The primary objective was to determine 
the safety and feasibility of adjuvant PC-H 
measured by the completion rate and the 
frequency and the grade of adverse events, 
using National Cancer Institute Common 
Terminology Criteria. The secondary objec-
tive was to estimate relapse-free survival and 
overall survival.
Results: Between 2010 and 2019, a total of 
thirty-nine patients were enrolled. Of those, 
34 patients (87.18%) completed the planned 
treatment. Severe adverse events of grade 3 or 
4 occurred in 27 patients (69.23%), including 
3 patients (7.69%) with grade 3-4 decrease in 
ejection fraction. At median follow up of 5.6 
years, all 39 patients were alive. The 5-year 
relapse-free survival was 94.30% (95% CI: 
75.3-100). 
Conclusions: PC-H regimen demonstrated 
overall safety and efficacy, yielding high rates 
of relapse-free survival among patients with 
early stage (HER2+) breast cancer.
#84 Perspectives From a Family Medicine Residency Program on Future Intent for Providing Obstetrical 
Care
Schae Hanson1, Kelsey Noble1
1Clarkson Family Medicine, Nebraska Medicine, Omaha, NE, USA
Mentor: Kelsey Noble
Program: Clarkson Family Medicine
Type: Original Research
Background: In recent years, the role of 
family medicine physicians in obstetric care 
has garnered increasing attention, espe-
cially concerning the continuity of practice 
post-residency. This study examines data 
from a family medicine residency program to 
evaluate the trends and experiences of resi-
dents who choose to practice obstetrics after 
completing their training.
Methods: The anonymous survey gathered 
data electronically from participating resi-
dents regarding their experiences and intent 
to practice obstetrics post-residency via a 
combination of questions aimed to quantify 
demographic information, training experi-
ences, and perceived confidence levels in 
obstetrical skills. There was also an opportu-
nity to elaborate on motivations for pursuing 
obstetric practice and any recommendations 
on how to further shape obstetrical expe-
riences/mentorship while in residency. 
Statistical analyses were conducted on 
quantitative data, while qualitative responses 
were subjected to thematic analysis to identify 
common trends and insights.
Results: Five of the eighteen residents polled 
intend to provide obstetrical care post-resi-
dency. Of those who noted they would not be 
providing this modality of care, 15% blamed 
lack of training, 46% expressed disinterest, 
8% noted bad experiences, and 30% selected 
“all of the above” to the previous. 
Conclusion: This data, alongside the avail-
able literature, highlights that fewer family 
medicine physicians plan to provide obstet-
rical care for various reasons, some of which 
include lack of training/exposure, disinterest, 
work-life balance, evolving landscape of 
healthcare policies, etc. This study contrib-
utes limited, yet valuable insights into the 
dynamics of family medicine training and its 
impact on the future workforce.


Percutaneous Transhepatic Cholangioscopy: New Horizons for Challenging Biliary Interventions

Desai, Ketav

Graduate Medical Education 
Research Journal 
Volume 7 Issue 1 Article 72 
June 2025 
A Rare Case of Benign Locally Aggressive Hamartoma- Facial 
Infiltrating Hamartoma 
Ketav Desai 
University of Nebraska Medical Center 
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Desai, K. A Rare Case of Benign Locally Aggressive Hamartoma- Facial Infiltrating Hamartoma. Graduate 
Medical Education Research Journal. 2025 Jun 30; 7(1). 
https://digitalcommons.unmc.edu/gmerj/vol7/iss1/72 
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accepted for inclusion in Graduate Medical Education Research Journal by an authorized editor of 
DigitalCommons@UNMC. For more information, please contact digitalcommons@unmc.edu. 
© 2025 The Authors 
A Rare Case of Benign Locally Aggressive Hamartoma- Facial Infiltrating 
Hamartoma 
Abstract 
NA 
Creative Commons License 
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 
License. 
This conference proceeding is available in Graduate Medical Education Research Journal: 
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Graduate Medical Education Research Journal49 Poster Presentations
*Names in bold type indicate presenting author.
#85 Diabetic Ketoacidosis in a Patient With Type 2 Diabetes Mellitus and Ketosis Prone Diabetes 
Jacqueline Hanson1
1Clarkson Family Medicine, Nebraska Medicine, Omaha, NE, USA
Mentor: Kelsey Noble
Program: Clarkson Family Medicine
Type: Case Report
Background: This is a case of a patient with 
type 2 diabetes mellitus (T2DM) presenting 
with diabetic ketoacidosis (DKA) instead of 
the typical hyperosmolar hyperglycemic state.
Case: A 54-year-old female presented to 
the emergency department due to 1 week of 
fatigue, polyuria, and polydipsia. Medical 
history included type 2 diabetes mellitus, 
hypertension, hyperlipidemia, obesity, and 
diffuse idiopathic skeletal hyperostosis 
(DISH). She had been diagnosed with T2DM 
six months earlier with an HbA1C of 6.6. She 
chose lifestyle modifications as treatment. On 
arrival, her glucose was greater than 800, and 
she had a high anion gap metabolic acidosis 
with beta hydroxybutyric acid of 3.6, which 
met the criteria for DKA. She required an 
insulin infusion with frequent glucose checks 
and metabolic panels to correct the abnormal-
ities. A repeat HbA1C was 12.5, and type 1 
diabetes labs for autoimmunity were obtained, 
and all were negative. Endocrinology was 
consulted and recommended long acting, short 
acting, and correction insulin. In addition, per 
their review of the patient’s presentation and 
lab results, it was speculated that she may 
have atypical ketosis prone diabetes. She was 
discharged home and followed up with endo-
crinology outpatient and has had improvement 
in her A1c and has been able to reduce her 
diabetic medication dosages. 
Conclusion: There is a subtype of type 2 
diabetes known as ketosis prone diabetes 
where an individual may require high doses 
of insulin for a short period of time but can 
show rapid improvement in their HbA1C. 
Furthermore, research has shown that there 
are more subtypes of type 2 diabetes that 
predispose patients to more accelerated 
advancement to CKD, cardiovascular disease, 
retinopathy, and neuropathy, which makes 
the screening for diabetic complications 
important.
#86 A Rare Case of Benign Locally Aggressive Hamartoma- Facial Infiltrating Hamartoma
Ketav Desai1, Allison Cushman-Vokoun1, Danita Velasco2
1Department of Pathology, Microbiology & Immunology, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA 
2Department of Pediatrics, Division of Genetics, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
Mentor: Allison Cushman-Vokoun
Program: Pathology – Molecular Genetic 
Pathology
Type: Case report
Background: Fewer than 80 cases of 
facial infiltrating hamartoma (FIL) have 
been reported in the literature. It was first 
described by Slavin in 1983 as a rare form 
of facial developmental malformation. In 
2014, somatic mutations in the phosphati-
dylinositol 3-kinase catalytic subunit alpha 
(PIK3CA) gene in abnormal tissues from six 
FIL patients were identified. A subset of cases 
can show epidermal nevi, hyperplasia, and 
deformity of maxillofacial bones and/or hemi-
megalencephaly. There is no standardized 
treatment protocol. Surgical debulking is the 
mainstay of treatment with a high recurrence 
rate. Targeted PI3K inhibition (Alpelisib) 
reduces the adipose volume and improves 
functionality. 
Case: We present a case of a 9-year-old 
female patient with a history of asymmetric 
right facial swelling involving maxillary and 
mandibular regions with infraorbital hyper-
pigmentation on the right. Previous surgical 
removal of a right scalp lipoma was noted. 
Imaging showed asymmetrically increased 
subcutaneous fat along the entire right side of 
the face with fatty infiltration and enlargement 
of the right parotid and submandibular 
glands and right masseter muscle (Figure 
1A). Deformities of the bony maxilla and 
mandible with asymmetric thickening were 
also present (Figure 1B-C). No brain abnor-
malities, including hemimegalencephaly, were 
identified. Surgical debulking was performed. 
Histopathologic examination of the tissue 
showed lobules of mature adipose tissue with 
interspersing fibrous tissue. Next generation 
sequencing identified PIK3CA c.3140A>G 
(p.H1047R) and TSC2 c.5051_5068+16dup 
(p.D1690Gfs*27) with variant allele frequen-
cies of 24% and 23.9%, respectively. 
Conclusion: FIL is a rare disease with no 
standardized treatment and a high recurrence 
rate after surgical debulking. PI3K inhibition 
(Alpelisib) reduces overgrowth, vascular 
lesions, and other functional complications.
Figure 1. Imaging findings: A, Asymmetrically increased subcutaneous fat along the right face with fatty infiltration 
and enlargement of the right parotid gland and right masseter muscle. B & C, Deformity of the bony maxilla and 
mandible with asymmetric thickening.
June 2025  |  Vol. 7 Iss. 1 Poster Presentations 50
*Names in bold type indicate presenting author.
#87 A Single Institutional Experience of FLT3-ITD in Genetically Rearranged Acute Myeloid Leukemias
Kayla Hoerschgen1, Neha Gupta1, Jeffrey J. Cannatella1 , Arash Ronaghy1, Shanxiang Zhang1, Kaeli Samson2, Joseph D. Khoury1, Safina Hafeez1 
1Department of Pathology, Microbiology & Immunology, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA 
2Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
Mentor: Safina Hafeez
Program: Pathology – Hematopathology
Type: Original Research
Background: The feline McDonough 
sarcoma (FMS)-like tyrosinase kinase 3 
(FLT3) gene is the most frequently somati-
cally mutated gene in acute myeloid leukemia 
(AML), with internal tandem duplication 
(FLT3-ITD) mutations being the most 
common. FLT3 testing is recommended in all 
AML diagnoses, given they portend a worse 
prognosis. The goal of our study was to find 
the frequency of FLT3-ITD in genetically 
rearranged AMLs and to compare the overall 
survival among FLT3-ITD mutated and unmu-
tated patients. 
Methods: The Institutional Review Board 
approved this study. A search for new acute 
myeloid leukemias in our database from 2020-
2024 yielded 267 cases. Data was obtained 
for genetic abnormalities, FLT3-ITD, and 
time interval between the diagnosis and last 
follow-up or death. The cases were classified 
as AML with defining genetic abnormalities 
based on the WHO 5th edition of hematolym-
phoid tumors. 
Results: We found 100 cases of AML with 
defining genetic abnormalities. Of the 100, 
66 were FLT3-ITD negative and 34 were 
positive. Of these, 47 cases (47%) had defined 
rearrangements, with 41 cases FLT3-ITD 
negative and six cases positive (12.8%). 
Of the six positive cases, five patients were 
alive until the last day of follow-up (2.2-44.5 
months). Of the negative cases, 10 patients 
died of the disease (range of survival, 0.3-12.4 
months). No follow-up data available for three 
patients. There was no significant difference 
in survival between the two groups (p = 0.67) 
(Figure 1). AML with nucleophosmin-1 
(NPM1) mutation was the most common 
AML enriched in FLT3-ITD (82%, 28/34). 
Conclusion: FLT3-ITD is uncommon in 
AMLs with defining genetic rearrangements 
and there is no significant difference in 
survival between FLT3-ITD negative and 
positive cases. 
#95 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
Mauna Gattenby1,2, Andrew Gaillardetz3,4, Paul Crawford5, Stephen Cagle1,2
1Department of Family Medicine, College of Medicine, University of Nebraska Medical Center, Omaha. NE, USA 
2United States Air Force 55th Medical Group, Offutt Air Force Base, NE, USA 
3Department of Family Medicine, School of Medicine, Saint Louis University, O’Fallon, IL, USA 
4United States Air Force 375th Medical Group, Scott Air Force Base, IL, USA 
5Department of Family Medicine, School of Medicine, Uniformed Services University, Bethesda, MD, USA
Mentor: Stephen Cagle
Program: Family Medicine 
Type: Original Research
Background: Scar acupuncture deactivation 
(SD) and infiltration (SI) compared against 
physical therapy (PT) for reduction of chronic 
pain in the postpartum period after low-trans-
verse cesarean (LTCS).
Methods: Unblinded randomized controlled 
trial for 16 weeks of therapy and a 20-week 
follow-up in outpatient military clinics. 
Participants were Tricare beneficiaries ≥3 
months post-partum, ≥18 years with abdom-
inal and/or back pain following a LTCS. Sixty 
enrollees were randomized to receive SI, SD, 
or PT every 2 weeks. Patient and Observer 
Scar Assessment (POSAS) and Defense and 
Veterans Pain Rating Scale (DVPRS) scores 
measured pain reduction. Chi-square tests and 
ANOVA assessed continuous variables.
Results: DVPRS declined in the PT, SD, and 
SI groups by -42.7%, -54.4%, and -63.5%, 
respectively. SD was associated with a 
stronger decline in POSAS score compared to 
PT (interaction regression coefficient = -0.29, 
95% CI -0.54 to -0.04, p = 0.0217). Although 
the point estimate for SI was negative, change 
over time compared to PT was not significant 
(interaction regression coefficient = -0.20, 
95% CI -0.45 to 0.05, p = 0.1179). No signif-
icant interactions were observed for SD and 
SI. DVPRS increased in the PT group from 
Figure 1. Survival curves comparing FLT3 positive patients to FLT3 negative patients. 
Graduate Medical Education Research Journal51 Poster Presentations
*Names in bold type indicate presenting author.
week 16 to week 20 by 1.8 points. SD and SI 
scores continued to decrease after completing 
treatment.
Conclusion: All groups demonstrated a 
reduction in DVPRS and POSAS. Only 
PT had a worsening DVPRS and POSAS 
scores between weeks 16 and 20. SD and SI 
improved scores from week 16 to week 20. 
SD had the most sustained improvement at 20 
weeks.
 
#96 The Truth Lies in Her Eyes
Jake Herber1, T. Jason Meredith1, Ross Mathiasen1
1Department of Family Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
Mentor: T. Jason Meredith
Program: Family Medicine
Type: Case Report
Background: Infectious mononucleosis (IM) 
is contagious and spread via bodily fluids. 
Symptoms are indolent; may take 4-6 weeks. 
Periorbital edema (Hoagland sign), a possible 
early symptom, may occur after fever onset, 
before exudative pharyngitis, cervical lymph-
adenopathy; may not be initially present. 
Team physicians need high suspicion for IM 
if an athlete presents with periorbital edema 
without cause.
Case: National Collegiate Athletic 
Association female rower presented for 
concussion evaluation. Concussion suffered 1 
day prior, struck by an oar to the back of the 
head. Immediate headache and blurry vision; 
headaches improved but now with difficulty 
focusing on objects. Friends noticed bilateral 
upper eyelid swelling. Denied swelling in her 
extremities. Took NSAIDs for headaches but 
no longer. The patient was advised to continue 
University’s Concussion Protocol and follow 
up in 48 hours; now with worsening fatigue 
and a desire to sleep all day. Eyelid swelling 
also worsened. Reported URI symptoms 1 
week before the concussion.
Conclusion: IM diagnosis was reviewed, 
and it was discussed that IM may explain 
the remaining symptoms. Updated American 
Medical Society of Sport Medicine guide-
lines on return to play after diagnosis were 
reviewed with the athlete, coaching staff. The 
patient was held from normal concussion 
RTP exercise protocol. Supportive cares for 
conservative management recommended for 
remaining symptoms. Symptoms resolved at 
2 week follow up. The patient was started on 
supervised low-intensity cardio training with 
gradual increase over 1 week. No splenic 
imaging was completed. The patient returned 
to full activity 4 weeks after the initial presen-
tation and completed her collegiate season.
#97 A Sweet Kick of Relief
Chandler James1, Sara McCall1
1Department of Family Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
Mentor: Sara McCall
Program: Family Medicine
Type: Case Report
Background: Chondromalacia patella 
can be a common cause of patellofemoral 
pain, which is a frequent complaint seen by 
clinicians. Physical therapy and oral anti-in-
flammatory medications continue to be first 
line treatment. Intra-articular injection therapy 
may be helpful but has shown inconsistent 
results. Currently, there are no reported studies 
involving injections to the patellar facets. 
Dextrose prolotherapy (DPT) may be effective 
in providing sustained relief in patients who 
do not respond to the above measures.
Case: A 36-year-old female presents with 
chronic bilateral knee pain with associ-
ated feelings of instability. She has been 
experiencing symptoms in her left knee for 
many years. She started to develop the same 
symptoms in her right knee but worse. She 
has no known history of knee injury. Her 
symptoms are worse with bending, squatting, 
and going up or down stairs. She completed 
multiple sessions of physical therapy but 
reports it has not provided any relief. She 
had 2 bilateral dextrose prolotherapy (DPT) 
intra-articular injections, which did not 
provide relief. In this case, a new approach 
was attempted where the patient underwent 
2 palpation-guided DPT injections consisting 
of 0.5mL 1% Lidocaine and 0.5mL 50% 
dextrose at the bilateral medial and lateral 
patellar facets at a 1-month interval. 
Conclusion: After a series of 2 DPT injec-
tions to the bilateral medial and lateral patellar 
facets, the patient was able to increase her 
activity and return to running, as well as stairs 
and squatting. She experienced significant 
sustained relief, reporting 75% improve-
ment in her symptoms for approximately 10 
months.


A Rare Case of Benign Locally Aggressive Hamartoma- Facial Infiltrating Hamartoma

Hoerschgen, Kayla

Graduate Medical Education 
Research Journal 
Volume 7 Issue 1 Article 73 
June 2025 
A Single Institutional Experience of FLT3-ITD in Genetically 
Rearranged Acute Myeloid Leukemias 
Kayla Hoerschgen 
University of Nebraska Medical Center 
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Hoerschgen, K. A Single Institutional Experience of FLT3-ITD in Genetically Rearranged Acute Myeloid 
Leukemias. Graduate Medical Education Research Journal. 2025 Jun 30; 7(1). 
https://digitalcommons.unmc.edu/gmerj/vol7/iss1/73 
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accepted for inclusion in Graduate Medical Education Research Journal by an authorized editor of 
DigitalCommons@UNMC. For more information, please contact digitalcommons@unmc.edu. 
© 2025 The Authors 
A Single Institutional Experience of FLT3-ITD in Genetically Rearranged Acute 
Myeloid Leukemias 
Abstract 
NA 
Creative Commons License 
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License. 
This conference proceeding is available in Graduate Medical Education Research Journal: 
https://digitalcommons.unmc.edu/gmerj/vol7/iss1/73 
Graduate Medical Education Research Journal49 Poster Presentations
*Names in bold type indicate presenting author.
#85 Diabetic Ketoacidosis in a Patient With Type 2 Diabetes Mellitus and Ketosis Prone Diabetes 
Jacqueline Hanson1
1Clarkson Family Medicine, Nebraska Medicine, Omaha, NE, USA
Mentor: Kelsey Noble
Program: Clarkson Family Medicine
Type: Case Report
Background: This is a case of a patient with 
type 2 diabetes mellitus (T2DM) presenting 
with diabetic ketoacidosis (DKA) instead of 
the typical hyperosmolar hyperglycemic state.
Case: A 54-year-old female presented to 
the emergency department due to 1 week of 
fatigue, polyuria, and polydipsia. Medical 
history included type 2 diabetes mellitus, 
hypertension, hyperlipidemia, obesity, and 
diffuse idiopathic skeletal hyperostosis 
(DISH). She had been diagnosed with T2DM 
six months earlier with an HbA1C of 6.6. She 
chose lifestyle modifications as treatment. On 
arrival, her glucose was greater than 800, and 
she had a high anion gap metabolic acidosis 
with beta hydroxybutyric acid of 3.6, which 
met the criteria for DKA. She required an 
insulin infusion with frequent glucose checks 
and metabolic panels to correct the abnormal-
ities. A repeat HbA1C was 12.5, and type 1 
diabetes labs for autoimmunity were obtained, 
and all were negative. Endocrinology was 
consulted and recommended long acting, short 
acting, and correction insulin. In addition, per 
their review of the patient’s presentation and 
lab results, it was speculated that she may 
have atypical ketosis prone diabetes. She was 
discharged home and followed up with endo-
crinology outpatient and has had improvement 
in her A1c and has been able to reduce her 
diabetic medication dosages. 
Conclusion: There is a subtype of type 2 
diabetes known as ketosis prone diabetes 
where an individual may require high doses 
of insulin for a short period of time but can 
show rapid improvement in their HbA1C. 
Furthermore, research has shown that there 
are more subtypes of type 2 diabetes that 
predispose patients to more accelerated 
advancement to CKD, cardiovascular disease, 
retinopathy, and neuropathy, which makes 
the screening for diabetic complications 
important.
#86 A Rare Case of Benign Locally Aggressive Hamartoma- Facial Infiltrating Hamartoma
Ketav Desai1, Allison Cushman-Vokoun1, Danita Velasco2
1Department of Pathology, Microbiology & Immunology, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA 
2Department of Pediatrics, Division of Genetics, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
Mentor: Allison Cushman-Vokoun
Program: Pathology – Molecular Genetic 
Pathology
Type: Case report
Background: Fewer than 80 cases of 
facial infiltrating hamartoma (FIL) have 
been reported in the literature. It was first 
described by Slavin in 1983 as a rare form 
of facial developmental malformation. In 
2014, somatic mutations in the phosphati-
dylinositol 3-kinase catalytic subunit alpha 
(PIK3CA) gene in abnormal tissues from six 
FIL patients were identified. A subset of cases 
can show epidermal nevi, hyperplasia, and 
deformity of maxillofacial bones and/or hemi-
megalencephaly. There is no standardized 
treatment protocol. Surgical debulking is the 
mainstay of treatment with a high recurrence 
rate. Targeted PI3K inhibition (Alpelisib) 
reduces the adipose volume and improves 
functionality. 
Case: We present a case of a 9-year-old 
female patient with a history of asymmetric 
right facial swelling involving maxillary and 
mandibular regions with infraorbital hyper-
pigmentation on the right. Previous surgical 
removal of a right scalp lipoma was noted. 
Imaging showed asymmetrically increased 
subcutaneous fat along the entire right side of 
the face with fatty infiltration and enlargement 
of the right parotid and submandibular 
glands and right masseter muscle (Figure 
1A). Deformities of the bony maxilla and 
mandible with asymmetric thickening were 
also present (Figure 1B-C). No brain abnor-
malities, including hemimegalencephaly, were 
identified. Surgical debulking was performed. 
Histopathologic examination of the tissue 
showed lobules of mature adipose tissue with 
interspersing fibrous tissue. Next generation 
sequencing identified PIK3CA c.3140A>G 
(p.H1047R) and TSC2 c.5051_5068+16dup 
(p.D1690Gfs*27) with variant allele frequen-
cies of 24% and 23.9%, respectively. 
Conclusion: FIL is a rare disease with no 
standardized treatment and a high recurrence 
rate after surgical debulking. PI3K inhibition 
(Alpelisib) reduces overgrowth, vascular 
lesions, and other functional complications.
Figure 1. Imaging findings: A, Asymmetrically increased subcutaneous fat along the right face with fatty infiltration 
and enlargement of the right parotid gland and right masseter muscle. B & C, Deformity of the bony maxilla and 
mandible with asymmetric thickening.
June 2025  |  Vol. 7 Iss. 1 Poster Presentations 50
*Names in bold type indicate presenting author.
#87 A Single Institutional Experience of FLT3-ITD in Genetically Rearranged Acute Myeloid Leukemias
Kayla Hoerschgen1, Neha Gupta1, Jeffrey J. Cannatella1 , Arash Ronaghy1, Shanxiang Zhang1, Kaeli Samson2, Joseph D. Khoury1, Safina Hafeez1 
1Department of Pathology, Microbiology & Immunology, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA 
2Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
Mentor: Safina Hafeez
Program: Pathology – Hematopathology
Type: Original Research
Background: The feline McDonough 
sarcoma (FMS)-like tyrosinase kinase 3 
(FLT3) gene is the most frequently somati-
cally mutated gene in acute myeloid leukemia 
(AML), with internal tandem duplication 
(FLT3-ITD) mutations being the most 
common. FLT3 testing is recommended in all 
AML diagnoses, given they portend a worse 
prognosis. The goal of our study was to find 
the frequency of FLT3-ITD in genetically 
rearranged AMLs and to compare the overall 
survival among FLT3-ITD mutated and unmu-
tated patients. 
Methods: The Institutional Review Board 
approved this study. A search for new acute 
myeloid leukemias in our database from 2020-
2024 yielded 267 cases. Data was obtained 
for genetic abnormalities, FLT3-ITD, and 
time interval between the diagnosis and last 
follow-up or death. The cases were classified 
as AML with defining genetic abnormalities 
based on the WHO 5th edition of hematolym-
phoid tumors. 
Results: We found 100 cases of AML with 
defining genetic abnormalities. Of the 100, 
66 were FLT3-ITD negative and 34 were 
positive. Of these, 47 cases (47%) had defined 
rearrangements, with 41 cases FLT3-ITD 
negative and six cases positive (12.8%). 
Of the six positive cases, five patients were 
alive until the last day of follow-up (2.2-44.5 
months). Of the negative cases, 10 patients 
died of the disease (range of survival, 0.3-12.4 
months). No follow-up data available for three 
patients. There was no significant difference 
in survival between the two groups (p = 0.67) 
(Figure 1). AML with nucleophosmin-1 
(NPM1) mutation was the most common 
AML enriched in FLT3-ITD (82%, 28/34). 
Conclusion: FLT3-ITD is uncommon in 
AMLs with defining genetic rearrangements 
and there is no significant difference in 
survival between FLT3-ITD negative and 
positive cases. 
#95 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
Mauna Gattenby1,2, Andrew Gaillardetz3,4, Paul Crawford5, Stephen Cagle1,2
1Department of Family Medicine, College of Medicine, University of Nebraska Medical Center, Omaha. NE, USA 
2United States Air Force 55th Medical Group, Offutt Air Force Base, NE, USA 
3Department of Family Medicine, School of Medicine, Saint Louis University, O’Fallon, IL, USA 
4United States Air Force 375th Medical Group, Scott Air Force Base, IL, USA 
5Department of Family Medicine, School of Medicine, Uniformed Services University, Bethesda, MD, USA
Mentor: Stephen Cagle
Program: Family Medicine 
Type: Original Research
Background: Scar acupuncture deactivation 
(SD) and infiltration (SI) compared against 
physical therapy (PT) for reduction of chronic 
pain in the postpartum period after low-trans-
verse cesarean (LTCS).
Methods: Unblinded randomized controlled 
trial for 16 weeks of therapy and a 20-week 
follow-up in outpatient military clinics. 
Participants were Tricare beneficiaries ≥3 
months post-partum, ≥18 years with abdom-
inal and/or back pain following a LTCS. Sixty 
enrollees were randomized to receive SI, SD, 
or PT every 2 weeks. Patient and Observer 
Scar Assessment (POSAS) and Defense and 
Veterans Pain Rating Scale (DVPRS) scores 
measured pain reduction. Chi-square tests and 
ANOVA assessed continuous variables.
Results: DVPRS declined in the PT, SD, and 
SI groups by -42.7%, -54.4%, and -63.5%, 
respectively. SD was associated with a 
stronger decline in POSAS score compared to 
PT (interaction regression coefficient = -0.29, 
95% CI -0.54 to -0.04, p = 0.0217). Although 
the point estimate for SI was negative, change 
over time compared to PT was not significant 
(interaction regression coefficient = -0.20, 
95% CI -0.45 to 0.05, p = 0.1179). No signif-
icant interactions were observed for SD and 
SI. DVPRS increased in the PT group from 
Figure 1. Survival curves comparing FLT3 positive patients to FLT3 negative patients. 
Graduate Medical Education Research Journal51 Poster Presentations
*Names in bold type indicate presenting author.
week 16 to week 20 by 1.8 points. SD and SI 
scores continued to decrease after completing 
treatment.
Conclusion: All groups demonstrated a 
reduction in DVPRS and POSAS. Only 
PT had a worsening DVPRS and POSAS 
scores between weeks 16 and 20. SD and SI 
improved scores from week 16 to week 20. 
SD had the most sustained improvement at 20 
weeks.
 
#96 The Truth Lies in Her Eyes
Jake Herber1, T. Jason Meredith1, Ross Mathiasen1
1Department of Family Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
Mentor: T. Jason Meredith
Program: Family Medicine
Type: Case Report
Background: Infectious mononucleosis (IM) 
is contagious and spread via bodily fluids. 
Symptoms are indolent; may take 4-6 weeks. 
Periorbital edema (Hoagland sign), a possible 
early symptom, may occur after fever onset, 
before exudative pharyngitis, cervical lymph-
adenopathy; may not be initially present. 
Team physicians need high suspicion for IM 
if an athlete presents with periorbital edema 
without cause.
Case: National Collegiate Athletic 
Association female rower presented for 
concussion evaluation. Concussion suffered 1 
day prior, struck by an oar to the back of the 
head. Immediate headache and blurry vision; 
headaches improved but now with difficulty 
focusing on objects. Friends noticed bilateral 
upper eyelid swelling. Denied swelling in her 
extremities. Took NSAIDs for headaches but 
no longer. The patient was advised to continue 
University’s Concussion Protocol and follow 
up in 48 hours; now with worsening fatigue 
and a desire to sleep all day. Eyelid swelling 
also worsened. Reported URI symptoms 1 
week before the concussion.
Conclusion: IM diagnosis was reviewed, 
and it was discussed that IM may explain 
the remaining symptoms. Updated American 
Medical Society of Sport Medicine guide-
lines on return to play after diagnosis were 
reviewed with the athlete, coaching staff. The 
patient was held from normal concussion 
RTP exercise protocol. Supportive cares for 
conservative management recommended for 
remaining symptoms. Symptoms resolved at 
2 week follow up. The patient was started on 
supervised low-intensity cardio training with 
gradual increase over 1 week. No splenic 
imaging was completed. The patient returned 
to full activity 4 weeks after the initial presen-
tation and completed her collegiate season.
#97 A Sweet Kick of Relief
Chandler James1, Sara McCall1
1Department of Family Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
Mentor: Sara McCall
Program: Family Medicine
Type: Case Report
Background: Chondromalacia patella 
can be a common cause of patellofemoral 
pain, which is a frequent complaint seen by 
clinicians. Physical therapy and oral anti-in-
flammatory medications continue to be first 
line treatment. Intra-articular injection therapy 
may be helpful but has shown inconsistent 
results. Currently, there are no reported studies 
involving injections to the patellar facets. 
Dextrose prolotherapy (DPT) may be effective 
in providing sustained relief in patients who 
do not respond to the above measures.
Case: A 36-year-old female presents with 
chronic bilateral knee pain with associ-
ated feelings of instability. She has been 
experiencing symptoms in her left knee for 
many years. She started to develop the same 
symptoms in her right knee but worse. She 
has no known history of knee injury. Her 
symptoms are worse with bending, squatting, 
and going up or down stairs. She completed 
multiple sessions of physical therapy but 
reports it has not provided any relief. She 
had 2 bilateral dextrose prolotherapy (DPT) 
intra-articular injections, which did not 
provide relief. In this case, a new approach 
was attempted where the patient underwent 
2 palpation-guided DPT injections consisting 
of 0.5mL 1% Lidocaine and 0.5mL 50% 
dextrose at the bilateral medial and lateral 
patellar facets at a 1-month interval. 
Conclusion: After a series of 2 DPT injec-
tions to the bilateral medial and lateral patellar 
facets, the patient was able to increase her 
activity and return to running, as well as stairs 
and squatting. She experienced significant 
sustained relief, reporting 75% improve-
ment in her symptoms for approximately 10 
months.


A Single Institutional Experience of FLT3-ITD in Genetically Rearranged Acute Myeloid Leukemias

Austin, Tyler

Graduate Medical Education 
Research Journal 
Volume 7 Issue 1 Article 83 
June 2025 
Extracorporeal Membrane Oxygenation (ECMO) and Abdominal 
Complications in Adults: Identifying the Risk Factors 
Tyler Austin 
University of Nebraska Medical Center 
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Recommended Citation 
Austin, T. Extracorporeal Membrane Oxygenation (ECMO) and Abdominal Complications in Adults: 
Identifying the Risk Factors. Graduate Medical Education Research Journal. 2025 Jun 30; 7(1). 
https://digitalcommons.unmc.edu/gmerj/vol7/iss1/83 
This Conference Proceeding is brought to you for free and open access by DigitalCommons@UNMC. It has been 
accepted for inclusion in Graduate Medical Education Research Journal by an authorized editor of 
DigitalCommons@UNMC. For more information, please contact digitalcommons@unmc.edu. 
© 2025 The Authors 
Extracorporeal Membrane Oxygenation (ECMO) and Abdominal Complications in 
Adults: Identifying the Risk Factors 
Abstract 
NA 
Creative Commons License 
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 
License. 
This conference proceeding is available in Graduate Medical Education Research Journal: 
https://digitalcommons.unmc.edu/gmerj/vol7/iss1/83 
June 2025  |  Vol. 7 Iss. 1 Poster Presentations 54
*Names in bold type indicate presenting author.
Conclusion: The updated pitch clock rules 
were associated with longer appearances on 
the IL, suggesting potential unintended conse-
quences of increased game pace and limited 
disengagement opportunities. These findings 
highlight the need for further investigation 
into the physical demands and recovery impli-
cations of pitch clock regulations.
 
 
#104 Assessing the Impact of a Resident Wellness Curriculum: A Retrospective Study in an Internal 
Medicine Residency Program
Ram Prakash Thirugnanasambandam1,2, Shannon Crehan2, Pascale Lafortune2, Ben Nguyen2, Christine Yun2, Harjinder Gill2, Patrick Geraghty2, Samy 
McFarlane2
1Department of Internal Medicine, Geriatrics, Gerontology & Palliative Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE, 
USA 
2Department of Internal Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
Mentor: Samy McFarlane
Program: Internal Medicine – Hospice & 
Palliative Medicine
Type: Original Research
Background: Residency training is a crucial 
career development period with high levels 
of stress and potential burnout. Wellness 
curriculums have been proposed as a solution, 
yet their impact remains underexplored in 
residency programs. This study assessed a 
resident-led wellness curriculum in an Internal 
Medicine residency program in Brooklyn, 
New York, focusing on resident awareness, 
program performance, and feedback.
Methods: A retrospective study in May 2024 
utilized a 20-point questionnaire distributed 
to residents across Post-Graduate Year (PGY) 
levels. The curriculum, based on the American 
Medical Association’s (AMA) six aspects of 
wellness, was integrated into outpatient rota-
tions. Expert-led talks covered burnout, sleep 
hygiene, nutrition, fitness, financial planning, 
emotional health, and relationships. Statistical 
analysis included Chi-squared tests, with 
significance set at p < 0.05.
Results: Out of 90 total residents, 48 (53%) 
participated in the survey. PGY-1 residents 
constituted 19 (40%) respondents. Twenty 
eight (58%) respondents reported awareness 
of AMA-defined wellness, and 40 (83%) 
expressed satisfaction with the curriculum. 
Supportive program leadership and work-
life balance were the most valued aspects. 
Forty one (85%) respondents recommended 
continuing the curriculum, suggesting 
improvements such as increased hospital 
support staff, upgraded computer systems, 
mental health workshops, addressing 
workplace culture, and team outings during 
didactics. Attendance at the wellness talks was 
high, underscoring resident engagement.
Conclusion: The implemented wellness 
curriculum addressed critical aspects of 
resident well-being, with increased levels 
of awareness and resident satisfaction. 
Resident feedback emphasized the importance 
of addressing organizational challenges, 
fostering a supportive workplace culture, and 
expanding the curriculum to better address 
resident needs. 
#106 Extracorporeal Membrane Oxygenation (ECMO) and Abdominal Complications in Adults: Identifying 
the Risk Factors
Tyler Austin1, Timothy McNamara1, Kevin Kemp2, Shaun Thompson1
1Department of Anesthesiology, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA 
2Department of Surgery, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
Mentor: Shaun Thompson
Program: Anesthesiology
Type: Original Research
Background: Extracorporeal membrane 
oxygenation (ECMO) is an invasive, 
advanced form of respiratory or circulatory 
support. ECMO is not without risk, and 
various complications may arise. We exam-
ined abdominal complications that occurred 
in an adult patient population during or after 
receiving ECMO support.
Methods: A total of 98 patients were included 
in this retrospective review, approved by 
the Institutional Review Board. Evaluated 
comorbidities included peripheral arterial 
disease, coronary artery disease, stroke, 
congestive heart failure, hypertension, chronic 
obstructive pulmonary disease, chronic kidney 
disease, diabetes, obesity, liver disease, 
neurological disorders, cancer, chronic 
hematologic disease, organ transplant, and 
immunosuppressive disorders. Social factors 
included a history of tobacco, alcohol, or 
drug use. Abdominal complications included 
gastrointestinal bleeding, abdominal compart-
ment syndrome, ischemic colitis, mesenteric 
ischemia, renal failure requiring dialysis, or 
the need for endoscopy or laparotomy.
Results: In this study, 65 patients (66.3%) 
experienced an abdominal complication. 
Coronary artery disease (p = 0.02) and 
obesity (p = 0.01) demonstrated statistical 
significance. Additionally, ECMO type 
(veno-arterial vs veno-venous), ECMO pump 
brand, downtime before ECMO, cardiac arrest 
prior to ECMO, vasopressor use, length of 
stay, need for Interventional Radiology inter-
vention, and number of days intubated were 
evaluated. The length of intubation (median 
4.5 vs 11 days, p = 0.03) and vasopressor 
use (p = 0.001) demonstrated statistical 
significance.
Conclusion: The results of this study high-
light the association between cardiovascular 
health and recovery from illness. Coronary 
artery disease and obesity, in particular, lead 
to an increased risk of abdominal complica-
tions in patients on ECMO. Moreover, there is 
an increased risk of complications in patients 
requiring prolonged intubation or vasopressor 
support.
Graduate Medical Education Research Journal55 Poster Presentations
*Names in bold type indicate presenting author.
#108 Inpatient Genetics Service and Testing Trends: A Retrospective Multi-Institution Analysis (2021-2024)
Travis Schreier1, Hannah Steber2,3, Kristen Fishler2,3, Lois J. Starr1,4
1Department of Pediatrics, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA 
2Department of Genetic Counseling, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA 
3Munroe-Meyer Institute for Genetics & Rehabilitation, University of Nebraska Medical Center, Omaha, NE, USA 
4Department of Medical Genetics, Children’s Nebraska, Omaha, NE, USA
Mentor: Lois J Starr
Program: Pediatrics - Medical Genetics
Type: Original Research
Background: Clinical genetics has been revo-
lutionized by rapid improvements in testing. 
The Medical Genetics consult team serves 
five hospitals. Prior to 2019, prior authoriza-
tions limited genetic testing. In 2019, these 
restrictions were lifted for microarray and 
cytogenetic testing. By the end of 2022, most 
institutions approved our ordering of rapid 
exome sequencing for patients with insurance 
without a formal prior authorization. These 
changes and advancements improved the 
quality and timeliness of care for patients and
reduced the burden of additional cost consid-
erations for families.
Methods: Every inpatient consult performed 
since January 2021 was recorded with patient 
demographics, location, indication, recom-
mendations, and results. Preliminary analysis 
assessed consult patterns, testing recommen-
dations, and results. No IRB was utilized for 
this project.
Results: Preliminary review identified 1,177 
genetic consults with 1,039 tests initiated. 
Neonatal intensive care units consistently 
accounted for 60-70% of consults each year. 
Only 1% involved adult patients. Diagnostic 
yield improved annually, with pathogenic 
results identified in 34%. Non-diagnostic 
results accounted for 43%, while variants of 
uncertain significance rates decreased from 
37% in 2021 to 15% in 2024. The proportion 
of pathogenic diagnoses increased from 27% 
in 2021 to 38% in 2024. 
Conclusion: Our findings underscore the 
critical role of inpatient genetic consultations 
in patient care. An increased diagnostic rate 
and reduction of uncertain results occurred 
since 2021, likely due to improved testing 
processes, availability of exome testing, 
and variant curation. Additional analyses 
will explore correlations between consult 
characteristics, test methodologies, and 
clinical outcomes. Our experience highlights 
the transformative potential of integrating 
advanced genetic diagnostics into inpatient 
care models and reinforces the importance of 
equitable access.
#110 A Rare Case: Dental Panoramic Radiograph Leads to the Diagnosis of a Large Internal Carotid Artery 
Aneurysm 
Vivek K. Sharma1, Jason B. Untrauer1
1Department of Surgery, Division of Oral & Maxillofacial Surgery, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
Mentor: Jason B. Untrauer
Program: Oral & Maxillofacial Surgery 
Type: Case Report 
Background: Extracranial internal carotid 
artery aneurysms are rare entities with an inci-
dence of <1% of all arterial aneurysms. They 
are usually asymptomatic and found inciden-
tally but can grow large enough to produce 
local mass effect symptoms, stroke-like symp-
toms, or rupture. Although previous studies 
have demonstrated 3-15% of panoramic radio-
graphs (PRs) show evidence of carotid artery 
calcifications (CACs), usually below the angle 
of the mandible near the C3-C4 intervertebral 
junction (Figure 1A), we were unable to find 
any case reports of carotid artery aneurysms 
identified on PR. The following case report 
illustrates the important role that dentists may 
play in the identification and surgical manage-
ment of carotid artery pathology. 
Case: A 38-year-old male presented to 
his dentist complaining of dental pain. A 
panoramic radiograph was taken and found 
by his dentist to have left CACs. The patient 
was otherwise asymptomatic and denied any 
history of trauma or neck surgery. He was sent 
to the University of Nebraska Medical Center 
for further evaluation. Further work up by 
vascular surgery with computed tomography 
angiography (CTA) of the neck revealed a 
3.9 cm mid-left internal carotid artery (ICA) 
aneurysm (Figure 1B). An extraoral vertical 
ramus osteotomy (EVRO) was performed 
by oral and maxillofacial surgery (OMFS) to 
assist vascular surgery with improved surgical 
exposure (Figure 1C-D). The ICCA (Figure 
1E-F) was successfully resected and free of 
recurrence or symptoms on follow-up. 
Conclusion: Panoramic radiographs can aid 
in the early diagnosis and intervention of 
ICA pathologies. This gives dentists an addi-
tional responsibility to carefully analyze this 
often-ignored area on PR.
Figure 1. (A) Panorex showing CAC (B) CTA Neck showing left ICA aneurysm (C) Extraoral vertical ramus 
osteotomy (D) Anterior rotation of proximal mandibular segment aid in vascular access (E) ICA aneurysm, and (F) 
Fixation of osteotomy after vascular repair. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
A B 
C D E F 
June 2025  |  Vol. 7 Iss. 1 Poster Presentations 56
*Names in bold type indicate presenting author.
#111 Temporomandibular Joint Articular Eminence Anatomy as a Predictor of Anterior Disc Displacement 
on MRI
Serin Lee1, Logan McNeil2, Lei Yu3, Jason Untrauer1
1Department of Surgery, Division of Oral & Maxillofacial Surgery, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA 
2College of Dentistry, University of Nebraska, Omaha, NE, USA 
3Department of Radiology, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
Mentor: Jason Untrauer
Program: Oral & Maxillofacial Surgery
Type: Original Research
Background: The temporomandibular joint 
(TMJ) is a ginglymoarthrodial synovial joint 
supported by a complex system of muscles 
and ligaments and plays an important 
role in masticatory function and speech. 
Temporomandibular joint dysfunction 
(TMJD) affects between 5-12% of the popula-
tion. TMJ anterior disc displacement (DD) is 
relatively common and is highly associated in 
patients with symptomatic TMJD. It has been 
suggested that articular eminence steepness 
and morphology may play a role in the devel-
opment of DD, as it directly influences the 
condylar and articular disc path of movement. 
The aim of this study was to help clarify the 
role that articular eminence anatomy plays in 
the development of DD of the TMJ, which has 
future implications on surgical management of 
internal derangement of the TMJ. 
Methods: This was a retrospective study 
approved by the institutional review board 
(UNMC IRB-0354-20-EP). TMJ MRIs of 129 
Patients (253 joints) with symptomatic TMJD 
were reviewed and assessed for disc displace-
ment and eminence characteristics. Statistical 
analysis was performed to investigate whether 
TMJ eminence morphology (classified into 
A- Box, B - Sigmoid, C- Flat, D-Deformed, 
Figure 1), eminence height, or inclination is 
related to DD. Fisher’s exact test was used for 
comparisons of categorical variables with any 
disk displacement (left or right) at the patient 
level. P < 0.05 was considered statistically 
significant.
Results: There were no statistically significant 
associations between TMJ morphology, mean 
height, and inclination with TMJ anterior disc 
displacement. 
Conclusion: In our study, TMJ eminence 
anatomy did not appear to have an associ-
ation with the presence of DD. Additional 
studies are needed to determine the role of the 
eminence in the development of TMJD. 
#112 Accuracy of Predicted Angular Measurements Utilizing Virtual Surgical Planning in Bimaxillary 
Orthognathic Surgery for Treatment of Angle Class III Malocclusions
Steven Santarossa1, Logan McNeil2, Jason Untrauer1
1Department of Surgery, Division of Oral & Maxillofacial Surgery, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA 
2College of Dentistry, University of Nebraska, Lincoln, NE, USA
Mentor: Jason Untrauer
Program: Oral & Maxillofacial Surgery
Type: Case Report
Background: Many studies have demon-
strated the accuracy of virtual surgical 
planning (VSP) for orthognathic surgery. 
Although the literature supporting VSP 
accuracy is growing, there are still unknowns 
surrounding the accuracy of predicted 
angular changes. Several important angular 
measurements to address facial symmetry 
and esthetics include the incisor angle to the 
Frankfort horizontal plane (FHP), the occlusal 
plane angle, the mandibular plane angle, and 
maxillary yaw. Orthognathic surgery involves 
3-dimensional changes, especially in patients 
with Angle class III malocclusions who 
often have some degree of facial asymmetry 
requiring yaw correction of the maxilla, there-
fore, accuracy should be assessed for both 
linear and angular measurements. 
Case: An 18-year-old Asian female under-
went orthognathic surgery utilizing VSP for 
correction of an Angle Class III skeletal. 
A postoperative Cone Beam Computed 
Tomography (CBCT) taken one week after 
surgery was compared to the preopera-
tive surgical plan. Angular measurements 
(Figure 1A-C) were measured at various 
cephalometric landmarks and compared. The 
postoperative CBCT was superimposed with 
the preoperative surgical plan (Figure 1D). 
The deviation between the planned and actual 
linear measurements were within the accept-
able range of 2.00 mm (Figure 1E). The 
difference between predicted versus actual for 
incisor angle was 0.83° (115.73° and 116.57°, 
respectively), 0.78° for occlusal plane angle 
Figure 1. Eminence morphology, eminence height, and inclination were identified for this study. Four types of TMJ 
eminence morphology: A, Box-shaped; B, Sigmoid-shaped; C, Flat; D, Deformed.


Extracorporeal Membrane Oxygenation (ECMO) and Abdominal Complications in Adults: Identifying the Risk Factors

Schafer, Kristin

Graduate Medical Education 
Research Journal 
Volume 7 Issue 1 Article 88 
June 2025 
Loss to Follow-Up in Patients Undergoing Thoracic Endovascular 
Aortic Repair for Trauma 
Kristin Schafer 
University of Nebraska Medical Center 
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June 2025  |  Vol. 7 Iss. 1 Poster Presentations 56
*Names in bold type indicate presenting author.
#111 Temporomandibular Joint Articular Eminence Anatomy as a Predictor of Anterior Disc Displacement 
on MRI
Serin Lee1, Logan McNeil2, Lei Yu3, Jason Untrauer1
1Department of Surgery, Division of Oral & Maxillofacial Surgery, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA 
2College of Dentistry, University of Nebraska, Omaha, NE, USA 
3Department of Radiology, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
Mentor: Jason Untrauer
Program: Oral & Maxillofacial Surgery
Type: Original Research
Background: The temporomandibular joint 
(TMJ) is a ginglymoarthrodial synovial joint 
supported by a complex system of muscles 
and ligaments and plays an important 
role in masticatory function and speech. 
Temporomandibular joint dysfunction 
(TMJD) affects between 5-12% of the popula-
tion. TMJ anterior disc displacement (DD) is 
relatively common and is highly associated in 
patients with symptomatic TMJD. It has been 
suggested that articular eminence steepness 
and morphology may play a role in the devel-
opment of DD, as it directly influences the 
condylar and articular disc path of movement. 
The aim of this study was to help clarify the 
role that articular eminence anatomy plays in 
the development of DD of the TMJ, which has 
future implications on surgical management of 
internal derangement of the TMJ. 
Methods: This was a retrospective study 
approved by the institutional review board 
(UNMC IRB-0354-20-EP). TMJ MRIs of 129 
Patients (253 joints) with symptomatic TMJD 
were reviewed and assessed for disc displace-
ment and eminence characteristics. Statistical 
analysis was performed to investigate whether 
TMJ eminence morphology (classified into 
A- Box, B - Sigmoid, C- Flat, D-Deformed, 
Figure 1), eminence height, or inclination is 
related to DD. Fisher’s exact test was used for 
comparisons of categorical variables with any 
disk displacement (left or right) at the patient 
level. P < 0.05 was considered statistically 
significant.
Results: There were no statistically significant 
associations between TMJ morphology, mean 
height, and inclination with TMJ anterior disc 
displacement. 
Conclusion: In our study, TMJ eminence 
anatomy did not appear to have an associ-
ation with the presence of DD. Additional 
studies are needed to determine the role of the 
eminence in the development of TMJD. 
#112 Accuracy of Predicted Angular Measurements Utilizing Virtual Surgical Planning in Bimaxillary 
Orthognathic Surgery for Treatment of Angle Class III Malocclusions
Steven Santarossa1, Logan McNeil2, Jason Untrauer1
1Department of Surgery, Division of Oral & Maxillofacial Surgery, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA 
2College of Dentistry, University of Nebraska, Lincoln, NE, USA
Mentor: Jason Untrauer
Program: Oral & Maxillofacial Surgery
Type: Case Report
Background: Many studies have demon-
strated the accuracy of virtual surgical 
planning (VSP) for orthognathic surgery. 
Although the literature supporting VSP 
accuracy is growing, there are still unknowns 
surrounding the accuracy of predicted 
angular changes. Several important angular 
measurements to address facial symmetry 
and esthetics include the incisor angle to the 
Frankfort horizontal plane (FHP), the occlusal 
plane angle, the mandibular plane angle, and 
maxillary yaw. Orthognathic surgery involves 
3-dimensional changes, especially in patients 
with Angle class III malocclusions who 
often have some degree of facial asymmetry 
requiring yaw correction of the maxilla, there-
fore, accuracy should be assessed for both 
linear and angular measurements. 
Case: An 18-year-old Asian female under-
went orthognathic surgery utilizing VSP for 
correction of an Angle Class III skeletal. 
A postoperative Cone Beam Computed 
Tomography (CBCT) taken one week after 
surgery was compared to the preopera-
tive surgical plan. Angular measurements 
(Figure 1A-C) were measured at various 
cephalometric landmarks and compared. The 
postoperative CBCT was superimposed with 
the preoperative surgical plan (Figure 1D). 
The deviation between the planned and actual 
linear measurements were within the accept-
able range of 2.00 mm (Figure 1E). The 
difference between predicted versus actual for 
incisor angle was 0.83° (115.73° and 116.57°, 
respectively), 0.78° for occlusal plane angle 
Figure 1. Eminence morphology, eminence height, and inclination were identified for this study. Four types of TMJ 
eminence morphology: A, Box-shaped; B, Sigmoid-shaped; C, Flat; D, Deformed.
Graduate Medical Education Research Journal57 Poster Presentations
*Names in bold type indicate presenting author.
(14.91°and 14.13°), 0.08° of change for 
mandibular plane angle (35.35° and 35.27°, 
and maxillary yaw change of 1.2° in a count-
er-clockwise direction (Figure 1E).
Conclusion: VSP was accurate for predicting 
surgical movements in both linear and angular 
dimensions for Skeletal Class III patients 
undergoing bimaxillary orthognathic surgery. 
#113 Loss to Follow-Up in Patients Undergoing Thoracic Endovascular Aortic Repair for Trauma
Kristin Schafer1, Jason Cook1
1Department of Surgery, Division of Vascular Surgery, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
Mentor: Jason Cook
Program: Surgery – Vascular Surgery 
Type: Original Research 
Background: High rates of loss to follow-up 
are common in the trauma population. Patients 
with traumatic thoracic aortic injuries who 
have undergone thoracic endovascular aortic 
repair (TEVAR) require routine surveillance 
to monitor for endoleak and other long-term 
complications, and therefore represent a high-
risk loss to follow-up cohort. The purpose of 
this study was to examine loss to follow-up 
after trauma TEVAR at our facility and to 
identify any factors contributing to failure to 
follow-up. 
Methods: A retrospective review was 
conducted of all patients undergoing trauma 
TEVAR at a single Level 1 trauma center from 
January 2018 to October 2021. Electronic 
medical records were reviewed for CPT codes 
and demographic information. All patients 
who qualified for long-term follow-up per 
Vascular Quality Initiative (VQI) guidelines 
were included. Data analysis was performed 
using Microsoft Excel. 
Results: A total of 17 trauma TEVARs were 
performed during the study period. One 
patient expired prior to hospital discharge. 
Of the 16 patients eligible for long-term 
follow-up, 5 (31%) were lost to follow-up. 
Age (p = 0.19), race (p = 0.81), gender (p = 
0.29), insurance status (p = 0.69), and travel 
distance to the medical center (p=0.69) 
were not significant contributors to loss to 
follow-up. 
Conclusion: Roughly one-third of our trauma 
TEVAR patients are lost to follow-up. No 
statistically significant demographic factors 
were identified as contributing to loss to 
follow-up. Moving forward, we would like to 
complete retrospective telephone surveys with 
our trauma patients to further understand their 
barriers to follow-up and to provide additional 
patient education on the importance of close 
monitoring of their aortic endografts.
#114 High-Energy, High-Resource: Attempting to Predict 4th of July Hand Call Burden
Olivia Thomas1, Joseph Morgan1
1Department of Orthopaedic Surgery & Rehabilitation, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
Mentor: Joseph Morgan
Program: Orthopaedic Surgery 
Type: Original Research
Background: Blast-related upper extremity 
injuries sustained during the Independence 
Day holiday are time- and resource- intensive. 
The objective of this study was to evaluate 
incidence of blast-related injuries and system 
burden against weather and holiday timing. 
Methods: Available records from 2017-2023 
for patients treated by fellowship-trained 
hand surgeons at a single tertiary insti-
tution for blast injuries sustained during 
the Independence Day holiday period (7 
days preceding and following the holiday) 
were reviewed. This study is IRB exempt. 
Tourniquet time and return to operating 
room within holiday period were collected 
as proxies for system burden. The weather 
as documented by National Oceanic and 
Atmospheric Administration data and the day 
of the week on which Independence Day fell 
were recorded.
Results: Twenty-three blast-related injuries 
occurred during the defined period. Mean 
Figure 1. A, Predicted versus actual mandibular plane angle; B, Planned versus actual maxillary incisor angle; C, 
Planned versus actual occlusal plane angle; D, Superimposition demonstrating planned versus actually maxillary 
yaw; 1.2 degrees of difference; E, Planned Vs. actual linear movements following orthognathic surgery.
June 2025  |  Vol. 7 Iss. 1 Poster Presentations 58
*Names in bold type indicate presenting author.
tourniquet time was 70.5 minutes and 10 of 
the injuries (43.5%) required 13 returns to 
the operating room within the period. Six of 
the injuries (26%) occurred each on Tuesday 
and Sunday while 10 (43.5%) total occurred 
Friday-Sunday. Fifteen (65.2%) injuries 
occurred on days with zero or trace precipi-
tation; the maximum amount of precipitation 
on any day of injury was 0.86 inches. High 
temperatures ranged from 78-92 degrees 
Fahrenheit on day of injury. 
Conclusion: The systematic burden of 
blast-related upper extremity injuries each 
year is likely influenced by multiple factors. 
Injuries in this study were almost evenly 
split between mid-week and weekend days; 
most injuries occurred on days without 
precipitation. Hand surgeons and hospital 
systems may be best served by optimizing 
resource flexibility.
#115 Initial Assessment of an Obstetrics and Gynecology Research Interest Group
Emma Bassette1, Caroline Doyle1, Jacqueline Theil1, Christine Jackson2, Kristen Gerjevic1
1Department of Obstetrics & Gynecology, Creighton University, Omaha, NE, USA 
2Department of Obstetrics & Gynecology, Washington University in St. Louis, MO, USA
Mentor: Kristen Gerjevic
Program: Obstetrics & Gynecology
Type: Original Research
Background: Specialty-specific research 
interest groups (RIG) have been shown to 
increase research participation throughout 
physician careers and serve as a formal setting 
for mentorship, encouraging residents to act in 
a mentor/teacher role. The goal of this project 
is to evaluate the utilization and impact of an 
Obstetrics and Gynecology (OB/GYN) RIG 
after its first year of implementation and iden-
tify areas of improvement.
Methods: This cross-sectional survey queried 
medical students, residents, and faculty about 
the department RIG at Creighton University 
Department of Obstetrics and Gynecology. 
The survey examined training level, satis-
faction, perceived accessibility of residents 
and faculty mentors, and interest in academic 
medicine. The institutional review board 
deemed the study exempt. 
Results: A total of 26 responses were 
collected: 14 students, six residents, and 
five faculty members. Resident and medical 
student reasons for attendance included: 
research mentorship (70%, n = 14), under-
standing research topics (50%, n = 10), and 
discovering research opportunities (84.6%, 
n = 22). Ninety percent (n = 18) of residents 
and medical students reported attendings 
are more approachable. Sixty-five (n = 17) 
percent reported satisfaction with the RIG. 
Respondents desired better communication 
regarding ongoing projects and more faculty 
involvement. In total, 34.6% (n = 9) of 
respondents reported they are considering an 
academic career after attending the RIG. 
Conclusion: RIGs are an important addi-
tion to clinical training to engage students, 
residents, and faculty, provide an avenue for 
mentorship, and foster interest in academic 
medicine. Results from this survey provide 
an understanding of the impact of a newly 
instituted RIG, and demonstrated areas for 
improvement, including providing updates on 
projects and expanding faculty involvement.
#116 A Case of Stage IIB Squamous Cell Carcinoma Arising in a Mature Cystic Teratoma of the Ovary
Emma Bassette1, Kaitlyn Traen1, Jennifer Ducie2 
1Department of Obstetrics & Gynecology, Creighton University, Omaha, NE, USA 
2Nebraska Methodist Hospital, Omaha, NE, USA
Mentor: Jennifer Ducie
Program: Obstetrics & Gynecology
Type: Case Report
Background: Malignant transformation 
occurs in 0.2-2% of mature cystic teratomas 
of the ovary and comprises 2.9% of all malig-
nant ovarian germ cell tumors. 
Case: A 46-year-old presented for consul-
tation for bilateral complex adnexal cysts. 
On exam, the uterus measured 6 cm, and a 
large, fixed pelvic mass occupied the poste-
rior cul-de-sac. Transvaginal ultrasound 
revealed a uterus measuring 11.0 x 3.0 x 6.0 
cm. Endometrial stripe measured 6.5mm. A 
large right adnexal mass present measured 
17.0 x 12.1 x 13.4 cm. Left ovary contained 
a 4.7 x 4.0 x 4.9 cm complex cyst. CA-125, 
CA 19-9, CEA 2.1, and Inhibin A and B 
were normal. Diagnostic laparoscopy was 
converted to exploratory laparotomy, and she 
underwent total hysterectomy and bilateral 
salpingo-oophorectomy with staging due to an 
intraoperative frozen section consistent with 
squamous cell carcinoma (SCC) arising within 
a mature cystic teratoma. Final pathology 
demonstrated stage IIB SCC; perirectal biopsy 
with invasive SCC upstaged the cancer. Her 
postoperative course was benign, and the 
PET CT was negative for occult malignancy 
elsewhere. She was treated with carboplatin, 
paclitaxel, and bevacizumab, with the plan for 
maintenance therapy with bevacizumab. 
Conclusion: In patients >45yo with large 
teratomas, an intraoperative frozen section 
should be performed. Staging and optimal 
debulking with lymphadenectomy has been 
shown to improve survival in advanced 
stages. High concentrations of squamous-cell 
carcinoma antigen and CA-125 are associated 
with decreased 5-year survival rates. Adjuvant 
treatment with carboplatin, paclitaxel, and 
bevacizumab for advanced stage disease may 
improve survival, but adjuvant radiotherapy 
has not been shown to improve survival. 


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