Quinnipiac University

BackgroundMachine learning (ML) was used to predict pain scores and opioid consumption after elective spine surgery in the presence and absence of erector spinae plane block (ESP).MethodsA single-center retrospective chart review of 2796 cases was conducted. These cases were divided into the control group (N=1255) consisting of patients who did not receive the ESP blocks and the treatment group consisting of patients who received the blocks (N=1541). The gradient boosting ensemble tree methodology was employed to develop the AI predictive models. Feature importance for each optimized gradient boosting model was quantified using impurity-based importance scores, as implemented in the scikit-learn library. Partial dependence analysis was conducted to characterize the direction, magnitude, and non-linear nature of predictor-outcome relationships across clinically relevant ranges.ResultsOn unadjusted univariate analysis, the ESP block was associated with a statistically significant (p=0.01) yet clinically irrelevant 1% increase in average postsurgical pain scores. Conversely, ESP block was associated with a statistically non-significant (p=0.13) but clinically relevant 6.7% reduction in opioid consumption (MME/kg/day). These associations are exploratory and should not be interpreted as causal. Three AI models were developed to predict postsurgical pain and opioid consumption. The best-performing model, which predicts average postsurgical pain, achieved a mean absolute error of 1.24 on a 10-point scale (approximately 12.4%). High-importance predictors across the models included preoperative pain scores, serum glucose, and white blood cell count, as well as age.ConclusionIt is feasible to use machine-learning approaches to identify risk factors for postoperative pain and predict population-level pain scores and opioid consumption in spine surgery using large datasets; these models are not intended for individual-level prediction. The role of ESP in spine surgery, however, remains uncertain, and ESP block findings should be interpreted as exploratory associations only.

Acute esophageal necrosis, also known as "black esophagus," is an uncommon but potentially life-threatening condition marked by diffuse circumferential necrosis of the esophageal mucosa. It typically presents with upper gastrointestinal bleeding, such as hematemesis or melena, in 85-90% of reported cases. Acute esophageal necrosis is often multifactorial in etiology and associated with underlying comorbidities including cardiovascular disease and esophageal mucosal injury. Owing to its rarity, atypical presentations of acute esophageal necrosis can delay diagnosis and appropriate management. This case is noteworthy for its nonclassical presentation and its support of the "two-hit" hypothesis for acute esophageal necrosis pathogenesis. A 71-year-old African American male with a medical history of coronary artery disease and untreated gastroesophageal reflux disease presented with odynophagia, epigastric discomfort, and nonradiating chest pain. He notably denied hematemesis or melena. Esophagogastroduodenoscopy revealed extensive circumferential black discoloration of the distal esophageal mucosa consistent with necrosis, along with duodenal ulcers. Biopsy findings confirmed the diagnosis of acute esophageal necrosis along with evidence of Candida infection. The patient was treated conservatively with intravenous proton pump inhibitors (esomeprazole), oral fluconazole, and sucralfate. A repeat esophagogastroduodenoscopy performed after several weeks demonstrated complete mucosal healing and resolution of necrosis. This case highlights an atypical, nonbleeding presentation of acute esophageal necrosis and reinforces the importance of maintaining clinical suspicion even in the absence of classic symptoms. It underscores the relevance of the "two-hit" hypothesis, where ischemic insult and impaired mucosal defense act synergistically to cause esophageal necrosis. Timely endoscopic evaluation and early initiation of appropriate therapy led to favorable outcomes in this high-risk patient. Increased awareness of such presentations can aid in earlier diagnosis and reduce the high morbidity and mortality associated with acute esophageal necrosis.

The purpose of this study was to investigate voluntary force modulation accuracy during the isometric mid-thigh pull (IMTP) and to investigate biological sex and relative strength as factors relating to error. Strength-trained males (n = 18) and females (n = 18) completed ascending (ASC) (25%, 50%, 75%) or descending (DESC) (75%, 50%, 25%) submaximal testing followed by maximal testing. Subjects rested before completing the opposite submaximal testing sequence. External feedback was not provided during testing. Measured and intended (INT) forces were analyzed with two-way repeated-measures ANOVAs with within- (ASC, DESC, and INT) and between-subject factors (male or female). Independent-samples t-tests analyzed differences in error between males and females. Pearson correlations were calculated to investigate associations between relative strength and error. Statistically significant differences were observed between INT and measured force at every intensity (p < 0.05); however, differences in error were not significant between males and females (p > 0.05). Statistically non-significant small relationships were observed between relative strength and error (p > 0.05). Subjects demonstrate error in force modulation during the IMTP, with the greatest error occurring at lower relative intensity. However, these results indicate that biological sex and relative strength may not influence force modulation accuracy.

Introduction: Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis characterized by inflammation of medium-sized arteries. CNS involvement occurs in as many as 14.8% of cases and is a poor prognostic indicator. Neurologic involvement is characterized by peripheral neuropathy, ischemic stroke, extracranial or intracranial aneurysm formation, hemorrhage, seizures or headache. Laboratory markers are nonspecific; tissue biopsy remains the gold diagnostic standard. CNS PAN is diagnosed with systemic disease, a compatible clinical presentation and supportive neurovascular imaging. Angiographic findings include small- and medium-sized arterial aneurysms, luminal irregularities or occlusions. Despite PAN representing a unique, rare, dangerous and treatable etiology of aneurysm formation, current literature is limited to case reports, and no prior studies have characterized the clinical features or outcomes of aneurysms in PAN. Methods: We performed a systematic literature review to characterize intracranial aneurysms in PAN. Searches of PubMed, Ovid and Google Scholar were performed using key terms and Boolean operators. Studies were screened against inclusion/exclusion criteria and data was extracted. Results: Thirty articles (n=30 patients) met inclusion criteria. Mean age was 31 years and 60.5% were male. 63% first presented a ruptured aneurysm. Complications included aneurysmal subarachnoid hemorrhage (40%), intracerebral hemorrhage (10%), intraventricular hemorrhage and cavernous sinus syndrome. Presentations included cranial neuropathies, monocular vision loss, gait disturbance, hemiparesis, hemisensory loss, ptosis, limb ataxia, loss of consciousness, headache or seizures. In 48%, PAN diagnosis followed aneurysm identification. Aneurysms were located in the anterior circulation (53%), posterior (40%), or both (17%); 67% had &gt; 2 aneurysms. 10% either underwent clipping or endovascular embolization while 80% did not undergo an intervention. 97% received steroids and 60% also received immunosuppressants. Mean follow-up was 30 months; 15% died during this period. 49% recovered without recurrence. 15% experienced progressive or relapsing symptoms. Conclusion: To our knowledge, this study is the first to describe the clinical features, treatment and outcomes of intracranial aneurysms in PAN. Although rare and treatable, aneurysms pose significant morbidity and mortality in PAN. We aim to inform practitioners about the spectrum of neurovascular disease in PAN.

Ransomware is a persistent cybersecurity threat, causing billions in damage and disrupting critical sectors, especially healthcare. This paper introduces Ransom Sentinel (RaSe), a conceptual framework that integrates offensive attack simulation with multi-layered defensive strategies to strengthen resilience against ransomware. Offensive testing used tools like N-map and custom client-server code to replicate reconnaissance, unauthorized access, and payload execution, exposing key system vulnerabilities. In response, RaSe combines Shamir's Secret Sharing for key management, Reed-Solomon erasure coding for resilient storage, anomaly detection, Zero Trust architecture, and context-aware access controls. Results show RaSe not only mitigates encryption and exfiltration risks but also sustains availability, compliance, and continuity in healthcare environments. RaSe demonstrates how integrating adversarial insights with cryptographic defenses can provide a robust model for protecting critical infrastructure.

Massive rotator cuff tears (RCTs) with significant retraction are challenging due to the high retear rates and limitations associated with existing repair techniques. Biceps tendon rerouting has recently emerged as an effective reinforcement technique for massive RCTs, particularly in achieving low retear rates. Arthroscopic RCT repair with proximal biceps tendon rerouting is a viable option for nonarthritic, active patients with massive, retracted RCTs for whom nonoperative treatment has failed and the long head of the biceps tendon is intact. The patient was placed in a lateral decubitus position with the arm in 10 lbs of traction. A diagnostic arthroscopy demonstrated a complete supraspinatus and infraspinatus tear with retraction to the glenoid, along with a frayed long head of the biceps tendon with an intact subscapularis tendon. The transverse humeral ligament was released to reroute the biceps tendon and anchor it 10 mm posterior to the bicipital groove. The rotator cuff was mobilized and sequentially repaired with medial-to-lateral advancement using 3 separate suture tapes passed through the supraspinatus, biceps tendon, and back through the supraspinatus to create a linked, reinforced construct. A horizontal mattress suture was placed posteriorly to reduce a posterior dog-ear soft tissue corner. The sutures were then tensioned and anchored on the greater tuberosity using 3 anchors. Arthroscopic massive RCT repair with biceps tendon rerouting has shown favorable clinical outcomes. Significantly lower retear rates compared with arthroscopic repair alone, and clinical outcomes equivalent to those of superior capsular reconstruction with autograft have been demonstrated in the literature for this technique.In this technical report, our patient experienced complete pain relief and regained full strength, along with near-complete range of motion, within 6 months after surgery. Biceps tendon rerouting in the setting of arthroscopic massive RCT repair is an effective surgical option in active individuals with an intact or minimally degenerated biceps tendon. This technique provides a cost-effective solution that offers additional mechanical support and supplies a rich autologous source of collagen to strengthen the repair. The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Regulations have been established, both nationally and internationally, to safeguard production and distribution of cosmetic products to the population. A core principle behind these regulations is to ensure that the products are safe for human use. The variation in regulations have led to an increased need for alternative testing methods for cosmetic products. One alternative is the use of human volunteers for product testing. However, there are increased ethical concerns for the volunteers participating in these studies. For cosmetic testing, the evaluation of a product’s safety in a human volunteer must be justified on a case-by-case basis. In addition, the benefit of using a human subject and the information gained from doing such must be sufficiently greater than if other testing methods were used. Although there is a movement to have more unified guidelines, there is still a large discrepancy between cosmetic regulations among the EU, U.S., and other nations. Without international consensus though, it remains difficult to establish ethical recommendations that would be universally acceptable to compliment regulatory policy.

BackgroundMetastatic colorectal cancer (mCRC) remains a leading cause of cancer-related mortality, emphasizing the need for effective later-line therapies. Fruquintinib, a selective vascular endothelial growth factor receptor (VEGFR)1–3 inhibitor, has emerged as a promising option for refractory mCRC. This systematic review and meta-analysis evaluates its efficacy and safety, both as monotherapy and in combination with programmed death-1 (PD-1) inhibitors.MethodsFollowing Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic search was conducted across PubMed, Embase, Online Vendor of International Databases (OVID), Cochrane Library, and ClinicalTrials.gov (2010–2025). Included studies were randomized controlled trials (RCTs) or real-world data on fruquintinib in mCRC after at least two prior therapies. Real-world evidence was included to complement RCT findings, as it captures broader populations, treatment patterns, and outcomes not fully reflected in controlled trial settings. Primary outcomes were progression-free survival (PFS) and overall survival (OS); secondary outcomes included objective response rate (ORR), disease control rate (DCR), and treatment-related adverse events (AEs). Pooled hazard ratios (HRs) and event rates were calculated using a random-effects model.ResultsFifteen studies were included; 12 qualified for meta-analysis (n=3,703). Fruquintinib improved PFS [HR =0.30; 95% confidence interval (CI): 0.26–0.35] and OS (HR =0.66; 95% CI: 0.57–0.76) vs. placebo. ORR was 4.9% (95% CI: 3.2–6.6%); DCR was 62.2% (95% CI: 57.1–67.3%). Combination therapy with PD-1 inhibitors was associated with a modestly higher ORR in observational data; however, this finding requires confirmation in randomized studies (7.8% vs. 4.0%, P=0.04). In cross-study comparisons, monotherapy appeared to yield numerically longer PFS, although this was not based on head-to-head trials. AEs occurred in 86.7%, with grade ≥3 in 30.9%, most often hypertension (8.1%) and hand-foot skin reaction (5.8%). High heterogeneity was observed for several outcomes including AEs and DCR.ConclusionsFruquintinib significantly improves PFS and disease control in refractory mCRC with manageable toxicity. Limitations include heterogeneity across studies, with most conducted in predominantly Chinese cohorts. Further studies should explore optimal combination strategies and biomarker-based selection.