St. Joseph Medical Center

Background/objectivesPatients suffering from Worker’s Compensation (WC) injuries typically demonstrate poorer outcomes despite optimal surgical management. In the occupational setting, shoulder pathology is the most implicated musculoskeletal disease. We recently described the Human Disharmony Loop (HDL), a clinical model of chronic, historically intractable pain of the neck, upper back, shoulder, and arm (Sharma and Friedman in Clin Med 14(5):1769, 2025. 10.3390/jcm14051769; Sharma et al. in J Clin Med 14(16):5650, 2025. 10.3390/jcm14165650; Friedman et al. in PLoS ONE 20(10):e0326815, 2025). Specifically, the asymmetric lower trunk innervation to the pectoralis minor (PM) can deform the scapula’s numerous connections and derange the full anatomy of the upper limb girdle, often after trauma. The purpose of this study was to retrospectively review our cohort of Workers’ Compensation patients (WCP) who met HDL diagnostic criteria and underwent treatment consisting of pectoralis minor release with infraclavicular neurolysis (PM + ICN). We hypothesize that WCP evaluated and treated for the HDL would show decreased pain, increased shoulder function, and a high rate of return to work.MethodsThis is a retrospective study of consecutive WCP meeting HDL criteria treated via PM + ICN. 6-month follow-up minimum was required. Outcomes included self-reported pain and headaches, shoulder range of motion, presence of neuropathy on exam, and return to work (RTW).Results36 patients were included. Average age was 48, sex was 61% male. Median follow-up was 10 months. Median preoperative pain was 8/10, headache prevalence was 69%, shoulder abduction was 90 degrees. Following treatment, median postoperative pain was 3/10, headache prevalence was 14%, and shoulder abduction was 180 degrees. 86% of patients returned to work. 25% required secondary neurolysis of the axillary, radial, cubital, and/or median nerves for persistent neuropathy.ConclusionsIn WCP who meet HDL criteria, PM + ICN provides significant clinical improvement in terms of dramatic reductions in pain and high rates of RTW. WCP with refractory pain preventing RTW should be evaluated and treated for the HDL.

Abstract Disclosure: R. Elangovan: None. K. Elangovan: None. J.R. Sethuraj: None. E. Krishnan: None. G. Palaniswamy: None. S. Nanduri: None. K. Sakalabaktula: None. U. Qureshi: None. F. Rahman: None. Z. Baloch: None. Z. Ahmed: None. S. Biswas: None. R. Muralidhar: None. C. Robert: None. K.J. Patel: None. G. Rajamani: None. N. Vora: None. S. Malapati: None. K. Noor: None. M. Kaur: None. A.S. Agrawal: None. A. Franklin Johnson: None. P. Uvaraj: None. T. Dontulwar: None. F. Madhumithaa Jagannathan: None. P.C. Sirait: None. M. Amro Alrouh: None. S. Tamma: None. S.S. Bhurchandi: None. S.K. Bhurchandi: None. Introduction: Endocrine cancers present critical challenges due to their systemic hormonal effects and intricate diagnostic profiles. With nearly 10 million cancer-related deaths annually, innovative solutions are imperative. Artificial intelligence (AI) is revolutionizing endocrinology by achieving unparalleled diagnostic precision in endocrine malignancies, offering scalable tools to reduce diagnostic errors and improve outcomes. AIM: This study aimed to develop and validate cutting-edge AI models for endocrine tumor evaluation, using multimodal data, ensuring their global generalizability, and deployment feasibility through a privacy-preserving, universally accessible application to promote equitable cancer care. Methods: Advanced deep learning architectures (EfficientNets and ResNets) were rigorously tested on anonymized multimodal datasets (CT, MRI, ultrasonography, cytopathology, and histopathology) from endocrine tumors in the thyroid, pancreas, pituitary gland, adrenal glands, and ovaries. Internal evaluations ensured model reliability, while external testing across diverse datasets from six continents validated generalizability. An online platform was developed, enabling users to test the models with their own data locally. Real-world applicability was confirmed through independent assessments by healthcare professionals worldwide. Results:EfficientNets and ResNets achieved exceptional diagnostic performance across multiple endocrine tumors (AUROC >99%) and robust generalizability. EfficientNetB0 excelled in treatment response monitoring (>97%). When deployed in an online application, EfficientNetB0 exhibited superior computational efficiency, while maintaining rapid processing speeds (<1 second/image) and diagnostic accuracy. Multi-national healthcare professionals validated the online platform’s reliability and usability, underscoring its global applicability. Conclusion: This study demonstrates the transformative impact of AI in endocrine oncology. Our findings illustrate a paradigm shift in biomedical AI, where minimal computational resources yield maximal diagnostic performance. This highlights the potential of AI-driven approaches to optimize diagnostic workflows, even with minimal computational resources, revolutionizing biomedical AI applications in cancer care. APPLICATION: The AI-powered application provides a privacy-preserving, scalable solution for endocrine tumor detection, classification, treatment monitoring, and advanced clinical decision-making. Validated multi-nationally by healthcare professionals, it ensures robust real-world applicability, fostering equitable cancer care globally. Its adaptability across platforms positions it as a universal tool for cancer care worldwide. Presentation: Sunday, July 13, 2025

The safety of internal thoracic artery (ITA) grafting in patients undergoing coronary artery bypass grafting (CABG) with prior mediastinal radiation remains controversial due to concerns regarding compromised sternal perfusion and radiation-induced injury. This study evaluated whether prior mediastinal radiation is associated with adverse perioperative outcomes in patients undergoing CABG with ITA grafting. We conducted a retrospective cohort study using the Maryland Cardiac Surgery Quality Initiative (MCSQI) database. A total of 29 206 patients who underwent CABG with ITA use between 1 July 2011 and 31 March 2023 were analysed. Patients with and without prior mediastinal radiation were propensity-matched (1:10) using the nearest neighbour method. The primary outcome was the composite of operative mortality and deep sternal wound infection (DSWI). Secondary outcomes included other infectious complications, major morbidities, postoperative hospital length of stay, and 30-day readmission. Among 29 206 patients, 294 (1%) had a history of mediastinal radiation. Patients with prior radiation were older (median (IQR) 70 (60-75) vs 66 (59-73) years, p<0.001), more frequently female (66% vs 25%, p<0.001) and had a higher prevalence of chronic lung disease (31% vs 19%, p<0.001). After propensity matching, no significant differences were observed in the primary composite outcome (2% vs 3%, p=0.53) or in secondary outcomes. In this large retrospective cohort, prior mediastinal radiation was not associated with an increased risk of perioperative adverse events in patients undergoing CABG receiving ITA grafts. These findings demonstrate no evidence of safety concerns with the use of ITA grafting in patients with prior radiation and challenge the practice of excluding these patients from arterial revascularisation strategies.

We report a case of an isolated bilateral corpus callosum stroke (body and splenium) who exhibited Balint syndrome (optic ataxia, simultanagnosia, optic apraxia), along with a partial Gerstmann syndrome (left/right disorientation, acalculia, finger agnosia), with extinction to double simultaneous stimulation and astereognosis without direct involvements of the parietal lobes. We review the vascular anatomy of the corpus callosum, mechanisms and risk factors for stroke in this area, and the components of Balint syndrome and localization, with descriptions of recent data on neural networks involved in higher-level cortical function. Attention to the visual-spatial symptoms of Balint syndrome is important to consider when evaluating and treating patients with ischemic disease of the corpus callosum.

BackgroundCementless fixation in total knee arthroplasty (TKA) has been associated with higher revision rates in the past. However, due to advancements in design, as well as surgical techniques, cementless TKA performance has significantly improved. The advantages of cementless fixation include reduced cement-related complications, shorter operating times, and the potential benefits of osseointegration. We aim to assess the improvement in revision rates for cementless TKA over the last 9 years based on international registry reports.MethodsA comprehensive retrospective review was conducted of six major English-speaking knee arthroplasty registries across the world including the National Joint Registry of England and Wales, Northern Islan Isle of Man and Guernsey (herby referred to as British), Swedish, Canadian, American, Australian, and New Zealand National Joint Registry. Data was collected from the year 2014 along with the most recent annual report published: 2022 or 2023. Data points collected included usage rates of cemented and cementless prostheses for primary TKA, their respective revision rates, and indications for revision.ResultsAcross four databases, there was an average 8.3% increase in the utilization of cementless fixation for primary TKA over the past decade. Three registries reported a reduction in revision rates for cementless fixation. Lower revision rates for cementless compared to cemented TKA were observed in the most recent American (3.2% cemented vs. 2.8% cementless) and New Zealand annual reports (11.8% cemented vs. 4.5% cementless). In 2022, the British registry reported lower rates of revision for infection with cementless fixation (0.56 vs. 0.89).ConclusionInternational registries demonstrate increased utilization of cementless TKA. Cementless TKA was reported to have lower revision rates in the most recent US and New Zealand annual reports when compared to cemented TKA.