Conference Research

Daniel Hahn, OMS-III (1), Lauren Velasquez, OMS-III (1), Marc Mohammed, OMS-III (1), Dr. Albert Cooper, MD (2)

(1) Touro College of Osteopathic Medicine, New York, NY,

(2) Interfaith Medical Center, Brooklyn, NY

Introduction

Mesenteric hematomas are uncommon conditions usually linked to trauma, vascular diseases, or anticoagulation therapy. Spontaneous mesenteric hematomas are rarer and can result from vascular tension, such as hernias. This report presents a unique case of a mesenteric hematoma complicating a sigmoid colon hernia.

Case Presentation

An 89-year-old male with a reducible left inguinal hernia presented with abdominal pain and urinary symptoms. Imaging revealed a 14-cm mesenteric hematoma adjacent to the herniated sigmoid colon, which extended into the inguinal canal. Surgical exploration showed the hematoma obstructing hernia reduction, necessitating aspiration and decompression. Once reduced, the hernia was repaired with mesh placement.

Discussion

This case demonstrates a rare occurrence of a mesenteric hematoma caused by a vascular injury from herniated sigmoid colon traction. Unlike hematomas linked to trauma or anticoagulant therapy, this case involved mechanical vascular strain without anticoagulant use. Imaging confirmed the hematoma’s stable, clotted nature, consistent with venous origin. The hematoma’s size and position complicated surgical hernia reduction, highlighting the importance of individualized preoperative imaging and intraoperative flexibility. Decompression of the hematoma allowed safe hernia repair, emphasizing the significance of managing potential complications from both conditions. Additionally, this case underscores the bidirectional relationship between hernias and mesenteric hematomas: prior hernia-related vascular strain can predispose to hematoma formation, while hematomas can obstruct hernia repair.

Conclusion

This case highlights the importance of recognizing mesenteric hematomas as potential complications in long-standing hernias. Comprehensive imaging and adaptive surgical strategies are essential for successful outcomes in such complex cases.

Keywords: Mesenteric Hematoma, Inguinal Hernia, Vascular Injury

Gabriel P. Ordonez (1), Lauren F. Uchiyama, PhD (2), Khoi Pham (1), John P. Kennelly (2), Lany D. Tran (1), Peter Tontonoz, MD, PhD (2,3), Alexander H. Nguyen, MD, PhD (1)

(1)Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School

Medicine, University of California, Los Angeles (UCLA) & UCLA Health;

(2)Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCL

(3)Department of Biological Chemistry, David Geffen School of Medicine at UC

Abstract: Peroxisome proliferator-activated receptor alpha (PPARa) is a nuclear hormone receptor that transcriptionally regulates lipid homeostasis and the liver fasting response through lipid uptake and catabolism. In humans, PPARa non-synonymous single nucleotide polymorphism (nsSNP) Val227Ala (V227A) occurs in East Asians with up to a 4% allele frequency. Clinical studies associate this variant with beneficial metabolic paramete including reduced plasma triacylglycerols (TG) and cholesterol, decreased metabolic dysfunction-associated steatotic liver disease (MASLD) incidence, and lowered body-mass index. Whether these correlations reflect causal relationship has not been physiologically modeled. To address this, we generated a V227A mouse model via CRISPR/Cas-mediated base editing of the endogenous Ppara gene locus. Base editing in mouse cell lines and pronuclei exhibits high editing efficiency. V227A mice display no difference in body or liver mass or hepatic accumulation. However, they exhibited decreased plasma TG, prominently under lipid-rich Western diet, aligning with clinical findings. Liver RNA sequencing confirmed upregulation of Ppara targets, including lipoprotein li (Lpl), the key enzyme in plasma TG hydrolysis. Gene expression analyses revealed increased liver and heart Lpl mRNA in fasted V227A mice. Notably, fasting and pharmacologic Ppara agonists induce Lpl mRNA, consistent with Lpl being a direct target. Functional TG assays showed increased TG uptake in the heart, and fluorometr assays confirmed elevated cardiac LPL activity. These findings suggest enhanced peripheral TG hydrolysis dr reduced plasma TG levels. Our study reveals a mechanistic link between PPARa-V227A and metabolic health, offering insights into human genetic variation and potential therapeutic targets in metabolic disease

Keywords: lipid metabolism, physiology, human genetic variation

Jasmine Santos (1,2), Gentian Lluri (1), Jamil Aboulhosn (1)

(1) Ahmanson/UCLA Adult Congenital Heart Disease Center

(2) University of the Philippines College of Medicine

Abstract (limit 250 words):

Patients with complex congenital heart disease require a palliative surgery called a Fontan procedure which creates a single-ventricle physiology. Virtually all Fontan patients develop Fontan Associated Liver Disease - a cause of major morbidity and mortality. But risk factors for disease progression are not fully understood. This study hypothesizes that Fontan patients with higher Fontan and/or Inferior Vena Cava (IVC) pressures will show liver fibrosis progression by serial liver biopsies. Fontan patients of the Ahmanson/UCLA Adult Congenital Heart Disease Center who had serial liver biopsies from 2009-2022 were identified. Fontan and IVC pressures measured during cardiac catheterization and liver biopsy results were extracted from medical records. METAVIR scoring for liver fibrosis was used. P-values were calculated using Chi-squared analysis. 21 patients had Fontan pressure measurements available, but only 17 had IVC pressure measurements. The threshold for “high” Fontan and IVC pressure was set at ≥ 15 mmHg. Among those with high Fontan pressures, 60% progressed versus 50% in low pressures (p = 0.67). Of those with high IVC pressures, 64% progressed, versus 50% in low pressures (p = 0.58). Upon lowering the threshold of IVC pressure to 14 mmHg, 66% vs 40% progressed in high vs low pressures respectively (p = 0.31). Lowering the threshold of Fontan pressure did not yield similar effects. This study was limited by small sample sizes from a single center. Although no statistical significance was found, it signals that IVC pressures might be a more sensitive predictor of liver fibrosis progression compared to Fontan pressures.

Keywords: Adults with Congenital Heart Disease, Fontan Circulation, Fontan Associated Liver Disease, Liver Disease Progression

NatalieDeana Badillo, BEng (1), Ana C. Krieger, MD, MPH (1,2)

(1) Weill Cornell Medicine, (2) Center for Sleep Medicine at Weill Cornell Medicine

Abstract: Idiopathic hypersomnia (IH) and narcolepsy are sleep disorders characterized by excessive daytime sleepiness and disrupted sleep patterns, often requiring complex diagnostic procedures. This project aims to develop a machine learning tool to improve the accuracy and speed of diagnosing these conditions by identifying key risk factors and enabling early detection. The goal is to create a more accessible and reliable diagnostic method validated against gold-standard sleep studies such as the Multiple Sleep Latency Test (MSLT) and polysomnography (PSG). The study analyzed 19,398 records from an academic sleep center, including clinical data, patient questionnaires, and polysomnography results collected over 10 years. Data preprocessing included normalization, handling missing values, and feature selection. Machine learning algorithms, including logistic regression and random forests, were used to develop predictive models trained on 80% of the dataset, with 20% reserved for validation and testing. Model performance was measured using accuracy, sensitivity, specificity, and AUC-ROC, with subgroup analyses ensuring generalizability across diverse populations. These models are expected to complement traditional diagnostic tools by identifying new clinical predictors, enhancing screening processes, and improving co-morbidity identification and management. With its uniquely large dataset, this project enables robust, data-driven predictions, reducing reliance on expensive diagnostic tests. The extensive data and curation enhance the predictive models’ reliability and open avenues for future research into links between sleep disorders and metabolic or neurological comorbidities. The impact of this work sets a precedent for applying machine learning to transform sleep medicine, enhance clinical screening for sleep disorders, and contribute to public health advancement.

Keywords: sleep medicine, machine learning, diagnostic accesibility, excessive daytime sleepiness

Ron Jako Domingo (1), Daniel Hahn (1) Vinay Tak, MD (2)

(1)Touro College of Osteopathic Medicine, New York, NY

(2)St. Mary’s General Hospital, Passaic, NJ

Spindle cell lipoma (SCL) is a rare, benign adipocytic tumor occurring in subcutaneous tissues, predominantly in older males and typically in the posterior neck, back, or shoulders. Histopathology, including CD34 and spindle cell morphology, distinguishes SCL from malignant neoplasms, such as liposarcomas.

Case Presentation

A 64-year-old female presented with a painless, left supraclavicular mass measuring 4.24 x 4.4 x 2.2 cm. Over nine months, the lesion grew to 7 x 6 x 5 cm. Imaging with a CT scan suggested a neoplastic process, raising concerns for malignancy. Fine needle biopsy confirmed a spindle cell lipoma with benign features, supported by CD34 positivity. Surgical excision revealed a well-circumscribed tumor without invasion into adjacent structures, consistent with SCL.

Discussion

This case illustrates the diagnostic complexity of SCL, particularly in atypical locations like the supraclavicular region or in female patients. Imaging, including MRI and CT, is crucial for evaluating tumor composition and margins, though low-fat variants can obscure visualization. Immunohistochemistry, specifically CD34 positivity and absence of markers such as SMA and Desmin, confirms the diagnosis. While SCL is slow-growing, atypical features such as rapid enlargement or unusual location may mimic malignancy, necessitating histopathological evaluation. Surgical excision remains the definitive treatment, with recurrence rates below 2% when complete resection is achieved. Early diagnosis and intervention prevent complications from mass effect or misdiagnosis.

Conclusion

A multidisciplinary approach involving imaging, biopsy, and surgical management ensures optimal outcomes for atypical SCL presentations. This case highlights the importance of early intervention to avoid diagnostic delays and unnecessary complications.

Keywords

Spindle Cell Lipoma, Benign Soft Tissue Tumors, Histopathology and Diagnosis

Mariel Aileen Buenavista Lansangan

Cedars Sinai Health Sciences University Graduate School of Biomedical Sciences

Coronary Artery Disease (CAD) is the third leading cause of death worldwide. Patients with a high BMI, diabetes, and severe hypertension face a subset of daily challenges, with many seeking surgical intervention to improve their quality of life. The expected surgical gold standard for treatment is conventional coronary artery bypass graft surgery (C-CABG). However, robotic-assisted technology in coronary artery bypass (RA-CAB) has been increasing in use as it provides a minimally invasive alternative to the C-CABG procedure, which utilizes a small anterior thoracotomy incision that eliminates the need for a cardiopulmonary machine. In this study, I hypothesize that using robot-assisted technology will lead to improved post-operative outcomes, including reduced levels of creatinine, ventilation hours, and surgical site bleeding, particularly in patients with high BMI, diabetes, and a diagnosis of CAD. Data on CABG and RA-CAB procedures was collected and analyzed from Cedars Sinai Medical Center between 2020 to 2024 (n=861) to compare procedure outcomes. Statistical tests in ANOVA will generate relationships between patient characteristics and outcomes by propensity score matching on covariates such as age, gender, weight, BMI, history of CAD, and diabetes. The research study will continue to review collected data until the end of 2024 to obtain an adequate sample size for comparison. Overall, the retrospective study aims to evaluate specific patient outcomes associated with each surgical procedure to support evidence-based practices so clinicians can provide higher standards of care through innovative technological advancements to reduce healthcare disparities across cultures.

Keywords: Robot-Assisted Cardiac Surgery

Angelina Jala (1), Bradley Johnson, MD-PhD (1), Qijun Chen, PhD (1)

(1) Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania,

Philadelphia, PA

Abstract: This study examines the role of telomeres in age-related causes of dementia, focusing on Alzheimer’s disease (AD) and primary age-related tauopathy (PART). Telomeres are protective structures at the ends of chromosomes that shorten with age and proteotoxic stress. This progressive shortening is hypothesized to drive neurodegenerative processes. Using telomere quantitative PCR (qPCR), we performed a blind associative study and produced T/S ratios (relative telomere length) in genomic DNA from peripheral blood samples. Samples from various disease groups were analyzed by T/S ratio and revealed consistent evidence of shorter telomeres in individuals with dementia compared to healthy controls (p = 0.0405). Nanopore sequencing, which has the potential to provide absolute telomere length measurements at single base resolution, was tested on PART samples, but did not yield conclusive results. Future research will expand the sample size and refine Nanopore techniques telomeres for more precise measurements of telomere length. This research contributes to a deeper understanding of the mechanisms causing age-related dementia and highlights the potential of telomere analysis as a biomarker for neurodegenerative diseases.

Keywords: telomeres, neurodegeneration, aging

Lauren Velasquez, OMS-III (1), Daniel Hahn, OMS-III (1), Dr. Bernard Pacella, MD (2)

(1) Touro College of Osteopathic Medicine, New York, NY,

(2) Wyckof Heights Medical Center, Brooklyn, NY

Papillary Thyroid Carcinoma (PTC) is the most common thyroid cancer, typically presenting as solid nodules. However, cystic variants (Cystic PTC) pose diagnostic challenges due to their atypical features and inconclusive fine-needle aspiration (FNA) results.

Case Presentation:

A 28-year-old female presented with a lateral neck mass initially classified as a benign cystic thyroid nodule (TI-RADS 4). Thyroid function tests were normal, and FNA cytology was Bethesda Category III (Atypia, Follicular Lesion of Undetermined Significance). Eight months later, the patient reported worsening hoarseness, dysphagia, and nodule growth (5.3 x 2.4 x 2.6 cm). Despite aspiration, the cyst recurred, prompting surgical excision. Pathology confirmed Cystic PTC with follicular nodular disease. The tumor was fully resected with clear margins and no vascular invasion.

Discussion:

Cystic thyroid nodules are typically benign, with malignancy risk around 6%. However, cystic variants of PTC present unique challenges: ultrasounds may underestimate malignancy, and FNA cytology is often inconclusive due to hypocellularity. For Bethesda III lesions, malignancy rates range from 6-48%, necessitating molecular testing or surgical intervention. Despite low suspicion on imaging, 80% of re-aspirated Bethesda III cystic PTC cases are malignant. Careful assessment of growth, clinical symptoms, and imaging findings, such as microcalcifications or irregular margins, is critical for timely diagnosis.

Conclusion:

In recent literature, an increasing number of Cystic PTC cases have been reported, potentially necessitating the subcategorization of Cystic PTC as its own subtype and clearer guidelines for management of cystic thyroid nodules with atypical features.

Keywords: Papillary Thyroid Carcinoma, Thyroid Cyst, Atypical Thyroid Features

Bradley Ventayen, B.S., Daniel Shoham, M.B.S, Tri Brian Nguyen, B.S., Jerome Torres, B.S., Ruth Sanchez, B.S., Breana Nguyen, B.S., Paul Medina, M.B.S, Clarisa Bloemhof, B.S., Ria Laxa, B.S., Christian Matabang, B.S., Ryan Lin, B.S., Kendrick Cruz, B.S., Celine Bojo, B.S., Haseeb Ahmad, B.S., Elvin Hernandez, DrPH, MPH, MCHES

California University of Science and Medicine - School of Medicine

Abstract

This cross-sectional cohort study explored the relationship between demographic factors and atherosclerotic cardiovascular disease (ASCVD) risk estimates among Filipino Americans aged 40-79 in Southern California's Inland Empire (IE). Data were collected at Bayanihan Project health fairs and included blood pressure, cholesterol levels, and survey responses addressing variables such as duration of U.S. residency, Filipino food consumption, education level, emotional support, income, smoking status, and sex. ASCVD risk was calculated using the American College of Cardiology’s Risk Estimate Tool.

Among 33 participants, no significant relationship was found between years spent in the U.S. and mean ASCVD risk (p=0.514). Similarly, no significance was observed between first- and second-generation Filipino Americans (p=0.514) or education level (p=0.428). However, daily consumption of Filipino food was significantly associated with higher ASCVD risk (13.40% vs. 5.50%, p=0.026). Emotional support also showed a significant impact, with participants lacking support having a mean ASCVD risk of 13.90% compared to 6.95% for those with support (p=0.006).

Income and ASCVD risk showed no statistical significance across all income brackets (p=0.426), nor did income levels below or above $50,000 annually (both p=0.06). However, sex was significantly associated with ASCVD risk, with males having a higher mean risk (14.61%) compared to females (7.77%, p=0.034).

These findings highlight the influence of dietary habits, emotional support, and sex on ASCVD risk in Filipino Americans. Further investigation on the dietary habits of Filipino Americans is warranted to understand the nutritional deficits of this community and tailor dietary interventions to the Filipino American community.

Keywords: Cardiovascular, Filipino Americans, Demographics

Bradley Ventayen, B.S., Daniel Shoham, M.B.S, Tri Brian Nguyen, B.S., Jerome Torres, B.S., Ruth Sanchez, B.S., Breana Nguyen, B.S., Paul Medina, M.B.S, Clarisa Bloemhof, B.S., Ria Laxa, B.S., Christian Matabang, B.S., Ryan Lin, B.S., Kendrick Cruz, B.S., Celine Bojo, B.S., Haseeb Ahmad, B.S., Elvin Hernandez, DrPH, MPH, MCHES

California University of Science and Medicine - School of Medicine

Abstract

Cardiovascular disease (CVD) is a leading cause of mortality worldwide, with disparities in risk across ethnic groups. Filipino Americans, identified as a high-risk population by the American Heart Association, experien elevated risks for atherosclerotic cardiovascular disease (ASCVD). Despite this, research on their specific ri factors remains limited. This study compares ASCVD risk estimates between Filipino Americans in Southern California's Inland Empire (IE) and ethnically diverse populations from the National Health and Nutrition Examination Survey (NHANES).

Using the American College of Cardiology’s ASCVD Risk Estimate tool, data were collected from 36 Filipino Americans (ages 40-79) at community health fairs. Results were compared to 2,497 participants from NHANES (2017-2020), representing various ethnicities. Analysis using a non-parametric One-Way ANOVA on Ranks revealed significantly higher 10-year ASCVD risk estimates for Inland Empire Filipinos (mean 9.10%) compared “Mexican-Americans” (5.65%), “Other Hispanics” (6.20%), and “Other Races” (5.71%) (p<0.05). No significa differences were found when compared to “Non-Hispanic White” (7.51%) and “Non-Hispanic Black” (8.18 groups.

These findings underscore the elevated ASCVD risk among Filipino Americans, attributed to dietary habits, physic inactivity, and cultural influences. The study highlights the urgent need for culturally tailored interventions address this health disparity. Public health strategies should focus on promoting heart-healthy diets, increasing physical activity, and reducing smoking and alcohol consumption. Such efforts could improve cardiovascul outcomes for Filipino Americans and advance equity in cardiovascular health.

Keywords: Cardiovascular, Filipino Americans, NHANES