United States

Robotic Prostatectomy (RP) is the predominant surgical approach for localized prostate cancer in the United States and over 50% of RP are performed as ambulatory or same-day discharge encounters. Current literature supports that RP performed in the outpatient setting are as effective and have no increase in complications compared to those performed inpatient and cost nearly 20% less than those performed inpatient. However, in 2022, the Centers for Medicare and Medicaid Services (CMS) removed robot-assisted radical prostatectomies from the list of covered procedures for ambulatory surgery centers (ASC).

In 2021, an independent multi-specialty physician group performed RP in both a freestanding ASC and in an affiliated hospital. This study compares the clinical and pathological factors, operative metrics, and postoperative outcomes between RP performed by this physician group in an ASC and in a hospital.

This is a retrospective study of consecutive RP cases performed by two high-volume robotic surgeons at an ASC or a hospital between May 2021 and December 2021. Data on demographics (age, body mass index), clinical and pathological variables (prostate specific antigen, grade group, prostate volume, pathological stage), and operative metrics (American Society of Anesthesiologists (ASA) classification, estimated blood loss, operative time) were collected. Outcomes and complications were defined by recovery time, total length of stay, adverse events, and Clavien-Dindo classification. Analysis involved the use of descriptive statistics, t-tests for continuous variables, and Chi-Square analysis and Fisher’s tests for categorical variables.

40 ASC cases and 50 hospital cases were identified. There were no significant differences in mean age, BMI, PSA, prostate volume, and final pathological stage between groups. The hospital group had higher grade group classification. There were no significant differences in ASA classification, estimated blood loss, operative time, or complications between groups. 

RP performed in an ASC demonstrated outcomes comparable to those performed in a hospital. These findings are consistent with published evidence that outpatient RP are safe and cost- effective, supporting reconsideration of current CMS reimbursement policies that restrict access to ambulatory surgical care for prostate cancer.

AMA Research Challenge 2025 

Comparison of Same-Day Discharge Robotic-Assisted Radical Prostatectomy in Ambulatory Surgery Center vs. Hospital Setting

### Welcome to The 63rd Annual Meeting of the Association for Computational Linguistics (ACL 2025)

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Welcome to The 63rd Annual Meeting of the Association for Computational Linguistics (ACL 2025)

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Hemodynamic responses to combined ice-cold water intake, leg raising, and the diving response in young healthy subjects – A potential intervention to convert paroxysmal atrial fibrillation.

Biola Eniola, Sukla Mohajan, Esmeralda Ponce, Gilda Tchao

Background: Patients with paroxysmal atrial fibrillation undergo electro-conversion approximately twice yearly, each requiring general anesthesia. In an attempt to reduce the number of required conversions, patients utilize self-management strategies including leg raising, autonomic maneuvers, and fluid/electrolyte intake. The effectiveness of such strategies is unknown. We explored the hemodynamic responses to these strategies in healthy participants.
Methods: The study was approved by the Institutional Review Board of Burrell College and all young healthy volunteers (n=15, 3♂) provided written informed consent. Exclusion criteria: Pregnancy/nursing; chronic or acute conditions; use of prescription medications except contraceptives. Some subjects participated in multiple sessions separated by at least two days. A 30-minute baseline recording (supine position) was followed by 10 minutes with legs raised by 20 cm (group 1); three inspiratory breath holds while wearing an ice-cold face mask (diving response, group 2); 30 minutes of recording following 500 mL ice-cold water imbibement (group 3); or a combination of these interventions (group 4). Stroke volume was obtained by impedance cardiography, heart rate was derived from the ECG, blood pressure was recorded by finger plethysmography. Data are presented as means±standard error of the mean. Statistics were calculated by one-way analysis of variance. 
Results: Systolic blood pressure increased with leg raising (121.9±4.0 mmHg at baseline vs. 139.4±7.2 mmHg, n=8, P=0.06), the diving response (121.9±3.0 mmHg at baseline vs. 136.1±5.0 mmHg, n=8, P=0.01), and ice-cold water imbibement (123.4±3.8 mmHg at baseline vs. 137.2±6.5 mmHg, n=8, P=0.03), but not for the combination of the three interventions (122.1±5.4mmHg at baseline vs.116.9±4.9mmHg, n=8, P= 0.16). Heart rate decreased in response to all interventions, with the most pronounced bradycardic response observed with the combination of the three interventions (68.8±3.5bmp at baseline vs 61.1±3.4bmp, n=8, P=0.01). The diving response increased stroke volume (68.6±6.6 mL at baseline vs. 94.4±10.2 mL, n=8, P=0.06) and cardiac output (4.2±0.4 L at baseline vs. 5.4±0.6 L, n=8, P=0.11). Likewise, the combination of all three interventions (group 4) increased stroke volume (59.1±6.8mL at baseline vs. 84.3±9.8 mL, n=8, P=0.01) and cardiac output (4.1±0.6 L at baseline vs. 5.2±0.7 L, n=8, P=0.03).
Conclusion: The combined application of ice-cold water imbibement, leg raising, and diving response elicited stronger hemodynamic responses than the individual interventions. The hemodynamic responses to the combined interventions are consistent with increased atrial stretch and cardiac autonomic modulation through baroreceptor and cardiopulmonary reflex responses. Whether these mechanisms can convert paroxysmal atrial fibrillation to sinus rhythm remains to be determined.

Hemodynamic Responses to Combined Ice-cold Water Intake, Leg Raising, and the Diving Response in Young Healthy Subjects – A Potential Intervention to Convert Paroxysmal Atrial Fibrillation.

Abstract Title: Impact of the Renin-Angiotensin System on Left Ventricular Hypertrophy in Polycystic Ovary Syndrome

Background: Polycystic Ovary Syndrome (PCOS) is characterized by androgen excess and ovulatory dysfunction, affecting 5 to 26% of reproductive-aged women. Recent studies suggest that women with PCOS may be at an increased risk for diastolic dysfunction. However, it remains unclear whether the activation of the renin-angiotensin system (RAS) contributes to left ventricle (LV) hypertrophy in PCOS. Using a well-characterized hyperandrogenemic female (HAF) rat model, we aim to test the hypothesis that RAS activation plays a role in the development of left ventricular hypertrophy in HAF rats.

Methods: Twenty Sprague Dawley female rats were randomly assigned to receive either silastic tubes containing dihydrotestosterone (DHT; 8 mg/90 days) or empty silastic tubes (control) via subcutaneous implantation. The LV was weighed and corrected by tibia length (TL). For histopathological examination, Masson Trichome staining was used to assess the myocardial fibrosis. Digital polymerase chain reaction (dPCR) was performed to measure mRNA expression of angiotensinogen (AGT), angiotensin-converting enzyme (ACE), angiotensin-converting enzyme 2 (ACE2), angiotensin type-1 receptor (AT1R) and androgen receptor (AR). Protein expression of AGT, ACE, and AR was analyzed by Western blotting. Data were analyzed using Student’s t-test. A p-value of <0.05 was considered statistically significant. GraphPad Prism was used for analyses.

Results: The HAF rat model exhibited an increase in LV/TL weight compared to controls (19.5 vs. 15.5 mg/mm). Quantification of fibrosis in the LV revealed significantly higher levels in DHT rats than in controls (34.2 vs. 16.2 μm³). dPCR analysis showed upregulation of AGT, ACE, and AT1R mRNA expression in DHT rats, whereas ACE2 and AR mRNA expression was reduced. Consistently, Western blotting demonstrated increased AGT and ACE protein levels and decreased AR protein levels in DHT rats compared to controls.

Conclusion: Despite downregulation of androgen receptor expression, chronic hyperandrogenemia in the HAF rat model led to LV hypertrophy and increased myocardial fibrosis. These changes were associated with upregulation of key RAS components, including AGT, ACE, and AT1R. This suggests that hyperandrogenemia may indirectly activate the RAS, contributing to cardiac remodeling independently of direct AR signaling.

Impact of the Renin-Angiotensin System on Left Ventricular Hypertrophy in Polycystic Ovary Syndrome

Traumatic injuries are the leading cause of death for individuals under the age of 46, with 30% to 40% of these deaths resulting from blood loss. In order to minimize the delay between presentation to the hospital and administration of blood products, Artificial Intelligence (AI) techniques were used to predict the need of transfusions in trauma patients. The Trauma Quality Improvement Program (TQIP) was used in an 80-20 train-test split for several different Machine Learning (ML) models. XGBoost was the best performing model with an AUROC of 0.845. Shapley values were then calculated, showing the 5 most important features for the model were ISS, SBP, Highest Activation, and Pulse Rate. This work showed that XGBoost was able to effectively predict transfusion requirements while Shapley values provided interpretability and trustworthiness. Future work includes comparing with additional AI models such as neural networks, as well as deploying the model for use in a clinical environment.

Prediction of Transfusions Using Machine Learning

Background
Quantitative analysis of nerve histomorphology is essential for nerve regeneration research. Manual quantification of axon numbers, diameters, and myelin thickness is time-consuming and labor-intensive. . Semi-automated processes have improved this process, but newer computational technologies may offer further opportunities for enhanced efficiency. Recently developed open access deep learning software, AxonDeepSeg, does offer many advantages for certain imaging analysis but is less proficient at analyzing brightfield microscopy images. We believed that this software could be further optimized for this application.

Methods
A modified UNet++ architecture was used to develop “DeepAxon”, an fully automated segmentation tool for nerve toluidine blue image analysis. Images were pre-processed into patches, segmented using the UNet++ model, and restitched using a Hann window algorithm. Morphometric analysis was automatically performed on segmented images to extract key parameters. Improved “DeepAxon” efficiency and proficiency was validated in comparison to alternative analysis techniques

Results
DeepAxon demonstrated comparable accuracy to manual segmentation in measuring g-ratio and axon diameter but reduced analysis time by 99.9% compared to manual segmentation and 96.2% compared to AxonDeepSeg.

Conclusions
DeepAxon is a novel automated segmentation tool for nerve immunohistochemistry images. It significantly reduces analysis time and provides accurate morphometric measurements. By addressing limitations of existing methods, DeepAxon offers a valuable tool for researchers in the field of nerve regeneration. Future improvements, such as a user-friendly interface and enhanced model training, will further expand its utility

DeepAxon: Automatic Morphometric Analysis of Axon Brightfield Microscopy

Abstract Title: Lung Lesion CT Imaging Features Associated with Sufficient Tissue Sampling by Monarch Platform Bronchoscopy 

Background 

Monarch Platform is a robot-assisted bronchoscopy (RAB) used to biopsy pulmonary lesions suspicious of lung cancer. Multiple studies have evaluated the safety and diagnostic yield of RAB, but the criteria used to calculate the diagnostic yield have varied leading to inconsistent results. This study aims to assist by identifying CT imaging features of lung lesions, such as diameter, associated with sufficient tissue sampling to calculate diagnostic yield. 

Methods 

Data was retrospectively collected of patients who underwent a Monarch Platform bronchoscopy at Penn State Hershey Medical Center for the past two years. Patients with a previous chest CT scan in which a diameter of the lesion was reported by a radiologist were included as well as the Monarch planning CT examination. Pathology results of the biopsy collected via RAB were determined. Biopsies relying on analysis of lymph node biopsy or cytology brushing were excluded. Diagnostic yield was calculated as the proportion of biopsies with a diagnostic result using the Conservative Criteria introduced by Vachani et al. Malignant and specific-benign diagnoses were diagnostic while all other results were non-diagnostic. 

Results 

The total number of patients analyzed in this retrospective study was 142. The average age was 69 with 56% being female (n=80). The median diameter of all lesions biopsied was 22 mm. The calculated diagnostic yield was 57%, with 81 patients having a diagnostic biopsy and 61 patients having a non-diagnostic biopsy. 

The median size of diagnostic lesions was 29 mm while the median size of non-diagnostic lesions was 17 mm (p=0.001). The total number of lesions with a diameter ≥15 mm was 114, and the total number of lesions with a diameter ≥30 was 50. The diagnostic yield of lesions ≥15 mm was 61%, while the diagnostic yield of lesions ≥30 mm was 80% (p=0.02). 

Conclusion 

Monarch Platform RAB is a valuable tool in diagnosing lung lesions. This study found that as the diameter of the lung nodule increased, the diagnostic yield also significantly improved, with an increased diagnostic yield from 61% to 80% between 15 mm and 30 mm. The size of the lesion identified on CT scan and its associated likely diagnostic yield could prove helpful to radiologists in determining if RAB is recommended.

Lung Lesion CT Imaging Features Associated with Sufficient Tissue Sampling by Monarch Platform Bronchoscopy


Introduction:

Myonecrosis is a rare but serious complication of diabetes, particularly in patients with end-stage kidney disease (ESKD), characterized by ischemic necrosis of skeletal muscles. Its diagnosis is often delayed due to overlapping presentations with cellulitis or deep vein thrombosis. Treatment is traditionally limited to supportive measures such as rest and pain control, which remains the cornerstone. The role of corticosteroids remains controversial in this condition as its effectiveness and utility is not widely understood. This case highlights the unconventional use of corticosteroids in managing refractory diabetic myonecrosis, emphasizing their potential in mitigating inflammation and promoting recovery.

Case Report:

We present a 31-year-old woman with ESKD on hemodialysis and a history of type 1 diabetes, who presented with recurrent, debilitating pain and swelling in the right lower extremity. Despite a comprehensive workup, including MRI and a muscle biopsy confirming myonecrosis, the patient’s symptoms persisted despite conventional supportive care. Following a multidisciplinary discussion, corticosteroid therapy was initiated, resulting in dramatic symptom resolution within 48 hours. The patient experienced significant pain reduction, improved mobility, and decreased swelling, allowing for discharge on a tapering steroid regimen. Notably, a subsequent recurrence of myonecrosis in a different muscle group also responded favorably to corticosteroid treatment, further underscoring its therapeutic potential in managing patients with this condition.

Discussion/Conclusion:

This case underscores the importance of considering corticosteroids as an adjunctive therapy in refractory diabetic myonecrosis, particularly in patients who fail to respond to standard care. A detailed workup, a high degree of suspicion, distinct clinical findings, and imaging such as MRI along with muscle biopsy can accurately diagnose this condition. While corticosteroids are not routinely used due to potential risks, their dramatic effect in this patient highlights the need for further research to better understand their role and refine treatment strategies. By expanding the therapeutic approach to diabetic myonecrosis, this case provides valuable insights for improving outcomes in this rare and challenging condition. This case opens the door for exploring corticosteroids as adjunctive therapy in similar diabetic patients with ESKD and refractory myonecrosis.

Steroids for Diabetic Myonecrosis in ESRD: An Unconventional Treatment with Unexpected Success

Background
The pelvic exam is used in the evaluation of many gynecologic complaints. Providers across all specialties should be able to perform this exam with an emphasis on consent, patient comfort, and accuracy. The OB/GYN clerkship is an important time for medical students to develop the technique and interpersonal skills necessary to perform pelvic exams on patients assigned female at birth. Graduating students should be able to independently perform these examinations accurately and sensitively; however, students report limited exposure in the clinical setting.
Methods
This was a prospective, mixed-methods study of medical students and OB/GYN preceptors at a large academic center in NYC between June 2024 and March 2025. The authors developed surveys using a modified Delphi process and refined them through cognitive interviews. Students logged the number of pelvic exams they performed and completed a survey at the end of the 5-week clerkship. Preceptors were surveyed via email. Quantitative analysis included descriptive statistics and nonparametric tests. Qualitative data from open-ended survey responses were analyzed inductively to identify key themes.
Results
Among 93 student respondents (91.2% response rate), the average number of exams performed per student was 4.25 speculum and 2.17 bimanual exams. Students at the academic center performed significantly fewer exams than those at the community hospital. Over half of students (51.6%) did not perform any bimanual exams. Cisgender male students performed fewer speculum exams than cisgender female students. Students reported increased confidence and reduced anxiety with pelvic exams after the clerkship. Simulation and gynecologic teaching associate sessions were rated as helpful, but students emphasized the need for real clinical opportunities. Among 89 preceptor respondents (52.0% response rate), barriers to student participation included patient preference, exam complexity, time constraints, and institutional climate. Preceptors at the academic center cited time constraints and institutional climate as barriers more often than those at the community hospital.
Conclusion
Despite improved confidence by the end of the OB/GYN clerkship, many students perform few pelvic exams in the clinical setting. Preceptor behavior, institutional policies, and clinical environment significantly impact student opportunity. To ensure all students meet pelvic exam learning objectives, institutions should supplement clinical training with simulation, improve preceptor engagement, and clearly communicate policies around student participation and patient consent.

Educational Experience & Ethical Tensions in Pelvic Exam Training: A Mixed-Methods Study

Background
Minority populations remain underrepresented in clinical trials due to multifactorial barriers, including restrictive eligibility criteria, systemic inequities, and patient-related factors. Although, culturally tailored, video-based educational interventions may help address these barriers, they remain understudied in thoracic oncology.
Methods
We developed 3 brief (<5 min), culturally tailored educational videos on clinical trials in thoracic oncology for Black (in English) and Hispanic/Latino patients (in English and Spanish). Eligible patients were adults (≥18 years) diagnosed with stage I–IV lung cancer, ECOG performance status of 0–2, self-identified as Black or Hispanic/Latino, proficient in English or Spanish, and had access to an electronic device. Patients completed pre-, immediate post-, and 6-month post-video surveys assessing knowledge, attitudes, and willingness to participate in clinical trials. Feasibility metrics included recruitment and survey completion rates, as well as video acceptability based on self-reported satisfaction. An exploratory aim was to assess clinical trial enrollment rates within 1 year of viewing the videos.
Results
Between April and September 2024, 54 patients were approached; 30 (56%) enrolled, 4 were deemed ineligible, and 20 declined participation. All enrolled participants completed both the pre- and immediate post-video surveys. Over 90% reported high satisfaction with the videos. Total knowledge scores increased significantly (p < .001), with specific gains in understanding pre-clinical studies (p = .012), placebo use (p = .001), and clinical trial registration (p = .012). Over 90% agreed that clinical trials are essential for drug development and improving lung cancer outcomes. However, 50% still reported potential barriers, including concerns about informed consent, randomization, cost, and provider communication. Willingness to participate in clinical trials increased significantly after viewing the videos (p = .04). At 6-month follow-up, 22 (73.3%) completed the survey; 2 (6.66%) participants had died. As part of our exploratory aim, within 1 year of the intervention, 8 patients (27%) enrolled in a therapeutic clinical trial (5 Black/African American; 3 Hispanic/Latino).
Conclusion
Our culturally tailored, patient-centered educational videos were feasible, well-received, and may have contributed to increased enrollment of minority patients in clinical trials. Broader implementation of these videos may enhance generalizability of findings and support more inclusive, evidence-based care as well as addressing disparities linked to the social construct of race.
Disclosures
Preliminary data presented at 2025 ASCO Annual Meeting as a poster (Abstract #1590); updated data presented here.

Updated Results from a Culturally Tailored Education Initiative to Enhance Clinical Trial Awareness in Thoracic Oncology

Assessing Patient Motivation for Requesting Safer Sex Kits in the Emergency Department: A Pilot Survey Study

Background
Condoms are an important public health resource to prevent sexually transmitted infections (STIs) and unwanted pregnancies. However, many barriers exist to access. Condom distribution programs (CDPs) are structural-level solutions that increase accessibility and availability of condoms in various settings. CDPs have increased condom use behaviors in diverse populations, including adolescents, sex workers, adults, and populations with high STI rates.

CDPs have been studied in outpatient and community settings, but there is limited data on their use in emergency departments (EDs). With increasing national rates of STI-related ED visits and increasing use of EDs for primary care, evaluation of safer sex resources in the ED is necessary. This pilot condom distribution survey study serves to close this gap in the research.

Our primary aim is to assess which patients are requesting safer sex kits and the relationship between sexual health risk factors and utilization. The secondary aim is to evaluate the University of Maryland ED as a potential condom distribution site for the Baltimore community.

Methods
ED staff provided safer sex kits consisting of condoms, STI education, and local resources by patient request from informational flyers. Each kit included the QR code to a brief anonymous survey. This questionnaire collected characteristics of patients who requested or received a kit in the ED. Participation was not a requirement for receiving the kits. 

Results
Ongoing distribution of the kits began on April 15, 2025. 31 responses to the survey have been received as of October 5, 2025. 43% were aged 18-25, 43% aged 26-35, and 13% aged 36-45. 57% identified as male and 3% non-binary/gender nonconforming. The most common reason reported for the ED visit was for STI/HIV testing (43%), 40% reported another reason, and 17% declined to answer. 30% of respondents reported using condoms approximately half the time when engaging in vaginal or anal sex. Barriers to condom use included decreased pleasure (30%), partner’s preference (27%), fit (10%), and other (17%). No respondents reported HIV, but 17% reported an STI diagnosed within the last year. Two respondents (7%) reported ever having sex in exchange for a place to stay, money, food, or other items

Conclusion
Preliminary findings suggest that safer sex kits in the ED can target young, sexually active individuals of all genders regardless of prior STI history. Although limited by sample size, initial results provide data on who is likely to access safer sex kits through the ED and suggest utility in considering the ED as another community CDP. Further research would need to be conducted to study this feasibility and impact as well as the pediatric ED as a CDP.

Assessing Patient Motivation for Requesting Safer Sex Kits in the Emergency Department: A Pilot Survey Study

Out-of-hospital cardiac arrest (OHCA) is a leading cause of preventable death, yet fewer than 40% of victims receive bystander CPR, with underserved communities facing the greatest barriers to access. Beat to Breathe CPR, a student-led nonprofit, implemented a mobile, outreach-based CPR program across New Jersey to improve community preparedness through free, one-hour training sessions tailored to specific audiences. In a pilot study of 15 youth camp counselors, average CPR confidence increased by 124% (p<0.001) and knowledge by 82% (p<0.001), with all participants reporting greater readiness to act during emergencies. These findings suggest that community-delivered, low-barrier CPR training can significantly improve layperson competence and confidence while reducing structural barriers such as cost and transportation. This model demonstrates a scalable approach to increasing CPR accessibility and preparedness among populations historically underrepresented in traditional CPR education.

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Hemodynamic Responses to Combined Ice-cold Water Intake, Leg Raising, and the Diving Response in Young Healthy Subjects – A Potential Intervention to Convert Paroxysmal Atrial Fibrillation.

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