All Publications

  • Bridging the Language Gap: Readability and Quality of English-and Spanish-Language Online Uterine Artery Embolization Patient Education Resources JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY Bellala, V., Laguna, A. R., Harwell Iii, A., Mai, M., Zhang, H., Angenent-Mari, V., Buchanan, S., Persad-Paisley, E. M., Ahn, S. 2026; 37 (3): 107927

    Abstract

    To assess whether the readability and quality of Spanish- and English-language online uterine artery embolization (UAE) patient education resources significantly exceed the recommended sixth-grade reading level and examine potential disparities in readability and quality between the 2 languages to inform efforts to mitigate disparities in fibroid care utilization.The first 100 Google search results for Spanish and English search terms for UAE were collected, and website content was extracted. Content readability scores were calculated using 3 validated metrics for Spanish and 6 for English. Credibility was measured using Journal of the American Medical Association (JAMA) criteria. Website technical quality was assessed using WooRank, a website performance algorithm. Mann-Whitney U testing was used for comparisons of readability. Differences in content length, credibility, and technical quality were interpreted using descriptive statistics.Sixty-seven Spanish-language and 53 English-language websites were included in the analysis. The readability of Spanish-language sites ranged from 9th to 10th grade level on 2 scales and was categorized as "slightly difficult" by all readability scales by a Spanish-speaking researcher. The mean readability for English-language content ranged from the 11th grade to college level on all readability scales. Adherence to JAMA benchmark criteria was poor, with a mean score of 1.10 and 1.23 on a 4-point scale for Spanish and English websites, respectively. The mean WooRank scores for Spanish and English sites were 53.99 and 61.7, respectively, indicating moderate performance.Spanish- and English-language UAE online patient education information is limited in quality and written above the recommended sixth-grade level.

    View details for DOI 10.1016/j.jvir.2025.107927

    View details for Web of Science ID 001648863500001

    View details for PubMedID 41314462

  • Education Research: Evaluating Racial, Ethnic, and Gender Diversity Trends in Neurology Residency Programs Between 2007 and 2020. Neurology. Education Umegboh, G. N., Williams, S. A., Rouffiac, A. J., Register, E., Paracha, S. S., Daruvala, S., Gentilesco, B. J., Persad-Paisley, E. M., Ayub, N. 2025; 4 (4): e200264

    Abstract

    Background and Objectives: With increasing efforts to ensure a racially and ethnically diverse physician workforce, it is unclear whether the improved diversity changes in medical schools have been reflected among neurology residents. We aimed to examine the demographic changes of neurology residency applicants and matriculants relative to their medical school graduate counterparts.Methods: This was a population-based repeated cross-sectional study of Association of American Medical Colleges data on self-reported race, ethnicity, and gender of US medical school graduates, neurology residency applicants, and neurology residency matriculants from 2007 to 2020. The representation quotient (RQ) for each applicant and matriculant cohort was calculated from the ratio of the percentage of a racial, ethnic, and gender group in the population to that of those graduating medical school. Median RQs greater than 1 indicated that a cohort is overrepresented compared with their medical school graduate counterparts, whereas RQs less than 1 indicated underrepresentation. Mann-Whitney U tests were used to assess statistical changes in representation between applicants and matriculants within each racial and gender identity. Yearly changes in RQ were assessed using linear regressions for each race by gender.Results: Asian men (RQapp = 1.20 [interquartile range (IQR) 1.13-1.28]), Black men (RQapp = 1.23 [IQR 0.94-1.39]), and Hispanic men (RQapp = 1.16 [IQR 0.89-1.29]) were overrepresented as applicants. RQapp for Asian men remained stagnant while all other applicants trended toward increased representation. Hispanic men were the only group to have a significant increase in RQmat during the study period. Asian women (RQapp = 0.98 vs RQmat = 1.12; p = 0.006) and White women (RQapp = 0.40 vs RQmat = 0.79; p < 0.001) experienced increases in representation when transitioning to matriculants. Black men (RQapp = 1.23 vs RQmat = 0.64; p < 0.001) experienced the largest reduction in representation, when comparing applicants with matriculants, among all groups. Black women (RQapp = 0.58 vs RQmat = 0.59; p = 0.49) were underrepresented throughout application.Discussion: Racially minoritized women were underrepresented among neurology applicants, and most did not show significant increases in representation as matriculants. Black men experienced the largest magnitude reduction in RQ when transitioning from applicants to matriculants. There is a need for greater professional support for applicants from historically underrepresented backgrounds to ensure their equitable recruitment into neurology.

    View details for DOI 10.1212/NE9.0000000000200264

    View details for PubMedID 41169759

  • Examining racial, ethnic, and gender representation of applicants and matriculants to dermatology residency programs from 2005-2021 Uriarte, S., Kaczynski, M., Persad-Paisley, E., Robinson-Bostom, L. MOSBY-ELSEVIER. 2025: AB204

    View details for Web of Science ID 001574371500019

  • Examining racial, ethnic, and gender representation of applicants and matriculants to emergency medicine residency programs from 2005 to 2021 AEM EDUCATION AND TRAINING Uriarte, S. A., Persad-Paisley, E. M., Barber Doucet, H. 2025; 9 (2): e70028

    Abstract

    The emergency medicine (EM) patient population is racially and ethnically diverse, and the presence of racial and gender minority physicians may help overcome health disparities among these patients. The purpose of this study was to examine representation and its trends of racial, ethnic, and gender identities entering the EM workforce.Reports on race, ethnicity, and gender for medical school graduates, EM applicants, and residents were obtained for the years 2005-2021. Racial and ethnic groups included Asian, Black, Hispanic, and White; gender identities included men and women. The proportion of each identity in each cohort was divided by a denominator of their corresponding U.S. medical school graduate proportion, producing representation quotients among applicants and matriculants (RQapp, RQmat) that refer to the group's medical school graduate representation. Mann-Whitney U-tests were used on RQ averages to assess for differences in representation among applicants compared to matriculants. Linear regressions of yearly RQs were used to assess representation trends.Men who self-identified as Black (RQapp 1.50), Hispanic (RQapp 1.84), or White (RQapp 1.15) had the highest EM applicant representation trend relative to other groups while making up 3.5%, 5.4%, and 36.3% of all applicants, respectively. Asian women were the least represented group among applicants (RQapp 0.52), dropping from 10.7% of medical school graduates to 5.7% of EM residency applicants. Among EM matriculants, Hispanic men (RQmat 1.56) and White men (RQmat 1.43) were the only overrepresented groups. Linear regression indicated that nearly all groups had significant increases in applicant representation over time, except for Asian women and Black men. White men and White women were the only two groups to experience increases in matriculant representation compared to their applicant counterparts.Asian men, Asian women, and Black women remain underrepresented in EM residencies. Additional recruitment efforts to ensure their equitable representation are necessary in future application cycles.

    View details for DOI 10.1002/aet2.70028

    View details for Web of Science ID 001460528400001

    View details for PubMedID 40201550

    View details for PubMedCentralID PMC11975056

  • Dermabond for reduction mammoplasty revisited: Its effects on postoperative wound healing JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY Francalancia, S., Lou, M., McIntire, D., Sobti, N., Baranwal, N., Persad-Paisley, E., Menville, J., Barrow, B., Liu, P., Sullivan, R., Breuing, K. 2025; 104: 67-75

    Abstract

    Wound dressing following reduction mammoplasty can be conducted using surface 2-octyl cyanoacrylate (Dermabond; Ethicon, Inc., Somerville, N.J), but its effect on long-term wound healing in these patients is inconclusive. We present an updated review of Dermabond's safety and efficacy in reduction mammoplasty patients.An IRB-approved retrospective analysis was conducted on 532 patients (1048 breasts) who underwent reduction mammoplasty by a single surgeon between March 2015 and February 2023. Data on demographics, operative times, and postoperative complications were collected from patient records. Patient data were separated into Dermabond and non-Dermabond dressing groups. The Wilcoxon rank sum or student's t-tests for continuous variables and Pearson's chi-squared test for categorical variables were used to evaluate the differences between both groups. Univariate and multivariable logistic regression assessed the association of Dermabond application with complications.Among the 1048 total breasts, Dermabond was used in 525 (50.1%), while it was not used in 523 (49.9%). There were significantly increased rates of dehiscence (p < 0.001), hypertrophic scarring (p = 0.005), fat necrosis (p = 0.028), and major complications (p < 0.001) in the Dermabond cohort; however, no significant differences in rates of seroma, hematoma, infection, or nipple necrosis were observed. Dermabond was a significant predictor of higher rates of dehiscence (p < 0.001) and incidence of major complications (p < 0.001) with and without adjustment for demographic or intra- and postoperative characteristics.Using Dermabond as wound dressing after reduction mammoplasty was associated with higher rates of dehiscence, hypertrophic scarring, and major complications, suggesting a negative impact on postoperative outcomes.

    View details for DOI 10.1016/j.bjps.2025.02.030

    View details for Web of Science ID 001467991000001

    View details for PubMedID 40117707

  • Technique refinement for complex locoregional reconstruction after spine surgery: Optimization of closed suction drain use JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY Sobti, N., Spake, C. S. L., Hu, D., Persad-Paisley, E., Rao, V., King, V., Sastry, R., Oyelese, A., Gokaslan, Z., Kwan, D., Liu, P. Y., Woo, A. S. 2025; 103: 148-156

    Abstract

    Plastic surgeons have become increasingly involved in the locoregional closure of spinal wounds after instrumentation, which has proven to minimize postoperative complications, especially among high-risk patient populations. Therefore, optimization and standardization of surgical techniques, including drain placement, for complex spine closure remain paramount. This study aims to investigate drain usage after plastic surgery closure for spine wounds to identify risk factors for postoperative complications that may provide insight to further guide intraoperative decision making.An IRB-approved retrospective chart review was conducted to identify 174 consecutive patients who underwent spinal instrumentation with plastic surgery-assisted locoregional flap closure performed at a tertiary academic medical center between January 2016 and July 2021.Patients who underwent locoregional complex closure of spinal wounds with a single drain (n = 89) demonstrated a lower incidence of infection (4.5% versus 16.5%, p = 0.01) and wound dehiscence (1.1% versus 9.4%, p = 0.02) when compared with the multidrain cohort (n = 85) via univariate and binomial regression analysis. The depth of infection (superficial versus deep) did not vary between groups. Seroma rates were comparable (13.5% versus 15.3%, p = 0.76). Longer time interval to drain removal (>3 weeks) was found to increase the risk of infection.Our results suggest that the use of multiple drains after locoregional closure of spinal wounds may confer an increased risk of surgical site infection, without theorized protection from seroma formation. In addition, the duration of drain placement should be used to guide the timing of drain removal, instead of daily output.

    View details for DOI 10.1016/j.bjps.2025.01.073

    View details for Web of Science ID 001429349900001

    View details for PubMedID 39978170

  • Craniosynostosis: Quantifying Differences in Skull Architecture CLEFT PALATE CRANIOFACIAL JOURNAL Menville, J. E., Shinde, N., Collins, S., Jiao, Z., Persad-Paisley, E. M., Baranwal, N., Woo, A. S. 2026; 63 (1): 38-48

    Abstract

    ObjectiveCraniosynostosis, a condition marked by the premature fusion of one or more cranial sutures, exhibits diverse phenotypes. This study aims to advance the understanding of these phenotypes beyond the conventional 2-dimensional analysis by focusing on identifying indicators of increased intracranial pressure (ICP) such as bony thinning or irregularities in skull morphology.MethodsA retrospective review was conducted for all pediatric patients with midline craniosynostosis who presented to our tertiary academic center for evaluation. Control patients were carefully selected to match for age, sex, and weight. All computed tomography data were segmented in 3-dimensional Slicer and then delineated along with suture lines into occipital, parietal, and frontal segments. Main outcome measures included general skull shape (assessed via measures of flatness and surface area to volume ratio) and skull topography (analyzed via measures of bone thickness, surface variance, and surface standard deviation).Results and ConclusionsForty-one patients with midline craniosynostoses were identified (22 metopic and 19 sagittal). Patients with sagittal craniosynostosis had significantly angulated frontal and occipital bones, reflective of the frontal bossing and occipital bulleting commonly seen in this population, and significantly flatter parietal bones, reflective of limited growth along with the transverse axis. Interestingly, evaluation of bone topography revealed that patients with sagittal craniosynostosis had significantly higher parietal bone surface variance, reflective of gyral impressions secondary to increased ICP. In contrast, patients with metopic craniosynostosis had statistically flatter frontal bones-reflective of limited anterior brain growth caused by the fused metopic suture-with minimal impacts to parietal or occipital bones.

    View details for DOI 10.1177/10556656241297526

    View details for Web of Science ID 001399745800001

    View details for PubMedID 39828920

  • Representation Quotients to Examine Diversity in Ophthalmology Residency Applicants and Matriculants JAMA OPHTHALMOLOGY Paracha, S. S., Williams, S. A., Shamshad, A., Persad-Paisley, E. M., Migliori, M. E. 2025; 143 (2): 145-152

    Abstract

    A diverse ophthalmic workforce is key to equitable care, and identifying areas of underrepresentation is important in tackling vision care disparities.To evaluate the diversity of applicants and matriculants in ophthalmology residency programs relative to medical school graduates and analyze the intersection of race and gender within this pathway.This retrospective cross-sectional study conducted from 2022 to 2024 used representation quotients (RQs) using reports from the Association of University Professors of Ophthalmology and San Francisco Match, along with demographic data from the Association of American Medical Colleges from 2008 to 2021. RQs measure equity by dividing a racial, ethnic, or gender group's proportion in a specific population by its proportion in a larger reference population. Individuals who graduated from US medical schools from 2008 to 2021 or who applied to or matriculated into US ophthalmology residency programs from 2015 to 2021 and from 2008 to 2021, respectively, were eligible for inclusion.Applying to or matriculating into ophthalmology residency.The primary outcome was median RQs and trends among racial, ethnic, and gender groups for ophthalmology applicants (RQapp) and matriculants (RQmat), with RQ differences evaluated using Mann-Whitney U tests.Among total applicants (n = 5304) and matriculants (n = 6139), 36% and 42% of applicants and matriculants, respectively, were female (applicants: 28% Asian, 4% Black, 7% Hispanic, and 47% White; matriculants: 31% Asian, 3% Black, 5% Hispanic, and 57% White). Self-identified Black individuals had the lowest median (IQR) RQs (RQapp, 0.604 [0.437-0.771]; RQmat, 0.469 [0.341-0.597]). Regression analysis revealed increased representation for male applicants (slope, 0.036; 95% CI, 0.015-0.057; P = .007) and matriculants (slope, 0.009; 95% CI, 0.002-0.016; P = .02), but decreased representation for female applicants (slope, -0.031; 95% CI, -0.010 to -0.102; P = .01) and matriculants (slope, -0.009; 95% CI, -0.016 to -0.002; P = .02). Black (RQapp, 0.604 vs RQmat, 0.469; P = .047) and Hispanic (RQapp, 1.46 vs RQmat, 1.04; P = .03) groups experienced a decrease between applicant and matriculants.This cross-sectional retrospective study found persistent underrepresentation of Black and female individuals in ophthalmology residency programs, with increases in Black and Hispanic applicants failing to translate into higher matriculation rates. Barriers that female or Black medical students face when applying or matriculating into ophthalmology residency may contribute to their underrepresentation in the field.

    View details for DOI 10.1001/jamaophthalmol.2024.5863

    View details for Web of Science ID 001401749300001

    View details for PubMedID 39821053

    View details for PubMedCentralID PMC11843372

  • The Impact of Socioeconomic Status on Decision on Withdrawal of Life-sustaining Treatments in Aneurysmal Subarachnoid Hemorrhage NEUROCRITICAL CARE Haripottawekul, A., Stipanovich, A., Uriarte, S. A., Persad-Paisley, E. M., Furie, K. L., Reznik, M. E., Mahta, A. 2025; 42 (3): 1054-1063

    Abstract

    Socioeconomic status affects outcomes in cerebrovascular disease, although its role in the withdrawal of life-sustaining treatments (WLST) remains uncertain. We aim to examine the impact of socioeconomic factors on outcomes including WLST in aneurysmal subarachnoid hemorrhage (aSAH).We conducted a retrospective study of a cohort of consecutive patients with aSAH who were admitted to an academic center from 2016 to 2023. Publicly available data on median neighborhood income by zip code areas were obtained from the US census. Low economic-insurance status (EIS) was defined as using Medicaid or having no insurance or living in a zip code within the lowest two quintiles of household income. High EIS was defined as not using Medicaid and having any other insurance and living in a zip code within the highest two quintiles of household income. The rest of the cohort who was not categorized in the high or low EIS groups was defined as middle EIS. We used multivariable logistic regression analysis to assess the association between socioeconomic and demographic factors and outcomes including WLST, mortality, and 3-month modified Rankin Scale.We included 410 patients, with mean age 57.9 years (standard deviation 13.8), who were 65% female, 70% white, 36.8% low EIS, and 35.6% high EIS. Higher EIS was associated with WLST (odds ratio 1.53 per increase in EIS, 95% confidence interval 1.07-2.18; p = 0.02) when adjusted for other predictors. In addition, a higher quintile of neighborhood income, regardless of insurance status, was associated with higher odds of WLST (odds ratio 1.41 per each quintile increase, 95% confidence interval 1.07-1.86; p = 0.014). However, there was no association between EIS and 3-month modified Rankin Scale when adjusted for disease severity factors.Higher EIS and residing in areas with higher neighborhood incomes were associated with higher odds of WLST in aSAH. Further multicenter studies are needed to investigate the underlying mechanisms that contribute to these associations.

    View details for DOI 10.1007/s12028-024-02197-7

    View details for Web of Science ID 001390945000001

    View details for PubMedID 39776349

    View details for PubMedCentralID 11097759

  • Misconceptions in Plastic Surgery: Crowdsourcing Public Perceptions of Plastic Surgery Urban Myths. Eplasty Baranwal, N., Persad-Paisley, E. M., Shinde, N., Spake, C., Menville, J. E., Mehrzad, R., Sobti, N., Kalliainen, L. K. 2025; 25: e16

    Abstract

    Background: Understanding public misconceptions about plastic surgery can inform plastic surgeons of the knowledge gaps among their patients and non-plastic surgeon colleagues about the field. This deepened understanding may aid in optimizing patient satisfaction and health outcomes. The objective of this study was to investigate the extent to which laypeople agree with common plastic surgery urban myths.Methods: A Likert scale-based survey of 10 popular plastic surgery myths was distributed via Amazon Mechanical Turk. Descriptive analyses and multinomial logistical regressions were performed to assess associations between respondent demographics and the likelihood of agreeing with each myth.Results: A total of 2000 completed surveys were included in this study. Of the respondents, 41% believed that hand dominance is associated with a larger ipsilateral breast, 40% believed that underwire bras cause breast cancer, and 59% believed that typing causes carpal tunnel syndrome. Respondents who were male or younger than 35 years were more likely to believe in inaccurate myths. Health care workers had higher odds of agreeing with the claims that plastic surgery uses plastic (odd ratio [OR] = 2.49 [95% CI, 1.82-3.41]; P <.001) and that plastic surgery is almost always cosmetic (OR = 1.85 [95% CI, 1.32-2.61]; P < .001). Participants who underwent a plastic surgery procedure or consultation were generally more likely to agree with the listed myths.Conclusions: The general public and non-plastic-surgeon health care workers appear to have misconceptions about the scope and practice of plastic surgery. Open-ended patient-physician communication and patient-centered educational resources can potentially overcome plastic surgery misconceptions, thereby optimizing patient health outcomes and satisfaction.

    View details for PubMedID 40661096

  • Microbubble Contrast-Enhanced Transcutaneous Ultrasound Enables Real-Time Spinal Cord Perfusion Monitoring Following Posterior Cervical Decompression WORLD NEUROSURGERY Leary, O. P., Shaaya, E. A., Chernysh, A. A., Seidler, M., Sastry, R. A., Persad-Paisley, E., Zhu, M., Gokaslan, Z. L., Oyelese, A. A., Beland, M. D., Fridley, J. S. 2024; 189: E404-E410

    Abstract

    Ultrasound imaging is inexpensive, portable, and widely available. The development of a real-time transcutaneous spinal cord perfusion monitoring system would allow more precise targeting of mean arterial pressure goals following acute spinal cord injury (SCI). There has been no prior demonstration of successful real-time cord perfusion monitoring in humans.Four adult patients who had undergone posterior cervical decompression and instrumentation at a single center were enrolled into this prospective feasibility study. All participants had undergone cervical laminectomies spanning ≥2 contiguous levels ≥2 months prior to inclusion with no history of SCI. The first 2 underwent transcutaneous ultrasound without contrast and the second 2 underwent contrast-enhanced ultrasound (CEUS) with intravenously injected microbubble contrast.Using noncontrast ultrasound with or without Doppler (n = 2), the dura, spinal cord, and vertebral bodies were apparent however ultrasonography was insufficient to discern intramedullary perfusion or clear white-gray matter differentiation. With application of microbubble contrast (n = 2), it was possible to quantify differential spinal cord perfusion within and between cross-sectional regions of the cord. Further, it was possible to quantify spinal cord hemodynamic perfusion using CEUS by measuring peak signal intensity and the time to peak signal intensity after microbubble contrast injection. Time-intensity curves were generated and area under the curves were calculated as a marker of tissue perfusion.CEUS is a viable platform for monitoring real-time cord perfusion in patients who have undergone prior cervical laminectomies. Further development has the potential to change clinical management acute SCI by tailoring treatments to measured tissue perfusion parameters.

    View details for DOI 10.1016/j.wneu.2024.06.077

    View details for Web of Science ID 001322026900001

    View details for PubMedID 38901475

  • The Role of Vascularized Nerve Grafting in Upper Extremity Reconstruction: A Systematic Review. Journal of hand surgery global online Hosseini, H., Diatta, F., Parikh, N., Dony, A., Yu, C. T., Persad-Paisley, E., Lu, J. C., Hill, E. J. 2024; 6 (5): 766-778

    Abstract

    Purpose: Vascularized nerve grafts (VNGs) have been proposed as encouraging alternatives to conventional nerve grafting; however, there is ongoing debate regarding the clinical advantages of the approach compared with standard grafting. This review aims to gather and analyze reported cases of upper extremity nerve repair using VNGs documented in the published literature.Methods: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, PubMed/MEDLINE, Embase, and Cochrane were searched. Inclusion criteria for this review included the following: (1) human subjects or cadaveric studies, (2) describing a vascularized nerve grafting procedure or suggesting a nerve and vascular supply for a potential vascularized nerve graft, and (3) upper extremity nerve repair in clinical studies.Results: Data were extracted from 45 clinical studies. Of 535 patients, the most common injury pattern was root avulsion and rupture (88.7%). The most utilized VNG was the ulnar nerve (72.8%), followed by nerve to long head of triceps (8.8%) and sural nerve (8.2%); most common recipients were median (57.6%), axillary (12.5%), and musculocutaneous nerves (11.9%). Between patients who had medical research council scale scores, 69% had functional (M3 and above) motor and 72.7% sensory (S3<) recovery.Conclusions: Vascularized nerve grafts can increase the odds of functional gain in challenging conditions such as large nerve gaps, nerve avulsions, ruptures, and scarred and irradiated beds. With the exception of well-known VNG options, literature on alternative VNGs is largely confined to case reports and series, with additional published cases, outcomes, and basic science research needed to establish the role of VNGs in nerve repair.Clinical relevance: Our findings support the promise of VNGs for complex cases of nerve reconstruction. Evidence from published cases also indicates that VNGs enhance motor and sensory function recovery compared with traditional nerve grafting.

    View details for DOI 10.1016/j.jhsg.2024.01.028

    View details for PubMedID 39381392

  • Dehiscence and Fistula Formation Following Anterior Palatal Reconstruction With Vomer Flap JOURNAL OF CRANIOFACIAL SURGERY Menville, J. E., Spake, C., Soliman, L., Shinde, N., Persad-Paisley, E. M., Baranwal, N., Woo, A. S. 2024; 35 (4): 1101-1104

    Abstract

    Anterior palatal reconstruction using vomer flaps has been described during primary cleft lip repair. In this procedure, the mucoperiosteal tissue of the vomer is elevated to reconstruct the nasal mucosa overlying the cleft of the hard palate. Here the authors, evaluate the efficacy of a technique in which a superiorly based vomer flap is sutured to the lateral nasal mucosa. The authors assess vomer flap dehiscence rates and compare the likelihood of fistula development in this cohort to patients who underwent palatoplasty without vomer flap reconstruction.A retrospective chart review was conducted of all palatoplasties performed by the senior author at an academic institution during a 7-year period. Medical records were reviewed for demographic variables, operative characteristics, and postoperative complications up to 1 year following surgery. Logistic regression analysis was conducted to assess the effects of vomer flap reconstruction on fistula formation, adjusting for age and sex.Fifty-eight (N=58) patients met the inclusion criteria. Of these, 38 patients (control group) underwent cleft palate reconstruction without previous vomer flap placement. The remaining 20 patients underwent cleft lip repair with vomer flap reconstruction before palatoplasty (vomer flap group). When bilateral cases were counted independently, 25 total vomer flap reconstructions were performed. Seventeen of these 25 vomer flap reconstructions (68%) were completely dehisced by the time of cleft palate repair. In the vomer flap group, 3 of the 20 patients (15%) developed fistulas in the anterior hard palate following the subsequent palatoplasty procedure. In the control group, only 1 of the 38 patients (2.6%) developed a fistula in the anterior hard palate. There was no significant association between cohorts and the development of anterior hard palate fistulas [odds ratio=10.88, 95% confidence interval (0.99-297.77) P =0.07], although analysis was limited by low statistical power due to the small sample size.In our patient population, anterior palatal reconstruction using a superiorly based vomer flap technique was associated with complete dehiscence in 68% of cases. Fistula formation in the anterior hard palate was also proportionately higher following initial vomer flap reconstruction (15% versus 2.6%). These results prompted the senior author to adjust his surgical technique to 1 in which the vomer flap overlaps the oral mucosa. While follow-up from these adjusted vomer flap reconstruction cases remains ongoing, early evidence suggests a reduced requirement for surgical revision following implementation of the modified technique.

    View details for DOI 10.1097/SCS.0000000000010267

    View details for Web of Science ID 001237601800071

    View details for PubMedID 38727218

  • Comparison of the Effects of Blood Pressure Parameters on Rebleeding and Outcomes in Unsecured Aneurysmal Subarachnoid Hemorrhage WORLD NEUROSURGERY Haripottawekul, A., Persad-Paisley, E. M., Paracha, S., Haque, D., Shamshad, A., Furie, K. L., Reznik, M. E., Mahta, A. 2024; 185: E582-E590

    Abstract

    Elevated systolic blood pressure (SBP) has been linked to preprocedural rebleeding risk and poor outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH). This study seeks to compare the effects of SBP and mean arterial pressure (MAP) on rebleeding and functional outcomes in aSAH patients.We performed a retrospective study of a prospectively collected cohort of consecutive patients with aSAH admitted to an academic center in 2016-2023. Binary regression analysis was used to determine the association between BP parameters and outcomes including rebleeding and poor outcome defined as modified Rankin Scale 4-6 at 3 months postdischarge.The cohort included 324 patients (mean age 57 years [standard deviation 13.4], 61% female). Symptomatic rebleeding occurred in 34 patients (11%). Higher BP measurements were recorded in patients with rebleeding and poor outcome, however, only MAP met statistical significance for rebleeding (odds ratio {OR} 1.02 for 1 mmHg increase in MAP, 95% confidence interval {CI}: 1.001-1.03, P = 0.043; OR 1 per 1 mmHg increase in SBP, 95% CI 0.99-1.01; P = 0.06)) and for poor outcome (OR 1.01 for 1 mmHg increase in MAP, 95% CI: 1.002-1.025, P = 0.025; OR 1 for 1 mmHg increase in SBP, 95% CI: 0.99-1.02, P = 0.23) independent of other predictors.MAP may appear to be slightly better correlated with rebleeding and poor outcomes in unsecured aSAH compared to SBP. Larger prospective studies are needed to identify and mitigate risk factors for rebleeding and poor outcome in aSAH patients.

    View details for DOI 10.1016/j.wneu.2024.02.078

    View details for Web of Science ID 001265674800001

    View details for PubMedID 38382760

  • Common Peroneal Nerve and Tarsal Tunnel Release Surgery in an Adolescent Male with Hunter Syndrome: Illustrative Case. Rhode Island medical journal (2013) Persad-Paisley, E. M., Shao, B., Rao, V., Kalliainen, L. K. 2024; 107 (5): 14-17

    Abstract

    BACKGROUND: Children with Hunter syndrome have a high prevalence of nerve compression syndromes given the buildup of glycosaminoglycans in the tendon sheaths and soft tissue structures. These are often comorbid with orthopedic conditions given joint and tendon contractures due to the same pathology. While carpal tunnel syndrome and surgical treatment has been well-reported in this population, the literature on lower extremity nerve compression syndromes and their treatment in Hunter syndrome is sparse.OBSERVATIONS: We report the case of a 13-year-old male with a history of Hunter syndrome who presented with toe-walking and tenderness over the peroneal and tarsal tunnel areas. He underwent bilateral common peroneal nerve and tarsal tunnel releases, with findings of severe nerve compression and hypertrophied soft tissue structures demonstrating fibromuscular scarring on pathology. Post-operatively, the patient's family reported subjective improvement in lower extremity mobility and plantar flexion.LESSONS: In this case, peroneal and tarsal nerve compression were diagnosed clinically and treated effectively with surgical release and postoperative ankle casting. Given the wide differential of common comorbid orthopedic conditions in Hunter syndrome and the lack of validated electrodiagnostic normative values in this population, the history and physical examination and consideration of nerve compression syndromes are tantamount for successful workup and treatment of gait abnormalities in the child with Hunter syndrome.

    View details for PubMedID 38687262

  • Single Surgeon Comparison of Midline Versus Overlapping Locoregional Flap Closure Following Spinal Instrumentation WORLD NEUROSURGERY Francalancia, S., Spake, C. S. L., Soliman, L., Sobti, N., Persad-Paisley, E., Hu, D., Crozier, J., Woo, A. S. 2024; 184: 821-829

    Abstract

    Two techniques for paraspinous muscle flap closure of spine surgeries have been described: one with tension-free mobilization of the muscle flaps approximated at the midline and one with perforators more aggressively dissected to allow for overlapping of the flaps. We seek to compare the surgical outcomes in patients who underwent either type of complex spinal closure as no investigation has yet evaluated a superior technique.An institutional review board (IRB)-approved retrospective analysis was conducted on all patients who underwent spine surgery followed by locoregional muscle flap complex closure performed by a single plastic surgeon between January 2016 and July 2021. Patients were divided into 2 groups based on which closure method was employed. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed by multivariable logistic regression with Firth's correction.One hundred and 10 patients with similar baseline demographics were included. There were significantly more smokers (15% vs. 0%, P = 0.02) and a significantly greater rate of postoperative radiation (40% vs. 17%, P = 0.009) in the overlapping group. After controlling for smoking and postoperative radiation, the incidence of surgical site infection, skin necrosis, dehiscence, hematoma, and seroma did not differ between the groups. The procedure length per centimeter of closure was shorter in the midline approximation group, although this data fell just short of significance (3.2 vs. 3.8 minutes/cm, P = 0.08).The present study demonstrates that both the overlapping and midline approximation of muscle flaps are equally safe and effective strategies for locoregional closure of spinal wounds.

    View details for DOI 10.1016/j.wneu.2024.02.070

    View details for Web of Science ID 001218240100001

    View details for PubMedID 38373687

  • Understanding diabetic cheiroarthropathy: a focus on clinical presentation JOURNAL OF SURGICAL CASE REPORTS Persad-Paisley, E. M., Lee, C., Bhatt, R. A. 2024; 2024 (3): rjae123

    Abstract

    Diabetic cheiroarthropathy (DCA) is a relatively uncommon and underdiagnosed complication of poorly controlled diabetes. It is caused by non-enzymatic glycation of collagen that ultimately leads to microvascular damage and polyarticular stiffness. If diagnosed early, optimal management of serum glucose levels may lessen joint stiffness and prevent microvascular and macrovascular complications associated with diabetes mellitus. We review the case of a 55-year-old male with type 2 diabetes mellitus who was diagnosed with DCA after complaints of chronic joint stiffness and immobility.

    View details for DOI 10.1093/jscr/rjae123

    View details for Web of Science ID 001181564100005

    View details for PubMedID 38463740

    View details for PubMedCentralID PMC10924721

  • A Brief Clinical Study: Consecutive Occurences of Frontal Sinus Pneumocele JOURNAL OF CRANIOFACIAL SURGERY Menville, J. E., Persad-Paisley, E. M., Woo, A. S. 2024; 35 (2): e191-e193

    Abstract

    Sinus pneumocele is a rare condition marked by pathologic expansion of a paranasal sinus with concomitant bone loss. Here, we describe the case of a 24-year-old male who first presented with a 2×3 cm bony projection of his right medial forehead. Exam and history were notably absent for any skin tethering, prior trauma, inflammation, or neurological symptoms. A computed tomography scan confirmed the prominence was secondary to an enlarged right frontal sinus. The pneumocele was successfully corrected through surgery, but the patient notably developed a similar presentation on the left frontal sinus nearly 1 year later. Clinical findings support a hypothesis of air trapping through mucosal thickening. This second pneumocele was managed similarly.

    View details for DOI 10.1097/SCS.0000000000009953

    View details for Web of Science ID 001177433400040

    View details for PubMedID 38231193

  • Is the <i>h</i>-Index Enough? A Comprehensive Bibliometric Analysis of 871 Academic Plastic Surgeons and Their Departments/Divisions ANNALS OF PLASTIC SURGERY Persad-Paisley, E. M., Gopal, J. R., Menville, J. E., Baranwal, N., Mcintire, D. R. T., Zeyl, V. G., Kalliainen, L. K. 2024; 92 (2): 245-252

    Abstract

    In plastic surgery academia, research output is heavily used as a metric of accreditation, from assessing residency applicants to evaluating faculty for promotion. The h index, defined as an author's h papers with at least h citations, is commonly used as a measure of academic success. However, the index itself disfavors junior researchers, favors publication quantity, and discounts highly cited works. Given the importance of bibliometrics within plastic surgery, there is a paramount need to adopt additional metrics to measure research productivity. The authors sought to validate the use of time-independent bibliometrics to complement the h index in measuring citation impact.The genders and academic titles of plastic surgeons affiliated with US plastic surgery programs were recorded. Author publications were retrieved from Scopus. Bibliometrics software was used to calculate the following metrics per surgeon: h index, e index, and g index. Time-adjusted versions of these indices were used to correct for the number of years since first publication. Medians and interquartile ranges (IQRs) are reported. Departmental ranks were determined using the cumulative sum of time-corrected indices and compared with Doximity departmental research rankings. P < 0.05 was deemed significant.Indices were calculated for 871 academic plastic surgeons in 85 departments/divisions. Men had statistically greater h index (median, 13.0 [IQR, 7.0-21.0] vs 6.0 [IQR, 3.0-13]; P < 0.001), e index (18.3 [IQR, 10.0-28.7] vs 11.1 [IQR, 5.5-18.4]; P < 0.001), and g index (23.0 [IQR, 11.0-39.0] vs 11.0 [IQR, 5.0-22.0]; P < 0.001) than women. Professors had the highest median time-uncorrected indices. After adjusting for the number of years since an author's first publication, there were no significant differences in m quotient (men: 0.66 [IQR, 0.40-0.98] vs women: 0.57 [IQR, 0.33-0.90]; P = 0.05) and ec index (men: 0.93 [IQR, 0.62-1.3] vs women: 0.87 [IQR, 0.50-1.3]; P = 0.08) between genders. Departmental chairs had significantly higher indices than other faculty after correcting for time. The calculated program rankings were low to moderately correlated with that of Doximity (correlation coefficient τ = 0.49 [95% confidence interval, 0.37-0.59; P < 0.001]).Men and women have statistically similar citation patterns after correcting for the time. Citation differences between academic levels are less pronounced when controlling for time, suggesting comparable research quality between academic roles.

    View details for DOI 10.1097/SAP.0000000000003775

    View details for Web of Science ID 001139937700002

    View details for PubMedID 38198630

  • Regenerative Peripheral Nerve Interfaces for the Management of Symptomatic Non-extremity Neuropathic Pain and Neuromas. Eplasty Baranwal, N., Menville, J. E., Persad-Paisley, E. M., Sobti, N., Kalliainen, L. K. 2024; 24: e59

    Abstract

    Introduction: Regenerative peripheral nerve interfaces (RPNI) can be used to mitigate neuropathic pain resulting from nerve injury or neuroma formation following trauma, surgery, or amputation. Most of the current literature discusses the utility of RPNI for the treatment of neuropathic pain in the upper and lower extremities; however, RPNI can also improve neuropathic pain in non-extremity regions. Our objective was to characterize and describe patient cases of non-extremity RPNIs.Methods: We retrospectively reviewed medical records of patients treated with RPNIs for non-extremity neuropathic pain by the senior author at a single institution between February 2020 and October 2023.Cases: Seven patients were treated with RPNI in non-extremity regions. For 1 patient, RPNI was performed prophylactically following discovery of injured peripheral nerves during a surgery and the patient did not report any neuropathic pain in the related regions afterwards. Six patients presented with nerve pain in multiple regions, including the scalp, face, trunk, and groin, that began either after a trauma or previous surgery. The nerve pain of 5 patients completely resolved after the creation of an RPNI.Discussion: The creation of an RPNI is relatively straightforward and can relieve or prevent peripheral nerve pain caused by injured nerves. While RPNIs have mainly been used for the treatment or prevention of neuromas in extremities, this case series demonstrates efficacy in non-extremity areas as well. Surgeons can, therefore, consider RPNI for patients who have neuropathic pain due to suspected nerve injury that has been refractory to other treatments.

    View details for PubMedID 39473998

  • Examining Racial and Gender Diversity in the Plastic Surgery Pipeline: Where is the Leak? PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN Persad-Paisley, E. M., Uriarte, S. A., Kuruvilla, A. S., Menville, J. E., Baranwal, N., Francalancia, S. C., Lou, M. Y., Zeyl, V. G., Rivera Perla, K. M., Rao, V., Kalliainen, L. K. 2024; 12 (1): e5552

    Abstract

    There is limited information about minority representation throughout the plastic and reconstructive surgery (PRS) pipeline. The aim of this study was to examine trends in representation among minorities at different stages of the PRS training pathway, starting with potential candidates in high school through practicing physicians.The PRS pipeline was defined as high school; college; medical school applicants, matriculants, and graduates; PRS residency applicants, matriculants, and active residents; and PRS practicing physicians. Racial data for each stage were obtained from the US Census and Association of American Medical Colleges. The proportion of races at each stage were divided by their US population counterpart proportions to produce representation quotients (RQs). Medians and interquartile ranges (IQRs) are reported. Mann-Whitney U tests compared RQ values within identities between successive stages.Black students had high representation in high school (RQ = 1.26 [IQR: 1.21-1.29]) but had significant, stepwise decreases in representation in subsequent stages. A similar trend was observed for Hispanic individuals, who had their highest representation in high school (1.43 [1.37-1.50]), followed by significant decreases in RQ at nearly every subsequent stage up to and including practicing physicians (0.30 [0.28-0.31). Asian individuals were overrepresented at every stage (high school RQ: 1.01 [1.00-1.03]; practicing physician RQ: 2.30 [2.27-2.32]). White individuals were underrepresented before residency but had an RQ that approximated 1 in subsequent stages.Racial minorities experienced decreases in representation at each successive stage in the PRS pipeline following high school. Ongoing diversity efforts should focus on premedical recruitment and professional support for minority students.

    View details for DOI 10.1097/GOX.0000000000005552

    View details for Web of Science ID 001148490500003

    View details for PubMedID 38274104

    View details for PubMedCentralID PMC10810573

  • A decade of diversity: using statistical indices to compare neurosurgery to other surgical specialties NEUROSURGICAL FOCUS Persad-Paisley, E. M., Uriarte, S. A., Wang, Z., Leary, O. P., Gopal, J. R., Balmaceno-Criss, M., Telfeian, A. E., Cielo, D. J. 2023; 55 (5): E2

    Abstract

    Studies have demonstrated the benefits of diversity in neurosurgery. However, recruitment of minoritized groups within the neurosurgical workforce consistently lags other surgical specialties. While racial and gender demographics of neurosurgical residents are well documented, there has been minimal exploration into the multidimensional nature of diversity. The current study will evaluate the longitudinal diversity changes in neurosurgery residency programs compared with other surgical fields with validated diversity indices.Nationwide reports including data about resident physicians were obtained from the American Medical Association and the Association of American Medical Colleges for the academic years 2008-2021. Self-reported race, biological sex, and medical school affiliation were recorded for surgical residents in the 10 commonly recognized surgical fields. The Gini-Simpson Diversity Index was used to calculate the effective counts (ECs) of races, sexes, and medical school types for each field. A Composite Diversity Index (CDI) comprising the aforementioned diversity traits was used to calculate the percentage of characteristics upon which two randomly selected residents within each specialty would differ. CDIs were calculated for each field in every year from 2008 to 2021. Median CDIs were compared between fields using Kruskal-Wallis testing, and p values < 0.05 were deemed statistically significant.Plastic surgery had the highest median sex EC (1.92, interquartile range [IQR] 1.78-1.95), indicating greater diversity, while neurosurgery had the third lowest sex EC (1.40, IQR 1.35-1.41). All surgical fields examined had fewer than 3 races effectively represented among their residents, despite there being 8 races present. Neurosurgery ranked among the top fields in effective racial diversity (EC 2.17, IQR 2.09-2.21) and medical school type diversity (EC 1.25, IQR 1.21-1.26). There were statistically significant differences in the sex, race, and school ECs between surgical specialties. While neurosurgery had a relatively low median overall diversity (CDI = 32.7, IQR 32.0-34.6), there was a consistent longitudinal increase in CDI from 2015 to 2021.Neurosurgery resident physicians have become increasingly diverse in the past decade but are more homogenous than residents in other surgical fields. The continued use of diversity indices to more accurately track diversity progress over time may better inform leaders in the field of how they may best focus their equity and inclusion efforts.

    View details for DOI 10.3171/2023.8.FOCUS23438

    View details for Web of Science ID 001143701700001

    View details for PubMedID 37913544

  • Continued underrepresentation of historically excluded groups in the neurosurgery pipeline: an analysis of racial and ethnic trends across stages of medical training from 2012 to 2020 JOURNAL OF NEUROSURGERY Persad-Paisley, E. M., Andrea, S. B., Leary, O. P., Carvalho, O. D., Zeyl, V. G., Laguna, A. R., Anderson, M. N., Shao, B., Toms, S. A., Oyelese, A. A., Gokaslan, Z. L., Sharkey, K. M. 2023; 138 (6): 1748-1757

    Abstract

    US allopathic medical schools have experienced improvements in racial and ethnic diversity among matriculants in the past decade. It is not clear, however, whether better representation of historically excluded racial and ethnic groups at medical school entry impacts subsequent stages of the medical training pipeline leading into a specific field. The aim of this study was to examine these trends as they relate to the neurosurgical medical education pipeline and consider the drivers that sustain barriers for underrepresented groups.Race and ethnicity reports from the American Association of Medical Colleges were obtained on allopathic medical school applicants, acceptees, and graduates and applicants to US neurosurgical residency programs from 2012 to 2020. The representation of groups categorized by self-reported race and ethnicity was compared with their US population counterparts to determine the representation quotient (RQ) for each group. Annual racial composition differences and changes in representation over time at each stage of medical training were evaluated by estimating incidence rate ratios (IRRs) and 95% confidence intervals (CIs) using non-Hispanic Whites as the reference group.On average, Asian and White individuals most frequently applied and were accepted to medical school, had the highest graduation rates, and applied to neurosurgery residency programs more often than other racial groups. The medical school application and acceptance rates for Black individuals increased from 2012 to 2020 relative to Whites by 30% (95% CI 1.23-1.36) and 42% (95% CI 1.31-1.53), respectively. During this same period, however, inequities in neurosurgical residency applications grew across all non-Asian racialized groups relative to Whites. While the incidence of active Black neurosurgery residents increased from 2012 to 2020 (0.6 to 0.7/100,000 Black US inhabitants), the prevalence of White neurosurgery residents grew in the active neurosurgery resident population by 16% more.The increased racial diversity of medical school students in recent years is not yet reflected in racial representation among neurosurgery applicants. Disproportionately fewer Black relative to White US medical students apply to neurosurgery residency, which contributes to declining racial representation among all active neurosurgery resident physicians. Hispanic individuals are becoming increasingly represented in neurosurgery residency but continue to remain underrepresented relative to the US population. Ongoing efforts to recruit medical students into neurosurgery who more accurately reflect the diversity of the general US population are necessary to ensure equitable patient care.

    View details for DOI 10.3171/2022.8.JNS221143

    View details for Web of Science ID 001018876000029

    View details for PubMedID 36272123

  • Translatability barriers between preclinical and clinical trials of AAV gene therapy in inherited retinal diseases VISION RESEARCH Shamshad, A., Kang, C., Jenny, L. A., Persad-Paisley, E. M., Tsang, S. H. 2023; 210: 108258

    Abstract

    Inherited retinal diseases (IRDs) are progressive degenerative diseases which cause gradual vision loss or complete blindness. As over 270 gene mutations have been identified in the underlying pathology of IRDs, gene therapy as a treatment modality has been an increasingly active realm of investigation. Currently, the most common vehicle of ocular gene delivery is the adeno-associated virus (AAV) vector. This is injected into the immune-privileged subretinal space to mediate transgene expression in retinal cells. Although numerous animal models of IRDs have demonstrated successful outcomes following AAV-mediated gene delivery, many of these studies fail to translate into successful outcomes in clinical trials. The purpose of this review is to A) comparatively assess preclinical and clinical IRD trials in which the success of AAV-mediated therapy failed to translate between animal and human participants B) discuss factors which may complicate the translatability of gene therapy in animals to results in humans.

    View details for DOI 10.1016/j.visres.2023.108258

    View details for Web of Science ID 001053553600001

    View details for PubMedID 37244011

    View details for PubMedCentralID PMC10526971

  • Using a Multidimensional Statistical Approach to Evaluate Diversity Trends Among US Neurology Residents Between 2008-2020 Persad-Paisley, E., Paracha, S., Moges, S., Daruvala, S., Mahta, A., Ayub, N. LIPPINCOTT WILLIAMS & WILKINS. 2023

    View details for DOI 10.1212/WNL.0000000000202819

    View details for Web of Science ID 001053672107007

  • Association of Blood Pressure Parameters in Unsecured Aneurysmal Subarachnoid Hemorrhage and Outcomes Haripottawekul, A., Paracha, S., Haque, D., Persad-Paisley, E., Shamshad, A., Meyer, A., Reznik, M., Furie, K., Yaghi, S., Mahta, A. LIPPINCOTT WILLIAMS & WILKINS. 2023

    View details for DOI 10.1212/WNL.0000000000202702

    View details for Web of Science ID 001053672102178

  • Applying Representation Quotient Methodology to Racial/Ethnic and Gender Trends of Applicants and Matriculants to Neurology Residency Programs from 2007-2021 Persad-Paisley, E., Paracha, S., Daruvala, S., Mahta, A., Ayub, N. LIPPINCOTT WILLIAMS & WILKINS. 2023

    View details for DOI 10.1212/WNL.0000000000202822

    View details for Web of Science ID 001053672105024

  • Applying Representation Quotient Methodology to Racial, Ethnic, and Gender Trends of Applicants and Matriculants to Urology Residency Programs From 2010-2018 Reply UROLOGY Persad-Paisley, E. M., Kazal, F. H., Shamshad, A., Zeyl, V. G., Douglas, C. M., Wasserman, M. C., Thavaseelan, S. 2023; 172: 32

    View details for DOI 10.1016/j.urology.2022.09.035

    View details for Web of Science ID 001058524300001

    View details for PubMedID 36773994

  • Applying Representation Quotient Methodology to Racial, Ethnic, and Gender Trends of Applicants and Matriculants to Urology Residency Programs From 2010-2018 UROLOGY Persad-Paisley, E. M., Kazal, F. H., Shamshad, A., Zeyl, V. G., Douglas, C. M., Wasserman, M. C., Thavaseelan, S. 2023; 172: 25-32

    Abstract

    To accurately examine the trends in the racial and gender composition of medical students applying and matriculating to urology residency programs.Reports on race/ethnicity and gender for medical school graduates, and urology residency applicants and matriculants were obtained for years 2010-2018. The proportions of individuals representing different racial and gender identities among urology applicants and matriculants were divided by a denominator of their proportion in medical school graduating classes to produce representation quotients (RQapp and RQmat, respectively). Linear regression models were performed on yearly RQs to estimate the RQ changes over time. Nonparametric testing was used to evaluate for differences in applicant to matriculant representation within each identity. ANOVA was performed separately on RQapp and RQmat values to assess differences in representation between identities in the applicant and matriculant populations.Asian men experienced increases in representation among urology applicants (RQapp: slope 2.04 × 10-2; P = .03) and matriculants (RQmat slope: 7.46 × 10-2; P = .0076) during the study period. Black men trended towards under-representation among applicants (RQapp slope -1.51 × 10-1; P = .03) and matriculants (RQmat slope: -1.71 × 10-1; P = .02). When examining genders, both men (RQapp=1.43 vs RQmat=1.44; P = .80) and women (RQapp=0.52 vs RQmat = 0.51; P = .67) had unchanged representation in the applicant and matriculant cohorts, but women severely underrepresented on average.Women and Black men are underrepresented in the urology workforce. These concerning findings demonstrate the dire need for initiatives regarding recruitment into urology to support and to ensure successful entry into the field for minority groups.

    View details for DOI 10.1016/j.urology.2022.09.032

    View details for Web of Science ID 001053462900001

    View details for PubMedID 36402268

  • Achieving diversity and equity through inclusion CELL Persad-Paisley, E. 2023; 186 (4): 676-678

    Abstract

    Elijah Malik Persad-Paisley is the winner of the third annual Rising Black Scientists Award for a graduate/postdoctoral scholar in the life and health sciences. For this award, we asked emerging Black scientists to tell us about their scientific vision and goals, experiences that sparked their interest in science, how they want to contribute to a more inclusive scientific community, and how these all fit together on their journey. This is his story.

    View details for DOI 10.1016/j.cell.2023.01.027

    View details for Web of Science ID 000944006600001

    View details for PubMedID 36803597

  • Association of asymptomatic cerebral vasospasm with outcomes in survivors of aneurysmal subarachnoid hemorrhage JOURNAL OF STROKE & CEREBROVASCULAR DISEASES Shamshad, A., Persad-Paisley, E. M., Wendell, L. C., Thompson, B. B., Reznik, M. E., Furie, K. L., Mahta, A. 2022; 31 (12): 106821

    Abstract

    Cerebral vasospasm (cVSP) is a common complication in aneurysmal subarachnoid hemorrhage (aSAH) and is associated with worse outcomes. However, clinical significance of asymptomatic cVSP is poorly understood. We sought to determine the association of asymptomatic cVSP with functional outcome and hospital length of stay (LOS).We performed a retrospective study of a prospectively collected cohort of patients with aSAH who survived hospitalization at an academic center between 2016 and 2021. We defined cVSP based on transcranial Doppler criteria. Multivariate logistic and multiple linear regression analyses were used to determine the association of asymptomatic cVSP with poor functional outcome (defined as modified Rankin scale 3-6 at 3 months after discharge) and hospital length of stay (LOS).The cohort consisted of 201 aSAH patients with a mean age 54.9 years (SD 13.6) and 60% were female. One hundred nine patients (54%) experienced cVSP, of whom 43 patients (39%) were asymptomatic. Patients with asymptomatic cVSP were younger (mean 50.5 years [SD 10.6] vs 61 years [SD12.5]; p < 0.001) and had longer ICU LOS (median 13 days [IQR12-20] vs median 12 days [IQR9-15], p = 0.018) compared to those without cVSP. However, after adjusting with other variables asymptomatic cVSP was not associated with longer ICU or hospital LOS. Asymptomatic cVSP was not associated with poor outcome either (p = 0.14).Asymptomatic cVSP, which was more common in younger patients, was neither associated with poor functional outcome nor hospital LOS.  Larger prospective studies are needed to assess the significance of asymptomatic cVSP on long-term outcomes.

    View details for DOI 10.1016/j.jstrokecerebrovasdis.2022.106821

    View details for Web of Science ID 000878291000008

    View details for PubMedID 36240674

  • Association of pre-admission antihypertensive agents and outcomes in aneurysmal subarachnoid hemorrhage JOURNAL OF CLINICAL NEUROSCIENCE Persad-Paisley, E. M., Shamshad, A., Stretz, C., Potter, N. S., Wendell, L. C., Thompson, B. B., Furie, K. L., Reznik, M. E., Mahta, A. 2022; 103: 119-123

    Abstract

    Delayed cerebral ischemia (DCI) and poor functional outcome are common complications in patients who suffer from aneurysmal subarachnoid hemorrhage (aSAH). It has been proposed that pre-admission beta-blocker therapy may lower cerebral vasospasm (cVSP) risk after aSAH; however, this association with other antihypertensives is unknown. We sought to determine the association between antihypertensives and clinical outcomes in aSAH patients.We performed a retrospective study on a prospectively collected cohort of consecutive patients with aSAH who were admitted to an academic center from 2016 to 2021. Association between pre-admission use of antihypertensives and patient outcomes was determined. Primary outcomes included DCI and poor functional outcome at 3 months after discharge defined as modified Rankin scale [mRS] 4-6. The secondary outcome was cVSP identified using transcranial Doppler (TCD).The cohort consisted of 306 aSAH patients with mean age 57.1 (SD 13.6) years with 187 females (61 %). Although pre-admission use of beta-blockers (OR 0.40, 95 % CI 0.21-80, p = 0.02), calcium channel blockers (OR 0.43, 95 % CI 0.19-0.93, p = 0.035), and thiazide (OR 0.31, 95 % CI 0.11-0.86, p = 0.025) were associated with lower risk of cVSP in univariate analysis, we did not find any association in a multivariate model after adjusting for age. There was no association between any class of antihypertensives and DCI or functional outcome.Pre-admission use of antihypertensive agents may affect TCD findings, however, none of them appear to be independently associated with DCI or functional outcome. Larger prospective studies are needed to establish any potential association.

    View details for DOI 10.1016/j.jocn.2022.07.013

    View details for Web of Science ID 000888204600008

    View details for PubMedID 35868228

  • Preadmission Anti-hypertensive Agents May Affect Cerebral Vasospasm Risk in Aneurysmal Subarachnoid Hemorrhage Persad-Paisley, E., Shamshad, A., Paracha, S., Stretz, C., Potter, N., Wendell, L., Thompson, B., Furie, K., Reznik, M., Mahta, A. LIPPINCOTT WILLIAMS & WILKINS. 2022

    View details for Web of Science ID 000894020500522

  • Pedicle Screw Placement Using Intraoperative Computed Tomography and Computer-Aided Spinal Navigation Improves Screw Accuracy and Avoids Postoperative Revisions: Single-Center Analysis of 1400 Pedicle Screws WORLD NEUROSURGERY Hagan, M. J., Syed, S., Leary, O. P., Persad-Paisley, E. M., Lin, Y., Zheng, B., Shao, B., Abdulrazeq, H., Yu, J. Y. H., Telfeian, A. E., Gokaslan, Z. L., Fridley, J. S., Oyelese, A. A. 2022; 160: E169-E179

    Abstract

    Intraoperative computed tomography and navigation (iCT-Nav) is increasingly used to aid spinal instrumentation. We aimed to document the accuracy and revision rate of pedicle screw placement across many screws placed using iCT-Nav. We also assess patient-level factors predictive of high-grade pedicle breach.Medical records of patients who underwent iCT-Nav pedicle screw placement between 2015 and 2017 at a single center were retrospectively reviewed. Screw placement accuracy was individually assessed for each screw using the 2-mm incremental grading system for pedicle breach. Predictors of high-grade (>2 mm) breach were identified using multiple logistic regression.In total, 1400 pedicle screws were placed in 208 patients undergoing cervicothoracic (29; 13.9%), thoracic (30; 14.4), thoracolumbar (19; 9.1%) and lumbar (130; 62.5%) surgeries. iCT-Nav afforded high-accuracy screw placement, with 1356 of 1400 screws (96.9%) being placed accurately. In total, 37 pedicle screws (2.64%) were revised intraoperatively during the index surgery across 31 patients, with no subsequent returns to the operating room because of screw malpositioning. After correcting for potential confounders, males were less likely to have a high-grade breach (odds ratio [OR] 0.21; 95% confidence interval [CI] 0.10-0.59, P = 0.003) whereas lateral (OR 6.21; 95% CI 2.47-15.52, P < 0.001) or anterior (OR 5.79; 95% CI2.11-15.88, P = 0.001) breach location were predictive of a high-grade breach.iCT-Nav with postinstrumentation intraoperative imaging is associated with a reduced need for costly postoperative return to the operating room for screw revision. In comparison with studies of navigation without iCT where 1.5%-1.7% of patients returned for a second surgery, we report 0 revision surgeries due to screw malpositioning.

    View details for DOI 10.1016/j.wneu.2021.12.112

    View details for Web of Science ID 000820559900011

    View details for PubMedID 34990843

  • Association Of Asymptomatic Cerebral Vasospasm With Outcomes In Aneurysmal Subarachnoid Hemorrhage Shamshad, A., Persad-Paisley, E. M., Stretz, C., Potter, N. S., Wendell, L. C., Thompson, B., Reznik, M., Furie, K. L., Mahta, A. LIPPINCOTT WILLIAMS & WILKINS. 2022

    View details for DOI 10.1161/str.53.suppl_1.TP150

    View details for Web of Science ID 000788100600435

  • Existing clinical evidence on the use of cellular bone matrix grafts in spinal fusion: updated systematic review of the literature NEUROSURGICAL FOCUS Darveau, S. C., Leary, O. P., Persad-Paisley, E. M., Shaaya, E. A., Oyelese, A. A., Fridley, J. S., Sampath, P., Camara-Quintana, J. Q., Gokaslan, Z. L., Niu, T. 2021; 50 (6): E12

    Abstract

    Spinal fusion surgery is increasingly common; however, pseudarthrosis remains a common complication affecting as much as 15% of some patient populations. Currently, no clear consensus on the best bone graft materials to use exists. Recent advances have led to the development of cell-infused cellular bone matrices (CBMs), which contain living components such as mesenchymal stem cells (MSCs). Relatively few clinical outcome studies on the use of these grafts exist, although the number of such studies has increased in the last 5 years. In this study, the authors aimed to summarize and critically evaluate the existing clinical evidence on commercially available CBMs in spinal fusion and reported clinical outcomes.The authors performed a systematic search of the MEDLINE and PubMed electronic databases for peer-reviewed, English-language original articles (1970-2020) in which the articles' authors studied the clinical outcomes of CBMs in spinal fusion. The US National Library of Medicine electronic clinical trials database (www.ClinicalTrials.gov) was also searched for relevant ongoing clinical trials.Twelve published studies of 6 different CBM products met inclusion criteria: 5 studies of Osteocel Plus/Osteocel (n = 354 unique patients), 3 of Trinity Evolution (n = 114), 2 of ViviGen (n = 171), 1 of map3 (n = 41), and 1 of VIA Graft (n = 75). All studies reported high radiographic fusion success rates (range 87%-100%) using these CBMs. However, this literature was overwhelmingly limited to single-center, noncomparative studies. Seven studies disclosed industry funding or conflicts of interest (COIs). There are 4 known trials of ViviGen (3 trials) and Bio4 (1 trial) that are ongoing.CBMs are a promising technology with the potential of improving outcome after spinal fusion. However, while the number of studies conducted in humans has tripled since 2014, there is still insufficient evidence in the literature to recommend for or against CBMs relative to cheaper alternative materials. Comparative, multicenter trials and outcome registries free from industry COIs are indicated.

    View details for DOI 10.3171/2021.3.FOCUS2173

    View details for Web of Science ID 000658799400008

    View details for PubMedID 34062506