John Christopher (J.C.) Panagides

All Publications

• Significant antibiotic use variations in testicular torsion surgery among us free-standing children's hospitals JOURNAL OF PEDIATRIC UROLOGY Panagides, J., Cahill, D., Song, J. J., Vasdev, R., Saunders, R., Nelson, C. P., Wang, H. 2025; 21 (3): 719-724

  Abstract

  There is no robust evidence for the efficacy of intraoperative antibiotics in preventing infections in testicular torsion surgery, the incidence of which is reported to be <0.2 %. In the absence of clear guidelines regarding the appropriate use of antibiotic prophylaxis, the factors influencing these differences in practice patterns remain unclear. Our study aimed to identify both patient and institution-level factors affecting whether a pediatric patient undergoing emergency testicular detorsion (orchiopexy or orchiectomy) will receive antibiotic prophylaxis.We utilized the Pediatric Health Information System (PHIS) database to identify patients≤18 years old who underwent testicular septopexy or orchiectomy with the diagnosis of torsion of the testis between 2015 and 2021. Patient visits for repeated presentations of torsion were excluded from the analysis. We used multivariate logistic regression to evaluate if pre-procedural antibiotic prophylaxis was associated with hospital-level factors (treating hospital) or patient-level factors (case complexity, concurrent orchiectomy, age category, race/ethnicity, income quintile, insurance).We included 5313 children who underwent surgeries for testicular torsion. Median age was 13 (IQR 10-15 years). 74.0 % patients received antibiotic prophylaxis. Compared to no antibiotic prophylaxis, those who received antibiotic prophylaxis were significantly older (p < 0.001). After adjusting for race/ethnicity, orchiectomy vs septopexy, income quintiles, insurance, and comorbidities, older age (12-18 years compared to the 0-12 age group, OR = 1.6 (95 % CI 1.4-1.9, p < 0.001) and hospital (p < 0.001) remained significantly associated with choice of antibiotic prophylaxis for testicular torsion surgeries.There is wide variation in antibiotic prophylaxis use for patients undergoing testicular detorsion at freestanding children's hospitals in the United States. Older patients (age 12-18) are more likely to receive antibiotic prophylaxis prior to testicular torsion surgery. On the other hand, no obvious benefit in reducing subsequent hospital readmission rate was found associated with antibiotic prophylaxis. This study was limited by an inherent reliance on accurate documentation of antimicrobial-associated allergic reaction(s) and readmission rates in this PHIS database.Given the risks associated with excessive antibiotic use, an understanding of the factors and proper standardization is warranted. Significant variation in antibiotic prophylaxis demonstrates the need for clearer guidelines and evidence-based practice. Future work may illustrate the potential impact on standardized protocols on reducing unwarranted antibiotic use.

  View details for DOI 10.1016/j.jpurol.2025.01.032

  View details for Web of Science ID 001516274800027

  View details for PubMedID 39947942

• Intradetrusor botox injection and augmentation cystoplasty trends among spina bifida patients at US freestanding children's hospitals JOURNAL OF PEDIATRIC UROLOGY Vasdev, R., Softness, K., Cahill, D., Panagides, J., Logvinenko, T., Saunders, R., Bauer, S., Estrada, C., Wang, H. 2024; 20 (3): 482.e1-482.e6

  Abstract

  Intra-detrusor botulinum toxin (Botox) injection is a minimally invasive alternative to augmentation cystoplasty in patients with refractory neurogenic bladder. Botox was first used for neurogenic bladder children two decades ago. However, there are no existing guidelines on indications or use among patients with spina bifida. Furthermore, there are little data regarding its use relative to bladder augmentation and patient volume on a national scale.We sought to investigate the contemporary trends of intra-detrusor Botox injection and augment cystoplasty in free-standing children's hospitals.We queried the Pediatric Health Information System database to identify spina bifida patients from 2016 to 2019 who underwent intra-detrusor Botox injection and augment cystoplasty based on CPT and ICD-10 codes. Total spina bifida population under care in the free-standing children's hospitals was estimated by all inpatient and ambulatory surgery encounters as denominators to calculate frequency by time for both intra-detrusor Botox injections and augmentation cystoplasty.In total, we included 1924 intra-detrusor Botox injections and 842 augmentation cystoplasties. 1413 (51.1%) patients were female. Median age at surgery was 10.0 (interquartile range 6.98-13.5) years. There was a significant increase in intra-detrusor Botox injection frequency (p < 0.001). While there was an overall decreasing, but not significant, trend for augmentation cystoplasty, there was a significant increase in this procedure during the summer months compared to the rest of the year (p < 0.001, Figure 1). Sensitivity analysis using only first intra-detrusor Botox injection per patient demonstrated similarly significant increasing trend.Use of intra-detrusor Botox injection for the management of neurogenic bladder has significantly increased among patients with spina bifida while augmentation cystoplasty has slightly decreased, but not significantly.Over time, practice patterns for the treatments of neurogenic bladder among spina bifida children have favored minimally invasive Botox injections while augmentation cystoplasty use has not significantly changed.

  View details for DOI 10.1016/j.jpurol.2024.02.012

  View details for Web of Science ID 001259138700001

  View details for PubMedID 38402080

• A machine learning algorithm predicting risk of dilating VUR among infants with hydronephrosis using UTD classification JOURNAL OF PEDIATRIC UROLOGY Wang, H., Li, M., Cahill, D., Panagides, J., Logvinenko, T., Chow, J., Nelson, C. 2024; 20 (2): 271-278

  Abstract

  Urinary Tract Dilation (UTD) classification has been designed to be a more objective grading system to evaluate antenatal and post-natal UTD. Due to unclear association between UTD classifications to specific anomalies such as vesico-ureteral reflux (VUR), management recommendations tend to be subjective.We sought to develop a model to reliably predict VUR from early post-natal ultrasound.Radiology records from single institution were reviewed to identify infants aged 0-90 days undergoing early ultrasound for antenatal UTD. Medical records were reviewed to confirm diagnosis of VUR. Primary outcome defined as dilating (≥Gr3) VUR. Exclusion criteria include major congenital urologic anomalies (bilateral renal agenesis, horseshoe kidney, cross fused ectopia, exstrophy) as well as patients without VCUG. Data were split into training/testing sets by 4:1 ratio. Machine learning (ML) algorithm hyperparameters were tuned by the validation set.In total, 280 patients (540 renal units) were included in the study (73 % male). Median (IQR) age at ultrasound was 27 (18-38) days. 66 renal units were found to have ≥ grade 3 VUR. The final model included gender, ureteral dilation, parenchymal appearance, parenchymal thickness, central calyceal dilation. The model predicted VUR with AUC at 0.81(0.73-0.88) on out-of-sample testing data. Model is shown in the figure.We developed a ML model that can predict dilating VUR among patients with hydronephrosis in early ultrasound. The study is limited by the retrospective and single institutional nature of data source. This is one of the first studies demonstrating high performance for future diagnosis prediction in early hydronephrosis cohort.By predicting dilating VUR, our predictive model using machine learning algorithm provides promising performance to facilitate individualized management of children with prenatal hydronephrosis, and identify those most likely to benefit from VCUG. This would allow more selective use of this test, increasing the yield while also minimizing overutilization.

  View details for DOI 10.1016/j.jpurol.2023.11.003

  View details for Web of Science ID 001299326100001

  View details for PubMedID 37993352

• Interventional Radiology Peer Learning Platform and Adverse Event Reporting (IR-PEER): Initial Experience Implementing a Team-based Novel Peer Learning System in Interventional Radiology JOURNAL OF THE AMERICAN COLLEGE OF RADIOLOGY Panagides, J. C., Hancel, K., Kalva, S., Schenker, M., Saini, S., Glazer, D. I., Khorasani, R., Daye, D. 2024; 21 (1): 93-102

  Abstract

  Although the transition from peer review to peer learning has had favorable outcomes in diagnostic radiology, experience with implementing a team-based peer review system in interventional radiology (IR) remains limited. Peer learning systems benefit diverse IR teams composed of multiple clinical roles and could contribute value in archiving events that have potential educational value. With multiple stakeholder input from clinical roles within the IR division at our institution (ie, radiologic technologists, nurses, advanced practice providers, residents, fellows, and attending physicians), we launched a HIPAA-compliant secure IR complication and learning opportunity reporting platform in April 2022. Case submissions were monitored over the subsequent 24 weeks, with monthly dashboard reports provided to departmental leadership. Preintervention and postintervention surveys were used to assess the impact of the peer learning platform and adverse event reporting in IR (IR-PEER) on perceptions of complication reporting in the IR division across clinical roles. Ninety-two peer learning submissions were collected for a weekly average ± standard error of 3.8 ± 0.6 submissions per week, and an additional 26 submissions were collected as part of the division's ongoing monthly complication review conference, for a total of 98 unique total case references. A total of 64.1% of submissions (59 of 92) involved a complication and/or adverse event, and 35.9% of submissions (33 of 92) identified a learning opportunity (no complication or adverse event). Nurses reported that IR-PEER made the complication-reporting process easier (P = .01), and all clinical roles reported that IR-PEER improved the overall process of complication reporting. Peer learning frameworks such as IR-PEER provide a more equitable communication platform for multidisciplinary teams to capture and archive learning opportunities that support quality and safety improvement efforts.

  View details for DOI 10.1016/j.jacr.2023.07.022

  View details for Web of Science ID 001167498700001

  View details for PubMedID 37659453

• IMIL: Interactive Medical Image Learning Framework Rao, A., Fisher, A., Chang, K., Panagides, J., McNamara, K., Lee, J., Aalami, O., IEEE IEEE COMPUTER SOC. 2024: 5241-5250

  View details for DOI 10.1109/CVPRW63382.2024.00533

  View details for Web of Science ID 001327781705047

• New Frontiers in the Role of Locoregional Therapies in Breast Cancer: Proceedings from the Society of Interventional Radiology Foundation Research Consensus Panel JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY Daye, D., Panagides, J., Norton, L., Ahmed, M., Fukuma, E., Ward, R. C., Gomez, D., Kokabi, N., Vogl, T., Abi-Jaoudeh, N., Deipolyi, A. 2023; 34 (10): 1835-1842

  Abstract

  Emerging evidence regarding the effectiveness of locoregional therapies (LRTs) for breast cancer has prompted investigation of the potential role of interventional radiology (IR) in the care continuum of patients with breast cancer. The Society of Interventional Radiology Foundation invited 7 key opinion leaders to develop research priorities to delineate the role of LRTs in both primary and metastatic breast cancer. The objectives of the research consensus panel were to identify knowledge gaps and opportunities pertaining to the treatment of primary and metastatic breast cancer, establish priorities for future breast cancer LRT clinical trials, and highlight lead technologies that will improve breast cancer outcomes either alone or in combination with other therapies. Potential research focus areas were proposed by individual panel members and ranked by all participants according to each focus area's overall impact. The results of this research consensus panel present the current priorities for the IR research community related to the treatment of breast cancer to investigate the clinical impact of minimally invasive therapies in the current breast cancer treatment paradigm.

  View details for DOI 10.1016/j.jvir.2023.06.037

  View details for Web of Science ID 001086433700001

  View details for PubMedID 37414212

• The Role of Artificial Intelligence in the Detection and Implementation of Biomarkers for Hepatocellular Carcinoma: Outlook and Opportunities CANCERS Mansur, A., Vrionis, A., Charles, J. P., Hancel, K., Panagides, J. C., Moloudi, F., Iqbal, S., Daye, D. 2023; 15 (11)

  Abstract

  Liver cancer is a leading cause of cancer-related death worldwide, and its early detection and treatment are crucial for improving morbidity and mortality. Biomarkers have the potential to facilitate the early diagnosis and management of liver cancer, but identifying and implementing effective biomarkers remains a major challenge. In recent years, artificial intelligence has emerged as a promising tool in the cancer sphere, and recent literature suggests that it is very promising in facilitating biomarker use in liver cancer. This review provides an overview of the status of AI-based biomarker research in liver cancer, with a focus on the detection and implementation of biomarkers for risk prediction, diagnosis, staging, prognostication, prediction of treatment response, and recurrence of liver cancers.

  View details for DOI 10.3390/cancers15112928

  View details for Web of Science ID 001005534900001

  View details for PubMedID 37296890

  View details for PubMedCentralID PMC10251861

• Synchronous Video-Based Virtual Visits in Interventional Radiology During the COVID-19 Pandemic-A Double-Edged Sword: Challenges and Opportunities for Improving Care ACADEMIC RADIOLOGY Nambiar, N., Panagides, J., Chittle, M., Salazar, G., Daye, D. 2021; 28 (12): 1824-1825

  View details for DOI 10.1016/j.acra.2021.09.006

  View details for Web of Science ID 000720055900026

  View details for PubMedID 34690050

  View details for PubMedCentralID PMC8455246

• Novel co-culture plate enables growth dynamic-based assessment of contact-independent microbial interactions PLOS ONE Moutinho, T. J., Panagides, J. C., Biggs, M. B., Medlock, G. L., Kolling, G. L., Papin, J. A. 2017; 12 (8): e0182163

  Abstract

  Interactions between microbes are central to the dynamics of microbial communities. Understanding these interactions is essential for the characterization of communities, yet challenging to accomplish in practice. There are limited available tools for characterizing diffusion-mediated, contact-independent microbial interactions. A practical and widely implemented technique in such characterization involves the simultaneous co-culture of distinct bacterial species and subsequent analysis of relative abundance in the total population. However, distinguishing between species can be logistically challenging. In this paper, we present a low-cost, vertical membrane, co-culture plate to quantify contact-independent interactions between distinct bacterial populations in co-culture via real-time optical density measurements. These measurements can be used to facilitate the analysis of the interaction between microbes that are physically separated by a semipermeable membrane yet able to exchange diffusible molecules. We show that diffusion across the membrane occurs at a sufficient rate to enable effective interaction between physically separate cultures. Two bacterial species commonly found in the cystic fibrotic lung, Pseudomonas aeruginosa and Burkholderia cenocepacia, were co-cultured to demonstrate how this plate may be implemented to study microbial interactions. We have demonstrated that this novel co-culture device is able to reliably generate real-time measurements of optical density data that can be used to characterize interactions between microbial species.

  View details for DOI 10.1371/journal.pone.0182163

  View details for Web of Science ID 000406768200048

  View details for PubMedID 28767660

  View details for PubMedCentralID PMC5540398