Allen R Kunselman

• Instructor at Penn State Hershey Medical Center and Penn State College of Medicine

Background: The objective was to evaluate mean cerebral blood flow velocity, gaseous microemboli (GME) counts, regional cerebral oxygen saturation (rSO2), and clinical outcomes using multimodality neuromonitoring in risk-stratified congenital cardiac surgery patients and by cyanotic and acyanotic heart disease. Methods: A total of 377 pediatric patie...

Category Trauma; Basic Sciences/Biologics Introduction/Purpose A variable pitch locking screw is intended to provide interfragmentary compression combined with fixed angle stability of locking plate constructs. The objective of this study was to compare variable pitch locking screws with standard locking screws in bicortical fixation scenarios in...

Background The study objective was to determine the impact of cardiopulmonary bypass perfusion modalities on cerebral hemodynamics and clinical outcomes in congenital cardiac surgery patients stratified by acyanotic versus cyanotic heart disease. Methods A total of 159 pediatric (age <18 years) cardiac surgery patients were prospectively randomize...

OBJECTIVES A variable pitch locking screw is intended to provide interfragmentary compression combined with fixed angle stability of locking plate constructs. The objective of this study was to compare variable pitch locking screws (3.5 mm KreuLock Ti Locking Compression Screws, Arthrex Inc., Naples FL) with standard locking screws (from same manuf...

Background Genicular nerve radiofrequency ablation (GNRFA) is a popular and effective procedure to treat arthritic knee pain. For refractory arthritic pain that fails conservative treatment, total knee arthroplasty (TKA) has been an excellent option. Unfortunately, 15–30% of people who undergo a TKA continue to experience pain and stiffness in the...

Objective The objective of this retrospective review was to evaluate whether or not pulsatile flow improves cerebral hemodynamics and clinical outcomes in pediatric congenital cardiac surgery patients. Methods This retrospective study included 284 pediatric patients undergoing congenital cardiac surgery with cardiopulmonary bypass support utilizin...

Background: Uncontrolled hemorrhage is the leading cause of preventable death in combat and civilian trauma. Efficacious hemostatic agents in junctional hemorrhage can quell blood loss and improve survival. We hypothesized that a novel hemostatic foam of starch and chitosan would improve hemostasis, and thereby increase survival in a swine femoral...

Background Genicular nerve radiofrequency ablation (RFA) is an effective procedure to alleviate knee pain. This procedure has been proven to be safe, except in the inferior lateral quadrant (ILQ) due to its innervation being near the common fibular nerve (CFN). Given the complexity of this approach, pain physicians do not routinely perform RFA in t...

Objectives: To investigate outcomes associated with conventional roller or centrifugal pumps during neonatal venovenous extracorporeal membrane oxygenation (ECMO). Our primary hypothesis is that in comparison with conventional roller-pump support, centrifugal pump use is associated with greater odds of survival. Our secondary hypothesis is that ce...

Postoperative opioid prescribing has historically lacked information critical to balancing the pain control needs of the individual patient with our professional responsibility to judiciously prescribe these high-risk medications. This data evaluates pain control, satisfaction with pain control, and opioid utilization among patients undergoing isol...

Uncertainty is a common element when designing a study and assumptions made around this uncertainty inform the statistical analysis to be performed. Sensitivity analyses provide confidence in the primary analytic results obtained from the study by probing at the assumptions and uncertainty. Researchers are strongly encouraged to consider sensitivit...

Objectives To assess whether state-level mandatory delay policies cause patients to “time-out” of accessing medication abortion. Methods North Carolina, a state with mandatory delays, was matched to Iowa, a comparator state, using population demographics and enacted abortion legislation. North Carolina implemented a 24-hour mandatory delay in 2011...

Objective To determine the feasibility, safety and outcomes of an oil-based, iodinated contrast using office-based, ultrasound-imaged hysterosalpingography (Sono-HSG) in women with infertility. Design Randomized Controlled Double Blind Clinical Trial. Setting Academic health center. Intervention(s) Tubal flushing with oil-based contrast medium (...

Study Objective Evaluate the impact of obesity on outcomes after apical pelvic organ prolapse surgery. Design Retrospective cohort study using cases identified in the ACS-NSQIP database from 2014-2018. Setting Surgical cases from 722 hospitals nationally. Patients or Participants 26,898 females age 18-89 who underwent apical prolapse repair were...

Study Objective To evaluate the clinical outcomes of patients undergoing laparoscopic hysterectomy with vs. without ovarian preservation for endometriosis. Design A retrospective cohort study, with 5-year follow-up. Setting Minimally Invasive Gynecologic Surgery Practice between 2010-2015. Patients or Participants A total of 289 patients underwe...

Objective The primary objective of this study was to report surgical outcomes for cesarean delivery (CD) patients following the implementation of an Enhanced Recovery after Surgery (ERAS) pathway based on the ERAS Society recommendations. The primary outcome for which the study was powered was the length of stay (LOS). Methods This IRB-approved co...

Background The preferred method of fixation and surgical treatment for ligamentous Lisfranc injuries is controversial. Transarticular screws, bridge plating, fusion, and flexible fixation have been described, yet none have demonstrated superiority. Furthermore, screw fixation and plating often require secondary surgery to remove implants, leading s...

Objective We analyzed the exclusion of pregnant and breastfeeding individuals and those capable of pregnancy in COVID-19 vaccine and clinical treatment trials. Methods Inclusion and exclusion criteria were extracted from all listed COVID-19 vaccine and treatment clinical trials from May 1, 2020 to October 31, 2020 using the U.S. National Library o...

Cutaneous microcirculatory perfusion is commonly measured using laser Doppler flowmetry (LDF) probes, which provide a continuous, non-invasive quantification of skin blood flow (SkBF). However, inhomogeneities in the skin’s microvasculature density contribute to a decrease in reproducibility whenever an LDF probe is removed and replaced, as is the...

Introduction: Ongoing recognition of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) and its link with textured devices has brought a paradigm shift in prosthetic-based breast reconstruction. Many institutions no longer offer textured expansion devices for staged reconstruction. However, there is a paucity of data regarding the...

Background Postoperative opioid prescribing has historically lacked information critical to balancing the pain control needs of the individual patient with our professional responsibility to judiciously prescribe these high-risk medications. Objective To evaluate pain control, satisfaction with pain control, and opioid utilization among patients u...

Objective Adverse childhood experiences (ACEs) are linked to worsening overall health outcomes and psychological diagnoses. Routine screening, particularly in patients with postpartum depression (PPD), would identify patients who could benefit from interventions to prevent the perpetuation of ACEs and establish a system of preventative care to miti...

Background The objective of this randomized clinical trial was to investigate the effects of perfusion modalities on cerebral hemodynamics, vital organ injury, quantified by the Pediatric Logistic Organ Dysfunction-2 (PELOD-2) Score, and clinical outcomes in risk-stratified congenital cardiac surgery patients. Methods This randomized clinical tria...

Introduction: Overprescribing by providers is a leading contributor to the opioid crisis. Despite available information regarding the role that physician prescribing plays in the community availability of opioids, guidelines for the management of acute pain remain sparse. This project aims to evaluate opioid prescribing, opioid usage patterns, and...

BACKGROUND: Psychiatric disorders, including anxiety and depression, are significantly more common in patients with inflammatory bowel disease. We established an integrated psychiatry clinic for IBD patients at our tertiary center IBD clinic to provide patients with critical, but frequently unavailable, coordinated mental health services. We undert...

Interventions have modest impact on reducing excessive gestational weight gain (GWG) in pregnant women with overweight/obesity. This two-arm feasibility randomized control trial tested delivery of and compliance with an intervention using adapted dosages to regulate GWG, and examined pre-post change in GWG and secondary outcomes (physical activity:...

Results Of 118 patients, there were 74 neonatal patients and 44 pediatric patients. Table 1 shows outcomes at PSHCH compared to the ELSO Registry. The most common patient-related complications associated with ECLS were clinical seizures, culture-proven infection, and intracranial hemorrhage (Figure 1). Transitions in ECLS equipment occurred in 2009...

During embryonic development, tendons transform into a hypocellular tissue with robust tensile load-bearing capabilities. Previous work suggests that this mechanical transformation is due to increases in collagen fibril length and is dependent on mechanical stimulation via muscle activity. However, the relationship between changes in the microscale...

Parkinson's disease (PD) is a neurodegenerative movement disorder that is routinely treated with levodopa. Unfortunately, long-term dopamine replacement therapy using levodopa leads to levodopa-induced dyskinesias (LID), a significant and disabling side-effect. Clinical findings indicate that LID typically only occurs following the progression of P...

Background Sensory stimulation threshold (SST) has been used as a surrogate marker to target a nerve branch for radiofrequency (RF) denervation; however, the validity of SST as a prognostic marker is still under debate. Objective To assess whether lower SST values correlate with better outcomes of radiofrequency denervation for facetogenic low bac...

Purpose The aim of this article is to investigate the impact of a 1-minute video describing resident training with a cataract surgical simulator on patients' perceptions regarding resident involvement in cataract surgery and to identify factors associated with patient willingness to have cataract surgery performed by a resident. Design Cross-sectio...

During embryonic development, tendons transform into a hypocellular tissue with robust tensile load-bearing capabilities. Previous work suggests that this mechanical transformation is due to increases in collagen fibril length and is dependent on mechanical stimulation via muscle activity. However, the relationship between changes in the microscale...

Background Lisfranc ligamentous injuries are complex, and their treatment, along with the preferred method of fixation, is controversial. Implementing a flexible synthetic augmentation device (fibertape) has been described as an alternative to traditional screw fixation. This biomechanical study evaluated two fibertape devices with interference scr...

Objective: To determine whether an inpatient post-cesarean analgesic regimen which separated oxycodone and acetaminophen resulted in less inpatient opioid use, when compared to a regimen using combination medications containing both acetaminophen and oxycodone in a cohort including patients of all gestational ages, acuity levels, and modes of oper...

Objective To evaluate the role of appendectomy in surgical excision of endometriosis and to assess complications associated with appendectomy. Methods Retrospective study of women undergoing appendectomy for pelvic pain and/or endometriosis during a primary gynecologic procedure. Results Record review was performed for 609 women who underwent app...

Purpose : This study aimed to identify patient and appointment characteristics associated with no-shows to new patient appointments at a US academic ophthalmology department. Design : Cross-sectional study. Methods : This was a study of all adult patients with new patient appointments scheduled with an attending ophthalmologist at Penn State Eye...

Objective To describe the prevalence of female sexual dysfunction in a well-defined polycystic ovary syndrome (PCOS) population, and to assess the impact of common PCOS treatments on sexual function. Design Secondary analysis of a randomized controlled trial, oral contraceptive pills and weight loss in PCOS. Setting Two academic medical centers....

Category Trauma; Basic Sciences/Biologics; Midfoot/Forefoot; Sports Introduction/Purpose Lisfranc ligamentous injuries are complex. Controversy exists regarding their treatment and preferred method of fixation. Fixation methods employing a FiberTape device and interference screw fixation have been described as an alternative to traditional screw f...

Objective: To examine effects of common treatments for PCOS on a panel of hormones(reproductive/metabolic). Design: Secondary analysis of blood from a RCT of three 16-week preconception interventions designed to improve PCOS-related abnormalities: continuous oral contraceptives(OCP, N=34 subjects), intensive lifestyle modification(Lifestyle, N =...

Objective To assess if a surgical boot camp improves laparoscopic skill among reproduction endocrinology and infertility (REI) fellows and increases fellow desire to incorporate surgical skills into practice and to examine whether fellowship in vitro fertilization (IVF) volume correlates with surgical efficiency. Design Prospective evaluation. Se...

Introduction: corneal transplantation is a surgical procedure requiring consistent long-term follow-up to maximize the chance of graft survival. The purpose of this study was to explore patient characteristics and reasons for being lost to follow-up (LTFU). Methods: a retrospective review of clinical records from January 2012 to October 2014 was...

Dwyer (lateral calcaneal closing wedge) osteotomy is commonly used in surgical correction of heel varus deformity. The purpose of this study was to determine the effect of wedge size and angle of osteotomy on deformity correction using preoperative imaging analysis with 3D printed modeling. Seven patients diagnosed with pes cavovarus deformity who...

Objective To study the development of children conceived from non-IVF infertility treatments consisting of gonadotropins, clomiphene, or letrozole. Design Prospective cohort study. Setting U.S. academic health centers. Patient(s) Children of women with polycystic ovary syndrome who conceived with letrozole (LTZ) or clomiphene (CC) in the PPCOS I...

Skin blood flow (SkBF) measurements with laser Doppler probe provide a continuous real‐time index for local microcirculatory blood flow under the probe. However, because the area detected by a single probe is very small, it is known that SkBF reading may vary significantly if the position of the probe is moved slightly. The possible low reliability...

Background Optimal modalities for pain control in shoulder arthroplasty are not yet established. Although regional nerve blockade has been a well-accepted modality, complications and rebound pain have led some surgeons to seek other pain control modalities. Local injection of anesthetics has recently gained popularity in joint arthroplasty. The pur...

Study objective: To evaluate the diagnosis of appendiceal endometriosis in coincidental appendectomy specimens using a standard versus modified histopathologic analysis. Design: Prospective analysis of 300 consecutive patients undergoing coincidental appendectomy at time of a primary gynecologic procedure. Setting: Academic tertiary referral h...

Prolonged reduction in weightbearing causes bone loss. Disuse of bone is associated with recovery from common musculoskeletal injury and trauma, bed rest due to various medical conditions, and spaceflight. The hindlimb suspension rodent model is popular for simulating unloading and disuse. We hypothesized that controlled mechanical loading of the t...

Background: Women diagnosed with polycystic ovary syndrome (PCOS) suffer from an unfavorable cardiometabolic risk profile, which is already established by child-bearing age. Objective and rationale: The aim of this systematic review along with an individual participant data meta-analysis is to evaluate whether cardiometabolic features in the off...

Rapid-eye-movement (REM) sleep without atonia (RSWA), a marker of REM sleep behavior disorder (RBD), is frequently comorbid with Parkinson’s disease (PD). Although rodent models are commonly used for studying PD, the neurobiological and behavioral correlates of RBD remain poorly understood. Therefore, we developed a behavior-based criteria to ident...

Study Objective To evaluate the diagnosis of appendix endometriosis in coincidental appendectomy specimens using a standard versus modified pathologic analysis. Design Prospective analysis of 300 consecutive patients who underwent coincidental appendectomy at time of a primary gynecologic procedure. Setting Academic tertiary referral hospital in...

Background: Admission to the intensive care unit (ICU) after surgery can be associated with significant morbidity and mortality. This observational cohort study aims to identify perioperative factors associated with postoperative ICU admission in patients undergoing elective non-cardiac surgery. Methods: Data from the ACS NSQIP® database at a te...

Quetiapine, an atypical antipsychotic medication has lacked pre-clinical validation for its purported benefits in the treatment of delirium. This laboratory investigation examined the effects of quetiapine on the attentional set shifting task (ASST), a measure of cognitive flexibility and executive functioning, in a rodent model of lipopolysacchari...

Purpose: The aim of our review was to ascertain factors associated with the successful completion of a randomized controlled trial in gynecological oncology. Materials and methods: This retrospective cohort study utilized data collected from the National Institutes of Health's US National Library of Medicine database on ClinicalTrials.gov. Data...

The objective of this study was to describe a single‐center experience with neonatal and pediatric extracorporeal life support (ECLS) and compare patient‐related outcomes with those of the Extracorporeal Life Support Organization (ELSO) Registry. A retrospective review of subject characteristics, outcomes, and complications of patients who received...

The Penn State Heart Assistant, a web-based, tablet computer-accessed, secure application was developed to conduct a proof of concept test, targeting patient self-care activities of heart failure patients including daily medication adherence, weight monitoring, and aerobic activity. Patients (n = 12) used the tablet computer-accessed program for 30...

INTRODUCTION The study objective was to examine trends in fetal MRI (fMRI) use and compare prenatal and postnatal diagnoses of fetal central nervous system (CNS) anomalies in a regional perinatal program. Prior studies have shown that fMRI improves diagnostic accuracy of CNS anomalies, altering counseling and management. METHODS This was a chart r...

Background CrossFit is a popular weightlifting sport, with participants who report significant improvements in physical health; however, others argue that CrossFit exposes participants to an increased risk and severity of injury. We address this through a retrospective cohort study. Purpose/Hypothesis The purpose of this study was to compare the l...

(Abstracted from J Minim Invasive Gynecol 2019;26:71–77) The primary sequelae of endometriosis are infertility and chronic pelvic pain (CPP). Nearly 40% of women with endometriosis are infertile, and 71% to 87% have CPP.

In 2017, we surveyed long-term care facilities in Pennsylvania regarding antimicrobial stewardship and infection prevention and control (IPC) practices. Among 244 responding facilities, 93% had IPC programs and 47% had antimicrobial stewardship programs. There was significant variation in practices across facilities, and a number of program impleme...

BACKGROUND: Serum peptide biomarkers are frequently abnormal in women with PCOS reflecting underlying reproductive and metabolic dysfunction. The effects of treatment on these biomarkers is poorly described. METHODS: We performed a secondary analysis on obese women with PCOS who had participated in a RCT(JCEM, PMID: 26401593) where they were random...

The objective of this study was to determine the influence of immediate pre-operative gabapentin on postoperative pain in patients undergoing laparoscopy for benign gynecologic indications. We completed a double-blind, placebo controlled, randomized trial at an academic tertiary care hospital. One-hundred-nine gynecologic patients undergoing laparo...

Objective: To determine whether men with unexplained infertility and low total T (TT) have abnormal spermatogenesis and lower fecundity. Design: Secondary analysis of the prospective, randomized, multicenter clinical trial, Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation (AMIGOS). Setting: Infertility clinics. Patient(...

Purpose: We sought to determine whether lower fertility-related QOL or depression in men of couples with unexplained infertility is associated with low total testosterone (TT) levels, abnormal semen quality, or erectile dysfunction (ED). Materials and methods: This study is a secondary analysis of a large, multicentered, randomized controlled tr...

Background: Successful tibiotalar joint fusion relies on adequate compression. Compression following joint preparation may be affected by the extent to which the fibula holds the joint out to anatomical length. The purpose of this study was to evaluate the effect of various distal fibula osteotomies on tibiotalar joint compression. Methods: Eigh...

Background: Pharmacologic angiotensin axis blockade (AAB) has been associated with profound hypotension following anesthetic induction with propofol. To combat this problem, investigators have attempted to withhold angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) preoperatively, or evaluated the effects of di...

Objective: The objective of this study is to evaluate the hemodynamic characteristics of two femoral arterial cannulae in terms of circuit pressure, pressure drop and hemodynamic energy transmission under non-pulsatile and pulsatile mode in a simulated adult extracorporeal life support (ECLS) system. Methods: The ECLS circuit consisted of i-cor...

Objective The objective of this study was to do an in‐vitro evaluation of venous line pressure using different venous line lengths and venous cannula sizes in pediatric venoarterial extracorporeal life support (VA‐ECLS) and venovenous ECLS (VV‐ECLS) circuits. Methods The pediatric VA‐ECLS circuit consisted of a Xenios i‐cor diagonal pump, a Maquet...

The purpose of this study was to evaluate the hemodynamic properties and microemboli capture associated with different VAVD vacuum levels and venous reservoir levels in a neonatal CPB circuit. Trials were conducted in 2 parallel circuits to compare the performance of Capiox Baby RX05 oxygenator with separate AF02 arterial filter to Capiox FX05 oxyg...

Objective To investigate the relationship between maximal placental thickness during routine anatomy scan and birthweight at delivery. Methods This retrospective descriptive study analyzed 200 term, singleton deliveries in 2016 at Penn State Hershey Medical Center. We measured maximal placental thickness in the sagittal plane from the ultrasound i...

Objective: Sepsis is a condition associated with a dysregulated inflammatory response to infection with significant morbidity. Recent advances have elucidated the vital role that the short chain fatty acid glycoprotein receptor 43 (FFA2/GPR43) plays in inflammatory and immunomodulatory pathways. We hypothesized that elevated whole blood GPR43 RNA...

Background: Pregnant patients are at an increased risk for severe morbidity and mortality when compared to the general population. Imaging studies have become an integral part of the work-up for patients who present to the emergency department. However, lack of clear guideline has led to confusion regarding the appropriate indications and protocol...

Background: We theorized that modafinil, an atypical psychomotor stimulant, utilized to improve daytime somnolence in patients with obstructive sleep apnea, would improve functional recovery after general anesthesia by improving time to extubation, post-anesthesia care unit (PACU) length of stay and subjective recovery after general anesthesia. M...