Joseph Fernandez-Moure

• MD MS
• Professor (Assistant) at Duke University Medical Center

BACKGROUND Rib fractures compromise approximately 40% of all fractures in the United States. Despite their prevalence, the relationship between rib fractures, solid organ injuries, and immune responses remains poorly understood. This exploratory study investigates the immunological profile associated with pulmonary and renal complications in rib fr...

Rib fractures occur in 10% of traumatic injuries and are a common source of morbidity and mortality. Mortality rates for rib fractures remain alarmingly high. Despite increasing literature in support of surgical stabilization of rib fracture (SSRF), acceptance and incorporation of SSRF as the standard of care has not occurred across trauma centers....

Background In 2021, a spike in Asian American hate crimes resurged discussion on Asian health disparities. This study describes the association between education and assault among Asian Americans and their subgroups. Methods This cross-sectional study used individual-level data from the mortality multiple cause-of-death data from the National Cent...

Background: Rib fractures are a common traumatic injury affecting more than 350,000 patients a year. Early stabilization has shown to be effective in reducing pulmonary complications. Platelet-rich plasma (PRP) is a growth factor-rich blood product known to improve soft tissue and bone healing. We hypothesized that the addition of PRP to a rib fra...

Purpose The inability to achieve primary fascial closure (PFC) after emergency laparotomy increases the rates of adverse outcomes including fistula formation, incisional hernia, and intraabdominal infection. Hypertonic saline (HTS) infusion improves early PFC rates and decreases time to PFC in patients undergoing damage control laparotomy (DCL) aft...

The use of medical implants continues to grow as the population ages. Biofilm-related implant infection is the leading cause of medical implant failure and remains difficult to diagnose and treat. Recent technologies have enhanced our understanding of the composition and complex functions of microbiota occupying various body site niches. In this re...

Ventral hernia repair (VHR) with acellular dermal matrix (ADM) has high rates of recurrence that may be improved with allogeneic growth factor augmentation such as amniotic fluid allograft (AFA). We hypothesized that AFA would modulate the host response to improve ADM incorporation in VHR. Lewis rats underwent chronic VHR with porcine ADM alone or...

Remodeling of the human bony skeleton is constantly occurring with up to 10% annual bone volume turnover from osteoclastic and osteoblastic activity. A shift toward resorption can result in osteoporosis and pathologic fractures, while a shift toward deposition is required after traumatic, or surgical injury. Spinal fusion represents one such state,...

Background: Infected hernia mesh is a cause of post-operative morbidity. Nitric oxide (NO) plays a key role in the endogenous immune response to infection. We sought to study the efficacy of a NO-releasing mesh against methicillin-resistant Staphylococcus aureus (MRSA). We hypothesized that a NO-releasing polyester mesh would decrease MRSA coloniza...

Incisional hernia continues to be a common complication of hernia repair in spite of the development of various synthetic and bio‐synthetic repair materials. Poor long‐term mechanical strength, leading to high recurrence rates, has limited the use of acellular dermal matrices (ADM) in ventral hernia repair (VHR). Biologically‐derived meshes have be...

After-hours surgery represents a novel solution that can effectively combat surgical fatigue of care teams in addition to addressing the high volume of surgical backlog associated with the repercussions of the COVID-19 pandemic. This commentary seeks to rationalize how successful employment of a dedicated after-hours surgical team and protocol has...

Introduction Timing to start of chemoprophylaxis for venous thromboembolism (VTE) in patients with traumatic brain injury (TBI) remains controversial. We hypothesize that early administration is not associated with increased intracranial hemorrhage. Methods A retrospective study of adult patients with TBI following blunt injury was performed. Pati...

Achieving bone fracture union after trauma represents a major challenge for the orthopedic surgeon. Fracture non-healing has a multifactorial etiology and there are many risk factors for non-fusion. Environmental factors such as wound contamination, infection, and open fractures can contribute to non-healing, as can patient specific factors such as...

The recurrence of ventral hernias continues to be a problem faced by surgeons, in spite of efforts toward implementing novel repair techniques and utilizing different materials to promote healing. Cadaveric acellular dermal matrices (Alloderm) have shown some promise in numerous surgical subspecialties, but these meshes still suffer from subsequent...

The potential clinical and economic impact of mesenchymal stem cell (MSC) therapy is immense. MSCs act through multiple pathways: (1) as "trophic" cells, secreting various factors that are immunomodulatory, anti-inflammatory, anti-apoptotic, proangiogenic, proliferative, and chemoattractive; (2) in conjunction with cells native to the tissue they r...

Thoracic skeletal injury is a common outcome of motor vehicle accidents. Skeletal reconstruction is guided by anatomic and physiologic variables dictated by the injury complex. Herein, we describe a report of a patient who sustained complex trauma to the thorax leading to complete thoracic dissociation. Clinical and operative decision making is dis...

Background: Surgical site infections (SSIs) increase mortality and the economic burden associated with emergency surgery (ES). A reliable and sensitive scoring system to predict SSIs can help guide clinician assessment and patient counseling of post-operative SSI risk. We hypothesized that after quantifying the ES post-operative SSI incidence, read...

The animal model of infection following ventral hernia repair (VHR) has previously been utilized in exploring treatments and innovative therapies, such as implantation of biologic mesh imbedded with various anti-bacterial properties. The rat model has been utilized most commonly, but prior work has failed to recreate an adequately clinically repres...

Bone morphogenetic protein-2 (BMP-2) has been demonstrated to be one of the most vital osteogenic factors for bone augmentation. However, its uncontrolled administration has been associated with catastrophic side effects, which compromised its clinical use. To overcome these limitations, we aimed at developing a safer controlled and sustained relea...

Endocrine emergencies are frequently encountered in the intensive care unit. This chapter will focus on several common disorders including diabetic ketoacidosis, hyperosmolar hyperglycemia, thyroid storm, myxedema coma, and vasopressin deficiency. Adrenal insufficiency is addressed elsewhere in this volume. Understanding the pathophysiology of thes...

Importance The outcomes of firearm injuries in the United States are devastating. Although firearm mortality and costs have been investigated, the long-term outcomes after surviving a gunshot wound (GSW) remain unstudied. Objective To determine the long-term functional, psychological, emotional, and social outcomes among survivors of firearm injur...

Background Complications of ventral hernia repair (VHR) may be investigated by computed tomography or ultrasound (US) but neither modality gives a quantifiable metric of repair quality short of identifying hernia recurrence. Platelet-rich plasma (PRP), a growth factor-rich autologous blood product, has been shown to improve incorporation of native...

Gemcitabine (GEM) is the first-line treatment for pancreatic adenocarcinoma (PAC) yet chemoresistance is common. Nitric oxide (NO) is the predominant species responsible for the cytotoxic action of macrophages against cancer cells yet localized delivery is difficult given the short half-life. We sought to study the effect of locally delivered NO on...

Prosthetic contamination and biofilm formation continue to plague implanted materials. With increasing resistance to traditional antibiotic regimens, alternative approaches to preventing bacterial adhesion and biofilm formation have focused on the physiochemical properties of the prosthetics. Roughness, topography, hydrophobicity, porosity, charge,...

Medical Emergency Response Teams (MERTs) are widespread throughout inpatient hospital care facilities. Besides the rise of the ubiquitous rapid response team, current MERTs span trauma, stroke, myocardial infarction, and sepsis in many hospitals. Given the multiplicity of teams with widely varying membership, leadership, and functionality, the stru...

The introduction of synthetic polypropylene mesh in hernia repair has improved the results of herniorrhaphy. To introduce mesh is to introduce foreign bodies that can impact the human body and may lead to inflammation, infection, fibrosis, calcification, seromas, or adhesions to vital organs such as the bowel. Bioprosthetic meshes, generated from s...

With the development of new biologics and bioconjugates, storage and preservation have become more critical than ever before. Lyophilization is a method of cell and protein preservation by removing a solvent such as water from a substance followed by freezing. This technique has been used in the past and still holds promise for overcoming logistic...

Intervertebral disc degeneration is a disease of the discs connecting adjoining vertebrae in which structural damage leads to loss of disc integrity. Degeneration of the disc can be a normal process of ageing, but can also be precipitated by other factors. Literature has made substantial progress in understanding the biological basis of interverteb...

Introduction: A de Garengeot hernia, a femoral hernia containing the appendix, is a difficult diagnosis often made intra-operatively when the hernia sac is opened. It is a rare finding, and complications are more frequent with a de Garengeot hernia. Presentation of case: A 92 year-old female presented to the emergency department (ED) complaining...

Introduction: Deep vein thrombosis (DVT) continues to be a significant source of morbidity for surgical patients. Placement of a retrievable inferior vena cava (IVC) filter is used when patients have contraindications to anticoagulation or recurrent pulmonary embolism despite therapeutic anticoagulation. Although retrievable IVC filters are often...

Infections following orthopedic device implantations often impose a substantial health burden and result in high medical costs. Currently, preventative methods are often employed following an orthopedic implant to reduce risk of infection; however, contamination of the surgical site can still occur. Although antibiotics have demonstrated a substant...

Background Surgical energy has been widely implemented because of ease of use, effective hemostasis, and surgical dissection. Studies demonstrate its use to be an independent risk factor for postoperative wound infection. Methicillin-resistant Staphylococcus aureus (MRSA) is the most common bacteria found in postoperative mesh infection. No reports...

A 56-year-old man presented after a day and a half of midabdominal pain, nausea, and bilious emesis. The patient had undergone Roux-en-Y gastric bypass 7 years earlier. During the physical examination, tachycardia and tachypnea were noted. The abdominal examination showed a distended, tympanic abdomen with severe generalized abdominal tenderness, i...

The degree of crosslinking within acellular dermal matrices (ADM) seems to correlate to neovascularization when used in ventral hernia repair (VHR). Platelet-rich plasma (PRP) enhances wound healing through several mechanisms including neovascularization, but research regarding its effect on soft tissue healing in VHR is lacking. We sought to study...

Background: To assess the integrity of hernia repair, imaging modalities such as computed tomography or ultrasound (US) are commonly used. Neither modality has currently the capacity to simultaneously image the mesh and quantify a prosthetic and surrounding tissue stiffness. In this pilot study, we hypothesize that US shear wave elastography (SWE)...

Background: Recurrence after ventral hernia repair (VHR) remains a multifactorial problem still plaguing surgeons today. Some of the many contributing factors include mechanical strain, poor tissue-mesh integration, and degradation of matrices. The high recurrence rate witnessed with the use of acellular dermal matrices (ADM) for definitive hernia...

Platelets are small anucleate cytoplasmic cell bodies released by megakaryocytes in response to various physiologic triggers. Traditionally thought to be solely involved in the mechanisms of hemostasis, platelets have gained much attention due to their involvement wound healing, immunomodulation, and antiseptic properties. As the field of surgery c...

Introduction: Appendicitis is a common surgical pathology with many clinical presentations. Diagnosis can be challenging if there is an alteration to the normal position of anatomical structures and their relationships. Case presentation: In this case, we report an unusual presentation of congenital intestinal malrotation in a nonagenarian prese...

The evolution of medicine and medical technology hinges on the successful translation of basic science research from the bench to clinical implementation at the bedside. Out of the increasing need to facilitate the transfer of scientific knowledge to patients, translational research has emerged. Significant leaps in improving global health, such as...

Surgical wound healing applications require bioprosthetics that promote cellular infiltration and vessel formation, metrics associated with increased mechanical strength and resistance to infection. Porcine acellular lung matrix is a novel tissue scaffold known to promote cell adherence while minimizing inflammatory reactions. In this study, we eva...

Mesenchymal stem cells (MSCs) hold great promise for regenerative therapies in the musculoskeletal system. Although MSCs from bone marrow (BM-MSCs) and adipose tissue (AD-MSCs) have been extensively characterized, there is still debate as to the ideal source of MSCs for tissue-engineering applications in bone repair. MSCs were isolated from cortica...

High recurrence rates because of poor tissue incorporation limit the use of acellular dermal matrices (ADMs) in ventral hernia repair (VHR). Platelet rich plasma (PRP) is a growth factor-rich autologous blood product known to enhance tissue repair through cellular proliferation and neovascularization. We sought to study the effect of PRP on a porci...

Soft tissue or 'whiplash' injuries following trauma, particularly motor vehicle accidents, are common. Estimated yearly incidence of whiplash injuries exceeds 1 million [1]. The impact of whiplash injuries extends beyond that of a short-lived soft tissue injury. Persistent pain and disability as well as psychosocial effects can occur and often enta...

Stem cells constitute the source of differentiated cells for the generation of tissues during development and for regeneration of tissues that are diseased or injured postnatally. Stem cell-based therapy often requires a scaffold to carry cells and/or growth factor to the injured site. Porous silicon (PSi) is a promising biomaterial for tissue engi...

Some patients will experience post-operative back pain following lumbar discectomy, and the potential sources for that pain are poorly understood. One potential source is the vertebral endplates. The goal of this study was to document the changes that occur in lumbar endplates following discectomies, and to assess associations between endplate chan...

The human genome was once thought to be a redundant sequence containing few functional regions coding for proteins. This teaching is being rewritten as we continue to understand the vast complexity of the noncoding regions of the genetic code. These regions we now understand are transcribed into small single-stranded segments or microRNAs (miRNAs)...

Advances in biomedical engineering have paved the way for medical innovation and expansion. Many diseases now have hope of a cure through technology brought to reality by the vision and creativity of basic researchers, translational scientists, and doctors. Cancer, in its various manifestations, has plagued the health of millions of people around t...

This manuscript constitutes a review of several innovative biomedical technologies fabricated using the precision and accuracy of silicon micro- and nanofabrication. The technologies to be reviewed are subcutaneous nanochannel drug delivery implants for the continuous tunable zero-order release of therapeutics, multi-stage logic embedded vectors fo...

The costs of healthcare have risen dramatically over the past several decades. In the United States, for instance, it is estimated that costs this year will exceed $28 Billion. Additionally the proportion of a family's income dedicated to healthcare costs have risen at a far greater pace than other household expenses; corporate profits have been tr...

In this chapter, an attempt is made to highlight the differences between evolutionaryand revolutionary hypotheses. Most hypotheses about etiology or novel therapies areevolutionary in nature and advance the field of medicine incrementally. Revolutionaryhypotheses, on the other hand, are received with skepticism, but they advance thefield enormously...

In this chapter, an attempt is made to highlight the differences between evolutionary and revolutionary hypotheses. Most hypotheses about etiology or novel therapies are evolutionary in nature and advance the field of medicine incrementally. Revolutionary hypotheses, on the other hand, are received with skepticism, but they advance the field enormo...

One purpose of the International Space Station (ISS) is to explore powerful new areas of biomedical science in microgravity. Recent advances in nanotechnology applied to medicine--what we now refer to as nano-medicine--and regenerative medicine have enormous untapped potential for future space and terrestrial medical applications. Novel means for d...

The biology of aortic aneurysm and dissection has evolved to where we now understand the genetic implications of changes in extracellular matrix proteins, smooth muscle cells, and growth factors and how they affect aortic wall homeostasis. These predeterminants are influenced by smoking, hypertension, and atherosclerosis, and the result in an infla...