Auburn Research Day 2021

Vitale Kyle Castellano, MS 1 ; Michael Zabala, PhD 1 ; Jon Commander, MD 2 ; Thomas Burch, PhD 1 1 Auburn University; 2 Edward Via College of Osteopathic Medicine B i omed i ca l Resea rch | Gr adua te / Undergr adua te St udent A Proposed Neuropathy Diagnostic Tool: Design and Testing Methodology 034

Neuropathy is categorized as a loss of sensation in the extremities, particularly in the hands and feet. It is often found in people with diabetes and is present in 40-60 million people. Symptoms include burning, numbness, shooting pain and an electrical sensation. Those who have neuropathy are at an increased risk of puncturing their feet as they may step on a sharp object and not even feel it. This can result in infection, amputation, ulceration and even death. There are a variety of tests used for neuropathy diagnosis, which includes vibration analysis via tuning forks, electrical stimulation and monofilament assessment. The Semmes-Weinstein monofilament assessment is the most popular tool used to diagnose neuropathy. It utilizes a nylon monofilament, which is applied normal to the surface of the foot, noninvasively, until it buckles. At the instant that the monofilament buckles it is assumed to apply a constant force to the skin. The most popular monofilament is the 5.07-gauge monofilament, which is advertised to produce 10 grams of equivalent force at buckling. However, there is a lack of consistent testing methodology when using the monofilament technique, and other factors likely also affect the accuracy of the assessment. For example, the monofilaments are influenced by temperature, humidity, fatigue, insertion speed and angle of insertion. Although the monofilaments produce a specific force at the instant they buckle,

they are capable of being over-inserted, resulting in greater amounts of contact force. With the potential for clinician biases during neuropathy evaluation, a better tool and methodology are needed to make the exam more reliable and accurate, while simultaneously standardizing the testing protocol. A machine was designed that could change the landscape of neuropathy assessment by automating the evaluation process. It uses the same monofilament that clinicians currently use, but it is attached to a series of belts and pulleys, which allow it to be applied anywhere on the plantar surface of the foot. Paired with a sensor, the machine is capable of applying a range of forces to the surface of the skin in order to quantify a person’s degree of threshold sensitivity. The device includes randomization and false positive assessments built into its testing protocol to remove clinician biases. A camera is used to take a photo of the patient’s foot, serving two purposes: to allow the clinician to select locations to be evaluated and documenting the results so that both are able to see the patient’s current degree of neuropathy. A non-provisional patent application was filed on the design and functionality of the diagnostic tool. It is anticipated that it could become a more accurate screening tool for neuropathy assessment in the future.

Cl i n i ca l Case Repor t | Med i ca l St udent Hysterectomy with Deep Infiltrating Endometriosis Adhesion Disease and Sigmoidectomy – A Surgical Case Report

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A. Clements; H. Walker; S. Hewlett; R. Ashford Brookwood Baptist Health; Grandview Medical Center, Birmingham, AL

Rationale: Endometriosis is a common debilitating gynecological disease associated with chronic pelvic pain and abnormal uterine bleeding. An estimated 10-15% of reproductive age women will suffer from endometriosis. Although the pathophysiology is poorly understood, endometriosis presents a patient with significant morbidity when complicated by pre-existing uterine fibroids. Endometriosis becomes especially problematic when involving the large bowel, often necessitating complicated surgical treatment. Although simple in theory, the management of complicated cases of endometriosis can require multidisciplinary surgical teams to achieve resolution. Case Presentation: A 33-year-old Gravid-two Para-two (G2P2002) African American woman presented with severe pelvic pain and bleeding. The patient has a significant history for uterine fibroids with almost daily bleeding for three months. A diagnosis of Abnormal Uterine Bleeding was made, with pending diagnostic laparoscopy for suspected endometriosis. Surgical history is

significant for tubal ligation eight years prior. After discussion and informed consent, the patient elected definitive therapy of robotic hysterectomy and diagnostic laparoscopy to resolve bleeding as she was complete in her childbearing goals. The initial hysterectomy was aborted due to newly diagnosed deep-infiltrating endometriosis adhesion disease involving the sigmoid colon. After obtaining consent, in order to remove the lesions of endometriosis, an en-bloc hysterectomy and sigmoidectomy was completed with anastomosis of the proximal and distal colon. The case required the utility of a multidisciplinary surgical team consisting of general, urological and gynecological surgeons. Conclusion: We report a case of complicated endometriosis with extensive sigmoid colon involvement requiring abortion of initial robotic hysterectomy and followed up with an en-bloc hysterectomy and sigmoidectomy with subsequent anastomosis due to extensive endometriosis adhesion disease.

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