Amanda Filiberto - Academia.edu (original) (raw)

Papers by Amanda Filiberto

Research paper thumbnail of National Surgical Quality Improvement Project and acute kidney injury: Getting with the times

Research paper thumbnail of Outcomes Of Open Mesenteric Bypass For Chronic Mesenteric Ischemia Among Elderly Patients

Annals of Vascular Surgery

Research paper thumbnail of Objective predictors of intern performance

BMC Medical Education

Background Residency programs select medical students for interviews and employment using metrics... more Background Residency programs select medical students for interviews and employment using metrics such as the United States Medical Licensing Examination (USMLE) scores, grade-point average (GPA), and class rank/quartile. It is unclear whether these metrics predict performance as an intern. This study tested the hypothesis that performance on these metrics would predict intern performance. Methods This single institution, retrospective cohort analysis included 244 graduates from four classes (2015–2018) who completed an Accreditation Council for Graduate Medical Education (ACGME) certified internship and were evaluated by program directors (PDs) at the end of the year. PDs provided a global assessment rating and ratings addressing ACGME competencies (response rate = 47%) with five response options: excellent = 5, very good = 4, acceptable = 3, marginal = 2, unacceptable = 1. PDs also classified interns as outstanding = 4, above average = 3, average = 2, and below average = 1 relativ...

Research paper thumbnail of A simulation curriculum for laparoscopic common bile duct exploration, balloon sphincterotomy, and endobiliary stenting: Associations with resident performance and autonomy in the operating room

Research paper thumbnail of Renal Artery Stenosis Impacts Postoperative Complications After Major Vascular Surgery

Annals of Vascular Surgery

Research paper thumbnail of Resident Operative Autonomy and Attending Verbal Feedback Differ by Resident and Attending Gender

Journal of the American College of Surgeons

Research paper thumbnail of Resolution of inflammation via RvD1 / FPR2 signaling mitigates Nox2 activation and ferroptosis of macrophages in experimental abdominal aortic aneurysms

Research paper thumbnail of Intraoperative hypotension and complications after vascular surgery: A scoping review

Surgery

Background: Intraoperative hypotension (IOH) during major surgery is associated with adverse heal... more Background: Intraoperative hypotension (IOH) during major surgery is associated with adverse health outcomes. This phenomenon represents a potentially important therapeutic target for vascular surgery patients, who may be uniquely vulnerable to IOH. This review summarizes current evidence regarding the impact of IOH on postoperative complications in patients undergoing vascular surgery, focusing on potentially modifiable procedure-and patient-specific risk factors. Methods: A scoping review of the literature from Embase, MEDLINE, and PubMed databases was conducted from inception to December 2019 to identify articles related to the effects of IOH on patients undergoing vascular surgery. Results: Ninety-two studies met screening criteria; nine studies met quality and inclusion criteria. Among the nine studies that defined IOH objectively, there were nine different definitions. Accordingly, the reported incidence of IOH ranged from 8 to 88% (when defined as a fall in SBP of >30 mmHg or MAP <65). The results demonstrated that IOH is an independent risk factor for longer hospital length of stay, myocardial injury, acute kidney injury, postoperative mechanical ventilation, and early mortality. Vascular surgery patients with comorbid conditions that confer increased vulnerability to hypoperfusion and ischemia appear to be susceptible to the adverse effects of IOH. Conclusions: There is no validated, consensus definition of IOH or other hemodynamic parameters associated with increased risk for adverse outcomes. Despite these limitations, the

Research paper thumbnail of Maresin 1 activates LGR6 signaling to inhibit smooth muscle cell activation and attenuate murine abdominal aortic aneurysm formation

The FASEB Journal, 2021

The specialized pro-resolving lipid mediator Maresin 1 (MaR1) is involved in the resolution phase... more The specialized pro-resolving lipid mediator Maresin 1 (MaR1) is involved in the resolution phase of tissue inflammation. It was hypothesized that exogenous administration of MaR1 would attenuate abdominal aortic aneurysm (AAA) growth in a cytokine-dependent manner via LGR6 receptor signaling and macrophage-dependent efferocytosis of smooth muscle cells (SMCs). AAAs were induced in C57BL/6 wild-type (WT) mice and smooth muscle cell specific TGF-β2 receptor knockout (SMC-TGFβr2 −/−) mice using a topical elastase AAA model. MaR1 treatment significantly attenuated AAA growth as well as increased aortic SMC α-actin and TGF-β2 expressions in WT mice, but not SMC-TGFβr2 −/− mice, compared to vehicle-treated mice. In vivo inhibition of LGR6 receptors obliterated MaR1-dependent protection in AAA formation and SMC α-actin expression. Furthermore, MaR1 upregulated macrophage-dependent efferocytosis of apoptotic SMCs in murine aortic tissue during AAA formation. In vitro studies demonstrate that MaR1-LGR6 interaction upregulates TGF-β2 expression and decreases MMP2 activity during crosstalk of macrophage-apoptotic SMCs. In summary, these results demonstrate that MaR1 activates LGR6 receptors to upregulate macrophage-dependent efferocytosis, increases TGF-β expression, preserves aortic wall remodeling and attenuate AAA formation. Therefore, this study demonstrates the potential of MaR1-LGR6 mediated mitigation of vascular remodeling through increased efferocytosis of apoptotic SMCs via TGF-β2 to attenuate AAA formation.

Research paper thumbnail of Abstract 11622: Resolution of Inflammation via Rvd1/fpr2 Signaling in Abdominal Aortic Aneurysms

Circulation, 2021

Introduction: Resolvin D1 (RvD1) is derived from a ω-3 polyunsaturated fatty acid and is involved... more Introduction: Resolvin D1 (RvD1) is derived from a ω-3 polyunsaturated fatty acid and is involved in the resolution phase of inflammation during abdominal aortic aneurysm (AAA) formation. Hypothesis: The aim of this study was to decipher the protective role of RvD1 via formyl peptide receptor 2 (FPR2) receptor signaling in attenuating AAA formation. Methods: C57BL/6 (WT) and FPR2 -/- mice (8-12 week old) underwent treatment with topical elastase or heat-inactivated elastase (control). Separate groups of mice were administered RvD1 (100ng/kg) or saline i.p. daily from day(d)1 to d13 and aortic diameter was measured by video micrometry on d14. mRNA quantification of FPR2 expression in aortic tissue was performed by RT-PCR on d7, 14 and 21. Human aortic tissue from AAA patients and controls (organ transplant donors) were analyzed for quantification of FPR2 expression. Data is presented as mean ± SEM and statistical analysis was performed by using Mann-Whitney test for phenotype or Wilc...

Research paper thumbnail of Pregnancy perceptions and experiences for surgeons and surgical trainees

Vascular Disease in Women, 2021

Research paper thumbnail of Performance Improvement With Implementation of a Surgical Skills Curriculum

Journal of Surgical Education, 2021

OBJECTIVE: To assess the efficacy of an intern surgical skills curriculum involving a boot camp f... more OBJECTIVE: To assess the efficacy of an intern surgical skills curriculum involving a boot camp for core open and laparoscopic skills, self-guided practice with positive and negative incentives, and semiannual performance evaluations.

Research paper thumbnail of Comparison of Operative Characteristics and Outcomes After Infected Endovascular and Open Surgical Abdominal Aortic Graft Excision

Journal of Vascular Surgery, 2021

Research paper thumbnail of Editorial: Machine Learning in Clinical Decision-Making

Frontiers in Digital Health, 2021

Research paper thumbnail of Cardiovascular and Renal Disease in Chronic Critical Illness

Journal of Clinical Medicine, 2021

With advances in critical care, patients who would have succumbed in previous eras now survive th... more With advances in critical care, patients who would have succumbed in previous eras now survive through hospital discharge. Many survivors suffer from chronic organ dysfunction and induced frailty, representing an emerging chronic critical illness (CCI) phenotype. Persistent and worsening cardiovascular and renal disease are primary drivers of the CCI phenotype and have pathophysiologic synergy, potentiating one another and generating a downward spiral of worsening disease and clinical outcomes manifest as cardio-renal syndromes. In addition to pharmacologic therapies (e.g., diuretics, beta adrenergic receptor blockers, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and blood pressure control), special consideration should be given to behavioral modifications that avoid the pitfalls of polypharmacy and suboptimal renal and hepatic dosing, to which CCI patients may be particularly vulnerable. Smoking cessation, dietary modifications (e.g., early high-prote...

Research paper thumbnail of Optimizing predictive strategies for acute kidney injury after major vascular surgery

Surgery, 2021

Background: Postoperative acute kidney injury (AKI) is common after major vascular surgery, and i... more Background: Postoperative acute kidney injury (AKI) is common after major vascular surgery, and is associated with increased morbidity, mortality and cost. High-performance risk stratification using a machine learning model can inform strategies that mitigate harm and optimize resource use. It is hypothesized that incorporating intraoperative data would improve machine learning model accuracy, discrimination and precision in predicting AKI among patients undergoing major vascular surgery. Methods: A single-center retrospective cohort of 1,531 adult patients who underwent nonemergent major vascular surgery including open aortic, endovascular aortic, and lower extremity bypass procedures was evaluated. The validated, automated MySurgeryRisk analytics platform used electronic health record data to forecast patient-level probabilistic risk scores for postoperative acute kidney injury using random forest models with preoperative data alone and perioperative data (preoperative plus intraoperative). The MySurgeryRisk predictions were compared with each other as well as with the American Society of Anesthesiologists (ASA) physical status classification. Results: Machine learning models using perioperative data had greater accuracy, discrimination and precision than models using either preoperative data alone or ASA physical status classification (accuracy

Research paper thumbnail of Maresin 1 Attenuates Murine Abdominal Aortic Aneurysms Via Vascular Smooth Muscle Cell-Dependent Transforming Growth Factor-β Signaling

JVS: Vascular Science, 2020

Research paper thumbnail of Metabolomic Profiling for Diagnosis and Prognostication in Surgery: A Scoping Review

Annals of Surgery, 2020

Objective: This review assimilates and critically evaluates available literature regarding the us... more Objective: This review assimilates and critically evaluates available literature regarding the use of metabolomic profiling in surgical decision-making. Summary Background Data: Metabolomic profiling is performed by nuclear magnetic resonance spectroscopy or mass spectrometry of biofluids and tissues to quantify biomarkers (i.e. sugars, amino acids, and lipids), producing diagnostic and prognostic information that has been applied among patients with cardiovascular disease, inflammatory bowel disease, cancer, and solid organ transplants. Methods: PubMed was searched from 1995-2019 to identify studies investigating metabolomic profiling of surgical patients. Articles were included and assimilated into relevant categories per PRISMA-ScR guidelines. Results were summarized with descriptive analytical methods. Results: Forty-seven studies were included, most of which were retrospective studies with small sample sizes using various combinations of analytic techniques and types of biofluids and tissues. Results suggest that metabolomic profiling has potential to effectively screen for surgical diseases, suggest diagnoses, and predict outcomes such as postoperative complications and disease recurrence. Major barriers to clinical adoption include a lack of high-level evidence from prospective studies, heterogeneity in study design regarding tissue and biofluid procurement and analytical methods, and the absence of large, multicenter metabolome databases to facilitate systematic investigation of the efficacy, reproducibility, and generalizability of metabolomic profiling diagnoses and prognoses.

Research paper thumbnail of Artificial Intelligence and Surgical Decision-making

JAMA Surgery, 2020

IMPORTANCE-Surgeons make complex, high-stakes decisions under time constraints and uncertainty, w... more IMPORTANCE-Surgeons make complex, high-stakes decisions under time constraints and uncertainty, with significant effect on patient outcomes. This review describes the weaknesses of traditional clinical decision-support systems and proposes that artificial intelligence should be used to augment surgical decision-making. OBSERVATIONS-Surgical decision-making is dominated by hypothetical-deductive reasoning, individual judgment, and heuristics. These factors can lead to bias, error, and preventable harm. Traditional predictive analytics and clinical decision-support systems are intended to augment surgical decision-making, but their clinical utility is compromised by time-consuming manual data management and suboptimal accuracy. These challenges can be overcome by automated artificial intelligence models fed by livestreaming electronic health record data with mobile device outputs. This approach would require data standardization, advances in model interpretability, careful implementation and monitoring, attention to ethical challenges involving algorithm bias and accountability for errors, and preservation of bedside assessment and human intuition in the decision-making process.

Research paper thumbnail of Treatment and Outcomes Of Aortic Graft Infections: A Single Center Experience

Annals of Vascular Surgery, 2020

Research paper thumbnail of National Surgical Quality Improvement Project and acute kidney injury: Getting with the times

Research paper thumbnail of Outcomes Of Open Mesenteric Bypass For Chronic Mesenteric Ischemia Among Elderly Patients

Annals of Vascular Surgery

Research paper thumbnail of Objective predictors of intern performance

BMC Medical Education

Background Residency programs select medical students for interviews and employment using metrics... more Background Residency programs select medical students for interviews and employment using metrics such as the United States Medical Licensing Examination (USMLE) scores, grade-point average (GPA), and class rank/quartile. It is unclear whether these metrics predict performance as an intern. This study tested the hypothesis that performance on these metrics would predict intern performance. Methods This single institution, retrospective cohort analysis included 244 graduates from four classes (2015–2018) who completed an Accreditation Council for Graduate Medical Education (ACGME) certified internship and were evaluated by program directors (PDs) at the end of the year. PDs provided a global assessment rating and ratings addressing ACGME competencies (response rate = 47%) with five response options: excellent = 5, very good = 4, acceptable = 3, marginal = 2, unacceptable = 1. PDs also classified interns as outstanding = 4, above average = 3, average = 2, and below average = 1 relativ...

Research paper thumbnail of A simulation curriculum for laparoscopic common bile duct exploration, balloon sphincterotomy, and endobiliary stenting: Associations with resident performance and autonomy in the operating room

Research paper thumbnail of Renal Artery Stenosis Impacts Postoperative Complications After Major Vascular Surgery

Annals of Vascular Surgery

Research paper thumbnail of Resident Operative Autonomy and Attending Verbal Feedback Differ by Resident and Attending Gender

Journal of the American College of Surgeons

Research paper thumbnail of Resolution of inflammation via RvD1 / FPR2 signaling mitigates Nox2 activation and ferroptosis of macrophages in experimental abdominal aortic aneurysms

Research paper thumbnail of Intraoperative hypotension and complications after vascular surgery: A scoping review

Surgery

Background: Intraoperative hypotension (IOH) during major surgery is associated with adverse heal... more Background: Intraoperative hypotension (IOH) during major surgery is associated with adverse health outcomes. This phenomenon represents a potentially important therapeutic target for vascular surgery patients, who may be uniquely vulnerable to IOH. This review summarizes current evidence regarding the impact of IOH on postoperative complications in patients undergoing vascular surgery, focusing on potentially modifiable procedure-and patient-specific risk factors. Methods: A scoping review of the literature from Embase, MEDLINE, and PubMed databases was conducted from inception to December 2019 to identify articles related to the effects of IOH on patients undergoing vascular surgery. Results: Ninety-two studies met screening criteria; nine studies met quality and inclusion criteria. Among the nine studies that defined IOH objectively, there were nine different definitions. Accordingly, the reported incidence of IOH ranged from 8 to 88% (when defined as a fall in SBP of >30 mmHg or MAP <65). The results demonstrated that IOH is an independent risk factor for longer hospital length of stay, myocardial injury, acute kidney injury, postoperative mechanical ventilation, and early mortality. Vascular surgery patients with comorbid conditions that confer increased vulnerability to hypoperfusion and ischemia appear to be susceptible to the adverse effects of IOH. Conclusions: There is no validated, consensus definition of IOH or other hemodynamic parameters associated with increased risk for adverse outcomes. Despite these limitations, the

Research paper thumbnail of Maresin 1 activates LGR6 signaling to inhibit smooth muscle cell activation and attenuate murine abdominal aortic aneurysm formation

The FASEB Journal, 2021

The specialized pro-resolving lipid mediator Maresin 1 (MaR1) is involved in the resolution phase... more The specialized pro-resolving lipid mediator Maresin 1 (MaR1) is involved in the resolution phase of tissue inflammation. It was hypothesized that exogenous administration of MaR1 would attenuate abdominal aortic aneurysm (AAA) growth in a cytokine-dependent manner via LGR6 receptor signaling and macrophage-dependent efferocytosis of smooth muscle cells (SMCs). AAAs were induced in C57BL/6 wild-type (WT) mice and smooth muscle cell specific TGF-β2 receptor knockout (SMC-TGFβr2 −/−) mice using a topical elastase AAA model. MaR1 treatment significantly attenuated AAA growth as well as increased aortic SMC α-actin and TGF-β2 expressions in WT mice, but not SMC-TGFβr2 −/− mice, compared to vehicle-treated mice. In vivo inhibition of LGR6 receptors obliterated MaR1-dependent protection in AAA formation and SMC α-actin expression. Furthermore, MaR1 upregulated macrophage-dependent efferocytosis of apoptotic SMCs in murine aortic tissue during AAA formation. In vitro studies demonstrate that MaR1-LGR6 interaction upregulates TGF-β2 expression and decreases MMP2 activity during crosstalk of macrophage-apoptotic SMCs. In summary, these results demonstrate that MaR1 activates LGR6 receptors to upregulate macrophage-dependent efferocytosis, increases TGF-β expression, preserves aortic wall remodeling and attenuate AAA formation. Therefore, this study demonstrates the potential of MaR1-LGR6 mediated mitigation of vascular remodeling through increased efferocytosis of apoptotic SMCs via TGF-β2 to attenuate AAA formation.

Research paper thumbnail of Abstract 11622: Resolution of Inflammation via Rvd1/fpr2 Signaling in Abdominal Aortic Aneurysms

Circulation, 2021

Introduction: Resolvin D1 (RvD1) is derived from a ω-3 polyunsaturated fatty acid and is involved... more Introduction: Resolvin D1 (RvD1) is derived from a ω-3 polyunsaturated fatty acid and is involved in the resolution phase of inflammation during abdominal aortic aneurysm (AAA) formation. Hypothesis: The aim of this study was to decipher the protective role of RvD1 via formyl peptide receptor 2 (FPR2) receptor signaling in attenuating AAA formation. Methods: C57BL/6 (WT) and FPR2 -/- mice (8-12 week old) underwent treatment with topical elastase or heat-inactivated elastase (control). Separate groups of mice were administered RvD1 (100ng/kg) or saline i.p. daily from day(d)1 to d13 and aortic diameter was measured by video micrometry on d14. mRNA quantification of FPR2 expression in aortic tissue was performed by RT-PCR on d7, 14 and 21. Human aortic tissue from AAA patients and controls (organ transplant donors) were analyzed for quantification of FPR2 expression. Data is presented as mean ± SEM and statistical analysis was performed by using Mann-Whitney test for phenotype or Wilc...

Research paper thumbnail of Pregnancy perceptions and experiences for surgeons and surgical trainees

Vascular Disease in Women, 2021

Research paper thumbnail of Performance Improvement With Implementation of a Surgical Skills Curriculum

Journal of Surgical Education, 2021

OBJECTIVE: To assess the efficacy of an intern surgical skills curriculum involving a boot camp f... more OBJECTIVE: To assess the efficacy of an intern surgical skills curriculum involving a boot camp for core open and laparoscopic skills, self-guided practice with positive and negative incentives, and semiannual performance evaluations.

Research paper thumbnail of Comparison of Operative Characteristics and Outcomes After Infected Endovascular and Open Surgical Abdominal Aortic Graft Excision

Journal of Vascular Surgery, 2021

Research paper thumbnail of Editorial: Machine Learning in Clinical Decision-Making

Frontiers in Digital Health, 2021

Research paper thumbnail of Cardiovascular and Renal Disease in Chronic Critical Illness

Journal of Clinical Medicine, 2021

With advances in critical care, patients who would have succumbed in previous eras now survive th... more With advances in critical care, patients who would have succumbed in previous eras now survive through hospital discharge. Many survivors suffer from chronic organ dysfunction and induced frailty, representing an emerging chronic critical illness (CCI) phenotype. Persistent and worsening cardiovascular and renal disease are primary drivers of the CCI phenotype and have pathophysiologic synergy, potentiating one another and generating a downward spiral of worsening disease and clinical outcomes manifest as cardio-renal syndromes. In addition to pharmacologic therapies (e.g., diuretics, beta adrenergic receptor blockers, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and blood pressure control), special consideration should be given to behavioral modifications that avoid the pitfalls of polypharmacy and suboptimal renal and hepatic dosing, to which CCI patients may be particularly vulnerable. Smoking cessation, dietary modifications (e.g., early high-prote...

Research paper thumbnail of Optimizing predictive strategies for acute kidney injury after major vascular surgery

Surgery, 2021

Background: Postoperative acute kidney injury (AKI) is common after major vascular surgery, and i... more Background: Postoperative acute kidney injury (AKI) is common after major vascular surgery, and is associated with increased morbidity, mortality and cost. High-performance risk stratification using a machine learning model can inform strategies that mitigate harm and optimize resource use. It is hypothesized that incorporating intraoperative data would improve machine learning model accuracy, discrimination and precision in predicting AKI among patients undergoing major vascular surgery. Methods: A single-center retrospective cohort of 1,531 adult patients who underwent nonemergent major vascular surgery including open aortic, endovascular aortic, and lower extremity bypass procedures was evaluated. The validated, automated MySurgeryRisk analytics platform used electronic health record data to forecast patient-level probabilistic risk scores for postoperative acute kidney injury using random forest models with preoperative data alone and perioperative data (preoperative plus intraoperative). The MySurgeryRisk predictions were compared with each other as well as with the American Society of Anesthesiologists (ASA) physical status classification. Results: Machine learning models using perioperative data had greater accuracy, discrimination and precision than models using either preoperative data alone or ASA physical status classification (accuracy

Research paper thumbnail of Maresin 1 Attenuates Murine Abdominal Aortic Aneurysms Via Vascular Smooth Muscle Cell-Dependent Transforming Growth Factor-β Signaling

JVS: Vascular Science, 2020

Research paper thumbnail of Metabolomic Profiling for Diagnosis and Prognostication in Surgery: A Scoping Review

Annals of Surgery, 2020

Objective: This review assimilates and critically evaluates available literature regarding the us... more Objective: This review assimilates and critically evaluates available literature regarding the use of metabolomic profiling in surgical decision-making. Summary Background Data: Metabolomic profiling is performed by nuclear magnetic resonance spectroscopy or mass spectrometry of biofluids and tissues to quantify biomarkers (i.e. sugars, amino acids, and lipids), producing diagnostic and prognostic information that has been applied among patients with cardiovascular disease, inflammatory bowel disease, cancer, and solid organ transplants. Methods: PubMed was searched from 1995-2019 to identify studies investigating metabolomic profiling of surgical patients. Articles were included and assimilated into relevant categories per PRISMA-ScR guidelines. Results were summarized with descriptive analytical methods. Results: Forty-seven studies were included, most of which were retrospective studies with small sample sizes using various combinations of analytic techniques and types of biofluids and tissues. Results suggest that metabolomic profiling has potential to effectively screen for surgical diseases, suggest diagnoses, and predict outcomes such as postoperative complications and disease recurrence. Major barriers to clinical adoption include a lack of high-level evidence from prospective studies, heterogeneity in study design regarding tissue and biofluid procurement and analytical methods, and the absence of large, multicenter metabolome databases to facilitate systematic investigation of the efficacy, reproducibility, and generalizability of metabolomic profiling diagnoses and prognoses.

Research paper thumbnail of Artificial Intelligence and Surgical Decision-making

JAMA Surgery, 2020

IMPORTANCE-Surgeons make complex, high-stakes decisions under time constraints and uncertainty, w... more IMPORTANCE-Surgeons make complex, high-stakes decisions under time constraints and uncertainty, with significant effect on patient outcomes. This review describes the weaknesses of traditional clinical decision-support systems and proposes that artificial intelligence should be used to augment surgical decision-making. OBSERVATIONS-Surgical decision-making is dominated by hypothetical-deductive reasoning, individual judgment, and heuristics. These factors can lead to bias, error, and preventable harm. Traditional predictive analytics and clinical decision-support systems are intended to augment surgical decision-making, but their clinical utility is compromised by time-consuming manual data management and suboptimal accuracy. These challenges can be overcome by automated artificial intelligence models fed by livestreaming electronic health record data with mobile device outputs. This approach would require data standardization, advances in model interpretability, careful implementation and monitoring, attention to ethical challenges involving algorithm bias and accountability for errors, and preservation of bedside assessment and human intuition in the decision-making process.

Research paper thumbnail of Treatment and Outcomes Of Aortic Graft Infections: A Single Center Experience

Annals of Vascular Surgery, 2020