Digital Commons Network^™

Multiparametric Mri Along With Machine Learning Predicts Prognosis And Treatment Response In Pediatric Low-Grade Glioma, Anahita Fathi Kazerooni, Adam Kraya, Komal Rathi, Meen Chul Kim, Arastoo Vossough, Nastaran Khalili, Ariana Familiar, Deep Gandhi, Neda Khalili, Varun Kesherwani, Debanjan Haldar, Hannah Anderson, Run Jin, Aria Mahtabfar, Sina Bagheri, Yiran Guo, Qi Li, Xiaoyan Huang, Yuankun Zhu, Alex Sickler, Matthew R Lueder, Saksham Phul, Mateusz Koptyra, Phillip Storm, Jeffrey Ware, Yuanquan Song, Christos Davatzikos, Jessica Foster, Sabine Mueller, Michael J Fisher, Adam Resnick, Ali Nabavizadeh

Department of Neurosurgery Faculty Papers

Pediatric low-grade gliomas (pLGGs) exhibit heterogeneous prognoses and variable responses to treatment, leading to tumor progression and adverse outcomes in cases where complete resection is unachievable. Early prediction of treatment responsiveness and suitability for immunotherapy has the potential to improve clinical management and outcomes. Here, we present a radiogenomic analysis of pLGGs, integrating MRI and RNA sequencing data. We identify three immunologically distinct clusters, with one group characterized by increased immune activity and poorer prognosis, indicating potential benefit from immunotherapies. We develop a radiomic signature that predicts these immune profiles with over 80% accuracy. Furthermore, our clinicoradiomic model predicts progression-free …

Nucleus-Translocated Gclm Promotes Chemoresistance In Colorectal Cancer Through A Moonlighting Function, Jin-Fei Lin, Ze-Xian Liu, Dong-Liang Chen, Ren-Ze Huang, Fen Cao, Kai Yu, Ting Li, Hai-Yu Mo, Hui Sheng, Zhi-Bing Liang, Kun Liao, Yi Han, Shan-Shan Li, Zhao-Lei Zeng, Song Gao, Huai-Qiang Ju, Rui-Hua Xu

Faculty, Staff and Student Publications

Metabolic enzymes perform moonlighting functions during tumor progression, including the modulation of chemoresistance. However, the underlying mechanisms of these functions remain elusive. Here, utilizing a metabolic clustered regularly interspaced short palindromic repeats (CRISPR)-Cas9 knockout library screen, we observe that the loss of glutamate-cysteine ligase modifier subunit (GCLM), a rate-limiting enzyme in glutathione biosynthesis, noticeably increases the sensitivity of colorectal cancer (CRC) cells to platinum-based chemotherapy. Mechanistically, we unveil a noncanonical mechanism through which nuclear GCLM competitively interacts with NF-kappa-B (NF-κB)-repressing factor (NKRF), to promote NF-κB activity and facilitate chemoresistance. In response to platinum drug treatment, GCLM is phosphorylated by P38 …

Adverse Prehospital Events And Outcomes After Traumatic Brain Injury, Amelia W Maiga, Hsing-Hua Sylvia Lin, Stephen R Wisniewski, Joshua B Brown, Ernest E Moore, Martin A Schreiber, Bellal Joseph, Chad T Wilson, Bryan A Cotton, Daniel G Ostermayer, Brian G Harbrecht, Mayur B Patel, Jason L Sperry, Francis X Guyette, Henry E Wang

Faculty, Staff and Student Publications

Importance: While national guidelines recommend avoidance of hypoxia, hypotension, and hypocarbia in the prehospital care of traumatic brain injury (TBI), limited data validate the association of these adverse physiologic events with TBI outcomes.

Objective: To validate the associations of prehospital hypoxia, hypotension, and hypocarbia with TBI outcomes in a US national trauma network.

Design, setting, and participants: This cohort study examined data from 8 level I trauma centers and their affiliated ground and air emergency medical services (EMS) agencies in the Linking Investigations in Trauma and Emergency Services (LITES) Network from January 1, 2017, to June 30, 2021. Adult patients …

The Role Of Iowa Gambling Task Performance In Response To Citalopram Treatment For Cocaine Use Disorder, Constanza De Dios, Robert Suchting, Charles E Green, Heather E Webber, F Gerard Moeller, Scott D Lane, Joy Schmitz

Faculty, Staff and Student Publications

Background:

Cocaine use disorder (CUD) is associated with executive functioning impairments linked to serotonergic function. Previous studies reported efficacy with the selective serotonin reuptake inhibitor citalopram in reducing cocaine use.

Objectives:

The current study explored moderation and mediation of citalopram effects on cocaine use by performance across executive function domains.

Methods:

We conducted a secondary analysis of a double-blind, placebo-controlled, randomized Bayesian adaptive trial investigating citalopram efficacy in CUD treatment-seeking adults. At baseline and mid-treatment, participants completed assessments of decision-making (Iowa Gambling Task; IGT), attention, response inhibition, and cognitive flexibility. Outcomes were longest duration of abstinence (LDA; count of consecutive …

Dexamethasone Dose Intensity Does Not Impact Outcomes In Newly Diagnosed Multiple Myeloma: A Secondary Swog Analysis, Rahul Banerjee, Rachael Sexton, Andrew J Cowan, Aaron S Rosenberg, Sikander Ailawadhi, S Vincent Rajkumar, Shaji Kumar, Angela Dispenzieri, Sagar Lonial, Brian G M Durie, Paul G Richardson, Saad Z Usmani, Antje Hoering, Robert Z Orlowski

Faculty, Staff and Student Publications

Dexamethasone is a key component of induction for newly diagnosed multiple myeloma (NDMM), despite common toxicities, including hyperglycemia and insomnia. In the randomized ECOG E4A03 trial, dexamethasone 40 mg once weekly was associated with lower mortality than higher doses. However, the performance of dexamethasone dose reductions below this threshold with regard to progression-free survival (PFS) and overall survival (OS) in NDMM has not been fully characterized. We conducted a secondary pooled analysis of the SWOG 0777 and SWOG 1211 studies of NDMM, which used lenalidomide and dexamethasone (Rd) alone, with or without bortezomib, and with or without elotuzumab. The planned …

Cardiovascular Disease And Breast Cancer Stage At Diagnosi\S, Ivan Angelov, Allen M Haas, Elizabeth Brock, Lingfeng Luo, Jing Zhao, Benjamin D Smith, Sharon H Giordano, Nicholas J Leeper, Kevin T Nead

Faculty, Staff and Student Publications

Importance: Cardiovascular disease (CVD) and cancer are the leading causes of mortality in the US. Large-scale population-based and mechanistic studies support a direct effect of CVD on accelerated tumor growth and spread, specifically in breast cancer.

Objective: To assess whether individuals presenting with advanced breast cancers are more likely to have prevalent CVD compared with those with early-stage breast cancers at the time of diagnosis.

Design, setting, and participants: This population-based case-control study used data from the Surveillance, Epidemiology, and End Results-Medicare linked databases from 2009 to 2020. The analysis was completed from May 2023 to August 2024. Participants were …

Enhanced Motivated Behavior Mediated By Pharmacological Targeting Of The Fgf14/Nav16 Complex In Nucleus Accumbens Neurons, Nolan M Dvorak, Paul A Wadsworth, Guillermo Aquino-Miranda, Pingyuan Wang, Douglas S Engelke, Jingheng Zhou, Nghi Nguyen, Aditya K Singh, Giuseppe Aceto, Zahra Haghighijoo, Isabella I Smith, Nana Goode, Mingxiang Zhou, Yosef Avchalumov, Evan P Troendle, Cynthia M Tapia, Haiying Chen, Reid T Powell, Timothy J Baumgartner, Jully Singh, Leandra Koff, Jessica Di Re, Ann E Wadsworth, Mate Marosi, Marc R Azar, Kristina Elias, Paul Lehmann, Yorkiris M Mármol Contreras, Poonam Shah, Hector Gutierrez, Thomas A Green, Martin B Ulmschneider, Marcello D'Ascenzo, Clifford Stephan, Guohong Cui, Fabricio H Do Monte, Jia Zhou, Fernanda Laezza

Faculty, Staff and Student Publications

Protein/protein interactions (PPI) play crucial roles in neuronal functions. Yet, their potential as drug targets for brain disorders remains underexplored. The fibroblast growth factor 14 (FGF14)/voltage-gated Na+ channel 1.6 (Nav1.6) complex regulates excitability of medium spiny neurons (MSN) of the nucleus accumbens (NAc), a central hub of reward circuitry that controls motivated behaviors. Here, we identified compound 1028 (IUPAC: ethyl 3-(2-(3-(hydroxymethyl)-1H-indol-1-yl)acetamido)benzoate), a brain-permeable small molecule that targets FGF14R117, a critical residue located within a druggable pocket at the FGF14/Nav1.6 PPI interface. We found that 1028 modulates FGF14/Nav1.6 complex assembly and depolarizes the voltage-dependence of Nav1.6 channel inactivation with …

Optimizing Electrode Configurations For Eeg Mild Cognitive Impairment Detection, Yi Jiang, Xin Zhang, Zhiwei Guo, Xiaobo Zhou, Jiayuan He, Ning Jiang

Faculty, Staff and Student Publications

The Optimal electrode configuration of Electroencephalograms (EEG) systems for mild cognitive impairment (MCI) detection and monitoring in non-clinical settings, i.e. number of electrodes and the positions of the electrodes, remains to be explored. In the current study, we explored the optimization of electrode configuration for MCI detection. We used a 32-channel EEG device to record the data of 21 MCI patients and 20 cognitively normal elderly (NC) undergoing working memory (WM) tasks. Based on the differential value (MCI group vs. NC group) from the Power Spectral Density (PSD) value of each electrode in θ and α frequency band during WM …

Atrx Silences Cartpt Expression In Osteoblastic Cells During Skeletal Development, Yi-Ting Chen, Ming-Ming Jiang, Carolina Leynes, Mary Adeyeye, Camilla F Majano, Barakat Ibrahim, Urszula Polak, George Hung, Zixue Jin, Denise G Lanza, Lan Liao, Brian Dawson, Yuqing Chen-Evenson, Oscar E Ruiz, Richard J Gibbons, Jason D Heaney, Yangjin Bae, Brendan Lee

Faculty, Staff and Students Publications

ATP-dependent chromatin remodeling protein ATRX is an essential regulator involved in maintenance of DNA structure and chromatin state and regulation of gene expression during development. ATRX was originally identified as the monogenic cause of X-linked α-thalassemia mental retardation (ATR-X) syndrome. Affected individuals display a variety of developmental abnormalities and skeletal deformities. Studies from others investigated the role of ATRX in skeletal development by tissue-specific Atrx knockout. However, the impact of ATRX during early skeletal development has not been examined. Using preosteoblast-specific Atrx conditional knockout mice, we observed increased trabecular bone mass and decreased osteoclast number in bone. In vitro coculture …

Meta-Ea: A Gene-Specific Combination Of Available Computational Tools For Predicting Missense Variant Effects, Panagiotis Katsonis, Olivier Lichtarge

Faculty, Staff and Students Publications

Computational methods for estimating missense variant impact suffer from inconsistent performance across genes, which poses a major challenge for their reliable use in clinical practice. While ensemble scores leverage multiple prediction methods to enhance consistency, the overrepresentation of certain genes in the training data can bias their outcomes. To address this critical limitation, we propose a gene-specific ensemble framework trained on reference computational annotations rather than on clinical or experimental data. Accordingly, we generate Meta-EA ensemble scores that achieve comparable performance to the top individual predicting method for each gene set. Incorporating the effects of splicing and the allele frequency …

In Vivo Evaluation Of Novel Nanoparticles And Repurposed Pharmaceuticals To Combat Antimicrobial Resistance, Sarah E. Evans

Theses, Dissertations and Capstones

In a 2019 report by the Centers for Disease Control and Prevention (CDC), infections resistant to antibiotic treatment amount to about three million infections and 48,000 deaths. Antimicrobial resistance is an escalating global threat as existing antibiotics lose efficacy over time. The project described is focused on partnering with pharmaceutical researchers and producers to test new nanoparticle-based or repurposed compounds. The central hypothesis of this thesis is that pharmaceutical formulations such as nanoparticles may provide a cost-effective means of combating the emerging antimicrobial resistance. The nanoparticle compounds allowed for a wide range of customization for the pharmaceutical design, since the …

Minimally Invasive Non-Expansile Tubular Extradural Posterior Fossa Decompression (Minted Technique) For The Management Of Chiari I.5 Malformation: Historical Overview Of Surgical Techniques, Technical Note, Proof Of Concept, Illustrative Case And Case Series. Lesser Is Better, José Alberto Israel Romero Rangel, Manuel Eduardo Soto García, Sergio Soriano Solís, Carlos Raúl Rangel Morales, Gerson Reyes Rodríguez, José Antonio Soriano Sánchez

Archives of Neurosurgery

BACKGROUND: Chiari's Malformation surgical treatment has significantly changed since the "classical" technique description by Gardner (1950). It is probably the most commonly performed approach, even when multiple techniques are available because no substantial changes nor any clear surgical objectives have been made. OBJECTIVE: To demonstrate a new cutting-edge surgical technique mastering the advantage of each surgical procedure ever described in the history of Chiari's Malformation establishing three critical points in surgical technique: clear patient-specific surgical goals, dynamic posterior fossa reconstruction, and extradural occipitoatlantal dense-adhesions release. METHODS: A comprehensive review of historically described approaches, proof of concept of surgical technique in …

Beyond The Numbers: A Qualitative Exploration Of Patient Perspectives On Postpartum Care And Maternal Mortality, Kristen A. Waters

Master of Public Health Program Student Publications

Introduction

Montgomery County faces one of Ohio's highest maternal mortality rates, with notable disparities by race. Despite their importance in reducing maternal deaths, up to 40% of women nationwide do not attend a postpartum care (PPC) visit. While well researched guidelines exist regarding the content and timing of PPC visits, there is a lack of patient perspective on this topic, specifically in the Black-identifying population in an area with a significant burden of maternal mortality.

Methods

Semi-structured interviews and focus group sessions were conducted with 31 participants of maternal health community events in Dayton, OH. Participants were asked their opinions …

Traumatic Injuries Of The Common Peroneal Nerve And Current Surgical Strategies For Improving Foot Drop. A Clinical Series And Literature Review., Carlos Alberto Rodríguez Aceves, María Elena Córdoba Mosqueda, Racob Alberto García Velazco, Humberto González Ugalde, Héctor Antonio Soriano Solís, Fabiola Estela Elizabeth Ortega Ponce, Kartik G. Krishnan

Archives of Neurosurgery

Background: Common peroneal nerve injuries are the most frequent nerve injuries in the lower extremity. They may produce severe gait deficits because of weakness or absence in ankle dorsiflexion. Functional improvement after injury, despite any intervention, remains unpredictable. There are various surgical strategies aimed to restore foot drop, but no consensus exists regarding the best surgical treatment.

Objective: In this article, we report our experience and reviewing general aspects of common peroneal nerve anatomy and lesions, current surgical strategies to restore functionality, and the overall outcomes previously published in the literature.

Methods: Retrospective review of patients with foot drop secondary …

Validation Of The Distress Thermometer In A Mexican Population With Brain Tumors: A Diagnostic Accuracy Study, Dan Morgenstern-Kaplan, Sergio Moreno-Jiménez, Fernanda Páez-Plascencia, Angel Ruiz-Chow, Fabiola Flores-Vázquez

Archives of Neurosurgery

Objective: Mental health in cancer patients must be addressed. This study's main objective was to evaluate the sensitivity and specificity of the DT in a population of patients with brain tumors and determine the optimal cut-off point for the DT. Methods: We performed a cross-sectional study at the National Institute of Neurology and Neurosurgery in Mexico City, in a cohort of 110 patients. Results: Of the 108 participants with brain tumors that were included in the analysis (2 patients excluded by incomplete DT), 40 had gliomas, 31 had pituitary adenomas, 21 had meningiomas, and 16 had other types of tumors. …

Suprameatal Tubercle Classification; Its Implementation On Clinical Cases, Humberto Reyna Mendez, Jose Alfredo Espinosa Mora, Laura Ubaldo Reyes, Alberto Angeles Castellanos, Ignacio Mora Magaña, Mauro Alberto Segura Lozano, Rachel Blue, John Yk Lee, Diego Mendez Rosito

Archives of Neurosurgery

Abstract:

Background: The suprameatal tubercle (SMT) is a variable prominence of the petrosal surface of the temporal bone that lies above the internal acoustic meatus. An enlarged SMT may present an obstacle during surgeries of the posterior fossa, including microvascular decompression or by itself cause trigeminal neuralgia.

Methods: Based on our prior study of 200 temporal bones, its data collection and establishing a classification of the SMT this extension study exemplifies its clinical application.

Results: According to the classification of the SMT four selected cases are clinically and anatomically correlated to exemplify the utility of this classification.

Conclusion: The SMT …

The Pipeline Endovascular Device Versus The Flow Re-Direction Endoluminal Device For Cerebral Aneurysm. A One-Year Follow-Up In A Single-Center Experience, Omar Pichardo, Alan Picazo, Omar Castillon, Jonathan Zuniga, Gustavo Alan Juarez Jimenez

Archives of Neurosurgery

Background: The Flow Diverters are devices derived from brain stents, made up of a network of microfilaments of various materials that allow the vessel remodeling. The Pipeline Embolization Device and The Flow Re-Direction Endoluminal Device are the two devices with more global clinical experience. Our objective is to compare the 1-year results using these devices in a cohort of patients assessing their occlusion rate and their clinical outcome as by the modified Rankin Score (mRS).

Methods: In this retrospective nested case-control cohort study, we reviewed the medical records of patients undergoing treatment with a Flow Diverter stent for brain aneurysms …

Chiari Formation And Atlantoaxial Instability. Commentary On Minimally Invasive Non-Expansile Tubular Extradural Posterior Fossa Decompression (Minted Technique) For The Management Of Chiari I.5 Malformation: Historical Overview Of Surgical Techniques, Technical Note, Proof Of Concept, Illustrative Case And Case Series. Lesser Is Better, Atul Goel

Archives of Neurosurgery

The authors have reviewed Chiari formation treatment and have put-forth their personal experience with minimally invasive techniques to perform foramen magnum decompression surgery. Based on the historical review of the subject, the authors have discussed the historical validity of only bone decompression, extra-arachnoidal decompression, and tonsillectomy. The article falls in line with the current minimally invasive surgery wave, a slightly larger cousin of the buttonhole surgery trend. It may be pertinent that I review my understanding of the subject based on the ongoing experience of nearly four decades. In the year 1998, we identified that the posterior fossa volume in …

Archives Of Neurosurgery: The Scientific Home Of Neurosurgery. The Creation Of The Unique Diamond-Open Access Journal In Neurosurgery With An Author-Friendly Advisory Peer-Reviewing And Publishing Policy Within Reach Of Everyone In The World… Born From The Ashes Of A World-Chaos., José Alberto Israel Romero Rangel, Fiacro Jiménez Ponce, José Antonio Soriano Sánchez

Archives of Neurosurgery

This is an editorial article.

Microendoscopic Versus Open Discectomy For The Treatment Of Extruded Lumbar Disc Herniation: A Comparative Cohort Study, Juan Guapo Mendoza, Antonio Guapo Mendoza, Juan Arturo Muciño Mercado, Sonia Melisa Juarez, Arturo Gonzalez, Vianney Guapo Ortiz

Archives of Neurosurgery

Background: Lumbosciatica syndrome affects millions of people worldwide, usually caused by a herniated disc. Most patients with extruded herniated discs are highly symptomatic, and they respond better to surgical treatment. Several studies have tried to compare the efficacy and benefits of microendoscopic discectomy (MED) and open discectomy (OD).

Objective: The objective of this study was to compare the results and complications of our MED experience versus standard OD in patients with lumbar disc extrusion.

Material and methods: We included patients from 18 to 60 years with radicular pain syndrome and single-level extruded disc herniation between January 2015 and December 2020. …

Hypothalamic Hamartoma Related To Pallister-Hall Syndrome In An Adolescent Patient: Illustrative Case., Victor Ramzes Chavez-Herrera, Roberto Casarrubias-Islas, Karen A Leal-Tapia, Rosa L Margarita Flores-Salgado, Juan C Huicochea-Montiel, Bayron A Sandoval-Bonilla

Archives of Neurosurgery

Background: Hypothalamic hamartomas in relationship to Pallister-Hall syndrome are extremely rare; just over 100 cases have been reported. Most hypothalamic hamartomas are sporadic.

Observation(s): A 17-year-old boy presented with a 3-year history of gelastic seizures and a suprasellar mass. The complete physical examination, blood work, and study images resulted in bilateral mesial-polydactyl, metacarpal syndactyly, glandular hypospadias, and hypoplastic nails. There were no hormone or neurological manifestations. MRI studies demonstrated a large non-enhancing suprasellar mass adjacent to the hypothalamus and displaced normal structures. An open biopsy of the mass and genetic studies were carried out to confirm the presumptive diagnosis. After …

Congress Proceedings Of The Xxviii Meeting Of The Mexican Society Of Neurological Surgery

Archives of Neurosurgery

No Abstract for this article.

Functional Foods In Society, Annie Lin, Carolyn Jackson

Faculty Books and Book Chapters

This booklet captures highlights from our Functional Foods in Society in-person activities, where NSU Graduate Nutrition students explore food as medicine through hands-on learning.

Inside, you'll find simple, nourishing dishes and activities using ingredients like anti-inflammatory spices, phytonutrients, quality proteins, and healthy fats.

We hope this inspires you to bring more intention, joy, and nourishment into your everyday meals!

A Thermodynamic Bottleneck In The Tca Cycle Contributes To Acetate Overflow In Staphylococcus Aureus, Nabia Shahreen, Jong-Sam Ahn, Adil Alsiyabi, Niaz Bahar Chowdhury, Dhananjay Shinde, Sujata S. Chaudhari, Kenneth W. Bayles, Vinai Chittezham Thomas, Rajib Saha

Journal Articles: Pathology and Microbiology

During aerobic growth, S. aureus relies on acetate overflow metabolism, a process where glucose is incompletely oxidized to acetate, for its bioenergetic needs. Acetate is not immediately captured as a carbon source and is excreted as waste by cells. The underlying factors governing acetate overflow in S. aureus have not been identified. Here, we show that acetate overflow is favored due to a thermodynamic bottleneck in the TCA cycle specifically involving the oxidation of succinate to fumarate by succinate dehydrogenase. This bottleneck reduces flux through the TCA cycle, making it more efficient for S. aureus to generate ATP via acetate …

A Case Of Injury-Induced Pyoderma Gangrenosum Requiring Skin Graft, Yukiko Brewer, Nameer Ascandar, Tesnim Hamdan, Iryna Witt, Sana Khan, Robert Cropper

West Florida Division GME Research Day 2025

No abstract provided.

Emphysematous Cystitis In A 60-Year-Old Female Who Had Reported No Medical Care For Decades, Taylor O'Brien, Scott Scher, Brian Wexler, Daniel Breznau, Karen Joseph

West Florida Division GME Research Day 2025

No abstract provided.

Superior Vena Cava Syndrome Masquerading As Angioedema: A Chemotherapy Port Complication, Vishal Shah, Philip Mardock, Austin Patrick-Eisenberg, Thaddeus Golden

South Atlantic Division GME Research Day 2025

No abstract provided.

Covid-19 Induced Mda5-Associated Necrotizing Myositis, Sarah Steadman, Amit Sikder, Harsh R. Desai, Bradley Collins, Tiffany Baker, Julie Worthington

South Atlantic Division GME Research Day 2025

No abstract provided.

Transformative Experiences, Anticipatory Regret, And Informed Consent, Elizabeth Lanphier, Shannon Fyfe

Scholarly Articles

Regret risk is not consistently part of information sharing within informed consent. Yet two kinds of decisions that often invoke concerns about future regret, abortion and sterilization, raise considerations for the role of regret in clinical decision-making and informed consent, particularly regarding decisions about potentially transformative experiences. We distinguish between first-personal and second-personal anticipatory regret and argue that first-personal anticipatory regret can play a productive role, but second-personal anticipatory regret can function in ways that are pernicious. Introducing second-personal anticipatory regret into medical informed consent processes is, we argue, not only not required for informed medical decision-making, but impermissible within …

Quaternized Chitosan Derivatives Inhibit Growth And Affect Biofilm Formation Of Staphylococcus Aureus, Alex Miranda, Nichole D. Brandquist, Kristen Johnson, Elena Muldiiarova, Aleksandr Fadeev, Mahboubeh Ghanbari, Jennifer L. Endres, Kenneth W. Bayles, Jason N. Mactaggart, Denis Svechkarev, Marat Sadykov, Yury Salkovskiy

Journal Articles: Pathology and Microbiology

Antimicrobial resistance (AMR) poses a global health threat, severely impeding the effective treatment of bacterial infections and jeopardizing the safety of routine medical procedures. Methicillin-resistant Staphylococcus aureus (MRSA) is particularly problematic because of its resistance to beta-lactams and the ability to form resilient biofilms. Conventional antibiotics, including last-resort options, have serious side effects and may contribute to further resistance. Chitosan, a natural biopolymer, offers a promising alternative due to its biocompatibility and antimicrobial properties, though its effectiveness against biofilms is limited. Recent studies suggest that increasing the positive charge density and adding hydrophobic moieties to chitosan, can enhance its antimicrobial …