Digital Commons Network^™

Dupilumab In Chronic Rhinosinusitis Without Nasal Polyps: Randomized Phase 2 Trial (Orion), Stella E. Lee, Anju T. Peters, Philippe Gevaert, Joseph K. Han, Claus Bachert, Francisco Moreira Da Silva, Andrés Rosenblüt, Chih-Chi Hu, Jennifer Maloney, Paolo Caferra, Adrianna Michalak, Andrew P. Fontenot, Lacey B. Robinson, Neelam A. Phadke

Department of Otolaryngology (ENT) Faculty Publications

BACKGROUND: Chronic rhinosinusitis (CRS) is often driven by type 2 inflammation and is characterized by nasal obstruction/ discharge, facial pain/pressure, and/or reduced smell, either with or without nasal polyps (CRSwNP or CRSsNP).

OBJECTIVE: To test whether dupilumab improves radiographic features in CRSsNP. Methods: ORION (NCT04678856), a phase 2, randomized, multicenter, double blind, placebo-controlled study, assessed dupilumab efficacy and safety in adults with uncontrolled CRSsNP. Patients were randomized 1:1 to dupilumab or placebo for 24 to 52 weeks. Endpoints included changes from baseline at week 24 in Lund–Mackay computed tomography (LMK-CT) score (dupilumab only [primary] and vs placebo [secondary]), sinus Total …

Comparative Spatial Biology: A Cross-Species Analysis Of Canine Oral Cancers As Models For Human Disease, Ram Pradhyumnan

Honors Undergraduate Theses

Oral squamous cell carcinoma (OSCC), one of the most common malignancies of the oral cavity, remains a clinically challenging disease due to its aggressive behavior, late-stage diagnosis, and limited improvements in therapeutic outcomes over recent decades. A significant barrier to progress in OSCC research and treatment is the lack of suitable preclinical models that recapitulate the complexity and natural progression of the disease. Most current models—including cell lines, xenografts, and genetically engineered mice—fail to capture key features such as the spatial organization of tumor epithelium, interactions with an intact immune system, and the stepwise evolution from normal mucosa to invasive …

Invasion Of Microplastics Into The Reproductive Tissues Of Feral And Domestic Felines, Emma K. Quade

Honors Undergraduate Theses

Although plastics have many useful properties in modern society, once these materials are introduced into the environment, they can cause extensive damage. Following degradation into microplastics (MP), plastic particles less than 5 mm in size, these contaminants can make their way into a variety of different environments and organisms. There are many studies that have investigated the prevalence of MP in marine environments, but fewer studies have looked into terrestrial systems, and even less that have focused on contamination in companion animals. This study sought to investigate the invasion of MP into the reproductive tissues of felines, Felis catus, …

How Does The Frequency Of Visits Impact The Quality Of Life For Nursing Home Residents?, Sophie M. Carlton

Honors Undergraduate Theses

This integrative literature review examines the relationship between quantity of visitation and quality of life (QOL) of nursing home residents. The purpose of this review is to examine existing research to determine whether an optimal “dosage” of visitation exists that meaningfully enhances QOL for this vulnerable population. Establishing an evidence based- guideline may help reduce uncertainty for families and promote more consistent improvements in resident well-being. Nursing home residents are the focus of this work because their limited ability to leave the facility makes visitation one of their primary sources of non-occupational social interaction. The COVID19 pandemic further heightened the …

Analyzing Early Medieval Perspectives Of Fetal Development, Nivedha Srinivasan

Honors Undergraduate Theses

This thesis examines early medieval perspectives of fetal development by analyzing two manuscripts: British Library, Cotton Tiberius A III and Leiden University, Vossianus lat. Q69. This study will investigate how knowledge of pregnancy was shared throughout England before the establishment of universities. Interest in medieval reproductive language has piqued in importance in recent years, especially due to modern legal debates surrounding reproductive rights. By examining descriptions of the nine months of fetal development in these two manuscripts, as well as in widely known earlier medical texts like Pliny’s Natural History and Vindicianus’ Gynaecia, this research explores how monastic writers in …

Studying Chronotypes And Their Role In Sleep And Mental Health: A Scoping Review, Evan Nguyen

Honors Undergraduate Theses

Sleep patterns remain a significant public health concern globally, impacting several aspects of life, including mental health. This scoping review examined how chronotype and circadian typology predict mental health, with sleep quality serving as a crucial mediator. While the importance of sleep is widely acknowledged, there is a lack of studies specifically investigating chronotype-aligned interventions to reduce psychological distress. To address the shortage, a comprehensive review of the peer-reviewed literature was conducted, identifying six papers for analysis. These studies mostly utilized cross-sectional designs to assess diverse global groups, including university students, healthcare workers, and military personnel. The results indicate that …

The Role Of Resistance Training In Managing Menopause-Related Changes, Alyson K. Strauss

Honors Undergraduate Theses

Resistance training serves as a critical non-pharmacological strategy for mitigating the physiological and psychological declines associated with the menopausal transition. This natural biological phase, marked by declining estrogen levels, typically leads to accelerated bone mineral density loss, sarcopenia, metabolic regulation disturbance, and heightened mood disturbances. To evaluate the efficacy of targeted exercise interventions, a systematic review was conducted following PRISMA guidelines. From an initial pool of 60 relevant articles, 13 studies met the specific inclusion criteria, focusing on structured resistance training protocols for perimenopausal, menopausal, and postmenopausal cohorts.

The synthesis of these studies indicates that resistance training is a highly …

Looking Beyond Traditional Therapy: The Promising Alternative Of Ketamine-Assisted Treatments In Improving The Quality Of Life Of Veterans, Noa Gutmann

Honors Undergraduate Theses

Posttraumatic stress disorder (PTSD) in United States veterans has a long history of treatment with standard care interventions and therapies. Unfortunately, many modern-day veterans experience treatment resistance and comorbid depressive symptoms that have yet to be resolved. This results in suicidal ideation, hospital readmission, and high treatment dropout rates of care plans. Recent evidence has shown a positive impact of ketamine, and esketamine, therapy on PTSD and depressive symptoms severity. Although, the outcomes and generalizability of this emerging therapy, compared to standard care, are not fully elucidated on. The purpose of this literary review was to further examine the current …

Assessing The Effects Of A Novel Breathing Exercise On Respiratory, Postural, And Muscular Performances, Tristan P. Wilson

Honors Undergraduate Theses

Background: Breathing exercises are used in both clinical and home settings for a variety of purposes. Their functions range from reducing anxiety and stress to recuperating pulmonary function, depending on the technique and style employed. Existing literature has demonstrated that breathing exercises increase Forced Vital Capacity (FVC) and may be able to improve postural stability due to engagement of the diaphragm when regularly practiced.

Objective: The purpose of this study was to determine whether a novel breathing exercise would be effective in improving respiratory, postural, and muscular function.

Methods: In order to evaluate this claim, a randomized, double-blind, controlled study …

Synthesis And Characterization Of Glass-Ceramic Nanoparticles And Nanobubbles For Integration Into Bone Regenerative Biomaterials, Sun Latt

Honors Undergraduate Theses

Osteoporosis affects over 200 million individuals worldwide and is characterized by an imbalance between osteoclastic bone resorption and osteoblastic bone formation, leading to fragility fractures that significantly diminish quality of life. Current clinical bone cements, such as poly(methyl methacrylate), are limited by poor osseointegration, toxic monomers, and an inability to address the underlying pathophysiology of osteoporosis. This work presents the synthesis, characterization, and systematic in vitro evaluation of a sol-gel-derived, magnesium-incorporated glass-ceramic (GC) nanoparticle within the CaO-MgO-SiO₂ system for incorporation into a novel hydrogel bone cement and bioresorbable magnesium implants. XRD confirmed a biphasic amorphous-crystalline diopside composition, and TEM …

Post-Metabolites Of Two Commensal Bacteria Suppress Dna Damage In An Experimental Model Of Acid Reflux Disease, Maanya Pradeep

Honors Undergraduate Theses

Chronic heartburn or gastroesophageal reflux disease (GERD) affects approximately 25% of the US population [1]. Repeated bile acid exposure from the regurgitation of stomach contents leads to the production of reactive oxygen species (ROS), which can cause oxidative DNA damage and promote genomic instability [2]. Barrett’s esophagus (BE), which can develop as a response to chronic bile acid exposure, increases the risk of esophageal adenocarcinoma (EAC) by 30% to 125% [1].

There are more than 18,000 new cases of esophageal cancer in the United States each year, and while its incidence is relatively low compared to other cancers, its mortality …

The Role Of P2y1 And P2y2 Receptors In Human Neural Stem Cell Proliferation, Daria Sokolova

Honors Undergraduate Theses

Endogenous neural stem cells (NSCs) are located in specialized niches of the adult brain and play a vital role in both neurogenesis and neuronal repair. However, declines in NSC proliferation and metabolism associated with age and pathology make these cells less efficient at responding to neurodegenerative disease. Understanding signaling pathways that regulate NSC function is therefore essential for the understanding and development of treatments for these conditions. P2Y receptors are G-protein-coupled purinergic receptors that are activated by extracellular nucleotides and regulate cellular metabolism and proliferation. Among the eight known P2Y subtypes, P2Y1 and P2Y2 have been linked to neuronal signaling …

Recurrence And Co-Occurrence Of Enhancer-Promoter Interactions Across Human Samples, Satvik Gunjala

Honors Undergraduate Theses

Experimental mapping of enhancer-promoter interactions (EPIs) is resource-intensive, and current computational prediction methods struggle with intrinsic genomic complexity and reliance on limited training data. To address this bottleneck and provide insights for improved computational methods, this study systematically analyzed chromatin contact datasets to investigate the recurrence and co-occurrence of enhancer-promoter interactions across human samples. Putative interactions were evaluated across two HiChIP datasets comprising 218 total samples and one Hi-C dataset comprising 266 samples to assess recurrence across samples and assess sequencing depth related to unique EPIs. Additionally, a preliminary item-based collaborative filtering recommender model was developed to assess co-occurrence patterns …

Magnesium-Based Metal Matrix Nanocomposite Implants And Nanobubble-Based Delivery Systems: Integrated Strategies For Bone Loss Treatment With Cytocompatibility Evaluation, Lucas José Martinho Bizuti

Honors Undergraduate Theses

This thesis intends to investigate the development of different multimodal therapeutic strategies for combating bone loss. Most specifically, this paper will emphasize the utilization of Magnesium-Based Metal Matrix Nanocomposite Implants (MMNC) and Nanobubble-Based Delivery Systems as options for future treatment focus. The effects of biodegradable magnesium implants were evaluated for cytotoxicity and cytocompatibility via Hematoxylin and Eosin, and Masson’s Trichrome staining, as well as radiological images. The Nanobubble-Based Delivery System is being developed and optimized as a delivery system to target osteoclast activity. This paper focused on optimizing experimental parameters, which include Rotational speeds for nanobubble stimulation under microgravity conditions …

Relationships Between Quadriceps Neuromuscular Function And Time From Surgery Following Acl Reconstruction Are Sex-Specific, Tatiana Restrepo

Honors Undergraduate Theses

Anterior cruciate ligament reconstruction (ACLR) is associated with persistent quadriceps dysfunction, including muscular weakness and altered spinal and cortical excitability. While recovery has been widely studied, most investigations focus on isolated domains and fixed postoperative time points. Emerging evidence suggests females often experience slower or less complete quadriceps recovery compared to males, yet the time-dependent nature of these sex-specific outcomes remains unclear. The purpose of this study is to examine whether relationships between time since ACLR and quadriceps neuromuscular outcomes differ by sex across muscular, spinal, and cortical domains. Adults aged 18–35 with a history of primary, unilateral ACLR were …

Exploring Anticholinergic Neurotoxicity: Diphenhydramine's Impact On Neuro-2a Cell Morphology, Expression, And Viability, Jordan B. Mcintyre

Honors Undergraduate Theses

Anticholinergic medications, such as diphenhydramine (commonly known as Benadryl), are increasingly recognized for their association with cognitive impairment and neurodegenerative disease. These medications, which inhibit the action of acetylcholine, a neurotransmitter essential for the formation and utilization of the central and peripheral nervous system, have been implicated in conditions such as dementia and may impact fundamental cellular processes like neurogenesis and cell proliferation. This study investigates the effects of diphenhydramine on neurogenesis when introduced to Neuro-2a cells during differentiation. For all studies cells were plated on coverslips or in 6-well plates with differentiation media containing 0 ng/mL, 50 ng/mL, …

A Qualitative Analysis Of Youtube-Based Dietary Messaging On Type 2 Diabetes For South Asians, Sukhmani K. Dhaliwal

Honors Undergraduate Theses

While South Asians experience a disproportionately high risk of Type 2 Diabetes Mellitus (T2DM), culturally tailored dietary guidance remains limited within healthcare settings. As digital platforms increasingly serve as sources of health information, YouTube has grown as a prominent space for the publishing and consumption of dietary advice. This study examines how diet-related messaging about T2DM is communicated in YouTube videos directed at South Asian populations.

Using qualitative thematic analysis, 21 videos published between 2016 and 2025 by influencers with a wide reach were analyzed. Videos were selected based on relevance to South Asian audiences, focus on dietary management of …

A Systematic Literature Review Of The Menstrual Cycle And Its Impact On Aerobic Performance In Female Athletes, Jaymie G. Loidolt

Honors Undergraduate Theses

The purpose of this systematic review is to examine existing literature regarding the menstrual cycle and its impact on aerobic performance in female athletes. This comprehensive review was conducted using the PRISMA 2020 method of analysis. All studies included involved normally menstruating females conditioned in endurance sport. Studies analyzing anaerobic sports, abnormally menstruating females, or physically inactive females were excluded. The databases used included: PubMed, Sport Discus, and Web of Science. The results of these were imported into JBIsumari for deduplication, title and abstract, and full text screening. The results conclude objective performance variables are unchanged regarding the phase of …

Analysis Of Alternative Gene Splicing Of Natural Killer Cell Exhaustion Markers During Siv Infection, Soledad B. Zayas

Honors Undergraduate Theses

Natural killer cells play a critical role in the innate immune response against Human Immunodeficiency Virus and Simian Immunodeficiency Virus infections. During HIV/SIV infection, NK cells undergo functional impairment characterized by an imbalance between activating and inhibitory surface receptors. The upregulation of inhibitory receptors, TIGIT and TIM-3, has proven to contribute to NK cell exhaustion during different retroviral infections. Although alternative splicing regulates immunity related genes, its role in TIGIT and TIM-3 expression during SIV infection remains poorly understood. This study aimed to characterize alternative splicing patterns of TIGIT and TIM-3 and evaluate transcript variant expression during SIV infection in …

The Environmental Impact On The Development Of Equine Degenerative Myeloencephalopathy, Victoria C. Reynolds

Honors Undergraduate Theses

The objective of this study was to examine potential associations between environmental factors and the progression of Equine Degenerative Myeloencephalopathy (EDM). While environmental contributions to neurodegenerative diseases are increasingly recognized in human patients, little is known about their role in EDM. A comprehensive literature review highlighted the lack of research in this area. Data for this study were collected by Dr. Amy Johnson at the University of Pennsylvania's New Bolton Center. The two main areas studied were a horse’s lifestyle (specifically turnout conditions) and their geographical proximity to chemicals (pesticides, airborne neurotoxins, and water contaminants). Statistical analysis revealed there was …

Hexavalent Chromium Promotes Malignant Transformation Via Enhanced Translation Of Suv39h1, Yiwei Gu, Yanan Cao, Qing Ye, Yujing Zhang, Zhishan Wang, Chengfeng Yang, Side Liu, Qing-Bai She

Markey Cancer Center Faculty Publications

Hexavalent chromium [Cr(VI)] is a widespread environmental carcinogen linked to lung cancer and other malignancies. Although genetic and epigenetic mechanisms of Cr(VI)-induced carcinogenesis have been extensively investigated, the role of translational control has remained largely unexplored. Here, we show that chronic low-dose Cr(VI) exposure in BEAS-2BR human bronchial epithelial cells activates eIF4E-driven cap-dependent translation through mTORC1-mediated phosphorylation and inactivation of the translational repressor 4E-BP1. Pharmacological inhibition of this pathway markedly suppresses Cr(VI)-induced cell transformation, cancer stem cell (CSC)-like properties, and DNA damage. Comparable inhibitory effects are observed following raptor knockdown, which disrupts mTORC1, or expression of a constitutively active non-phosphorylatable …

Rna-Micelles As Self-Assembling Structures For Efficient Co-Delivery Of Synergistic Sirna And Nucleoside Analogues To Treat Crc Lung Metastasis, Kai Jin, Piotr G. Rychahou, Daniel W. Binzel, B. Mark Evers, Peixuan Guo

Markey Cancer Center Faculty Publications

SiRNA has been widely studied in cancer gene silencing over the last 25 years. However, few siRNA-based therapeutics have been approved by the FDA. An RNA-micelle platform provides a powerful therapeutic tool through simple one-step, high-yield production that is capable of efficient colorectal cancer lung metastasis treatment, a current lethal condition with a short survival rate post-diagnosis. Here, it is reported that the use of RNA-micelles co-carrying siRNA and nucleoside analogues to completely inhibit lung metastasis of colorectal cancer (CRC). The major advantage of the RNA-micelle is the successful co-delivery of siRNA and chemotherapeutic agent in a single delivery vehicle …

Case Report: Prolonged Response To Cabozantinib And Pembrolizumab In Treatment-Refractory Metastatic Pancreatic Ductal Adenocarcinoma, Anna M. Reagan, Hannah G. Mcdonald, Jaewon Kang, Hoda Saghaeiannejad Esfahani, Caroline G. Wright, Charles J. Bailey, Carleton S. Ellis, Kaylyn R. Collette, Reema A. Patel, Mayte Murillo, Samantha F. Stokley, Michael J. Cavnar, Prakash Pandalai, Mautin T. Barry-Hundeyin, Jessica Moss, Joseph Kim

Markey Cancer Center Faculty Publications

Immunotherapy has yet to demonstrate durable efficacy in pancreatic ductal adenocarcinoma (PDAC) despite the fact that pancreatic cancer cells have higher levels of immune checkpoint expression than other cancer cell types in which immunotherapy efficacy has been well established. We observed effective cytotoxicity with the combination therapy of pembrolizumab (an anti-PD-1 monoclonal antibody, mAb) and cabozantinib (an anti-MET small molecule) in vivo. This served as the basis for an investigator-initiated phase II clinical trial (NCT05052723). The trial was open to patients with treatment-refractory metastatic PDAC with a single-arm treatment protocol of pembrolizumab and cabozantinib. Here, we report the case of …

A Phase 1 Dose Escalation Of Lapatinib And Paclitaxel In Recurrent Ovarian Cancer, Connie D. Cao, Joseph Robert Mccorkle, Donglin Yan, Hoda Saghaeiannejad Esfahani, Rani Jayswal, Dava W. Piecoro, Ning Li, Lauren Baldwin, Rachel W. Miller, Christopher P. Desimone, Charles S. Dietrich, Frederick R. Ueland, Jill M. Kolesar

Markey Cancer Center Faculty Publications

Objective: The development of ABCB1-mediated resistance limits the clinical efficacy of paclitaxel. Lapatinib is a small-molecule reversible tyrosine kinase and ABCB1 inhibitor that could prevent resistance. Our objective was to determine a recommended phase 2 dose (RP2D) of the combination of paclitaxel and lapatinib.

Methods: A phase 1 dose-escalation study utilizing a Bayesian optimal interval (BOIN) design in recurrent ovarian cancer patients was conducted. Patients were pretreated with pulsed lapatinib in the 48 h preceding weekly paclitaxel (80 mg/m²) in 28-day cycles for up to three cycles. We evaluated three lapatinib doses, escalating from 750 to 2000 mg …

Survival Outcomes Of First-Line Therapy In De Novo Metastatic Urothelial Carcinoma With Histologic Subtypes: A National Cancer Database Analysis, Zin W. Myint, Feitong Lei, Bin Huang

Markey Cancer Center Faculty Publications

Background: Urothelial carcinoma with histologic subtypes represent an aggressive and understudied population frequently excluded from prospective clinical trials. Evidence guiding optimal first-line systemic therapy in de novo metastatic disease with histologic subtypes remains limited.

Method: Patients with de novo stage IV urothelial carcinoma with histologic subtypes diagnosed between 2016 and 2021 were identified from the National Cancer Database (NCDB). Eligible patients received first-line chemotherapy, immunotherapy, or concurrent chemoimmunotherapy (both modalities initiated within 30 days). Overall survival (OS) was compared across groups using Kaplan–Meier methods and compared using log-rank tests and multivariable Cox regression. Result: Among 800 patients, 596 (74.5%) received …

Eef2k Promotes Immune Evasion In Melanoma Via Cyclin D1–Mediated Stabilization Of Pd-L1, Yijie Ren, Darby J. Ballard, Anil Kumar, Andy F. Song, Mitiksha Gupta, Xiaofang Xiong, Xingcong Ren, Jugal Kishore Das, Jin-Ming Yang, Jianxun Song

Markey Cancer Center Faculty Publications

Eukaryotic elongation factor 2 kinase (eEF2K) is a stress-responsive regulator of protein synthesis implicated in melanoma progression, but its role in tumor immune evasion remains poorly defined. We investigated how eEF2K influences programmed death ligand 1 (PD-L1) expression through modulation of Cyclin D1. We analyzed gene expression and dependency datasets from The Cancer Genome Atlas and the Cancer Dependency Map. Protein–protein interactions were assessed by co-immunoprecipitation. Cyclin D1 was inhibited pharmacologically with palbociclib. Immune responses were evaluated in murine B16-OVA and human A2058 melanoma models using flow cytometry and immunohistochemistry after genetic or pharmacologic modulation of eEF2K and Cyclin D1. …

Improving Blood Pressure Control Through Lifestyle Modification In African Americans Adults With Uncontrolled Hypertension, Tasha Leonard

Doctor of Nursing Practice (DNP) Scholarly Projects

African American adults have the highest incidence of uncontrolled hypertension (HTN), leading to premature cardiovascular death in Texas and worldwide. In a South Texas cardiac clinic, over 90% of African American adults with HTN also have obesity, compared with 55% of their Caucasian counterparts. The most prevalent factor affecting this group is poor understanding of blood pressure management, which leads to nonadherence to dietary and exercise recommendations, medication regimens, and blood pressure monitoring. The objective was to determine whether lifestyle modification using a hypertensive bundle would improve blood pressure management among African American adults in the clinical setting. The initiative …

Multisite, Multiancestry Genome-Wide Association Study Meta-Analysis Of Functional Seizure Disorder In A Hospital Sample Of 675,680 Patients, Slavina B Goleva, Costin Leu, Yen-Chen Anne Feng, David Burstein, Sanan Venkatesh, Rebecca Birnbaum, Veera M Rajagopal, Peter Straub, Jakob Christensen, Jocelyn F Bautista, Robyn M Busch, Imad M Najm, Jakob Grove, Anders D Børglum, Georgios Voloudakis, Panos Roussos, Jordan Smoller, Dennis Lal, Lea K Davis

Faculty, Staff and Student Publications

Background: Functional seizures (FS) are paroxysmal episodes that phenotypically resemble epileptic seizures but are not associated with brain epileptiform discharges; they are also known as psychogenic nonepileptic seizures. The exact etiology and pathophysiology of FS is unknown; however, trauma and stress-related disorders are known risk factors.

Methods: We used a validated algorithm applied to electronic health records to identify individuals with FS in 6 international biobanks and hospital sites. We conducted a multisite FS genome-wide association study (GWAS) meta-analysis, including 10,910 FS cases (9040 predicted European ancestry [EA] and 1870 predicted African ancestry [AA]) and 664,500 (561,150 EA and 103,350 …

Optimisation Of Sampling For A New Skin Microbiome Assay Pilot Study, Anita Smith

Theses

Recent interest in the diverse ecosystem of bacteria, fungi and viruses that make up the skin microbiome has led to numerous studies investigating the microbiome in healthy skin and in dermatological diseases. An imbalance of the normal skin microbial flora can cause some skin diseases, and current culture techniques are often unable to detect a microorganism to further our understanding of the clinical–microbiological correlates of disease and dysbiosis. Atopic dermatitis and rosacea are presentations that General practitioners (GPs) often manage that may have an infective or microbiological component and can be challenging to treat. Further research using culture-independent techniques is …

Breast Milk Versus Formula Feeding In The Development Of Necrotizing Enterocolitis Among Nicu Infants: An Integrative Review, Mackenzie Jameson, Faye Li, Liudmila Ryzhova, Mia Smith

Master's Projects

Introduction/Question: NEC is a serious condition characterized by the death of intestinal tissue, primarily affecting premature infants or those with low birth weight. The incidence of NEC poses a significant concern in neonatal healthcare due to its substantial mortality risk, particularly among vulnerable populations. This condition can lead to various complications, including sepsis, nutritional deficiencies, delays in growth and development, and, in severe cases, death. NEC not only impacts the health of the infant but also affects the emotional well-being and bonding experiences of parents. Despite advancements in neonatal care, the rate of NEC has increased, highlighting the need …