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Unitary Rational Functions: The Scaled Quaternion Case, Daniel Alpay, Ilwoo Choo, Mihaela Vajiac

Mathematics, Physics, and Computer Science Faculty Articles and Research

We develop the theory of minimal realizations and factorizations of rational functions where the coefficient space is a ring of the type introduced in our previous work, the scaled quaternions, which includes as special cases the quaternions and the split quaternions. The methods involved are not a direct generalization of the complex or quaternionic settings, and in particular, the adjoint is not the classical adjoint and we use properties of real Hilbert spaces. This adjoint allows to define the counterpart of unitarity for matrix-rational functions, and we develop the corresponding theories of realizations and unitary factorizations. We also begin a …

Cd8+ T Cells In The Tumor Microenvironment Modulate The Response To Endocrine Therapy In Breast Cancer, Fabiana Napolitano, Yunguan Wang, Dhivya R Sudhan, Paula I Gonzalez-Ericsson, Luigi Formisano, Shahbano Shakeel, Khushi Ahuja, Lei Guo, María Rosario Chica-Parrado, Yuki Matsunaga, Pamela Luna, Chang-Ching A Lin, Yasuaki Uemoto, Kyung-Min Lee, Hongli Ma, Nathaniel J Evans, Alberto Servetto, Saurabh Mendiratta, Spencer D Barnes, Roberto Bianco, Yisheng V Fang, Lin Xu, Jeon Lee, Tao Wang, Justin M Balko, Gordon B Mills, Marilyne Labrie, Ariella B Hanker, Carlos L Arteaga

Faculty, Staff and Student Publications

The role of the tumor immune microenvironment (TIME) in modulating responses to antiestrogen therapy in hormone receptor-positive (HR+) breast cancers remains unclear. We analyzed pre- and on-treatment biopsies from patients with HR+ breast cancer treated with letrozole to induce estrogen deprivation (ED). Stromal tumor-infiltrating lymphocytes, assessed by H&E staining, and immune-related gene sets, including IFN-γ signaling genes, measured by RNA-Seq, were increased in ED-resistant tumors. Cyclic immunofluorescence and spatial transcriptomics revealed an abundance of CD8+ T cells and enhanced antigen processing and immune gene signatures in ED-resistant tumors. In this group, the expression of CXCL9, CXCL10, and CXCL11 - chemokine …

Dispersion-Enhanced Nitrogen-Centered Photocatalysis Of The Direct Hydrogen Atom Transfer, Jiasong Zhang, Kaitong Zhuang, Ramon Trevino, Babu Raj Dhungana, Huiying Sun, Yuting Li, Xiaoyu Xia, Ramy Elerian, Yao Sun, Seth O Fremin, Chao Huang, Min He, Maosheng Cheng, Oleg V Larionov, Shengfei Jin

Faculty, Staff and Student Publications

The development of structurally distinct and modular photocatalysts for direct hydrogen atom transfer (HAT) has emerged as a key frontier in radical-mediated C-H functionalization of strong carbon-hydrogen bonds. Despite the largely untapped potential across the fields of organic synthesis, medicinal chemistry, and materials science, few classes of direct HAT photocatalysts are currently known, and the approaches to enhancing their photocatalytic activity remain underdeveloped. We report herein the development of nitrogen-centered direct HAT photocatalysts based on the acridine framework, which leverage a C9-ortho-biaryl substituent for enhancing the photocatalytic activity through stabilizing dispersion interactions with the substrate as the key steering effect. …

Women's Preferences For Home-Based Self-Sampling Or Clinic-Based Testing For Cervical Cancer Screening, Joël Fokom Domgue, Monalisa Chandra, Olajumoke Oladoyin, Manali Desai, Robert Yu

Faculty, Staff and Student Publications

Importance: While home-based self-sampling for cervical cancer screening is an evidence-based strategy proven to increase screening access and uptake, it is not currently recommended in the US despite recent Food and Drug Administration approval of the first at-home self-sampling device. Little nationally representative research has examined preference for and drivers of home-based self-sampling over clinic-based testing (the standard of care).

Objective: To assess women's perspectives about, reasons for considering, and factors associated with preferring at-home self-sampling for cervical cancer screening.

Design, setting, and participants: This population-based cross-sectional study used data from the 2024 Health Interview National Trends Survey (HINTS 7), …

Osimertinib Activates A Tgf-Β2-Dependent Secretory Program That Drives Lung Adenocarcinoma Progression, Madhurima Ghosh, Chao Wu, Abhishek Kumar, Monique Nilsson, John V Heymach, Jiang Yu, Na Ding, Shike Wang, Guan-Yu Xiao, Angelo Chen, Kate Grimley, William K Russell, Chad J Creighton, Xiaochao Tan, Jonathan M Kurie

Faculty, Staff and Student Publications

EGFR-mutant lung adenocarcinomas (LUADs) that are vulnerable to the EGFR antagonist osimertinib (Osi) eventually relapse, owing in part to the emergence of drug-tolerant persister (DTP) cells that arise through epigenetic mechanisms. Intratumoral DTP cells can herald a worse clinical outcome, but the way in which DTP cells influence LUAD progression remains unclear. Osi-resistant (OR) cells exhibit typical DTP cell features, including a propensity to undergo senescence and epithelial-mesenchymal transition (EMT), which can activate heightened secretory states. Therefore, we postulated that OR cells influence LUAD progression through paracrine mechanisms. To test this hypothesis, we utilized congenic pairs of EGFR-mutant LUAD cell …

The Impact Of Vascular Management On Postoperative Complications In Patients Undergoing Surgery For Retroperitoneal Leiomyosarcoma, Neha Malik, Seokhun Kim, Christopher P Scally, Emily Z Keung, Heather Lillemoe, Kelly K Hunt, Christina L Roland, Heather G Lyu

Faculty, Staff and Student Publications

Background: Retroperitoneal leiomyosarcomas are aggressive malignancies. Complete surgical resection with negative margins is crucial to decrease the risk of recurrence but can be risky due to vascular involvement. The aim of our study was to evaluate the different approaches to IVC and renal vein management and their impact on postoperative complications.

Methods: We performed a retrospective review of patients who underwent surgery for retroperitoneal leiomyosarcoma with IVC and/or renal vein involvement at our institution from 2016 to 2024. Patients were stratified by intraoperative vascular management, including ligation only versus varying forms of vascular reconstruction. Postoperative complications, including bleeding, transfusions, the …

The Association Between Long-Term Opioid Therapy And Composite Infection-Related Dental Outcomes, Anne C. Black, Kirsha S. Gordon, James D. Dziura, Declan T. Barry, Stephen Crystal, E. Jennifer Edelman, Gretchen Gibson, Michelle Hamilton, M. Marianne Jurasic, Yu Li, Brandon D.L. Marshall, Melissa Skanderson, Katie J. Suda, William C. Becker

Faculty and Staff Publications

Background: The Food and Drug Administration's warning that transmucosal buprenorphine, a partial opioid agonist used to treat opioid use disorder and chronic pain, may cause dental disease opens questions about potential class-wide adverse effects involving more widely prescribed opioid analgesics.

Methods: This was a retrospective matched national cohort study of patients in care at the Department of Veterans Affairs (VA) between October 2010-September 2019. Patients prescribed LTOT were matched 1:2 to patients not prescribed LTOT on age, sex, service region, and VA dental coverage. Cox regression models estimated the association between LTOT and a composite infection-related dental outcome (CIDO). Sensitivity …

Temporal Linkages Of Explosive Activity Of Kolumbo And Santorini Volcanoes (Greece), Abigail Metcalfe, Katharina Pank, Steffen Kutterolf, Jonas Preine, Paraskevi Nomikou, Christian Hübscher, Thomas A. Ronge, Sarah Beethe, A Bernard, Carole Berthod, Hehe Chen, Shun Chiyonobu, Acacia Clark, Susan Debari, Tatiana Fernandez-Perez, Ralf Gertisser, Christopher Jones, Raymond Johnston, Kumar Batuk Joshi, Jens Karstens, Günther Kletetschka, Olga Koukousioura, Hao Yang Lee, Xiaohui Li, Michael Manga, Molly Mccanta, Iona Mcintosh, Tony Morris, Dimitrios Papanikolaou, Ally Peccia

School of Geography, Earth and Environmental Sciences

The histories of submarine explosive volcanoes are commonly poorly known due to inaccessibility of their eruptive archives. This raises uncertainties in the eruption frequencies of these highly hazardous systems, and in their interactions with neighboring volcanoes. The submarine Kolumbo Volcanic Chain (KVC) northeast of Santorini is made up of the polygenetic Kolumbo Volcano and a linear zone of more than 20 smaller volcanic cones and is one of the most active eruptive centers on the South Aegean Volcanic Arc. However, despite the destructive eruption of Kolumbo in 1650 CE, and unrest in 2024–2025, the eruptive history of the KVC is …

Fedda-Tsformer: Federated Domain Adaptation With Vision Timesformer For Left Ventricle Segmentation On Gated Myocardial Perfusion Spect Image, Yehong Huang, Chen Zhao, Rochak Dhakal, Min Zhao, Guang-Uei Hung, Zhixin Jiang, Weihua Zhou

Michigan Tech Publications

BACKGROUND: Accurate assessment of left ventricular function is essential for diagnosing and managing cardiovascular disease. Gated myocardial perfusion SPECT (MPS) enables simultaneous evaluation of perfusion and function, but reliable contour extraction is challenged by image noise, resolution limits, and anatomical variability. Multi-center validation is further restricted by data privacy concerns, underscoring the need for robust and privacy-preserving contouring methods. METHODS: In this study, we propose a novel approach, FedDA-TSformer, which integrates Federated Domain Adaptation with the TimeSformer model for the task of left ventricle segmentation using MPS images. The proposed model captures spatial and temporal features through a Divide-Space-Time-Attention mechanism, …

The Chronic Apical Abscess: A Case Report On A Diagnostic Dilemma, Jonathan Hope, Guy Lambourn, Ewen Mccoll, Casper Jonker

Peninsula Dental School

A chronic apical abscess is an endodontic condition commonly characterised by the presence of a notable sinus tract through which pus periodically discharges. In general, these cases can be considered “straight forward” to diagnose but on some occasions, diagnosis can be challenging. Any misdiagnosis can compromise the treatment approach for the patient and lead to adverse outcomes such as unnecessary biopsies or referrals. Therefore, clinicians should follow a meticulous treatment approach consisting of appropriate diagnostic measures to establish the correct diagnosis and treatment pathway.

A Multicomponent Strategy To Increase Human Papillomavirus Vaccination Rates In Primary Care: A Cluster Randomized Clinical Trial, Ruoyun Wang, Lei Liu, Sherry Dodd, Sharon Graham, Shannon Rook, Lauren Ericson, Katie Plax, Abigail Barker, Virginia Mckay, Michelle I Silver, Jason G Newland, Allison A King

2020-Current year OA Pubs

IMPORTANCE: Human papillomavirus (HPV) vaccination prevents multiple cancers, yet vaccination rates by the recommended age remain well below national goals.

OBJECTIVE: To evaluate the effectiveness of a multicomponent strategy in increasing HPV vaccination rates in primary care settings by 13 years of age.

DESIGN, SETTING, AND PARTICIPANTS: This cluster randomized clinical trial with a parallel-group design and 1:1 allocation was conducted at 20 pediatrics primary care practices from a practice-based research network in the St Louis, Missouri, metropolitan area by clinicians delivering routine well-child visits within participating practices. The intervention was implemented over 24 months (July 1, 2020, to September …

Thriving Hives, Beekeeping Monthly Calendar, Sheriden M. Hansen, Andree Walker-Bravo, Jaydee Gunnell

All Current Publications

This calendar was created in an effort to simplify and make beekeeping easier to understand and learn for the beginning beekeeper. The calendar offers a broad understanding of what is happening in the hive in addition to guidelines for basic beekeeping tasks on a monthly basis. The calendar also provides users with lists of in-bloom plants to look for in the landscape as the beekeeping season progresses. This can help beekeepers assess resources available for the bees in the landscape. In addition to the monthly tasks, suggested recipes for some of the feeding supplements and treatments mentioned in the calendar …

Organising Care For Complexity: A Pathways Model For Adult Community Intellectual Disability Services, Rohit Shankar, Indermeet Sawhney, Samuel Tromans, Bhathika Perera, Laura Korb, Rory Sheehan, Heather Hanna, Richard Laugharne, Niall O'Kane, Jana Devilliers, Ganesan Rajagopal, Lance Watkins, Jane Mccarthy, Kiran Purandare, Regi Alexander, Ashok Roy, Asif Zia, Satheesh Gangadharan, Angela Hassiotis

Peninsula Medical School

Adult community intellectual disability services in the United Kingdom (UK) are required to deliver specialist, evidence-based care for a variety of conditions while minimising restrictive practices and reliance on inpatient provision. Care pathway models have emerged as a potential mechanism to reconcile these aims yet remain under-used in care philosophies in intellectual disabilities. We propose a generalisable pathways model for community intellectual disability services and examine its implications for policy, clinical practice, and research. The model integrates care navigation, proportionate specialist input, and defined clinical condition care including behaviours that challenge, mental and physical health, forensics, neurodevelopmental conditions, epilepsy, and …

A Solution To The Tension Of Burning On Neutron Stars And Nuclear Physics, Yuri Cavecchi, D. K. Galloway, A. Heger, P. Santillán-Ortega, M. Nava-Callejas, F. M. Vincentelli, Liliana E. Rivera Sandoval, A. Goodwin, Z. Johnston

Physics & Astronomy Faculty Publications

When neutron stars accrete matter from a companion star, this matter forms a disk around them and eventually falls on their surface. Here, the fuel can ignite into bright flashes called Type I bursts. Theoretical calculations based on state-of-the-art nuclear reactions are able to explain many features of the bursts. However, models predict that the bursts should cease at high accretion rates, whereas in many sources they disappear at much lower rates. Moreover, their recurrence times also show strong discrepancies with predictions. Although various solutions have been proposed, none can account for all the observational constraints. Here, we describe a …

Mapping The Causal Chain From Genetic Risk Variants To Lipid Dysmetabolism In Parkinson’S Disease, Hiba Saade, Fatima Chavez, Téah Segura, Maria Valeria Lozano, Michelle Etoundi, Karla Silos, Naomi Kass, Viktoriya Korchina, Harshavardhan Doddapaneni, Eric Venner, Joseph C Masdeu, Valory Pavlik, Melissa M Yu, Chi-Ying R Lin, Joseph Jankovic, Aron S Buchman, Donna Muzny, Richard A Gibbs, Sarah H Elsea, Asa Abeliovich, Peter Lansbury, Nora Vanegas-Arroyave, Chad A Shaw, Joshua M Shulman

Faculty, Staff and Students Publications

The molecular pathways linking genetic variants to Parkinson's disease (PD) onset and progression remain incompletely defined; however, risk alleles in multiple genes, including GBA1, strongly implicate lipid metabolism. To systematically identify causal biomarker signatures, we analyzed comprehensive metabolome profiles from blood plasma in 149 PD patients and 150 controls, along with complementary genetic, RNA-sequencing, and metabolic data from other available clinical and pathologic cohorts. Using colocalization and summary-data-based Mendelian randomization, we tested whether expression and metabolic quantitative trait loci mediate the association between implicated genetic variants and PD risk. We further integrated differential metabolomics and proteomics from blood and brain …

Lysine Demethylase 4a (Kdm4a) Maintains Basal Body Architecture And Protects Against Ciliary Destabilization, Xiaoli Wang, Yuya Nakatani, Sofia Vargas-Hernandez, Sung Y Jung, Menuka Karki, Cheryl Walker, Anna-Karin Gustavsson, Ruhee Dere

Faculty, Staff and Students Publications

Primary cilia are sensory organelles essential for signaling and defects in formation, maintenance or structure underlie diverse ciliopathies. Here, we identify lysine demethylase 4A (KDM4A) as a previously unrecognized mediator of ciliogenesis. Using genetic depletion and pharmacologic inhibition, we show that KDM4A is required for cilia assembly and maintenance. Super-resolution imaging reveals KDM4A localization at the basal body, where it distinctively wraps around the centrioles. We uncover a direct interaction between KDM4A and Rootletin (CROCC), a structural protein mediating centriole cohesion, and demonstrate that KDM4A loss increases inter-centriolar distances, implicating basal body architecture in ciliary failure. Together, these findings define …

Mechanical Characterization Of Petg – Carbon Fiber Composite Parts Using 3d Printing For Drone Frame Application, Dawit Tafesse Gebreyohannes

Faculty, Staff and Students Publications

PETG (Polyethylene Terephthalate Glycol)–Carbon Fiber composites fabricated using fused deposition modeling are emerging as promising alternatives for lightweight UAV structures; however, their performance is strongly influenced by internal infill architecture and structural design. From an initial set of 21 infill patterns, five mechanically efficient patterns (Tri-Hexagon, Triangle, Support Cubic, Rectilinear, and Quarter Cubic) were shortlisted and evaluated through tensile, wear, impact, and hardness tests. Rectilinear infill exhibited the highest tensile strength (35 N/mm2) and superior wear resistance under loads up to 30 N, while Quarter Cubic showed comparable tensile performance (34 N/mm2). Support Cubic infill demonstrated the highest impact energy …

Clinical Features Of Infantile Epileptic Spasms Syndrome: A Systematic Review, Zihan Zhang, Sanjanaa Seshadri, Jiyeon Cha, Ming Li, Lei-Shih Chen

Faculty, Staff and Students Publications

Introduction

Infantile Epileptic Spasms Syndrome (IESS) is a severe epilepsy in children between one month and two years of age. Urgent referral of possible IESS cases from pediatricians and family physicians who care for children to neurologists for diagnosis and treatment has been shown to significantly improve patient health outcomes. Yet, a comprehensive list of IESS clinical features is lacking. We conducted a systematic review of studies to report IESS clinical features.

Methods

Articles from the MEDLINE Complete and Embase databases were searched from the earliest years of databases availability (1979) to July 31, 2024. We followed the Preferred Reporting …

The Advantages Of Saudi Arabia’S Fixed Exchange Rate Regime For Inflation Control: An Econometric And Empirical Analysis, Rodrigo Bochner

Arab Economic and Business Journal

Since 1986, Saudi, has maintained a fixed exchange rate, pegging the Saudi Riyal (SAR) to dollar at SAR 3.75/USD. This stabilizing domestic prices, and promoting macroeconomic stability in an oil-dependent and economy exposed to volatile global commodity prices and international shocks. This paper provides a assessment of the fixed exchange rate’s advantages for inflation control. Leveraging a dataset spanning 1980–2025 and econometric tools— Ordinary Least Squares (OLS), Vector Error Correction Models (VECM), Autoregressive Distributed Lag (ARDL) techniques, and GARCH models—this study identifies the causal channels and measures the peg’s impact on inflation dynamics, with a review of literature, confirming that …

The Use Of Acupuncture To Address Health Disparities In The Treatment Of Low Back Pain, Vivian Li, Alexander Reals, Deepa Manda, Elizabeth Loomis

Advances in Clinical Medical Research and Healthcare Delivery

Low back pain (LBP) is a leading cause of disability, and treatment often involves a combination of pharmacological and non-pharmacological therapies. Acupuncture is a medical treatment and ideology rooted in traditional Chinese medicine that utilizes applying small needles or pressure to specific points in the body. Utilized as an adjunct to supplement standard medical care, acupuncture is a procedure that can be done in a primary care setting. Multiple studies have shown efficacy in treating acute or chronic back pain, with up to 1.5% of the US population having used acupuncture at one point.

In the pursuit of holistic health, …

Evidence Based Management Of High Ldl-C For Prevention Of Atherosclerotic Cardiovascular Disease In Adult Patients In Resident Run Clinic: A Qi Project, Astha Prasai, Sahej Manesh Singh Arora, Hafsa Jawaid, Aakriti Jain, Omofolarin Babayale, Nauman Naeem, Hina Ukrani, Nawid Latifi, Binita Neupane, Soon-Il Song, Gaurav Sharma

Advances in Clinical Medical Research and Healthcare Delivery

Background:

Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of death worldwide and in the United States, with significant healthcare and economic burden. Despite clear guideline recommendations, the implementation of ASCVD risk assessment and statin use for primary prevention remains suboptimal.

Methods:

A quality improvement project was conducted at a resident run clinic with an objective to improve ASCVD risk documentation and guideline-based lipid management. A total of 600 patients aged 40-75 years without a history of cardiovascular disease were randomly selected- 300 in the pre-intervention group and 300 in the post-intervention group. The intervention included didactic sessions and quick …

Rare Event: Neonatal Anaphylaxis Following Hepatitis B Vaccination – A Case Series From A Tertiary Care Center In India, Aarthi Ma, Revanth R

Advances in Clinical Medical Research and Healthcare Delivery

We report two cases of anaphylaxis following Hepatitis B vaccination in one-day-old neonates at a tertiary care hospital in India. Both cases presented with similar patterns of cutaneous reactions and respiratory symptoms shortly after intramuscular administration of the Hepatitis B vaccine. To our knowledge, this is among the few documented case series of neonatal anaphylaxis post–Hepatitis B vaccination, underscoring its rarity yet clinical importance. The cases highlight the critical importance of vigilant post-vaccination monitoring and prompt recognition of vaccine-associated adverse events in neonates. This report reviews current literature on anaphylaxis following vaccination and discusses optimal management strategies.

An Exploratory Study Of Social Determinants And Pediatric Lead Exposure In Chemung County, Ny, Jenna Mccracken, Anika Stundtner, Megan Kerbag, Madison Desantis, Jennifer Coseo, Richard Terry

Advances in Clinical Medical Research and Healthcare Delivery

Background: Lead exposure in children is a persistent public health concern due to its irreversible neurological and developmental effects. Children under 6 years old are particularly vulnerable due to frequent hand-to-mouth activity and increased environmental exposure. Existing literature suggests a relationship between adverse social determinants of health (SDOH), such as low parental education and residence in high-poverty areas, and elevated pediatric blood lead levels (BLLs). This study, subsidized through a community service grant from Excellus Blue Cross Blue Shield, aimed to examine the association between BLLs and SDOH among children screened at the ACCEL Community Health Clinic in Chemung County, …

Hallucinations And Diabetes – Could It Be The Hip? An Interesting Case Of Cobalt Poisoning, Mahrukh Tariq, Zauraiz Anjum

Advances in Clinical Medical Research and Healthcare Delivery

Cobalt (Co) poisoning has been described historically in beer-drinkers when cobalt was used as an additive. In present times, this type of poisoning is usually caused by occupational exposure or metal prosthesis breakdown. We present a case of Co poisoning from metal prosthesis breakdown with exceptionally high levels, and thus, some unique symptoms. Interestingly our patient not only had symptoms commonly associated with Co poisoning, e.g., paresthesia, sensory-neural hearing loss, acute kidney failure, but also developed new onset diabetes, which is not commonly associated with this type of pathology. Moreover, when we had this patient under our care, we had …

Transient T-Wave Inversions In A Pregnant Patient: Normal Variant Or Cause For Concern?, Muhammad Hammad Sharif, Madeeha Khaleeque, Muhammad Hassan Jan, Atif Ahmed, Aniket-Vijay Rao, Aditya Sanjeevi, Bipul Baibhav

Advances in Clinical Medical Research and Healthcare Delivery

Pregnancy can cause physiological changes in various body systems, including the cardiovascular system. This manifests as physiological changes in the electrocardiogram (EKG) in the form of sinus tachycardia, a change in the QRS axis, a short PR interval, the development of Q waves, a prolonged QT interval, T-wave inversions, and ST-segment depression. These changes are typically benign and reflect the body's adaptation to pregnancy. Physiological T-wave inversions can occur during pregnancy because of an increased workload on the heart due to expanding blood volume. It is important to identify these physiological EKG changes to avoid unnecessary invasive cardiac work-up and …

Late Bioprosthetic Valve Migration- A Rare Entity After Tavi, Sahej Arora, Ghazi Khan, Jeremiah Depta

Advances in Clinical Medical Research and Healthcare Delivery

We present a case of hemolytic anemia due to a rare complication of late bioprosthetic valve migration, who underwent successful treatment with valve in valve transcatheter aortic valve implantation. Our patient with symptomatic moderate aortic stenosis underwent the index procedure a year ago and treated for bacteremia 3 months ago, presented with hemolytic anemia and echocardiography revealing aortic paravalvular leak. The hemolysis was attributed to Bioprosthetic valve dysfunction after a negative hematological workup. The patient's aortography revealed ventricular migration of the valve, not seen on a cardiac CT scan performed before. This was followed by a successful valve in valve …

Neuroinflammation And Its Role In Depression– A Review Of Emerging Biomarkers And Therapeutic Targets, Sophia M. Valerino

Advances in Clinical Medical Research and Healthcare Delivery

Major depressive disorder (MDD) is a prevalent and debilitating mental illness that affects millions globally. Traditionally, the pathophysiology of MDD was thought to be due primarily neurotransmitter imbalances. However, emerging research highlights the role of neuroinflammation in MDD pathogenesis. Elevated levels of pro-inflammatory cytokines, microglial activation, and blood-brain barrier dysfunction have been implicated in the etiology of MDD. Additionally, biomarkers such as C-reactive protein and neuroimaging findings further support the neuroinflammatory hypothesis. This growing body of evidence has led to increased interest in novel treatment approaches, including anti-inflammatory medications and lifestyle interventions, as potential therapeutic strategies. While selective serotonin reuptake …

Prompt Thyroid Hormone Replacement Reversing Severe Bradycardia & Syncope, Cassie R. Girardin, George Vega, Rohail Baig

Advances in Clinical Medical Research and Healthcare Delivery

Thyroid disease, particularly hypothyroidism, can significantly affect the cardiovascular system, leading to structural, functional, and conduction abnormalities. Hypothyroidism decreases inotropy and chronotropy and may cause bradycardia or conduction defects. Although these changes are typically reversible with thyroid hormone replacement, severe cases may necessitate pacemaker placement. This case describes an 82-year-old female with hypothyroidism, atrial fibrillation, and left bundle branch block (LBBB) who presented with recurrent syncope due to hypothyroidism-induced bradycardia with sinus pauses. Her symptoms resolved with thyroid hormone optimization, highlighting the importance of prompt recognition and treatment of hypothyroidism-related cardiac manifestations to prevent unnecessary pacemaker implantation.

Diagnostically Complex Case Of Trivalvular Infectious Endocarditis Complicated By Hiv, Hcv, Pulmonary Septic Emboli, And Epidural Abscess, Madison Baker, Natasha Singh, Rohail A. Baig, Justin Nistico

Advances in Clinical Medical Research and Healthcare Delivery

Background:

Infective endocarditis (IE) can be visualized on echocardiograms. However, there is a significant discrepancy between transthoracic and transesophageal echocardiograms. This imaging modality is also impacted by operator dependent factors. The risk of right sided endocarditis is elevated in people who inject drugs (PWID). In individuals with human immunodeficiency virus (HIV), there is an increased risk of IE, and there is also a relationship that has yet to be fully established between hepatitis C virus (HCV) and IE.

This report describes a woman with a history of IVDU who was diagnosed with HIV/AIDS, HCV, and sepsis secondary to methicillin-resistant Staphylococcus …

A Rare Case Of Gastrointestinal Stromal Tumor Outside The Gastrointestinal Tract, Ashton I. D'Souza, Jasdeep S. Bajwa, Basil George Verghese

Advances in Clinical Medical Research and Healthcare Delivery

Extra-gastrointestinal stromal tumors are rare mesenchymal tumors occurring outside the gastrointestinal tract, comprising ~5% of all gastrointestinal stromal tumors. A 65-year-old man undergoing evaluation for nephrolithiasis was incidentally found to have a 7.2 cm mesenteric mass proven to be gastrointestinal stromal tumors on biopsy. After limited response to imatinib, the patient underwent successful surgical resection. Mesenteric gastrointestinal stromal tumors often present larger and more aggressive, but in this instance, early incidental detection permitted effective intervention. This case highlights the diagnostic challenges posed by extra-gastrointestinal stromal tumors due to their atypical location and nonspecific symptoms. Extra-gastrointestinal stromal tumors should be considered …