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Full-Text Articles in Medicine and Health Sciences

Home Dialysis For Undocumented Individuals: A Five-Year Single Center Experience, Laurene M Asare, Dia R Waguespack, Jose J Perez, Jade M Teakell Feb 2025

Home Dialysis For Undocumented Individuals: A Five-Year Single Center Experience, Laurene M Asare, Dia R Waguespack, Jose J Perez, Jade M Teakell

Faculty, Staff and Students Publications

No abstract provided.


Unprecedented Female Mutation Bias In The Aye-Aye, A Highly Unusual Lemur From Madagascar, Richard J Wang, Yadira Peña-García, Muthuswamy Raveendran, R Alan Harris, Thuy-Trang Nguyen, Marie-Claude Gingras, Yifan Wu, Lesette Perez, Anne D Yoder, Joe H Simmons, Jeffrey Rogers, Matthew W Hahn Feb 2025

Unprecedented Female Mutation Bias In The Aye-Aye, A Highly Unusual Lemur From Madagascar, Richard J Wang, Yadira Peña-García, Muthuswamy Raveendran, R Alan Harris, Thuy-Trang Nguyen, Marie-Claude Gingras, Yifan Wu, Lesette Perez, Anne D Yoder, Joe H Simmons, Jeffrey Rogers, Matthew W Hahn

Faculty, Staff and Students Publications

Every mammal studied to date has been found to have a male mutation bias: male parents transmit more de novo mutations to offspring than female parents, contributing increasingly more mutations with age. Although male-biased mutation has been studied for more than 75 years, its causes are still debated. One obstacle to understanding this pattern is its near universality-without variation in mutation bias, it is difficult to find an underlying cause. Here, we present new data on multiple pedigrees from two primate species: aye-ayes (Daubentonia madagascariensis), a member of the strepsirrhine primates, and olive baboons (Papio anubis). In stark contrast to …


Historical Demography And Species Distribution Models Shed Light On Speciation In Primates Of Northeast India, Mihir Trivedi, Kunal Arekar, Shivakumara Manu, Lukas F K Kuderna, Jeffrey Rogers, Kyle Kai-How Farh, Tomas Marques Bonet, Govindhaswamy Umapathy Feb 2025

Historical Demography And Species Distribution Models Shed Light On Speciation In Primates Of Northeast India, Mihir Trivedi, Kunal Arekar, Shivakumara Manu, Lukas F K Kuderna, Jeffrey Rogers, Kyle Kai-How Farh, Tomas Marques Bonet, Govindhaswamy Umapathy

Faculty, Staff and Students Publications

Past climate change is one of the important factors influencing primate speciation. Populations of various species could have risen or declined in response to these climatic fluctuations. Northeast India harbors a rich diversity of primates, where such fluctuations can be implicated. Recent advances in climate modeling as well as genomic data analysis has paved the way for understanding how species accumulate at a particular geographic region. We utilized these methods to explore the primate diversity in this unique region in relation to past climate change. To ascertain the population level changes, we inferred the demographic history of nine species of …


Defining Neonatal Status Epilepticus: A Scoping Review From The Ilaee Neonatal Task Force, Magda L Nunes, Elissa G Yozawitz, Courtney J Wusthoff, Renée A Shellhaas, Efraín Olivas-Peña, Jo M Wilmshurst, Ronit M Pressler, Chahnez C Triki, Hans Hartmann, Terrie Inder, Geraldine B Boylan, Kette Valente, Solomon L Moshe, Eli M Mizrahi, Nicholas S Abend Feb 2025

Defining Neonatal Status Epilepticus: A Scoping Review From The Ilaee Neonatal Task Force, Magda L Nunes, Elissa G Yozawitz, Courtney J Wusthoff, Renée A Shellhaas, Efraín Olivas-Peña, Jo M Wilmshurst, Ronit M Pressler, Chahnez C Triki, Hans Hartmann, Terrie Inder, Geraldine B Boylan, Kette Valente, Solomon L Moshe, Eli M Mizrahi, Nicholas S Abend

Faculty, Staff and Students Publications

Objective: To review the available literature concerning the definition of neonatal status epilepticus (SE) and/or seizure burden.

Methods: The International League Against Epilepsy Neonatal Task Force performed a scoping review of the definitions of neonatal SE. Following a systematic literature review, articles were screened and data were abstracted regarding: (1) article characteristics (author identification, publication year, journal name, digital object identifier, title, objective, and study design); (2) cohort characteristics (sample size, gestational age, seizure etiology); (3) definition of SE and/or seizure burden; and (4) the method used to identify and classify SE, including routine EEG (EEG), continuous EEG monitoring (cEEG), …


Magnesium Sulfate In The Management Of Acute Ischemic Stroke: A Review Of The Literature And Future Directions, Maximillian S Feygin, Alex Brenner, Omar Tanweer Feb 2025

Magnesium Sulfate In The Management Of Acute Ischemic Stroke: A Review Of The Literature And Future Directions, Maximillian S Feygin, Alex Brenner, Omar Tanweer

Faculty, Staff and Students Publications

Background: The management of acute ischemic stroke (AIS) was revolutionized within the last 15 years with the introduction of mechanical thrombectomy (MT) to standard of care. Despite the success of mechanical thrombectomy (MT) in achieving high recanalization rates for large vessel occlusion, functional independence post-treatment remains suboptimal. The current limitations of MT prompt evaluation of the role of adjunctive pharmacologic neuroprotective therapies to prevent excitotoxicity, cellular apoptosis, and inflammation that cause irreversible neuronal damage during AIS. Magnesium (MgSO4) provides an attractive neuroprotectant profile, having many different effects, and is inexpensive, readily available, and has a long-established safety and tolerability profile …


Pancreatic Organogenesis Mapped Through Space And Time, Marissa A Scavuzzo, Wojciech J Szlachcic, Matthew C Hill, Natalia M Ziojla, Jessica Teaw, Jeffrey C Carlson, Jonathan Tiessen, Jolanta Chmielowiec, James F Martin, Malgorzata Borowiak Feb 2025

Pancreatic Organogenesis Mapped Through Space And Time, Marissa A Scavuzzo, Wojciech J Szlachcic, Matthew C Hill, Natalia M Ziojla, Jessica Teaw, Jeffrey C Carlson, Jonathan Tiessen, Jolanta Chmielowiec, James F Martin, Malgorzata Borowiak

Faculty, Staff and Students Publications

The spatial organization of cells within a tissue is dictated throughout dynamic developmental processes. We sought to understand whether cells geometrically coordinate with one another throughout development to achieve their organization. The pancreas is a complex cellular organ with a particular spatial organization. Signals from the mesenchyme, neurons, and endothelial cells instruct epithelial cell differentiation during pancreatic development. To understand the cellular diversity and spatial organization of the developing pancreatic niche, we mapped the spatial relationships between single cells over time. We found that four transcriptionally unique subtypes of mesenchyme in the developing pancreas spatially coordinate throughout development, with each …


Prediction Models Of Basal Energy Expenditure In Children And Adolescents Across The Bmi Spectrum Based On Room Calorimetry: A Cross-Sectional Cohort Study, Maurice Puyau, Roman Shypailo, Nancy F Butte, Salma Musaad, Fida Bacha Feb 2025

Prediction Models Of Basal Energy Expenditure In Children And Adolescents Across The Bmi Spectrum Based On Room Calorimetry: A Cross-Sectional Cohort Study, Maurice Puyau, Roman Shypailo, Nancy F Butte, Salma Musaad, Fida Bacha

Children’s Nutrition Research Center Staff Publications

Background: Existing equations for prediction of basal energy expenditure (BEE) may not be accurate in children with overweight or obesity (OW/OB).

Objectives: We aimed to develop BEE prediction equations applicable to children and adolescents across a wide BMI spectrum using gold standard room calorimetry.

Methods: We measured weight, height, waist and hip circumferences, body composition (DXA), and BEE (whole room calorimetry) in a cross-sectional cohort of 1155 healthy children, 5-19 years of age. 67% of the males and 51% of the females were classified as OW/OB. We applied multiple linear regression analyses to develop BEE prediction models for each sex. …


Benefits And Harms Of Hepatocellular Carcinoma Screening Outreach In Patients With Cirrhosis: A Multicenter Randomized Clinical Trial, Amit G Singal, Darine Daher, Manasa Narasimman, Sruthi Yekkaluri, Yan Liu, Vanessa Cerda, Chaitra Banala, Aisha Khan, Minjae Lee, Karim Seif El Dahan, Caitlin C Murphy, Jennifer R Kramer, Ruben Hernaez Feb 2025

Benefits And Harms Of Hepatocellular Carcinoma Screening Outreach In Patients With Cirrhosis: A Multicenter Randomized Clinical Trial, Amit G Singal, Darine Daher, Manasa Narasimman, Sruthi Yekkaluri, Yan Liu, Vanessa Cerda, Chaitra Banala, Aisha Khan, Minjae Lee, Karim Seif El Dahan, Caitlin C Murphy, Jennifer R Kramer, Ruben Hernaez

Faculty, Staff and Students Publications

Background: The value of hepatocellular carcinoma screening is defined by the balance of benefits from early tumor detection vs harms because of false-positive results. We evaluated the value of a mailed outreach strategy for hepatocellular carcinoma screening in patients with cirrhosis.

Methods: We conducted a multicenter pragmatic randomized clinical trial comparing mailed outreach for hepatocellular carcinoma screening (n = 1436) and usual care with visit-based screening (n = 1436) among patients with cirrhosis at 3 health systems from March 2018 to September 2021. Outcomes of interest were early stage hepatocellular carcinoma detection (ie, screening benefit) and diagnostic evaluation for false-positive …


Active Versus Passive Learning In Large-Group Sessions In Medical School: A Randomized Cross-Over Trial Investigating Effects On Learning And The Feeling Of Learning, Peter Boedeker, Tobias Schlingmann, Joshua Kailin, Ajith Nair, Cara Foldes, David Rowley, Katherine Salciccioli, Ronald Maag, Nancy Moreno, Nadia Ismail Feb 2025

Active Versus Passive Learning In Large-Group Sessions In Medical School: A Randomized Cross-Over Trial Investigating Effects On Learning And The Feeling Of Learning, Peter Boedeker, Tobias Schlingmann, Joshua Kailin, Ajith Nair, Cara Foldes, David Rowley, Katherine Salciccioli, Ronald Maag, Nancy Moreno, Nadia Ismail

Faculty, Staff and Students Publications

Purpose: The evidence base for active learning in medical education is based largely on trials with suspect internal validity. We empirically compared the learning and feeling of learning of participants when in large-group interactive sessions and passive lectures using a rigorous trial capable of providing an unambiguous assessment of effect. Further, we evaluated if there was a differential effect based on prior achievement.

Materials and method: We conducted a two-day randomized cross-over trial with 146 s-year medical students. Passive learning involved lecture-based case presentation with minimal interaction; in the large-group interactive session, students worked in teams on the same cases. …


Implementation Of In Utero Laparotomy-Assisted Fetoscopic Spina Bifida Repair In Two Centers In Latin America: Rationale For This Approach In This Region, Jezid Miranda, Miguel A Parra-Saavedra, William O Contreras-Lopez, Cristóbal Abello, Guido Parra, Juan Hernandez, Amanda Barrero, Isabela Leones, Adriana Nieto-Sanjuanero, Gerardo Sepúlveda-Gonzalez, Magdalena Sanz-Cortes Feb 2025

Implementation Of In Utero Laparotomy-Assisted Fetoscopic Spina Bifida Repair In Two Centers In Latin America: Rationale For This Approach In This Region, Jezid Miranda, Miguel A Parra-Saavedra, William O Contreras-Lopez, Cristóbal Abello, Guido Parra, Juan Hernandez, Amanda Barrero, Isabela Leones, Adriana Nieto-Sanjuanero, Gerardo Sepúlveda-Gonzalez, Magdalena Sanz-Cortes

Faculty, Staff and Students Publications

Background: Spina bifida (SB) is a severe congenital malformation that affects approximately 150,000 infants annually, predominantly in low- and middle-income countries, leading to significant morbidity and lifelong disabilities. In Latin America, the birth prevalence of SB is notably high, often exacerbated by limited healthcare resources and poor access to advanced medical care. The implementation of laparotomy-assisted fetoscopic in-utero SB repair programs in Latin America targets reducing prematurity rates and enabling vaginal births while preserving the benefits of decreased need for hydrocephalus treatment and improved mobility in children.

Objective: This study evaluated the safety, efficacy, and outcomes of laparotomy-assisted fetoscopic in-utero …


Implementation Of Electronic Triggers To Identify Diagnostic Errors In Emergency Departments, Viralkumar Vaghani, Ashish Gupta, Usman Mir, Li Wei, Daniel R Murphy, Umair Mushtaq, Dean F Sittig, Andrew J Zimolzak, Hardeep Singh Feb 2025

Implementation Of Electronic Triggers To Identify Diagnostic Errors In Emergency Departments, Viralkumar Vaghani, Ashish Gupta, Usman Mir, Li Wei, Daniel R Murphy, Umair Mushtaq, Dean F Sittig, Andrew J Zimolzak, Hardeep Singh

Faculty, Staff and Students Publications

Importance: Missed diagnosis can lead to preventable patient harm.

Objective: To develop and implement a portfolio of electronic triggers (e-triggers) and examine their performance for identifying missed opportunities in diagnosis (MODs) in emergency departments (EDs).

Design, setting, and participants: In this retrospective medical record review study of ED visits at 1321 Veterans Affairs health care sites, rules-based e-triggers were developed and implemented using a national electronic health record repository. These e-triggers targeted 6 high-risk presentations for MODs in treat-and-release ED visits. A high-risk stroke e-trigger was applied to treat-and-release ED visits from January 1, 2016, to December 31, 2020. A …


Polygenic Score For Clinicopathologic Features And Survival Outcomes In Papillary Thyroid Carcinoma, Sophie Li, Guibin Zheng, Li Xu, Maitrayee Goswami, Mark E Zafereo, Steven I Sherman, Guojun Li, Erich M Sturgis, Jennifer R Wang Feb 2025

Polygenic Score For Clinicopathologic Features And Survival Outcomes In Papillary Thyroid Carcinoma, Sophie Li, Guibin Zheng, Li Xu, Maitrayee Goswami, Mark E Zafereo, Steven I Sherman, Guojun Li, Erich M Sturgis, Jennifer R Wang

Faculty, Staff and Students Publications

Importance: Genome-wide association studies have identified germline variants associated with the development of papillary thyroid carcinoma (PTC) that can be used to construct a polygenic score (PGS). It is important to determine whether patients with higher germline genetic risk, as summarized using PGS, present with more aggressive disease and/or develop worse clinical outcomes.

Objective: To assess whether germline risk defined by PGS is associated with clinicopathologic features and survival outcomes for patients with PTC.

Design, setting, and participants: This retrospective cohort study included patients with newly diagnosed PTC who presented to The University of Texas MD Anderson Cancer Center for …


The Efficacy Of Complementary And Alternative Medicines In Medical Dermatology: A Comprehensive Review, Promise Ufomadu, Bartley Joseph Gill, Ida Orengo, Theodore Rosen, Ikue Shimizu Feb 2025

The Efficacy Of Complementary And Alternative Medicines In Medical Dermatology: A Comprehensive Review, Promise Ufomadu, Bartley Joseph Gill, Ida Orengo, Theodore Rosen, Ikue Shimizu

Faculty, Staff and Students Publications

Background: In recent years, there has been a widespread patient use of complementary and alternative medicines (CAMs) for dermatological application, despite few RCT-level studies on these supplements. This creates a barrier for dermatologists and others in counseling patients who may be using or might be tempted to use these CAM agents. This review investigates various CAM modalities used by patients for medical dermatology, exploring their efficacy and toxicity profiles.

Methods: A comprehensive review was performed on the effectiveness of several CAMs utilized in medical dermatology by patients. A literature search was conducted using PubMed, Embase, Google Scholar, Web of Science, …


Skin Manifestations And Related Clinical Characteristics Of Multisystem Inflammatory Syndrome In Children: A Descriptive Retrospective Cohort Study At Texas Children’S Hospital, Matthew Penna, Lauren Pupa, Grace Lee, Soo Jung Kim Feb 2025

Skin Manifestations And Related Clinical Characteristics Of Multisystem Inflammatory Syndrome In Children: A Descriptive Retrospective Cohort Study At Texas Children’S Hospital, Matthew Penna, Lauren Pupa, Grace Lee, Soo Jung Kim

Faculty, Staff and Students Publications

BACKGROUND: Little is known about the dermatologic manifestations of multisystem inflammatory syndrome in children (MIS-C) in children and adolescents.

OBJECTIVE: We sought to describe the demographic background, key clinical features, and the clinical consequences of developing rash manifestations in MIS-C patients at Texas Children's Hospital.

METHODS: Descriptive retrospective cohort study of 290 hospitalized eligible patients between May 2020 and April 2022.

RESULTS: Among MIS-C patients, 51% exhibited a rash. We found that younger children (8.62 vs 9.49 years of age,

LIMITATIONS: Rash characteristics were initially described by a variety of physicians in the pediatric primary care services.

CONCLUSION: Rash manifestations …


Ignatzschineria Species Bacteremia: A Case Report And Review Of The Literature, Katherine Sandomirsky, Mark Sayegh, Priscila Lopez, Yone Lwin, Sharon Mannheimer Jan 2025

Ignatzschineria Species Bacteremia: A Case Report And Review Of The Literature, Katherine Sandomirsky, Mark Sayegh, Priscila Lopez, Yone Lwin, Sharon Mannheimer

Marshall Journal of Medicine

Ignatzschineria species, a member of the Gammaproteobacteria class of bacteria, is a gram-negative, aerobic, non-spore forming rod. This emerging human pathogen has been found in the digestive tract of the parasitic Wohlfarhtia magnifica fly. Infections in humans are uncommon and are usually associated with maggot infestation (wound myiasis). Rare cases of Ignatzschineria species bacteremia have been reported in individuals with myiasis of chronic skin wounds. Current literature describes 4 known species of Ignatzschineria: I. indica, I. larvae, I. ureiclastica, and I. cameli. An additional 2 cases of Ignatzachineria bacteremia were caused by Ignatzschineria species that were “unable to …


Atypical Presentation Of Non-Small Cell Lung Carcinoma With Metastasis To Breast Tissue, Tylar P. Seckman, Diane Krutzler-Berry, Mohamed Ashal, Waqas Mahmud, Krista L. Denning, Logan M. Lawrence Jan 2025

Atypical Presentation Of Non-Small Cell Lung Carcinoma With Metastasis To Breast Tissue, Tylar P. Seckman, Diane Krutzler-Berry, Mohamed Ashal, Waqas Mahmud, Krista L. Denning, Logan M. Lawrence

Marshall Journal of Medicine

Malignant neoplasms of the lung commonly metastasize to lymph nodes, bone, brain, and liver via hematogenous and lymphatic routes. Much less commonly, metastasis occurs in the breast. Secondary metastatic disease of the breast is very rare, with a reported incidence ranging from 0.4-1.3%­­—with primary lung cancer being one of the most anomalous sources. This case details non-small cell lung cancer metastasis to the breast with proven primary contralateral lung origination. This atypical finding prompts medical professionals to consider these malignant cells' immunologic, histologic, and pathologic makeup to understand further and treat the neoplasm.


Neurovascular Complications Of Acute Aortic Syndrome, Dean Zeldich, Matthew Bierowski, Leah Shabo, Sridhara Yaddanapudi, Gregary Marhefka Jan 2025

Neurovascular Complications Of Acute Aortic Syndrome, Dean Zeldich, Matthew Bierowski, Leah Shabo, Sridhara Yaddanapudi, Gregary Marhefka

Jefferson Hospital Staff Papers and Presentations

Acute aortic syndromes (AAS) such as aortic dissection, intramural hematoma, and penetrating aortic ulcer pose significant neurovascular risks, affecting patient outcomes. This review examines the incidence, clinical presentation, and outcomes of neurovascular complications in AAS patients. Common complications include stroke, spinal cord ischemia, and transient ischemic attacks, with stroke being the most prevalent. Managing aortic dissection necessitates careful blood pressure control to prevent dissection progression while avoiding compromised cerebral and spinal perfusion. Carotid involvement, particularly dissection, increases stroke and transient ischemic attack risks. Emergency surgical interventions, though essential to prevent rupture or repair dissection, carry risks of perioperative neurovascular complications. …


Crosstalk Between Nnos/No And Cox-2 Enhances Interferon-Gamma-Stimulated Melanoma Progression, Anika Patel, Shirley Tong, Moom R. Roosan, Basir Syed, Amardeep Awasthi, Richard B. Silverman, Sun Yang Jan 2025

Crosstalk Between Nnos/No And Cox-2 Enhances Interferon-Gamma-Stimulated Melanoma Progression, Anika Patel, Shirley Tong, Moom R. Roosan, Basir Syed, Amardeep Awasthi, Richard B. Silverman, Sun Yang

Pharmacy Faculty Articles and Research

Background/Objectives: Interferon gamma (IFN-γ) in the melanoma tumor microenvironment plays opposing roles, orchestrating both pro-tumorigenic activity and anticancer immune responses. Our previous studies demonstrated the role of neuronal nitric oxide synthase (nNOS) in IFN-γ-stimulated melanoma progression. However, the underlying mechanism has not been well defined. This study determined whether the nNOS/NO and COX-2/PGE2 signaling pathways crosstalk and augment the pro-tumorigenic effects of IFN-γ in melanoma. Methods: Bioinformatic analysis of patient and cellular proteomic data was conducted to identify proteins of interest associated with IFN-γ treatment in melanoma. Changes in protein expression were determined using various analytical techniques including …


Accelerated Symptom Improvement In Parkinson’S Disease Via Remote Internet-Based Optimization Of Deep Brain Stimulation Therapy: A Randomized Controlled Multicenter Trial, Alireza Gharabaghi, Sergiu Groppa, Marta Navas-Garcia, Alfons Schnitzler, Laura Muñoz-Delgado, Vicky L. Marshall, Jessica Karl, Lin Zhang, Ramiro Alvarez, Mary S. Feldman, Michael J. Soileau, Lan Luo, S. Elizabeth Zauber, Benjamin L. Walter, Chengyuan Wu, Hong Lei, Damian M. Herz, Ming-Hua Chung, Yagna Pathak, Bram Blomme, Binith Cheeran, Corneliu Luca, Daniel Weiss Jan 2025

Accelerated Symptom Improvement In Parkinson’S Disease Via Remote Internet-Based Optimization Of Deep Brain Stimulation Therapy: A Randomized Controlled Multicenter Trial, Alireza Gharabaghi, Sergiu Groppa, Marta Navas-Garcia, Alfons Schnitzler, Laura Muñoz-Delgado, Vicky L. Marshall, Jessica Karl, Lin Zhang, Ramiro Alvarez, Mary S. Feldman, Michael J. Soileau, Lan Luo, S. Elizabeth Zauber, Benjamin L. Walter, Chengyuan Wu, Hong Lei, Damian M. Herz, Ming-Hua Chung, Yagna Pathak, Bram Blomme, Binith Cheeran, Corneliu Luca, Daniel Weiss

Department of Neurosurgery Faculty Papers

BACKGROUND: Deep brain stimulation (DBS) has emerged as an important therapeutic intervention for neurological and neuropsychiatric disorders. After initial programming, clinicians are tasked with fine-tuning DBS parameters through repeated in-person clinic visits. We aimed to evaluate whether DBS patients achieve clinical benefit more rapidly by incorporating remote internet-based adjustment (RIBA) of stimulation parameters into the continuum of care.

METHODS: We conducted a randomized controlled multicenter study (ClinicalTrails.gov NCT05269862) involving patients scheduled for de novo implantation with a DBS System to treat Parkinson's Disease. Eligibility criteria included the ability to incorporate RIBA as part of routine follow-up care. Ninety-six patients were …


Recanalization Outcomes And Procedural Complications In Patients With Acute Ischemic Stroke And Covid-19 Receiving Endovascular Treatment, João Pedro Marto, Davide Strambo, George Ntaios, Thanh N. Nguyen, Pawel Wrona, Simon Escalard, Simona Marcheselli, Ossama Yassin Mansour, Blanca Fuentes, Malgorzata Dorobek, Marta Nowakowska-Kotas, Elena Oana Terecoasa, Jonathan M. Coutinho, Mariana Carvalho-Dias, Patricia Calleja, João Sargento-Freitas, Ana Paiva-Nunes, Martin Šrámek, Priyank Khandelwal, Torcato Meira, Mohamad Abdalkader, Pascal Jabbour, Martin Kovář, Oscar Ayo-Martin, Patrik Michel, Roman Herzig, Anna Członkowksa, Jelle Demeestere, Raul G. Nogueira, Alexander Salerno, Susanne Wegener, Philipp Baumgartner, Carlo W. Cereda, Giovanni Bianco, Morin Beyeler, Marcel Arnold, Emmanuel Carrera, Paolo Machi, Valerian Altersberger, Leo Bonati, Henrik Gensicke, Manuel Bolognese, Nils Peters, Stephan Wetzel, Marta Magriço, João Nuno Ramos, Rita Machado, Carolina Maia, Egídio Machado, Patrícia Ferreira, Teresa Pinho-E-Melo, André Paula, Manuel Alberto Correia, Pedro Castro, Elsa Azevedo, Luís Albuquerque, José Nuno-Alves, Joana Ferreira-Pinto, Liliana Pereira, Miguel Rodrigues, André Araújo, Marta Rodrigues, Mariana Rocha, Ângelo Pereira-Fonseca, Luís Ribeiro, Ricardo Varela, Sofia Malheiro, Manuel Cappellari, Cecilia Zivelonghi, Giulia Sajeva, Andrea Zini, Mauro Gentile, Stefano Forlivesi, Ludovica Migliaccio, Maria Sessa, Sara La Gioia, Alessandro Pezzini, Davide Sangalli, Marialuisa Zedde, Rosario Pascarella, Carlo Ferrarese, Simone Beretta, Susanna Diamanti, Ghil Schwarz, Giovanni Frisullo, Pierre Seners, Candice Sabben, Michel Piotin, Benjamin Maier, Guillaume Charbonnier, Fabrice Vuillier, Loic Legris, Pauline Cuisenier, Francesca R. Vodret, Gaultier Marnat, Jean-Sebastien Liegey, Igor Sibon, Fabian Flottmann, Gabriel Broocks, Nils-Ole Gloyer, Ferdinand O. Bohmann, Jan Hendrik Schaefer, Christian H. Nolte, Heinrich Audebert, Eberhard Siebert, Marek Sykora, Wilfried Lang, Julia Ferrari, Lukas Mayer-Suess, Michael Knoflach, Elke-Ruth Gizewski, Jeffrey Stolp, Lotte J. Stolze, Paul J. Nederkoorn, Ido Van-Den-Wijngaard, Joke De Meris, Robin Lemmen, Sylvie De Raedt, Fenne Vandervorst, Matthieu Pierre Rutgers, Antoine Guilmot, Anne Dusart, Flavio Bellante, Fernando Ostos, Guillermo Gonzalez-Ortega, Paloma Martín-Jiménez, Sebastian García-Madrona, Antonio Cruz-Culebras, Rocio Vera, Maria-Consuelo Matute, María Alonso-De-Leciñana, Ricardo Rigual, Exuperio Díez-Tejedor, Soledad Pérez-Sánchez, Joan Montaner, Fernando Díaz-Otero, Natalia Perez-De-La-Ossa, Belén Flores-Pina, Lucia Muñoz-Narbona, Angel Chamorro, Alejandro Rodríguez-Vázquez, Arturo Renú, Francisco Hernandez-Fernandez, Tomas Segura, Herbert Tejada-Meza, Daniel Sagarra-Mur, Marta Serrano-Ponz, Thant Hlaing, Isaiah See, Robert Simister, David J. Werring, Espen Saxhaug Kristoffersen, Annika Nordanstig, Katarina Jood, Alexandros Rentzos, Libor Šimu Ne, Dagmar Krajíčková, Antonín Krajina, Robert Mikulík, Martina Cviková, Jan Vinklárek, David Školoudík, Martin Roubec, Eva Hurtikova, Rostislav Hrubý, Svatopluk Ostry, Ondrej Skoda, Marek Pernicka, Lubomír Kočí, Zuzana Eichlová, Martin Jíra, Michal Panský, Pavel Mencl, Hana Paloušková, Aleš Tomek, Petr Janský, Anna Olšerová, Roman Havlíček, Petr Malý, Lukáš Trakal, Jan Fiksa, Matěj Slovák, Michał Karlińsk, Maciej Nowak, Halina Sienkiewicz-Jarosz, Anna Bochynska, Tomasz Homa, Katarzyna Sawczynska, Agnieszka Slowik, Ewa Wlodarczyk, Marcin Wiącek, Izabella Tomaszewska-Lampart, Bartosz Sieczkowski, Halina Bartosik-Psujek, Marta Bilik, Anna Bandzarewicz, Justyna Zielińska-Turek, Krystian Obara, Paweł Urbanowski, Sławomir Budrewicz, Maciej Guziński, Milena Świtońska, Iwona Rutkowska, Paulina Sobieszak-Skura, Beata Łabuz-Roszak, Aleksander Dębiec, Jacek Staszewski, Adam Stępień, Jacek Zwiernik, Grzegorz Wasilewski, Cristina Tiu, Razvan-Alexandru Radu, Anca Negrila, Bogdan Dorobat, Cristina Panea, Vlad Tiu, Simona Petrescu, Atilla Özcan-Özdemir, Mostafa Mahmoud, Hussam El-Samahy, Hazem Abdelkhalek, Jasem Al-Hashel, Ismail Ibrahim Ismail, Athari Salmeen, Abdoreza Ghoreishi, Sergiu Sabetay, Hana Gross, Piers Klein, Kareem El Naamani, Stavropoula Tjoumakaris, Rawad Abbas, Ghada-A Mohamed, Alex Chebl, Jiangyong Min, Majesta Hovingh, Jenney-P Tsai, Muhib-A Khan, Krishna Nalleballe, Sanjeeva Onteddu, Hesham-E Masoud, Mina Michael, Navreet Kaur, Laith Maali, Michael Abraham, Ivo Bach, Melody Ong, Denis Babici, Ayaz-M Khawaja, Maryam Hakemi, Kumar Rajamani, Vanessa Cano-Nigenda, Antonio Arauz, Pablo Amaya, Natalia Llanos, Akemi Arango, Miguel A. Vences, José-Domingo Barrientos, Rayllene Caetano, Rodrigo Targa, Sergio Scollo, Patrick Yalung, Shashank Nagendra, Abhijit Gaikwad, Kwon-Duk Seo Jan 2025

Recanalization Outcomes And Procedural Complications In Patients With Acute Ischemic Stroke And Covid-19 Receiving Endovascular Treatment, João Pedro Marto, Davide Strambo, George Ntaios, Thanh N. Nguyen, Pawel Wrona, Simon Escalard, Simona Marcheselli, Ossama Yassin Mansour, Blanca Fuentes, Malgorzata Dorobek, Marta Nowakowska-Kotas, Elena Oana Terecoasa, Jonathan M. Coutinho, Mariana Carvalho-Dias, Patricia Calleja, João Sargento-Freitas, Ana Paiva-Nunes, Martin Šrámek, Priyank Khandelwal, Torcato Meira, Mohamad Abdalkader, Pascal Jabbour, Martin Kovář, Oscar Ayo-Martin, Patrik Michel, Roman Herzig, Anna Członkowksa, Jelle Demeestere, Raul G. Nogueira, Alexander Salerno, Susanne Wegener, Philipp Baumgartner, Carlo W. Cereda, Giovanni Bianco, Morin Beyeler, Marcel Arnold, Emmanuel Carrera, Paolo Machi, Valerian Altersberger, Leo Bonati, Henrik Gensicke, Manuel Bolognese, Nils Peters, Stephan Wetzel, Marta Magriço, João Nuno Ramos, Rita Machado, Carolina Maia, Egídio Machado, Patrícia Ferreira, Teresa Pinho-E-Melo, André Paula, Manuel Alberto Correia, Pedro Castro, Elsa Azevedo, Luís Albuquerque, José Nuno-Alves, Joana Ferreira-Pinto, Liliana Pereira, Miguel Rodrigues, André Araújo, Marta Rodrigues, Mariana Rocha, Ângelo Pereira-Fonseca, Luís Ribeiro, Ricardo Varela, Sofia Malheiro, Manuel Cappellari, Cecilia Zivelonghi, Giulia Sajeva, Andrea Zini, Mauro Gentile, Stefano Forlivesi, Ludovica Migliaccio, Maria Sessa, Sara La Gioia, Alessandro Pezzini, Davide Sangalli, Marialuisa Zedde, Rosario Pascarella, Carlo Ferrarese, Simone Beretta, Susanna Diamanti, Ghil Schwarz, Giovanni Frisullo, Pierre Seners, Candice Sabben, Michel Piotin, Benjamin Maier, Guillaume Charbonnier, Fabrice Vuillier, Loic Legris, Pauline Cuisenier, Francesca R. Vodret, Gaultier Marnat, Jean-Sebastien Liegey, Igor Sibon, Fabian Flottmann, Gabriel Broocks, Nils-Ole Gloyer, Ferdinand O. Bohmann, Jan Hendrik Schaefer, Christian H. Nolte, Heinrich Audebert, Eberhard Siebert, Marek Sykora, Wilfried Lang, Julia Ferrari, Lukas Mayer-Suess, Michael Knoflach, Elke-Ruth Gizewski, Jeffrey Stolp, Lotte J. Stolze, Paul J. Nederkoorn, Ido Van-Den-Wijngaard, Joke De Meris, Robin Lemmen, Sylvie De Raedt, Fenne Vandervorst, Matthieu Pierre Rutgers, Antoine Guilmot, Anne Dusart, Flavio Bellante, Fernando Ostos, Guillermo Gonzalez-Ortega, Paloma Martín-Jiménez, Sebastian García-Madrona, Antonio Cruz-Culebras, Rocio Vera, Maria-Consuelo Matute, María Alonso-De-Leciñana, Ricardo Rigual, Exuperio Díez-Tejedor, Soledad Pérez-Sánchez, Joan Montaner, Fernando Díaz-Otero, Natalia Perez-De-La-Ossa, Belén Flores-Pina, Lucia Muñoz-Narbona, Angel Chamorro, Alejandro Rodríguez-Vázquez, Arturo Renú, Francisco Hernandez-Fernandez, Tomas Segura, Herbert Tejada-Meza, Daniel Sagarra-Mur, Marta Serrano-Ponz, Thant Hlaing, Isaiah See, Robert Simister, David J. Werring, Espen Saxhaug Kristoffersen, Annika Nordanstig, Katarina Jood, Alexandros Rentzos, Libor Šimu Ne, Dagmar Krajíčková, Antonín Krajina, Robert Mikulík, Martina Cviková, Jan Vinklárek, David Školoudík, Martin Roubec, Eva Hurtikova, Rostislav Hrubý, Svatopluk Ostry, Ondrej Skoda, Marek Pernicka, Lubomír Kočí, Zuzana Eichlová, Martin Jíra, Michal Panský, Pavel Mencl, Hana Paloušková, Aleš Tomek, Petr Janský, Anna Olšerová, Roman Havlíček, Petr Malý, Lukáš Trakal, Jan Fiksa, Matěj Slovák, Michał Karlińsk, Maciej Nowak, Halina Sienkiewicz-Jarosz, Anna Bochynska, Tomasz Homa, Katarzyna Sawczynska, Agnieszka Slowik, Ewa Wlodarczyk, Marcin Wiącek, Izabella Tomaszewska-Lampart, Bartosz Sieczkowski, Halina Bartosik-Psujek, Marta Bilik, Anna Bandzarewicz, Justyna Zielińska-Turek, Krystian Obara, Paweł Urbanowski, Sławomir Budrewicz, Maciej Guziński, Milena Świtońska, Iwona Rutkowska, Paulina Sobieszak-Skura, Beata Łabuz-Roszak, Aleksander Dębiec, Jacek Staszewski, Adam Stępień, Jacek Zwiernik, Grzegorz Wasilewski, Cristina Tiu, Razvan-Alexandru Radu, Anca Negrila, Bogdan Dorobat, Cristina Panea, Vlad Tiu, Simona Petrescu, Atilla Özcan-Özdemir, Mostafa Mahmoud, Hussam El-Samahy, Hazem Abdelkhalek, Jasem Al-Hashel, Ismail Ibrahim Ismail, Athari Salmeen, Abdoreza Ghoreishi, Sergiu Sabetay, Hana Gross, Piers Klein, Kareem El Naamani, Stavropoula Tjoumakaris, Rawad Abbas, Ghada-A Mohamed, Alex Chebl, Jiangyong Min, Majesta Hovingh, Jenney-P Tsai, Muhib-A Khan, Krishna Nalleballe, Sanjeeva Onteddu, Hesham-E Masoud, Mina Michael, Navreet Kaur, Laith Maali, Michael Abraham, Ivo Bach, Melody Ong, Denis Babici, Ayaz-M Khawaja, Maryam Hakemi, Kumar Rajamani, Vanessa Cano-Nigenda, Antonio Arauz, Pablo Amaya, Natalia Llanos, Akemi Arango, Miguel A. Vences, José-Domingo Barrientos, Rayllene Caetano, Rodrigo Targa, Sergio Scollo, Patrick Yalung, Shashank Nagendra, Abhijit Gaikwad, Kwon-Duk Seo

Department of Neurosurgery Faculty Papers

No abstract provided.


Wearable Penile Devices: The Techring, Gal Saffati, Daniela Orozco Rendon, Riley Daily, Mohit Khera, John P Mulhall Jan 2025

Wearable Penile Devices: The Techring, Gal Saffati, Daniela Orozco Rendon, Riley Daily, Mohit Khera, John P Mulhall

Faculty, Staff and Students Publications

The integration of wearable technology into healthcare has transformed patient monitoring, particularly in urology. Wearable penile devices (WPDs), such as the FirmTech TechRing, offer real-time data on erectile function, providing critical insights into nocturnal penile tumescence (NPT) patterns that can indicate underlying health issues. This piece highlights the potential of the FirmTech TechRing, a WPD, to advance erectile function monitoring by providing real-time data on NPT and intra-coital activity. It explores its promise in detecting early dysfunction, assessing cardiovascular risk, and enhancing proactive health management. By measuring parameters like firmness, girth expansion, and the frequency of erections, the TechRing enables …


Pfkfb3 Connects Glycolytic Metabolism With Endothelial Dysfunction In Human And Rodent Obesity, Robert K Batori, Zsuzsanna Bordan, Caleb A Padgett, Yuqing Huo, Feng Chen, Reem T Atawia, Rudolf Lucas, Masuko Ushio-Fukai, Tohru Fukai, Eric J Belin De Chantemele, David W Stepp, David J R Fulton Jan 2025

Pfkfb3 Connects Glycolytic Metabolism With Endothelial Dysfunction In Human And Rodent Obesity, Robert K Batori, Zsuzsanna Bordan, Caleb A Padgett, Yuqing Huo, Feng Chen, Reem T Atawia, Rudolf Lucas, Masuko Ushio-Fukai, Tohru Fukai, Eric J Belin De Chantemele, David W Stepp, David J R Fulton

Faculty, Staff and Students Publications

Obesity and type 2 diabetes (T2D) increase cardiovascular risk, largely due to altered metabolic state. An early consequence of T2D/obesity is the loss of endothelial function and impaired nitric oxide (NO) signaling. In blood vessels, endothelial nitric oxide synthase (eNOS) synthesizes NO to maintain vessel homeostasis. The biological actions of NO are compromised by superoxide that is generated by NADPH oxidases (NOXs). Herein we investigated how altered metabolism affects superoxide/NO balance in obesity. We found that eNOS expression and NO bioavailability are significantly decreased in endothelial cells (ECs) from T2D patients and animal models of obesity. In parallel, PFKFB3, a …


A Guide To Diagnosis And Management Of Hypertrichosis, Rahib K. Islam, Victoria T. Tong, Shari R. Lipner Jan 2025

A Guide To Diagnosis And Management Of Hypertrichosis, Rahib K. Islam, Victoria T. Tong, Shari R. Lipner

School of Medicine Faculty Publications

Hypertrichosis is a phenotype characterized by excessive hair growth in areas not typically prone to dense hair coverage. It may be congenital or acquired, and has significant clinical and psychosocial implications, often leading to psychological distress and social stigmatization. Diagnostic approaches emphasize the importance of thorough clinical evaluation and differentiation from hirsutism. Treatment options include topical and systemic treatments, as well as mechanical methods and laser therapies. Special considerations are given to pediatric patients regarding the psychosocial aspects of the phenotype. This review aims to provide physicians and researchers with a thorough understanding of hypertrichosis to facilitate better diagnosis, treatment, …


Molecular Modification Of Queen Bee Acid And 10-Hydroxydecanoic Acid With Specific Tripeptides: Rational Design, Organic Synthesis, And Assessment For Prohealing And Antimicrobial Hydrogel Properties, Song Hong, Sachin B. Baravkar, Yan Lu, Abdul Razak Masoud, Qi Zhao, Weilie Zhou Jan 2025

Molecular Modification Of Queen Bee Acid And 10-Hydroxydecanoic Acid With Specific Tripeptides: Rational Design, Organic Synthesis, And Assessment For Prohealing And Antimicrobial Hydrogel Properties, Song Hong, Sachin B. Baravkar, Yan Lu, Abdul Razak Masoud, Qi Zhao, Weilie Zhou

School of Medicine Faculty Publications

Royal jelly and medical grade honey are traditionally used in treating wounds and infections, although their effectiveness is often variable and insufficient. To overcome their limitations, we created novel amphiphiles by modifying the main reparative and antimicrobial components, queen bee acid (hda) and 10-hydroxyl-decanoic acid (hdaa), through peptide bonding with specific tripeptides. Our molecular design incorporated amphiphile targets as being biocompatible in wound healing, biodegradable, non-toxic, hydrogelable, prohealing, and antimicrobial. The amphiphilic molecules were designed in a hda(hdaa)-aa1-aa2-aa3 structural model with rational selection criteria for each moiety, prepared via Rink/Fmoc-tBu-based solid-phase peptide synthesis, and structurally verified by NMR and LC–MS/MS. …


Enhancing Immunotherapy Efficacy With Synergistic Low-Dose Radiation In Metastatic Melanoma: Current Insights And Prospects, Zahid Rafiq, Mingyo Kang, Hampartsoum B Barsoumian, Gohar S Manzar, Yun Hu, Carola Leuschner, Ailing Huang, Fatemeh Masrorpour, Weiqin Lu, Nahum Puebla-Osorio, James W Welsh Jan 2025

Enhancing Immunotherapy Efficacy With Synergistic Low-Dose Radiation In Metastatic Melanoma: Current Insights And Prospects, Zahid Rafiq, Mingyo Kang, Hampartsoum B Barsoumian, Gohar S Manzar, Yun Hu, Carola Leuschner, Ailing Huang, Fatemeh Masrorpour, Weiqin Lu, Nahum Puebla-Osorio, James W Welsh

Faculty, Staff and Student Publications

Recent advances in oncology research have highlighted the promising synergy between low-dose radiation therapy (LDRT) and immunotherapies, with growing evidence highlighting the unique benefits of the combination. LDRT has emerged as a potent tool for stimulating the immune system, triggering systemic antitumor effects by remodeling the tumor microenvironment. Notably, LDRT demonstrates remarkable efficacy even in challenging metastatic sites such as the liver (uveal) and brain (cutaneous), particularly in advanced melanoma stages. The increasing interest in utilizing LDRT for secondary metastatic sites of uveal, mucosal, or cutaneous melanomas underscores its potential efficacy in combination with various immunotherapies. This comprehensive review traverses …


Hypoxia Signaling In The Adipose Tissue, Phu M Huynh, Fenfen Wang, Yu A An Jan 2025

Hypoxia Signaling In The Adipose Tissue, Phu M Huynh, Fenfen Wang, Yu A An

Faculty, Staff and Student Publications

Obesity per se is rapidly emerging all over the planet and further accounts for many other life-threatening conditions, such as diabetes, cardiovascular diseases, and cancers. Decreased oxygen supply or increased relative oxygen consumption in the adipose tissue results in adipose tissue hypoxia, which is a hallmark of obesity. This review aims to provide an up-to-date overview of the hypoxia signaling in the adipose tissue. First, we summarize literature evidence to demonstrate that hypoxia is regularly observed during adipose tissue remodeling in humans and rodent models with obesity. Next, we discuss how hypoxia-inducible factors (HIFs) are regulated and how adipose tissues …


Establishing A Student-Run Mobile Clinic In Appalachian Kentucky: A Community-Based Pilot Program To Address Health Inequities, Bradley A. Firchow, John C. Cornelius Jan 2025

Establishing A Student-Run Mobile Clinic In Appalachian Kentucky: A Community-Based Pilot Program To Address Health Inequities, Bradley A. Firchow, John C. Cornelius

Journal of Appalachian Health

The establishment of a student-run mobile clinic in Morehead, Kentucky, led by students from the University of Kentucky College of Medicine’s (UKCOM) Rural Physician Leadership Program (RPLP), aims to address health inequities in rural Appalachian communities. This pilot program is designed to serve vulnerable populations, including the unhoused, by delivering free, accessible healthcare services directly to underserved populations. This program serves as a model for expanding access to healthcare in rural regions while promoting a collaborative, community-based approach to addressing social determinants of health.


Current Attitudes And Barriers Among Appalachian Patients Towards Orthopaedic Surgery, Dylan Smith Md, Justin B. West Ms, Wade Smith Md, Micah Macaskill Md, Jonathan Lash, Matthew W. Bullock Do, Mpt Jan 2025

Current Attitudes And Barriers Among Appalachian Patients Towards Orthopaedic Surgery, Dylan Smith Md, Justin B. West Ms, Wade Smith Md, Micah Macaskill Md, Jonathan Lash, Matthew W. Bullock Do, Mpt

Journal of Appalachian Health

Introduction: This study explores the challenges faced by residents of rural West Virginia in accessing orthopaedic care due to geographic and socioeconomic barriers.

Purpose: This study seeks to survey rural West Virginia residents about their attitudes and experiences regarding access to orthopaedic care in southern West Virginia.

Methods: A total of 132 electronic surveys were collected from rural West Virginia residents during an appointment with their primary care provider located at an affiliated outreach clinic. The survey was designed to investigate various factors influencing their access to orthopaedic care.

Results: Delays in seeking orthpaedic care are common in rural West …


Recent Advances In Cardiac Resynchronization Therapy: Current Treatment And Future Direction, Arasalan Siddiqui, Vasiliki Tasouli-Drakou, Marc Ringor, Micael V. Dicaro, Brianna Yee, Kachon Lei, Tahir Tak Jan 2025

Recent Advances In Cardiac Resynchronization Therapy: Current Treatment And Future Direction, Arasalan Siddiqui, Vasiliki Tasouli-Drakou, Marc Ringor, Micael V. Dicaro, Brianna Yee, Kachon Lei, Tahir Tak

Department of Internal Medicine Faculty Research

Cardiac Resynchronization Therapy (CRT) has been established as a major component of heart failure management, resulting in a significant reduction in patient morbidity and death for patients with increased QRS duration, low left ventricular ejection fraction (LVEF), and high risk of arrhythmias. The ability to synchronize both ventricles, lower heart failure hospitalizations, and optimize clinical outcomes are some of the attractive characteristics of biventricular pacing, or CRT. However, the high rate of CRT non-responders has led to the development of new modalities including leadless CRT pacemakers (CRT-P) and devices focused on conduction system pacing (CSP). This comprehensive review aims to …


Genetic Ancestry Concordant Rna Splicing In Prostate Cancer Involves Oncogenic Genes And Associates With Recurrence, Muthana Al Abo, Wen-Chi Foo, Lauren Howard, Shannon Mcgue, Bonnie Lacroix, Julie Kephart, Angela Clayton, Blair Thornburg, Monika Anand, Michael Rothberg, Shannon Mccall, Jiaoti Huang, Thomas Esther, Judd Moul, Michael Ferrandino, Thomas Polascik, Cary Robertson, Brant Inman, Andrew Armstrong, Yuan Wu, Terry Hyslop, Daniel George, Steven Patierno, Jennifer Freedman Jan 2025

Genetic Ancestry Concordant Rna Splicing In Prostate Cancer Involves Oncogenic Genes And Associates With Recurrence, Muthana Al Abo, Wen-Chi Foo, Lauren Howard, Shannon Mcgue, Bonnie Lacroix, Julie Kephart, Angela Clayton, Blair Thornburg, Monika Anand, Michael Rothberg, Shannon Mccall, Jiaoti Huang, Thomas Esther, Judd Moul, Michael Ferrandino, Thomas Polascik, Cary Robertson, Brant Inman, Andrew Armstrong, Yuan Wu, Terry Hyslop, Daniel George, Steven Patierno, Jennifer Freedman

Department of Pharmacology, Physiology, and Cancer Biology Faculty Papers

Black men suffer disproportionately from prostate cancer (PCa) compared to men of other races and ethnicities. Comparing the molecular landscape of PCa among Black and White patients has the potential to identify targets for development of new precision medicine interventions. Herein, we conducted transcriptomic analysis of prostate tumors and paired tumor-adjacent normals from self-reported Black and White PCa patients and estimated patient genetic ancestry. Clinical follow-up revealed increased biochemical recurrence (BCR) among Black patients compared to White patients with high-grade PCa. Transcriptomic analysis identified differential alternative RNA splicing events (ARSs) between Black and White PCa patients. Genes undergoing genetic ancestry-concordant …