Medicine and Health Sciences Commons^™

Comparative Effectiveness Of En-Bloc Vs Conventional Transurethral Resection For Non-Muscle-Invasive Bladder Cancer A Systematic Review And Meta-Analysis, David E Hinojosa-Gonzalez, Gal Saffati, Troy La, Jackson Cathey, Juan C Angulo-Lozano, Gustavo Salgado-Garza, Jonathan Walsh, Bailey Slawin, Shane Kronstedt, Kate Lowrey, Jeremy R Slawin

Faculty, Staff and Students Publications

Introduction: Transurethral en-bloc resection of bladder tumor (ERBT) has emerged as an alternate technique to conventional transurethral resection of bladder tumor (cTURBT). While theoretically advantageous, the comparative effectiveness of ERBT across various technical approaches remains unclear. We performed an updated systematic review and meta-analysis to evaluate perioperative, pathologic, and oncologic outcomes of ERBT vs. cTURBT.

Methods: We systematically searched PubMed, EMBASE, Scopus, and Google Scholar for randomized controlled trials (RCTs) comparing ERBT and cTURBT. The primary outcome was recurrence-free survival (RFS). Secondary outcomes were operative time, complication rates, detrusor muscle presence, and need for repeated resection. Meta-analyses were performed, with …

Optical Coherence Tomography Enables The Depth-Resolved Measurement Of Cilia Beat Frequency In Ex Vivo Human Fallopian Tubes, Dilara J Long, Tian Xia, Photini F Rice, Deirdre M Scully, Makayla Johnson, Ryan Mistifer, Andrea Aguirre, John M Heusinkveld, Irina V Larina, Jennifer K Barton

Faculty, Staff and Students Publications

Objectives: The movement of cilia in the fallopian tubes (FTs) facilitates important processes involved in fertility, and abnormalities in cilia function are linked with diseases including endometriosis and pelvic inflammatory disease. For the first time, we demonstrate the use of optical coherence tomography (OCT) to create depth-resolved mapping of motile cilia locations and quantify cilia beat frequency (CBF) in human FT samples ex vivo.

Methods: Segments of the FT ampulla were acquired from five patients following salpingectomy under an IRB approved protocol. The samples were longitudinally opened to expose the luminal surface for imaging. A sequence of at least 500 …

High-Fidelity Finite Element Modeling Technique To Improve Sensitivity To Bone Tissue Changes Of Older Adults With Obesity Undergoing Intensive Lifestyle Intervention, Michael A K Liebschner, Daeseung Kim, Nina Klonis, Giulia Gregori, Reina Armamento-Villareal, Clifford Qualls, Dennis T Villareal

Faculty, Staff and Students Publications

Introduction: Obesity presents a significant health risk for the aging population. Research shows that weight loss and regular exercise can greatly improve the functional status of older adults who are obese. However, weight loss may also result in a decrease in bone mass. To properly assess changes in fracture risk due to lifestyle interventions, a direct biomechanical evaluation of bone strength and fracture risk at metabolically active sites is essential.

Methods: Computed tomography scans taken at two different time points of ten human volunteers provided the foundation for this study. A high-fidelity segmentation and modeling approach was taken to generate …

A Review Of The United States Global Surgery Program Landscape By Website Analysis, Lauren E Cox, Cassandra M D'Amico, Shriya Bhoothapuri, Joseph A Q Karam, Rachel W Davis, Mike M Mallah

Faculty, Staff and Students Publications

Background: Over the past decade, since the 2015 Lancet Commission on Global Surgery (LCoGS) highlighted the global burden of disease attributable to a lack of safe surgical care, medical degree-granting institutions across the United States (US) have worked to increase engagement in global surgery. The research team aimed to analyze the current landscape and provide an overview of all US-based global surgery programs. It was predicted that most medical institutions in the US would not have established programs. For those with global surgery programs, their mission statements and demonstrated output were classified according to a list of five domains, including …

Postoperative Staphylococcal Toxic Shock Syndrome In A Patient Following Right Knee Fracture Repair: A Case Report, Nicole Nyamongo, James Garritano, Daniel Rosen, Theodore Rosen

Faculty, Staff and Students Publications

Toxic shock syndrome (TSS) is a rare but life-threatening multisystem disorder most commonly caused by Staphylococcus aureus. It is characterized by the acute onset of high fever, hypotension, a diffuse macular rash, and multiorgan involvement. We report the case of a male in his late 30s who sustained a patellar fracture with associated retinacular injury following trauma and subsequently underwent open reduction and internal fixation. Several days after discharge, he developed fever, chills, hypotension, and a pruritic, erythematous rash. He was readmitted and initially evaluated by the orthopedic service, which did not recommend additional imaging or surgical intervention, as …

Emergency Department Utilization Among Co-Residing Family Caregivers Of Persons Living With Dementia, Pei-Chun Cha, Craig Rothenberg, Anita N Chary, Justine Seidenfeld, Ula Hwang, Terri Fried, Joan K Monin, Arjun K Venkatesh, Cameron J Gettel

Faculty, Staff and Students Publications

No abstract provided.

Muscle Spectrin, Matthew N Rasband, Ahmet Hoke, Chuansheng Zhang, Ozlem Sert

Faculty, Staff and Students Publications

No abstract provided.

Silent Damage, Early Signals: A Narrative Review Of The Evolving Role Of Cardiac Biomarkers In Oncology-Driven Cardiotoxicity, Aura Calderon, Luis Salcedo, Jose Loayza, Catherine Matos, Ivan Mogollon, Francisco Arias, Everardo Cobos

School of Medicine Publications

Advancements in cancer therapy have led to improved patient survival but have also introduced an increasing risk of cardiotoxicity, particularly with agents such as anthracyclines, trastuzumab, and various targeted treatments. Cardiotoxic effects may present as myocardial injury, systolic or diastolic dysfunction, or heart failure (HF), often developing insidiously before clinical symptoms become evident. Early detection is therefore crucial to preserve cardiovascular health in oncology patients. This narrative review examines the expanding role of cardiac biomarkers; including high-sensitivity troponins, natriuretic peptides, Galectin-3, soluble ST2, and novel molecular markers like microRNAs, in identifying and monitoring chemotherapy-induced cardiac injury. It also highlights how …

Cmr Findings In The Long-Term Outcomes After Multisystem Inflammatory Syndrome In Children (Music) Study, Sean M Lang, Dongngan T Truong, Andrew J Powell, Valiantsina Kazlova, Jane W Newburger, Jordan D Awerbach, Edem Binka, Tamara T Bradford, Mark Cartoski, Andrew Cheng, Michael P Dilorenzo, Audrey Dionne, Adam L Dorfman, Matthew D Elias, Olukayode Garuba, Jennifer F Gerardin, Keren Hasbani, Pei-Ni Jone, Christopher Z Lam, Nilanjana Misra, Lerraughn M Morgan, Arni Nutting, Jyoti K Patel, Joshua D Robinson, Eleanor L Schuchardt, Kristen Sexson Tejtel, Gautam K Singh, Timothy C Slesnick, Felicia Trachtenberg, Michael D Taylor, Music Study Investigators

Faculty, Staff and Students Publications

Background: Multisystem Inflammatory Syndrome in Children is characterized by high rates of acute cardiovascular involvement with rapid recovery of organ dysfunction. However, information regarding long-term sequelae is lacking. We sought to characterize the systolic function and myocardial tissue properties using cardiac magnetic resonance (CMR) imaging in a multicenter observational cohort of patients with Multisystem Inflammatory Syndrome in Children.

Methods: In this observational cohort study, comprising 32 centers in North America, CMR studies were analyzed by a core laboratory to assess ventricular volumetric data, tissue characterization, and coronary involvement.

Results: A total of 263 CMRs from 255 patients with Multisystem Inflammatory …

Systematic Review And Evidence Gap Mapping Of Alzheimer's Disease Biomarker Studies In Those With Intellectual And Developmental Disability, Lubnaa B. Abdullah, Ney Alex Alliey, Emma Elizondo, Ney Alliey Rodriguez, Gladys Maestre, James Hall

School of Medicine Publications

There are a relatively small number of investigations into brain aging in those with intellectual and developmental disability (I/DD). This project seeks to (1) characterize the internationally available multi-omics Alzheimer's disease (AD) biomarker studies including those with I/DD, and (2) discuss future research directions. PubMed, Web of Science, and Scopus were searched under the following criteria: cross-sectional or longitudinal AD-omics studies on adults (18 +) with I/DD. 532 studies were identified, 186 studies were evaluated for full-text, 79 studies were excluded, and 117 studies were extracted. Most biological specimens were analyzed in blood, plasma, or serum. Metabolomics, hormonomics, and transcriptomics …

Computational Analysis Of Dna Methylation From Long-Read Sequencing, Yilei Fu, Winston Timp, Fritz J Sedlazeck

Faculty, Staff and Students Publications

DNA methylation is a critical epigenetic mechanism in numerous biological processes, including gene regulation, development, ageing and the onset of various diseases such as cancer. Studies of methylation are increasingly using single-molecule long-read sequencing technologies to simultaneously measure epigenetic states such as DNA methylation with genomic variation. These long-read data sets have spurred the continuous development of advanced computational methods to gain insights into the roles of methylation in regulating chromatin structure and gene regulation. In this Review, we discuss the computational methods for calling methylation signals, contrasting methylation between samples, analysing cell-type diversity and gaining additional genomic insights, and …

High-Resolution Mapping Of Alcohol-Related Brain Connectivity In Adults Using 7t Fmri And Multivoxel Pattern Classification, Alan N. Francis, Ihsan Salloum

School of Medicine Publications

Background: Emerging evidence suggests that alcohol use disrupts large-scale brain network interactions, particularly within the triple network model-comprising the Salience Network (SN), Default Mode Network (DMN), and Frontoparietal Network (FPN). However, few studies have examined how these connectivity alterations vary across the full spectrum of alcohol consumption, especially using ultra-high-field imaging and data-driven approaches. This study leverages 7 Tesla resting-state fMRI and multivariate pattern analysis (MVPA) to characterize distinct brain connectivity patterns across heavy, moderate, and non-drinking adults, aiming to identify neural signatures that differentiate alcohol use severity levels.

Methods: We analyzed resting-state functional connectivity data from 69 adults (Mean …

Safety Of Uninterrupted Anticoagulation Use In Patients Undergoing Hemodialysis Access Creation With Regional Anesthesia: A Research Report, Melissa M. Cruz, James J. Fitzgibbon, Abena Appah-Sampong, Patrick Heindel, Lucinda R. Holden-Wingate, Dirk M. Hentschel, Charles Keith Ozaki, Felicity Billings, Kamen V. Vlassakov, Mohamad A. Hussain

School of Medicine Publications

No abstract provided.

Systematic Review And Evidence Gap Mapping Of Alzheimer's Disease Biomarker Studies In Those With Intellectual And Developmental Disability, Lubnaa B. Abdullah, Ney Alex Alliey, Emma Elizondo, Ney Alliey Rodriguez, Gladys Maestre, James Hall

School of Medicine Publications

There are a relatively small number of investigations into brain aging in those with intellectual and developmental disability (I/DD). This project seeks to (1) characterize the internationally available multi-omics Alzheimer's disease (AD) biomarker studies including those with I/DD, and (2) discuss future research directions. PubMed, Web of Science, and Scopus were searched under the following criteria: cross-sectional or longitudinal AD-omics studies on adults (18 +) with I/DD. 532 studies were identified, 186 studies were evaluated for full-text, 79 studies were excluded, and 117 studies were extracted. Most biological specimens were analyzed in blood, plasma, or serum. Metabolomics, hormonomics, and transcriptomics …

Society Of Vascular And Interventional Neurology (Svin) Stroke Interventional Laboratory Consensus (Silc) Criteria For Training Standards And Maintenance Of Certification In Neurointervention, Ossama Y. Mansour, Kaiz S. Asif, Roberta Novakovic-White, Boris Pabon, Santiago Ortega-Gutierrez, Atilla Ozcan Ozdemar, Alicia Castonguay, Brijesh Mehta, Dileep R. Yavagal, Ameer E. Hassan

School of Medicine Publications

The global shortage of neurointerventionalists presents a challenge to timely stroke care, particularly in low‐ and middle‐income countries. The Society of Vascular and Interventional Neurology Stroke Interventional Laboratory Consensus criteria aim to standardize training and certification in neurointervention to address these disparities. This white paper reviews existing training standards in various regions, identifies gaps, and proposes a structured framework encompassing entry requirements, program structure, and certification processes. The Stroke Interventional Laboratory Consensus criteria further outline requirements for training centers and program directors. By establishing global standards, the Stroke Interventional Laboratory Consensus criteria seek to improve patient outcomes and expand access …

Unravelling The Global Tapestry Of Genetic Ataxias: Epidemiology And Genetic Testing Approaches, Malco Rossi, Christopher D Stephen, Joana Damásio, José Luiz Pedroso, Sheng-Han Kuo, Chi-Ying R Lin, Oluwadamilola Ojo, Shaimaa El-Jaafary, Woong-Woo Lee, Harutyun Madoev, Orlando G P Barsottini, Achal Kumar Srivastava, Christine Klein, Bart P Van De Warrenburg

Faculty, Staff and Students Publications

The landscape of genetic ataxias is influenced by migration, population genetics, consanguinity, and founder effects, resulting in significant regional variation. Within the expanding domain of genetic ataxias, knowledge of regional epidemiology is scarce, particularly outside of North America and Europe. Understanding the epidemiology of genetic ataxias, together with deep phenotyping and knowledge of the appropriate ancillary studies, is crucial for the development and deployment of diagnostic testing strategies. This review offers a comprehensive, data-driven overview of 2932 articles with regional epidemiological estimates and the occurrence and prevalence of 548 genes associated with ataxia across 122 countries. Regional differences in epidemiology …

Experiences Of Emotional Support Among Parents Of Children And Adolescents With Type 1 Diabetes: A Qualitative Study, Sahar S Eshtehardi, Marissa N Baudino, Barbara J Anderson, Deborah I Thompson, David G Marrero, Marisa E Hilliard

Faculty, Staff and Students Publications

Objective: Parents of youth with type 1 diabetes (T1D) experience substantial disease-specific demands and distress, yet their perceptions about the emotional support they receive related to the challenges of caring for a child with diabetes have not been well described. This research aimed to characterize the types of emotional support parents of youth with T1D receive and how they experience emotional support.

Methods: As part of a larger qualitative study on diabetes health-related quality of life, 23 parents (96% mothers) of youth with T1D (M age = 10.9 ± 3.8 years; 35% female) completed semi-structured interviews about various aspects of …

Spatial Omics Enters The Microscopic Realm: Opportunities And Challenges, Yichen Si, Joo Sang Lee, Goo Jun, Hyun Min Kang, Jun Hee Lee

Faculty, Staff and Students Publications

Spatial transcriptomics (ST) enables systematic profiling of whole-transcriptome gene expression in tissues while preserving spatial context. Recent advances in sequencing- and imaging-based ST technologies have ushered in the era of microscopic-resolution ST (μST), allowing transcriptome mapping at cellular and even subcellular scales with unprecedented precision. Despite these advances, μST faces substantial challenges, including sparse transcript discovery per submicron (or micron)-sized spatial units and data fragmentation across platforms, hindering integration and analysis. There is also a growing demand for scalable, segmentation-free, and universally applicable analysis methods, as well as strategies for 3D mapping, multi-omics integration, and artificial intelligence (AI)-driven spatial analysis. …

Prenatal Obsessive Beliefs Predict Postpartum Obsessive-Compulsive Symptoms: A Prospective Study, Jonathan S Abramowitz, Samantha N Hellberg, Janice Krasnow, Joseph B Friedman, Nicholas S Myers, Paul S Nestadt, Heidi J Ojalehto, Emily K Juel, Jack Samuels, Mary E Kimmel, Lauren M Osborne, Eric A Storch, Gerald Nestadt, Rashelle J Musci

Faculty, Staff and Students Publications

This longitudinal study examined whether specific cognitive patterns during pregnancy predict postpartum obsessive-compulsive (OC) symptoms. A diverse sample of 256 women was assessed at 20 weeks of pregnancy (Time 1), 6 weeks postpartum (Time 2; n = 233), and 6 months postpartum (Time 3; n = 231). At each point, participants completed interview and/or self-report measures of OC symptoms, psychological distress, and obsessive beliefs (i.e., cognitive patterns related to OC symptoms). Postpartum OC symptoms were common, reported by 87.1 % at Time 2 and 74.5 % at Time 3. Stronger prenatal obsessive beliefs during pregnancy predicted greater postpartum OC symptom …

A Functional Perspective On Astrocyte Heterogeneity, Wookbong Kwon, Michael R Williamson, Benjamin Deneen

Faculty, Staff and Students Publications

Astrocytes are glial cells of the central nervous system (CNS) that perform an array of diverse functions that are essential for brain activity. Studies on the functional diversity of astrocytes suggest that such diversity may be derived from specialized populations. We provide an overview of the current state of research on astrocyte diversity and outline current challenges and knowledge gaps while also examining the developmental origins of these populations and how their interactions with neurons contribute to their functional heterogeneity. We highlight recent studies that provide evidence for functionally diverse astrocyte populations under homeostatic conditions and as an adaptive response …

Circulating Fibroblast Growth Factor 21 And Growth Differentiation Factor 15 Are Associated With Severity Of Hepatic Steatosis In People With Hiv, Paula Debroy, F Pike, S Gawrieh, K E Corey, S Hartig, A Balasubramanyam, K Ailstock, N Funderburg, J E Lake

Faculty, Staff and Students Publications

BACKGROUND: Hepatic steatosis poses a significant health burden in people with HIV. Fibroblast growth factor 21 (FGF21) production from the liver regulates glucose metabolism. Higher serum levels of FGF21 are associated with hepatic steatosis and liver fibrosis in the general population. Growth differentiation factor 15 (GDF15) secretion from the liver is also upregulated in chronic inflammatory diseases and is associated with cardiovascular dysfunction in people with HIV. Here, we measured serum FGF21 and GDF15 concentrations in people with HIV and hepatic steatosis.

METHODS: A total of 177 people with HIV with no other known cause of liver disease underwent vibration-controlled …

Comparative Effectiveness Of Less Vs More Frequent Hydrocortisone Dosing In Septic Shock, Alan Hao, Tianshi David Wu, Keegan Collins, Danielle Guffey, Rebecca Kessinger, Meghna Vallabh, Ali Omranian

Faculty, Staff and Students Publications

Objectives: Guidelines recommend hydrocortisone as an adjunctive treatment in septic shock, but the optimal dosing regimen is unknown. A national shortage of hydrocortisone in 2023 prompted a change in institutional practice for hydrocortisone administration from 50 mg every 6 hours to 100 mg every 12 hours in an effort to reduce waste and conserve vials, creating an opportunity to evaluate the comparative effectiveness of these two regimens. The primary efficacy outcome was time to shock resolution, and secondary outcomes evaluated in this study were mortality, renal replacement therapy (RRT), medication costs, and maximum vasopressor dose attained.

Design: Single-center, retrospective cohort …

A Prospective, Randomized, Controlled Clinical Trial Of High-Frequency Electromagnetic Coupling Powered Permanent Peripheral Nerve Stimulator For The Treatment Of Chronic Craniofacial Pain, Salim M Hayek, Nameer Haider, Ashwin Viswanathan, Mehul Desai, Jeffrey Rosenberg, Niek E Vanquathem

Faculty, Staff and Students Publications

than one-fifth of the US population. While various medications and conservative treatment modalities are available for this condition, many patients have refractory symptoms. These patients suffer from social impairment, reduced quality of life, and increased financial burdens.

Objective: The objective of this study was to examine the clinical outcomes of patients receiving a permanent, high-frequency electromagnetic coupling (HF-EMC) powered peripheral nerve stimulator (PNS) system for the treatment of chronic craniofacial neuropathic pain.

Study design: This study was a multicenter, randomized, controlled clinical trial conducted under an investigational device exemption (IDE).

Setting: This study was conducted in 7 clinical sites in …

Superior Vena Cava And Atrial Cardiomyopathy: Role Of Adjunctive Superior Vena Cava Isolation Ablation In Atrial Fibrillation, Bharat K Kantharia, Xander H T Wehrens, Dominik Linz

Faculty, Staff and Students Publications

No abstract provided.

Pancrelipase Treatment Of Exocrine Pancreatic Insufficiency Due To Chronic Pancreatitis: Rationale And Methodology Of A Real-World, Prospective, Observational Study, Mohamed O Othman, Jens J Kort, Tamas A Gonda, Guru Trikudanathan, Darshan J Kothari, Walter Park, Luis F Lara, Moming Li, Diala Harb

Faculty, Staff and Students Publications

No abstract provided.

Atrial Fibrillation In Advanced Ckd: To Anticoagulate, Or Not, And With What?, Muhammad S Ajmal, Wolfgang C Winkelmayer

Faculty, Staff and Students Publications

No abstract provided.

Atherosclerotic Cardiovascular Disease In Gulf War Veterans In Relation To Deployment Exposures, Sarah T Ahmed, Ruosha Li, Lea Steele, Peter Richardson, Kellie Sims, Rachel Quaden, Kelly M Harrington, Vijay Nambi, John M Gaziano, Robert Morgan, George L Delclos, Drew A Helmer

Faculty, Staff and Students Publications

Many 1990-1991 Gulf War Veterans (GWVs) were exposed to toxicants and environmental hazards during deployment, including oil well fire smoke, chemical/biological agents, pyridostigmine bromide (PB) pills, and pesticides. Multiple constituents of smoke are associated with increased risk for atherosclerotic cardiovascular diseases (ASCVD), and other toxic exposures have been associated with autonomic and lipid dysfunction. We used data from the Gulf War Era Cohort and Biorepository Study of veterans deployed to Gulf War in 1990-1991 (n = 942). We evaluated the association of deployment exposures (no, yes (1-6 days), (7-30 days), (31 + days), and not sure) with clinical risk factors …

Ideal Navitor Implant Depth For Redo-Tavr Feasibility And Coronary Access: A Ct Simulation Study, Sahil Khera, Syed Zaid, Parasuram Krishnamoorthy, Anoop N Koshy, Sneha Gudibendi, Megan Berdan, Lucy M Safi, Stamatios Lerakis, George D Dangas, Samin K Sharma, Annapoorna S Kini, Gilbert H L Tang

Faculty, Staff and Students Publications

Background: The impact of implant depth of the Abbott Navitor intra-annular, self-expanding valve on redo-transcatheter aortic valve replacement (TAVR) feasibility is unknown.

Objectives: The authors sought to determine the feasibility of redo-TAVR and coronary access with Edwards Sapien 3 (S3) valve after initial Navitor valve, based on various implant depths on computed tomography (CT) simulation.

Methods: Using 2050 pre-TAVR CTs of patients with native aortic stenosis, initial Navitor TAVR simulations were done at 3 implant depths (0 mm, 3 mm, and 5 mm), with frame expansion assumed at native annular dimensions and commissural alignment not achievable. Redo-TAVR with S3 was …

Cardiogenic Shock With Acute Myocardial Infarction Among Older Adults In The United States, Taha Mansoor, Ali Bin Abdul Jabbar, Mahmoud Ismayl, Dylan Yu, Kartik Gupta, Sachin Parikh, Austin Brubaker, Abdul Mannan Khan Minhas, Dmitry Abramov, Jagadeesh Kalavakunta, Vishal Gupta, Salim S Virani, Santhosh K G Koshy

Faculty, Staff and Students Publications

Background: Characteristics and outcomes associated with cardiogenic shock (CS) with acute myocardial infarction (AMI) in older patients have not been well characterized.

Objectives: The purpose of this study was to investigate characteristics and outcomes of older patients admitted with CS with AMI.

Methods: We used the National Inpatient Sample database to evaluate clinical characteristics of hospitalizations, clinical outcomes, and health care utilization of hospitalizations of older patients ≥80 years with CS and AMI from 2003 to 2021. We also compared data from older patients with a reference relatively younger patient population (18-79 years).

Results: During the study period, 207,333 hospitalizations …

The Potential Of 4-Methylumbelliferone To Be Repurposed For Treating Liver Fibrosis, Xi Chen, Huiqiao Li, Yanru Deng, Jieyi Meng, Shangang Zhao, Clavia Ruth Wooton-Kee, Xia Gao, Bingning Dong, Dongyin Guan, Chaodong Wu, Philipp E Scherer, Yi Zhu

Faculty, Staff and Students Publications

4-Methylumbelliferone (4-MU) is the active component of hymecromone, a choleretic and antispasmodic drug with an excellent safety profile. In rodent studies, high doses of 4-MU are also used to inhibit the production of hyaluronan (HA), a biomarker of liver fibrosis. Further, 4-MU shows excellent efficacy in inhibiting liver fibrosis of different etiologies in animal studies, eliciting interest in its repurposing for this condition. However, 4-MU's mechanism of action, and whether it inhibits liver fibrosis by impeding HA synthesis remains unclear. Using several transgenic mouse models with HA overproduction or degradation in different types of liver cells, we found that both …