Analytical, Diagnostic and Therapeutic Techniques and Equipment Commons^™

The Role Of Ucp2 In Pancreatic Cancer Metabolism And Its Potential As A Radiosensitizer, Emily Rieff

Dissertations and Theses (Open Access)

Uncoupling protein 2 (UCP2) is a mitochondrial protein that regulates the flow of protons down the gradient established by the electron transport chain (ETC) without generating ATP, thus uncoupling the proton gradient from ATP generation. In tumors, specifically pancreatic cancer (PDAC), the ETC is highly stimulated to generate the copious ATP needed by the tumor to grow. However, extended ETC use increases reactive oxygen species (ROS), and if left unchecked, results in cell death. To evade this, PDAC employs antioxidant strategies, including upregulating UCP2 in tumor cells. In addition to its uncoupling function, UCP2 indirectly controls ROS levels by maintaining …

Normative Variability In Retinal Nerve Fiber Layer Thickness: Does It Matter Where The Peaks Are?, Sowjanya Gowrisankaran, Ashkan Abbasi, Xubo Song, Joel Schuman, Gadi Wollstein, Bhavna Antony, Hiroshi Ishikawa

Wills Eye Hospital Papers

PURPOSE: Retinal nerve fiber layer thickness (RNFLT), a glaucoma biomarker, has a wide normative range affecting its sensitivity and specificity for abnormality detection. The interindividual RNFLT peak location variability contribution to this wide normative range has not been directly evaluated. The purpose of this study is to assess the effect of RNFLT peak normalization (PN) on normative variability.

METHODS: Circumpapillary RNFLT profiles at 1.7 mm radius from the optic nerve head (ONH) were re-sampled from optical coherence tomography (OCT) volumes (Cirrus HD-OCT, 200 × 200) obtained from one eye of 83 healthy individuals. Fovea-ONH axis (FOA) was calculated from corresponding …

Advancing Research On Retinitis Pigmentosa: An Investigation Of Natural History, Visual System Plasticity, And Mutation-Independent Treatment., Cecilia A. Attaway

Electronic Theses and Dissertations

Retinitis Pigmentosa (RP) is an inherited retinal disease characterized by rod and then cone photoreceptor degeneration. ~25% of cases are caused by a genetic mutation that results in autosomal dominant RP (adRP). There has been a lack of exploration of the progression of degeneration in adRP models. In Chapter Two, I examined visual acuity (VA) changes, retinal structure, and function from early to late-stage disease in a murine P23H Rho ‘knock-in’ mouse model (Rho^P23H/+), the most common form of adRP in North America. To establish a natural history, I evaluated behavioral VA, using the visual water task, …

Toward The Application Of Natural Language Processing In Electronic Health Record Analysis For Taxonomy Development, Latoya Mcdonald

All Dissertations

Electronic health records (EHRs) are pivotal resources for nurse practice because they increase the timeliness and reliability of patient information at the point of care and support access by multiple healthcare providers and the individual patients themselves. However, it is widely recognized that data extraction from EHRs is challenging due to the variability in the language used in clinical care notes and the lack of standardized terminology across healthcare systems. The broad objective of this dissertation is to develop taxonomy-based classification models for nursing care by applying feature engineering approaches to EHRs that include nursing care of ostomy patients following …

Serendipitous Supernormality, Behzad B. Pavri, Eitan Frankel

Division of Cardiology Faculty Papers

We describe a patient who underwent AV node modification to create complete heart block in the setting of incessant, ablation-and-drug-refractory, symptomatic atypical atrial flutter. His dual chamber defibrillator (previously implanted for resuscitated cardiac arrest) was programmed to the VVIR mode at a faster pacing rate of 85 bpm. Serendipitously, this rate was an almost exact factorial of his flutter rate of 250-260 bpm. This resulted in every 6th flutter wave falling in the supernormal period, resulting in fixed-coupled supraventricular bigeminy and trigeminy in the setting of complete heart block. Reprogramming the pacing rate to 75 bpm abolished bigeminy and trigeminy.

The Development Of Magmas Inhibition As A Potential Therapeutic Target In Temozolomide Resistant Glioma, Jennifer Duyen Tran

Electronic Theses, Projects, and Dissertations

Glioblastoma (GBM) is a highly aggressive brain tumor that remains a significant challenge in neuro-oncology today. Approximately 90% of GBM patients experience tumor recurrence within one to two years of diagnosis. Therefore, due to its high resistance to conventional therapies, new treatment strategies are urgently needed. The current standard of care for GBM is the chemotherapeutic Temozolomide (TMZ). TMZ is an oral alkylating agent, it functions by delivering a methyl group to purine bases. The development of resistance to TMZ is partially regulated by the DNA repair enzyme O6- methylguanine-DNA methyltransferase (MGMT). Despite the potential shown by MGMT promoter methylation …

Efficacy And Safety Of Moxibustion For Knee Osteoarthritis: A Systematic Review And Meta-Analysis, Shun Chen, Weiting Liu, Changhao Liang, Hanjiang Liu, Pei Wang, Qinwei Fu

Research outputs 2022 to 2026

Background and purpose: Although several reviews have examined moxibustion for knee osteoarthritis (KOA), they have some methodological limitations. This systematic review aims to synthesize current evidence on various moxibustion interventions for KOA pain relief. Methods: We conducted a comprehensive search across seven databases up to June 2024. The Cochrane risk of bias tool (ROB2) was used to assess the risk of bias, and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criterion approach was employed to evaluate the certainty of evidence for primary outcomes. Primary outcomes included Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), …

From Molars To Bronchus; The Tale Of An Aspirated Dental Instrument, Yisroel Grabie, Sudeep Acharya, Fasih Sami Siddiqui, Gabriel A. Chavez Reyna, Michel Chalhoub

HCA Healthcare Journal of Medicine

Background

Aspiration of dental instruments is a rare event that carries potentially serious complications when it occurs, especially in older patients, where protective reflexes are diminished. Clinical management may be difficult because of the risk of granulation tissue and different retrieval strategies according to the object’s characteristics. In this report, we describe the case of an 84-year-old man who aspirated a dental bur during a routine dental procedure, necessitating immediate intervention. Timely and precise management was essential to avert severe complications.

Case Presentation

During a routine dental procedure, an 84-year-old man aspirated a bud-shaped cross-cut carbide dental bur. Despite initial …

Using Point-Of-Care Ultrasound For The Medical Management Of Marathoners And Spectators: A Case Series, Jacob D. Pope, Casey Wilson, Kelsey Daller, Jonathan Hardin, Steven Rickett

HCA Healthcare Journal of Medicine

Background

Temporary field hospitals play a crucial role in providing medical care to individuals who experience illnesses and injuries during mass gathering events. Handheld point-of-care ultrasound (POCUS) devices offer an affordable and portable adjunct for emergency care. We present multiple patients from a field hospital during a marathon event in which handheld POCUS devices changed clinical management.

Case Presentation

A 75-year-old man who had fallen was able to be discharged after a lung exam confirmed no rib fractures or pneumothorax. A hypotensive and hypoglycemic 21-year-old man had an echocardiogram confirming volume depletion. He received treatment, and a repeat exam demonstrated …

Portable Head Computed Tomography Protocol For Trauma, Christian Quinones, Alexander Bolufer, Cory Hewitt, Sagun Tuli

HCA Healthcare Journal of Medicine

The use of portable computed tomography (CT) scanners has been shown to reduce risks associated with intrahospital transport and to expedite imaging in critically ill patients. While their use is established in intensive care units, their utility on intraoperative trauma patients remains underexplored. This paper reviews existing literature on portable CT use, defines appropriate clinical indications, outlines contraindications, and identifies quality metrics and implementation challenges. It also presents a proposed protocol for integrating portable head CT imaging into trauma workflows, focusing on early identification of intracranial or spinal injuries in the operating room. The development and analysis of standardized protocols …

Social Determinants Of Health Screening In The Pediatric Population: Evaluating The Effectiveness Of Staff Education, Brenda Awuah, Kansas S. Logan, Sally Humphrey Dnp, Aprn, Cpnp-Pc, Sharon Little Dnp, Aprn, Fnp-Bc

Doctor of Nursing Practice Projects

Social Determinants of Health (SDOH) are conditions that influence health outcomes. SDOHs are screened and addressed in many clinics and hospitals to reduce patients' social needs. Research indicates how unaddressed SDOH can negatively impact chronic illness, along with the daily life of pediatric patients. SDOH's role in pediatric patients includes food security, housing stability, access to healthcare, caregiver education, and parental mental health. Previous research has addressed these factors; however, the lack of staff education prevents effective compliance and follow-up on SDOH screening. Challenges remain in implementing and integrating SDOH into routine well-child visits. This scoping review will evaluate and …

Evaluating Referral Rates For Positive Postpartum Depression Screenings At Telehealth And Well-Child Visits: A Scoping Review, Rachel Macklin Barber, Mph, Bsn, Rn, Damaris Amber Brooks, Bsn, Rn, Ashli-Emeria Gary, Bsn, Rn, Margaret Harvey, Phd, Acnp-Bc, Chfn, Kate Fouquier Phd, Aprn, Cnm, Pmh-C, Facnm

Doctor of Nursing Practice Projects

Purpose/Background

Postpartum depression (PPD) affects one in nine women. It has distressing impacts, including behavioral and attachment issues and toveruse of healthcare services. PPD occurs within 4 weeks to 12 months postpartum. A scoping review was conducted to compare referral rates to mental health providers after PPD screenings were conducted via telehealth versus those completed at well-child visits.

Methods

Peer-reviewed articles published within five years before the initial search, beginning September 2022 and ending November 2024, were selected. Articles were sourced from several publications using an online library database with various MeSH terms and Boolean operators. Search results were narrowed …

Evaluating The Efficacy Of Htk (Histidine-Tryptophan-Ketoglutarate) And Potassium-Based Cardioplegia Solutions In Adult Cardiac Surgery: A Scoping Review Of Postoperative Outcomes, Efficiency, And Complications, Lauren Ryan

Student Works

Background/Introduction: Cardioplegia solutions are integral to myocardial protection during cardiac surgery, particularly during ischemic periods induced by cardiopulmonary bypass (CPB). Histidine-Tryptophan-Ketoglutarate (HTK) solution and potassium-based solutions such as Del Nido, St. Thomas, 4:1, and Microplegia are widely utilized for their distinct biochemical mechanisms and protective properties. Despite their widespread application, variability in clinical outcomes and procedural contexts has led to uncertainty about the optimal choice of cardioplegia solution. This scoping review aims to compare HTK and potassium-based solutions, focusing on their efficacy, postoperative outcomes, and complications in adult patients undergoing coronary artery bypass graft (CABG) and valve surgeries, including minimally …

Bibliometric Analysis Of Research Trends Related To Human Immunodeficiency Virus., Madyson E. Johnson, Kaitlyn R. Coffman, Valerie Rivas, Elizabeth Barrett

ATU Scholars Symposium

Human immunodeficiency virus poses major health burden across the globe including the United States of America and has its zoonotic origin from the Simian Immunodeficiency viruses of sooty mangabey monkey and chimpanzee in Africa. Epidemiological trends indicate that even though the mortality rates for HIV are falling globally, the rates of new cases have been rising since 2010 in several countries including the USA. An estimated 0.5% of the human population is currently infected with the virus with countries like USA, India, Nigeria and South Africa carrying the highest burden of the disease. Host receptors such as CD4 and coreceptors …

Ambulatory Ekg Project, Samuel G. Grisham

ATU Scholars Symposium

This project seeks to advance the work of previous researchers in the field of cardiac arrhythmia detection [1]. By leveraging existing wearable technology, a system which is capable of real time heart rate monitoring, timely alerts and electrocardiograph data acquisition was designed. In addition, a python script capable of identifying potential pathological patterns present in EKG recordings was designed. Future endeavors may include integrating these two systems

For real time heart rate monitoring and timely alerts, a Galaxy watch FE is used. Using Android studio integrated development environment, a wearable app was developed to notify a user when their heart …

Assessing The Efficacy Of Tranexamic Acid In Adjunct To Oxytocin In Reducing Blood Loss During Cesarean Deliveries: A Scoping Review, Hilary Clair Ray Bsn, Rn, Shelbie Freeman Hendrix Bsn, Rn, Lauren Elizabeth Hubbard Bsn, Rn, Helen Maisen Conley Bsn, Rn, Dwayne Accardo Dnp, Ccrn, Faana

Doctor of Nursing Practice Projects

Purpose/Background

Globally, postpartum hemorrhage (PPH) is the leading cause of morbidity and mortality during the peripartum and postpartum period in delivering people. Emerging evidence suggests that combining second-line uterotonics with tranexamic acid (TXA) improves maternal outcomes, reduces blood loss, and lowers morbidity and mortality related to PPH (Jones et al., 2023; Al-dardery et al., 2023). TXA, an antifibrinolytic, enhances clotting, reduces blood loss, transfusion needs, hemoglobin drop, and the use of additional uterotonics (Bellos & Pergialiotis, 2021). This review highlights the benefits of TXA.

Methods

A scoping review required a literature search conducted from August 2023 to February 2024 using …

Eye Dissection Video Guide: An Innovative Approach To Anatomy Education Of The Orbit, Eye, And Intraocular Lens, Jack Dryden, Malli Barremkala

Posters

No abstract provided.

Evaluation Of Depression Screening Tools For Utilization In Adolescents: A Scoping Review, Helen Whitaker Bsn, Rn, Jade Bray Bsn, Rn, Tracy Mcclinton Dnp, Aprn, Agacnp-Bc, Hget-C, Ebp-C, Jacqueline Sharp Dnp, Aprn, Pmhp-Bc, Sharon Little Dnp, Fnp-Bc

Doctor of Nursing Practice Projects

Purpose/Background

Anxiety and depression are prevalent mood disorders among the adolescent population with significant impacts on academic performance, social interactions, and mental well-being. With depression rates continuing to rise and suicide among the leading causes of death in adolescents, there is an urgent need for effective screening and intervention. While depression screening is recommended in the primary care setting, many adolescents do not have regular access to healthcare, complicating early identification and treatment. The purpose of this scoping review is to compare the effectiveness of two depression screening tools, the Patient Health Questionnaire (PHQ-9) and the Beck Depression Inventory (BDI), …

A Mean Field Theory For Pulse-Coupled Neural Oscillators Based On The Spike Time Response Curve, Carmen C. Canavier

School of Medicine Faculty Publications

A mean field method for pulse-coupled oscillators with delays used a self-connected oscillator to represent a synchronous cluster of N - 1 oscillators and a single oscillator assumed to be perturbed from the cluster. A periodic train of biexponential conductance input was divided into a tonic and a phasic component representing the mean field input. A single cycle of the phasic conductance from the cluster was applied to the single oscillator embedded in the tonic component at different phases to measure the change in the cycle length in which the perturbation was initiated, that is, the first-order phase response curve …

Comparison Of Outcomes Among Neurovascular Patients Managed In Dedicated Neurological Intensive Care Units Vs. General Intensive Care Units, Joanna Roy, Basel Musmar, Nassos Tziviskos, Saarang Patel, Roberto Deleon, Ashley Thommana, Shady Mina, Stavropoula Tjoumakaris, Michael Gooch, Robert Rosenwasswer, Pascal Jabbour

Department of Neurosurgery Faculty Papers

Background/Objectives: Patients with neurovascular conditions often require multidisciplinary management to optimize recovery. Our systematic review identifies literature comparing outcomes among neurovascular patients managed at dedicated neurological intensive care units (ICUs) compared to general ICUs. Methods: PubMed was searched to identify articles that reported outcomes among patients managed at dedicated neurological ICUs versus general ICUs. Articles that reported outcomes among patients with neurovascular conditions were included. Articles that reported outcomes among patients managed at stroke units were excluded. The Newcastle Ottawa Scale (NOS) was used to assess for risk of bias across individual studies. Results: After a title and abstract screen …

Enhancing Schizophrenia Treatment Outcomes: Integrating Cbt With Medication Therapy To Reduce Hospital Readmission, Kamauri Fleming Msn, Rn, Grace Adeniji-Ilesanmi Fnp-Bc, Zillah Anagho Tah Fnp-C, Alex Cook Msn, Rn, Margaret Harvey Phd, Acnp-Bc, Chfn, Sharon Little Dnp, Aprn, Fnp-Bc, Jacqueline Sharp Dnp, Aprn, Pmhnp-Bc

Doctor of Nursing Practice Projects

Purpose/Background Schizophrenia is a chronic mental illness that disrupts cognition, emotion, and social functioning, imposing significant personal and societal burdens. While antipsychotic medications are effective in alleviating psychotic symptoms, they are often associated with side effects, poor adherence, and relapse risk. Cognitive behavioral therapy (CBT) has shown promise as an adjunct to medication, addressing persistent symptoms and improving outcomes. This scoping review examines the integration of CBT with medication therapy to reduce hospital readmissions and improve quality of life for adult patients hospitalized with schizophrenia.

Methods A systematic search of databases, including PubMed, PsycINFO, Embase, and Cochrane Library, was conducted …

Decreasing Extubation Times Using Adaptive Support Ventilation: A Scoping Review, Daphne Thomas, Cole Vest, Luke Wilson, Shannon Witcher, Bobby Bellflower Dnsc, Nnp-Bc, Faanp

Doctor of Nursing Practice Projects

Purpose/Background:This scoping review explores the effectiveness of adaptive support ventilation (ASV) compared to conventional ventilation modes in reducing postoperative extubation times in adults undergoing general anesthesia with ventilatory support. Ventilator weaning is a critical determinant of recovery and outcomes in intensive care settings. ASV, a closed-loop ventilation mode, automatically adjusts ventilator parameters based on patient-specific respiratory mechanics and demand to optimize the weaning process. Although promising, evidence regarding ASV’s effectiveness remains inconsistent across different patient populations and surgical contexts.

Methods: A systematic literature search was conducted from August 2023 to December 2024 across PubMed, CINAHL, Medline, JAMA, and Google …

Evaluating The Efficacy Of Discharge Education On Readmission Rates In Pediatric Patients With Chronic Conditions: A Scoping Review, Camden Shaw Bsn, Rn, Cpn, Ashely St. Julien Bsn, Rn, Claire Avant Bsn, Rn, Michelle Rickard Dnp, Cpnp-Ac, Chppn

Doctor of Nursing Practice Projects

Abstract Assignment

Purpose/Background

Children with multiple chronic health conditions account for a significant portion of hospital readmission and healthcare expenses. A scoping review was completed to analyze and summarize the available research regarding the effectiveness of discharge education on readmission rates and associated outcomes in children with chronic conditions. The following PICOT question was created: In pediatric patients with chronic disease, how does a discharge education bundle compared to no discharge education bundle affect readmission rates within 30 days of discharge?

Methods

A systematic approach was utilized for analysis to determine article eligibility. The initial search yielded 30 articles; however, …

The Impact Of The Utilization Of Shared Decision-Making Tools In Contraceptive Counseling On Patient Satisfaction In Adolescents: A Scoping Review, Akaninyene Ruffin Msn,Fnp-C, Judith Tunney Bsn, Rn, Mary Katherine Fouquier Phd, Aprn, Cnm, Facnm, Margaret Harvey Phd, Aprn, Acnp-Bc

Doctor of Nursing Practice Projects

Purpose/Background

Robust adolescent contraceptive counseling requires deep understanding of the specific context in which adolescents are receiving reproductive health care. As teen pregnancy rates rise, particularly in places across the Deep South, providers must find ways to engage their adolescent patients about their sexual and reproductive health. Professional organizations like the American College of Obstetricians and Gyencologists and the American Academy of Pediatrics both offirm the need for robust contraceptive counseling for adolescents. The purpose of this is to ascertain the impact of utilizing shared-decision making aids during contraceptive counseling on patient satisfaction in adolescent populations.

Methods

A systematic literature …

Evaluating The Efficacy Of The Implementation Of A Food Insecurity Screening Tool In Identifying Risk Amongst Nicu Families, Jessica Daniels Bsn, Rn, Sahtiah Williams Bsn, Rn, Bobby Bellflower Dnsc, Nnp-Bc, Faanp

Doctor of Nursing Practice Projects

Purpose/Background

Infants admitted to the Neonatal Intensive Care Unit (NICU) are critically ill and at risk of increased infections, developmental delays, and higher readmission rates after discharging due to complex health needs when compared to healthy term newborns. Nutrition has been widely recognized as an important predictor of readmission and developmental delay. However, current practice often does not provide any screening for food insecurity (FI) in NICU families, which assumes security and displays a gap in care surrounding discharge planning. This quality improvement project implements the use of an FI screening tool for NICU families to help practitioners identify FI …

Effectiveness Of The Use Of An Opt-Out Script To Increase Hiv Screening In Adolescent Clients In Pediatric Primary Care Clinics In West Tennessee: A Scoping Review, Julie Cupples Msn, Rn, Allison Johnson Ms, Bsn, Rn, Sally Humphrey Dnp, Aprn, Cpnp-Pc

Doctor of Nursing Practice Projects

Purpose/Background

The American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) recommend one-time human immunodeficiency virus (HIV) screening for all adolescents. Pediatric primary care providers are on the front lines of adolescent healthcare and can provide testing that is adolescent-friendly, confidential, and easily accessible. This scoping review aims to synthesize the evidence and assess the literature on the efficacy of using an opt-out script to increase HIV testing in adolescent well-child checks.

Methods

A literature review was conducted between October 2022 and August 2024 to collect studies assessing adolescents aged 12-18, provider-led sex education, and …

Autoradai: A Versatile Artificial Intelligence Framework Validated For Detecting Extracapsular Extension In Prostate Cancer, Pegah Khosravi, Shady Saikali, Abolfazl Alipour, Saber Mohammadi, Maxwell Boger, Dalanda M. Diallo, Christopher J. Smith, Marcio C. Moschovas, Iman Hajirasouliha, Andrew J. Hung, Srirama S. Venkataraman, Vipul Patel

Publications and Research

Preoperative identification of extracapsular extension (ECE) in prostate cancer (PCa) is crucial for effective treatment planning, as ECE presence significantly increases the risk of positive surgical margins and early biochemical recurrence following radical prostatectomy. AutoRadAI, an innovative artificial intelligence (AI) framework, was developed to address this clinical challenge while demonstrating broader potential for diverse medical imaging applications. The framework integrates T2-weighted MRI data with histopathology annotations, leveraging a dual convolutional neural network (multi-CNN) architecture. AutoRadAI comprises two key components: ProSliceFinder, which isolates prostate-relevant MRI slices, and ExCapNet, which evaluates ECE likelihood at the patient level. The system was trained and …

Surgical Specimen Management Protocols In The Pre-Analytical Phase, Jordan L. Hall

Doctor of Nursing Practice Final Project Abstract

Purpose

This quality improvement (QI) project aimed to decrease surgical specimen errors during the pre-analytical phase at the target institution by 50% by January 2025 by developing best practices for specimen labeling and documentation.

Background

The QI project was implemented within a level two trauma center with a 24-suite operating room (OR) in The Woodlands, Texas, which provides care across all surgical specialties except ophthalmology.

Methodology

The target institution changed from nurse-hand-written specimen labels and requisition sheets to electronic medical record (EMR) generated specimen labels and requisition sheets. The change was congruent with the target institution’s shift to a new …

Leveraging Lower Body Negative Pressure For Enhanced Outcomes In Orthopedic Arthroplasty—Insights From Nasa’S Bone Health Research, Phani Paladugu, Rahul Kumar, Tamer Hage, Swapna Vaja, Tejas Sekhar, Samuel Weisberg, Kyle Sporn, Ethan Waisberg, Joshua Ong, Amar S. Vadhera, Mouayad Masalkhi, Ryung Lee, Chirag Gowda, Ram Jagadeesan, Nasif Zaman, Alireza Tavakkoli

SKMC Student Presentations and Publications

Exposure to microgravity causes rapid bone loss and muscle atrophy, posing serious challenges for long-duration spaceflight. In response, NASA developed countermeasures such as Lower Body Negative Pressure (LBNP) to simulate gravitational loading on astronauts’ lower extremities. LBNP, often combined with exercise, has proven effective in mitigating musculoskeletal degradation during bed rest analogs. This opinion paper argues that LBNP’s success in preserving bone mass and muscle function in microgravity can be translated to improve re- covery after orthopedic arthroplasty on Earth. We draw physiological parallels between microgravity-induced musculoskeletal disuse and the postoperative period following total joint replacement, during which reduced weight-bearing …

Hepatic Manifestations Following Gene Therapy, Akash Roy, Shalini Bansal, Anand Kulkarni, K. Rajender Reddy

SKMC Student Presentations and Publications

Gene therapy involves the introduction of genetic materials, most commonly using viral vectors, to alter gene expression to ameliorate or cure disease symptoms with minimal adverse events. While interest in gene therapy has been on the increase, concerns have arisen about the potential for hepatotoxicity, which arises from diverse mechanisms. While viral vectors can produce dose-dependent hepatotoxicity secondary to integration, immune responses appear to be the primary driving mechanism. A mild increase in aminotransferases is the most common hepatic manifestation, occurring variably in 20%-80%, while there has been rare progress to acute liver failure. The occurrence of hepatotoxicity is unpredictable …