Medical Specialties Commons^™

Metformin In Overcoming Enzalutamide Resistance In Castration-Resistant Prostate Cancer, Kendall Simpson, Derek B. Allison, Daheng He, Jinpeng Liu, Chi Wang, Xiaoqi Liu

Markey Cancer Center Faculty Publications

Androgen deprivation is the standard treatment for patients with prostate cancer. However, the disease eventually progresses as castration-resistant prostate cancer (CRPC). Enzalutamide, an androgen receptor inhibitor, is a typical drug for treating CRPC and with continuous reliance on the drug, can lead to enzalutamide resistance. This highlights the necessity for developing novel therapeutic targets to combat the gain of resistance. Metformin has been recently investigated for its potential antitumorigenic effects in many cancer types. In this study, we used enzalutamide and metformin in combination to explore the possible rescued efficacy of enzalutamide in the treatment of enzalutamide-resistant CRPC. We first …

Portable Multi-Parametric Microscopy For Noninvasive Metabolic And Vascular Imaging Of Orthotopic Tongue Cancer Models In Vivo, Pranto Soumik Saha, Jing Yan, Caigang Zhu

Markey Cancer Center Faculty Publications

Significance: Precise imaging of tumor metabolism with its vascular microenvironment becomes emerging critical for cancer research because increasing evidence shows that the key attribute that allows a tumor to survive therapies is metabolic and vascular reprogramming. However, there are surprisingly few imaging techniques available to provide a systems-level view of tumor metabolism and vasculature in vivo on small animals for cancer discoveries.

Aim: We aim to develop a new multi-parametric microscope that can faithfully recapitulate in vivo metabolic and vascular changes with a wide field of view and microscope-level resolution to advance cancer-related investigations. To maximize the ease and accessibility …

Dihydropyrimidine Enzyme Activity And Its Effect On Chemotherapy Toxicity: Importance Of Genetic Testing, Alexia Shamaei Zadeh, Danielle Roberts, Abby Williams, Deepali Pandey, John L. Villano

Markey Cancer Center Faculty Publications

Purpose

Patients with partial or complete DPD deficiency have decreased capacity to degrade fluorouracil and are at risk of developing toxicity, which can be even life-threatening.

Case

A 43-year-old man with moderately differentiated rectal adenocarcinoma on capecitabine presented to the emergency department with complaints of nausea, vomiting, diarrhea, weakness, and lower abdominal pain for several days. Laboratory findings include grade 4 neutropenia (ANC 10) and thrombocytopenia (platelets 36,000). Capecitabine is used as a component of first-line adjuvant therapy by approximately 2 million patients worldwide each year. Capecitabine is metabolized to fluorouracil via the enzyme dihydropyrimidine dehydrogenase (DPD). With worsening pancytopenia …

Burkitt's Lymphoma Presenting As Multiple Nerve Sheath Tumors Of The Cauda Equina., Jason Milton, Punit Pandya, Sergio Ulloa, Vijay Kudithipudi, Shakir Sarwar, Victor Awuor

Oncology Articles

BACKGROUND: Primary central nervous system lymphomas comprise 0.8% of all lymphomas. Burkitt's lymphoma is a B-cell lymphoma with highly aggressive features that rapidly progress and have early hematogenous spread. Sporadic Burkitt's lymphoma accounts for 1-2% of adult lymphomas worldwide. Extranodal sites are involved in approximately 40% of cases of B-cell lymphomas. Central nervous system disease is found in < 15% of sporadic cases. Less than 5% of cases of all non-Hodgkin's lymphomas present with radiculopathy, with the thoracic spinal region being most commonly affected.

CASE DESCRIPTION: In this report, we discuss the case of a patient with extranodal Burkitt's lymphoma within the nerve roots of the cauda equina who underwent surgical intervention due to the presence of lumbar radiculopathy and weakness. This patient also exhibited hematogenous …

Perspectives Of Healthcare Providers And Patients With Relapsed/Refractory Multiple Myeloma On Treatment Priorities And Novel Therapies., Sikander Ailawadhi, Yelak Biru, Solène Clavreul, Maite San Miguel, Nicolas Cormier, Yvonne Efebera, Maximilian Merz, Anna Sato, Cathy Zeanah, Jack L Watkins, James Farrell, Erinn Hoag Goldman, Rakesh Popat

Oncology Articles

PURPOSE: With novel therapies including chimeric antigen receptor T-cell (CAR-T) therapy and bispecific antibodies (BsAbs), healthcare providers (HCPs) face complexities managing treatment for patients with relapsed/refractory multiple myeloma (RRMM). This study, among the largest surveys on RRMM, examined unmet needs in care access, barriers to novel therapy use, and treatment decision-making.

METHODS: This survey-based study (March-June 2024) enrolled 2284 participants (patients: 1301; HCPs: 983) across 7 countries. Patients with >1 relapse/progression and HCPs managing ≥3 patients were included. Data were analyzed using descriptive statistics and Χ

RESULTS: For patients, treatment priorities included slowing disease progression (second line [2L], 47%; third …

Optimizing Opioid Selection For Vaso-Occlusive Crisis: Identifying The Best Option To Reduce Hospital Length Of Stay, Benjamin H. Bridges, Laura Strom, Eric Belcher, Winston Daniels, Ansley Connelly, Joshua Ferrell

South Atlantic Division GME Research Day 2025

No abstract provided.

Skin Grafting After Reconstruction For Head And Neck Cancer: Does Thickness Matter?, P Larson Miller, Nicholas Hrdlicka, Eric Shaw, Robert Liebman, Matthew Ochsner

South Atlantic Division GME Research Day 2025

No abstract provided.

Autism Prevalence And Appropriate Care Analytics, Brittany Bare, Final Patel, Peyton Dekle, Jessica Donaldson

South Atlantic Division GME Research Day 2025

No abstract provided.

Exploring The Link Between Low-Income Communities And Increased Cancer Risk From Nitrate Contamination In Drinking Water: A Review, Anna Wiggins, Rena Phillips, Michael L. Phillips, Wei-Hsiung Yang

South Atlantic Division GME Research Day 2025

No abstract provided.

Abnormal Pap Smears In Pregnancy And The Potential For Fulminant Cervical Cancer: A Case Report And Review Of Staging And Contemporary Treatment, Aliya Nurani, Claud Crosby, Ashley Valenzuela, Meenah Dhir, Mikalah Maury, Stephen Salmieri, Anthony Royek

South Atlantic Division GME Research Day 2025

No abstract provided.

Occlusive Thrombosis Of Superior Mesenteric And Portal Veins, Radhika Mohan, Genevieve Mccloskey, Curtis Wong, Hedaya Othman, Valerie Sinkler

South Atlantic Division GME Research Day 2025

No abstract provided.

A Complex Case Of Invasive Ductal Carcinoma In A Patient With Multisystem Complications Leading To Acute Cerebral Infarctions And Debility, Genevieve Mccloskey, Radhika Mohan, Michael A. Smith

South Atlantic Division GME Research Day 2025

No abstract provided.

A Case Of Dress Syndrome Following Recurrent Hardware-Related Knee Infection: Diagnosis, Management, And Recovery, Cooper Alden Josephs, Himani Patel, James Everhart

South Atlantic Division GME Research Day 2025

No abstract provided.

A Rare Case Of Vulvar Endometriosis, Taylor Penny, Shelby Freeberg, Brittany Stofko

South Atlantic Division GME Research Day 2025

No abstract provided.

Ballistics Gel Model To Teach Ultrasound Guided Pericapsular Nerve Group (Peng) Block, Nicholas Murphy, Matthew Carr, Taryn Hoffman, Leily Naraghi

South Atlantic Division GME Research Day 2025

No abstract provided.

Impact Of Fluid Balance On Clinical Outcomes In Icu Patients W. Pulmonary Arterial Hypertension, Geran Maule, John Rickards, Abdallah Rayyan, Moh'd Alamin Daise, Kobina Essilfie-Quaye, Peters Okonoboh

North Florida Division GME Research Day 2025

No abstract provided.

A Retrospective Cross-Sectional Study Of Glp-1 Agonist Effects On Outcomes After Total Knee Arthroplasty, Mckenna Box, Troy B. Puga, Neil J. Werthmann, Andrew M. Jen, Yingxian Liu, John T. Riehl

North Texas Research Forum 2025

Objective: Total knee arthroplasty (TKA) is one of the most common elective orthopaedic surgeries. In addition, there are rising rates of obesity and diabetes and, with it, medications to treat them. This retrospective cross-sectional analysis aims to examine the outcomes of patients who underwent TKA and were on a Glucagon-like peptide-1 agonist (GLP-1a) at the time of surgery Methods: This study analyzes a database using CPT and ICD-10 codes to identify patients having primary TKA for knee osteoarthritis. Patients were divided into two groups based on GLP-1a use at TKA. Control variables included sex, age, BMI, smoking status, ECI, and …

A Rare Case Of Cutaneous Vulvar Leiomyoma Complicated By Postoperative Hematoma Formation, Ariel Moskowitz, Kimberly Udell

North Texas Research Forum 2025

Leiomyomas are benign, well-circumscribed, monoclonal smooth muscle tumors. While leiomyoma of the uterus are exceedingly common, soft tissue leiomyomas are rare and often misdiagnosed. While excisional therapy is the mainstay of treatment, wide vulvar excisions can cause significant discomfort and disfigurement of the vulva. Here we present a unique case of a vulvar hematoma excision complicated by hematoma formation. A 39-year-old female presented to the ambulatory gynecology clinic with a 4-month history of an enlarging vulvar mass. On exam, a 4-cm mass was seen arising from the right upper labium. Office biopsy showed a well-circumscribed spindle cell lesion without nuclear …

Is Fixation Of A Single End Of Flail Segment Rib Fractures Enough?, Anthony Perugini, James Iandoli, Nicholas Pelz, Daniel Degenova, Anthony Melaragno, Mallory Faherty, Benjamin C Taylor

OhioHealth Research Institute Articles

BACKGROUND: Segmental rib fractures in blunt thoracic trauma present with increased morbidity and mortality with an association of increased pulmonary insult and concomitant injuries. There is a paucity within the literature regarding the necessity of fixation of one or both segments of rib fractures in a flail chest. This study aimed to analyze surgical rib fixation and assess outcomes for non-fixed fractured rib ends in segmental rib fractures.

METHODS: This is a retrospective review of 125 patients who underwent open reduction internal fixation of flail segmental rib fractures at our urban Level 1 trauma center. Initial plain films and CT …

Examining Isokinetic Knee Peak Torque And Time To Peak Torque As Predictors Of Vertical Jump Height In Division I Men's Basketball Players., Caroline Westwood, Arakua Welbeck, Carolyn Killelea, Peter Howard, Mallory Faherty, Daniel Le, Ryan Zerega, Charles R Reiter, Timothy C Sell

OhioHealth Research Institute Articles

The vertical jump (VJ) is one of the most important movements for basketball athletes and therefore determining modifiable predictors of the VJ would aid substantially in crafting more effective training regimens. The purpose of this study was to determine if isokinetic quadriceps strength and torque predict VJ height and which characteristics and testing speed is the strongest predictor of VJ height. Fifteen subjects (age: 18.5 ± 1.0 years, height: 195.9 ± 6.9 cm, weight: 96.2 ± 13.7 kg) from a single Division I men's basketball team were recruited for this study. All participants performed a standing vertical jump with arm-swing …

Acute Hepatitis B Infection In A Patient With Confirmed Immunity On Long-Acting Cabotegravir/Rilpivirine, William K B Boateng, Neil Carlin, Etan Spira, Maria E Szabela, Kosisochukwu J Ezeh

Faculty and Staff Publications

Long-acting injectable formulation of cabotegravir/rilpivirine (CAB/RPV) is a promising novel maintenance therapy for HIV infection. However, coinfection with active hepatitis B virus (HBV) infection is a contraindication to initiating this therapy. Despite guidelines, patients with HBV immunity can still contract acute HBV infection. We report a case of a 30-year-old man with HIV who transitioned from antiretroviral therapy to CAB/RPV and had confirmed HBV immunity. The patient, though asymptomatic, showed significantly elevated liver function tests (LFTs) before his monthly CAB/RPV injection. He was hospitalized and diagnosed with acute HBV infection. His LFTs improved, and he was taken off CAB/RPV and …

A Knowledge-Based Planning Model To Identify Fraction-Reduction Opportunities In Brain Stereotactic Radiotherapy, Shane Mccarthy, William St. Clair, Damodar Pokhrel

Radiation Medicine Faculty Publications

Objective: To develop and validate a HyperArc-based RapidPlan (HARP) model for three-fraction brain stereotactic radiotherapy (SRT) plans to then use to replan previously treated five-fraction SRT plans. Demonstrating the possibility of reducing the number of fractions while achieving acceptable organs-at-risk (OAR) doses with improved target biological effective dose (BED) to brain lesions. Methods: Thirty-nine high-quality clinical three-fraction HyperArc brain SRT plans (24–27 Gy) were used to train the HARP model, with a separate 10 plans used to validate its effectiveness. Fifty-eight five-fraction HyperArc brain SRT plans (30–40 Gy) attempted to be retrospectively replanned for three fractions scheme using the HARP …

An Investigation Into The Feasibility And Efficacy Of Stereotactic Radiosurgery For 1–3 Cm Single Brain Lesions On The Ring-Mounted Halcyon Linac, Kristin J. Hazelwood, Shane Mccarthy, Josh Misa, David Castelvetere, William St. Clair, Damodar Pokhrel

Radiation Medicine Faculty Publications

Purpose: An evaluation of the accuracy, safety, and efficiency of the Halcyon ring delivery system (RDS) for stereotactic radiosurgery (SRS) treatment to relatively small (1–3 cm) brain lesions.

Methods: After completing the extensive in-house quality assurance checks including Winston–Lutz test and independent dose verification via MD Anderson IROC SRS head phantom irradiation on Halcyon, fifteen brain SRS patients previously treated with a single dose of 20 Gy on TrueBeam (6MV-FFF) with HyperArc geometry were retrospectively replanned on Halcyon (6MV-FFF). Plan quality metrics including conformity index (CI), gradient index (GI), gradient distance (GD), PTV coverage, gross tumor volume (GTV) dose, heterogeneity …

A Predictive Quality Assurance Model For Patient-Specific Gamma Passing Rate Of Hyperarc-Based Stereotactic Radiotherapy And Radiosurgery Of Brain Metastases, Shane Mccarthy, Brent Harrison, Damodar Pokhrel

Radiation Medicine Faculty Publications

Objective: Measurement-based patient specific quality assurance (PSQA) is an increasingly debated topic among medical physicists. Developments like online adaptive radiotherapy and same-day stereotactic treatments limit the time to do measurement-based PSQA. Herein, we develop a predictive machine learning model to supplement PSQA by predicting the gamma passing rate (GPR) per stereotactic arc. This streamlines PSQA, providing planners the insight to replan potentially sub-optimal plans, to mitigate machine time inefficiencies.

Methods: 122 patients that had previously received HyperArc stereotactic radiosurgery/radiotherapy on a TrueBeam LINAC (Millenium 120 MLCs, 6MV-FFF) were used to generate a long short-term memory (LSTM) recurrent neural network to …

Automated Hippocampal Sparing Whole Brain Radiotherapy With Simultaneous Integrated Boost For Multiple Brain Metastases: Halcyon, Hyperarc On Truebeam, And Coplanar Truebeam, Shane Mccarthy, Ryan Clark, Anthony Magliari, William St. Clair, Damodar Pokhrel

Radiation Medicine Faculty Publications

Purpose: To demonstrate the ease and feasibility that hippocampal sparing whole brain (WB) simultaneous integrated boost (HSWB-SIB) plans can be generated using knowledge-based planning and Eclipse Scripting Application Programming Interface (ESAPI) for three different modalities, HyperArc on TrueBeam (TB-HA), a coplanar beam arrangement on TrueBeam (TB-Co), and the ring-mounted Halcyon LINAC (Hal).

Methods: Twelve patients with 2–14 brain metastases were retrospectively replanned for HSWB-SIB using a published HSWB RapidPlan model with modifications for the automated addition of SIB to metastases. Prescribed dose was 30 Gy to the WB planning target volume (PTV) and 50 Gy to the metastases in 10 …

Feasibility Of Treatment Planning With Hyperarc Stereotactic Radiosurgery Methods For Ocular Tumors, Chase Cochran, Shane Mccarthy, William St. Clair, Damodar Pokhrel

Radiation Medicine Faculty Publications

Purpose/objectives

Currently, ocular disease is primarily managed with COMS plaque brachytherapy. Various stereotactic radiosurgery (SRS) platforms have also been employed, yet widespread access remains a challenge. Herein, we demonstrate the feasibility of using the HyperArc SRS system to provide an additional platform for the treatment of ocular malignancies.

Materials/methods

Twenty previously treated COMS patients with ocular melanoma were selected for a retrospective HyperArc SRS planning study. The average gross tumor volume (GTV) derived from MRI was 1.19 ± 0.60 cc. Planning target volumes (PTV) were generated from a 2 mm expansion of the GTVs. HyperArc plans were created for a …

Hemifacial Spasm Due To Dolichoectasia Of Vertebral And Basilar Arteries, Meena Iyer, Shasthara Paneyala Dr.

Digital Journal of Clinical Medicine

Dolichoectasia refers to the non-focal dilatation and tortuosity of arteries, primarily affecting the vertebral and basilar arteries due to severe tunica intima degeneration. It is associated with genetic predisposition and atherosclerosis, leading to vessel wall weakening. Patients may remain asymptomatic or develop neurological deficits due to mass effect. We report a case of a 60-year-old male presenting with hemifacial spasm secondary to vertebral artery dolichoectasia. Magnetic Resonance Angiography (MRA) revealed ectatic and tortuous basilar and vertebral arteries, with the left vertebral artery compressing the left facial nerve complex. Using Smoker’s criteria, a diagnosis of dolichoectasia was confirmed. Dolichoectasia-induced hemifacial spasm …

Comparison Of The Effectiveness Of Preoperative Dexmedetomidine Nebulization Versus Lignocaine Nebulization In Attenuation Of Stress Response During Direct Laryngoscopy And Endotracheal Intubation In Elective Surgeries Under General Anaesthesia: A Randomised Control Study At A Tertiary Care Hospital, Mandya, Sumayya E., Kiran A V., Santhosh M C B., Shivakumar G

Digital Journal of Clinical Medicine

Introduction: Direct laryngoscopy and tracheal intubation are known to provoke harmful stimuli that can lead to transient, unpredictable, and variable hemodynamic alterations, primarily due to heightened sympathoadrenal activity.¹ Various pharmacological agents have been explored to mitigate this stress response; however, none have emerged as optimal.²

Aim: This study aims to compare the effects of nebulized dexmedetomidine in comparison to nebulized lignocaine on the hemodynamic stress response during direct laryngoscopy and tracheal intubation, including any adverse effects in patients undergoing general endotracheal anesthesia.

Materials and Methods: Informed consent was obtained from 60 patients aged 18 to …

Lymphoma Chronicles: Insights From A Distinct Hodgkin's Lymphoma Case Report, Srirangam Shankaralingam, Vibha Nagaragatta

Digital Journal of Clinical Medicine

Hodgkin lymphoma (HL) is a kind of lymphatic malignancy distinguished by the presence of Reed-Sternberg cells. It often manifests as painless lymphadenopathy and systemic symptoms (B symptoms and can affect a variety of lymphoid tissues. The causes of HL are complicated and include genetic predisposition, environmental conditions and viral infections, particularly the Epstein-Barr virus (EBV). The diagnosis is primarily based on histological evaluation of lymph node samples, with immunophenotyping assisting classification. Herein, we report a case of classical Hodgkin’s lymphoma (HL) in an otherwise healthy 31-year-old male who had a mass per abdomen for a year and recently noticed a …

Felt Need For Psychiatry Clubs In Medical Colleges To Enhance Teaching-Learning, Aditya Rao, Sheryl Agarwal, Sharanya Bose, M Kishor

Digital Journal of Clinical Medicine

Mental health competence is critical for medical graduates, yet in India the treatment gap for common mental disorders remains substantial, with prevalence estimates indicating up to 80.4% of unmet need. Recent reforms under the Competency-based Medical Education (CBME) curriculum have expanded psychiatry training; however, deficiencies in applied skills, preventive psychiatry, and communication remain. Psychiatry clubs have been proposed as supplementary, student-led platforms to address these limitations. This cross-sectional study assessed the perceived need for psychiatry clubs among undergraduate medical students and explored their potential role in enhancing teaching–learning. A structured online survey was administered to 94 students across different phases …