Background: Hydrogenogenic small intestine bacterial overgrowth (SIBO) has been associated with growth stunting and neurodevelopmental deficits in children from low and middle-income countries. However, methanogenic overgrowth has yet to be studied in this population. We sought to determine if increased methane levels on glucose breath tests (GBT) could predict growth and neurodevelopment.
Methods: GBT was performed at 6, 12, and 18 months on Tanzanian infants as part of the Early Life Interventions for Childhood Growth and Development in Tanzania (ELICIT) study conducted in rural Tanzania. Area under the methane curve was calculated and averaged over the three tests (CH4 AUC). Neurodevelopment was assessed using the Malawi Developmental Assessment Tool (MDAT).
Results: Univariate and multivariate linear regressions were performed to determine if CH4 AUC predicted growth or neurodevelopment and to determine predictors driving CH4 AUC levels. There was significant seasonal variation in CH4 AUC levels per child birth-month, with the highest levels associated with the spring months (March-May). Multivariable analysis showed no significant association between CH4 AUC and length-for-age Z score at 18 months, MDAT total score, or MDAT component scores. Birth month was a significant predictor of CH4 AUC (F= 66.614, p<.001). However, when analyzing patients with significant methanogenic SIBO (as determined by the top 50% of valid CH4 AUC values), antimicrobial administration had a positive but non-significant association with growth LAZ18 ( p=0.05), and nicotinamide administration revealed a significant association for LAZ18 when controlling for significant descriptive variables ( p=0.005) as compared to antimicrobial and nicotinamide administration in patients with negligible methanogenic SIBO (p=0.08, p=0.53, respectively).
Conclusion: This initial study does support a relationship between methanogenic overgrowth and growth stunting through the positive growth effect in positive SIBO children who received nicotinamide treatment, an effect that was not seen in the children without SIBO. Further study is needed to understand the relationship between methanogenic overgrowth and environmental enteric dysfunction and/or gastrointestinal symptomatology.

Analyses of Methanogenic Small Intestine Overgrowth Effects on Growth in Tanzanian Children

Introduction
Clostridium difficile (C. diff) is the leading cause of nosocomial diarrhea and has been shown to impact about 13 in every 1000 hospitalized patients. The occurrence of C. diff and Inflammatory bowel disease (IBD) have been linked to disruption of the gut microbiota (dysbiosis) which may explain the parallel rise of C. diff infection in IBD patients. Our study aimed to analyze the cost burden and clinical outcomes of hospitalized IBD patients with C. diff infections.
Methods
240,550 adults hospitalized with Crohn’s disease or Ulcerative colitis were analyzed using the NIS data from 2016-2019. Patients were classified into a group with C. diff and a group without C. diff and variables like Age, gender, race, diabetes mellitus, nicotine use, anemia, end-stage renal disease (ESRD), thrombocytopenia, albumin abnormality, peritoneal abscess, toxic megacolon, gastrointestinal bleed, vesicovaginal fistula, anorectal fistula, vesicointestinal fistula, mortality, and hospitalization cost were analyzed using the two-sample t test, chi-square test, and multiple linear regression. P value < 0.05 was considered statistically significant.
Results
We found that compared to men, women hospitalized with IBD are more likely to get infected with C. diff (4.2% vs 4.5%, P = < 0.001). Older IBD patients (Mean age of 53.1) are at risk compared to other age groups (P = < 0.001). Whites had the least C. diff rates compared to blacks, Hispanics, Asians, Native America, and others (4.2% vs 4.7% vs 5.6% vs 5.3% vs 4.4% vs 4.5%, P = < 0.001). IBD patients with anemia and thrombocytopenia had a significantly higher rate of C. diff infection (P = < 0.001). Interestingly, nicotine dependence and peritoneal abscess protected against C. diff infection (P = < 0.001 and 0.008). The average total hospital cost among IBD patients with C. diff was $20,254 higher compared to those without C. diff after controlling the effects of the variables - age, gender, race, nicotine status, anemia, ESRD, peritoneal abscess, thrombocytopenia, gastrointestinal bleed, and vesicovaginal fistula. The odds of mortality among IBD patients with C. diff was more than twice compared to those without C. diff (OR = 2.1, p = < 0.001).
Discussion
IBD patients remain at increased risk of C. diff infection and more hospital expenses. Hence, clinicians should rule out C. diff infection first in every IBD patient presenting with disease flare-ups or diarrhea.


In-hospital Mortality, Outcomes and Cost Analysis of Hospitalized Inflammatory Bowel Disease Patients with Clostridium difficile Infection.


Background: In the United States, the incidence of head and neck cancer (HNC) is over 54,000 cases per year, resulting in over 11,000 deaths annually. The average hospitalization cost for patients undergoing HNC treatment is $18,371 and the average hospital length of stay (LOS) is 6.6 days. Although much literature focuses on the effect of hemoglobin A1C, weight loss, and smoking status contributing to LOS, less attention has been focused on socioecological metrics. This study aims to identify socioecological factors that may predict increased LOS for patients
undergoing surgical treatment for HNC in Western New York (WNY).
Methods: A retrospective review of patients in WNY with a diagnosis of HNC treated between October 2017 and November 2022. The CDC’s Social Vulnerability Index (SVI) was used at the census tract level. Statistical analysis was conducted using Microsoft Excel and R Studio.
Results: LOS data for 419 patients was analyzed, 31% (n=131) were female, 65% (n=280) identified as white, and 76% (n=319) lived in urban counties. Median LOS was 8 days (range:1-96) for patients from rural counties and 8 days for patients from urban counties (range: 1-189). For areas that had a low or low-medium SVI, average LOS was 13.3 days (SD=18.6). For medium-high and high areas, average LOS was 13.4 days (SD=18.7), demonstrating no significant difference. Poisson regression modeling revealed that distance to hospital, ethnicity, gender, and insurance carrier all contribute significantly to LOS (p<0.0001).
Conclusions: SVI and geographic region independently do not influence LOS for HNC patients, but when socioecological factors are combined into a regression model, there is an influence. This suggests that multiple social determinants of health impact LOS for patients who undergo complex procedures for HNC. Further investigation with multiple institutions in WNY may provide insight into the impact of socioecological factors on LOS in this region.

Socioecological Determinants of Length of Stay for Head and Neck Cancer Patients

Abnormal calcium deposition is among the sequelae that may follow major burn injury. This may manifest as heterotopic ossification or dystrophic calcification (DC) of scarred skin. While the two processes are distinct, the term heterotopic ossification (HO) is often used by clinicians in reference to both processes. While HO is well-documented, there appears to be less attention devoted to DC, the most common subtype of calcinosis cutis. HO is the abnormal formation of mature lamellar extraskeletal bone in muscle and soft tissues. Risk factors include traumatic injuries and surgeries such as spinal cord injury, hip arthroplasty, and burns with >30% TBSA. It commonly occurs in upper extremities, especially the elbows, and on average takes weeks to months to develop. In contrast, DC is the pathologic calcification of scar itself, and can present in cases of burn survivors as the calcification of burn and skin graft scar, often decades after the original burn injury. It manifests as the build-up of insoluble calcium salts in damaged subcutaneous tissues in the absence of abnormal serum calcium and phosphate levels. Applicability of this research is to increase awareness of burn sequelae; this research was not externally funded. 
We present a case of DC to highlight the distinct differences between DC and HO in hopes of promoting use of the semantically correct terms. A 67 year old female presented to the clinic 65 years after a >40% TBSA burn treated with excision and skin grafting at the time of injury. She had a months-long history of a draining sinus with a~5mm diameter white hard plaque at the base, and a broader contiguous area of hard plaque palpable beneath the surrounding area of skin graft scar. She had been experiencing recurrent bouts of infection and sought definitive treatment. The area was widely excised and ultimately resurfaced with a new split thickness skin graft. Clinical and histopathologic photographs will be presented. The histopathologic findings were consistent with the dystrophic calcification variant of calcinosis cutis. The presentation was consistent with ~10-12 other cases seen by the senior author over a 20 year career, and consistent with other cases reported in the literature. The term "heterotopic ossification" is sometimes used too broadly to describe any pathologic calcium deposition in burn survivors. We highlight the difference between heterotopic ossification and dystrophic calcification out of a belief that as subject matter experts in burns and their sequelae, burn care providers should want to use the most accurate terminology wherever possible.

Revisiting the Taxonomy of Abnormal Calcium Deposits in Burn Survivors: Heterotopic Ossification versus Calcinosis Cutis

Background: Depression is a public health concern affecting the well-being and development of adolescents. Despite evidence-based guidelines promoting routine depression screening, many youths remain unidentified and untreated. Quality improvement (QI) initiatives may enhance depression screening practices. This retrospective chart review assesses a QI initiative's impact on depression screening rates among 12 to 18-year-old patients at four pediatric clinics in urban Nebraska from 2018 to 2022. The study evaluates trends in positive depression screens and the effectiveness of targeted interventions to increase adolescent depression screening. 
Methods: Electronic health record data was used to calculate adolescent depression screening rates and the percentage of positive depression screens. The screening rate equaled the total number of completed adolescent depression screens divided by the total number of well child exams for 12 through 18-year-old patients. The percentage of positive depression screens was the percentage of all adolescents who were screened and were positive on the Patient Health Questionnaire-4 (PHQ-4). The QI initiative comprised a “Lunch and Learn" session to raise provider awareness about the importance of depression screening. Additional interventions involved creating supportive materials for managing positive screenings, integrating depression screening into well-child exam rooming, and posting educational materials in the clinic's computer system for easy access by patients and providers. The impact of the initiative on depression screening rates was analyzed annually over five years. 
Results: The data revealed variations in depression screening rates and stability in the percentage of positive depression screens over the five-year study period. In 2018, the screening rate at well- child exams was 25.9%, with 8.1% of patients positive for depression. In 2019, the screening rate decreased to 21.6%, while the percentage of positive screenings increased to 13.1%. Following the initiation and continuation of the QI initiative in 2019, screening rates notably increased, reaching 37.2% with 11.7% positive patients in 2020. Screening rates further improved to 48.4% and 88.6% in 2021 and 2022, respectively, while the percentage of positive screenings remained relatively stable at 11.2% and 10.1%. 
Conclusion: The QI initiative positively impacted depression screening rates among adolescent patients at the four pediatric clinics, empowering healthcare providers to recognize and support adolescents facing depression. Continuous screening practice improvement efforts are crucial for early identification and intervention. The initiative offers a promising approach to enhance adolescent mental health care. 


Impact of Targeted Interventions on Depression Screening Rates among Adolescent Patients: A Retrospective Chart Review

Background
The purpose of this research is to test the clinical validity of a computerized version of the Trail Making Test (TMT) in an acute rehabilitation center for predicting concurrent inpatient disability. The TMT is a widely used neuropsychological assessment that has been shown to predict brain damage. Despite its value and efficacy in testing cognitive function, the TMT is limited to patients who have intact manual dexterity because it requires using a pen. Individuals with conditions that limit manual use (e.g. bone fracture, paralysis, burns, etc.) cannot take the test. Although there are adapted TMTs to include these populations, not many of these tests still involve visual interaction. Assessment of executive function using the Computer-Assisted TMT (CTMT) has already shown to be feasible in rehabilitation patients with intact manual dexterity. This study tested the Computer-Assisted TMT (CTMT) in rehabilitation patients who lack motor hand use.
Methods
This cross-sectional study was conducted in an acute rehabilitation hospital setting with patients (n = 37) who lack hand usability with either hand. Because patients with brain illness may have slower speech, the CTMT scores were corrected for maximal oral speech rate. Participants were tested in their hospital rooms over two sessions of the CTMT to evaluate test-retest reliability. Test-retest reliability was evaluated with Pearson correlation.
Results
50 patients were approached to be in the study, and 37 of them consented to participate. Out of the 37 participants, 33 participants were able to complete one round of testing and 17 participants were able to complete both rounds of testing. Time for CTMT completion was corrected by the maximal speech production rate (diadochokinesis or DDK). Since DDK rate has shown to be modulated by age, we also corrected people 47 years and older by a factor of 0.9316, which is based on previous research. The CMT versions had excellent test-retest reliability (r = 0.93 for CTMT-A, r = 0.83 for CTMT-B, and r =0.92 for CTMT-3).
Conclusion
The results of this study could help to determine if the CTMT can reliably predict concurrent physical disability and inform new forms of cognitive rehabilitation.


The Validation of a Computer-Assisted Trail Making Test in Acute Rehabilitation Inpatients with Manual Disability

Background
Premature ovarian failure, whether occurring spontaneously or iatrogenically, especially as a result from chemotherapy, is a challenging clinical problem in Reproductive Endocrinology and Infertility and Oncology. These patients have no autologous fertility-restoration options available if preemptive egg or embryo freezing was not successfully completed. Lack of endogenous hormone production has sequelae beyond reproduction, including accelerated bone loss, increased risk of cardiovascular disease, and sexual dysfunction. While hormone replacement therapies exist, long-term outcomes from such treatments, especially when initiated at a young age, remain unclear. These issues are heightened in cancer survivors, who have lower baseline fertility rates and success with assisted reproduction.
Methods
A methodology for the creation of oocytes via reprogrammed granulosa cells was first performed in mouse and, to the greatest extent possible, recapitulated in human cells. Granulosa cells (GCs) were reprogrammed to generate induced pluripotent stem cells (IPSCs) as previously described in our lab. Human GCs and follicular fluid were obtained from the IVF lab after oocyte removal during egg retrieval procedures. Cells were labeled with GFP and differentiated into ovarian lineages using an oocyte derivation media containing follicular fluid. Stem cell and differentiated cell status was verified via RT-PCR, immunocytochemistry, alkaline-phosphatase reaction, steroidogenic activity, and the formation of embryoid bodies and teratomas. Mouse GFP-labeled differentiated IPSCs were orthotopically implanted into one ovary of subfertile immunocompromised mice which also had chemotherapeutically-induced ovarian failure to assess for the restoration of hormone production and fertility.
Results
Differentiated IPSCs expressed ovarian markers (i.e. AMHR2, ZP1) and were able to produce physiologically relevant concentrations of the reproductive steroid hormones (i.e. estradiol/progesterone) in vitro. Interestingly, the addition of follicular fluid increased the steroidogenic potential of the cells in mice. Mice treated with alkylating chemotherapy to induce ovarian failure had ovarian follicular atresia and breast atrophy, which was reversed within 72 hours of transplanting terminally differentiated GFP-IPSCs into the thighs or ovaries of these mice. In subfertile nude mice, the orthotopic implantation of terminally differentiated IPSCs enhanced fertility, resulting stem cell-derived neogametogenesis and delivery of F1 and F2 litters with GFP expression.
Conclusion
New autologous methods of restoring fertility and ovarian function would be indispensable for patients with prematurity ovarian insufficiency or failure. Our work demonstrates that other populations of cells within the body may be reprogrammed for the purpose of endocrine health and fertility restoration in such patients.

The Generation of Stem Cell-Derived Functional Oocytes from Reprogrammed Granulosa Cells

Background
Type 2 diabetes mellitus (T2DM) is a global epidemic affecting approximately 9.3% of the world population and has an all-cause mortality rate of 8.5%. An increasing number of patients with chronic conditions access online resources for educational purposes, with recent statistics suggesting that up to 80% of adults in the United States have obtained medical information through online search engines. This study aims to assess the accuracy of the information offered by artificial intelligence (AI) chatbots to T2DM questions using ChatGPT.

Methods:
An initial set of questions about T2DM and its complications were obtained from an online platform such as American Diabetes Association. Subsequently, these questions underwent a thorough evaluation by physicians well-versed in diabetes management before being presented to ChatGPT. Each question was introduced to ChatGPT three times, and the responses were recorded. Two study staff reviewed the three sets of responses and summarized the majority response that was repeated at least twice. Data were reviewed by two board-certified internal medicine physicians with a minimum of 11 years of experience. Responses were categorized into appropriate; provide accurate information that meets the standard of care, inappropriate; contain erroneous information but meets the minimal standard of care, and unreliable; the response provides inconsistent content that does not meet the standard of care.


Results:
Of the original 110 questions, 70 were included in the final dataset. Out of the 70 summarized responses generated by ChatGPT, 89.3% were categorized as appropriate, indicating that the AI model provided accurate information meeting the standard of care for Type 2 diabetes management and its associated complications. On the other hand, 10% of the responses were deemed inappropriate, containing errors but still meeting the minimal standard of care in addressing the questions. The remaining 0.7% of ChatGPT's responses were classified as unreliable, displaying inconsistent content that did not meet the standard of care in terms of accuracy and reliability


Conclusion
ChatGPT offers a promising source of information for educating patients with T2DM. The study demonstrates high accuracy in providing appropriate responses that align with the standard of care, positioning it as a useful tool in enhancing patient education and diabetes management.


Artificial Intelligence Shifting the Paradigm of Diabetes Care

Background: Point-of-Care-Ultrasound (POCUS) has become an increasingly useful tool in modern medical practice. These non-invasive diagnostic instruments can be used to quickly assess many pathologies, including pleural effusion. In particular, there are several equations described in the literature that aim to estimate pleural effusion volumes using lung ultrasound (US) imaging. Among these described equations, we seek to determine the accuracy of these formulas with consideration of their practicality in clinical use. 
Methods: To assess this, a search was conducted using PubMed in which fourteen articles were found. We included articles that attempted to answer the question regarding volume estimation using POCUS within the last 20 years. Within these articles, ten different formulas were identified which were defined and described in relation to the patient’s position, the probe orientation, and the distance between the thoracic wall and lung or lung to the diaphragm. Our exclusion criteria were based on the age of the article, availability of free publications, review of the articles’ abstracts, determining their relevance to fluid volume estimation, and their use of lung ultrasound for pleural effusions. 
Results: Upon review, we determined that the pleural effusion estimated volume (EV) using the Goeke and Schwerck 2 formula (EV= (H + D) x 70, where H is the craniocaudal extent of the effusion at the dorsolateral chest wall and D is the distance from lung base to the apex of diaphragm cupola) in erect patients yielded the most accurate results. The most accurate simplified formula, requiring only one variable measurement in erect patients, proved to be the Hassan formula (EV = H x 100). With consideration of practicality in the Point-of-Care setting and patient’s performance status, we determined that the Balik formula (EV = C x 20, where C is the maximum perpendicular distance between the pulmonary surface and the chest wall) and Usta formula (EV=D×16, where D=distance from lung base to the apex of the diaphragm cupola) provide a sensitive and practical approach for measuring pleural effusion volume in the supine position when compared with other equations, albeit sacrificing accuracy.
Conclusions: In patients with reduced performance status and inability to be placed in the erect position, the Balik and Usta formulas provide a sensitive and practical approach for measuring pleural effusion volume when compared with the gold standard left lateral decubitus chest X-ray. In addition, our investigations noted that the most accurate equation used as an estimation tool for pleural effusion volume across multiple studies proved to be the Goecke and Schwerck 2 formula in erect patients. The most accurate simplified formula proved to be the Hassan formula, sacrificing some accuracy for practicality. With this in mind, providers should note the patient’s positioning (supine vs. erect) when performing a POCUS examination to decide which formula is best to use. POCUS offers a practical way to measure pleural effusion volume that facilitates timely care, supports and considers the patient’s performance status, and reduces both patient and hospital costs.


Pleural Effusion Volume Estimation Using Handheld Lung Ultrasound

Objective: Salivary gland tumors are a heterogenous group of lesions with variable pathology and clinical outcomes. Most published data is derived from studies conducted at tertiary care centers. Our study analyzed the experience from a community setting to determine significant differences, if any, in pathological distribution and clinical outcomes compared to the existing literature.

Methods: We performed a retrospective analysis of all salivary gland tumors that presented to a large community practice over a 20-year period. Retrospective chart analysis was performed for demographics, clinical presentation, imaging, cytology, histopathology, and clinical outcome data.

Results: Of 806 patients, the parotid gland was the most common site in 683 patients (84.7%), followed by submandibular in 78 (9.7%) and sublingual in 45 (5.6%). 203 patients were managed conservatively without definitive diagnosis or lost to follow up. A total of 495 patients underwent surgical intervention within the community practice. 26 patients underwent surgical excision at an outside hospital. 82 patients were determined to have a benign diagnosis based on FNA or excisional biopsy alone. Final histopathology was benign in 505 cases (83.7%), while 98 tumors (16.3%) received a diagnosis of primary or secondary malignancy. For the parotid gland, pleomorphic adenoma (155) and Warthin’s tumor (155) were the most common benign diagnoses, while mucoepidermoid carcinoma (13), adenocarcinoma (8), and acinic cell carcinoma (8) were the most common primary malignancies. 

Conclusions: We found a higher rate of benign tumor pathology compared to the existing literature. While the outcome data on surgical treatment of benign tumors is comparable to the existing literature, the same conclusion cannot be drawn for malignant tumors, given relatively small numbers in our series and likely disparity in the complexity of the surgical cases in tertiary care centers.

Salivary Gland Tumors: A Twenty-Year Review from a Single Community Practice

Introduction:
High-fidelity three-dimensional (3D) models provide a better understanding of spatial relationships among complex anatomical structures. Medical students often lack hands-on opportunities to develop an in-depth understanding of applied anatomy prior to their clinical years, a trend exacerbated by the COVID-19 pandemic. There is limited research on the utilization of 3D models in the clinical years. This study evaluates the effectiveness of an interactive 3D-printed inguinal hernia model in teaching applied surgical anatomy to third-year medical students (MS3).

Materials and Methods:
3D-printed models of inguinal anatomy were created using de-identified CT scans, 3D-modeling software, and 3D-printing services. A single-blind randomized control trial of third-year medical students was conducted at a single academic institution. The tactile-group received three educational tools describing inguinal hernia anatomy and repair: an established video module (WISE-MD), an illustrated procedure guide, and a 3D-printed model. The non-tactile group was provided the WISE-MD module and the illustrated procedure guide. Both groups received pre- and post-tests on basic and applied anatomy. Statistical analysis was performed using a t-test or Mann–Whitney U test for continuous variables and Chi-square or Fisher's exact tests for categorical variables. Statistical significance was defined by p <0.05.

Results:
One hundred and three third-year medical students participated in this study. There were no differences in pre-test scores between study groups (p= 0.98). The tactile-group scored better on post-test questions on applied anatomy (p= 0.03), but no differences were noted in scores on basic anatomy questions (p= 0.41). When comparing performance between overall pre-test and post-test scores, the tactile group demonstrated improvement in test scores which trended toward significance (p= 0.09).

Conclusions:
Third-year medical students using high-fidelity 3D-printed models demonstrated improved test scores on applied anatomy when compared to students who were exposed to conventional educational resources. With the rising use of virtual learning environments, interactive learning tools like 3D-printed anatomy models may have an important role in knowledge acquisition during the surgical clerkship.

3D Printing in Surgical Education:A Visuospatial and Kinesthetic Learning Module of Inguinal Hernia Repair for Third-Year Medical Students

Background:
Intrahepatic cholangiocarcinoma (iCCA) is an aggressive cancer with few treatment options. Oncolytic viruses (OV) can induce anti-tumor immunity by exploiting immuno-inflammatory responses. Emerging concepts suggest cooperative immune evasion between dsDNA Vaccinia (VACV) and other OVs, like ssRNA Vesicular Stomatitis Virus (VSV) can enhance anti-tumor immunity. This project tests the hypothesis that VACV attenuation of interferon-α/β (IFN) enhances VSV oncolysis and immunogenicity.
Methods: 
To understand iCCA susceptibility to select OVs, we infected iCCA cells with VACV +/- VSV. To elucidate OV efficacy as a function of IFNα/β stimulation, we measured cytotoxicity and viral replication via MTT assay and 50% tissue culture infectious dose (TCID50) +/- IFNα stimulation. To study cooperative immune evasion (VACV-induced IFNα/β suppression enhancing VSV oncolysis), we quantified proteins from pathways that activate IFNα/β. Western blots (WB) of STING (DNA pathogen sensing) & RIG1 (RNA pathogen sensing) were performed to evaluate the impact of infection on IFN-stimulating cell-signaling. 
To assess efficacy of VACV+VSV in vivo as a function of IFNα/β response, we infected patient-derived iCCA xenograft (PDX) with PBS, VACV, VSV, or VACV+VSV. Tumor size and IFNα/β signaling (RIG1/STING) were assessed. Tumor growth abrogation was evaluated with repeated measures, one-way ANOVA, and post hoc multiple comparison was made with Dunnett’s test between groups.
Results: 
In vitro, VACV & VSV both show dose-dependent viral replication and cytotoxicity against iCCA measured through TCID50 and MTT cell viability assays. IFNα pretreated iCCA cells showed significant and robust upregulation of both RIG1/STING following viral infection with VACV (p=0.003/0.03, respectively), slightly less intense upregulation was seen in VACV+VSV combination (p=0.02/0.03, respectively), and no change was seen with VSV infection (p=0.89/0.78, respectively).
In vivo, iCCA PDX growth was significantly abrogated in the VACV group (p=0.007) & combination group (p=0.04) compared to control (figure 1). ANOVA results showed significant effect of treatment on tumor volume changes [F(1.385, 12.46)=11.97, p=0.0025, η²=0.5708]. No significant differences observed between the PBS & VSV groups (p=0.5452). WB quantification showed upregulated RIG1 in the combination group (p=0.03) and no significant difference between groups for STING expression (p=.4304).
Conclusions: 
The VACV and VACV + VSV combination treatments resulted in significant tumor growth abrogation compared to VSV treatment and PBS control. However, the RIG1 and STING signaling suggests that this does not occur via immune evasion or rescue of VSV by VACV in this model. These findings underscore the therapeutic potential of combination OV in iCCA and warrant further investigation to elucidate the underlying mechanism.


Underline digital video library

Analyses of Methanogenic Small Intestine Overgrowth Effects on Growth in Tanzanian Children

In-hospital Mortality, Outcomes and Cost Analysis of Hospitalized Inflammatory Bowel Disease Patients with Clostridium difficile Infection.

Socioecological Determinants of Length of Stay for Head and Neck Cancer Patients

Revisiting the Taxonomy of Abnormal Calcium Deposits in Burn Survivors: Heterotopic Ossification versus Calcinosis Cutis

Impact of Targeted Interventions on Depression Screening Rates among Adolescent Patients: A Retrospective Chart Review

The Validation of a Computer-Assisted Trail Making Test in Acute Rehabilitation Inpatients with Manual Disability

The Generation of Stem Cell-Derived Functional Oocytes from Reprogrammed Granulosa Cells

Artificial Intelligence Shifting the Paradigm of Diabetes Care

Pleural Effusion Volume Estimation Using Handheld Lung Ultrasound

Salivary Gland Tumors: A Twenty-Year Review from a Single Community Practice

3D Printing in Surgical Education:A Visuospatial and Kinesthetic Learning Module of Inguinal Hernia Repair for Third-Year Medical Students

Treating intrahepatic cholangiocarcinoma with combination viroimunnotherapy

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