United States

TITLE: Histotripsy for the Treatment of Oral Tumors: A Canine Ex-Vivo Feasibility Study

AUTHORS: Dana Wang (2), Victor A. Lopez (1), Jessica Gannon (1), Sheryl Coutermarsh-Ott (3), Jeremy A. Brown (4), Adam Maxwell (1), Joanne Tuohy (5), Eli Vlaisavljevich (1)

(1 )Biomedical Engineering and Mechanics, Virginia Tech 
(2) Virginia Tech Carilion School of Medicine, Virginia Tech 
(3) Biological Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine 
(4) School of Biomedical Engineering, Dalhousie University
(5) Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine 

BACKGROUND: Oral tumors are frequently diagnosed in both humans and dogs and have potential for malignancy. Current standard of care treatments like surgery, radiation, and chemotherapy are invasive, often leading to facial disfigurements and other adverse effects that decrease quality of life. There is a pressing need for less invasive treatments that preserve oral function and appearance.

Histotripsy is a non-invasive, non-thermal, and non-ionizing image-guided focused ultrasound technique. It utilizes acoustic cavitation to break down tissue into acellular debris by producing high-pressure ultrasound pulses that converge at the transducer focus to generate a cavitation bubble cloud for mechanical tissue ablation. While current clinical histotripsy systems are large, cart-based devices operating at low frequencies for deep tissue treatments like the liver, this study aims to develop miniaturized high-frequency histotripsy transducers for targeting smaller, superficial structures like oral tumors.

METHODS: CT images from ten canines with oral tumors were segmented and analyzed in MATLAB to identify accessible acoustic windows with histotripsy treatment. This guided the design of 2MHz and 6.3MHz single-element transducers which were tested on excised canine oral tumors, producing bubble cloud diameters of approximately 2mm and 0.25 mm, respectively. Excised tumors were degassed, embedded in 1% agarose gel, treated with a pulse repetition frequency of 1kHz and 2,000 pulses per point. Real-time ultrasound imaging was used for treatment monitoring and post-treatment ablation was confirmed histologically with hematoxylin and eosin staining.

RESULTS: Acoustic window analysis visualized accessible ultrasound paths to the tumor without impedance by bony structures such as the skull. The tumor volumes varied in size and ranged from 2.2 cm3 to 223.8 cm3, informing the need for a flexible and versatile device to target tumors in the oral cavity. Both transducers produced well-confined cavitation bubble clouds during treatment. After treatment, hypoechoic regions observed via ultrasound correlated to tissue ablation, which was confirmed histologically with sharply demarcated, decolorized ablation zones. Notably, the 2MHz transducer achieved ablation approximately 7.4 times faster than the 6.3MHz transducer. 

CONCLUSIONS: Acoustic window analysis informed optimal transducer positioning and device design for targeting oral tumors effectively with a miniaturized transducer system. Both 2MHz and 6.3 MHz transducers successfully ablated excised canine oral tumors, demonstrating feasibility. Future work will include analysis of additional canine and human tumors and development of an electronically steerable transducer to reduce treatment time. Overall, this study is the first to demonstrate the feasibility of histotripsy for ablating oral tumors and offers key insights for optimizing transducer design for oral tumor treatment.

AMA Research Challenge 2025 

Histotripsy for the Treatment of Oral Tumors: A Canine Ex-Vivo Feasibility Study

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The neuropeptide hormone, endothelin (specially, ET-1) plays an important role in the invasiveness of breast cancer. High ET-1 levels are associated with decreased disease-specific survival. Very few studies highlight the differential expression of ET-1 and its receptors ETAR and ETBR among triple negative breast cancer (TNBC), non-TNBC, and normal phenotypes. The purpose of the present study was to find out whether the expression of ET-1, ETAR and ETBR is higher in TNBC cells versus non-TNBC and normal cells. An association between higher expression of ET-1 axis and promotion of aggressive TNBC phenotype could represent ET-1 axis as useful biomarkers of TNBC prognosis and potential therapeutic targets. Our hypothesis is that expression levels of ET-1 and its receptors might play an important role in the development and progression of TNBC cells as compared to non-TNBC and normal cells. We aimed to assess the possible prognostic and predictive values of ET-1, ETAR and ETBR by studying their mRNA expression and protein levels in TNBC and non-TNBC via formalin fixed paraffin embedded breast tissue from 4 subjects with TNBC and 4 normal subjects, representing non-TNBC. Western blot, immunofluorescent, and immunohistochemical analysis served to quantify the differential expression. Results from Western Blotting showed ET1 levels were 81.6% higher, ETAR levels were 35% higher, and ETBR levels were 30% higher in TNBC vs non-TNBC cell lines. Immunofluorescence revealed greater intensity of ETBR in all cell lines compared to ETAR, greater expression of ET-1 and ETBR in TNBC cell lines, HCC-1806 and MDA- 231, and greater expression of ETBR in the nucleus of all cell lines and of all proteins in MDA- 231. Immunohistochemistry visually depicted greater staining of ET1, ETAR, and ETBR and quantitatively showed approximately 20% higher ET1, 40% higher ETAR, and 20% higher ETBR positive cells in TNBC vs normal breast tissue. Due to the similar results obtained from Western blot analysis with cell lines and immunohistochemical analysis with breast tissue, our hypothesis that expression of ET-1 and its receptors is higher In TNBC than non- TNBC and control is validated and thus could guide subsequent investigations for targeted pharmaceuticals against these biomarkers in TNBC. 

Supported by MVTCP U54CA162069 and Fuji Oil Company, Osaka, Japan, and NIH MeTRC5U5AMD007593.

Differential Expression of Endothelial-1 (ET1) and its Receptors, Endothelin Receptor Type A (ETAR), and Endothelin Receptor Type B (ETBR) between Subjects with Normal, Triple Negative, and Non-Triple Negative Breast Cancer

Background
Raoultella planticola is a gram-negative, encapsulated bacillus, commonly isolated from environmental sources such as soil and water, as well as the human gastrointestinal tract. Formerly classified under Klebsiella, improved microbiologic identification methods—such as MALDI-TOF MS and VITEK 2—have refined its classification and led to increased recognition in clinical settings. Historically, it is rarely associated with clinical infection, but there has been an increase in the number of case reports attributed to R .planticola infections in the past decade. This calls the need for establishing guidelines to manage infections due to this emerging pathogen.

Case Presentation
A 46-year-old woman with a past medical history of anxiety disorder and depression presented with concerns of recurrent urinary symptoms (dysuria and frequency). She was previously treated empirically with Amoxicillin-Clavulanate without improvement. She has a remote history of vulvovaginal candidiasis resolved with a single Fluconazole dose. Repeat urine culture done on this visit grew Raoultella planticola (50,000–100,000 CFU/mL), resistant to ampicillin but sensitive to multiple other antibiotics including Cephalexin with which the patient was treated for 7 days. The patient has no other comorbidities and neither is immunocompromised.

Discussion
R. planticola infection was first reported in 1984. Since then it has been implicated in various infections including urinary tract infections (UTIs), bacteremia, pneumonia, cholangitis, and soft-tissue infections. This pathogen primarily infects patients who are immunocompromised, critically ill, have undergone invasive surgical procedures, or individuals with underlying malignancies. Infections in immunocompetent individuals are exceedingly rare, with fewer than 10 documented cases in the literature. We report an unusual case of R. planticola UTI in an immunocompetent patient which was treated to resolution with Cephalexin 500mg BID for 7 days. The majority of reported R.planticola UTIs occurred in older adults with underlying conditions such as diabetes mellitus, chronic kidney disease, or neurogenic bladder manifesting as asymptomatic bacteriuria to severe urosepsis that have responded well to antibiotic therapy when guided by susceptibility results. Notably, R. planticola is intrinsically resistant to ampicillin but generally remains susceptible to β-lactam/β-lactamase inhibitors, cephalosporins, fluoroquinolones, and aminoglycosides. Rare cases of extended-spectrum beta-lactamase production and carbapenem resistance have been reported, underscoring the need for precise identification and targeted treatment. Given its emerging clinical relevance, particularly in recurrent or treatment-resistant UTIs, recognition of R. planticola as a potential uropathogen is important. This case adds to the limited but growing literature and highlights the importance of accurate microbiological diagnosis in managing atypical urinary pathogens.


Rare case of Raoultella planticola UTI in an immunocompetent patient

Background:
Mycoplasma pneumoniae (MP) is a common respiratory pathogen that may cause extrapulmonary manifestations, including mucocutaneous involvement. Reactive infectious mucocutaneous eruption (RIME) is one such manifestation, with skin involvement occurring in approximately 25% of the pediatric cases. MP has also been associated with immune dysfunction and autoimmune disease development. We present a case of a previously healthy child who developed RIME following MP infection, and was subsequently diagnosed with new-onset type 1 diabetes mellitus (T1D). 

Case Presentation: 
A previously healthy 9-year-old male presented with ten days of decreased oral intake due to painful oral mucosa, along with dysuria, penile blisters, and weight loss. Two days prior to symptoms onset, he developed fever and respiratory symptoms, testing positive for MP by PCR. He was initially treated at a community hospital for eight days with presumptive pneumonia and herpes, but was referred to our tertiary center due to persistent mucocutaneous lesions. 

On arrival, he was afebrile with stable vital signs, but presented marked hyperglycemia (glucose 431 mg/dL). Physical examination revealed oral mucositis with hemorrhagic crusting at the lip commissures, erosions on the glans penis, and erythematous plaques on lower extremities and lateral neck. Nikolsky sign was negative. Laboratory workup revealed elevated HbA1c (7.2%), hyponatremia, hyperkalemia, and glucosuria. 

During prior hospitalization, the patient received methylprednisolone for four days. However, glucosuria was documented before steroid initiation. His family denied diabetes symptoms or abnormal glucose levels, and there was no family history. He was started on azithromycin, mucocutaneous supportive care, and insulin therapy. At three week follow-up, skin lesions had resolved, but glycemic control required ongoing endocrinologic follow-up.

Discussion: 
RIME is a clinical diagnosis that may be underrecognized due to overlap with other mucocutaneous conditions. Diagnostic criteria include evidence of an infectious trigger, mucosal involvement at ≥2 sites, or cutaneous involvement affecting <10% of body surface. Drug-induced etiologies must be excluded. In this case, RIME was diagnosed after referral to a supra-tertiary pediatric center, where dermatologists evaluated the patient.

Although autoimmune diseases associated with MP have been documented within the first two years post-infection, the concurrent presentation of T1D raises the possibility of infection-triggered autoimmune disease. While the elevated HbA1c suggests a more prolonged course, the absence of glucose data limits definitive conclusions. Although the timing of both diagnosis could be coincidental, the possibility of a primary autoimmune process cannot be excluded. Clinicians should remain alert to this rare but notable association.

A Pediatric Case of Mycoplasma Pneumoniae presenting with Reactive Infectious Mucocutaneous Eruption with concurrent Type 1 Diabetes Mellitus

Background
Pancreatic Leiomyosarcoma (PLS), a rare malignancy (0.1% of pancreatic cancers), is seldom Estrogen Receptor(ER)-positive (<3%). This case involves a 55-year-old woman, post-hysterectomy, with ER-positive pulmonary Benign Metastasizing Leiomyomatosis (BML) and ER-positive PLS with identical markers, suggesting pancreatic spread. This first-reported dual presentation highlights diagnostic challenges and multidisciplinary approach for Uterine Leiomyoma spreading to lungs and pancreas.
Case Presentation
A 55-year-old woman with a history of Uterine Leiomyoma with s/p hysterectomy (2015), type 2 diabetes mellitus, hypertension, hyperlipidemia, asthma, knee osteoarthritis, and mild thalassemia underwent preoperative chest X-ray in 2022 which revealed bilateral pulmonary nodules up to 2 cm, suspicious for metastatic lung cancer. PET-CT showed well-defined pulmonary nodules in the right upper lobe (RUL- 1.9x1.9 cm), left upper lobe (LUL- 1.1x0.9 cm), and left lower lobe (LLL- 1.5x1.3 cm) without hypermetabolic activity. Endobronchial ultrasound-guided biopsy confirmed smooth muscle cells, positive for desmin, ER, Progesterone Receptor and smooth muscle actin(SMA), consistent with Pulmonary BML. 
Follow-up PET-CT after 4 months showed increased nodule sizes (RUL: 2.4x2.1 cm, LUL: 1.9x1.5 cm, LLL: 1.8x1.5 cm) with mild hypermetabolism. The patient was started on daily oral Anastrozole 1 mg.
Surveillance CT with contrast done in August 2023 revealed reduced nodule size but identified a 0.7cm pancreatic tail lesion. MRCP revealed a 2.3x1.8x1.6 cm lesion within the tail of pancreas and cytology indicated a Pancreatic Cyst with atypical epithelioid cells with mild spindling. In October 2024, the patient underwent a distal pancreatectomy and splenectomy and histopathology confirmed a 3.4 cm ER-positive PLS (pT1, pN0, pMx; Ki67 50%), positivity for ER, desmin, SMA and hCaldesmin, with negative EBER in situ hybridisation showing no association of EBV induced leiomyomas.The patient remains asymptomatic and stable on anastrozole.
Discussion
This case of ER-positive pulmonary BML and PLS post-hysterectomy raises intriguing questions about metastatic spread versus new primary tumors. Anastrozole reduced pulmonary BML, confirming hormonal responsiveness, yet aggressive PLS (high Ki67) emerged, requiring surgery. Could CDK inhibitors (palbociclib or ribociclib) or Selective Estrogen Receptor Degrader (SERD) such as fulvestrant, effective in ER-positive breast cancer, provide better control of hormonal spread in such rare tumors? The rarity of ER-positive PLS highlights the need for molecular profiling to clarify origins and optimize therapies like CDK inhibitors or SERD, opening avenues for future research.


Estrogen Receptor positive Leiomyoma with Metastatic Leap to Pancreas Over a Decade

Background
Peripheral artery disease (PAD) is a leading cause of functional limitation in older adults, with revascularization often required in advanced cases. Coexisting venous disorders, such as May-Thurner syndrome (MTS), can further complicate hemodynamics and outcomes. The combination of bilateral MTS and recurrent claudication following prior vascular reconstruction is rare and poses diagnostic and therapeutic challenges.

Case Presentation
A 66-year-old woman with coronary artery disease (status post-CABG), COPD, diabetes mellitus, and a history of extensive PAD presented with recurrent left calf claudication. Her vascular history included bilateral iliac vein stenting for MTS, bilateral common femoral endarterectomy, and a left CFA-to-above-knee popliteal bypass using a PTFE graft. Despite these interventions, she experienced exertional calf pain after walking two blocks. On exam, distal pulses were diminished. ABI was 0.73 on the left. Arterial duplex revealed 70% inflow stenosis at the bypass origin and 50% outflow stenosis. A revascularization attempt via CFA and radial access failed due to inability to cross the lesion. She is currently under multidisciplinary
evaluation for further intervention.

Discussion
This case underscores the complexity of managing PAD in the context of bilateral MTS and prior prosthetic bypass. Persistent claudication despite anatomically successful interventions suggests that both inflow and outflow disease can recur and affect graft patency. Bilateral MTS, though rare, may exacerbate venous congestion, impairing perfusion and masking arterial insufficiency. The case also highlights the limitations of prosthetic conduits like PTFE in maintaining long-term durability, especially in high-risk patients. Comprehensive vascular imaging, hemodynamic assessment, and individualized care planning are crucial in such
complex cases to optimize outcomes and prevent limb-threatening complications.

Recurrent Claudication Due to Bypass Inflow and Outflow Stenosis in a Patient with Bilateral May-Thurner Syndrome and a Complex Vascular History

Hyper-IgE syndrome (HIES) is a rare primary immunodeficiency that is characterized by elevated serum IgE levels, recurrent sinopulmonary infections, and chronic eczema, among other symptoms. Though reports on patients with HIES exist, they primarily focus on the clinical features, diagnosis, and management of HIES without detailing surgical interventions.

Here, we present the surgical management of an extensive cellulitic infection that developed into skin necrosis in a HIES patient with a history of polysubstance abuse. The patient had a diagnosis of Job’s Syndrome, the autosomal dominant form of HIES. In this case, severe infection resulting from immunodeficiency led to cellulitis and full thickness tissue loss in the left upper limb. Due to the extent of infection and necrosis, multiple debridements and upper extremity reconstruction were necessary for limb preservation.

The 625 cm2 wound, which involved the left upper extremity and crossed the elbow joint, was managed with initial debridement followed by a period of local wound care to allow for clearance of infection. We then performed reconstruction in a staged fashion with dermal substitute (Integra) placement and split thickness skin grafting. In this case, we demonstrate that the extensive soft tissue infections that may be found in HIES patients can be successfully managed with skin grafting and dermal substitute.

The Surgical Management of Extensive Cellulitic Infection and Tissue Necrosis in Rare Immunodeficiency: Hyper-IgE Syndrome

Background
Corona mortis (CM), meaning “crown of death,” is a vascular anatomical variation involving an anastomosis between the obturator artery and either the external iliac or inferior epigastric artery. This variation, present in a significant portion of individuals, is located near the superior pubic ramus, placing it at risk during pelvic or abdominal surgeries and trauma cases. Historical anatomical studies have documented CM as a key vascular hazard, given its propensity for severe hemorrhage if injured. This case highlights the implications of CM injury, emphasizing preoperative planning, intraoperative vigilance, and understanding of vascular variations among surgeons and radiologists.
Case Presentation
A 42-year-old male with end-stage cirrhosis presented to the emergency department with acute right lower quadrant abdominal pain and hypotension, two weeks post-robotic assisted bilateral inguinal and umbilical hernia repair. He was transferred from an outside hospital after imaging revealed intra-abdominal bleeding.
Upon arrival at the outside facility, the patient exhibited hypotension (90/58 mm Hg), tachycardia (128 bpm), and labs revealed a hemoglobin of 11.1 g/dL and hematocrit of 31.4%. Initial stabilization involved transfusion with 7 units of packed red blood cells before transfer.
Interventional radiology was consulted, and angiography identified bleeding from a right-sided CM variant arising from the inferior epigastric artery. Coil embolization was performed.
Following embolization, the patient was admitted to the ICU. His condition deteriorated, with worsening hemodynamic instability requiring intubation and pressor support. Despite consultations with general surgery and nephrology and aggressive resuscitative efforts, the patient ultimately experienced a pulseless electrical activity arrest. At the family’s request, further resuscitative measures were withheld.
Discussion
This anatomical variation poses a heightened risk for cirrhotic patients who are prone to coagulopathy and impaired hemostasis, complicating surgical outcomes and increasing the risk of severe hemorrhage, as demonstrated in our patient post-hernia repair. Preoperative imaging with CT angiography can help identify CM, aiding in surgical planning to minimize intraoperative risks. Surgeons should exercise caution with retractors and dissection near the superior pubic ramus, and in the event of an unexpected CM injury, direct pressure, hemostatic agents, or embolization may be necessary.
This case illustrates the critical need for heightened awareness of anatomical variations, particularly when operating on high-risk patients. Key takeaways include the value of preoperative imaging, cautious dissection near the pubic rami, and an interdisciplinary approach. Awareness of CM, combined with prompt identification and management, can prevent fatal outcomes.

Life-threatening Hemorrhage Due to Corona Mortis Injury: A Case Report

Background: Lung cancer screening with LDCT can lead to early detection and reduced lung cancer mortality. Sadly, uptake remains suboptimal with an estimated 5% of those eligible receiving LDCT. Cancer survivors require surveillance and preventive care but may face barriers to recommended screenings. Evidence also suggests survivors have higher lung cancer rates after LDCT than those without a cancer history, magnifying its benefit. This study examines smoking status and whether or not LDCT screening were discussed based on survivorship status.

Methods: Data from the nationally representative Health Information National Trends Survey 2022 were used to assess discussions of LDCT, comparing those with a prior cancer diagnosis (survivors) and those w/o cancer. Sample was limited to prior or current smokers aged 50-80 (pack year history not available); lung cancer survivors were excluded given expected surveillance with diagnostic CT scans. Demographics included age, race/ethnicity, gender, education, income, employment, and sexual orientation. Univariate analyses and logistic regression focused on predictors of LDCT discussion.

Results: Overall, 3,585 with current or prior smoking history were included of which 560 (15.6%) were cancer survivors. Survivors were older (median 69 vs. 65), less likely employed (26.2% vs. 40.4%), more commonly White (89.8% vs. 84.4%), and less often Black race (23.1% vs. 27.3%) (p < 0.05 for all) than those w/o a cancer history.

Among the cohort, 59 (10.5%) survivors vs. 346 (11.4%) non-survivors are current smokers (p=0.54). Actively smoking survivors were younger than survivors who had quit smoking (median age 63 vs. 68, p= 0.04).

More cancer survivors reported having a LDCT discussion with their provider in the last year than those w/o a cancer history (10.5% vs. 4.8%, p<0.001). Logistic regression confirmed this association, survivors were less likely to have not had a LDCT discussion (OR = 0.43, 95% CI [0.32, 0.59], p < 0.001). Further evaluation limited to survivors showed no significant differences in reported LDCT discussion by age, gender, race, ethnicity, sexual orientation, income, education, or current smoking status.

Conclusion: In this national study, cancer survivors with a smoking history report low rates of discussion of LDCT, despite one in ten being active smokers. While more common in survivors, only a tenth of eligible survivors and one in twenty without cancer are having this important screening discussion. Future interventions should focus on standardizing provider communication, improving survivorship care, and ensuring equitable LDCT screenings among all eligible individuals.


Low-Dose CT (LDCT) Discussions for Cancer Survivors with a Smoking History

Background

Large language models (LLMs) are transforming medicine in general and ophthalmology in particular. Many patients deviate from medical advice due to misunderstandings, leading to adverse effects on visual outcomes. Patient educational materials (PEMs) typically require a high level of language understanding, posing comprehension challenges for marginalized populations. Given the average American reads at a 6th grade level, a potential application of LLM technology includes explaining diagnoses and customizing care plans to patients’ comprehension level. The purpose of this study is to review the literature for LLM-generated ophthalmologic PEMs to determine type and frequency of LLMs used, topics most frequently addressed, metrics used to evaluate PEMs, and success of LLMs in generating and simplifying text.

Methods

A literature review was conducted on PubMed using the search term “ChatGPT and Ophthalmology Educational Material,” resulting in 36 articles. 10 were excluded due to no generation of PEMs (n=4), non-ophthalmologic topic (n=3), prognostic/diagnostic use of AI (n=2), and no use of AI/LLMs (n=1). 26 articles were used in the final analysis. 

Results

The most frequently used LLMS were Chat-GPT 3.5 (65%, n=17) followed by Google Bard/Gemini (62%, n=16) and Chat-GPT 4.0 (50%, n=13). The most frequently used metrics to analyze PEMs were readability (100%, n=26) followed by grade level (88%, n=23) and accuracy (54%, n=14). The most frequently covered topics were pediatric ophthalmology/strabismus (27%, n=7) followed by cornea/external disease (19%, n=5). Studies consistently found PEMs generated by LLMS, especially Chat-GPT 3.5 and 4.0, were longer and more difficult to read requiring a university degree. Most LLM-generated PEMs were of high quality, understandability, and accuracy. Furthermore, Chat-GPT 3.5 responses were more accurate than other LLMs.

Several studies showed that when prompted to rewrite PEMs at a lower reading level, Chat-GPT 3.5 and 4.0 were most successful in simplifying text, reducing average grade level to middle or high-school without sacrificing quality, understandability or accuracy, and comprehensiveness. One article found Chat-GPT 3.5 was more efficacious in simplifying Spanish PEMs compared to English PEMs.

Conclusion

ChatGPT is the most used LLM among studies and represents a viable information source for eye health. By using specific prompts requesting easier-to-understand health information, LLMs have the potential to both create and modify already-existing content for patients with varying health literacy, thereby improving readability while maintaining quality and accuracy. Finally, physicians can overcome limitations of AI by proofreading LLM outputs to ensure they are evidence-based and accurate before administering to patients.


Large Language Model-Generated Ophthalmologic Patient Educational Materials: A Literature Review

Background 
The anatomy course is a core part of medical education; however, studies have shown that anatomy exams significantly raise stress levels. Mentorship programs have been proven effective in enhancing students’ well-being and performance; however, there is limited research on the impact of anatomy mentorship on medical and physician assistant (PA) students. The main goal of this study is to assess the effect of the Anatomy Student Mentorship Program (ASMP) on academic performance and well-being of PA students. 

Methods 
The ASMP offered guided anatomy review sessions led by upperclassmen for PA students at Creighton University’s Phoenix campus. Forty-six students who took the course from 2024 to 2025 were invited to an anonymous Qualtrics survey evaluating their well-being and lab performance. In addition, students/mentor participation hours were recorded by each anatomy session, de-identified, and linked to two anatomy exam scores (MSK and all systems). The association between ASMP participation and quantitative academic performance were assessed using Pearson’s correlation coefficient in SPSS. The study was approved by the institutional IRB. 

Results 
Overall, 72% (33 students) participated in ASMP. There was no significant correlation between ASMP participation hours and exam performance for each exam (p>0.05) or between previous anatomy lab experience and exam performance (p>0.05). However, there is a positive Pearson correlation between the performance of first and second exam (0.471, P=0.001). There is also a positive correlation between participation of ASMP for the first and second exam (0.402, p=0.006). Overall, the total number of ASMP participation hours among all students decreased from the first to second exam (118.5 to 44 hours) and the class average scores decreased by 8.22%. The survey response rate was 15% (7 students) with 100% ASMP participation. All respondents reported that ASMP improved their ability to recognize, identify, and find different structures. Only 42.9% said ASMP reduced stress, but all reported increased confidence. The top benefits were reinforcing anatomy knowledge and receiving personal support, while 85.7% cited time constraints as the main barrier. Overall satisfaction was 94.2%. 

Conclusion 
There was no direct correlation between ASMP participation and exam on an individual level, but greater use of ASMP with the first exam led to higher class average compared to the second exam. Overall, ASMP increased students’ confidence and comfort in the anatomy lab. Despite limitation in response rate, ASMP is shown to enhance learning experiences and should continue as a resource to support interprofessional medical education.

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