United States

Abstract Title: Bilateral Panuveitis and Optic Papillitis Associated with Positive IgG P23 Titer

Background: Lyme disease, caused by the spirochete Borrelia burgdorferi, is primarily transmitted through the bite of infected Ixodes ticks.1-4 While Lyme disease typically presents with dermatologic, neurologic, musculoskeletal, and rheumatologic symptoms, ocular manifestations, though less common, are increasingly recognized and pose significant diagnostic challenges.1-4 Uveitis is one such ocular manifestation associated with Lyme disease, often requiring a high degree of clinical suspicion for accurate diagnosis.1-4 The diagnostic work-up for Lyme-associated uveitis typically involves serological testing, emphasizing the need for targeted antibody testing based on the patient&#39;s exposure history and clinical presentation.5,6

Case Presentation: This case report describes an unusual case of fulminant bilateral uveitis and optic neuritis related to seropositive IgG P23 possibly aggravated by antecedent SARS-CoV-2 infection. A 43-year-old, Caucasian female reported to the eye clinic with complaints of conjunctival hyperemia, conjunctivitis, blurry vision, floaters, headaches, and diarrhea. The patient had a history of a tick bite 1 week prior to onset of her symptoms and at the time or presentation was being treated for suspected Lyme disease. Serology yielded only a single seropositive titer (IgG P23) for Lyme disease. The patient did not receive any COVID-19 vaccine and reports to have been infected with COVID-19 on three occasions between 2020 and 2022. The patient was diagnosed with severe acute anterior bilateral iridocyclitis and was instructed to use topical steroid and cycloplegic eye drops. Three months following onset of symptoms, the patient was noted to have bilateral optic papillitis, which subsided after 3 months of continued prednisolone use. 

Discussion: The implications of this case are the possible emergence of increased ocular manifestations from Lyme disease and other tick-borne diseases capable of dissemination especially among patients with previous COVID-19 infections. The patient’s past history of multiple SARS-CoV-2 infections may be a contributor to this atypical presentation of Lyme-related uveitis due to viral immune system alterations, which has previously been reported in the literature.7 As the long term impacts of SARS-CoV-2 are still being determined, it is important to document unusual cases such as these where immune alterations with COVID may induce different clinical manifestations. In addition, the p23 antibody present in this patient may be a potential predictive marker for development of uveitis in patients with Lyme disease.

1. Mikkilä H, Seppälä I, Leirisalo-Repo M, Karma A. The Significance of Serum Anti-Borrelia Antibodies in the Diagnostic Work-Up of Uveitis. Acta Ophthalmol Scand. 1997;75(4):373-376. doi:10.1111/j.1600-0420.1997.tb00637.x.
2. Mikkilä HO, Seppälä IJ, Viljanen MK, Peltomaa MP, Karma A. The Expanding Clinical Spectrum of Ocular Lyme Borreliosis. Ophthalmology. 2000;107(1):114-120. doi:10.1016/S0161-6420(99)00128-1.
3. Zaidman GW. The Ocular Manifestations of Lyme Disease. Ophthalmology. 1993;100(3):415-418. doi:10.1097/00004397-199303310-00004.
4. Wang Y, Yang L, Zhang ZL. Panuveitis with Oral and Genital Ulcer Misdiagnosed as Behçet&#39;s Disease: Two Cases Report and Literature Review. Ocul Immunol Inflamm. 2016;24(2):231-234. doi:10.3109/09273948.2015.1074958.
5. Shivpuri A, Turtsevich I, Solebo AL, Compeyrot-Lacassagne S. Pediatric Uveitis: Role of the Pediatrician. Front Pediatr. 2023;11:874711. doi:10.3389/fped.2023.874711.
6. Mandal S, Tayyab H, Mandal SC, Sideeg A. Co-infectious Uveitis With Syphilis and Lyme Disease: A Case Report. Cureus. 2024;16(2)
. doi:10.7759/cureus.58608.
7. Feng H, Zhao M, Mo J, Cao X, Chen W, Wang H. New onset or recurrence of uveitis following COVID-19 infection. BMC Ophthalmol. 2024;24(1):23. Published 2024 Jan 17. doi:10.1186/s12886-024-03289-w


AMA Research Challenge 2025 

Bilateral Panuveitis and Optic Papillitis Associated with Positive IgG P23 Titer

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AMA Research Challenge 2024 

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Abstract Title: Bilateral Panuveitis and Optic Papillitis Associated with Positive IgG P23 Titer

Background: Lyme disease, caused by the spirochete Borrelia burgdorferi, is primarily transmitted through the bite of infected Ixodes ticks.1-4 While Lyme disease typically presents with dermatologic, neurologic, musculoskeletal, and rheumatologic symptoms, ocular manifestations, though less common, are increasingly recognized and pose significant diagnostic challenges.1-4 Uveitis is one such ocular manifestation associated with Lyme disease, often requiring a high degree of clinical suspicion for accurate diagnosis.1-4 The diagnostic work-up for Lyme-associated uveitis typically involves serological testing, emphasizing the need for targeted antibody testing based on the patient's exposure history and clinical presentation.5,6

Case Presentation: This case report describes an unusual case of fulminant bilateral uveitis and optic neuritis related to seropositive IgG P23 possibly aggravated by antecedent SARS-CoV-2 infection. A 43-year-old, Caucasian female reported to the eye clinic with complaints of conjunctival hyperemia, conjunctivitis, blurry vision, floaters, headaches, and diarrhea. The patient had a history of a tick bite 1 week prior to onset of her symptoms and at the time or presentation was being treated for suspected Lyme disease. Serology yielded only a single seropositive titer (IgG P23) for Lyme disease. The patient did not receive any COVID-19 vaccine and reports to have been infected with COVID-19 on three occasions between 2020 and 2022. The patient was diagnosed with severe acute anterior bilateral iridocyclitis and was instructed to use topical steroid and cycloplegic eye drops. Three months following onset of symptoms, the patient was noted to have bilateral optic papillitis, which subsided after 3 months of continued prednisolone use. 

Discussion: The implications of this case are the possible emergence of increased ocular manifestations from Lyme disease and other tick-borne diseases capable of dissemination especially among patients with previous COVID-19 infections. The patient’s past history of multiple SARS-CoV-2 infections may be a contributor to this atypical presentation of Lyme-related uveitis due to viral immune system alterations, which has previously been reported in the literature.7 As the long term impacts of SARS-CoV-2 are still being determined, it is important to document unusual cases such as these where immune alterations with COVID may induce different clinical manifestations. In addition, the p23 antibody present in this patient may be a potential predictive marker for development of uveitis in patients with Lyme disease.

1. Mikkilä H, Seppälä I, Leirisalo-Repo M, Karma A. The Significance of Serum Anti-Borrelia Antibodies in the Diagnostic Work-Up of Uveitis. Acta Ophthalmol Scand. 1997;75(4):373-376. doi:10.1111/j.1600-0420.1997.tb00637.x.
2. Mikkilä HO, Seppälä IJ, Viljanen MK, Peltomaa MP, Karma A. The Expanding Clinical Spectrum of Ocular Lyme Borreliosis. Ophthalmology. 2000;107(1):114-120. doi:10.1016/S0161-6420(99)00128-1.
3. Zaidman GW. The Ocular Manifestations of Lyme Disease. Ophthalmology. 1993;100(3):415-418. doi:10.1097/00004397-199303310-00004.
4. Wang Y, Yang L, Zhang ZL. Panuveitis with Oral and Genital Ulcer Misdiagnosed as Behçet's Disease: Two Cases Report and Literature Review. Ocul Immunol Inflamm. 2016;24(2):231-234. doi:10.3109/09273948.2015.1074958.
5. Shivpuri A, Turtsevich I, Solebo AL, Compeyrot-Lacassagne S. Pediatric Uveitis: Role of the Pediatrician. Front Pediatr. 2023;11:874711. doi:10.3389/fped.2023.874711.
6. Mandal S, Tayyab H, Mandal SC, Sideeg A. Co-infectious Uveitis With Syphilis and Lyme Disease: A Case Report. Cureus. 2024;16(2)
. doi:10.7759/cureus.58608.
7. Feng H, Zhao M, Mo J, Cao X, Chen W, Wang H. New onset or recurrence of uveitis following COVID-19 infection. BMC Ophthalmol. 2024;24(1):23. Published 2024 Jan 17. doi:10.1186/s12886-024-03289-w


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Cancers evade the immune system by inducing immunosuppressive tumor microenvironments (TMEs). Tumor cells release cytokines and growth factors that induce myeloid cell precursors to differentiate into an immunosuppressive cell population: myeloid-derived suppressor cells (MDSCs). In cancer patients, MDSCs are found in TMEs and in the blood, where their higher levels correlate with poor prognosis, increased disease progression, and reduced long-term survival. MDSCs are categorized into two major types: monocytic (M-MDSC) and granulocytic (G-MDSC), based on their molecular marker surface expression. In their normal physiologic role, MDSCs localize to the placenta, wounds, and other sites associated with immunosuppression and 'immune privilege’, where they potently suppress T and natural killer cells. However, MDSCs also accumulate with cancer and other pathogenic chronic inflammatory conditions such as sepsis and persistent viral infections. However, it remains unclear whether specific tumor types consistently favor enrichment of distinct MDSC subtypes. Our research aims to characterize tumors based on the MDSC subtypes present in their microenvironment and identify whether certain cancers induce MDSC differentiation into monocytic, granulocytic, or both. Our objective is to define tumor-specific MDSC profiles that could serve as biomarkers for immune evasion and guide targeted immunomodulatory therapies. We used a ‘tumor education’ model, an ex vivo tumor–primary CD14+ human monocyte co- culture to mirror MDSC generation during cancer progression. We examined melanoma and renal cell carcinoma in this system. We isolated myeloid cells from the co-cultures and used flow cytometry with antibodies against the following markers: CD33, CD11b, CD14, CD15, and HLA-DR, to determine whether MDSC phenotypes differed across tumor types and donors. Our model captured features of the distinct MDSC populations that are preferentially expanded across different cancer types. Specifically, we demonstrate that melanoma induces more M- MDSCs, whereas renal cell carcinoma (RCC) induces comparatively fewer M-MSDCs. These findings are consistent with the observed MDSC profiles in patients with these cancer types. Overall, our model provides insight into the mechanisms underlying MDSC heterogeneity in cancer and has the potential to support cancer patient MDSC screening that guides effective immunotherapies. We are using this assay as a prototype to model MDSC conversion in individual cancer patients, enabling precision oncology through screening of cancer-specific and personalized immunotherapies that reduce MDSC-mediated immunosuppression. Currently, we are expanding our model to include additional cancer types and incorporate a larger sample of donors.

Myeloid-Derived Suppressor Cells Express Diverse Biomarkers Across Tumor Type and are Potential Targets for Cancer-Specific and Personalized Immunotherapies


In the past two decades, oncolytic viruses (OVs) have emerged as a promising candidate for cancer treatment by utilizing genetically modified viruses to target and deliver anti-tumor reagents precisely. These CRISPR-modified oncolytic viruses elicit reduced pathogenicity yet preserve cytotoxicity and tissue specificity, allowing for dual antitumor effects: the target-specific delivery of tumor microenvironment (TME) immune-enhancers and initiation of antiviral immunity. We performed systematic literature searches of the PubMed databases that pertain to oncolytic viruses and the delivery of reagents that target immunosuppressive factors in the TME. We intend to look at multiple study designs that followed clinical trial phases, being tested first in animal models and then followed by safety and efficacy in humans. Oncolytic viruses paired with several different anti-immunosuppressive reagents were identified, namely, anti-PD-1, anti-CTLA-4, anti-PD-L1, anti-GM-CSF, and anti-TGFβ. As outlined in this work, the different anti-immunosuppressive reagents co-expressed and co-delivered with the oncolytic virus have shown to be a promising new method to be further explored in patients with local and metastatic tumors. We anticipate that future directions include, but are not limited to, novel pharmacologic cargos, circumnavigating immune-restricted cancer sites, and the usage of oncolytic viruses for tangent diseases.

Harnessing Viruses for Good: Advancements and Efficacy in Oncolytic Virus Therapy 
for Cancer

Abstract Title
Effect of Climate and Energetics within Southeast Asian Nasal Morphology 

Authors: Isaac Nebeker1, Fabio Savoldi2, James Kit-Hon Tsoi3, Michael Rivera4, Andy Wai Kan Yeung5, Alexa P. Kelly1

1Campbell University School of Osteopathic Medicine; 2University of Brescia, Orthodontics, Dental School, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health 3The University of Hong Kong, Dental Materials Science, Applied Oral Sciences and Community Dental Care, Faculty of Dentistry 4The University of Hong Kong, Faculty of Social Sciences 5The University of Hong Kong, Oral and Maxillofacial Radiology, Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, 


Background
Under normal breathing (eupnea), virtually all inspired air must pass through the internal nasal cavity. Recent research has revealed that inspiration functionality may vary according to environmental climate and body size constraints. In turn, these constraints have altered the shape and size of not only the nose, but total craniofacial anatomy, over the course of human history. Populations indigenous to colder-drier environments consistently exhibit taller, narrower, and longer internal noses. This morphological adaptation increases the heating and humidification of inspired air, as well as satisfies metabolic oxygen demand. Thus far, studies evaluating the effects of energetics and environmental climate on nasal morphology have not incorporated large samples of humans from hot-humid climates. Accordingly, this study aimed to quantify nasal variation in the context of climate and body size in a large sample of humans from Southeast Asia.

Methods
We employed three-dimensional geometric morphometrics, a quantitative methodology widely used in biological anthropology, facilitated by recent advancements in 3D imaging technology that allow for high-resolution analysis of craniofacial structures. In this study, computed tomography (CT) scans were obtained from 63 individuals (11 females, 52 males) curated in the Human Bone Collection at The University of Hong Kong. Using 3D Slicer imaging software, forty-nine three-dimensional coordinate landmarks were systematically recorded on the cranial CT scans and then utilized in Procrustes-based shape analysis. Additionally, body mass and climate-specific basal metabolic rate (BMR) were estimated through established predictive equations applied to postcranial skeletal elements associated with each cranium.

Results
In this sample, significant sexual dimorphism was observed in both BMR (p < 0.0003) and nasal centroid size (p < 0.0001), with males exhibiting larger internal nasal structures and higher metabolic rates. While nasal height (p = 0.398) and breadth (p = 0.114) were not significantly associated with BMR, nasal length was (p < 0.025), suggesting a relationship between internal nasal elongation and energetic demand. Additionally, a progressive increase in nasal height and length was observed in individuals with high BMRs.

Conclusion
These findings suggest that in hot, humid environments where ambient air is closer to core body temperature and humidity, evolutionary pressures on nasal height and breadth for air conditioning are reduced. Instead, nasal morphology appears to reflect a balance between respiratory efficiency and thermoregulation, particularly through increases in nasal length to accommodate metabolic demand. This has important implications in otolaryngology; especially in our increasingly globalized world wherein individuals are frequently inhabiting diverse environments with greater frequency.


Effect of Climate and Energetics within Southeast Asian Nasal Morphology

Abstract Title: 3D Modeling and Virtual Implantation of Pediatric Leadless Pacemakers: Predictors of Acute Implant Angles

Background
Leadless pacemakers (LP) have advantages for treatment of arrhythmic disease in pediatric patients including high efficacy and lower rates of complications when compared to technologies involving leads. Anatomical differences among pediatric patients, including vertical cardiac orientation (acute IVC-to-target implant location angle) can make delivery catheter positioning and device implantation difficult. Early clinical experience at our institution suggests that access from the right internal jugular vein can aid in crossing of the tricuspid valve and improve catheter maneuverability. In this exploratory analysis we used 3D modeling of cross-sectional imaging to measure implantation angles from the IVC and SVC and correlate these features with anthropomorphic traits to aid in procedural planning.

Methods
Data collection/Inclusion Criteria: CT-Angiography scans obtained from 2022-2025 representing a varied pediatric cohort were collected. Patients with structural heart disease or non-diagnostic scans were excluded.
Modeling: 3D Slicer was used to create models from scans via combined automatic segmentation with manual refinement. Pacemaker implant location at the apical third of the ventricular septum was identified. IVC-implant angle (IVCia) and SVC-implant angle (SVCia) were recorded. Virtual implant was performed using high-fidelity pacemaker model created using photogrammetry.
Data analysis: Descriptive statistics for the cohort were completed with grouped comparisons by age, height, weight, and BMI quartiles.

Results
51 patients were included (29 Female [57%], mean age 13 ± 3.7 yrs, height 153 ± 20 cm, weight 56 ± 27 kg, BMI mean 20 ± 7). The mean IVCia was significantly more acute than the SVCia (81 ± 17 vs. 116 ± 12, p < 0.01). IVCia became more acute with increasing age (<10 y (n=11) 100.7 ± 27.2, 10-14 y (n=18) 82.2 ± 14.6, 14-18y (n = 24) 77.5 ± 15.7), p = 0.017) while SVCia was age-invariant. No significant difference in weight, height, or BMI quartiles were noted for IVCia or SVCia. A single patient was noted to have less than 1 cm from the tricuspid valve annulus to the proximal end of the pacemaker.

Conclusion
In this our exploratory analysis, we found that the IVCia was more acute than the SVCia, suggesting that jugular approach may be easier in the majority of pediatric patients. The youngest patients in the cohort had the least acute IVCia, but no other patient characteristics were predictive of implant angle. Future studies correlating readily available studies such as plain chest film to IVCia/SVCia may prove to be of significant benefit. 





3D Modeling and Virtual Implantation of Pediatric Leadless Pacemakers: 
Predictors of Acute Implant Angles

Background
The Model for End-Stage Liver Disease (MELD) score has helped prioritize liver transplant candidates based on disease severity since 2002. Changes to its algorithm rendered MELD 2.0 in 2016 and MELD 3.0 in 2022. The revisions to each model aimed to enhance transplant allocation and equity, but each model’s ability to predict post-transplant outcomes remains unclear.

Methods
Utilizing the Organ Procurement Transplantation Network database, 10 post-transplant outcomes were compared between MELD 1.0 (n=76,732), MELD 2.0 (n=52,615), and MELD 3.0 (n=23,299) cohorts. Binary logistic regression models evaluated the association between MELD cohort and each dichotomous outcome, adjusting for MELD score. MELD 1.0 served as the reference category. Odds ratios (ORs), 95% confidence intervals (CIs), and p-values were reported for comparisons between MELD 2.0 versus MELD 1.0 and MELD 3.0 versus MELD 1.0. Statistical significance was defined as p<0.05. All analyses were conducted using IBM SPSS Statistics, version 29.

Results
MELD 3.0 best predicted an increased risk of graft failure due to infection (OR=1.30, p=0.02), diffuse cholangitis (OR=2.32, p<0.001), hepatic artery thrombosis (OR=2.51, p<0.001), primary non-function (OR=3.93, p<0.001), and overall graft loss (OR=6.34, p<0.001). MELD 3.0 also was the greatest predictor of a decreased risk in chronic rejection (OR=0.67, p=0.041), recurrent disease (OR=0.12, p<0.001), and hepatitis recurrence (OR=0.03, p<0.001). However, an increased risk of acute rejection (OR=1.58, p<0.001) was better predicted by MELD 2.0. Graft failure due to other vascular thrombosis was not significantly predicted by either model.

Conclusion
MELD model revisions may have utility in predicting post-transplant outcomes as evidenced by the 3.0 model best predicting 8 out of the 10 selected outcomes. Further studies should examine the ability of MELD 3.0 to predict male versus female transplant outcomes, as the purpose of the MELD 3.0 revision was to improve equitable distribution of available livers to females.

Investigating the Utility of Each MELD Edition in Predicting Liver Transplant Outcomes

Background
Perforator flaps, like deep inferior epigastric perforator (DIEP) and thoracodorsal artery perforator (TDAP) flaps, use perforating vessels to transfer tissue while sparing underlying muscle and motor nerves in microvascular reconstruction. Obtaining computed tomography angiograph (CTA) studies prior to flap surgeries is the gold standard for identifying appropriate perforators. Although CTA provides high-quality vascular imaging, concerns persist regarding the potential risks of radiation exposure and the financial costs associated with its use. This systematic review assesses how different preoperative imaging methods correlate with complication rates.
Methods
A systematic review was conducted using controlled keywords across multiple databases to identify studies utilizing preoperative CTA imaging in patients undergoing DIEP breast reconstruction published up to 2024. Keywords utilized included ("flap surgeries" OR "flap surgery" OR "flap procedures" OR “DIEP” OR “Autologous breast reconstruction” OR “deep inferior epigastric artery flap”) AND ("preoperative identification" OR "perforator vessels" OR "CTA" OR "Computed Tomography Angiography"). Eligible studies included clinical trials, observational studies, case series, and reports involving patients aged 18 or older. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were utilized. Each study went through a two-stage review process including an initial title and abstract screening followed by a full-text screening with two reviewers using Covidence software. 19 studies met inclusion criteria and data were abstracted into Excel by study design, total population, preoperative imaging type used, and complications.
Results
Out of 19 studies included, there were 3043 patients included in studies that shared complication rates. 499 patients (16.4%) reported complications during or after surgery. When our analysis was subdivided by preoperative imaging type, 134 of 625 (21.4%) US alone, 115 of 622 (18.5%) CTA alone, and 87 of 603 (14.4%) US + CTA patients reported complications. Of the total 499 patients with complications, 40 (8.0%) suffered complete flap loss, 69 (14%) experienced partial flap loss, and 96 (19%) developed fat necrosis.
Conclusion
Our preliminary analysis demonstrates that studies utilizing CTA alone or with US for preoperative planning reported lower rates of complications when compared to studies using US alone. These findings suggest while preoperative CTA is demonstrated to decrease intraoperative times, it may also be associated with better surgical outcomes in DIEP breast reconstructions. These findings emphasize the need for accurate preoperative perforator identification in minimizing complications and optimizing surgical outcomes.


Evaluating the Efficacy of Preoperative CTA in DIEP Flap Breast Reconstructions

Background
Neurological conditions are the leading cause of disease burden and disability worldwide (4). Underserved populations face significant challenges in accessing neurological care due to ethnic/racial, economic, educational, and geographic barriers (1). Complex conditions can exacerbate these challenges, contributing to job insecurity and social stigma (1). Combined with physician shortages, these barriers limit access to timely care, contributing to disparities in morbidity and mortality.

Student-Run Free Clinics (SRFCs), such as the Columbus Free Clinic (CFC), address care gaps by offering free neurological services to disadvantaged populations in Franklin County, Ohio. CFC provides continuity of care, access to low-cost medications, and specialty referrals. However, complex neurological conditions like dementia, stroke, seizure disorders, migraines, and movement disorders, result in cognitive and functional impairments that are not fully addressed by neurology alone. Even with treatment, patients may experience memory deficits, daily functioning and communication challenges, leading to distress, dependency, and diminished quality of life (2,3). Neuropsychologists uniquely assess cognition, behavior, and function through testing, and aid in differential diagnoses for treatment and rehabilitation planning (2,3). Their integration into CFC could help address current care gaps and improve quality of life for this population.

Methods
To assess the possible benefit of neuropsychology integration, we conducted a retrospective IRB-approved study of neurology referrals at CFC between January 2024 and May 2025. Data included age (≥18), presenting neurological concern, and referral date. Patients were categorized by diagnosis (e.g., seizure disorders, headache/migraine, stroke, memory and movement disorders, TBI, others); cognitive or functional concerns were flagged.

Results
A total of 46 patients were included in the analysis based on neurology referrals received. Common referral reasons were headache/migraine (30.4%), other (radiculopathies/peripheral muscle concerns) (28.2%), seizure disorders (13.0%), memory disorders (10.9%), stroke (10.9%), movement disorders (6.5%), and TBI (2.2%). Two cases included cognitive concerns, and one included functional concerns. Of these 46 patients, over 70% were flagged as potentially benefiting from neuropsychological evaluation due memory loss, cognitive impairment, or functional concerns. These patients spanned diagnostic categories including dementia, stroke, seizure disorders, TBI, and headache/migraine cases. Despite this, no neuropsychological referrals were documented.

Conclusion
Preliminary results suggest care gaps for patients with neurological conditions that could be addressed through neuropsychological integration. Incorporating neuropsychology could help by improving rehabilitation efforts and treatment plans, strengthening coping strategies, and providing resources. Future work should evaluate the outcomes of such integration and explore models for incorporating and sustaining future neuropsychology services.

Gaps in Neurological Care: A Retrospective Review Supporting Neuropsychology Integration in a Student-Run Free Clinic

Background
Historically, men were the default subjects of clinical research, as women of childbearing age were excluded from participation in early-phase clinical trials by FDA guidelines enacted in 1977. However, significant changes occurred in the 1990s with the establishment of the Women’s Health Initiative (WHI), a groundbreaking clinical research effort focused on women’s health. Following the introduction of the WHI, we hypothesize that females and males are equally represented in medical research. 

Methods
A PubMed search was conducted using keywords for two categories. Keywords used for the first category include conditions that affect men and women at different rates: hypertension, cardiovascular disease and type 2 diabetes. Keywords used for the second category include conditions that occur in a 1:1 ratio in men and women: bipolar I disorder and ankylosing spondylitis. Search results were filtered with the following criteria: published between 1990 and 2025, conducted on human subjects, and article type of a randomized controlled trial or a clinical trial. Filtration for male and female sex was established through utilization of PubMed’s sex filter. PubMed describes their sex filter as the assignment of an associated MeSH term for sex during MEDLINE indexing. It should be noted that PubMed acknowledges the possibility of excluding relevant results due to a lack of an associated MeSH term. Composite X2 tests were performed to assess the relationship between the quantity of publications and gender using R Studio V4.4.3.

Results
Results from keyword searches are as follows: “hypertension” 26,464 articles categorized as female and 26,209 categorized as male; “cardiovascular disease” 106,144 articles categorized as female and 107,065 categorized as male; “type 2 diabetes” 15,696 articles categorized as female and 15,859 categorized as male. A composite X2 p-value of .13 was obtained based on these results. Results for disorders that occur in a 1:1 ratio of men and women are as follows: “bipolar I disorder” 157 articles categorized as female and 154 categorized as male; “ankylosing spondylitis" 713 articles categorized as female and 752 categorized as male. A composite X2 p-value of .39 was obtained based on these results. Both composite X2 tests demonstrate no statistical significance between genders. 

Conclusion
Based on our study, we conclude that medical research publications from 1990-2025 equally represent males and females, a testament to the efficacy of the WHI. Further research is needed to quantify the shift in medical research using female subjects pre- and post-WHI.

Assessing Gender Representation in Medical Research Post-Women’s Health Initiative

Background
Hiring faculty who trained at different institutions can enrich residents’ exposure to diverse practice styles. Methods are needed to quantify the breadth of training backgrounds amongst faculty complements and the degree to which programs are connected through their alumni. The objective of this study is to perform quantitative network analysis of faculty in U.S. residency programs and the influence of individual programs on the specialty landscape, using academic neurosurgery as a case study.

Methods
We performed a cross-sectional analysis of 2024-25 ACGME-accredited U.S. neurosurgery residency programs, integrating faculty training histories with program-level geographical, research, leadership, and ranking characteristics. Social network algorithms included multilayer graph modeling, community detection, link analysis, and generalized entropy measures. We developed three core metrics to characterize each institution: influence upon network connectivity (‘influence’); breadth of training backgrounds among faculty (‘institutional diversity’); and degree of academic career mobility afforded to residency alumni (‘mobility’).

Results
The network of 1,910 faculty across 115 programs was non-random and highly structured (modularity=0.2402). Although highly connected in aggregate, the network comprised a small, closely linked group of institutions surrounded by a larger group of sparsely connected institutions (skewness coefficient=1.371). Geographic proximity and private institutional status were significant predictors of clustering. Influence correlated with higher U.S. News rankings and faculty size (P<0.001). Institutional diversity was limited among most faculty complements, and was inversely correlated with influence (τ = –0.287, P<0.001). Programs with the most diversely trained faculty had significantly lower rankings, faculty sizes, and frequency of chairpersons trained internally. Mobility was moderately skewed (skewness coefficient = 0.648) and significantly influenced by chair and program director characteristics. Mobility was not significantly correlated with influence or institutional diversity.

Conclusion
Quantitative social network analysis revealed significant clustering and asymmetries in the landscape of academic neurosurgery. Influence and connectivity are highly concentrated among a minority of programs, partly associated with geographic proximity, private institutions, and higher rankings. Influence is inversely correlated with training diversity amongst faculty, suggesting that influential programs may be the most siloed. Residency alumni mobility is significantly influenced by program leadership but not by other characteristics, suggesting that structural factors may not limit graduates’ career options. Characterizing residency programs using these novel metrics has the potential to enrich training by identifying barriers to, and opportunities for, institutional cross-pollination and equity.

The Social Network of United States Neurosurgery Residency Programs

Background
Global surgery is a rapidly growing field focused on addressing health inequities by improving access to surgical care, particularly in underserved regions. Opportunities for U.S. medical students to engage with global surgery remain scarce. The purpose of this scoping review was to explore U.S. medical students’ knowledge, perspectives, and interest in the field of global surgery.

Methods 
The scoping review was conducted following the PRISMA-ScR checklist. Searches were conducted in APA PsycINFO, MEDLINE (Ovid), PubMed, Scopus, and Embase. The databases were selected because of the subject coverage of health sciences, education, and global health. The search strategies utilized controlled vocabulary and keywords such as medical students, knowledge/comprehension, and global health. Studies were included if they focused on U.S. medical students’ global surgery knowledge, perspectives, or interest. 

Results
Of the 262 studies initially identified, five met the inclusion criteria. These studies assessed global surgery educational initiatives, demonstrating improvements in students’ knowledge and clinical confidence following pilot courses. Students expressed strong interest in global surgery but held misconceptions, such as underestimating the global burden of trauma and the economic feasibility of surgical interventions. Pilot courses received overwhelmingly positive feedback, with most students advocating for their continuation.

Conclusion
This review highlights significant gaps in global surgery education for U.S. medical students, alongside persistent misconceptions despite evident enthusiasm for the field. Expanding access to targeted educational initiatives and fostering multi-institutional collaborations may address these gaps, inspire future global surgeons, and advance efforts to strengthen the global surgical workforce.

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