United States

Background
Invasive candidiasis is a growing concern. Several Candida species have been placed in the Critical Priority and High Priority groups by the WHO, and within months of these new priorities, the CDC published a study noting prevalence of nosocomial candidemia in 26 states. Climate change and drug resistance are compounding the health threat, and new agents are needed in the antimycotic armamentarium. To better understand fungal energy homeostasis and explore new potential drug targets, we cloned and characterized nicotinamide mononucleotide adenylyltransferase (NMNAT) from C. parapsilosis (CpNMNAT) and performed a small in vitro inhibitor screen. 
Methods
CpNMNAT was synthesized and inserted into pET30(a)+ containing an N-terminal His-tag, subcloned into E. coli. Enzyme assays were conducted using modified NMNAT assay from our laboratory (doi: 10.1177/2472555219879644), employing a luciferase-coupled assay to monitor end-point concentrations of ATP. CpNMNAT assays were run in the “forward” direction using ATP and NMN as substrates and generating NAD and PPi, as well as the “reverse” direction using NAD and PPi as substrates and generating ATP and NMN. 

Results
BL21 (DE3) harboring CpNMNAT produced a protein with a molecular weight of approximately 46kDa, which had enzymatic activity with both the forward and reverse directions. CpNMNAT displayed Michaelis-Menten kinetics, with Kms of around 1 and 400 μM for NAD and PPi, respectively, and the reaction was inhibited by known human NMNAT inhibitors gallotannin and dichloronapthoquinone. The inhibitor screen identified a micromolar inhibitor of CpNMNAT.
Conclusion
These results show promise towards identifying small molecule probes for ATP/NAD homeostasis in fungal pathogens, which ultimately could better inform antimycotic drug discovery. Future directions will include expanding our compound library, in addition to test CpNMNAT-active hits against Candida cultures.


AMA Research Challenge 2025 

In the Heat of the MoNMNt: Pharmacological Screen of a Fungal Nicotinamide Mononucleotide Adenylyltransferase (NMNAT)

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Join the AMA Research Challenge poster symposium and semifinals to explore top research posters and score posters in the semifinals (an AMA member exclusive opportunity).

poster

Neuropathic pain is a prevalent and often debilitating component of chronic arthritis, yet its mechanisms in the context of ongoing joint inflammation remain poorly understood. This study aimed to identify key genetic and molecular drivers of neuropathic pain within rheumatoid arthritis (RA) by leveraging bioinformatics analysis and literature review. We compiled a comprehensive list of pain- and inflammation-associated genes from published studies and analyzed their interactions using the STRING database to visualize and rank protein-protein interaction networks. Our findings highlight several highly interconnected genes, including BDNF, TRPV1, IL10, and TGF-β1, implicated in both immune modulation and neuronal sensitization. STRING clustering revealed distinct gene groups linking immune pathways, neuroplasticity, and cytokine signaling as potential points of intersection between arthritis-driven inflammation and neuropathic pain. These results suggest that neuropathic pain in RA is underpinned by complex, overlapping pathways involving both inflammatory and neurogenic mechanisms. By pinpointing critical molecular drivers, this work provides a foundation for targeted studies and novel therapeutic strategies aimed at alleviating neuropathic pain in patients with arthritis. Future investigations should validate these targets in preclinical models and consider their relevance to clinical pain management.

Neuroimmune Crosstalk: An Investigation Into the Pahology of Neuropathic Pain in Rheumatoid Arthritis

Authors: Matthew Becker, Meredith Morgan, Miles Rothstein, Virginia Simmons, Julie Martin, Jeffery Edenfield, and Anna Blenda

Abstract Title

First Look: Non-Small Cell Lung Cancer Genetic Mutations in a Previously Uncharacterized South Carolina Cohort 

Background

Treating non-small cell lung cancer (NSCLC) remains elusive as tumor heterogeneity and mutation profiles vastly differ per patient. This reality is supported by the combined 5-year survival rate for patients diagnosed with NSCLC being only 32%, according to the American Cancer Society. Newer interventions, like adjuvant anaplastic lymphoma kinase (ALK) and tyrosine kinase (TK) inhibitors, have improved patient survival. Still, these agents reach a minority of NSCLC patients and, over time, prove less effective as the disease mutationally evolves under treatment pressure. This mutational flux, including NSCLC mutation discoveries, suggests that continued molecular surveillance and profiling are needed to effectively treat and manage NSCLC disease.

Methods

We analyzed NSCLC tumor mutation data from the Prisma Health Cancer Institute (PHCI) cohort, comprising 222 unique patients from the Upstate region of South Carolina. The dataset included mutations across 50 tumor suppressor genes and oncogenes, elucidated by the Ion Ampliseq Cancer Hotspot Panel, v2, and provided by Precision Genetics (Greenville, SC, USA). Our analysis identified over 50 new NSCLC mutations, 29 of which had not been previously reported in publicly available mutation databases, including TCGA, COSMIC, and ClinVar. We conducted multivariate logistic regression and Fisher's Exact Tests to assess associations between the presence of the newly identified NSCLC mutations and clinical variables. Odds ratios from the regression analysis were adjusted for age and gender.

Results

More than 50 patients from the PHCI cohort had newly identified NSCLC mutations. Of the eight covariates, only two, diabetes mellitus (DM) and smoking status, contributed significantly to not carrying new mutations after adjusting for age and gender. Interestingly, patients with DM had 72% lower odds of harboring a new NSCLC mutation than those without DM (p=0.047). Similarly, patients who currently smoke were found to have 68% reduced odds of harboring a new NSCLC mutation compared to non-smokers (p=0.035). Race, age, gender, body mass index, cancer stage, and histology were not associated with the presence of novel NSCLC mutations.

Conclusion

This cohort analysis revealed 29 not-yet-described somatic mutations and that clinical and lifestyle traits, specifically DM and smoking status, significantly impact the likelihood of harboring new NSCLC mutations. In practice, this may augment how clinicians identify patients for more in-depth sequencing panels, tailoring diagnostic and treatment decisions to patient clinic realities. More broadly, sequencing efforts like the one described in our research widen the pool of potential gene product targets, facilitating the creation of next-generation therapies.


First Look: NSCLC Genetic Mutations in a Previously Uncharacterized South Carolina Cohort

Background
Post-stroke dysphagia is a prevalent complication amongst adults and can cause significant implications. Various
therapeutic interventions have been developed to manage this condition such as Chin Tuck Against Resistance
(CTAR) and Capsaicin. However, the comparative effectiveness between the two remains unclear. This network
meta-analysis aims to assess and compare the efficacy of CTAR and capsaicin in improving swallowing function in
patients with post-stroke dysphagia.

Methods
This network meta-analysis followed PRISMA 2020 guidelines and is registered in PROSPERO
(CRD420251074631). A search was conducted across Cochrane, PubMed, Embase, and Scopus library databases to
identify randomized controlled trials (RCTs), cohort studies, and observational studies evaluating CTAR or capsaicin
interventions in stroke patients with dysphagia. Included outcomes used validated swallowing assessments such as
the Penetration-Aspiration Scale (PAS), Functional Dysphagia Scale (FDS), Standardized Swallowing Assessment
(SSA), and Video fluoroscopic Dysphagia Scale (VDS). Two reviewers extracted data. A total of 1080 studies were
screened, twelve underwent data extraction and nine RCTs (n= 407 participants) met inclusion criteria. The netmeta
package in R was used to compare interventions using between-group standard mean differences (SMDs) as the
primary effect measure. Heterogeneity was assessed using the I^2 statistic, and publication bias was determined with
funnel plots.

Results
Of the nine included RCTs, six evaluated CTAR and three assessed capsaicin. Pooled SMDs favored both
interventions over control. CTAR compared to control had an SMD of 0.90, 95% CI [0.58, 1.21], p<0.000, and
capsaicin compared to control had an SMD of 1.17, 95% CI [0.81, 1.52], p<0.001. Capsaicin compared to CTAR
indirectly had an SMD of 0.27, 95% CI [-0.20, 0.74], p= 0.258. Heterogeneity was low: T^2 = 0.024, I^2 = 18.1%,
suggesting low inconsistency across studies. These findings confirm that CTAR and Capsaicin both significantly
improve swallowing function compared to control, with capsaicin demonstrating a numerically larger effect size.
However, the difference between interventions was not statistically significant, indicating comparable efficacy.

Conclusion
Both CTAR and capsaicin are effective non-invasive interventions for improving swallowing function in patients
with post-stroke dysphagia. While capsaicin showed a slightly greater effect size compared to CTAR, the difference
between the two was not statistically significant. Given its low cost and rapid onset, capsaicin may represent a
promising therapeutic adjunct. Further trials are needed to confirm these findings and explore patient-centered
outcomes.

Comparative Effectiveness of Chin Tuck Resistance (CTAR) vs. Capsaicin for Post-Stroke Dysphagia: A Network Meta-Analysis

Background : 
Mucoepidermoid carcinoma (MEC) is one of the most common malignancies arising from the major salivary glands. Histologic grading including low, intermediate, and high grades guide the need for adjuvant treatment post-primary surgical therapy. While adjuvant radiotherapy is commonly recommended for high-grade MEC, intermediate-grade tumors occupy a clinical gray zone. This study aims to assess adjuvant radiotherapy treatment patterns in intermediate-grade lesions and whether radiotherapy lends a survival benefit in this subgroup.

Methods: 
The National Cancer Database (NCDB) was queried for patients diagnosed with salivary MEC between 2004 and 2020. Baseline demographic comparisons utilized univariate chi-square and independent t-test analyses. Multivariable Cox regression and Kaplan-Meier analyses were conducted to assess 5-year overall survival (OS).

Results: 
Among the 6,348 patients included, low-grade tumors comprised 46.0%, intermediate-grade 39.4%, and high-grade 14.6%. Kaplan-Meier analysis demonstrated nearly identical 5-year OS for low- and intermediate-grade MEC (p < 0.001). Cox proportional hazards modelling showed no significant survival difference between low-grade and intermediate-grade MECs (HR: 1.148 [CI: 0.94-1.39], p = 0.165). 

Conclusions:
Based on our survival analyses indicating comparable OS between intermediate- and low-grade MEC and treatment trends, intermediate-grade MEC appears to behave similarly to low-grade MEC. As some institutions have begun adjusting their treatment of intermediate-grade MEC, a reconsideration of the indications for adjuvant therapy based on tumor grade may be warranted.

Treatment Patterns And Survival In Mucoepidermoid Carcinoma

Background
Dementia is a pressing global health challenge affecting more than 50 million people worldwide with a net impact on the global economy of 1 trillion USD. One aspect of the condition is the potential for deterioration to the point where a crisis situation occurs requiring emergency intense psychiatric support, either in the form of intense community care or admission to an inpatient facility. Such care is only needed for a minority of patients. If patients can be identified at the point of diagnosis it raises the potential for stratified care pathways for those at highest risk with the aim of improving outcomes. Our previous work from two United Kingdom sites found that younger, male patients, and those with impaired cognition were at risk of deteriorating. In this study, we aimed to create mathematical models of risk and use the results to develop a mobile application that is ready for clinical use. 

Methods
Using on our retrospective cohort study (n=25,326) we have identified several epidemiological, and behavioural factors that showed the highest association with subsequent need for enhanced care. The top 10 variables were selected using dominance analysis and systematic regression in Cambridgeshire and the models externally validated in a second data set from London. The same threshold was used for classifying patients into the high and low risk groups as in our previous retrospective study. 

Results
The top predictive variables in Cambridgeshire were age (OR:0.97, p<0.001), gender (OR:1.74, p<0.001), marital status (OR: 1.34, p<0.05), dementia subtype (OR<0.61, p<0.05), and the following 6 Health of the Nation Outcome Score (HoNOS) subcategories: behaviour (OR: 1.43, p<0.001), hallucinations (OR:1.20, p<0.05), cognitive (OR:1.19, p<0.05), disability (OR: 0.79, p<0.001), other mental and behavioural problems (OR:1.23, p<0.01) and relationships(OR: 1.26, p<0.01). The AUC was 0.74-0.79 for 1 to 4 years after diagnosis in Cambridgeshire with a similar AUC of 0.74 in the validation dataset in London. The resulting PREDICDEM app is a tool which can be used to stratify people in terms of risk at the point of dementia diagnosis.

Conclusion
We have used routinely collected clinical data to model risk of needing enhanced care in dementia. This data can be incorporated into models of risk prediction and into a smartphone app. This will allow stratification of patients at the time of diagnosis and facilitate trials of interventions to decrease the risk of crisis events.


The development of a mobile app to predict the need for enhanced care for people with dementia


Background
Dupilumab is a monoclonal antibody used to treat inflammatory skin diseases such as atopic dermatitis (AD) but does not treat collagen vascular diseases (CVD). Some studies suggest an association between AD and CVD, however, there is currently no literature presenting co-occurrent dermatomyositis (DM) with AD and its management with dupilumab. We present a unique case of severe AD with DM overlap unmasked by dupilumab.

Case Presentation
A 78-year-old woman presented with pruritic rashes on the forearms, upper sternum, and back. On physical examination she had scaly, pruritic plaques with violaceous erythema in shawl-like distribution, ragged cuticles, and widely distributed eczematous patches. Biopsy demonstrated spongiotic and interface epidermal change and dermal inflammation with eosinophils consistent with AD. She was treated with dupilumab and drastically improved, however, one year later still had pruritic areas on her scalp and neck and had overtly ragged cuticles. A repeat biopsy showed spongiosis and vacuolar interface dermatitis without eosinophils. The patient’s clinical and dermatopathological findings indicated dermatomyositis, and methotrexate was added to dupilumab for treatment. After two months of methotrexate, her symptoms improved.

Discussion
One possible explanation for our patient’s remarkable clinical response to dupilumab is that AD was exacerbating the inflammatory processes of DM. Some studies suggest an association between AD and CVD, implying a shared autoimmune mechanism. It is critical to consider the whole picture regarding a patient’s condition, including history and changes in dermatopathology, while also considering co-occurrent skin pathologies based on patient presentation and response to treatment.


Dupilumab unmasks histopathologic diagnosis of dermatomyositis in a patient with severe atopic dermatitis and dermatomyositis overlap

Background:
Due to the pandemic, virtual nursing is further utilized and shown to improve patient experiences, communication, and patient adherence. This study uses Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) top-box scores after its implementation across multiple U.S. healthcare centers to study patient experience.
Objective:
This study aims to assess the impact of virtual nursing on patient experience across multiple healthcare centers.
Methods:
HCAHPS top-box scores of patient experience were collected from 2020-2021, pre-implementation period of 2023-2024, and post-implementation of virtual nursing. Center A-C had virtual nursing implementation while D center had no implementation. Scores were categorized by hospital units (PCU, Med-Surg). The primary outcomes include scores for "Communication with Doctors," "Communication with Nurses," and "Rate the Hospital 0-10."
Results:
There was a significant increase in top-box scores for each category from 2020-2024. Healthcare center A had significant improvements in the ICU unit with scores improving for: nursing (+4.27%), doctor (+10.23%), and hospital (+5.22%) scores. Healthcare center B experienced declines after implementation. Healthcare Center C showed mixed results, with significant increases in doctor (+27.05%) and hospital (+18.23%) scores but a decline in nursing (-7.71%). The variability in scores indicates differences in the effectiveness of implementing virtual nursing. 
Conclusion:
Overall, virtual nursing implementation had a positive impact on patient experience. The variability between top-box scores convey the need for further research on its utility. Further studies can explore the institutional barriers of implementing virtual nursing and the long term impacts on healthcare.

The Implications of Virtual Nursing on Patient Experience and Satisfaction: A Multicenter Quality Improvement Analysis

Background
Gap years before medical school have become an increasingly popular opportunity for students to gain research, clinical, and other experience, leading to diverse medical school cohorts where students have varying lengths of time since last engaging in formal education. This underscores the need for medical schools to adapt curriculum designs to accommodate these diverse learner backgrounds. One way to approach this adaptation involves reevaluating how student performance is assessed in the preclerkship phase. McGovern Medical School utilizes a hybrid preclerkship grading system in which the first semester is graded on a pass/fail basis, and the second through fourth semesters are graded on a tiered basis (i.e. honors, high pass). This study explores how students’ perceptions on this grading system differs based on their educational backgrounds, and how these perceptions can inform broader discussions on preclerkship grading practices across medical schools nationwide.

Methods
Following exemption by the UTHealth Houston Center for Protection of Human Subjects Institutional Review Board, an online survey was distributed to third- and fourth-year students at McGovern Medical School. “Traditional” students were defined as those who matriculated without taking gap years; “non-traditional” students took one or more gap years before medical school. The survey included Likert-scale and free-response questions assessing perceptions of the hybrid system’s effectiveness and overall student satisfaction.

Results
71 medical students completed the survey, including 37 non-traditional students and 34 traditional students. No statistically significant differences in perceptions of the pass/fail and tiered grading components were observed between traditional and non-traditional students (p > 0.05). Overall, 88.9% of students agree that one semester of pass-fail grading offers sufficient time to adjust to the rigor of medical school. Furthermore, correlation analysis revealed a moderately positive association between students who felt pass/fail grading gave them adequate time to adjust and those who felt tiered grading later on increased motivation (Spearman’s rho = .62, p < .01). 

Conclusion
This study found no significant differences in perceptions of the preclerkship hybrid grading system between traditional and non-traditional students at McGovern Medical School, suggesting that the combination of an initial pass/fail semester followed by tiered grading is broadly acceptable across diverse educational backgrounds. As many U.S. medical schools continue to use tiered preclerkship grading, these results support the idea that integrating a pass/fail transition period may help students adjust to medical school regardless of their prior educational pathway, while preserving the motivational benefits of tiered grading. 


Comparing the Perceptions of Traditional and Non-Traditional Medical Students on a Hybrid Preclerkship Grading System

Disparities in Septicemia-related Mortality in the Black and White American Populations, 2000–2020

Co-authors:
Zachary Lebowitz, Berk Madendere, Rutgers New Jersey Medical School
Yazan Abboud, UCLA Medical School

Background and Aims: Racial disparities are a persistent determinant of health outcomes in the United States. Septicemia is a leading cause of death, yet long-term trends in race-specific mortality remain underexplored. This study analyzed racial disparities in septicemia-related mortality among non-Hispanic Black and non-Hispanic White adults from 2000–2020, stratified by age and sex.
Methods: Age-adjusted mortality rates (per 100,000, standardized to the 2000 U.S. population) were obtained from the CDC’s National Center for Health Statistics. Two age groups were assessed: younger adults (<55 years) and older adults (≥55 years). Joinpoint regression estimated annual percentage change (APC) and average APC (AAPC). Coincidence and parallelism tests evaluated differences by race and sex (α = 0.05).
Results: From 2000–2020, 764,504 septicemia-related deaths were recorded: 80.3% in Whites and 17.3% in Blacks. Mortality declined in both groups overall and among older adults, but more sharply in Blacks (AAPC: -2.36 vs. -0.48 overall; -2.46 vs. -0.68 in ≥55 years, Black vs. White, respectively). Among younger adults, mortality increased in Whites but declined in Blacks (AAPC: +1.38 vs. -1.16). Patterns were consistent across sexes: in younger adults, mortality rose in White males (+1.24) and females (+1.38) but declined in Black males (-1.45) and females (-1.16). Despite steeper declines, septicemia-related mortality remained higher in Blacks across all age and sex categories.
Conclusions: Between 2000 and 2020, septicemia mortality declined overall but diverged by race and age. Younger White adults experienced rising mortality, whereas Black adults saw sustained declines. Nonetheless, mortality remained disproportionately higher among Blacks across subgroups. These findings highlight persistent inequities and call for further research into underlying causes and targeted interventions.


Disparities in Septicemia-related Mortality in the Black and White American Populations, 2000–2020

Background: Cancer survivors frequently experience coexisting chronic diseases that extend beyond their primary diagnosis. This study aimed to identify independent predictors of self-reported cancer history using multivariable models incorporating chronic conditions, biomarkers, and body composition metrics in a nationally representative U.S. population.

Methods: Data were obtained from the National Health and Nutrition Examination Survey, covering adults aged ≥18 years from 1999 to 2018. Cancer history was determined by self-report. Candidate predictors included chronic health conditions (e.g., anemia, emphysema, bronchitis, liver disease, thyroid disorder, arthritis), body composition metrics derived from dual-energy X-ray absorptiometry such as appendicular lean mass index and additional variables including waist circumference, smoking status and systolic blood pressure. Multivariable survey-weighted logistic regression was used to identify predictors of cancer history, adjusting for age, sex, education, marital status, and income. Variables significant in univariable models were entered into a final multivariable model. Performance was evaluated using the area under the curve, and multicollinearity was assessed using variance inflation factors.

Results: Among 55,021 adults included in the dataset, 5,166 participants reported cancer history. In weighted descriptive analysis, individuals with cancer history had significantly higher prevalence of multiple chronic conditions, including emphysema, bronchitis, anemia, and arthritis.

In the final multivariable survey-weighted logistic regression model, adjusted for age, sex, education, marital status, and income, several conditions emerged as independent predictors of cancer history. Anemia (OR = 1.78), liver disease (OR = 1.76), emphysema (OR = 1.55), bronchitis (OR = 1.47), thyroid disorder (OR = 1.42), and arthritis (OR = 1.32) were all associated with increased odds of cancer history. Current smoking (OR = 1.35) and larger waist circumference (OR = 1.01 per cm) also remained significant. In contrast, higher appendicular lean mass index was associated with lower odds of cancer history (OR = 0.83), indicating a potential protective role of skeletal muscle mass. The final model demonstrated moderate discriminatory power with an area under the ROC curve of approximately 0.79.


Conclusion: A history of cancer is independently associated with a broad range of chronic conditions and unfavorable changes in body composition. Conditions such as anemia, emphysema, and low lean muscle mass were among the strongest predictors, reflecting a lasting systemic burden among cancer survivors. These findings underscore the need for comprehensive survivorship care that includes regular screening for chronic disease, monitoring of musculoskeletal health, and targeted management of modifiable risk factors. Longitudinal studies are warranted to explore causal relationships and evaluate interventions to improve long-term outcomes in this growing population.

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