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Echo of the Bell
Full text linkThe author submitted this entry in the 10-Word Story category (Amateur division) for the 2025 On My Own Time™ (OMOT) Art Show.This piece is inspired by the bittersweet nature of nostalgia and the enduring presence of the past in abandoned or quiet spaces. It evokes the feeling of revisiting a place filled with personal history, where the echoes of childhood--laughter, lessons, friendships--linger long after the actual inhabitants have departed. It's a reflection on memory's power to fill empty spaces with vibrant life
HIV, SARS-CoV, vaccines and what have we learned
Full text linkDetailed formal protocol with illustrations and extensive bibliography.A recording of the protocol presentation is available on UT Southwestern’s Mediasite. Note: Access to the video is restricted to authorized UT Southwestern users only.UT Southwestern--Internal Medicin
Waiting for the Stars
Full text linkThe author submitted this entry in the Open Verse Poetry category (Amateur division) for the 2025 On My Own Time™ (OMOT) Art Show.My inspiration for "Waiting for the Stars" came from a friend and her glow-in-the-dark star stickers. These stars had decorated her ceiling ever since she was a kid, and no matter where she moved, she always put them up. After hearing her story, I began to think about how it would feel not to have the comforting sight of those stars, especially in an unfamiliar environment. I realized that this difficult adjustment is what every patient experiences when admitted to the hospital. What emotions arise as they lie there in the room? How many wishes are made to be able to leave? Thus, this piece reflects on the longing to recover and return to a cherished place
Cardiovascular disease and cancer: a dangerous liaison
No full textDetailed formal protocol with illustrations and extensive bibliography.A recording of the protocol presentation is available on UT Southwestern’s Mediasite. Note: Access to the video is restricted to authorized UT Southwestern users only.UT Southwestern--Internal Medicin
Epithelial Tubular Fusion, Measuring Interconnection, and the Quest for Solving the Continuity Problem
Full text linkThe formation of functional epithelial tubules is a central feature of many organ systems. Although it has been well-studied how epithelial cells form tubules, it is not well understood how tubules and related epithelial micro-tissues such as spheroids and organoids interconnect with each other to form functional networks. Currently available model systems that spontaneously undergo epithelial tubular interconnections rely heavily on animal models of organ development, which are time- and resource-intensive, and limit the scope of hypothesis testing. Here we have designed a novel assay to quantitatively examine epithelial tubular interconnection in vitro using epithelial spheroids with fluorescently-tagged apical surfaces and lumens to enable direct visualization of interconnection. We used single cell RNA-Seq data combined with receptor-ligand analyses from mouse kidney tubules that undergo interconnection to build a list of candidate effectors. One such candidate was hepatocyte growth factor (HGF), which has known roles in cell migration, tubulogenesis, and cell proliferation. Addition of HGF robustly induced interconnection of adjacent spheroids. The proliferative effect of HGF neither promoted nor inhibited the interconnections. Additional studies with inhibitors of matrix metalloproteinases (MMPs) revealed a significant role for extracellular matrix turnover in lumen coalescence. These results lay the groundwork for investigating how to promote functional interconnections between tubular epithelia, which has important clinical implications for the intersection of organoid biology and transplant medicine
Communication at the Cellular Level: Discovery and Application
Full text linkCell-cell communication is essential to the functioning of all multicellular organisms, and understanding these critical processes can help solve current biomedical problems. As a demonstration of the utility of this approach, existing knowledge of the interactions between B cells and T cells in the B cell maturation process is used to create a novel model to tackle the longstanding problem of B cell epitope prediction. Despite decades of effort and advancements in experimental and computational techniques, this problem remains challenging, with available tools performing only marginally better than random guess. Strikingly, the incorporation of cell-cell communication information significantly enhances the prediction of linear B cell epitopes while also provides interesting mechanistic insights to the underlying biological processes. However, current knowledge of cell-cell communication remains relatively incomplete. Despite the usefulness of understanding such interactions, most research focuses on intracellular rather than intercellular processes, in part due to the relative difficulty in observing and manipulating cell-cell communication among diverse cells. To help address this issue, I present an innovative approach that leverages recent advancements in spatially resolved transcriptomics technologies and multiple-instance learning to enable high-throughput detection of intercellular communications. This new approach addresses a number of shortcomings of existing methods such as poor specificity, limited to certain types of interactions, reliance on existing, limited databases, and lack of consideration of complex, multiple-to-one interactions. Furthermore, I demonstrate that this new method enables biologically and clinically relevant discoveries using various cancer datasets. Overall, this work represents a notable step in advancing the quantification of cell to cell communication as well as its application to solve contemporary biomedical problems
Cancer Cachexia Is Associated with Increased Risk of Venous and Arterial Thromboembolic Events in CRC and NSCLC
Full text linkThe 63rd Annual Medical Student Research Forum at UT Southwestern Medical Center (Tuesday, January 28, 2025; 3-6 p.m.; D1.700 Lecture Hall)Each year the Medical Student Research Program awards students for the best oral presentation and the best poster presentation as judged by faculty across campus. This author received an award as one of the best poster presentations at this forum.INTRODUCTION: Cancer cachexia is a multifactorial catabolic syndrome of muscle and adipose tissue wasting, resulting in marked weight loss. Its development is characterized by chronic inflammation. Cancer-associated thromboembolic events develop through inflammatory pathways that share remarkable similarities to cachexia through cytokine release. As the inflammation driving cachexia may also contribute to the hypercoagulable state of cancer, patients with cancer cachexia may have a higher rate of developing either venous (VTE) or arterial thrombotic events (ATE) compared to non-cachectic patients.
METHODS: 2,685 patients with stage IV NSCLC and advanced stage colorectal cancer treated from 2006-2020 were retrospectively reviewed. Cox proportional hazards regression and competing-risks regression were performed for time-to-event analyses modeling the risk of first VTE and ATE in pre-treatment cachexia and non-cachexia groups, controlling for factors known to impact thrombosis risk (16 and 18 in VTE and ATE models, respectively). D-dimer and thrombin-antithrombin (TAT) complex levels were assessed through ELISA using plasma samples from a prospective human cachexia cohort.
RESULTS: Patients with cachexia (n=1,086) had similar rates of thrombotic risk factors as compared to non-cachexia patients (n=1,478). Cachexia patients in the colorectal cohort had significantly higher rates of initial thromboembolic events compared to non-cachexia patients (VTE: 26.7%(119) vs 16.5%(104), p<0.001, ATE: 15.9%(71) vs 9.3%(59), p=0.001). On multivariate analysis, VTE risk attributable to cachexia was significant in the colorectal (Cox model: hazard ratio 1.96, [95% confidence interval [CI]: 1.47-2.60, p < 0.001], competing risks: subhazard ratio 1.77 [95% CI: 1.33-2.35, p < 0.001]) and NSCLC cohorts (Cox model: hazard ratio 1.39, [95% confidence interval [CI]: 1.11-1.75, p = 0.004], competing risks: subhazard ratio 1.28 [95% CI: 1.01-2.63, p = 0.041]). ATE risk attributable to cachexia was significant in the colorectal cohort (Cox model: hazard ratio 1.81, [95% confidence interval [CI]: 1.25-2.64, p = 0.002], competing risks: subhazard ratio 1.68 [95% CI: 1.13-2.50, p = 0.010]). Average D-dimer levels were significantly elevated in the cachexia (n=29) group compared to the non-cachexia (n=28) groups (12.9 vs 7.0 ng/mL, p=0.030).
CONCLUSIONS: In time-to-event analyses controlling for thrombosis risk factors, cachexia conferred a significant risk of VTE in colorectal and NSCLC patients and a significant risk of ATE in colorectal patients. Pre-clinical studies further suggest increased coagulation activation in cachexia patients.Southwestern Medical Foundatio
Optimal blood pressure targets with age: from SHEP to ESPRIT
Full text linkDetailed formal protocol with illustrations and extensive bibliography.A recording of the protocol presentation is available on UT Southwestern’s Mediasite. Note: Access to the video is restricted to authorized UT Southwestern users only.UT Southwestern--Internal Medicin
Polygenic embryo screening: ethical challenges
Full text link[Note: The video and slides are both not available from this event.] Tuesday, March 11, 2025; noon to 1 p.m. (Central Time); Room NB2 100A or via Zoom. "Polygenic Embryo Screening: Ethical Challenges". Vardit Ravitsky, Ph.D., President and Chief Executive Officer of The Hastings Center.[Note: The video and slides are both not available from this event.] Recent advances in genetic screening have made the science fiction allure of choosing our children's traits ever more possible. Many parents-to-be already screen human embryos derived from in vitro fertilization (IVF) to avoid passing along harmful genetic diseases. However, with the falling cost of genetic sequencing, along with increased understanding of the genetic basis of many characteristics, fertility clinics are starting to offer couples additional technologies. These allow prospective parents to screen embryos before implantation in the womb, to see how likely each one is to develop conditions or traits that depend on many genes, such as schizophrenia, Crohn's disease, and prospects of educational attainment. Some of these applications are quite controversial. This talk will discuss the ethical challenges raised by these emerging developments.UT Southwestern--Program in Ethic
The Effect of Liposomal Bupivacaine (Exparel) on Postoperative Narcotic Consumption Following Lumbar Spinal Fusion
Full text linkThe 63rd Annual Medical Student Research Forum at UT Southwestern Medical Center (Tuesday, January 28, 2025; 3-6 p.m.; D1.700 Lecture Hall)BACKGROUND: Lumbar spine surgery via posterior approaches can involve significant trauma of native structures that often results in intense postoperative pain. Despite advances in less invasive surgical technique and acute pain management, reliance on opioid medications remains a major issue following these spinal procedures. While the analgesic effects of opioid medications can be effective, the large side-effect profile, delayed recovery times, and risk of addiction/overdose associated with narcotic use demonstrates the clear need for alternative pain management strategies. This study assessed the efficacy of intraoperative liposomal bupivacaine infiltration in reducing postoperative opioid consumption and admission/PACU times.
METHODS: A retrospective chart review of 96 patients who underwent lumbar laminectomy and fusion treated by two surgeons in a single institution was conducted. Inclusion criteria for the analysis was limited to either transforaminal lumbar interbody fusion or posterolateral arthrodesis for single-level or multi-level lumbar fusions. 48 patients who received intraoperative liposomal bupivacaine were compared with 48 control patients who were operated on prior to the initial hospital use of liposomal bupivacaine. Total postoperative narcotic consumption was measured and converted to morphine milligram equivalents (MME). Hospital length of stay (LOS) and total time spent in the PACU were also recorded.
RESULTS: The liposomal bupivacaine cohort demonstrated significantly lower IV opioid consumption during their admission compared with the control group (p = 0.0142). Oral opioid consumption, LOS, and PACU time were not statistically lower compared to the control cohort; however, there was a trend toward decreased oral narcotic use and PACU/admission times in the liposomal bupivacaine group. These findings suggest that liposomal bupivacaine injections may be a useful adjuvant for postoperative pain management following posterior lumbar decompression and fusion, though the treatment effect is marginal and its clinical significance may not justify the cost in all cases.Southwestern Medical Foundatio