United States

Background
Lung cancer remains a leading cause of cancer-related mortality, with early detection and classification significantly improving patient outcomes. The LUNA25 challenge provides a standardized dataset to develop computational methods for lung nodule classification. Transfer learning by leveraging advanced neural networks like GoogleNet has shown promise in improving diagnostic performance, yet optimizing model training and architecture remains crucial.

Methods
We utilized the LUNA25 dataset, extracting 3D lung nodule patches and transforming them into 2D images via a 2.75D spiral scan technique. Using GoogleNet, we applied transfer learning strategies, selectively unfreezing specific layers, fully connected (fc), inception5b, and inception5a, in separate experiments. Each model configuration was trained for 10 epochs, employing randomized rotations and translations for data augmentation. Model performance was assessed using Area Under the Curve (AUC).

Results
Selective unfreezing demonstrated increasing performance with more layers unfrozen, though there were diminishing returns. Training only the fc layer achieved a peak AUC of 0.8549, unfreezing fc plus inception5b layers improved AUC to 0.9007, and unfreezing fc, inception5b, and inception5a layers yielded the best performance with an AUC of 0.9050. The model with unfrozen fc, 5b, and 5a was submitted to the open development phase of the LUNA 25 challenge and scored AUC of 0.8608 on a private dataset.

Conclusion
Overall, we used a transfer learning approach to fine-tune and re-train GoogleNet for pulmonary nodule classification with reasonable accuracy. Our findings indicate that progressively unfreezing the layers of a network, starting from the final fully connected layer and moving backwards, enhances model performance up to a point. Leveraging transfer learning with selective layer training provides a practical approach to optimize predictive accuracy, contributing to improved automatic classification of lung nodules.

AMA Research Challenge 2025 

Transfer Learning with GoogleNet for Lung Nodule Classification from CT Imaging

## Welcome to 2024 Annual Conference of the North American Chapter of the Association for Computational Linguistics!
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NAACL 2024

2024 Annual Conference of the North American Chapter of the Association for Computational Linguistics

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Background:
Lomentospora prolificans (formerly Scedosporium prolificans and Scedosporium inflatum) is an environmental mold and recognized human pathogen which can infect both immunocompetent and immunocompromised hosts. Immunocompetent hosts most commonly suffer soft tissue or osteoarticular infections following direct, often-traumatic inoculation. Treatment is complicated by its intrinsic resistance to most anti-fungals. Novel agents are being investigated including the first-in-class dihydroorotate dehydrogenase inhibitor, olorofim. Here we present a case of osteoarticular infection following traumatic inoculation in an immunocompetent host treated with olorofim, with significant results showing clinical improvement.

Case Presentation:
A 39-year-old male with no past medical history presented to the hospital after sustaining an accidental, self-inflicted axe injury to his left suprapatellar region. It was 2 cm in length and superficial, not extending past subcutaneous adipose tissue. Over the ensuing 30 days after wound closure, he had progressive swelling of the left knee with significant tenderness that limited ambulation and required arthrocentesis and imaging. Unfortunately, given the lack of systemic signs of infection, his joint effusion and synovitis were attributed to non-infectious etiologies. A later arthrocentesis was performed and began to grow mold (speciated to Lomentospora prolificans), prompting surgical debridement of the joint capsule and synovium with initiation of anti-infective therapy. In total, he underwent nine surgical procedures - debridement and irrigation procedures with anti-septic irrigants, placement of anti-fungal impregnated beads, and placement of an antifungal impregnated articular spacer. The patient was briefly managed with voriconazole monotherapy but was eventually transitioned to a combination of voriconazole, terbinafine, and caspofungin. Despite this, intraoperative findings and cultures continued to suggest ongoing fungal infection. Given the pan-resistance of the patient’s isolate, an emergency IND application for olorofim as a salvage regimen was pursued and approved. Debridement performed after a week of olorofim therapy resulted in a greatly reduced number of positive tissue cultures with successful post-operative healing and improved function. Within four months of drug administration, fungal cultures from debridement were negative and fungitell labs were undetectable.

Discussion:
This case illustrates a prototypic presentation of Lomentospora prolificans in the immunocompetent host, including the diagnostic delay that is commonly encountered. After our patient failed to respond to both voriconazole alone and a salvage regimen of voriconazole, terbinafine, and caspofungin, he was placed on an investigational therapy with positive clinical results. Within four months after the initiation of olorofim, the patient’s last surgical washout yielded no additional positive fungal cultures and demonstrated negative fungitell labs.


Bury My Axe in Wounded Knee: Lomentospora Prolificans Joint Infection in an 
Immunocompetent Host

Cytophagic histiocytic panniculitis (CHP) is a rare form of lobular panniculitis, characterized by macrophages (histiocytes) exhibiting hemophagocytosis within subcutaneous fat. This reflects a deeper immune dysregulation that may progress to hemophagocytic lymphohistiocytosis (HLH), a life-threatening hyperinflammatory syndrome.
We present the case of a 6-year-old boy with a history of inverse psoriasis who developed subcutaneous plaques and joint swelling. A prompt skin biopsy confirmed CHP. Shortly afterward, he developed high fever and progressive respiratory distress, meeting diagnostic criteria for secondary HLH. His treatment included high-dose corticosteroids, biologic agents, cytotoxic immunosuppressants, and extracorporeal membrane oxygenation (ECMO).
This case emphasizes the importance of early recognition and biopsy of atypical panniculitis, given the potential for rapid progression to HLH with high mortality despite aggressive therapy.

Cytophagic Histiocytic Panniculitis with Secondary Hemophagocytic Lymphohistiocytosis in a Child: A Case Report


Case Report: Treatment of Diffuse-Type Tenosynovial Giant Cell Tumor with Vimseltinib

Background
Tenosynovial Giant Cell Tumor (TSGCT) is a rare, benign proliferative disorder involving the synovial lining of joints, bursae, and tendon sheaths. The diffuse subtype (D-TSGCT) is particularly uncommon, with an estimated incidence of approximately 5 cases per million person-years. It is locally aggressive and can be challenging to manage, particularly when surgical resection is incomplete.

Case Presentation
A middle-aged male with no prior history of trauma presented to his primary care physician with progressive right knee pain, stiffness, and swelling over the course of one year. He was initially diagnosed with a meniscal injury and treated conservatively with nonsteroidal anti-inflammatory drugs (NSAIDs) before being referred to an orthopedic specialist. Magnetic resonance imaging (MRI) revealed hemosiderin deposition along the synovium, raising suspicion for diffuse-type TSGCT. Despite surgical intervention, the patient reported only minimal symptomatic improvement. He was subsequently referred to a hematologist-oncologist and initiated on Vimseltinib, a selective CSF1R inhibitor. Within two weeks of therapy, the patient experienced marked improvement in knee pain, stiffness, and swelling.

Discussion
TSGCTs are driven by overexpression of colony-stimulating factor 1 (CSF1) due to chromosomal translocations, leading to recruitment of CSF1 receptor (CSF1R)-expressing cells and subsequent tumor growth. Complete surgical excision is often difficult, especially in diffuse cases, and recurrence is common following incomplete resection. This case illustrates the efficacy of Vimseltinib, an oral, selective CSF1R inhibitor recently approved by the FDA for the treatment of TSGCT. The patient demonstrated significant clinical improvement shortly after initiation of therapy, highlighting the potential of targeted pharmacologic treatment as a viable alternative or adjunct to surgery in managing diffuse-type TSGCT.


Case Report: Treatment of Diffuse-Type Tenosynovial Giant Cell Tumor with Vimseltinib

Background.
Any traveler with a fever within two months of visiting a malaria-endemic area should be
presumed to have malaria until definitively diagnosed, given the high prevalence in these
regions. We are presenting a clinical case where the travel history was a clue in the diagnosis of
the patient with unexplained severe abdominal pain and no fever on admission.
Case presentation.
A 48-year-old woman with no significant past medical history presented with severe right upper
quadrant abdominal pain radiating to the lower back, accompanied by nausea and bilious
vomiting that began one day prior to admission. She reported normal bowel movements and no
fever or chills. The patient had traveled to Sierra Leone for one month and returned two weeks
before admission, with no prior preventive medical treatment or vaccination before her trip.
Her vital signs: t 98.9 F, heart rate 118 bpm, blood pressure 100/68 mm Hg; non icteric sclera;
significant tenderness and guarding along the right lower rib cage on palpation, with no signs of
fluid shift.
Laboratory test on admission were normal except mild elevation of liver function tests (LFT):
Total bilirubin 2.3 mg/dL ( reference range 0.0 - 1.3), AST 76 U/L (14-36), ALT 67 U/L (<35),
Alkaline Phosphatase 113 U/L (38-126), Lipase 102 U/L (23-300)
CT abdomen with IV contrast: liver without focal lesions, no intrahepatic ductal distention, non
distended gallbladder, normal pancreas.
Third day from admission: fever of 102.2°F, with a significant drop in platelet and hemoglobin
levels, Hb 8.6 (G/DL), Platelet 69 (10^3uL), and worsening LFT: total bilirubin 4.4, direct bilirubin
2.3, AST 40, ALT 35, Alkaline phosphatase 90.
Blood smear revealed ring form inclusions in the red blood cells (RBC), positive for parasites.
Antigen test was positive for Plasmodium falciparum (PF).
Discussion.
Malarial hepatopathy, characterized by bilirubin levels >2.5x upper limit of normal and elevated
transaminases, indicates malaria-associated liver injury.
Elevated liver function tests (LFTs) in early-stage PF infection are significantly associated with
parasite load and inflammatory markers. Later, the progression of severe PF malaria often
results from parasitized RBC cytoadherence to the vascular endothelium, as well as from
infected RBC (platelet-mediated agglutination) and uninfected erythrocyte interactions
(rosetting). This sequestration in the microvasculature reduces local oxygen delivery, leading to
vital organ failure.
Malarial hepatopathy should be considered in travelers presenting before the fever onset to
facilitate early diagnosis of malaria.

Early Malaria Presentation in Afebrile Patient with Unexplained Severe Abdominal Pain

Abstract Title: A Decade Of Headaches Unraveled: Jugular 
Decompression Via C1 Osteotomy In Venous Eagle Syndrome
Background:
Eagle syndrome is a rare disorder most commonly associated with an elongated styloid process causing cervicofacial pain, dysphagia, or carotid compression. A lesser-known variant, venous Eagle syndrome, involves internal jugular vein (IJV) compression, typically between the styloid process and the C1 transverse process, which can impair venous outflow from the brain. This variant is increasingly recognized in the pathophysiology of headache disorders, yet the role of C1 transverse process osteotomy as a definitive treatment remains poorly documented and underreported in literature.
Case Presentation:
A 57 y/o female with no significant past medical history presented with intractable right sided headaches and facial pain persisting for over a decade that were near daily and disabling. She denied associated nausea, vomiting, or visual disturbances. The impact on her quality of life was substantial, limiting her daily function and productivity. Extensive evaluation including CT brain, CTA neck and CTA brain revealed no acute findings or vascular malformations. Prior treatments including medication and conservative measures by her neurologists had failed. Given her refractory symptoms, diagnostic cerebral venography with manometry was performed, which identified bilateral IJV stenosis due to compression between the styloid process and the C1 transverse process, worse on the left. Dynamic occlusion of the left IJV occured with certain neck positions. Critically, monometry demonstrated a > 4 cm H2O pressure gradient across the stenosis, confirming hemodynamic significance of the compression. The patient underwent microsurgical resection of the left C1 transverse process with stereotactic navigation. Notably, no styloidectomy was performed. The procedure was uncomplicated. Postoperatively, she experienced complete and sustained resolution of her headaches and facial pain, with full relief maintained at her three month follow up with no use of medications, marking her first period of complete remission in over ten years.
Discussion:
This case underscores the importance of recognizing venous Eagle syndrome as a potential cause of refractory chronic headache, particularly when standard imaging is unrevealing. While styloidectomy is the traditional surgical approach, C1 transverse process osteotomy alone can be curative when bony impingement at C1 contributes to IJV compression. The use of manometry was pivotal in documenting the physiologic impact and guiding surgical decision making. For patients with chronic, unexplained headaches and documented venous outflow obstruction, C1 transverse process osteotomy may offer complete symptom relief. This case contributes to the limited literature on this targeted intervention and highlights the need for greater clinical awareness of venous Eagle syndrome in headache evaluation.

A Decade of Headaches Unraveled: Jugular Decompression Via C1 Osteotomy in Venous Eagle Syndrome

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


Bilateral Panuveitis and Optic Papillitis Associated with Positive IgG P23 Titer

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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