Rocky Vista University (RVU) is a private, for-profit medical school with campus locations in Parker, Colorado and Ivins, Utah. The school opened in 2006 as the only modern for-profit medical school in the United States although other for-profit schools have since opened. RVU's College of Osteopathic Medicine (RVUCOM) grants the Doctor of Osteopathic Medicine degree and admitted its inaugural class of medical students at the Parker, Colorado campus in August 2008.
BACKGROUND:Sporotrichosis is a dimorphic fungal infection of increasing global relevance. Although usually cutaneous or lymphocutaneous, disseminated disease occurs in immunocompromised hosts. Large-scale data on its epidemiology, treatment and outcomes remain limited. OBJECTIVES:To characterise the clinical features, comorbidities, antifungal prescribing patterns and one-year mortality associated with sporotrichosis, with emphasis on patients with HIV and other forms of immunosuppression. PATIENTS/METHODS:We performed a retrospective global cohort study using the TriNetX Research Network. Adults (≥ 18 years) diagnosed with sporotrichosis were identified using ICD-9/10 codes (1995-2024). Demographics, comorbidities, laboratory parameters and antifungal prescriptions were analysed. The primary outcome was all-cause mortality at 1 year. Secondary outcomes included hospitalisation and admission to the intensive care unit (ICU). RESULTS:Among 2124 adults, the mean age was 52 years, and 56.5% were female. Nearly half of the cases originated internationally, with the southeastern United States accounting for the majority of domestic cases. Neoplasms (25%) and diabetes (11%) were the most common comorbidities. Lymphocutaneous disease was uncommon (9%), and disseminated infection occurred in 1% of cases. One-year mortality was 17%, with a higher risk among older adults and those with neoplasms, lymphocutaneous or disseminated infection or hyperferritinemia. Seventeen patients (0.8%) had HIV and were more likely to have pulmonary or disseminated disease. Itraconazole was the most commonly prescribed antifungal (52%), while the use of amphotericin B remained low (< 2%). CONCLUSIONS:Sporotrichosis causes substantial global mortality. Outcomes appear driven by host factors and gaps in guideline-based management. Earlier recognition, optimised antifungal therapy, and use of inflammatory markers to guide risk stratification may improve outcomes and inform prevention strategies.
Background/Objectives: Radiomics-based machine learning models have demonstrated high accuracy in differentiating benign from malignant orbital masses, with early studies suggesting performance comparable to expert radiologists. However, translation into clinical practice remains limited due to dataset constraints, including retrospective study designs, single-center cohorts, and underrepresentation of diverse patient populations. This review aims to evaluate the current evidence supporting radiomics in orbital disease while critically examining barriers to generalizability and equity across ophthalmology, otolaryngology, and plastic surgery. Methods: A narrative literature review was conducted to assess radiomics applications in orbital oncology and reconstruction. Studies evaluating diagnostic accuracy, margin assessment, postoperative surveillance, and surgical planning across ophthalmology, head and neck surgery, and reconstructive surgery were analyzed, with particular attention paid to dataset composition, validation strategies, and imaging standardization. Results: Radiomics models demonstrated high diagnostic performance in differentiating orbital tumors, optimizing surgical planning, and aiding postoperative monitoring. However, most studies relied on small, homogeneous datasets lacking racial, ethnic, and pediatric representation. External validation was uncommon, and imaging heterogeneity limited reproducibility. These deficiencies restrict the clinical translation of radiomics and risk exacerbating healthcare disparities, particularly among underrepresented populations. Conclusions: Radiomics holds promise as a precision medicine tool for orbital diagnosis, surgical navigation, and postoperative care. Nevertheless, its clinical adoption is constrained by dataset bias, lack of standardization, and limited prospective validation. Future progress requires multi-institutional, demographically diverse datasets and standardized imaging protocols to ensure equitable and generalizable implementation across specialties.
ABSTRACT Background Although the impact of increased time to treatment initiation (TTI) on outcomes for patients with oropharyngeal squamous cell carcinoma (OPSCC) has been well‐studied, a deeper understanding of the mechanisms underlying delay in patients with human papillomavirus (HPV)‐negative OPSCC is lacking in the current literature. Objective To assess differences in sociodemographic factors and treatment timelines between patients with HPV‐negative OPSCC with shorter versus. longer TTI. Methods Patients treated for HPV‐negative OPSCC at a single academic institution between 2013 and 2023 were retrospectively identified via chart review and dichotomized by the cohort median TTI (53.5 days; defined as the time from biopsy to first treatment initiation). Clinical timelines between delayed and nondelayed patients were compared using descriptive statistics and Mann–Whitney U testing. Independent predictors of delayed TTI (> 53.5 days) were evaluated using multivariate logistic regression modeling, with adjusted odds ratios (aORs) and 95% confidence intervals reported. Results Seventy‐six patients were identified. On multivariable analysis, male sex (aOR 3.28; 95% CI 1.02–10.49), unmarried status (aOR 5.96; 95% CI 1.36–26.07), primary chemoradiation versus surgery (aOR 0.25; 95% CI 0.07–0.85), and biopsy available before arrival (aOR 4.08; 95% CI 1.32–17.36) were independently and significantly (p< 0.05) associated with delayed treatment initiation. Treatment timeline analysis revealed that both the interval from biopsy to referral and the interval from PET scan to treatment initiation differed significantly between delayed and nondelayed patients (p< 0.05). Conclusion Primary nonsurgical treatment and lack of social support were found to be independently associated with treatment delay in patients with HPV‐negative OPSCC. These findings highlight opportunities for improving the care of HPV‐negative OPSCC at the specialty level.
BackgroundSwimming-induced pulmonary edema (SIPE) is an underrecognized cause of acute respiratory distress in healthy individuals engaged in open-water activities. Often misdiagnosed or overlooked, SIPE poses significant risks in both athletic and military settings. This review aims to consolidate current understanding of the pathophysiology, clinical presentation, risk factors, and emergency management of SIPE, with an emphasis on evidence relevant to emergency medicine practice.MethodsA scoping literature review was conducted using PRISMA extension for scoping reviews analysis employing PubMed to identify studies, case reports, and clinical guidelines on SIPE. Data were extracted on proposed pathophysiologic mechanisms, diagnostic strategies, epidemiologic trends, and treatment modalities. Special focus was given to recent research on lung ultrasound, hemodynamic factors, and recurrence prevention.ResultsSIPE is characterized by acute dyspnea, cough, and occasionally hemoptysis during or shortly after swimming, particularly in cold water. Pathophysiology involves increased pulmonary capillary pressures from central blood pooling, cold-induced vasoconstriction, and exercise-driven cardiac output. Risk factors include hypertension, female sex, cold-water exposure, tight wetsuits, and prior episodes of SIPE. Lung ultrasound demonstrates promise as a rapid, noninvasive diagnostic tool. Current management is supportive, focusing on rapid removal from water, oxygen therapy, and, in some cases, positive airway pressure. Despite rapid resolution in most cases, recurrence rates are significant, with long-term preventive strategies still under investigation.ConclusionSIPE is a life-threatening but reversible condition requiring heightened awareness in emergency and prehospital settings. Prompt recognition, accurate differentiation from other aquatic and cardiopulmonary emergencies, and appropriate supportive care are critical to favorable outcomes. Further research is essential to develop standardized diagnostic criteria, explore genetic or physiologic predispositions, and guide evidence-based prevention and treatment protocols.
Astrocytes regulate key aspects of the neural microenvironment that can be co-opted by cancer to support tumor growth and invasion. Secreted protein acidic and rich in cysteine-like 1 (SPARCL1) is a matricellular glycoprotein expressed by astrocytes and stromal cells, whose expression varies across cancer types. While SPARCL1 is downregulated in many peripheral cancers, reports of its expression in gliomas, specifically glioblastoma (GBM), are inconsistent. The biological context underlying these divergent findings, and the role of SPARCL1 in GBM malignancy, remains unclear. Publicly available transcriptomic datasets from the Ivy Glioblastoma Atlas Project (Ivy GAP), GlioVis, and TCGA were analyzed to evaluate SPARCL1 expression across GBM cohorts. Spatially resolved gene expression data from Ivy GAP were used to assess SPARCL1 expression from defined tumor regions. Microarray and RNA sequencing datasets from GlioVis and TCGA, respectively, were used to assess SPARCL1 expression across whole-tumor samples. Spatial transcriptomics from Ivy GAP show SPARCL1 expression was upregulated along the leading edge and in infiltrating tumor regions. Microarray datasets showed greater SPARCL1 expression in tumors of astrocyte lineage as opposed to oligodendrocyte lineage. Bulk RNA sequencing showed high SPARCL1 expression in low-grade gliomas, which is consistent with astrocytic lineage, IDH mutation, and spatial averaging effects that might obscure regional associations. These findings demonstrate that SPARCL1 expression in GBM is shaped by tumor architecture, molecular classification, and microenvironment interactions. Enrichment of SPARCl1 at invasive tumor margins is consistent with prior studies linking SPARCL1 to neuron-glioma synapse formation and angiogenesis.
