Publications by authors named "Lehman L"

Epidural steroid injections (ESIs) are often used to treat low back pain (LBP) due to lumbosacral radiculopathy as well as LBP without a clear component of radiculopathy, in some cases. While it is increasingly recognized that psychosocial factors are associated with pain outcomes, few studies have assessed the contribution of these factors to common pain interventions like ESIs. This study aimed to summarize the scope and nature of how psychosocial factors are accounted for in research on ESIs for the treatment of LBP with or without lumbosacral radiculopathy and to identify gaps and recommendations for future research.

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Although prediction models for heart transplantation outcomes have been developed previously, a comprehensive benchmarking of survival machine learning methods for mortality prognosis in the most contemporary era of heart transplants following the 2018 donor heart allocation policy change is warranted. This study assessed seven statistical and machine learning algorithms-Lasso, Ridge, Elastic Net, Cox Gradient Boost, Extreme Gradient Boost Linear, Extreme Gradient Boost Tree, and Random Survival Forests in a post-policy cohort of 7,160 adult heart-only transplant recipients in the Scientific Registry of Transplant Recipients (SRTR) database who received their first transplant on or after October 18, 2018. A cross-validation framework was designed in mlr.

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Background: Otitic hydrocephalus is increased intracranial pressure without ventricular dilation secondary to mastoiditis and cerebral venous sinus thrombosis (CVST). It is associated with significant visual morbidity, though more detailed data on visual outcomes is lacking. We sought to better characterize the management of increased intracranial pressure and visual outcomes in this population.

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  • The study evaluates the role of cardiorespiratory variables in a Reinforcement Learning (RL) model designed to optimize drug treatment strategies for septic patients in the ICU.
  • The RL model developed showcases a significant performance boost when using cardiorespiratory data, outperforming other models that utilized different sets of features.
  • The findings advocate for real-time recommendation systems in sepsis treatment, leveraging the continuous availability of cardiorespiratory monitoring data.
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Malaria and HIV/AIDS are the two most common infections responsible for morbidity and mortality in sub-Saharan Africa. The studies were carried out worldwide. However, no study has targeted HIV-positive patients at the Bafoussam Regional Hospital (West Cameroon), one approved treatment center, where patients are adhering well to their HIV treatment.

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Objective: To assess whether white matter injuries differ in symptomatic vs asymptomatic moyamoya-affected hemispheres using diffusion magnetic resonance imaging since there is controversy regarding when or if to revascularize children with asymptomatic moyamoya.

Study Design: We conducted a cross-sectional study of children with moyamoya who underwent diffusion magnetic resonance imaging before revascularization surgery as well as controls without moyamoya. We measured the fractional anisotropy, mean diffusivity, radial diffusivity, and axial diffusivity of white matter tracts in the watershed regions.

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  • The study analyzed trends in the diagnosis of venous thromboembolism (VTE) and arterial ischemic stroke (AIS) in pediatric patients during the COVID-19 pandemic, using data from the Pediatric Health Information Systems database from 2018 to 2021.
  • The rate of VTE diagnoses increased by 28.6% during the pandemic years compared to previous years, while AIS rates remained stable; COVID-19 diagnosis was linked to a higher likelihood of VTE but not AIS.
  • Utilization of pharmacological thromboprophylaxis doubled during the pandemic, especially among patients with COVID-19, indicating a significant response in treatment approaches despite the rising rates of VTE.
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  • Heart transplant recipients have a cancer incidence rate that is twice as high as the general population, but the exact link between cancer and mortality in this group is not well understood.
  • In a study of 51,597 heart transplant patients from 1987 to 2020, 25.6% were diagnosed with cancer, showing increasing cumulative incidence rates over time, reaching 56.6% by 20 years.
  • Those diagnosed with cancer had significantly higher mortality rates, with the strongest associations found in pancreatic, leukemia, and esophageal cancers, particularly in the first years post-diagnosis.
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Background: The gold standard for evaluation of the severity of moyamoya vasculopathy is the Suzuki grade determined with cerebral catheter angiography (CA). With greater use of magnetic resonance angiography (MRA) it is important to understand if MRA is truly comparable to CA.

Methods: Children with moyamoya were evaluated using the Suzuki score for CA and the modified MRA six-stage Suzuki score to describe the angiographic findings in moyamoya from initial narrowing of the distal internal carotid artery to the "puff of smoke" appearance of the lenticulostriate collaterals and finally to the disappearance of this network of collaterals.

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Sepsis is a life-threatening condition that occurs when the body's normal response to an infection is out of balance. A key part of managing sepsis involves the administration of intravenous fluids and vasopressors. In this work, we explore the application of G-Net, a deep sequential modeling framework for g-computation, to predict outcomes under counterfactual fluid treatment strategies in a real-world cohort of sepsis patients.

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Introduction: Neuromuscular blockade (NMB) in ventilated patients may cause benefit or harm. We applied "incremental interventions" to determine the impact of altering NMB initiation aggressiveness.

Methods: Retrospective cohort study of ventilated patients with PaO2/FiO2 ratio < 150 mmHg and PEEP≥ 8cmH2O from the Medical Information Mart of Intensive Care IV database (MIMIC-IV version 1.

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This study investigates the potential benefits of using tectonite dust as a soil amendment in central Oregon. Tectonite, a rare mineral byproduct of the Warm Springs Composite Products Company, has unique properties that can enhance soil fertility and water-holding capacity. The study includes analyses of tectonite's physical and chemical properties, small-scale growth trials, and farm-scale experiments to measure grain yield.

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Objective: Perioperative stroke is a major complication of revascularization surgery in patients with moyamoya. Vomiting is common after neurosurgical procedures and may result in acute changes in intracranial pressure and cerebral blood flow. The authors instituted a standardized perioperative nausea and vomiting protocol for children with moyamoya undergoing indirect bypass surgery at their institution and analyzed its association with perioperative stroke.

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  • - Cerebrovascular issues are a significant yet often overlooked complication in children with neurofibromatosis type 1 (NF1), particularly affecting the brain's blood vessels.
  • - Moyamoya syndrome is the most common form of cerebral vasculopathy linked to NF1, and symptoms can range from none at all to serious neurological issues like TIAs or strokes.
  • - Challenges in creating screening protocols for these vascular changes include the large NF1 patient population, the need for sedation for effective imaging, and the wide age range in which these issues can arise.
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Purpose: Few guidelines exist for genetic testing of patients with moyamoya arteriopathy. This study aims to characterize the yield of genetic testing of non-syndromic moyamoya patients given the current pre-test probability.

Methods: All pediatric moyamoya patients who received revascularization surgery at one institution between 2018 and 2022 were retrospectively reviewed.

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Perinatal stroke leads to significant morbidity over a child's lifetime, including diagnosis of various neurodevelopmental disorders. Specific studies examining the prevalence of autism spectrum disorder in children with perinatal stroke are scarce. Following the clinical observation of autism spectrum disorder in a pediatric referral stroke center, we evaluated the rate of autism spectrum disorder diagnosis after perinatal ischemic stroke, including analysis by subtypes of perinatal ischemic stroke.

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  • Surgical revascularization can lower long-term stroke risks in children with moyamoya arteriopathy, but increases stroke risk during surgery, highlighting a need for improved perioperative care practices.
  • Experts used a modified Delphi process to gather insights from 30 specialists on effective management strategies for these patients, culminating in 39 consensus statements.
  • Key recommendations include preadmission for high-risk children, mandatory intravenous fluids around surgery, continuous aspirin usage, and rigorous monitoring of vital signs and neurological status post-surgery.
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A 33-year-old man in Baltimore, Maryland, USA, with untreated HIV infection had a 74-day course of mpox with multiorgan system involvement and unique clinical findings. In this clinical experience combining 3 novel therapeutic regimens, this patient died from severe mpox in the context of untreated HIV and advanced immunodeficiency.

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Objective: Neurosurgical outcomes are not well defined in the management of pediatric patients with cerebral venous sinus thrombosis (CVST) following acute mastoiditis. Specific notable sequelae are otogenic (otitic) hydrocephalus and CVST management. Correspondingly, the aim of this study was to integrate the currently published metadata to summarize these outcomes.

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  • Moyamoya disease leads to narrowing of the cerebral arteries, resulting in strokes or silent brain injuries, primarily identified through MRI studies showing abnormal white matter characteristics.
  • In a study involving 15 children with moyamoya, specific white matter tracts were found to have lower fractional anisotropy and higher mean diffusivity, indicating potential unrecognized injuries.
  • The affected tracts, including key pathways like the uncinate and arcuate fasciculus, were situated in vascular watershed regions, suggesting that the abnormalities may stem from reduced blood flow rather than immediate infarctions.
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Background: Adverse effects of excessive sedation in critically ill mechanically ventilated patients are well described. Although guidelines strongly recommend minimizing sedative use, additional agents are added as infusions, often empirically. The tradeoffs associated with such decisions remain unclear.

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Objectives: Tuberculosis is uncommon in the United States and a rare cause of meningitis in children with severe neurologic consequences. Tuberculous meningitis (TBM) is an even rarer cause of moyamoya syndrome with only a handful of cases previously reported.

Methods: We report the case of a female patient who initially presented at 6 years of age with TBM and developed moyamoya syndrome requiring revascularization surgery.

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  • The study investigates the best strategy for transitioning mechanically ventilated patients from strict lung protective ventilation to patient-directed ventilation, weighing aggressive versus conservative approaches.
  • Researchers analyzed data from 7,433 patients and found that aggressive strategies significantly expedited the first liberation attempt compared to conservative methods.
  • While aggressive liberation increased the number of ICU-free and ventilator-free days, it had a minimal impact on overall mortality rates, but slightly elevated mortality risk in patients with high severity of illness.
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