Real-World Evaluation of i-gel Introduction on Intraoperative Airway-Related Safety Events: A Retrospective Cohort Study From a New England Hospital Network.

Background: Several health care networks have fully adopted second-generation supraglottic airway (SGA) i-gel. Real-world evidence of enhanced patient safety after such practice change is lacking. We hypothesized that the implementation of i-gel compared to the previous LMA®-Unique™ would be associated with a lower risk of airway-related safety events.

Safety and Efficacy of IV Onasemnogene Abeparvovec for Pediatric Patients With Spinal Muscular Atrophy: The Phase 3b SMART Study.

Background And Objectives: Safety and efficacy of IV onasemnogene abeparvovec has been demonstrated for patients with spinal muscular atrophy (SMA) weighing <8.5 kg. SMART was the first clinical trial to evaluate onasemnogene abeparvovec for participants weighing 8.

Incidence and Prevalence of Post-COVID-19 Myalgic Encephalomyelitis: A Report from the Observational RECOVER-Adult Study.

Background: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) may occur after infection. How often people develop ME/CFS after SARS-CoV-2 infection is unknown.

Objective: To determine the incidence and prevalence of post-COVID-19 ME/CFS among adults enrolled in the Researching COVID to Enhance Recovery (RECOVER-Adult) study.

Association of Sleep Spindle Rate With Memory Consolidation in Children With Rolandic Epilepsy.

Background And Objectives: Rolandic epilepsy (RE), the most common childhood focal epilepsy syndrome, is characterized by a transient period of sleep-activated epileptiform activity in the centrotemporal regions and variable cognitive deficits. Sleep spindles are prominent thalamocortical brain oscillations during sleep that have been mechanistically linked to sleep-dependent memory consolidation in animal models and healthy controls. Sleep spindles are decreased in RE and related sleep-activated epileptic encephalopathies.

Preliminary Development and Validation of Automated Nociception Recognition Using Computer Vision in Perioperative Patients.

Background: Effective pain recognition and treatment in perioperative environments reduce length of stay and decrease risk of delirium and chronic pain. We sought to develop and validate preliminary computer vision-based approaches for nociception detection in hospitalized patients.

Methods: Prospective observational cohort study using red-green-blue camera detection of perioperative patients.

Electroconvulsive therapy in autism spectrum disorders: an update to the literature.

Purpose Of Review: Over the last quarter century, the clinical evidence surrounding the use of electroconvulsive therapy (ECT) in individuals with autism spectrum disorder (ASD) has expanded. This review provides the most up-to-date findings on the usage of ECT in ASD and discusses these results within the historical context and direct patient care experience.

Recent Findings: ECT is typically implemented for psychotropic-refractory catatonic, affective, psychotic, and combined pathology for individuals across the lifespan.

Severity of Impaired Oxygenation and Conservative Oxygenation Targets in Mechanically Ventilated Children: A Post Hoc Subgroup Analysis of the Oxy-PICU Trial of Conservative Oxygenation.

Objectives: A conservative oxygenation strategy is recommended in adult and pediatric guidelines for the management of acute respiratory distress syndrome to reduce iatrogenic lung damage. In the recently reported Oxy-PICU trial, targeting peripheral oxygen saturations (Spo2) between 88% and 92% was associated with a shorter duration of organ support and greater survival, compared with Spo2 greater than 94%, in mechanically ventilated children following unplanned admission to PICU. We investigated whether this benefit was greater in those who had severely impaired oxygenation at randomization.

Bilingual Perspectives of Functional Dyspepsia Management in People from Underserved Areas.

Introduction: Disorders of gut-brain interaction (DGBIs), like functional dyspepsia (FD), are prevalent and challenging conditions. In other gastrointestinal (GI) disorders, individuals from underserved areas (UAs) have difficulty accessing care. Little is known about UA FD patient perspectives of their care, especially in those with limited English proficiency (LEP).

Prevalence and characteristics of group standardized letters of evaluation in emergency medicine: A cross-sectional observational study.

Background: The standardized letter of evaluation (SLOE) for emergency medicine (EM) is a well-established tool for residency selection. While previous work characterizes the utility and outcomes related to SLOE use, less is known about SLOE authorship patterns and trends.

Objective: The objective was to measure the prevalence of group SLOEs in EM over time, characterize the role groups represented in group SLOEs, and compare the rating practices of groups of authors versus single authors.

Selective diet induced nutritional optic neuropathy in developmentally normal children.

Purpose: Nutritional deficiencies in developed countries are a rare but potentially intervenable cause of optic neuropathy in pediatric populations. To date, much of the literature on nutritional optic neuropathy has focused on children with developmental delay, however, a growing body of evidence supports other underreported risk factors.

Observations: We describe three pediatric patients with normal neurodevelopment, who presented with decreased vision and were subsequently found to have optic neuropathy attributed to vitamin deficiencies, predominantly vitamin B12.

Langerhans Cells Directly Interact with Resident T Cells in the Human Epidermis.

Adult human skin contains nearly twice as many T cells as the peripheral blood, which include tissue-resident memory T cells. However, the precise mechanisms maintaining tissue-resident memory T cells in the healthy skin remain unclear. Using normal human skin samples, we find that Langerhans cells (LCs) contact T cells in the epidermis of the elderly.

Clinical Problem Solving: Two Patients With Gait Instability and Difficulty With Hand Coordination.

Subacute-to-chronic gait instability has a broad differential diagnosis. The neurological exam can help elucidate the localization and suggest an underlying etiology of the symptomatology, which can lead to a more focused diagnostic approach. Two patients are described - 1 with a month of worsening difficulty with ambulation that evolved to bilateral hand discoordination and another with 18 months of progressive difficulty with ambulation that also then progressed to involve her bilateral hands.

Cryopreservation Method for Preventing Freeze-Fracture of Small Muscle Samples.

Histological techniques to study muscle are crucial for assessing skeletal muscle health. To preserve tissue morphology, samples are usually fixed in formaldehyde or cryopreserved immediately after excision from the body. Freezing samples in liquid nitrogen, using isopentane as a mediator for efficient cooling, preserves the tissue in its natural state.

Academic Pursuits in Teleradiology: At the Crossroads of Technology, Radiology, and Implementation.

Teleradiology is an essential part of modern radiology practice. It enhances efficiencies in image interpretation by improving availability and accessibility of radiologists. Being at the crossroads of technology, diagnostic radiology, and complex workflows, teleradiology provides abundant opportunities for academic engagement and innovative workflows, and allows for research and publication encompassing these multiple facets.

Uncertainty estimation in diagnosis generation from large language models: next-word probability is not pre-test probability.

Objective: To evaluate large language models (LLMs) for pre-test diagnostic probability estimation and compare their uncertainty estimation performance with a traditional machine learning classifier.

Materials And Methods: We assessed 2 instruction-tuned LLMs, Mistral-7B-Instruct and Llama3-70B-chat-hf, on predicting binary outcomes for Sepsis, Arrhythmia, and Congestive Heart Failure (CHF) using electronic health record (EHR) data from 660 patients. Three uncertainty estimation methods-Verbalized Confidence, Token Logits, and LLM Embedding+XGB-were compared against an eXtreme Gradient Boosting (XGB) classifier trained on raw EHR data.

A standards-based application for improving platelet transfusion workflow.

Objective: Thrombocytopenia is a common complication of hematopoietic stem-cell transplantation (HSCT), though many patients will become immune refractory to platelet transfusions over time. We built and evaluated an electronic health record (EHR)-integrated, standards-based application that enables blood-bank clinicians to match platelet inventory with patients using data previously not available at the point-of-care, like human leukocyte antigen (HLA) data for donors and recipients.

Materials And Methods: The web-based application launches as an EHR-embedded application or as a standalone application.

Global, regional, and national trends in drug use disorder mortality rates across 73 countries from 1990 to 2021, with projections up to 2040: a global time-series analysis and modelling study.

Background: Drug use disorder (DUD) poses a major public health crisis globally, necessitating immediate attention to global trends and future projections to develop effective health policies and interventions. Thus, we aimed to estimate the global trends in DUD mortality rates from 1990 to 2021 and future projections of DUD deaths until 2040 across 73 countries.

Methods: In this time-series analysis and modelling study, we investigated the global trends in DUD mortality rates from 1990 to 2021 using the WHO Mortality Database and forecasted future trends through 2040.

Reimagining community engagement in TB elimination: a perspective from the field.

The role of community engagement (CE) in TB policy, care provision and research has been recognized as important, but most models of CE put communities at the periphery of these activities. In this Editorial, written by TB-impacted community members and care providers, we explore the meaning of CE and current barriers to its implementation. We present a model of CE that places community members at the center of TB policy, care provision and research.

Biventricular Repair of Univentricular Heart Lowers Risk of Liver Disease Compared With the Fontan Operation.

Background: The Fontan operation is associated with chronic venous hypertension, liver and renal disease, and several other sequelae. The alterative surgical approach, when feasible, a biventricular conversion (BiV), may diminish some of these long-term risks.

Objectives: The aim of this study was to compare long-term outcomes of patients undergoing BiV with those undergoing a destination Fontan operation.

Cardiovascular Risk Prediction Scores in Type 1 Diabetes: A Systematic Review and Meta-Analysis.

Background: The extent of the performance and utility of scores for the risk of cardiovascular disease (CVD) in persons with type 1 diabetes (T1DM) largely remains unclear.

Objective: The purpose of this study was to synthesize data on the performance of CVD risk scores in people living with T1DM.

Methods: This study is a systematic review and meta-analysis.