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Objective: Vagus nerve stimulation (VNS) paired with rehabilitation therapy improved motor status compared to rehabilitation alone in the phase III VNS-REHAB stroke trial, but treatment response was variable and not associated with any clinical measures acquired at baseline, such as age or side of paresis. We hypothesized that neuroimaging measures would be associated with treatment-related gains, examining performance of regional injury measures versus global brain health measures in parallel with clinical measures.

Methods: Baseline magnetic resonance imaging (MRI) scans in the VNS-REHAB trial were used to derive regional injury measures (extent of injury to corticospinal tract, the primary regional measure; plus extent of injury to precentral gyrus and postcentral gyrus; lesion volume; and lesion topography) and global brain health measures (degree of white matter hyperintensities, the primary global brain measure; plus volumes of cerebrospinal fluid, cortical gray matter, white matter, each thalamus, and total brain).

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While mostly de novo truncating variants in SCAF4 were recently identified in 18 individuals with variable neurodevelopmental phenotypes, knowledge on the molecular and clinical spectrum is still limited. We assembled data on 50 novel individuals with SCAF4 variants ascertained via GeneMatcher and personal communication. With detailed evaluation of clinical data, in silico predictions and structural modeling, we further characterized the molecular and clinical spectrum of the autosomal dominant SCAF4-associated neurodevelopmental disorder.

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Post-PCI coronary physiology: clinical outcomes and can we optimize?

Cardiovasc Revasc Med

December 2024

Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, TX, United States of America. Electronic address:

Invasive coronary physiology is well-established for identifying stable lesions appropriate for revascularization with percutaneous coronary intervention (PCI). Furthermore, fractional flow reserve (FFR)-guided PCI is associated with better clinical outcomes compared with routine angiography-guided PCI. The rise of intravascular imaging-guided PCI has generated great interest in optimizing the technical results of a PCI procedure, and this has now extended to an interest in optimizing coronary physiology following PCI.

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Article Synopsis
  • This study analyzed decisions regarding decompressive hemicraniectomy (DHC) and early withdrawal of life-sustaining therapy (WLST) in patients with large vessel occlusion (LVO) and large ischemic strokes from the SELECT2 trial.* -
  • Among 352 patients, DHC was utilized in 55 patients, and WLST was chosen for 81, showing no significant differences in usage between those receiving endovascular thrombectomy (EVT) and those treated medically.* -
  • About 21% of DHC patients were able to walk independently after one year, indicating that DHC did not negatively impact the benefits of thrombectomy, while WLST generally resulted in poor outcomes.*
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Article Synopsis
  • * An 11-year-old boy exhibited severe symptoms including flank pain and foamy urine, with genetic testing revealing a novel pathogenic variant associated with the disease.
  • * The case highlights the importance of genetic testing for early diagnosis in patients with renal issues, especially when there is a family history of kidney disease.
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Introduction: Pairing vagus nerve stimulation with traditional rehabilitation therapies results in improved motor recovery in people with stroke. However, this approach has not yet been studied in people with spinal cord injury (SCI). Motor recovery continues to be challenging after SCI, and there is a need for innovative research strategies to enhance motor recovery after SCI.

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Background: Pediatric firearm injuries disproportionately affect groups experiencing socioeconomic disadvantage. Firearm injuries increased during the COVID-19 pandemic, but the impact on communities by degree of socioeconomic disadvantage is unknown. We examined the association between socioeconomic vulnerability and change in pediatric firearm injuries before versus during the pandemic.

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Previous studies have shown that beta-band transcranial alternating current stimulation (tACS) applied at the M1 hotspot can modulate corticospinal excitability. However, it remains controversial whether tACS can influence motor unit activities at the spinal cord level. This study aims to compare the efficacy of applying tACS over the hotspot versus the conventional C3 site on motor unit activities and subsequent behavioral changes.

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The process of developing a comprehensive maternal-fetal surgery center.

Am J Obstet Gynecol MFM

November 2024

Department of Surgery, Division of Pediatric Surgery, Oregon Health & Science University, Portland, OR (Jafri and Azarow, and Sun).

Article Synopsis
  • Fetal therapy has evolved to include treatments for complex fetal disorders, leading to the establishment of specialized maternal-fetal surgery centers across the country.
  • These centers adopt a multidisciplinary approach to prioritize both the safety of pregnant patients and the health of the fetus.
  • While existing literature outlines what makes an effective center, there’s a lack of guidance on how to actually create one, highlighting the complex and resource-intensive journey involved in building these facilities.
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The ability to sense and respond to host defenses is essential for pathogen survival. Some mechanisms involve two-component systems (TCSs) that respond to host molecules, such as antimicrobial peptides (AMPs), and activate specific gene regulatory pathways to aid in survival. Alongside TCSs, bacteria coordinate cell division proteins, chaperones, cell wall sortases, and secretory translocons at discrete locations within the cytoplasmic membrane, referred to as functional membrane microdomains (FMMs).

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Article Synopsis
  • Endovascular thrombectomy (EVT) has proven safe and effective for patients suffering from large core strokes, but the effects of reperfusion quality and procedure details on outcomes are still unclear.
  • In the SELECT2 trial, findings indicated that 80% of patients experienced successful reperfusion, which correlates with better clinical outcomes, particularly in those who achieved near-complete reperfusion.
  • Longer procedure times negatively impacted patient outcomes, while the method of thrombectomy (aspiration vs stent-retriever) showed no significant differences in reperfusion success or functional recovery.
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Transitions From Basic Experimental to Clinical Coronary Pathophysiology for Guiding Chronic CAD Management.

Circ Cardiovasc Imaging

November 2024

Weatherhead P.E.T. Center, Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, Houston (K.L.G., N.P.J.).

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Article Synopsis
  • Endovascular thrombectomy (EVT) is shown to be cost-effective for patients with extensive ischemic injury, providing better health outcomes and lower societal costs compared to standard care among various populations, including those in the US, Australia, and Spain.
  • The analysis utilized a Markov model to assess outcomes based on quality-adjusted life years (QALYs) and found significant cost savings, with reductions of $23,409 in the US, $10,691 in Australia, and $30,036 in Spain.
  • EVT remains cost-effective across different age groups and severity levels of strokes, indicating a need to adapt healthcare systems to increase thrombectomy access for patients with larger strokes.
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  • The study investigates the relationship between early seizures and intellectual disability in children with tuberous sclerosis complex (TSC), focusing on how timing and frequency of seizures affect development.
  • Researchers analyzed data from 129 TSC patients over 36 months, using machine learning to identify neurodevelopmental subgroups and effective biomarkers for predicting outcomes.
  • Findings indicate that the total number of seizures (accumulated seizure burden) is a stronger predictor of cognitive development at 36 months than the age at which seizures begin, highlighting the importance of seizure management for better developmental outcomes.
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Article Synopsis
  • Clinical trials indicate that using a mobile stroke unit (MSU) for prehospital management can lead to better outcomes for acute ischemic stroke patients who may need thrombolysis, but real-world data is limited.
  • This study aimed to compare the effects of prehospital MSU management versus standard emergency services (EMS) on patient disability levels at the time of hospital discharge.
  • The analysis included over 19,000 patients treated across multiple hospitals, revealing that those managed in an MSU had improved functional outcomes compared to those receiving standard EMS care.*
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Adult emergency resuscitative thoracotomy: A Western Trauma Association clinical decisions algorithm.

J Trauma Acute Care Surg

October 2024

From the Department of Surgery (R.T.), University of California, San Francisco, San Francisco, California; Comparative Effectiveness and Clinical Outcomes Research Center (R.C.), Riverside University Health Systems Medical Center, Moreno Valley; Loma Linda University School of Medicine (R.C.), Loma Linda, California; Scripps Memorial Hospital La Jolla (W.L.B.), La Jolla, California; University of Colorado (C.C.B.), Aurora, Colorado; University of Florida College of Medicine (C.A.C.), Gainesville, Florida; University of Maryland School of Medicine (C.F.), Baltimore, Maryland; University of Kansas Medical Center (J.L.H.), Kansas City, Kansas; University of Arizona College of Medicine-Phoenix (N.K.), Phoenix, Arizona; Methodist Dallas Medical Center (M.L.), Dallas, Texas; Division of Acute Care Surgery, Department of Surgery (M.J.M., M.S.), Los Angeles General Medical Center, Los Angeles, California; Division of Vascular Surgery and Endovascular Therapy (G.A.M.), Keck Medical Center of USC, Los Angeles, California; Division of Acute Care Surgery, Department of Surgery (L.J.M.), The University of Texas McGovern Medical School - Houston Red Duke Trauma Institute, Memorial Hermann Hospital, Houston, Texas; Medical University of South Carolina (A.R.P.), North Charleston, South Carolina; Yale School of Medicine (K.M.S.), New Haven, Connecticut; St. Joseph's Hospital and Medical Center (J.A.W.), Phoenix, Arizona; and Program in Trauma (D.M.S.), University of Maryland School of Medicine, Baltimore, Maryland.

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Purpose: The purpose of this study was to review the pharmacokinetic profile of gentamicin among neonates with hypoxic ischemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH) treatment.

Methods: This was a retrospective study of neonates with HIE undergoing TH in the neonatal intensive care unit who received gentamicin between 2009 and 2014. Demographic information, diagnoses, laboratory test results, and medication administration and monitoring information were collected, and data were analyzed using SciPy.

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Unlabelled: Normative values for intracardiac and extracardiac vascular structures help in understanding normal growth and changes over time in children; this normative data is not currently available for ECG-gated computed tomography angiography (CTA). We sought to establish ECG-gated CTA-derived normative values for the aortic root, aorta, and aortic arch in children. Aortic root, ascending aorta, aortic arch, and descending aorta were measured in systole and diastole in 100 subjects who had ECG-gated CTA at our center between January 2015 and December 2020 and met our inclusion criteria.

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Background: Homozygous cyclin-dependent kinase inhibitor 2A/B (CDKN2A/B) loss is one of the parameters that support the designation of meningiomas as Central Nervous System (CNS) WHO grade 3 tumors. Evaluation of CDKN2A/B by sequencing or Fluorescence in situ hybridization (FISH) is costly and not always readily accessible. An immunohistochemistry (IHC)-based marker for the evaluation of CDKN2A/B loss would provide faster results at a lower cost.

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Nutrition Management in Children Less than 5 Years of Age with Glycogen Storage Disease Type I: Survey Results.

Nutrients

September 2024

Division of Medical Genetics, Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth Houston), Children's Memorial Hermann Hospital, Houston, TX 77030, USA.

Nutrition management for GSD Type I (GSDI; OMIM #232200, 232220) is complex, with the goal being to maintain euglycemia while minimizing metabolic derangements. Management guidelines were published in 2002 and 2014. However, there is limited information on the nuances of nutrition management and the unique feeding challenges of children.

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Background: Genetic Metabolic Dietitians International (GMDI) conducted a professional status survey of metabolic dietitians working in the United States to describe job satisfaction and establish salary and compensation benchmarks specific to metabolic dietitians.

Methods: The survey was anonymously administered in a web-based format via REDCap between October and November 2023. Registered dietitians working with inborn errors of metabolism (IEM) were eligible to participate.

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Article Synopsis
  • A recent study analyzed the effect of oxytocin dosage on cesarean delivery rates and adverse outcomes in low-risk nulliparous patients undergoing labor induction at 39 weeks or more.
  • The research compared mid- to high-dose oxytocin regimens with low-dose regimens, finding that higher doses were associated with fewer cesarean deliveries, without increasing negative perinatal outcomes.
  • The study was a secondary analysis of a larger randomized trial and utilized various statistical methods to evaluate the impact of the different oxytocin dosages on the primary outcomes.
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