Artificial Intelligence-Enhanced Perfusion Scoring Improves the Diagnostic Accuracy of Myocardial Perfusion Imaging.

We previously demonstrated that a deep learning (DL) model of myocardial perfusion SPECT imaging improved accuracy for detection of obstructive coronary artery disease (CAD). We aimed to improve the clinical translatability of this artificial intelligence (AI) approach using the results to derive enhanced total perfusion deficit (TPD) and 17-segment summed scores. We used a cohort of patients undergoing myocardial perfusion imaging within 180 d of invasive coronary angiography.

The Impact of Preoperative Right Ventricular Dysfunction and Ventricular Arrhythmias on Left Ventricular Assist Device Outcomes.

Ventricular arrhythmias (VA) are common in patients being evaluated for left ventricular assist devices (LVADs) but the impact of comorbid right ventricular dysfunction (RVD) on outcomes after LVAD is not known. We performed a single-center, retrospective cohort study of patients undergoing LVAD implantation from 2005 to 2021. Patients were stratified by VA history before LVAD into no VA, low burden VA (LBVA), or clinically significant VA (CSVA) groups.

Comparative efficacy and safety of SpyGlass percutaneous transhepatic cholangioscopy versus conventional cholangioscopy in challenging biliary access: a systematic review and meta-analysis.

Percutaneous transhepatic cholangioscopy (PTCS) is essential for managing patients with altered biliary anatomy when endoscopic retrograde cholangiopancreatography fails. This study aimed to compare the safety and efficacy of conventional PTCS (C-PTCS) with the SpyGlass PTCS (S-PTCS) system in cases of challenging biliary access. A systematic review and meta-analysis included 12 studies with 998 patients.

Structural variation, selection, and diversification of the gene family from the human pangenome.

The (nuclear pore interacting protein) gene family has expanded to high copy number in humans and African apes where it has been subject to an excess of amino acid replacement consistent with positive selection (1). Due to the limitations of short-read sequencing, human genetic diversity has been poorly understood. Using highly accurate assemblies generated from long-read sequencing as part of the human pangenome, we completely characterize 169 human haplotypes (4,665 paralogs and alleles).

Adolescents' Use of Music for Pain Management.

To investigate the experiences of adolescents with chronic pain who participated in an intensive interdisciplinary pain treatment program, this secondary study analyzes the themes that emerged regarding the spontaneous utilization of music in coping strategies for chronic pain. During research interviews focused on coping skills and treatment engagement, participants spontaneously reported using music as an effective coping strategy for managing pain. A deductive thematic analysis revealed key themes related to their usage, including using music as a distractor, motivator and in other ways as coping strategies.

Successful Endovascular Management of Concomitant Ischemic Stroke, Myocardial Infarction, and Massive Pulmonary Embolism.

Background: Ischemic stroke, myocardial infarction (MI), and pulmonary embolism (PE) are emergent conditions which can be treated with catheter-directed therapies. Concomitant management of these conditions with catheter-directed therapy is not well-documented and lacks strong guidelines.

Case Summary: A 70-year-old woman presented with stroke symptoms and ST-segment elevation MI.

National Prescribing Practices for Pediatric Dystonia Among Providers in the United States.

While multiple oral medications are used to treat dystonia, limited information exists on current prescribing practices. This study analyzes real-world prescribing practices for pediatric dystonia in the United States, evaluating prescription frequency, dosing, and the impact of comorbidities. Oracle electronic health record real-world data were queried from 2014 to 2019 for encounters of patients under age 18 with a dystonia diagnosis and available medication records.

International Expert Opinion on Standard of Care for Patients With Schinzel-Giedion Syndrome: A Modified Delphi Study.

Schinzel-Giedion Syndrome (SGS) is an ultra-rare, multisystem, genetic developmental disorder caused by gain-of-function pathogenic variants in the SETBP1 gene. No standard of care (SoC) recommendations currently exist. To assess expert opinion on SoC for individuals with SGS using a modified Delphi method.

Comparison Between Dynamic Models for Predicting Response to Corticosteroids in Alcohol-Associated Hepatitis: A Global Cohort Study.

Several dynamic models predict mortality and corticosteroid response in alcohol-associated hepatitis (AH), yet no consensus exists on the most effective model. This study aimed to assess predictive models for corticosteroid response and short-term mortality in severe AH within a global cohort. We conducted a multi-national study of patients with severe AH treated with corticosteroids for at least 7 days, enrolled between 2009 and 2019.

Effect of sotagliflozin on major adverse cardiovascular events: a prespecified secondary analysis of the SCORED randomised trial.

Background: Sodium-glucose co-transporter (SGLT)-2 inhibitors have shown consistent benefit in improving heart failure-related outcomes but not ischaemic cardiovascular events such as myocardial infarction or stroke. We assessed if the dual SGLT1/2 inhibitor sotagliflozin improves ischaemic outcomes.

Methods: We did a prespecified secondary analysis of the SCORED trial, which was a double-blind, placebo-controlled, randomised clinical trial enrolling patients (aged ≥18 years) with type 2 diabetes, chronic kidney disease (estimated glomerular filtration rate [eGFR] 25-60 mL/min per 1·73 m), and additional cardiovascular risk factors.

X-Linked Hypophosphatemia Management in Children: An International Working Group Clinical Practice Guideline.

Background: An International Working Group (IWG) developed new guidelines on the diagnosis, evaluation, management, and monitoring of X-linked hypophosphatemia (XLH) in children. Over the past 5 years, important advances have occurred in our understanding of the presentation, complications and treatment of XLH.

Methods: A group of 50 international experts in XLH from Canada, the United States, Europe, Asia and South America, along with methodology experts and patient partners, held 18 teleconference meetings in 2023-2024.

Associations Among Problematic Internet Usage in Adolescents, Parental Internet Factors, and Parent-Adolescent Communication.

Objective: Adolescents with problematic internet use (PIU) have excessive, impulsive, or risky internet use that negatively affects social, physical, and functional outcomes. The role of parents in the prevention of adolescent PIU remains unclear. The purpose of this study was to evaluate possible association between adolescent PIU, parent PIU, and internet-related parenting factors.

NICHD Magnetic Resonance Brain Imaging Score in Term Infants With Hypoxic-Ischemic Encephalopathy: A Secondary Analysis of a Randomized Clinical Trial.

Importance: The neonatal brain injury score on magnetic resonance imaging following moderate or severe hypoxic-ischemic encephalopathy developed by the National Institute of Child Health and Human Development Neonatal Research Network has been revised to separate watershed and basal ganglia or thalamic injury and their associated outcomes.

Objective: To evaluate the association of the injury score with outcomes of death or moderate or severe disability among all infants, and with neurodevelopment among survivors in a trial of deeper and longer cooling.

Design, Setting, And Participants: In this secondary analysis of a multicenter randomized clinical trial, brain imaging was obtained from infants between October 2010 and November 2013.

Efficacy and Safety of Zilucoplan in Amyotrophic Lateral Sclerosis: A Randomized Clinical Trial.

Importance: The etiology of amyotrophic lateral sclerosis (ALS), a fatal neurodegenerative disease, is unknown. However, neuroinflammation and complement activation may play a role in disease progression.

Objective: To determine the effects of zilucoplan, an inhibitor of complement C5, in individuals with ALS.

Enhancing Patient Education on Cardiovascular Rehabilitation with Large Language Models.

Introduction: There are barriers that exist for individuals to adhere to cardiovascular rehabilitation programs. A key driver to patient adherence is appropriately educating patients. A growing education tool is using large language models to answer patient questions.

Resource Management Challenges in Rural Dermatological Care: A Mapping Review.

Skin cancer prevalence in the United States is rapidly on the rise, particularly in rural communities where individuals are subjected to heavy sunlight exposure through occupations such as agricultural work and construction. These geographic regions are often lacking in dermatologic specialty care, thus increasing the disease burden of skin conditions in primary care settings. Access barriers to specialized dermatology care are exacerbated by prolonged wait times to schedule an appointment, travel demands, and a relative paucity of dermatology providers in rural areas as compared to urban areas.

Increasing Safety Net Antibiotic Prescriptions for Acute Otitis Media in Urgent Care Clinics.

Objective: To evaluate the effectiveness of multifaceted interventions in improving the use of safety net antibiotic prescriptions (SNAPs) for nonsevere acute otitis media (AOM).

Study Design: We used quality improvement methodology to develop iterative Plan-Do-Study-Act cycles to increase the use of SNAP for nonsevere AOM in 3 pediatric urgent care centers from October 2021 to June 2023. Interventions included education, electronic health record changes, audits and feedback, and a time-limited financial incentive.

Retrospective Investigation of Pediatric Histoplasmosis Diagnosed at a Tertiary Children's Hospital in an Endemic Area over 11 years.

Background: Most histoplasmosis data are from adults. We describe pediatric histoplasmosis diagnosed at a tertiary pediatric care center in an endemic area.

Methods: We performed a retrospective chart review of patients birth-18 years seen in our institution (January 1, 2010 - August 15, 2022) with histoplasmosis identified by International Classification of Disease (ICD) codes.

Prevalence and Predictors of Suspected Metabolic Dysfunction-Associated Steatotic Liver Disease in Adolescents in the United States.

Background: Nomenclature for steatotic liver disease has been updated to include metabolic dysfunction-associated steatotic liver disease (MASLD), which requires the presence of hepatic steatosis and at least one cardiometabolic risk factor. The prevalence of MASLD in adolescents is understudied.

Aim: To determine the prevalence of suspected MASLD among adolescents in the United States and to examine the relationships between elevated alanine aminotransferase (ALT) and cardiometabolic risk factors.

Randomized Phase II Study to Assess the Role of Single-Agent Nivolumab to Maintain Remission in Acute Myeloid Leukemia.

We conducted a multi-center, open-label, randomized phase II study to assess the efficacy of Nivolumab as maintenance therapy for patients with AML in first complete remission (CR) or CR with incomplete hematologic recovery (CRi) who were not candidates for SCT. Patients were stratified and randomized to Observation (Obs) or Nivolumab (Nivo, 3mg/kg IV every 2 weeks for 46 doses). The primary endpoint was progression-free survival (PFS) defined as time to disease relapse or death due to any reason.

A Scoping Review of Sexual and Reproductive Health Interventions With Youth in U.S. Juvenile Facilities.

Youth placed in U.S. juvenile detention facilities face multilevel barriers that contribute to disparate sexual and reproductive health (SRH) outcomes when compared to their peers in the general adolescent population.