Publications by Year: 2026

OBJECTIVE: Cerebral cavernous malformations (CCMs) are groups of blood vessels that develop abnormally in both the brain and/or spinal cord. Currently, MRI and/or CT are the primary methods for assessing CCMs. Plasma-based biomarkers could serve as a complement to standard imaging techniques by providing a quantitative and molecular-based technique to detect disease at lower cost. Therefore, the authors evaluated cell division cycle 42 binding protein beta (CDC42BPB) as a potential novel plasma biomarker for CCMs.

METHODS: Plasma samples were obtained from patients with pathological analysis-confirmed CCM (n = 10, age 1-16 years) and compared to controls (n = 24, age 1-19 years). The protein levels were measured using the Olink Proximity Extension Assay. Findings were confirmed with ELISA. CDC42BPB expression was further analyzed with Western blot and immunohistochemistry analysis in patient-derived primary cells and CCM tissues, respectively.

RESULTS: CCM patients exhibited significantly higher CDC42BPB plasma levels compared to controls (approximately 6-fold greater expression, p = 0.004). Furthermore, the high CDC42BPB plasma expression was concordant with the protein levels in CCM tissues and patient-derived primary cells.

CONCLUSIONS: The authors present data supporting the measurement of CDC42BPB plasma level as a putative biomarker for CCMs. These findings have implications relevant to improving diagnosis, follow-up, and molecular pathophysiological analysis.

INTRODUCTION: Children with hip pain, limp and inability to bear weight often present a diagnostic clinical challenge. Sonography is an ideal first-line imaging modality to assess for effusion, and recent literature suggests that point-of-care ultrasound (POCUS) performed by emergency providers can be safely and accurately performed at the bedside. This systematic review and meta-analysis aims to summarize the diagnostic accuracy of POCUS for pediatric hip effusion.

METHODS: MEDLINE, Embase, Web of Science, CINAHL, and Cochrane Central databases were searched through July 2025, with no date limits, using pre-defined criteria for articles assessing the diagnostic accuracy of POCUS for pediatric hip effusion. Data were extracted and quality assessment was performed using the QUADAS-2 tool. Test characteristics were pooled using a bivariate mixed effects model for meta-analysis.

RESULTS: Four studies, with a total of 526 hips scanned, met our inclusion criteria. The reference standard for all included studies was radiology-performed ultrasonography. POCUS demonstrated a pooled sensitivity of 88% (95% CI, 82%-92%), specificity of 97% (95% CI, 93%-99%), positive likelihood ratio of 35 (95% CI, 12.0-100.8), and negative likelihood ratio of 0.13 (0.08-0.19).

CONCLUSIONS: POCUS has high specificity and moderate sensitivity for hip effusion in children and is a valuable first-line diagnostic tool for evaluating children with hip pain, limp and inability to bear weight in emergency and acute care settings.

BACKGROUND: Cognitive deficits are cardinal features of schizophrenia-spectrum disorders (SSD) and bipolar disorder (BD). However, their heterogeneous and overlapping characteristics require a dimensional approach to better understand the neurobiological basis of cognition in the psychosis spectrum. To date, only a few studies have examined the neuroanatomical features of cognitive subgroups in transdiagnostic samples, and white matter microstructural characteristics of these subgroups have not been elucidated. This study aimed to investigate white matter and cortical thickness alterations in cognitive subgroups in the schizophrenia-bipolar spectrum.

METHODS: Globally Impaired (n = 31) and Near-Normal (n = 28) cognitive subgroups, comprising individuals diagnosed with schizophrenia (SZ), schizoaffective disorder (SAD) or BD, and healthy controls (HCs, n = 29), underwent 3T T1-weighted structural magnetic resonance imaging and diffusion tensor imaging scanning. Fractional anisotropy and cortical thickness measures were compared between the cognitive subgroups and healthy controls.

RESULTS: Abnormalities in white matter microstructure were only observed in patients with global cognitive impairment compared to HCs. The Near-Normal subgroup did not differ from HCs in white matter integrity. A bilateral reduction in cortical thickness was observed in both the Globally Impaired and Near-Normal subgroups when compared to HCs. Cortical thickness measures did not differentiate between the cognitive subgroups.

CONCLUSIONS: While reductions in cortical thickness in frontal and temporal regions appear to be a common feature of SZ and BD, abnormalities in white matter microstructure are associated with global cognitive impairment in the schizophrenia-bipolar spectrum. These original findings may be important in identifying more biologically valid clinical syndromes within the schizophrenia-bipolar spectrum.

Practicing CBT skills outside of therapy sessions is a core component of effective treatment, yet meaningful engagement can be difficult during periods of elevated psychological distress. Smartphone-based ecological momentary interventions (EMIs) offer a promising approach to support real-time skill use, but most research has focused on frequency rather than quality of engagement. This study examined the quality of CBT skills practice in a 28-day smartphone-based EMI following inpatient discharge and explored its associations with internal context and intervention effectiveness. Twenty-three adults hospitalized for suicidal thoughts and behaviors participated, selecting and practicing one of three guided CBT skills exercises (Mindful Emotional Awareness, Countering Emotional Behavior, or Cognitive Flexibility) up to three times daily. A structured coding system was used to rate the completeness and relevance of 945 total exercises (0-2 scale). Quality varied primarily within individuals and was lower during moments of high suicidal intent and urge. When combining across all skills, quality was not associated with proximal change. However, higher-quality Countering Emotional Behavior practice predicted greater reductions in suicidal intent, and higher-quality Countering Emotional Behavior and Cognitive Flexibility practice predicted greater reductions in anger. These findings suggest that momentary distress can impact engagement quality, and that the short-term impact of skills practice may depend on both the specific CBT strategy and type of distress targeted. Understanding and enhancing engagement quality is a key step toward optimizing mobile interventions for individuals in the midst of psychological distress.

Posterior Cortical Atrophy (PCA) is a neurodegenerative syndrome most commonly associated with Alzheimer's disease, characterized by progressive visuospatial and visuoperceptual decline. Although voxel-based morphometry studies have described gray matter loss in PCA, a comprehensive and updated coordinate-based meta-analysis is still missing, and associated structural connectivity alterations remain unclear. We conducted a systematic review and meta-analysis of whole-brain voxel-based morphometry studies comparing patients with PCA and healthy controls (PROSPERO ID: CRD420251010673). Analyses were performed using Seed-based d Mapping with Permutation of Subject Images (SDM-PSI) with family-wise error correction, and meta-regressions assessed the impact of demographic and clinical variables. To investigate structural connectivity, deterministic tractography was carried out on a normative diffusion MRI template, using meta-analytic gray matter clusters as seeds. Eighteen studies were included (339 PCA; 577 healthy controls). The meta-analysis revealed consistent bilateral gray matter atrophy in the lateral occipital cortex, inferior parietal lobule, precuneus, and ventral occipitotemporal regions. Meta-regression highlighted an interaction between age and disease duration, associated with atrophy in the left superior temporal gyrus and right thalamus. Tractography demonstrated that affected clusters were embedded within major long-range pathways, including the superior and inferior longitudinal fasciculi, vertical occipital fasciculi, and parietal aslant tract. Regression-derived clusters additionally mapped onto the arcuate fasciculus, frontal aslant tract, and superior thalamic radiations. This is the first systematic review and voxel-based meta-analysis of PCA conducted after the establishment of consensus diagnostic criteria, providing a statistically robust characterization of gray and white matter alterations and identifying potential imaging biomarkers for diagnosis and treatment.

Patients who receive hematopoietic stem cell transplantation (HSCT) undergo complex treatment regimens often accompanied by significant physical and psychological symptom burdens. However, patient access to psychosocial care is limited, likely in the context of persistent shortages of supportive care clinicians and services. Clinicians can offer valuable insights into psychosocial needs, barriers to accessing psychosocial support, and recommendations to improve psychosocial care for the HSCT population. This qualitative study aimed to explore the perspectives of HSCT clinicians to better understand the challenges HSCT recipients face accessing psychosocial support and how these barriers can inform strategies to enhance psychosocial care. Unlike existing literature that largely focuses on unmet needs in the HSCT population from patient perspectives and patient-reported outcomes, this study delves into the unique insights of HSCT clinicians. A purposive sampling strategy was employed to recruit clinicians across specialties in the United States, including mental health and oncology, involved in HSCT care. Semistructured individual interviews were conducted to explore psychosocial care within HSCT programs. Using a framework-guided rapid analysis, 2 coders analyzed the interviews for emergent themes. Participants (N = 21) shared perspectives on multiple emerging themes, including (1) patient psychosocial challenges (eg, isolation, psychological distress); (2) barriers to psychosocial care (eg, workforce shortage, gaps in integration and continuity of care); and (3) recommendations to improve care delivery (eg, adopting a holistic, team-based model that is proactive and tailored to the needs of HSCT patients throughout their treatment and recovery). Findings highlight critical gaps in psychosocial care for HSCT recipients and offer actionable clinician recommendations to improve psychosocial care delivery for the HSCT population.

BACKGROUND: Over 3.5 million US men are living with prostate cancer (Pica), many with underlying cardiovascular disease (CVD). Fine particulate matter (PM2.5) contributes to higher CVD mortality through inflammation and other mechanisms, and so may increase non-cancer mortality in men with PCa.

METHODS: We conducted a retrospective cohort study of 886,876 men diagnosed with PCa between 2000 and 2015 and followed through 2018 across eight state cancer registries. Annual average predictions of five residential PM2.5 component exposures (elemental carbon (EC), organic carbon (OC), nitrate, ammonium (NH4+), sulfate (SO42-)) were obtained from an ensemble-based machine learning model and assigned to geomasked addresses at diagnosis within 50 m (urban) or 1 km (rural). Adjusted hazard ratios (aHR) for associations of components separately and as a mixture with all-cause, PCa, and CVD mortality were estimated from covariate adjusted Cox models.

RESULTS: There were 233,898 deaths over 5,836,741 person-years. Per interquartile range (IQR) increase, OC (aHR 1.03 [95 % CI: 1.02-1.04]), NH4+ (aHR 1.02 [1.01-1.03]), and SO42- (aHR 1.11 [1.09-1.13]) were associated with all-cause mortality. CVD mortality was associated with higher EC (aHR: 1.04 [1.02-1.06]), OC (aHR 1.05 [1.03, 1.07]), NH4+ (aHR 1.09 [1.06-1.12]) and SO42- (aHR 1.19 [1.15-1.24]). There were no associations with nitrates or PCa mortality. Per IQR, PM2.5 components mixtures were associated with higher all-cause (aHR 1.03 [1.02-1.04]), PCa (aHR 1.02 [0.99, 1.05]), and CVD mortality (aHR 1.08 [1.05, 1.11]).

DISCUSSION: Certain PM2.5 components were associated with higher all-cause and CVD mortality in men with PCa. Studies of air pollution in cancer survivors should consider impacts on non-cancer mortality.