Publications by Year: 2026

OBJECTIVE: To investigate the effects of a collegiate ice hockey season and the repetitive head impacts (RHI) experienced on the neurologic health using a multifaceted assessment battery.

DESIGN: Cross-sectional.

SETTING: Research laboratory.

PARTICIPANTS: Thirty-six male collegiate club ice hockey players.

INDEPENDENT VARIABLES: Time (preseason, midseason, postseason) and head impact measures (number of impacts, mean linear acceleration).

MAIN OUTCOME MEASURES: Athletes wore Smart Impact Monitor (SIM-G) accelerometers throughout 1 season and completed testing at preseason, midseason, and postseason. The battery included a 22-item graded symptom checklist, Standardized Assessment of Concussion, Balance Error Scoring System, Trails A & B, King-Devick, Near Point Convergence, Clinical Reaction Time, Tandem Gait (single- and dual-task), and computerized neurocognitive testing (ImPACT).

RESULTS: There was a significant main effect of time, with improved performance, on the Standardized Assessment of Concussion (F(2, 70) = 4.43, P = 0.015), Trails A (F(2, 67) = 7.16, P = 0.002), Trails B (F(2,71) = 5.19, P = 0.008), King-Devick (F(2, 72) = 4.31, P = 0.017), Clinical Reaction Time (F(2, 69) = 4.54, P = 0.014), ImPACT Verbal Memory (F(2, 76) = 3.82, P = 0.026), and Tandem Gait (ST: F(2, 76) = 6.11, P = 0.003; DT: F(2, 78) = 4.65, P = 0.012). Multiple regression analyses identified an association between the overall head impact model and Visual Motor score (R2 = 0.354, F(2, 29) = 3.698, P = 0.016), whereby increased head kinematics corresponded to higher (better) Visual Motor performance.

CONCLUSIONS: A season of collegiate ice hockey RHI did not negatively affect multifaceted clinical assessments. Additional investigation is warranted to determine the effect of RHI sustained during collegiate hockey participation later in life.

PURPOSE: Uncorrected refractive error (URE) is the leading cause of vision impairment, especially in rural, underserved areas. We previously evaluated the accuracy of a smartphone app for measuring spherical equivalent refraction. In this study, we evaluated the benefits of vision correction based on the prescription given by the app.

METHODS: The app estimates myopic refractive error by measuring the far point distances for reading 20/20 Tumbling E letters. Trial lenses rounded to 0.25 diopter (D) were fitted to 100 patients (myopic refractive error, astigmatism < 1.5 D) visiting MCM Eye Unit in Addis Ababa, Ethiopia. The age range of the participants was 10 to 68 years (mean = 31.3 ± 13.0 years). The refraction measurement and visual acuity (VA) tests were all performed without cycloplegia.

RESULTS: The range of spherical equivalent refractive error was -0.5 D to -6 D (interquartile range [IQR] = -2.25 D to -0.95 D), and the range of astigmatism was 0 to -1.25 D (IQR = -0.5 D to 0 D), according to subjective refraction performed by a study optometrist. On average, the uncorrected VA of the 200 eyes was 0.57 ± 0.32 logMAR. With the spherical equivalent correction based on the refraction app, their VA was improved significantly to 0.03 ± 0.09 logMAR-more than 5 lines of improvement, on average.

CONCLUSIONS: This study indicates that using the app to determine the spherical equivalent prescription for vision correction addresses the URE problem, whereas its effect for prominent astigmatism is yet to be evaluated.

TRANSLATIONAL RELEVANCE: This approach, which requires minimal training, has potential in fighting avoidable blindness in underserved areas lacking optometry services, such as remote Sub-Saharan Africa.

OBJECTIVE: To propose a mechanistic framework for the use of transcranial photobiomodulation (tPBM) as an adjunctive treatment in Rett syndrome (RTT).

BACKGROUND DATA: RTT is a severe X-linked neurodevelopmental disorder caused mainly by MECP2 variants, with limited disease-modifying therapies. tPBM delivers red-to-near-infrared light to the brain and shows promising effects in several neurocognitive and neuropsychiatric conditions.

METHODS: We reviewed key cellular mechanisms of RTT, namely mitochondrial dysfunction, oxidative stress, neuroinflammation, and impaired synaptic plasticity, and summarized established bioenergetic, redox, anti-inflammatory, and neurotrophic actions of tPBM.

RESULTS: The convergence between these pathways suggests that tPBM could partially compensate for bioenergetic and signaling abnormalities in RTT, acting as a multi-target, pathophysiology-informed neuromodulation strategy.

CONCLUSIONS: Although speculative, this mechanistic convergence supports prioritizing preclinical studies in Mecp2-deficient models and early-phase feasibility trials of tPBM in individuals with RTT.

BACKGROUND: Celiac disease (CD) is a chronic immune-mediated enteropathy triggered by gluten ingestion in genetically predisposed individuals and is increasingly diagnosed in childhood. Growing evidence suggests an association between CD and metabolic syndrome (MetS), potentially mediated by chronic inflammation, intestinal dysbiosis, oxidative stress, and micronutrient deficiencies. In addition, although a gluten-free diet (GFD) is essential for intestinal recovery, its frequent reliance on ultra-processed, energy-dense products may adversely affect metabolic health, particularly in pediatric patients.

OBJECTIVE: This narrative review aims to examine the relationship between CD and MetS, with a specific focus on pediatric populations, by analyzing shared pathophysiological mechanisms, the metabolic impact of a GFD, and preventive nutritional strategies to reduce long-term cardiometabolic risk.

METHODS: A narrative review was performed using PubMed and Scopus databases, focusing on studies published in the past 15 years. Search terms included "Celiac Disease," "Metabolic Syndrome," "Child," "Adolescent," "Risk Factors," and "Prevention." Among 229 identified papers, 43 were selected after critical appraisal. Evidence was synthesized on epidemiology, mechanisms, dietary effects, and preventive strategies.

RESULTS: Studies indicate that MetS prevalence in CD ranges from 3 to 11% at diagnosis and may rise to 14-29% after 1 year on a GFD, particularly in adults. In children, complete MetS is rare, though isolated components, central adiposity, dyslipidemia, and hypertension, are increasingly observed. Mechanistically, gluten-induced barrier disruption, inflammation, dysbiosis, and nutritional imbalances contribute to systemic metabolic alterations. Adherence to a Mediterranean-style GFD emphasizing whole, naturally gluten-free foods reduces cardiometabolic risk.

CONCLUSION: CD and MetS share interconnected inflammatory and metabolic pathways. While GFD remains essential for CD management, it necessitates tailored nutritional guidance and metabolic monitoring. Early lifestyle-based interventions-promoting balanced diet quality, micronutrient adequacy, and physical activity, offer key opportunities to prevent metabolic complications in children with CD.

PURPOSE: Many rare genetic conditions manifest soon after birth and result in admission to the Neonatal Intensive Care Unit (NICU), where prior research suggests that parents experience high levels of stress and uncertainty. However, further insight into parent-reported, longer-term outcomes for these infants and their families is needed.

METHODS: We undertook a qualitative analysis of parent-reported experiences with genomic care over the course of their NICU admission and beyond, after an initial quantitative study of 110 families who received genetic evaluation in the NICU, in a mixed-methods approach. Twenty families participated in individual semistructured interviews eliciting the impact of the NICU experience and genetic diagnostic odyssey on the infant and family.

RESULTS: We identified 4 main themes: (1) Rare Disease as "Culture Shock," (2) Parental Trauma and Stressors, (3) Family Resiliency, and (4) Hospital System Recommendations. Early, rapid, and broad genomic testing was appreciated by parents, although additional genomic- and nongenomic supports after NICU discharge were desired. Stressors in the NICU related to uncertainty and critical illness occurred independent of genetic testing applications or results. Parents reported adapting their expectations regarding the benefits of a genetic diagnosis over time, ultimately focusing on day-to-day care and finding pride in medical and social resilience.

CONCLUSION: The NICU experience, particularly for infants with rare conditions, has long-lasting impact on the family. Enhanced attention to longitudinal supports from NICU to home may be beneficial for families undergoing genetic diagnostic odysseys.

Intrarenal renin-angiotensin system (iRAS) activation has been implicated in tubulopathy in diabetic kidney disease (DKD), its underlying mechanisms remain unclear. Type 1 diabetic Akita mice and Akita mice with angiotensinogen (Agt) deletion in renal tubules (Akita AgtRT KO) and their respective controls were studied at 42 weeks. Akita mice exhibit increased AGT expression, oxidative stress, tubular cell size and luminal dilation in proximal tubules (PTs), while reduced in Akita AgtRT KO mice. Elevated senescence-associated β-galactosidase (SA-β-gal) activity and senescence-associated secretory phenotype (SASP) along with increased senescence marker p16 expression in distal tubules (DTs) were also observed in Akita mice, all normalized in Akita AgtRT KO mice. Human CKD/DKD datasets confirmed AGT positively correlated with CDKN2A/p16 expression. Akita mice also showed elevated NADPH oxidase 4 (NOX4) expression and mitochondrial cristae disruption in PTs, accompanied by significant oxidative DNA damage, renal inflammation, fibrosis and apoptosis cf. Akita AgtRT KO mice. In vitro, high glucose and angiotensin II (Ang II) triggered NOX4-mediated mitochondrial oxidative stress and dysfunction in proximal tubular (HK-2) cells. In addition, Ang II induced p16-dependent senescence in distal tubular (Madin-Darby canine kidney, MDCK) cells. Conditioned medium from senescent MDCK cells triggered epithelial-to-mesenchymal transition in HK-2 cells, which was reversed by losartan or N-acetylcysteine. These findings suggest that iRAS promotes tubulopathy in DKD through NOX4-induced mitochondrial oxidative stress and dysfunction in PTs and oxidative DNA damage-induced senescence in DTs, providing new therapeutic targets.

Hepatocellular carcinoma (HCC) represents one of the leading contributors to cancer-related deaths, with the majority of patients diagnosed at stages where curative treatment is no longer possible. Combining stereotactic body radiotherapy (SBRT) with immune checkpoint inhibition (ICI) has gained increasing attention as a therapeutic approach. Beyond its ability to provide high local tumor control (LC), SBRT can provoke immunogenic tumor cell death, promote antigen release and presentation, and modulate the tumor microenvironment in ways that enhance systemic antitumor immunity. In this narrative review, we outline the scientific rationale for integrating SBRT with ICIs, discuss mechanistic and translational findings and summarize results from key clinical trials. The currently available data indicate a synergistic interaction, most notably reflected in improved survival and response rates. Nevertheless, variability in dose and fractionation schedules, treatment sequencing, and patient characteristics complicates interpretation. Well-designed prospective studies are needed to establish optimal protocols and identify predictive biomarkers to guide patient selection.

The BraTioUS (Brain Tumor Intraoperative Ultrasound) dataset [1] is a large-scale, multicenter, and publicly available collection of intraoperative ultrasound (ioUS) images acquired during glioma surgeries. Created through an international collaboration among six hospitals across five countries, BraTioUS comprises 1669 B-mode 2D ioUS images from 142 glioma patients collected between 2018 and 2023 using various ultrasound systems and acquisition protocols. It also includes masks supervised by experts of tumor segmentation from every ioUS image. BraTioUS addresses several limitations found in existing public datasets, such as lack of diversity in acquisition hardware, imaging protocols, and glioma types. The primary objective of this dataset is to be publicly available and accessible for the training and validation of machine learning models aimed at improving the interpretation and use of ioUS. The dataset's scale, quality, and heterogeneity make it a valuable resource for training and validating AI tools aimed at improving intraoperative decision-making and patient outcomes in glioma surgery.

BACKGROUND CONTEXT: Patients in a double-occupancy room during recovery will have different experiences based on bed location. For instance, patients near a window will have access to natural light while a patient near the door may experience higher noise levels. This study aims to assess the impact of inpatient bed placement on postoperative recovery for adolescent idiopathic scoliosis (AIS) patients undergoing posterior spinal fusion (PSF).

METHODS: This retrospective cohort study included 448 AIS patients who underwent PSF from 2011 to 2017 at a single center. Demographics and baseline radiographic measurements were summarized using appropriate statistics. Intraoperative and postoperative outcomes, NRS pain scores and total daily opioid administration were compared across bed types using t-tests, Wilcoxon rank sum tests, chi-squared tests, or Fisher's exact tests, as appropriate. GEE models were constructed to examine the influence of bed type and days since surgery on outcomes such as postoperative complication, PACU pain levels, length of stay, daily numerical ranking scale (NRS) pain scores and total daily opioid administration.

RESULTS: 325 (73%) patients in the cohort were assigned to a bed by the window and 123 (27%) were assigned to a bed by the door. The mean age was 15±2 years and 85% of patients were female. Length of hospital stay, complication rates, 2-year outcomes, inpatient pain scores, and daily opioid usage did not significantly differ between bed types (all p>.05). Adjusted GEE models revealed no significant associations between bed type and pain scores (p=.9) or between bed type and total opioid dosage (p=.95).

CONCLUSIONS: Proximity to a window while recovering from PSF surgery for AIS does not impact inpatient outcomes. When bed space is scarce, usage of all available beds can serve as a relief valve to continue elective practices without compromising postoperative outcomes.