Publications by Year: 2026

INTRODUCTION: The value of esophageal baseline impedance (BI) in assessing proximal reflux and laryngopharyngeal symptoms (LPSs) is unclear.

METHODS: Two hundred eighteen patients with LPS underwent 24-hour combined hypopharyngeal-esophageal impedance-pH monitoring. Proximal/distal BI was obtained, and a slope-and-intercept model of proximal BI contour was constructed.

RESULTS: Proximal BI correlated with proximal/pharyngeal reflux (r = -0.21, P < 0.01) and reflux symptom index (r = -0.14, P = 0.08). The proximal BI contour model incorporating both the BI change (slope) and BI just below upper esophageal sphincter (intercept) outperformed models using individual BI measures in predicting proximal (Akaike information criterion: 110 vs 251-253) or pharyngeal (akaike information criterion: 32 vs 141-148) reflux.

DISCUSSION: Proximal esophageal impedance contour predicts proximal reflux in patients with LPS.

OBJECTIVES: Individuals with both avoidant/restrictive food intake disorder (ARFID) and pediatric acute-onset neuropsychiatric syndrome (PANS) report restrictive eating. Inflammatory and immunological alterations may drive the onset of restrictive eating and comorbid obsessive-compulsive (OC) symptoms in PANS, while the etiology of restrictive eating in ARFID is unknown. Nevertheless, few studies have explored PANS and related OC symptoms among individuals with ARFID. We aimed to identify the frequency and nature of PANS and OC symptoms among those with full or subthreshold ARFID. We also explored associations between OC severity, ARFID profiles, and infection history.

METHODS: The study included 37 adolescents and young adults with subthreshold or full ARFID. We quantified the frequency of PANS/pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection symptoms and diagnoses, as well as OC symptoms and severity, in our ARFID sample. We analyzed associations between ARFID profiles and OC severity, along with the relationship between infection history and OC severity.

RESULTS: Two individuals (5%) met PANS criteria, and 17 (46%) reported lifetime mild-severe OC severity. The fear of aversive consequences profile was associated with a significant increase in log-transformed OC severity (β = 1.2, p = 0.04, adjusted R2 = 0.10) after adjusting for sensory sensitivity, lack of interest, and body mass index z-score. We did not find any associations between OC severity and infection history.

DISCUSSION: In the first study to examine PANS and related symptoms among individuals with ARFID, we demonstrated salient overlap between PANS, OC symptoms, and ARFID. Further research is needed to examine the relationship between ARFID and PANS.

BACKGROUND: Patients with cerebellar disorders often experience fatigue and the cerebellar cognitive affective syndrome (CCAS), both of which impair quality of life (QoL). There are no approved treatments.

OBJECTIVE: To test the hypothesis that stimulant medications improve fatigue and CCAS in patients with cerebellar disorders.

METHODS: We administered a questionnaire to 20 patients with cerebellar disorders, assessing the impact of stimulant medications on nine domains: QoL, fatigue, alertness, verbal expression, thinking clearly, and multitasking, as well as emotional state, social interactions, and physical symptoms. Patients also completed the Patient-Reported Outcome Measure of Ataxia, Mental section (PROM-Ataxia MEN), rating symptoms before and during treatment.

RESULTS: Patients perceived improvements in all domains, with 95% reporting improved alertness, 90% fatigue, and 80% executive control. PROM-Ataxia MEN scores improved by 26%.

CONCLUSIONS: These preliminary findings suggest that stimulants may be associated with perceived symptom improvements in cerebellar disorders. Given the small, heterogeneous sample and reliance on retrospective patient-report, further exploration is warranted.

The escalating global burden of diseases-including cancer, neurodegenerative, and cardiovascular disorders-poses severe threats to human health and social development. The inherent limitations of conventional diagnostic, imaging, and therapeutic modalities have driven the rapid evolution of nanomedicine, particularly nanotheranostics, which integrates diagnostic and therapeutic functionalities within a single nanoplatform for enhanced precision and safety. Despite remarkable advances in nanotechnology and materials science over recent decades, challenges such as the biological complexity of living systems, incomplete understanding of nano-bio interactions, inefficiencies in nanoparticle synthesis, and limited clinical translation continue to hinder progress. The recent convergence of nanomedicine with artificial intelligence (AI) and computational sciences has opened transformative opportunities to overcome these obstacles. AI-empowered algorithms, including machine learning, deep learning, and generative models, are increasingly being applied to optimize nanoparticle design and synthesis, predict nano-bio interactions, and improve diagnostic and therapeutic efficacy. These approaches not only accelerate materials discovery but also enable data-driven, adaptive nanotheranostic systems capable of autonomous optimization across disease contexts. This review systematically summarizes the current landscape of AI-powered nanomedicine, highlighting advances in nanoparticle design, synthesis, and the development of AI-guided diagnostic and therapeutic nanoplatforms. It further discusses applications in bioimaging, targeted therapy, and clinical translation, while identifying existing challenges and future perspectives in establishing next-generation AI-empowered nanotheranostics. Ultimately, the integration of artificial intelligence and nanotechnology is expected to revolutionize precision medicine by bridging the gap between fundamental nanoscience and clinical implementation, paving the way toward intelligent, personalized healthcare.

Guidelines recommend fasting before catheterization laboratory (cath lab) procedures. However, recent studies question the necessity of fasting, suggesting that fasting may not provide significant clinical benefits. This study aims to evaluate the existing evidence between outcomes for patients with fasting and nonfasting regimens. We conducted a comprehensive search for randomized controlled trials comparing fasting and nonfasting protocols before cath lab procedures. Outcomes included hypoglycemia, aspiration pneumonia, contrast nephropathy, all-cause mortality, and cardiovascular mortality. A random effects meta-analysis was performed to derive odds ratios (ORs) and 95% confidence intervals (CIs). The meta-analysis included 8 randomized controlled trials with a total of 3068 participants: 1544 in the fasting group and 1524 in the nonfasting group. Compared with fasting, nonfasting was not associated with significant differences in hypoglycemia (OR = 0.77, 95% CI, 0.44-1.34), aspiration pneumonia (OR = 1.33, 95% CI, 0.38-4.72), contrast nephropathy (OR = 1.82, 95% CI, 0.88-3.75), all-cause mortality (OR = 1.29, 95% CI, 0.51-3.28), or cardiovascular mortality (OR = 0.94, 95% CI, 0.22-4.05). Nonfasting regimens show no significant differences in safety outcomes compared with fasting, suggesting it may be implemented to improve patient experience without compromising safety. Larger trials are needed to confirm the safety of nonfasting regimens. Summary of outcomes (CEID, cardiac implantable electronic device; PCI, percutaneous coronary intervention; TAVR, transcatheter aortic valve replacement). The design features graphical elements sourced from Servier Medical Art, which are provided by Servier under the Creative Commons Attribution 4.0 unported license.

BACKGROUND: Coronary artery disease (CAD), tuberculosis (TB), and HIV are major global health concerns. Individuals affected by one or more of these conditions often exhibit chronic inflammation and immune dysregulation, with monocytes playing a central role. Monocyte subsets are known to expand in individuals with HIV, TB, or CAD, but the mechanisms by which these cells contribute to inflammation and immune responses remain poorly understood.

METHODS: We employed high-dimensional mass cytometry to characterize monocyte heterogeneity in 61 Ugandan adults with varying combinations of HIV, TB, and subclinical or overt CAD. An integrative approach was used, combining manual gating, unsupervised clustering, and machine learning to identify distinct monocyte phenotypes associated with CAD and TB. Monocyte activation markers soluble CD14 (sCD14) and sCD163 were measured in plasma. CAD was diagnosed by coronary computed tomography angiography. TB was determined by a questionnaire and interferon-gamma release assay (IGRA) testing.

RESULTS: Participants' demographics and clinical characteristics were similar by CAD or HIV/TB status. Median age was 61 years; 37.7% were female. People living with HIV and latent TB or prior active TB had higher sCD14 plasma levels compared with HIV/TB-negative individuals. Individuals with CAD showed reduced surface expression of the scavenger receptor CD163 on non-classical monocytes. Unsupervised clustering further revealed 2 distinct non-classical monocyte subsets associated with disease states: A CD86dim CX3CR1dim CD45RA+ GPR56+ CXCR3+ subset significantly depleted in individuals with CAD, and a CD86+ CX3CR1++ CD45RA++ GPR56- CD38- CXCR3- subset enriched in individuals with latent TB.

CONCLUSIONS: These findings underscore the complexity of the monocyte landscape in CAD progression, particularly in regions where HIV and TB are co-endemic. Our study reveals distinct alterations within 2 non-classical monocyte subpopulations associated with CAD and with HIV/TB, offering mechanistic insights that may support the development of precision biomarkers and immune-targeted therapies across these disease contexts.

Childhood-onset movement disorders are clinically and genetically heterogeneous, with over 500 implicated genes. Standard clinical genetic testing, including exome sequencing, has limited sensitivity for certain variants, including repeat expansions, structural variants (SVs), copy number variants (CNVs), and deep intronic changes. We evaluated the diagnostic utility of short-read whole genome sequencing (srWGS) and, in selected cases, long-read genome sequencing (lrWGS) in a real-world cohort of children and young adults with early-onset progressive movement disorders and prior nondiagnostic genetic testing. One hundred individuals (<30 years) with progressive movement disorders with a suspected genetic etiology were recruited from a tertiary pediatric movement disorders program. All had prior nondiagnostic testing. SrWGS (Illumina NovaSeq 6000) assessed single nucleotide variants (SNVs), CNVs, SVs, and repeat expansions; lrWGS (Pacific Biosciences) was applied to select unsolved trios. Variants were reviewed by a multidisciplinary team using standard variant interpretation guidelines and phenotype correlation. A molecular diagnosis was achieved in 27% (27/100) of cases, and candidate variants were identified in an additional 33% (33/100). Among solved cases, 81.5% (22/27) were identified from exome-level data, while 18.5% (5/27) required genome-level analysis to detect variants such as repeat expansions in HTT and FXN, an intragenic duplication in MECP2, an Alu insertion in ATM, and a deletion in FA2H. Genome-level analysis contributed an additional diagnostic yield of 5% (5/100) only. Notably, in 33.3% (9/27) of solved cases, variants had been previously reported but not recognized as diagnostic. LrWGS of 14 unsolved trios did not yield additional diagnoses. SrWGS provided a modest incremental yield over exome sequencing in early-onset movement disorders, with most diagnoses achieved through reanalysis of exome-level data. Findings highlight the importance of iterative variant interpretation and the need for improved analytic pipelines to fully realize the potential of genome sequencing.

BACKGROUND: Distal biceps tendon ruptures often require surgical repair to restore elbow flexion and forearm supination. However, the reinsertion procedure may be complicated by postoperative posterior interosseous nerve palsy caused by iatrogenic injury to the deep branch of the radial nerve (DBRN). While safe drilling trajectories for distal biceps tendon repair have been extensively studied, the potential influence of a bony gap between the insertion sites of the supinator muscle layers, referred to as the bare area of the proximal radius, has not been adequately addressed.

PURPOSE: To determine the frequency, morphometrics, and topography of the bare area and to propose a safe bicortical drilling trajectory for single-incision distal biceps tendon repair that minimizes the risk of injury to the DBRN in the context of the bare area.

STUDY DESIGN: Descriptive laboratory study.

METHODS: A cadaveric dissection of 100 formalin-fixed upper limbs was conducted. Additionally, 1000 dry radii were examined for an osseous groove corresponding to the bare area. Furthermore, 10 fresh-frozen elbows were used for assessment of safe bicortical drilling trajectories in the presence of the bare area.

RESULTS: The bare area was present in 56.0% of cases, with no significant side or sex predominance. The bare area was 13.7 ± 5.2 mm long and 5.1 ± 1.6 mm wide, and occupied an area of 58.7 ± 33.8 mm2. Direct contact between the DBRN and the periosteum of the radius was noted in 28.6% of specimens. The extent of an osseous groove corresponding to the bare area overlapped with the radial tuberosity in 28.5% of the cases. Experimentally, bicortical drilling directed 30° ulnarly and 45° proximally ensured a safe distance from both the DBRN and the bare area.

CONCLUSION: The frequent occurrence of the bare area should be a critical consideration during bicortical drilling for distal biceps tendon repair. Drilling angles directed ulnarly and proximally are recommended to minimize the risk of neural injury.

CLINICAL RELEVANCE: This study highlights the increased risk of DBRN injury during distal biceps tendon repair in individuals with the bare area and provides safe drilling trajectories to guide surgeons in reducing the likelihood of this neural injury.

Intensive care units (ICU) produce numerous progress notes that may contain stigmatizing language that perpetuate negative biases and punitive approaches against patients. Patients with substance use disorders are particularly vulnerable to stigma. This study examined the performance of Large Language Models (LLMs) in the identification of stigmatizing language. We annotated a dataset with over 77,000 stigmatizing and non-stigmatizing notes from the MIMIC-III database. We utilized Meta's Llama-3 8B Instruct LLM to run the following experiments for stigma detection: zero-shot; in-context learning; in-context learning with a selective retrieval; supervised fine-tuning (SFT); and keyword search. All approaches were evaluated on a held-out test set and external validation (University of Wisconsin Health System). SFT had the best performance with 97.2% accuracy, followed by in-context learning. The LLMs with in-context learning and SFT provided appropriate reasoning for false positives during human review. Both approaches identified clinical notes with stigmatizing language that were missed during annotation. SFT achieved 97.9% accuracy on external validation dataset. LLMs, particularly SFT and in-context learning, effectively identify stigmatizing language in ICU notes with high accuracy while explaining their reasoning in an asynchronous fashion and demonstrated the ability to identify novel stigmatizing language, not explicitly in training data nor existing guidelines.