Citations

BACKGROUND/OBJECTIVES Pediatric hospital medicine (PHM) is a growing field with a unique scholarly perspective and evolving role in academic leadership. Since the last systematic assessment of PHM research in 2009, predating subspecialty certification in 2016 and fellowship accreditation in 2020, the research infrastructure within PHM has not been reevaluated. We sought to assess the current state of PHM research by assessing the number, scope, and scholarly domains of research faculty, as well as research funding and support. METHODS Using the Pediatrics Research in Inpatient Settings Network, we distributed a cross-sectional survey to PHM group leaders across the United States and Canada. The 16-item instrument, adapted from prior PHM and adult hospital medicine surveys, assessed program demographics, faculty effort allocation, research support, funding, and scholarly domains. Surveys were distributed via REDCap with follow-up reminders. Descriptive statistics were used. RESULTS 49 programs responded (51% response rate), representing 1702 faculty (∼40% of US pediatric hospitalists). Fewer than half of programs (n = 21, 43%) reported faculty with more than 50% research effort. One-hundred and ninety faculty members (11%) had dedicated research time, and 72% of those conducting quality improvement research did so without any protected effort. Most PHM programs (n = 27, 55%) received less than $100 000 in total annual research funding. CONCLUSIONS Despite recent PHM subspecialty designation and pediatric hospitalist desire to conduct research, dedicated time and associated supports are uncommon in PHM groups. Improvements in the PHM research pipeline will require understanding institutional financial constraints and diversifying and strengthening research funding.

Abstract Effective filtration and concentration of stool specimens is an essential pre-analytical step for reducing fecal debris and improving organism recovery using microscopy-based ova and parasite (O&P) examination. This study evaluated three commercially available fecal sedimentation-based filtration/concentration systems – ParaPak SpinCon® (Meridian Bioscience), Mini Parasep SF® (Apacor), and the newly-available Paradevice® (Reingenuity) – for qualitative parasite detection and workflow logistics using conventional and artificial intelligence (AI)-assisted microscopy. Forty clinical stool specimens (20 parasite-positive and 20 parasite-negative) were processed with the 3 devices, and the resultant 120 wet mount and 120 trichrome-stained smear preparations were examined using conventional microscopy. Trichrome-stained slides were also scanned at 40x magnification using a Hamamatsu® NanoZoomerS360® flatbed digital slide scanner and images were analyzed using the Techcyte® Fusion Human Fecal Trichrome AI algorithm. Positive and indeterminate digital findings were confirmed by conventional glass slide microscopy. Slides and digital images were reviewed in a blinded manner. Concordance was assessed among the 360 initial evaluations (microscopy and AI-assisted), and discrepant parasitology results were resolved through re-review and specimen reprocessing as needed. Final qualitative agreement across slide/image evaluations using all three concentration systems was 100%. Minor discrepancies in protozoan and white/red blood cell detection/identification were noted in 5 and 7 cases, respectively, and likely reflected sampling and observer variability. While the three concentration systems produced equivalent qualitative results, the Paradevice® and Mini Parasep SF® offered the most streamlined workflows. These findings support the Paradevice® and Mini Parasep SF® as efficient, analytically equivalent systems that are compatible with traditional and AI-assisted O&P workflows. Importance Microscopy-based examination of stool specimens remains an important diagnostic tool for intestinal parasitic infections. Filtration and concentration methods improve test performance by increasing organism recovery and reducing obscuring fecal debris prior to evaluation. These methods may also facilitate the preparation of thin monolayer trichrome-stained slides for digital scanning and automated parasite detection. Because many clinical laboratories rely on commercial filtration and concentration systems, supply chain disruptions, product shortages, and manufacturer recalls threaten testing continuity, underscoring the need for validated alternatives. This study demonstrates that multiple commercially available concentration systems provide equivalent parasite detection while supporting both conventional microscopy and emerging digital workflows. These findings provide laboratories with evidence-based alternatives that enhance operational resilience without compromising diagnostic performance.

Summary Human spaceflight has historically been led by government agencies, but the emergence of commercial organizations is enabling broader participation and new research opportunities. In this study, we present a comprehensive molecular characterization of early human responses to spaceflight, leveraging multi-omics data across the first three weeks of two commercial missions. Biospecimens from six individuals, four from the Axiom 2 mission (10 days) and two from Axiom 3 (21 days), were analyzed using single-cell and bulk RNA sequencing, alongside proteomic profiling. Individual and integrative analyses of these datasets reveal systemic changes in cell types, transcripts, and proteins related to immune regulation, osteoclast differentiation, NF-κB signaling, and blood homeostasis pathways. Importantly, several of the detected pathways align with physiological patterns observed in longer-duration missions. This work establishes a foundational resource for understanding early adaptation to spaceflight at the cellular and molecular levels, providing insights to reduce future space-travel health risks. Highlights First integrated multi-omics analysis using single-cell, bulk RNA sequencing and proteomic profiling of early human spaceflight responses across two commercial missions (Ax-2 and Ax-3). Distinct PBMC clustering was observed across Ax-2 and Ax-3, and post-flight samples. It showed fewer monocytes, dendritic cells, and megakaryocytes with increased naïve CD4⁺ and cytotoxic T cells. Multi-omics integration identifies shared biological signatures, including osteoclast differentiation, metabolic stress, and coagulation changes. These findings lay the foundation for developing countermeasures to protect immune, skeletal, and vascular health during spaceflight.

Syndesmotic injuries are complex and often require a longer return to play as compared with lateral ankle sprains. As common as they are, they can be difficult to diagnose owing to the complex biomechanics of the ankle joint as well as their varying degrees of stability. A careful physical examination and dedicated imaging can assist with the diagnosis. Weightbearing ankle X-rays should be obtained to assess for fractures or gross instability with anteroposterior, lateral, and mortise views. If these are inconclusive but there is high clinical suspicion, stress views can be added. Advanced imaging also plays a role. Classification systems attempt to distinguish a stable, dynamically unstable, and unstable injury, as this guides management. Stable injuries can be treated conservatively and unstable injuries warrant surgical intervention. It is the diagnosis and treatment of unstable injuries that can be particularly challenging.

Prehabilitation with Impella 5.5 offers hemodynamic support while allowing early mobilization, yet its overall effect on post-transplant recovery remains unclear. The aim was to assess recovery during Impella 5.5–supported prehabilitation and determine its association with early post-heart transplant outcomes, including a potential dose–response relationship with ambulatory activity. We conducted a single-center retrospective cohort study of adults bridged to transplant with Impella 5.5 between April 1, 2022 and September 30, 2024. Daily walking distance, recorded by nursing staff, served as the intervention. Primary outcome was postoperative hospital length of stay (LOS); the secondary outcome was time to extubation. Fine–Gray competing-risk models, adjusted for age, Sequential Organ Failure Assessment (SOFA) score, New York Heart Association (NYHA) class, and days of Impella support, assessed associations. Longitudinal recovery trajectories were analyzed with linear mixed-effects models incorporating restricted cubic splines. Among 82 eligible patients, 65 met the inclusion criteria. Patients who walked farther during Impella 5.5 support in the intensive care unit (ICU) had shorter hospital stays and were taken off the ventilator sooner after transplantation. The overall recovery peaked during the first 2–3 weeks of support, with smaller recovery thereafter, indicating that most functional recovery occurred early during prehabilitation.

Acute lymphoblastic leukemia (ALL) is the most common pediatric cancer, arising from both B and T cell lineages (B-ALL and T-ALL). Current therapy exploits ALL cells’ low expression of asparagine synthetase (ASNS) by using L-asparaginase, a bacterial enzyme that depletes circulating asparagine. However, resistance can emerge through induction of ASNS, mediated in part by the amino acid stress sensor GCN2. In this study, we addressed the efficacy of L-asparaginase in combination with genetic or pharmacological inhibition of GCN2 and the ASNS inhibitor ASX-173. Using a Kras G12D -driven mouse model of T-ALL, we found that GCN2 is dispensable for leukemogenesis. However, genetic inactivation or pharmacologic inhibition of GCN2 sensitized ALL cells to asparagine depletion, correlating with impaired ASNS induction. While GCN2 targeting enhanced sensitivity to asparagine depletion, a subset of Gcn2 –/– T-ALL cells retained high ASNS expression and remained resistant to L-asparaginase. Likewise, some human T-ALL cells with elevated ASNS levels were refractory to GCN2 inhibition even under asparagine-depleted conditions. When combined with L-asparaginase, ASX-173 effectively eliminated ASNS hi leukemic cells in vitro and in vivo. These findings suggest that direct targeting of ASNS provides therapeutic benefit in leukemias that express high levels of ASNS and are resistant to GCN2 inhibition under asparagine-depleted conditions.

This cohort study evaluates 20-year trends to quantify changes in menopause-related online searches compared with other health domains.

Abstract Introduction The EROS (Erectile Restoration Outcomes and Satisfaction) registry provides prospective, questionnaire-based follow-up after IPP, established in 2020. Objective We sought to assess general trends in the open-ended responses portion of the questionnaire. Methods Data were collected from 2020 to 2025, with a total of 568 responses. The survey included six open-ended questions pertaining to lifestyle change since IPP, reasons not to repeat the procedure, impediments to use, dissatisfaction, what patients wish they had known more about the procedure, and other recommendations. Evaluable data included 6-month responses from Rochester, Jacksonville, and Phoenix. Results Open-ended feedback was given by 66% of patients on what they wished they had known, 54% gave other recommendations, 38% gave lifestyle feedback, 7% elaborated upon reasons not to use, 3% on reasons for dissatisfaction, and 2% on reasons they would not repeat IPP. There was an overall very positive response (“Significant Improvement”, n=74.3%) from those who underwent the IPP placement, with some patients reporting that it was far more convenient than other forms of treatment, and even increased spontaneity in their sexual lives, leading to improved relationships. Among the reported responses are increased confidence (n=39.4%), increased sexual activity (n=13.3%), and improved health and exercise levels (n=6.6%). When questioning patients about why they would not repeat the procedure and what their sources of dissatisfaction were, among those who responded to each question (n=12, n=16), the most frequently reported complaint was the exaggeration of pre-existing curves (n=41.7%, n=25.0%), particularly due to Peyronie’s disease. When questioned about what prevents use, the main responses were partner-related or due to personal problems (n=45.2%). The patients did not have many recommendations, but hoped for a better way to deflate and inflate the device (n=20.4%) and reported adequate pre-operative education and use of the pump. The table below outlines the categories of responses and the percentage of each keyword reported per question type. Conclusions In addition to standard pre-operative IPP counseling, providers should also focus on potential difficulties with device inflation/deflation, length loss (IPP not in the glans), pain/ recovery expectations, the potential for new or worsened curve (erect or flaccid), and potential changes in sensation. IPP satisfaction is high, as only 2% of patients gave responses on why they would not repeat the IPP, with many men expressing an increased level of overall confidence. Disclosure No