Citations

Background Microsurgery is a critical component of plastic and reconstructive surgery. However, the high cost of training and equipment pose significant barriers, particularly in resource-limited settings. To address this challenge, the Microsurgery and Regenerative Medicine Lab within the Division of Plastic Surgery at the University of Wisconsin developed a low-cost, 3D-printed surgical microscope. This study qualitatively appraised the use of this novel microscope for microsurgery training by surveying surgeons about their experiences using this tool relative to traditional magnification methods. Methods In this prospective, multi-institutional appraisal study, surgical residents, fellows, and attending surgeons with varying microsurgical experience performed a single end-to-end microsurgical anastomosis on chicken thigh femoral arteries using the 3D-printed microscope. Participants then completed a survey assessing ease of use, adequacy for microsurgical training, educational value, and perceived impact on teaching capacity in local and global settings. Results Over 80% of participants reported that performing an end-to-end anastomosis was easier or equivalent using the 3D-printed microscope compared to surgical loupes. All respondents expressed willingness to use the device for microsurgery teaching and practice. Additionally, 91.7% (33/36) believed access to the microscope would enhance microsurgical teaching at their home institutions, and 97.1% (34/35) felt it would improve teaching capacity in globally. Qualitative feedback was overwhelmingly positive, with suggestions primarily related to ergonomics and lighting. Conclusion This study supports that this low-cost, 3D-printed microscope is an effective microsurgical training tool. Ongoing design refinements informed by user feedback may further optimize its role in expanding access to microsurgery education worldwide.

Obstructive sleep apnea (OSA) is a common, heterogeneous disorder managed through a multidisciplinary pathway that connects recognition, physiologic testing, treatment selection, specialty referral, insurance coverage, and longitudinal reassessment. This narrative review provides a clinically oriented, system-level overview of the adult OSA care ecosystem in the United States for an international clinical audience, with particular emphasis on the evolving role of otolaryngology. We describe the organization and complementary functions of sleep physicians, otolaryngologists, dentists, and allied health professionals. We also outline the roles of polysomnography and home sleep apnea testing, along with major therapeutic pathways including positive airway pressure, oral appliance therapy, weight management, upper-airway surgery, and neurostimulation. Otolaryngology provides an important interface between physiologic diagnosis and airway-specific treatment by integrating anatomic evaluation, sleep-state airway phenotyping, intervention selection, and post-treatment reassessment. Recent advances in neurostimulation, pharmacologic weight management, wearable and home-based monitoring, airflow analysis, and artificial intelligence are expanding opportunities for accessible and phenotype-informed care. Important challenges include underdiagnosis, treatment attrition, fragmented transitions, variable coverage, and reliance on the apnea–hypopnea index. Although health-care structures differ internationally, multidisciplinary coordination, individualized treatment selection, and longitudinal reassessment provide broadly applicable principles for developing patient-centered OSA programs.

Abstract Backgrounds Isolated REM sleep behaviour disorder (iRBD) is a prodromal marker of α-synucleinopathies. Although cognitive impairment is consistently reported in iRBD, its assessment varies considerably across studies. This study characterized mild cognitive impairment (MCI) patterns in iRBD using machine learning and identified the minimal neuropsychological test battery needed for accurate diagnosis. Methods Comprehensive neuropsychological data from 216 assessments (162 with MCI, 54 without) in 110 iRBD patients were analysed. Four supervised classifiers (logistic regression, support vector machine, random forest, gradient boosting) were trained across three frameworks (raw scores, raw scores plus demographics, binarized scores) to distinguish MCI status. A multi-objective hyperparameter optimization approach then identified the minimal test subset preserving diagnostic accuracy. Results Of MCI cases, 30% were single-domain and 70% multi-domain, with attention/executive functions and memory most frequently impaired. Binarized neuropsychological scores yielded the best classification performance, with support vector machine achieving 94.7% accuracy. Feature importance analyses consistently highlighted episodic memory, executive, and visuospatial measures. The optimization framework identified a mean of 8 informative tests spanning these domains, achieving comparable diagnostic accuracy to the full battery. Conclusions Cognitive impairment is common in iRBD and predominantly multidomain. Machine learning approaches applied to neuropsychological data can accurately classify MCI status and identify a concise, clinically feasible set of tests with high diagnostic value. These findings support comprehensive, multidomain neuropsychological assessment in iRBD and may inform optimized risk stratification in prodromal α-synucleinopathies.

The chemotherapeutic 5‐fluorouracil (5‐FU) is commonly used to treat solid tumors, especially colorectal cancer. Deleterious variants in DPYD, which encodes dihydropyrimidine dehydrogenase (DPD), are strongly associated with severe and potentially lethal 5‐FU toxicity. Phenotypic assays for DPD function have been proposed as alternative or complementary approaches to identify DPD deficiencies with the rationale that they may capture unrecognized causes. These assays include the direct measurement of DPD activity in peripheral blood mononuclear cell (PBMC) lysates and measuring plasma metabolites uracil (U), dihydrouracil (UH 2 ), and the dihydrouracil/uracil (UH 2 :U) ratio. We evaluated correlations between PBMC DPD activity and plasma metabolite measures in matched samples from 203 patients with available DPYD exome sequencing data. We also compared the ability of phenotypic measures to identify carriers of deleterious DPYD variants. In addition to established high‐risk variants, we identified three rare DPYD variants predicted to be deleterious: c.274C>G, c.966C>A, and c.1435G>A. Collectively, these variants were associated with impaired DPD function with effect sizes comparable to well‐studied toxicity‐associated variants. At the population level and within carriers of specific genotypes, weak but significant correlations were observed between PBMC DPD activity and either UH 2 :U ratio or U level. These findings suggest that although phenotypic assays can detect severe DPD deficiency, high variability limits their utility as standalone diagnostic tools. Integration with genetic testing may provide a more robust pretreatment risk assessment strategy.

Background & Aims: We examined treatment patterns and clinical outcomes in a contemporary cohort of children with newly diagnosed inflammatory bowel disease (IBD) in a large, commercially insured U.S. population. Methods: Using the OptumLabs® Data Warehouse, we created an inception cohort of physician-diagnosed IBD in children aged 6–17 years between 2007–23. We examined cumulative incidence of hospitalization, surgery, safety events, and medication use in patients with Crohn's disease (CD) and ulcerative colitis (UC), overall and stratified by diagnostic era, race and ethnicity, sex, and age at diagnosis. Results: Among 787 children with newly diagnosed CD (age at diagnosis, 13.4±2.9y; 57% male; 82% White, 5% Black, 7% Hispanic) followed over mean 4.6±3.0y, 5-year risk of IBD-related hospitalization and major surgery was 30% and 10%, respectively. In children diagnosed in 2019–23, 1-year cumulative use of corticosteroids and advanced therapy was 46% and 75%, respectively; advanced therapy use increased significantly over time (aHR, 3.43 [95% CI, 2.71–4.32] for 2019–23 vs. 2007–12), while corticosteroid use declined (0.67 [0.53–0.84]). Risk of IBD-related hospitalization was lower in children diagnosed between 2019–23 (0.65 [0.43–0.97]) compared with those diagnosed between 2007-12; surgical risk did not decline significantly, with confidence intervals compatible with a clinically meaningful reduction. Among 399 children with newly diagnosed UC (age at diagnosis, 14.0±3.0y; 53% male; 78% White, 5% Black, 7% Hispanic) followed over 4.5±3.0y, 5-year risk of IBD-related hospitalization and colectomy was 36% and 8%, respectively. Advanced therapy use increased significantly over time (4.46 [2.85–6.98] for 2019–23 vs. 2007–12), with no significant change in hospitalization or surgical risk across eras. No consistent racial and ethnic, age, or sex differences in advanced therapy use or clinical outcomes were identified in either CD or UC. Conclusions: In a contemporary cohort of commercially insured children with newly diagnosed IBD, early advanced therapy use has increased markedly over time. Surgical risk did not decline significantly in either disease; however, the study was not powered to exclude a clinically meaningful reduction, and these findings are hypothesis-generating rather than conclusive.

Background African American adults experience a disproportionate burden of dementia, shaped by structural and clinical factors that remain unclear. Objective To quantify associations between multimorbidity, polypharmacy, and cognition in the context of neighborhood disadvantage. Methods This study is a cross-sectional analysis of 348 African American adults aged 45–92 years (mean 64.3 years; 73.6% female) from the Aging Research Characterizing Health Exposome via Social drivers (ARCHES) cohort. Comorbidity burden was assessed using a modified Charlson Comorbidity Index (CCI), polypharmacy as ≥5 medications, and neighborhood disadvantage using the Area Deprivation Index (ADI). Linear regression estimated associations with a Preclinical Alzheimer’s Cognitive Composite (PACC). The polypharmacy model included modified CCI as a covariate, and effect modification by ADI was assessed using an interaction term between polypharmacy and ADI. Results Higher modified CCI was associated with lower cognitive performance (B = −0.071; 95% CI: −0.130, −0.012). Polypharmacy was not independently associated with cognition after modified CCI adjustment (B = −0.081; β = −0.057; p = 0.257). No significant ADI interaction was found (p = 0.064).

ABSTRACT Background Intrathecal opioids are widely used for postoperative analgesia in pediatric spine surgery, but optimal dosing remains undefined. We evaluated the relationship between intrathecal hydromorphone (ITH) dose, analgesia, and adverse effects in adolescents undergoing posterior spinal fusion (PSF). Methods In this single‐center, prospective, blinded dose‐escalation study using a biased‐coin up‐down sequential allocation design, patients aged 10–17 years undergoing PSF received ITH starting at 3.5 mcg kg −1 , with dose adjustments based on analgesic response (range 2.0 to 7 mcg kg −1 with a maximum of 400 mcg). The primary outcome was maximum postoperative pain within 18 h. Secondary outcomes included pain burden (area under the curve), 24‐h systemic opioid consumption (oral morphine equivalents [OME], excluding ITH), adverse effects, supplemental diazepam use, and rescue opioid use. Associations between dose and outcomes were assessed using Spearman correlation and logistic regression. Results Twenty‐seven patients completed the study. The median ITH dose received was 5.5 mcg kg −1 (IQR, 3.5–7.0), with a median absolute dose of 370 mcg (IQR, 180–400). No significant association was observed between ITH dose and maximum pain ( r = 0.16, p = 0.41), pain burden ( r = 0.32, p = 0.10), or 24‐h OME ( r = 0.13, p = 0.52). ITH dose was not significantly associated with the time to rescue opioid (HR = 1.24; 95% CI 0.68–2.25; p = 0.485) or diazepam (HR = 1.10; 95% CI 0.72–1.71; p = 0.655). Adverse respiratory events occurred at doses > 5 mcg kg −1 without improved analgesia. Conclusions Increasing ITH dose was not associated with improved analgesia or change in supplemental opioid or diazepam use. Doses > 5 mcg kg −1 were associated with adverse respiratory effects. These findings support conservative dosing strategies and underscore the need to define the minimum effective dose in pediatric populations.