Citations

ABSTRACT Objective This study aims to explore whether racial identity or socioeconomic status (SES) is associated with growth trajectory before and after palatoplasty. Methods This study was a single‐site retrospective chart review at a tertiary pediatric hospital. This study involved children with cleft palate repaired between 2006 and 2022. Primary outcomes were changes in growth trajectories before and after palatoplasty stratified by race and median neighborhood income (MNI) as a measure of SES. Results In the data query, 187 and 149 patients met the inclusion criteria for the racial identity and MNI analyses, respectively. The median pre‐ and post‐surgical weekly weight gain was 0.11 kg/wk. and 0.05 kg/wk. for patients who are BIPOC (Black, Indigenous, and People of Color) ( p = < 0.0001), and 0.12 and 0.07 kg/wk. for patients who are White ( p = < 0.0001). Change in median growth percentile following palatoplasty was significant for patients who are White but was not significant for patients who are BIPOC. MNI displayed a significant relationship with weekly weight gain and growth percentile changes following palatoplasty. Conclusion Patient racial identity is associated with clinically meaningful differences in growth trajectory outcomes following palatoplasty. While growth outcomes may differ across MNI, living in areas with higher MNI does not directly translate to improved growth trajectories following palatoplasty. Addressing all social determinants of health in this population is critical, but interventions should focus on supporting racial minorities as they experience the most significant disparities. Level of Evidence 3.

Adoptive cell therapy (ACT) has shown remarkable success in the treatment of some malignancies, particularly leukemia. However, there are multiple factors that limit the durability of ACT in solid tumors, including dose-limiting toxicities, the immunosuppressive tumor microenvironment, and T-cell exhaustion. As the manufacture and preparation of adoptive T-cell therapies allows time and adequate conditions for ex vivo T-cell engineering, forward genetic screens can identify novel genetic targets that could improve their effectiveness. CRISPR is a commonly used functional genomics tool that has been successfully used to both enhance our understanding of mechanisms of resistance and to discover potential genetic edits to improve ACT. A complementary approach, Sleeping Beauty transposon mutagenesis provides additional opportunities to identify novel genetic edits without being constrained by the annotated human genome. Here, we summarize forward genetic screens and their tools to uncover strategies to enhance ACT. Complementary approaches can be combined and improved on to identify translatable genetic editing strategies through studies that accurately recapitulate disease-specific challenges.

Abstract Background: For large language models (LLMs) to reach their potential as information technology tools that make medication use safer, clinically relevant benchmarks capable of automated grading and designed specifically to measure the performance of LLMs for medication tasks are required. The purpose of this study was to design a suite of benchmarking tests reflective of Comprehensive Medication Management (CMM; the standard of care for medication optimization) and quantify the baseline performance of the latest LLMs. Methods: We established six benchmarks representing critical stages of the CMM process: drug formulation matching, drug order (sig) generation, drug route matching, drug-drug interaction identification, renal dose identification, and drug-indication matching. For each benchmark, we curated a clinician-annotated dataset comprising 250 standardized input-output pairs including both inpatient and outpatient medications. We evaluated the clinical knowledge retrieval capabilities of three LLMs: GPT-4o-mini, MedGemma-27B, and LLaMA3-70B. We employed a zero-shot prompting strategy, excluding in-context examples, to assess the models’ internal clinical knowledge rather than their few-shot learning potential. To check reliability, each model was run three times using a temperature of 0.7 (a mid-range value of an LLM setting controlling text generation randomness). Performance was assessed using task-specific evaluation metrics including precision (positive predictive value), recall (sensitivity), F1-score, accuracy, and correctness consistency across trials. Results: Across six benchmarks, LLaMA3-70B demonstrated the highest performance in four tasks: drug-formulation matching (F1, 54.0% [95 CI: 50.1-58]), drug-order generation (accuracy, 88.0%), drug-route identification (F1, 74.3% [95 CI: 71-78]), and drug-indication identification (accuracy, 97.6% [95 CI: 95.6-99.2]). In the drug–drug interaction task, GPT-4o-mini achieved the highest overall accuracy (70.4% [95 CI: 64.8-75.7]). For renal dose–adjustment identification, GPT-4o-mini demonstrated the highest F1 score (83.3% [95 CI: 77.6-88]). Correctness-consistency scores ranged from 8.0% to 97.6% across benchmarks, with no model exhibiting uniformly superior consistency. Conclusions: Model performance varied substantially across medication-related tasks. LLaMA3-70B demonstrated promising baseline performance in tasks involving formulation, ordering, route, and indication. GPT-4o-mini showed potential advantages in drug–drug interaction detection and renal dose adjustment. These findings underscore the need for task-specific evaluation when deploying models for medication-focused clinical decision support.

Background: Differences in total daily energy expenditure (TDEE) across sports, sex, and skill level support the need for sport- and athlete-specific energy intake recommendations. The purpose of the current review was to examine TDEE and related markers of energy expenditure across field-based team sports. A secondary aim was to evaluate physical activity levels (PAL), calculated as TDEE divided by resting metabolic rate (RMR), and their utility in estimating energy needs within team sports. Methods: The review was limited to studies that included the field-based team sports of rugby or soccer and reported energy expenditure data using doubly labeled water (DLW). A literature review identified 11 studies meeting criteria. Weighted means (Xw) and standard deviations (SDw) were calculated for each variable when pooled across each sport category. Results: Rugby (4417 ± 654 kcal·d−1) had a higher average TDEE than soccer (3157 ± 331 kcal/day; p < 0.001). When normalized to body mass, rTDEE was similar between sports (rugby: 49.5 ± 1.3 kcal·kg−1·day−1; soccer: 49.3 ± 1.8 kcal·kg−1·day−1; p = 0.967). PAL values were significantly higher in rugby (2.2 ± 0.4) compared to soccer (1.7 ± 0.2; p = 0.004). RMR was also greater in rugby (2136 ± 322 kcal·d−1) compared to soccer (1835 ± 208 kcal·d−1; p = 0.04). Conclusions: Rugby athletes exhibited higher TDEE values than soccer athletes, reflecting greater absolute energy demands. However, similar relative TDEE values suggest that differences in body size and composition likely contribute to the observed differences in absolute expenditure. These findings underscore the importance of individualized nutrition strategies within team sports and highlight PAL as a useful metric to contextualize energy requirements.

ABSTRACT Background Electrical storm (ES) is a life‐threatening manifestation of recurrent ventricular arrhythmia. While anti‐arrhythmic drugs (AADs) have historically been the first‐line treatment, the role of catheter ablation (CA) as an initial therapy in ES remains incompletely defined. This meta‐analysis evaluates the efficacy and safety of radiofrequency CA compared to escalating medical therapy in patients with ES. Methods A systematic search of PubMed, Science Direct, and Cochrane databases was conducted for studies published from 2010 to 2025 that compared CA with medical therapy as first‐line treatment for ES. Outcomes of interest included ES recurrence, ventricular arrhythmia recurrence, in‐hospital mortality, procedural complications, and follow‐up survival. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random‐effects models. Results Six studies encompassing 963 patients (473 CA, 490 medical therapy) were included. The mean age was 67.8 years, and 87.7% were male. The mean left ventricular ejection fraction was 33%, and ischemic cardiomyopathy was present in 77.5% of CA and 72.1% of MT patients. CA reduced the risk of ES recurrence by 71% compared to medical therapy (OR: 0.29; 95% CI: 0.15–0.53; p < 0.001; I ² = 53%). Recurrence of any ventricular arrhythmia, in‐hospital mortality, and long‐term survival were also significantly improved with CA. Conclusion This meta‐analysis suggests that CA is associated with lower ES and VA recurrence and in‐hospital mortality and improved survival compared to medical therapy alone. These findings support consideration of catheter ablation as a first‐line strategy. Larger prospective trials are needed to confirm these findings and guide patient selection.

Abstract Using the US National Inpatient Sample, we analyzed 424,540 adult hospitalizations for sickle cell crisis (SCC) from 2016–2020 to quantify cardiovascular comorbidities and their associations with in-hospital mortality. The cohort (mean age 32.4 years; 55.4% female) was predominantly Black (93.0%) and socioeconomically disadvantaged (51.1% lowest income quartile); most admissions occurred at urban teaching hospitals (82.1%). Age showed a monotonic relation with mortality (multivariable HR per year 1.04, 95% CI 1.03–1.05). In adjusted models, six cardiovascular factors independently predicted higher mortality: systolic heart failure (HR: 2.0; 1.35–2.96), atrial fibrillation/flutter (HR: 1.58; 1.08–2.30), ischemic stroke (HR: 3.25; 1.85–5.71), right ventricular failure (HR: 3.14; 1.46–6.75), pulmonary embolism (HR: 5.61; 3.78–8.33) and acute coronary syndrome (HR: 3.70; 2.30–5.95) (All p<0.01). By contrast, chronic coronary artery disease was inversely associated with mortality (adjusted OR 0.41, 0.23–0.74, p<0.01), a paradoxical pattern that likely reflects index-event (collider) bias, treatment confounding, or differential specialty follow-up and warrants prospective adjudication. Compared with White patients, Black patients had lower adjusted in-hospital mortality (HR 0.44, 0.21–0.94, p = 0.03). Our findings prioritize thrombo-ischemic and rhythm/pump failure phenotypes as high-yield targets for risk stratification and crisis-time management, and they motivate integrated cardio-hematologic strategies and prospective validation.

Background: Previous research has demonstrated that moderate-intensity inspiratory muscle training (IMT) improves inspiratory strength and exercise performance in athletes, but the impact of high-intensity IMT on inspiratory strength in healthy adults is unclear. The purpose of this study was to compare the effects of high-intensity versus moderate-intensity IMT on inspiratory strength and VO 2 peak in healthy adults. Methods: Twenty-six adults enrolled in this double-blinded randomized controlled trial. Participants completed an inspiratory strength assessment through S-Index and VO 2 peak testing before randomization into a moderate-intensity or high-intensity group. Participants in both groups performed IMT to 40 repetitions or task failure once per day, 5 times per week for 8 weeks. IMT intensity was 50% and 80% of pretraining S-Index for the moderate-intensity and high-intensity groups, respectively. S-Index and VO 2 peak testing were repeated at the end of the trial. Repeated measures ANOVA were used to assess differences of pretraining and post-training S-Index and VO 2 peak between groups. Results: A significant increase in mean (SD) S-Index from pretraining to post-training was present for both moderate-intensity (7.6% (8.9), P = .001) and high-intensity (10.8% (11.7), P < .001) groups. No significant group ( P = .88) or interaction ( P = .44) effects existed for S-Index. There were no significant main effects for group, time, or interaction for VO 2 peak ( P > .05 for all). Conclusions: Both moderate-intensity and high-intensity IMT to task failure in healthy adults led to significant improvements in inspiratory strength. No effects were observed in either group on changes in VO 2 peak. Given that moderate-intensity and high-intensity IMT to task failure were both effective at improving inspiratory strength in healthy adults, training intensity at less intense, moderate levels can be used to achieve similar strength gains.

Abstract Fields, JB, Jones, MT, Kitts, SE, King, EL, and Jagim, AR. Relationships between disordered eating, body dissatisfaction, and low energy availability in women collegiate athletes. J Strength Cond Res 40(2): e164–e171, 2026—Women collegiate student-athletes face unique challenges regarding nutrition, body image, and athletic performance, increasing their risk for low energy availability (LEA), disordered eating (DE), and body dissatisfaction (BID). However, limited data exist exploring LEA, DE, and BID across a variety of women's sports. Therefore, the purpose of this study was to evaluate the prevalence of and relationships among LEA risk, DE behaviors, and BID in women collegiate athletes from multiple sports. Division I, II, and III women student-athletes ( n = 115) participated in this cross-sectional, descriptive study. Athletes completed the low energy availability for females questionnaire (LEAF-Q), eating attitudes test (EAT-26), muscularity-oriented eating test (MOET), and body dissatisfaction items from the eating disorder examination questionnaire (EDE-Q) to assess LEA risk, DE behaviors, and BID, respectively. Sixty-four percentages of athletes were at risk for LEA, with the highest prevalence in volleyball (100%), wrestling (68%), lacrosse (67%), and cross country (57%). However, only 8% of athletes were classified at risk for eating disorders. Notably, 81 and 84% of athletes reported body weight and shape dissatisfaction, respectively, which was strongly associated with disordered eating behaviors (EAT-26: r = 0.707; MOET: r = 0.723, p < 0.001). These results show a high prevalence of LEA risk and BID across athletes, with DE behaviors strongly linked to body image concerns. Despite a high LEA risk among athletes, clinical eating disorder risk remained low, suggesting that undereating may often be unintentional. Targeted interventions focused on nutritional education, body image, and psychological support are critical for improving health and performance outcomes among collegiate women student-athletes.

Malignant transformation of intracranial nongerminomatous germ cell tumors (NGGCTs) is a rare but clinically relevant phenomenon. We present the case of a 13-year-old boy with a localized, pineal NGGCT. After an initial favorable response, tumor growth was noted while still on chemotherapy. Histopathologic characterization revealed that 40% of the tumor was embryonal rhabdomyosarcoma (RMS), consistent with potential malignant transformation. Due to the rare nature of NGGCT malignant transformation, the best clinical approach to these cases remains unclear. We explore existing cases, treatments, and outcomes of malignant transformation in intracranial NGGCTs to help inform future clinical decision-making and the establishment of treatment guidelines.