Association of preoperative nocturnal hypoxaemia nadir and fentanyl ventilatory sensitivity in children with obstructive sleep apnoea undergoing general anaesthesia: multicentre clinical cohort study.

Background: Obstructive sleep apnoea (OSA) has been thought to increase the risk of respiratory depression from opioids. The primary aim of this study was to assess whether preoperative hypoxaemia by sleep study pulse oximetry imparts greater opioid sensitivity.

Methods: A multicentre observational cohort study with in-cohort dose randomisation was performed in children 2-8 yr of age with OSA undergoing adenotonsillectomy.

Association of Dietary Micronutrient Intake and the Metabolome in Children with Chronic Kidney Disease.

Background: Children with chronic kidney disease (CKD) experience poor growth and development via multiple mechanisms. We aimed to describe deficiencies in dietary micronutrient intake and associate dietary micronutrient intake with metabolic pathways.

Methods: The Chronic Kidney Disease in Children cohort study enrolled participants six months to 16 years with CKD stage 2-4 across North America.

Recalibrating Self-Assessment: Navigating Imposter Syndrome Through Metacognitive Reflection.

Background: Accurate self-assessment is foundational for life-long learning, professional development and patient safety, yet many learners struggle to develop this fundamental skill. Even skilled self-assessors-or savvy calibrators-may sometimes struggle with self-assessment accuracy, particularly during professional transitions and challenges. This study explored the metacognitive processes employed by high-performing physicians to maintain or recalibrate accurate self-assessment across diverse professional contexts.

Network dysfunction precedes neurodegeneration in a dox-regulatable TDP-43 mouse model of ALS-FTD.

Neuronal hyperexcitability is a hallmark of amyotrophic lateral sclerosis (ALS) but its relationship with the TDP-43 aggregates that comprise the predominant pathology in over 90% of ALS cases remains unclear. Emerging evidence indicates that TDP-43 pathology induces neuronal hyperexcitability, which may contribute to excitotoxic neuronal death. To characterize TDP-43 mediated network excitability changes in a disease-relevant model, we performed in vivo continuous electroencephalography monitoring and ex vivo acute hippocampal slice electrophysiology in rNLS8 mice (males and females), which express human TDP-43 with a defective nuclear localization signal (hTDP-43ΔNLS).

Increasing Rate of Unfilled Training Positions in the Advanced Heart Failure and Transplant Cardiology Match.

Advanced Heart Failure and Transplant Cardiology (AHFTC) is a vital subspecialty addressing the growing burden of heart failure and the increasing need for advanced therapies such as mechanical circulatory support and heart transplantation. Despite rising clinical demand, interest in AHFTC fellowship training appears to be declining. This study evaluated trends in applicants, training positions, match rates, and unfilled positions in the AHFTC match from 2020 to 2025.

The effect of TERT promoter mutation on predicting meningioma outcomes: a multi-institutional cohort analysis.

Background: Molecular aberrations have been incorporated into tumour classification guidelines of meningioma. TERT-promoter (TERTp) mutation is associated with worse prognosis and is designated a WHO grade 3 biomarker. However, it remains unclear whether TERTp mutation is context-dependent, with other co-occurring genetic alterations potentially driving its association with prognosis.

Single-Sample Confirmation of Positive Gonorrhea and Chlamydia Results Using the Roche Cobas CT/NG and Cepheid Xpert CT/NG Assays.

Background: Testing for sexually transmitted infections (STIs) in preadolescent patients carries significant medical and legal implications. Guidelines from the Centers for Disease Control and Prevention (CDC) support the use of nucleic acid amplification testing (NAAT) for diagnosis of Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) in children. These guidelines also recommend confirmation of positive results by repeat testing of either the original specimen or a separately collected specimen to reduce the risk of false positives.

Then and Now: Medical Therapy for Glaucoma.

There has been a remarkable evolution of medical therapy for glaucoma over the 4 decades since the founding of the American Glaucoma Society in 1985. The therapeutic landscape has undergone a transformation from limited, poorly tolerated treatment options to sophisticated patient-centered approaches that prioritize efficacy, convenience, and improved quality of life. This evolution was propelled not only by advances in pharmacological understanding and drug delivery innovation, but also by a growing recognition of how medication-related side effects contribute to nonadherence and the overall burden of disease.

The Community Health Workers and Mobile Health for Emerging Adults Transitioning Sickle Cell Disease Care (COMETS) Trial: Protocol for a Randomized Controlled Trial.

Background: Transitioning from pediatric to adult sickle cell disease (SCD) care is challenging for emerging adults (aged 17-25 years). This period is marked by a 7-fold increase in mortality rates and has the highest rates of hospitalizations, emergency room visits, and hospital readmissions compared with children living with SCD. These challenges are exacerbated by fragmented care coordination, difficulty navigating adult health care systems, and increased self-management responsibilities.

Pulmonary Vascular Compromise Is Associated With Survival in Pediatric Pulmonary Hypertension: A New Computational Model.

Pediatric pulmonary arterial hypertension (PAH) has a long asymptomatic period with progressive vascular loss. A recent computational model of simulated PAH in humans has demonstrated that up to 70% of the pulmonary vasculature is lost before clinical PAH criteria are met. We used this model in pediatric subjects with PAH to evaluate whether estimated pulmonary vascular loss or compromise (PVC) was associated with hemodynamic variables, survival, and other clinical outcomes.

The Founding and Future of the National Emergency Airway Registry for Pediatric Emergency Medicine (NEAR4PEM).

This Special Feature article accompanies the manuscript "Site-Level Variation in Tracheal Intubation in the Pediatric Emergency Department: A Report from the National Emergency Airway Registry for Pediatric Emergency Medicine (NEAR4PEM)" and provides background on the formation, structure, and future directions of the NEAR4PEM collaborative. Established in 2021 as a subgroup of the National Emergency Airway Registry for Children (NEAR4KIDS), NEAR4PEM is a rapidly growing multicenter registry and collaborative focused on advancing the science and practice of airway management in pediatric emergency settings. Participating sites prospectively collect data on pediatric tracheal intubations to characterize practice variability, support quality improvement initiatives, and inform educational efforts in airway management.

Positive Preprocedure Depression Screening Is Associated With Worse Outcomes After Single-Level Posterior-Only Lumbar Fusion: A Retrospective Cohort Analysis.

Background And Objectives: Major depressive disorder affects approximately 10% of all adults in the United States, but the condition remains underdiagnosed for patients with degenerative spine disease and radicular pain. The impact of comorbid undiagnosed depression on postoperative outcomes after lumbar fusion is not well characterized and may contribute to excessive health care utilization. This study isolates the relationship between undiagnosed depression, assessed by the Patient Health Questionnaire 2 (PHQ-2) screening tool, and short-term postoperative outcomes after single-level posterior lumbar fusion.

Do you Really Want to Know-Patient and Physician Attitudes of Physicians and English-Proficient Asian Patients toward Direct Release of Radiology Reports in Singapore.

In Singapore, there are plans to release radiological reports to patients directly, potentially before their physician clinic visits. While several studies have researched this policy in Caucasian-majority populations, there is scarce data for Asian-majority populations. This study aims to understand the perceptions of releasing radiological reports directly to patients before their clinic visit, by surveying physicians and patients at a major tertiary hospital in Singapore.

Long-term efficacy of migalastat in females with Fabry disease.

Background: Fabry disease is a progressive, X-linked lysosomal disorder caused by reduced or absent α-galactosidase A activity due to variants. Females with Fabry disease often experience diagnostic delays and an underappreciated disease burden owing to their variable disease presentation and progression.

Methods: We conducted a analysis of all females from the clinical studies FACETS (NCT00925301) and ATTRACT (NCT01218659) and their open-label extensions, assessing baseline characteristics and long-term efficacy of migalastat regarding cardiac and renal function and Fabry-associated clinical events (FACEs).

Site-Specific Adaptation of an Inpatient Patient Navigator Program at 2 Children's Hospitals.

Objective: The Family Bridge Program was developed at a single pediatric hospital to improve outcomes for hospitalized children from families of color, who are low income, or who speak a language other than English. The program uses a family navigator ("Guide") that supports families via 6 service domains: Language Access, Orientation to the Hospital, Communication Preferences and Coaching, Addressing Unmet Social Needs, Supportive Check-Ins, and Discharge Follow-Up. This study describes an analysis to translate the program to a second pediatric hospital.

A Quality Improvement Initiative to Reduce Underdosing of Rectal Diazepam as Home Seizure Rescue Medication After Hospitalization.

Background And Objectives: Seizure rescue medications are commonly prescribed to patients with epilepsy to treat and prevent clusters of seizures or status epilepticus. Underdosing of rescue medications decreases their efficacy, which may lead to status epilepticus and potentially avoidable emergency department (ED) visits or hospitalizations. In this quality improvement initiative, we aimed to reduce the rate of underdosed rectal diazepam prescriptions for children discharged from the inpatient neurology service at our institution from a baseline of 6% to 3% by July 2023.

Clinician Specialization in Skilled Nursing Facility Practice and Post-Acute Outcomes of Patients With Dementia.

Objective: To evaluate the effects of physician and advanced practitioner specialization in skilled nursing facility (SNF)-based practice (SNFists) on the outcomes of patients with Alzheimer's disease and related dementias (ADRD) admitted to SNF for post-acute care.

Study Setting And Design: Taking advantage of the natural experiment provided by the growth of SNFists, we conducted a within-SNF difference-in-differences analysis with cross-temporal matching. Our primary outcome was functional improvement at SNF discharge, measured using a validated activities of daily living (ADL) score.

In vitro acetyltransferase activity assays for N-terminal acetyltransferases.

N-terminal acetyltransferases (NATs) mediate co- and post-translational N-terminal protein acetylation to mediate essential protein functions, and their altered activities are linked to several diseases. Because of this connection of NATs to normal and abnormal cellular function, it is important to have assays available to evaluate NAT activity in vitro. This chapter outlines three in vitro assays for studying NAT activity: a sensitive radioactive method, and a scalable fluorescence-based approach and luminescence-coupled assay compatible with high-throughput screening.