Faculty Bibliography

Animals need daily intakes of three macronutrients: sugar, protein, and fat. Under fasted conditions, however, animals prioritize sugar as a primary source of energy. They must detect ingested sugar-specifically D-glucose-and quickly report its presence to the brain. Hypothalamic neurons that can respond to the caloric content in the gut regardless of the identity of macronutrient have been identified, but until now, the existence of neurons that can encode the specific macronutrients remained unknown. We found that a subset of corticotropin-releasing factor (CRF)-expressing neurons in the hypothalamic paraventricular nucleus (CRF^PVN) respond specifically to D-glucose in the gut, separately from other macronutrients or sugars. CRF^PVN neuronal activity is essential for fasted mice to develop a preference for D-glucose. These responses of CRF^PVN neurons to intestinal D-glucose require a specific spinal gut-brain pathway including the dorsal lateral parabrachial nuclei. These findings reveal the neural circuit that encodes the identity of D-glucose.

OBJECTIVES/OBJECTIVE:Achalasia is an esophageal motility disorder that impairs quality of life and is often missed (20-50%) on endoscopy. A newly developed computer-aided detection (CAD) software has shown high accuracy for achalasia diagnosis in preclinical settings. However, its benefit in a clinical setting remains unclear. METHODS:Between February and August 2023, 83 endoscopists from 27 centers assessed 50 randomized endoscopic videos (25 achalasia, 25 nonachalasia) without and with CAD. Endoscopists assessed videos without CAD, then with CAD after 2 months. The primary end-point was improvement in sensitivity for nonexperienced endoscopists (no endoscopic experience of achalasia). Sensitivity, specificity, and accuracy with and without CAD were compared using the McNemar test. RESULTS:Sensitivity for diagnosing achalasia increased significantly with CAD, rising from 74.2% (95% confidence interval [CI] 72.2-76.0%) to 91.2% (95% CI 89.9-92.4%) for all readers, showing a difference of 17.1% (95% CI 15.1-19.0%). Specifically, sensitivity improved from 66.9% (95% CI 63.6-70.0%) to 91.9% (95% CI 89.9-93.6%) among nonexperienced endoscopists, resulting in a difference of 25.0% (95% CI 21.7-28.4%), and from 79.5% (95% CI 77.1-81.8%) to 90.8% (95% CI 89.0-92.3%) among experienced endoscopists (endoscopic experience of at least one achalasia case), with a difference of 11.3% (95% CI 8.9-13.6%). Accuracy and specificity improved significantly with CAD assistance, regardless of reader's experience. CONCLUSION/CONCLUSIONS:CAD improves achalasia detection by 17%, confirming preclinical results. The benefit was higher for nonexperienced endoscopists. CAD assistance may lead to prompt and effective treatment, minimizing the risk of false-negative diagnosis in clinical practice. TRIAL REGISTRATION/BACKGROUND:This study was registered in the University Hospital Medical Information Network Clinical Trial Registry (https://www.umin.ac.jp/ctr/) number: UMIN000053047.

BACKGROUND:Febrile seizures occur in 3%-4% of US children aged six months to five years and are considered benign. However, sudden unexplained death in childhood is associated with 10 times increase in febrile seizures. We assessed the characteristics of children with febrile seizure and sudden death to identify factors that confer increased sudden death risk. METHODS:We conducted a case-control analysis of children with febrile seizure and subsequent sudden death versus living controls from December 2021 to June 2023 through an ∼10-minute anonymous online survey. We enrolled parents of children, living or deceased, whose child had experienced a febrile seizure from age six months to six years. Subjects were excluded if the child had an afebrile seizure or parents had not witnessed a febrile seizure. Demographic characteristics, parasomnias, and febrile seizure features were analyzed. RESULTS:A total of 381 completed surveys were received; 53 (14%) cases of febrile seizure with sudden death and 328 (86%) living controls. Cases reported febrile seizure onset >2 months earlier (P = 0.013) and reported developmental concerns (odds ratio [OR] = 2.32, 95% confidence interval [CI] [1.14, 4.71], P = 0.03), less frequent night awakenings (OR = 0.34, 95% CI [0.18, 0.65], P = 0.001), and less restless sleep (OR = 0.37, 95% CI [0.16, 0.85], P = 0.02). Cases were also less likely to drool (OR = 0.442, 95% CI [0.218, 0.900], P = 0.032) or be unresponsive for more than one minute (OR = 0.45, 95% CI [0.238, 0.854], P = 0.021). CONCLUSIONS:We report novel associations of febrile seizure and sudden death related to age, development, sleep, and observed ictal features. Anonymous survey methodology cannot exclude ascertainment bias and any related potential effect on results. Our findings suggest that impaired arousal mechanisms may increase risk of death in subjects with febrile seizure.

BACKGROUND:Temporary epicardial pacing wires (TEPWs) are commonly used for postoperative arrhythmia management in cardiac surgery. Although generally safe, they can cause rare complications, including migration years after placement. CASE SUMMARY/METHODS:A 59-year-old man with a history of cardiac arrest and acute myocardial infarction requiring urgent coronary artery bypass grafting 2 years prior presented with new-onset dysphagia and odynophagia. Full workup and imaging revealed a migrated TEPW embedded in the right external carotid artery. The wire was successfully removed using advanced endovascular techniques, providing immediate symptom relief. DISCUSSION/CONCLUSIONS:This rare case of a retained TEPW highlights the importance of "thinking outside the box." Combinatorial analysis, which combines medical knowledge with comprehensive data from numerous simple observations, tests, and procedures, guided us to the optimal treatment for our patient. TAKE-HOME MESSAGE/CONCLUSIONS:Clinicians should maintain vigilance for delayed TEPW complications and consider alternatives that reduce long-term risks associated with retained wires.

The rapid evolution of large-language models such as ChatGPT, Claude, and Gemini is reshaping the methodological landscape of obstetrics and gynecology (OBGYN) research. This narrative review provides a comprehensive account of generative AI capabilities, key use-cases, and recommended safeguards for investigators. First, generative AI expedites hypothesis generation, enabling researchers to interrogate vast corpora and surface plausible, overlooked questions. Second, it streamlines systematic reviews by composing optimized search strings, screening titles and abstracts, and identifying full-text discrepancies. Third, AI assistants can draft reproducible analytic code, perform preliminary descriptive or inferential analyses, and create publication-ready tables and figures. Fourth, the models support scholarly writing by suggesting journal-specific headings, refining prose, harmonizing references, and translating technical content for multidisciplinary audiences. Fifth, they augment peer-review and editorial workflows by delivering evidence-focused critiques. In educational settings, these models can create adaptive curricula and interactive simulations for trainees, fostering digital literacy and evidence-based practice early in professional development among clinicians. Integration into clinical decision-support pipelines is also foreseeable, warranting proactive governance. Notwithstanding these opportunities, responsible use demands vigilant oversight. Large-language models occasionally fabricate citations or misinterpret domain-specific data ("hallucinations"), potentially propagating misinformation. Outputs are highly prompt-dependent, creating a reliance on informed prompt engineering that may disadvantage less technical clinicians. Moreover, uploading protected health information or copyrighted text raises privacy, security, and intellectual-property concerns. We outline best-practice recommendations: maintain human verification of all AI-generated content; cross-validate references with primary databases; employ privacy-preserving, on-premises deployments for sensitive data; document prompts for reproducibility; and disclose AI involvement transparently. In summary, generative AI offers a powerful adjunct for OBGYN scientists by accelerating topic formulation, evidence synthesis, data analysis, manuscript preparation, and peer review. When coupled with rigorous oversight and ethical safeguards, these tools can enhance productivity without compromising scientific integrity. Future studies should quantify accuracy, bias, and downstream patient impact.

BACKGROUND:Black men are underrepresented in hypertension trials, even though this population has higher prevalence and more adverse sequelae from hypertension, compared to other groups. In this article we present recruitment and community engagement strategies for the Community-to-Clinic Linkage Implementation Program (CLIP), a cluster-randomized trial on hypertension prevention among Black men. METHODS:Using a 2-stage recruitment process: 1) we enrolled Black-owned barbershops from zip-codes with high hypertension prevalence; and 2) recruited Black male participants who fulfilled the eligibility criteria and were customers of the barbershops. Barbershop and participant recruitment was conducted by a partner community-based organization. RESULTS:The study met the recruitment goals for barbershop enrollment (N=22) and individual participants. Of eligible individuals (N=461), 430 enrolled in the study (93% consent rate, exceeding the original enrollment goal of N=420 participants). Throughout recruitment, the study team conducted 101 unique engagements (41 prior to recruitment, 60 during recruitment), totaling engagement with180 partners across all events, including individual and group meetings, attendance at community events, and educational presentations. In addition to a primary partner community organization, the study team collaborated with a Community Advisory Council, comprised of residents, and civic and community leaders, and with the local health department and varied other organizations. CONCLUSIONS:In CLIP, a high number of academic-community engagement encounters and close collaboration with community partners contributed to successful recruitment of Black men at risk for hypertension and with adverse social determinants. Our experience may serve as to inform investigators focused on recruiting underserved populations in hypertension research trials.

OBJECTIVE:To assess the effectiveness, technical considerations, and long-term outcomes of the Z-plasty technique for correcting pediatric penile and scrotal anomalies. METHODS:A retrospective analysis of 100 consecutive Z-plasty procedures across various pediatric urological conditions was conducted. These included bifid scrotum reconstruction, chordee correction, penoscrotal webbing repair, and complex hypospadias reconstruction. Technical variations, including classic Z-plasty, multiple Z-plasties, and double-opposing Z-plasty configurations were evaluated. Patients were followed for a minimum of one year (range: 1-2 years), with 97% completing all scheduled follow up visits. RESULTS:Z-plasty successfully addressed a spectrum of penile and scrotal abnormalities including 41 hypospadias revisions, 28 primary hypospadias repairs, 10 chordee corrections, and 21 other reconstructive procedures, through strategic modification of the number and angles of incisions. Primary skin flap healing was achieved in 98% of procedures. Only one case (1%) required healing by secondary intention due to suture line separation, and one (1%) developed a hypertrophic scar managed with local steroid application. All patients with complete follow-up (97%) demonstrated stable corrections with minimal visible scarring at final evaluation. CONCLUSIONS:Z-plasty is a highly effective, versatile, and safe technique for pediatric genital reconstructive surgery. This adaptable approach enables optimal resurfacing and correction of diverse penoscrotal abnormalities with minimal morbidity. By minimizing linear scarring and redistributing tissue tension, Z-plasty simultaneously improves cosmetic outcomes and provides durable functional benefits. Future studies should focus on establishing standardized outcome measures and evaluating long-term results into adulthood.

BACKGROUND:Acute appendicitis is the most common abdominal surgical emergency worldwide. Researchers from various countries have evaluated the impact of the COVID-19 pandemic on its diagnosis and treatment, as well as a possible change in its management, such as outpatient treatment. The objective of this study was to describe the characteristics of acute appendicitis treated during the COVID-19 State of Emergency (SOE) and to assess whether it could be included in an ambulatory surgery program. METHODS:Retrospective observational study involving patients treated at public hospitals for appendix diseases (K35-K38). We collected sociodemographic and clinical data. The influence of the lockdown on each variable was evaluated with a multivariate analysis. RESULTS:201 patients were included. The SOE period group comprised 78 patients, and the pre-SOE period (control) included 123 patients who met the same inclusion criteria. The risk of complicated acute appendicitis increased by 1.015 times with age (p = 0.000). The longer surgery time was associated with a 7.265 times higher risk of postsurgical complications (p = 0.000). No differences were observed with respect to drain placement (p = 0.281), although the percentage was higher in 2020 (13.9% vs 19.7%). The length of hospital stay decreased significantly during the lockdown (p = 0.017). CONCLUSION/CONCLUSIONS:The lockdown did not influence the outcome of complicated acute appendicitis from the standpoint of morbidity and mortality, reducing the hospital stay, facilitating the path towards outpatient treatment.