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Imaging in Movement Disorders: A Clinician's Perspective on Novel Applications
No full textThe utility of neuroimaging in the diagnosis and management of movement disorders has been steadily increasing as both imaging and image analysis technologies have advanced in the last decade. Neuroimaging is also playing a critical role in the search for novel therapies to prevent, slow down, and treat various movement disorders. This article reviews both standard and innovative imaging tools available for both clinicians and researchers. We focus predominantly on the clinician's perspective, discussing imaging tools that are becoming rapidly available and how these may be integrated into the clinic to provide cutting-edge and patient-centered care. We discuss novel and emerging techniques and their potential implications for the field, as well as highlight areas still in need of imaging solutions.No embarg
Comorbidity prevalence and incidence in cancer survivors: a longitudinal All of Us study
Get PDFComorbidities worsen cancer survival but patterns of pre-existing and new onset comorbidities among cancer survivors are unknown. We investigated self-reported and clinically diagnosed comorbidity among cancer survivors in the All-of-Us program's national database. Eight highly prevalent comorbidities were identified using self-reported data from the personal health history (PHH) survey among cancer survivors (n = 20,534) and non-cancer adults (n = 113,628), and validated among cancer survivors (n = 26,978) using data from electronic health records (EHRs). Among 5-year survivors (n = 9,174) documented in EHR, we further estimated the incidence of new-onset comorbidities. The most prevalent comorbidities identified in PHH data were hypertension (40.5%), osteoarthritis (28.4%), depression (28.0%), and obesity (23.2%). EHR data identified pre-existing comorbidities: hypertension (43.3%), osteoarthritis (29.4%), depression (19.4%), and obesity (19.1%). During five-year survival, over 50% cancer survivors developed at least one new comorbidity, and over 25% developed two or more. The onset of new comorbidities showed a sharp increase in the first-year post-diagnosis. Incidence rates varied by age, race and ethnicity. Future research is needed to develop effective strategies to prevent newly onset comorbidities during and after cancer treatment.No embarg
Subnuclear Phacoemulsification to Reduce Corneal Injury in Nuclear Cataract Surgery: Evidence From a Randomized Controlled Trial
Get PDFTo assess the safety and effectiveness of subnuclear phacoemulsification (SNP), a new technique for reducing corneal injury in nuclear cataract surgery. This randomized controlled trial (RCT) was designed in March 2020 and carried it out from April 1 to September 30, 2020, including a 3 months' follow-up. We recruited 256 age-related hard nucleus cataract patients and randomly assigned them to two groups: the experimental group receiving SNP, and the control group receiving conventional phacoemulsification (CP). A single surgeon performed all the surgeries. We compared the two groups on the cumulative dissipated energy (CDE), phacoemulsification ultrasound time (UST), and complications for safety, as well as at multiple postsurgery follow-up timepoints on three major outcomes for effectiveness: visual acuity, central corneal thickness, and central corneal endothelial cell density. The two groups were well-matched in terms of demographics, nuclear density, and safety measures (ultrasound energy, phacoemulsification time, and complications). For effectiveness after surgery, compared to the CP group, the SNP group had better visual acuity and thinner central cornea postsurgery within 1 week and had higher central corneal endothelial cell density at the 1- and 3-month follow-up. Compared to CP, SNP is more effective for reducing corneal injury in cataract surgery. The widespread application of this technology will greatly improve the safety of cataract surgery, especially hard cataract surgery. Chinese Clinical Trial Registry: ChiCTR2000031114.No embarg
UMCCTS Newsletter, May 2025
Get PDFThis is the May 2025 issue of the UMass Center for Clinical and Translational Science Newsletter containing news and events of interest.Supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grants UL1 TR001453, TL1 TR001454 and KL2 TR001455.No embarg
Changes to Family Life, Youth COVID-19 Pandemic-Related Traumatic Stress, and the Youth Mental Health Crisis
No full textObjective: Traumatic stress symptoms increase the risk for mental health problems. We examine patterns of COVID-19-related changes in youth and family experiences (material hardships, behavior change, coping strategies), how these patterns vary with sociodemographic factors, and how COVID-19-related experiences associate with youth pandemic-related traumatic stress (PTS) symptoms.
Method: K-means clustering examined patterns of pandemic-related experiences in Environmental influences on Child Health Outcomes data (April 2020-August 2021; N = 9,139; 48% female), a demographically and regionally diverse sample. Clusters were characterized by sociodemographic factors measured pre-pandemic. Sparse partial least squares regression evaluated associations between cluster parameters and youth PTS symptoms in two samples (children [<13 years-old, n = 1,293]; adolescents [≥13 years-old], n = 1,272).
Results: Clustering replicated in the child and adolescent samples. One cluster reported more (HiChange) and one reported less (LoChange) pandemic-related change. The LoChange (versus HiChange) group included more Black individuals, single-parent households, and had lower income and education. PTS Scale scores were more associated with the youth's own versus the parent/caregiver's experiences. Nonetheless, across all youth, a report of "no change" in parent/caregiver behavior was associated with lower youth PTS Scale scores. For all children, lower PTS Scale scores are associated with the parent/caregiver being able to isolate. Use of coping strategies was not associated with lowered scores. Higher scores are associated with changes in youth health behaviors (e.g. eating, exercise, time outside), health care access, and increased media use.
Conclusion: Results provide information for public health guidance, which can minimize youth PTS symptoms now and in future health disasters: stability in health behaviors, access to healthcare, and ability to isolate are paramount.No embarg
Descriptive Characteristics of Psychiatric Medication Discontinuation Among Perinatal Women With Depressive Symptoms
No full textIntroduction: This study examined the prevalence of psychiatric medication discontinuation amongst perinatal women with depressive symptoms and describes characteristics of those who discontinued compared to those who continued medications in pregnancy.
Methods: We conducted a cross-sectional analysis using baseline data from the PRogram In Support of Moms study. Amongst 98 women prescribed psychiatric medication, we descriptively assessed sociodemographic characteristics of participants who discontinued versus continued medications. A logistic regression model evaluated the association between depressive symptoms and medication discontinuation.
Results: Approximately 65% reported medication discontinuation in pregnancy (95% CI: 55%-74%). Those who discontinued had a median Edinburgh Postnatal Depression Scale (EPDS) score that was 1 point higher than those who continued (p = 0.12). Of those who discontinued medications, 27% were never married, 52% reported annual incomes < $60 000, and 56% were Medicaid-insured.
Conclusion: Most participants prescribed psychiatric medications before pregnancy discontinued them in pregnancy. Adequately powered studies are needed to validate findings and to explore mediating factors.
Trial registration: NCT02760004.No embarg
Quantitative CT in Fibrotic Interstitial Lung Disease: Two Steps Forward on a Long Journey
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Smartphone language features may help identify adverse post-traumatic neuropsychiatric sequelae and their trajectories
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Language features may reflect underlying cognitive and emotional processes following a traumatic event that portend clinical outcomes. The authors sought to determine whether language features from usual smartphone use were markers associated with concurrent posttraumatic symptoms and worsening or improving posttraumatic symptoms over time following a traumatic exposure. This investigation was a secondary analysis of the Advancing Understanding of RecOvery afteR traumA study, a longitudinal study of traumatic outcomes among survivors recruited from 33 emergency departments across the United States. Adverse posttraumatic sequelae were assessed over the six months following the initial traumatic exposure. Language features were extracted from usual smartphone use in a specialized app. Bivariate linear mixed models were used to identify and validate language features that are markers associated with posttraumatic symptoms. Participants were 1744 trauma survivors, with a mean age of 39 [SD = 13] years old, and 56% were female. Fourteen language features were associated with severity level of posttraumatic symptoms at specific timepoints (cross-sectional markers) and five features were associated with change in severity level of posttraumatic symptoms (longitudinal markers). References to the body and health or illness were predictive of worsening pain, somatic, and thinking/concentration/fatigue symptom severity over time. An increase in references to others was associated with improvement in somatic symptom severity over time and increases in expressions of causation or cognitive processes were associated with improvement in pain symptom severity over time. Language features derived from usual smartphone use can convey important information about health, functioning, and recovery following a traumatic event. Clinicians might utilize such information to determine who may experience a high symptom burden or risk of worsening posttraumatic symptoms.
Lay Summary
Via usual smartphone use following trauma exposure, this study identified language markers associated with patient-reported severity and change in severity for multiple symptoms. Using language markers as a proxy for the status of and changes in specific symptoms supports efficient remote health status monitoring and can provide clinicians with valuable real-time insights into health, functioning, and recovery. These insights can be leveraged to guide targeted interventions tailored to individual trauma survivors.No embarg
Transcriptomic and Therapeutic Insights in ADPKD Identify Tumor-Associated Calcium Signal Transducer 2 (TACSTD2) as a Cyst-Specific Target
Get PDFAutosomal dominant polycystic kidney disease (ADPKD) is a common inherited disorder characterized by progressive cyst formation, tubular disruption, and eventual progression to end-stage renal disease. Although tolvaptan, a vasopressin V2 receptor antagonist, slows cyst growth, its limited efficacy and tolerability underscore the need for alternative therapeutic strategies (Torres et al., 2018). Emerging approaches target epithelial proliferation and fluid secretion through mechanisms involving mTOR, Src, RTKs, MAPKs, CFTR, TMEM16A, and heat shock proteins. While several interventions reduce cyst burden and total kidney volume (TKV) in preclinical models, translation to preservation of renal function in clinical studies remains limited.
This body of work describes the identification of tumor-associated calcium signal transducer 2 (TACSTD2) as an early pathogenic biomarker in ADPKD and explores its potential as a therapeutic target (Smith et al., 2024). Transcriptomic analysis revealed Tacstd2 upregulation before cyst formation in polycystin-deficient mouse kidneys, human ADPKD biopsies, and iPSC-derived kidney organoids (Smith et al., 2024). Immunofluorescence localized TACSTD2 predominantly to cyst-lining epithelium with minimal expression in non-cystic tubules. Targeting TACSTD2 with Sacituzumab govitecan, an FDA-approved antibody-drug conjugate, in ADPKD kidney organoids selectively eliminated cyst-lining cells while preserving non-cystic structures, contrasting with the widespread cytotoxicity observed following free SN-38 administration. These findings propose that selective targeting of TACSTD2-overexpressing cyst epithelium represents a viable strategy to disrupt cyst expansion while minimizing injury to intact renal tissue. Further investigation into TACSTD2-directed therapies may broaden therapeutic approaches for managing ADPKD progression.MD/PhDNo embarg
Mobile health intervention for type 2 diabetes management delivered by community health workers and clinical pharmacists: Intervention costs and healthcare resource utilization
No full textPurpose: As the prevalence of diabetes continues to rise, innovative strategies are essential to optimize patient outcomes while curbing the economic burden on healthcare systems. This study aims to describe the costs of implementing a team-based mobile health intervention for diabetes management (the mDAS intervention) that successfully lowered glycated hemoglobin (HbA1c) in African American and Latinx adults with type 2 diabetes from a health-system perspective, and to compare healthcare resource utilization (HCRU) and associated costs between the intervention and usual care groups over one year.
Methods: Intervention delivery costs were described by providing a breakdown of start-up and operating costs. Frequencies of outpatient, inpatient, and emergency department (ED) visits and associated charges were obtained using health system billing data. Negative binomial regression models were employed to compare frequencies of visits, and gamma regression models to assess differences in total healthcare costs.
Results: The total cost of implementing the mDAS intervention for 1 year was 11,627 in start-up costs and $44,660 in annual operational costs. The intervention (n = 108) and usual care (n = 112) groups exhibited similar rates of outpatient visits (rate ratio [RR], 1.07; P = 0.52), ED visits (RR, 0.82; P = 0.68), and total healthcare costs (cost ratio, 1.03; P = 0.86) over 1 year.
Conclusion: The mDAS intervention incurred modest implementation costs. It did not result in significant differences in short-term HCRU and associated costs when compared to usual care. Future research should explore specific mechanisms impacting HCRU and the long-term cost-effectiveness of implementing such interventions more broadly in nonacademic clinical environments.1 year2026/06/2