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Abstract WP131: Sleep Apnea and Risk of In-Hospital Pneumonia After Stroke: A Statewide Analysis from the Florida Stroke Registry
No full textIntroduction: In-hospital pneumonia is a serious complication of acute stroke, linked with longer stay, worse outcomes, and higher mortality. Sleep apnea, common yet underdiagnosed in stroke, may increase pneumonia risk through impaired airway clearance, hypoxia, aspiration, and systemic inflammation. While post-stroke pneumonia is often attributed to dysphagia and immune dysfunction, whether sleep apnea independently increases pneumonia risk in stroke patients remains unexamined in large real-world cohorts.
Methods: We conducted a retrospective cohort study using the Florida Stroke Registry, which includes 170+ hospitals in the American Heart Association's Get With The Guidelines-Stroke program. Adult patients discharged between January 2010 and January 2025 with complete data on sleep apnea and pneumonia were included. The primary outcome was in-hospital pneumonia; the main exposure was history of sleep apnea. Multivariable logistic regression adjusted for demographic (age, sex, race/ethnicity, insurance), behavioral (smoking), clinical (BMI category, NIHSS score, stroke subtype, thrombolysis [IV/IA tPA], hypertension, diabetes, dysphagia, coronary artery disease, atrial fibrillation, dyslipidemia, deep vein thrombosis/pulmonary embolism [DVT/PE]), and system-level factors (arrival mode, stroke center type, and region). Adjusted odds ratio (aOR) with 95% confidence intervals (CI) are reported. Model diagnostics showed good fit (mean VIF = 2.10).
Results: Among 189,757 stroke patients, 2.1% had sleep apnea, and 4.6% developed pneumonia. Pneumonia occurred in 7.9% of patients with sleep apnea vs. 4.5% without. Sleep apnea was independently associated with higher in-hospital pneumonia risk (aOR=1.76, 95% CI: 1.55-2.00). Other predictors included male sex, atrial fibrillation, diabetes, dyslipidemia, depression, and smoking. Stroke severity showed a graded association, with severe stroke carrying the highest odds. Dysphagia and DVT/PE had particularly strong associations (aORs >2-3). Comprehensive and primary stroke centers reported higher pneumonia rates (Figure 1).
Conclusion: In acute stroke care, sleep apnea independently predicts in-hospital pneumonia, likely due to aspiration risk, respiratory compromise, and systemic inflammation. Given the challenges of formal screening in acute care, efforts should focus on recognizing pre-existing sleep apnea and supporting adherence to therapies (e.g., CPAP/BiPAP) alongside standard pneumonia prevention protocols
Comprehensive neurointervention training and service capacity in the Middle East & North Africa (NITA-MENA) study
No full textThe Middle East and North Africa (MENA) region faces a critical neurointervention workforce shortage, with an estimated 115,000-130000 preventable deaths annually from treatable neurovascular conditions. We quantified training capacity, service availability, and implementation barriers across 19 countries encompassing 688.2 million inhabitants.
We conducted a cross-sectional survey of 168 eligible hospitals with 24-hour emergency services, neuroimaging capability, and ≥100 annual neurovascular admissions between May-August 2024. Primary outcomes were Neurointervention Training Access (annual fellowship positions/population-based demand using 2.5 operators per million standard) and Neurointervention Operator Availability (current operators/regional requirements). Multivariable regression identified training capacity predictors.
Among 131 responding institutions (78%response rate), current capacity reached only 19.1% of required neurointerventionists for the region. Training capacity met 4.4%of projected needs, varying from 12.1%in high-income to 0%in low-income countries (
< 0.001). While 80.9% of hospitals performed neurointervention procedures, only 33.6% qualified as comprehensive centers. Among comprehensive centers, 72.7% hosted fellowship programs and 68.2%maintained 24/7 coverage. Significant predictors of higher training capacity included per-capita GDP (β = 0.012,
< 0.001), formal certification pathways (β = 0.285,
= 0.002), and emergency medical services protocols (β = 0.252,
= 0.01). Primary barriers were funding limitations (82.4%), equipment shortages (70.2%), and faculty scarcity (65.6%). Current training infrastructure produced 96 annual graduates against a projected regional deficit of 1434specialists.
The MENA neurointervention capacity meets less than 20% of population needs, with pronounced socioeconomic disparities resulting in substantial preventable mortality and disability. Strategic expansion to 28 regional training hubs producing 171 annual fellows may achieve workforce adequacy within 8.4 years, requiring coordinated international investment and policy reform
Analysis of VHI-10 in Patients with Comorbid Primary Muscle Tension Dysphonia and Emotional Disturbances
No full textThe goal of this study was to determine if coexisting emotional disturbance affects Voice Handicap Index-10 (VHI-10) scores in patients with primary muscle tension dysphonia (pMTD). We hypothesize that those with emotional disturbances will have a higher perceived voice handicap, and therefore higher VHI-10 scores.
Retrospective chart review.
We reviewed the medical charts of patients diagnosed with pMTD at initial voice evaluation in 2019. We included patients in the emotional disturbances group if they self-reported depression, anxiety, or acute stress; were diagnosed with a depressive episode, major depressive disorder, anxiety disorder, or severe acute stress episode; or received a score ≥5 on the Patient Health Questionnaire-9 depression screener, indicating at least mild levels of depression. We used univariable and multivariable linear regression models to analyze the severity of VHI-10 scores, prevalence of abnormal VHI-10 scores, and compare International Classification of Diseases, Tenth Revision diagnoses and VHI-10 scores between groups.
Three-hundred twenty-nine patients met the selection criteria. One-hundred nineteen patients had an emotional disturbance, and 210 patients did not. There was no significant association between higher VHI-10 scores and patients with emotional disturbances. Patients with a diagnosis of depressive episode had higher VHI-10 scores, with an average of 15.7, compared to the rest of the sample, with an average of 11.7 (P = 0.01). No association was found between higher VHI-10 scores and diagnosis of anxiety, though anxiety was the most common comorbidity with depression. An increase in age was also found to correlate with an increase in VHI-10 score, and identifying as Hispanic or Latino was correlated with lower VHI-10 scores.
Patients with coexisting emotional disturbance and pMTD do not have significantly higher perceived voice handicap than patients with pMTD and no emotional disturbance. Patients with pMTD and a history of depressive episode had greater perceived voice handicap
The sixth bioelectronic medicine summit: Neurotechnologies for individuals and communities
No full textThe Sixth Bioelectronic Medicine Summit took place on March 4 and 5, 2025 at the Garden City Hotel in New York, and was co-hosted by the Feinstein Institutes for Medical Research (FIMR), Northwell Health and the University of Minnesota. The Summit brought together speakers and attendees from academia, medicine and industry to discuss the evolving landscape of neuromodulation and bioelectronic therapeutics. This year’s Summit was titled “Neurotechnologies for Individuals and Communities” and emphasized approaches that consider differences between subjects to deliver precision neuromodulation therapies, as well as approaches that expand the therapeutic footprint of neuromodulation to underserved populations and communities. The Summit included sessions covering basic and translational research, device development and commercialization, and emerging clinical applications. This meeting report summarizes the major events from the two days of the Summit, including keynote addresses, scientific sessions, discussion panels, award presentations, and sponsored talks
Targeting mGlyR with nanobodies for depression
No full textDevelopment of therapies for neuropsychiatric conditions is one of the greatest challenges of modern medicine. Common limitations of traditional small molecule drugs include poor efficacy, off-target side effects and difficult druggability of many targets. In this study, we report a different approach deploying small engineered single domain antibodies, known as nanobodies, for the treatment of depression, a prevalent neuropsychiatric condition. We develop highly selective nanobodies for a recently discovered glycine receptor mGlyR crucially linked to pathophysiology of depression. Using a mouse model of stress-induced depression, we show that non-invasive intranasal delivery of nanobody produces rapid and lasting anti-depressant effect. We solve an atomic structure of mGlyR bound to nanobody and use a variety of cell-based approaches to reveal the mechanism of mGlyR modulation and its impact on neural circuitry. These findings support development of biologics for the treatment of intractable brain disorders
Effectiveness and implementation of a multi-faceted intervention to facilitate adoption of asthma self-management practices in Peruvian children and adolescents: a hybrid type 2 individually randomized controlled trial
Get PDFBackground Peru has one of the highest burdens of asthma in the world, as well as large gaps in access to evidence-based treatments. Studies often overlook the ways in which the research context and data collection activities interact and influence the experience of a research participant, their perception of an intervention, and, by extension, study outcomes.Methods We conducted an individually randomized type 2 hybrid-implementation trial to evaluate the implementation and effectiveness of a locally adapted, multi-faceted intervention package to improve adherence to self-management practices. We enrolled 110 children with physician-diagnosed asthma living in nine urban districts Lima, Peru, and followed them monthly for 6 months. 101 children completed the study. Participants in the intervention group received case management from a designated nurse manager, who provided ongoing educational, social, and self-management support in the form of follow-up home visits and phone-based communication. Long-term inhaler therapy was provided free of charge to both the intervention and control groups. We measured clinical effectiveness and implementation outcomes, guided by the Reach, Effectiveness, Adoption, Implementation, Maintenance framework.Results Overall, both arms of the study saw improvements in asthma control, adherence, child- and caregiver- quality of life, and caregiver depressive symptoms, with the greatest improvement occurring between baseline and 1 month follow-up. However, there were no statistical differences in these outcomes between intervention and control arms at 6 months. Most caregivers in both arms perceived an improvement in asthma control and wellbeing. Caregivers and nurse managers found the intervention acceptable. Our results suggest that data collection activities involving regular check-ins regarding asthma symptoms and quality of life, as well as medication provision, may have contributed to improvements in clinical outcomes in both arms and partially explain the null results between arms.Discussion Our study highlights the need for structural solutions, particularly around medication availability and affordability, for improving asthma management in these contexts. Our study design and analytical approach allowed us to identify underlying mechanisms that contributed to improvements in both study arms, despite the absence of a statistically significant effect in the primary outcome analysis. Work clearly accessible to a broad readership.Clinical trial registration ClinicalTrials.gov, https://clinicaltrials.gov/study/NCT03986177.</p
Merging multimodal digital biomarkers into “Digital Neuro Fingerprints” for precision neurology in dementias: the promise of the right treatment for the right patient at the right time in the age of AI
Get PDFDigital biomarkers are revolutionizing medicine in ways that were unimaginable a few years ago. Consequently, precision medicine approaches now realistically can promise personalization, i.e., the right treatments for the right patients at the right time, including earlier, targeted interventions which lead to a major paradigm shift in how medicine is practiced from reactive to preventive action. Although the scientific evidence is clear on the power of digital biomarkers, there is an unmet need for translating these findings into actionable insights in clinical practice. In this paper, we focus on Alzheimer's disease and related dementias (ADRD), and how digital biomarkers could empower clinical decision making in its preclinical stages. We argue that a new all-encompassing score is needed, akin to a BrainHealth Index linked to the established and validated risk stratifications frameworks and is directed at the prevention of ADRD. Specifically, we propose the new concept “Digital Neuro Fingerprint (DNF)”, built with simultaneous collection of multimodal digital biomarkers (speech, gait, eye movements etc.) from smartphone based augmented reality or virtual reality while an individual is immersed in activities of daily living. Fusing the captured multimodal digital biomarkers, data is automatically analyzed with custom combinations of machine- and deep-learning approaches and enhanced with explainable artificial intelligence (XAI) and uncertainty quantifications. We argue that DNF is useful for capturing ADRD progression and should supersede the biomarkers that are invasive and expensive to obtain, offering a sensitive and highly specific score that measures meaningful aspects of health for the patients in high-frequency intervals
Prognostic Value of Non-nodal Regional Metastases in Predicting Sentinel Lymph Node Status in Cutaneous Melanoma: Multicenter Analysis of the Sentinel Lymph Node Working Group Database
No full textNon-nodal regional metastases, including microsatellite lesions, satellites, and in-transit metastases, are an uncommon but aggressive entity in cutaneous melanoma. We evaluated their association with clinicopathological features, sentinel lymph node (SLN) status, and prognosis.
The Sentinel Lymph Node Working Group (SLNWG) database was used to examine the clinicopathological associations of non-nodal regional metastases, their prognostic significance in relation to SLN status, and their impact on clinical outcomes, including in patients with negative SLN status, using multivariable logistic regression and Cox regression models, respectively.
Of 13,474 patients in the SLNWG database, 12,644 underwent SLN biopsy, and 3.4% (n = 426) had non-nodal regional metastases at diagnosis. These were associated with adverse clinicopathological features, higher odds of SLN positivity (OR 2.75; 95% CI 2.18-3.47; P < 0.001), and worse relapse-free survival (RFS: HR 1.47, 95% CI 1.07-2.02, P = 0.02), melanoma specific survival (MSS: HR 1.72, 95% CI 1.06-2.78, P = 0.03), overall survival (OS: HR 1.49, 95% CI 1.01-2.21, P = 0.05). Adverse prognostic associations were also observed in the SLN negative subgroup (RFS: HR 1.93; 95% CI 1.58-2.36, P < 0.001; MSS: HR 2.24; 95% CI 1.58-3.17, P < 0.001, and OS: HR 1.51; 95% CI 1.17-1.95, P = 0.002).
Non-nodal regional metastases independently predict SLN involvement and adverse prognosis, and outcomes remain poor even when SLN is negative. These findings reinforce the risk stratification and prognostic relevance of SLN assessment in clinically node-negative patients with non-nodal regional metastases
