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Diagnosis and Management of Primary Fetal Pleural Effusion: A Narrative Review
No full textPrimary fetal pleural effusion involves the accumulation of fluid in the fetal pleural space, posing considerable challenges for perinatal diagnosis and management. Primary effusions, emerging from the maldevelopment of lymphatic vessels, differ significantly from secondary effusions, which are associated with a spectrum of anomalies and conditions, affecting clinical approach and prognosis. The diagnosis of primary fetal pleural effusion is one of exclusion. The natural history of the condition ranges from spontaneous resolution in mild cases to progression to life-threatening complications. Fetal interventional strategies, including thoracocentesis, pleurodesis, and thoracoamniotic shunt placement, have evolved with varying degrees of success. The prognosis is largely affected by gestational age at diagnosis, the presence of hydrops, and the implementation of fetal intervention, with improved outcomes observed in non-hydropic fetuses. This narrative review focuses on primary fetal pleural effusion, detailing its diagnosis, natural history, management options, and outcomes, with the aim of clarifying the best approaches to improve outcomes for affected fetuses.
•Primary fetal pleural effusion requires early diagnosis for effective management.•The natural history of the condition varies, from spontaneous regression to fetal hydrops and perinatal death.•Management includes thoracocentesis, pleurodesis, and shunting, with variable success.•Key prognostic factors are gestational age at diagnosis, hydrops, and effusion progression despite intervention.•Fetal interventions have notably improved survival rates
Pediatric patients with tenosynovial giant cell tumor: real-world evidence from an observational registry
No full textTenosynovial giant cell tumor (TGCT) is a rare, locally aggressive tumor originating in the synovial lining of the joint, bursa, and tendon sheath. TGCT typically affects individuals between 20 and 50 years of age and pediatric cases are considered ultra-rare. Research and clinical trials thus far have been largely focused on the adult TGCT population. Therefore, data are needed to understand the impact of TGCT on pediatric patients' quality of life and any differences between adults. Here we report the result of the pediatric TGCT population enrolled in an observational patient registry.
A total of 122 pediatric patients (9.5%) were included in this exploratory, cross-sectional analysis of a longitudinal 1,278-patient registry from October 06, 2022 to November 26, 2024. Among pediatric patients, 73.0% had diffuse TGCT (D-TGCT; n = 89), 16.4% had localized TGCT (L-TGCT; n = 20), and 10.6% had unspecified TGCT (n = 13). Pediatric patients had a median age at diagnosis of 14.5 years.
More than half of pediatric patients were initially misdiagnosed and were more likely to be misdiagnosed than adults (62.3% vs. 49.9%, p < 0.01) and received joint aspirations significantly more frequently than adult patients (47.5% [n = 58] vs. 22.5% [n = 112], p < 0.05). Most pediatric patients were diagnosed by orthopedic surgeons (n = 79, 64.8%), and 52.5% of pediatric patients were diagnosed ≥ 1 years after symptom onset. Pediatric patients with D-TGCT underwent an average of 3.4 surgeries, compared to 1.8 surgeries for those with L-TGCT. Recurrence rates were similar among adults and pediatric patients with 66.3% of pediatric patients with D-TGCT having ≥ 1 post-operative recurrence compared to 15.0% of L-TGCT pediatric patients, respectively. Despite no approved systemic therapies for pediatric use, pediatric and adult patients consulted medical oncologists in similar rates and systemic therapies were prescribed similarly but infrequently overall (n = 21, 17.2% in pediatric patients and n = 95, 19.1% in adults).
Pediatric patients had significant disease burden, as compared to adults with TGCT, which severely affected their quality of life. The reliance on surgical treatment and underuse of multidisciplinary care emphasizes the unmet need for provider education and treatment advancements tailored to this population.
This study was an analysis of an observational patient registry and therefore was not registered as a clinical trial; no trial registration number is available. The study protocol was approved by Advarra (protocol reference number: Pro00077310). Patient enrollment for this analysis occurred from October 6, 2022, to November 26, 2024
Abstract TP038: Impact of Guideline-Based Antihypertensive Prescribing After Stroke on 30-Day Outcomes: Insights from the Florida Stroke Registry
No full textBackground: There is emerging evidence that, in addition to blood pressure control intensity, the choice of antihypertensives matters for improving secondary outcomes. Our prior research has shown a gap in prescribers' medication choices compared to guideline-recommended therapies at discharge. This study evaluates trends in antihypertensive prescribing following stroke, prescriber adherence to evidence-based hypertension management (Prescriber-Choice Adherence), and its impact on 30-day readmissions.Methods: We used data from the linked Florida Stroke Registry-AHCA dataset (2017-2019), including 38,954 acute ischemic stroke patients. Prescriber-Choice Adherence was defined using a hierarchical set of evidence-based rules for antihypertensive selection. The primary exposure was whether patients received guideline-compliant antihypertensives. Logistic regression assessed the association between receipt of guideline-recommended prescriptions and 30-day readmission, adjusting for age, sex, comorbidities, and stroke severity.Results: Among the population (mean age 70, 49.5% female, 68% white, 18% African American, 13% Hispanic), only 49.6% received guideline-recommended antihypertensives. Adherence to specific hierarchical rules ranged from 45% to 57%, highest in diabetic patients (57.03%). Notably, 15.5% were prescribed beta-blockers without a compelling cardiac indication, contrary to guidelines (table 1). No statistically significant associations were found between Prescriber-Choice Adherence and 30-day readmission (table 2).Conclusions: Only half of post-stroke patients received guideline-concordant therapy, underscoring persistent gaps and challenges in real-world implementation of post-stroke blood pressure guidelines. The lack of significant association with 30-day readmission may reflect an insufficient timeframe for antihypertensive effects to manifest. These findings highlight the need to re-evaluate both the strength of current evidence and the relevance of short-term outcome measures. Future studies should assess longer-term outcomes and whether post-stroke hypertension guidelines require updating
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
DNA methylation signature of cognitive reserve moderates CSF tau pathology in prodromal Alzheimer's disease
No full textBackground Cognitive reserve (CR) refers to differences in the adaptability of cognitive processes that modify the impact of Alzheimer's disease (AD) pathology on cognitive performance. Currently there are no established blood-based biomarkers of CR in prodromal AD. In this study, we operationalize CR as memory reserve, defined as moderation (attenuation) of the CSF pTau181-memory association. DNA methylation (DNAm) integrates genetic and environmental influences and may capture biological processes that mitigate the impact of AD pathology on memory. We aimed to identify blood DNAm loci that moderate the association between cerebrospinal fluid (CSF) phosphorylated tau (pTau181) and memory in mild cognitive impairment (MCI). We also sought to determine if a DNAm-based signature of memory reserve predicts future memory decline. Methods We analyzed 92 amyloid positive MCI participants from the Alzheimer's Disease Neuroimaging Initiative (ADNI) with blood DNAm, CSF pTau181, and memory scores (PHC_MEM) collected at the same visit. We first regressed memory scores on covariates (age, sex, number of APOE4 alleles, estimated major immune cell type proportions) and used the residuals as covariate-adjusted memory scores. At each CpG, we then fitted linear models of memory on DNAm, pTau181, and their interaction. Inflations were corrected using the bacon method. We identified differentially methylated regions (DMRs), assessed pathway enrichment, and performed integrative analyses incorporating external resources including expression quantitative trait methylation (eQTM), methylation quantitative trait loci (mQTL) databases, AD genome-wide association study summary statistics, and blood-brain DNAm correlations. A methylation score was constructed and evaluated in linear mixed-effects models of longitudinal memory in 88 participants with follow-up information. Results After removing CpGs with low variability, we identified 6 CpGs with suggestive significance for DNAm×pTau181 interaction ( P- value < 1×10 -5 ) and 11 DMRs that passed multiple comparisons correction. These loci mapped to genes involved in synaptic function, vascular and blood-brain barrier integrity, amyloid clearance, immune and metabolic regulation. Almost all showed no strong marginal associations with pTau181 or memory, supporting a moderating rather than mediating role. Pathway analysis revealed enrichment of adipocytokine signaling and adipose metabolic pathways, and a number of CpGs associated with mQTLs overlapped with AD genetic risk loci. A higher baseline MRS attenuated the pTau-memory association and significantly associated with slower future memory decline, independent of age, sex, education, APOE ε4, and baseline pTau181. Conclusions Blood DNAm patterns that moderate the pTau-memory relationship capture biology underlying memory reserve involving synaptic, vascular, immune, and metabolic pathways, and can be summarized into an MRS that predicts longitudinal memory trajectories in MCI. These findings support blood DNAm as a promising, non-invasive biomarker of cognitive resilience to AD pathology.Background Cognitive reserve (CR) refers to differences in the adaptability of cognitive processes that modify the impact of Alzheimer's disease (AD) pathology on cognitive performance. Currently there are no established blood-based biomarkers of CR in prodromal AD. In this study, we operationalize CR as memory reserve, defined as moderation (attenuation) of the CSF pTau181-memory association. DNA methylation (DNAm) integrates genetic and environmental influences and may capture biological processes that mitigate the impact of AD pathology on memory. We aimed to identify blood DNAm loci that moderate the association between cerebrospinal fluid (CSF) phosphorylated tau (pTau181) and memory in mild cognitive impairment (MCI). We also sought to determine if a DNAm-based signature of memory reserve predicts future memory decline. Methods We analyzed 92 amyloid positive MCI participants from the Alzheimer's Disease Neuroimaging Initiative (ADNI) with blood DNAm, CSF pTau181, and memory scores (PHC_MEM) collected at the same visit. We first regressed memory scores on covariates (age, sex, number of APOE4 alleles, estimated major immune cell type proportions) and used the residuals as covariate-adjusted memory scores. At each CpG, we then fitted linear models of memory on DNAm, pTau181, and their interaction. Inflations were corrected using the bacon method. We identified differentially methylated regions (DMRs), assessed pathway enrichment, and performed integrative analyses incorporating external resources including expression quantitative trait methylation (eQTM), methylation quantitative trait loci (mQTL) databases, AD genome-wide association study summary statistics, and blood-brain DNAm correlations. A methylation score was constructed and evaluated in linear mixed-effects models of longitudinal memory in 88 participants with follow-up information. Results After removing CpGs with low variability, we identified 6 CpGs with suggestive significance for DNAm×pTau181 interaction ( P- value < 1×10 -5 ) and 11 DMRs that passed multiple comparisons correction. These loci mapped to genes involved in synaptic function, vascular and blood-brain barrier integrity, amyloid clearance, immune and metabolic regulation. Almost all showed no strong marginal associations with pTau181 or memory, supporting a moderating rather than mediating role. Pathway analysis revealed enrichment of adipocytokine signaling and adipose metabolic pathways, and a number of CpGs associated with mQTLs overlapped with AD genetic risk loci. A higher baseline MRS attenuated the pTau-memory association and significantly associated with slower future memory decline, independent of age, sex, education, APOE ε4, and baseline pTau181. Conclusions Blood DNAm patterns that moderate the pTau-memory relationship capture biology underlying memory reserve involving synaptic, vascular, immune, and metabolic pathways, and can be summarized into an MRS that predicts longitudinal memory trajectories in MCI. These findings support blood DNAm as a promising, non-invasive biomarker of cognitive resilience to AD pathology
Comorbidity Burden and Biologic Access in an Uninsured Psoriasis Population: A 20-Year Descriptive Study
No full textPsoriasis is a chronic immune-mediated disease associated with multiple systemic comorbidities. Biologic therapies have transformed the management of moderate-to-severe psoriasis; however, their high cost remains a major barrier for uninsured and socioeconomically disadvantaged individuals. The Psoriasis Biologics Center for Indigent Patients at Jackson Memorial Hospital provides a structured dermatology access model for underserved populations.
We conducted a descriptive retrospective cohort study of patients with moderate-to-severe psoriasis receiving biologic therapy through a dedicated safety-net access program between 2005 and 2025. Patient demographics, comorbidities, and management strategies were obtained from electronic medical records and standardized intake questionnaires. Only descriptive statistics were performed; standardized disease severity and quality-of-life measures such as the Psoriasis Area and Severity Index (PASI) or the Dermatology Life Quality Index (DLQI) were not available.
A total of 450 patients (mean age 52.6 years; 54% female) were included. Nearly half (49.8%) presented with at least one systemic comorbidity. The most common were psoriatic arthritis (35.1%), hypertension (31.3%), diabetes mellitus (20%), cardiovascular disease (19.1%), obesity (13.8%), and dyslipidemia (12.2%). Psychiatric comorbidities included depression (9.6%) and anxiety (3.8%). Infectious conditions occurred at higher-than-expected frequencies, including hepatitis B/C (3.8%), latent tuberculosis (3.6%), and human immunodeficiency virus (HIV) (2.7%). Care delivery was organized within a structured safety-net model that incorporated standardized screening protocols, referral pathways, and multidisciplinary coordination to support biological access for uninsured patients.
This 20-year descriptive cohort characterizes comorbidity burden and biologic access within an indigent psoriasis population. This study does not assess clinical outcomes or treatment effectiveness. These findings describe a care delivery framework that may inform future health system and health equity-focused initiatives
Exploring Nursing Care Coordination Through Swanson's Theory of Caring: Perspectives of Families of Children and Youth With Special Health Care Needs
No full textCaring for children and youth with special health care needs can be overwhelming for families. Higher levels of need often require more extensive and coordinated support. The burden of caring for children with complex health care needs can result in negative effects for parents and caregivers over time, thus increasing the risk of poor physical, emotional, and social well-being. Nursing care coordination is an evidence-based intervention that provides families with guidance and support by delivering safe and effective care. The quality of coordination, however, can profoundly shape families' experiences. The purpose of this study was to explore caregivers' perceptions of nursing care coordination provided by their child's public health plan through the lens of Kristen Swanson's Middle Range Caring Theory.
The study was conducted across three counties in Florida.
A descriptive qualitative design was used. A total sample of nine caregivers and parents were interviewed. Semistructured interviews were used, and data were analyzed utilizing Colaizzi's interpretive method. Categories, subthemes, and themes were created.
The findings of this study highlighted caregivers' experiences of successes and challenges with their child's nurse care coordinators. The exploration of caregivers' perceptions led to two major themes: Triumphs of Nursing Care Coordination and Pitfalls of Nursing Care Coordination. The two themes produced five subthemes: (a) It Takes a Village, (b) Being my Voice, (c) Third Class Citizen, (d) Being Out of Touch, and (e) Just a Title.
Strengths of care coordination include enhanced access to resources, clear guidance for navigating complex health care systems, and improved understanding of treatment options, all of which help alleviate caregiver strain. While nursing care coordination offers many benefits, challenges with the current infrastructure still exist. Nurses must advocate for policies that alleviate caseload pressures, strengthen continuity of care, and identify barriers like fragmented communication and inadequate staffing. Nurses can foster a sense of support by creating forums where parents and caregivers share experiences, while encouraging decision-makers to stay informed about the challenges these families face
56 - Burned scalp/forehead and brow
No full textThe upper third of the face is composed of the eyebrow, forehead, and scalp. These anatomic units play a significant role in an individual’s appearance and relationship to society. Facial burns should be definitively managed only after the patient is stabilized from the acute burn insult. At this point, successful aesthetic and functional repair can be achieved through an individualized approach employing the reconstructive ladder. Standard plastic surgical techniques encompass grafts, flaps, and tissue expansion
Stability and spatial variance of Mobula yarae-associated fish aggregates in South Florida
No full textDespite their importance to organismal and ecosystem function, symbiotic associations in marine environments are often poorly understood. In the case of manta rays, casual and temporary associations with fish and other hitchhiker species have been documented, but the extent of these interactions and their stability over time remain largely unknown. Here we examined nine years (2016–2024) of
Mobula yarae
visual survey data collected by freedivers in south Florida. A total of 465 manta ray encounters were analyzed to assess individual identification, symbiont community composition, and abundance. A subset of 213 videos captured between 2022 and 2024 were further analyzed for symbiont species spatial position relative to their hosts. Manta-associated fish aggregates were composed of four groups of teleosts (
Echeneidae
spp.,
Rachycentridae
spp.,
Decapterus
spp., and non-
Decapterus Carangidae
spp.) and manta rays were most frequently associated with fish in the family
Echeneidae
. Teleost symbionts differed in where they were most likely to be seen on their manta host by species, but overall, symbionts were most often associated with the ventral side of their hosts in the posterior righthand quadrant of the manta’s body. Studying manta-associated fish aggregates and symbiont community structure provides insight into the broader role manta rays may play in their environments and the need for consideration of species interactions in effective conservation and management
su(2) symmetry of XX spin chains su(2) symmetry of XX spin chains
No full textWe show that, after suitably adjusting a uniform transverse magnetic field, the generic inhomogeneous open XX spin chain has a two-fold degeneracy, and an exact
su
(2) symmetry whose “inhomogeneous” nonlocal generators depend on coefficients that can be explicitly computed for models associated with discrete orthogonal polynomials