Nevin Manimala

Neurology. 2024 Apr 9;102(7_supplement_1):3343. doi: 10.1212/WNL.0000000000205074. Epub 2024 Apr 9.

ABSTRACT

OBJECTIVE: This study examined associations of concomitant hypertension and elevated body mass index (BMI) with persistence of concussion symptoms.

BACKGROUND: Most patients with concussion experience symptom resolution within weeks after injury. However, approximately one-third of patients’ symptoms last for months or longer. Identifying risk factors for prolonged concussion symptoms is clinically meaningful for evaluating at-risk patients and for developing treatments.

DESIGN/METHODS: This study included a retrospective review of medical records from the NYU Langone Health Concussion Center between 2013-2022. Patients included had no prior history of concussion and received care within one year of injury. Captured variables included blood pressure and BMI at initial visit, existing hypertension diagnosis, number of visits, number of days between injury and final visit, and diagnosis of post-concussion syndrome (PCS).

RESULTS: Of 422 patients, the mean age was 41 (SD=16.7), 65% were female, 60% reported white race, and 65% reported non-Hispanic or Latino ethnicity. Patients with hypertension had a greater mean duration from injury to last appointment compared with non-hypertensive patients (465 vs. 240 days, p<0.0001, Wilcoxon Rank-Sum Test). The same pattern was observed for patients with elevated BMI compared to those without (388 vs. 259 days, p=0.002). Hypertension and elevated BMI were associated with greater numbers of visits (4.5 vs. 2.5 visits for hypertensive vs. non-hypertensive, p<0.0001; 3.8 vs. 2.7 visits for patients with vs. without elevated BMI, p=0.003). The probability of receiving a PCS diagnosis was increased for hypertensive patients (35% vs. 17%, p<0.001) and patients with elevated BMI (29% vs. 19%, p=0.021). When accounting simultaneously for injury mechanism, race, ethnicity, age, and sex, all reported associations for hypertension remained statistically significant.

CONCLUSIONS: Hypertension may be a risk factor for greater symptom duration and continued referrals following concussion. Further investigation is needed to determine whether treatment of hypertension prior to or following injury could improve concussion-related outcomes. Disclosure: Mr. De Souza has nothing to disclose. Ms. Hyman has nothing to disclose. Dr. Grossman has nothing to disclose. An immediate family member of Dr. Balcer has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Children’s Hospital of Philadelphia. Dr. Balcer has received personal compensation in the range of $50,000-$99,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for North American Neuro-Ophthalmology Society.

PMID:39977937 | DOI:10.1212/WNL.0000000000205074

Neurology. 2024 Apr 9;102(7_supplement_1):6883. doi: 10.1212/WNL.0000000000208153. Epub 2024 Apr 9.

ABSTRACT

OBJECTIVE: To create a dedicated, multi-stakeholder feedback survey focused on residency didactic education and utilize corresponding results to prioritize educational initiatives.

BACKGROUND: The didactic curriculum constitutes a significant component of trainee education, but existing program performance measures provide very little focused feedback on this element of learning.

DESIGN/METHODS: We designed three overlapping online surveys targeting residents, teaching faculty, and alumni of the adult neurology residency program at the our institution following best practice survey development recommendations. Surveys were sent out over email in the spring of 2023. Descriptive statistics were used to summarize responses.

RESULTS: Survey response rate for the current residents was 78% (39/50), 29% (28/98) for teaching faculty, and 7% for alumni (27/386). Residents and faculty differed on their views of the ideal overall goal of the didactic curriculum with 62% of residents selecting “review of foundational knowledge” and 54% of faculty selecting “application of concepts to practice.” However, residents and faculty aligned on their most desired and most used interactive teaching strategies respectively, with both groups selecting case-based learning, questioning, and discussions as their top three strategies. Alumni reported the three most important areas to cover in didactics were cerebrovascular diseases, neurological exam skills, and epilepsy. Residents reported the three strongest areas of our current curriculum were cerebrovascular diseases, neuroimmunology and neuromuscular medicine. Faculty and residents agreed the weakest areas of resident performance were in EMG and neuro-ophthalmology. Faculty additionally reported weakness in the business of medicine, while residents reported additional weakness in neuroanatomy.

CONCLUSIONS: The unique perspectives of residents, faculty, and alumni may allow us to bridge gaps between teachers and learners and ensure our residents are well-equipped for practice in a variety of settings and locations. Periodic surveying of the stakeholders can provide a pulse measurement of didactic curriculum as it pertains to both groups. Disclosure: Dr. Uysal has nothing to disclose. An immediate family member of Dr. Swetlik has received personal compensation for serving as an employee of Pfizer. Dr. Mays has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for CoolTech Medical. Dr. Mays has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Abbvie. The institution of Dr. Mays has received research support from Amgen. Dr. Soni has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Abbvie. Dr. Marquardt has nothing to disclose. Dr. Buletko has nothing to disclose. The institution of Dr. Ross has received research support from National MS Society.

PMID:39977924 | DOI:10.1212/WNL.0000000000208153

Neurology. 2024 Apr 9;102(7_supplement_1):3364. doi: 10.1212/WNL.0000000000205087. Epub 2024 Apr 9.

ABSTRACT

OBJECTIVE: To provide an artistic environment that strengthens connections between patients and healthcare providers in the setting of difficult clinical experiences.

BACKGROUND: The Synapses Art and Literary Magazine is a Back to Bedside Initiative project that provides a meaningful outlet for patients and providers to reflect on their experiences.

DESIGN/METHODS: This is a prospective observational study evaluating patients and providers before and after the creation of an artistic piece. Interested patients and providers are given art supplies during hospital admission along with a pre/post-survey. The art pieces are published in an institutionally approved Art Magazine. Patient surveys include the Patient Health Questionnaire-9 and Generalized Anxiety Disorder Questionnaire-7, while provider surveys include the Professional Fulfillment Index. A total of 45 art projects were completed by 43 medical providers and 2 patients. A total of 23 pre-surveys and 18 post-surveys were completed, and 16 projects were included when adjusted for missing data. The patients surveys were excluded due to inability to draw any statistical conclusions. Paired t-tests and linear regression were used for statistical analysis. Thematic analysis was used for evaluating free-response questions.

RESULTS: Statistical analysis showed an 8% significant increase in the mean value from the pre-survey to the post-survey in workplace happiness (9.18 vs 6.71, p=0.02), 11% increase in Self-Esteem (6.35 vs 7.18, p=0.001) and 9% increase in Connection with Patient (6.94 vs 7.65), p=0.01). Linear regression analysis revealed a positive association (R2=0.2606) between the increase in the self esteem of providers and positive connection with patients. Thematic analysis used for the qualitative portion of the data shows recurrent themes of increased connection and positive perception of illness.

CONCLUSIONS: This study shows that artistic expression as a reflective tool for providers is associated with an increase in self-esteem and interpersonal connection with patients. Larger focused studies are needed to further evaluate the proposed associations. Disclosure: Dr. Wilson has nothing to disclose. Miss Sblendorio has nothing to disclose. Dr. Pawar has nothing to disclose. Dr. Seachrist has stock in Medtronic. Dr. Seachrist has stock in Pfizer. The institution of Dr. Seachrist has received research support from Bristol Myers Squibb. Dr. Seachrist has a non-compensated relationship as a Topic Group, QOD Committee, and Wellness Program Committee with American Academy of Neurology that is relevant to AAN interests or activities. Dr. Peshwe has nothing to disclose. The institution of Dr. Frey has received research support from Tourette Association of America.

PMID:39977923 | DOI:10.1212/WNL.0000000000205087

Neurology. 2024 Apr 9;102(7_supplement_1):6885. doi: 10.1212/WNL.0000000000208155. Epub 2024 Apr 9.

ABSTRACT

OBJECTIVE: To analyze whether cerebrospinal fluid (CSF) biomarkers, such as total tau (t-Tau), phosphorylated tau (p-Tau), and amyloid-β42 (Aβ42), increase with sleep deprivation (SD).

BACKGROUND: Several studies have assessed CSF biomarkers associated with Alzheimer’s disease (AD) that could increase with SD; however, the results remain conflicting.

DESIGN/METHODS: We conducted a prognostic systematic review and meta-analysis of randomized and non-randomized studies evaluating SD of any type versus regular sleep patterns in patients without AD. This study was registered with PROSPERO (CRD42023453244). There were no restrictions on follow-up or age. We calculated the mean differences (MD) with 95% confidence intervals (CI) to compare continuous endpoints between the intervention and control arms. Cochran’s Q test and I² statistics were used to evaluate heterogeneity. We defined low heterogeneity as p > 0.10 and I² < 25%, moderate heterogeneity as I² between 25%-75%, and high heterogeneity as I² > 75%. The DerSimonian Laird random effects model was used to calculate the pooled effect estimates. Statistical significance was set at p ≤ 0.05. We conducted the statistical analyses using Review Manager 5.4 (Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark).

RESULTS: We searched PubMed, Embase, and Cochrane Library and found 27 studies. After screening and selection, following the Cochrane and PRISMA recommendations, 5 studies with 177 patients were included. Our analysis showed that SD increased p-Tau levels (MD 1.01, 95% CI 0.29 to 1.74, p=0.06, I² = 0%). However, SD was not associated with changes in Aβ42 (MD -9.57, 95% CI -89.92 to 70.78, p=0.815, I² = 61%) or t-Tau levels (MD 16.29, 95% CI -9.20 to 41.78, p=0.210, I² = 35%).

CONCLUSIONS: Sleep deprivation increased p-Tau, but not t-Tau nor Aβ42 in patients without AD. Disclosure: Mr. Berton has nothing to disclose. Mr. Moreira has nothing to disclose. Ms. Rodrigues has nothing to disclose. Miss Batista Donadon has nothing to disclose. Mrs. Dreon Calza has nothing to disclose. Mrs. Menegat has nothing to disclose. Mrs. Brkanitch has nothing to disclose. Miss Mattei has nothing to disclose. Mr. Dias has nothing to disclose. Mr. Guerra has nothing to disclose. Dr. Tonial has nothing to disclose.

PMID:39977921 | DOI:10.1212/WNL.0000000000208155

Neurology. 2024 Apr 9;102(7_supplement_1):6886. doi: 10.1212/WNL.0000000000208156. Epub 2024 Apr 9.

ABSTRACT

OBJECTIVE: Migraine affects about 14.4% of the population causing substantial burden. Our objective was to describe the populations of individuals diagnosed with migraine headache with regards to diagnosis and review healthcare service utilization across various categories.

DESIGN/METHODS: We reviewed recent (8/2018 – 7/2021) medical and pharmacy data from Health Verity for N=187,780. The final sample included 76,684 migraine cases matched to (matching criteria included demographic, geographic, comorbidity, and time-based variables) 76,684 non-migraine controls.

RESULTS: Within the migraine group, 68.4% were female (44.7 yrs, SD=13.9) vs. 69.7% female in the control group (45.6 yrs, SD=14.6). At baseline, migraine cases had higher rates of all-cause healthcare service utilization in each utilization subgroup: Migraine group was more likely to be hospitalized (10.4% vs. 4.5%*), have an Emergency Department (ED) visit (30.3% vs. 11.9%*), have a primary care physician visit (88.1% vs. 54.4%*), have a neurology visit (20.3% vs. 2.0%*), have higher overall use of other medical services, and have higher prescription fill rates (21.3 fills vs 9.53*) (*= p < 0.05). Similar differences were noted during the follow-up period, with migraine cases having higher rates of all-cause healthcare service utilization in each utilization subgroup. Notably, Neurology visits were 12.2 times more likely among the migraine case group compared to the control group, followed by other outpatient visits (OR: 9.5*), prescription fills (OR: 8.8*), PCP visits (OR: 6.9*), inpatient hospitalizations (OR: 3.4*), and ED visits (OR: 2.9*).

CONCLUSIONS: Migraine groups experienced significantly higher rates of healthcare service utilization across various categories, including hospitalization, ED and PCP visits, neurology consultations, and prescription fill rates underscoring continuous need to enhance the management of this condition. Disclosure: Dr. Petrova has nothing to disclose. Miss Besedina has received personal compensation for serving as an employee of Click Therapeutics Inc.. Mr. Hare has received personal compensation for serving as an employee of Click Therapeutics. Dr. Gupta has received personal compensation for serving as an employee of Click Therapeutics. Dr. Lakhan has received personal compensation for serving as an employee of Zogenix, Fern Health, Thriveworks, The Learning Corp, Click Therapeutics. Dr. Lakhan has received personal compensation in the range of $1,000,000+ for serving as a Consultant for Shaheen Lakhan, MD, PhD, LLC. Dr. Lakhan has received personal compensation in the range of $100,000-$499,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Neurocrine, Fern Health, Lin Health. Dr. Lakhan has received personal compensation in the range of $500,000-$999,999 for serving as an officer or member of the Board of Directors for Click Therapeutics, SpineThera. Dr. Lakhan has stock in Zogenix, NeuroSport, Click Therapeutics, SpineThera.

PMID:39977919 | DOI:10.1212/WNL.0000000000208156

Neurology. 2024 Apr 9;102(7_supplement_1):3368. doi: 10.1212/WNL.0000000000205091. Epub 2024 Apr 9.

ABSTRACT

OBJECTIVE: This study aimed to clarify the clinical significance of complex repetitive discharges (CRDs) identified on needle electromyography (EMG) in patients with radiculopathies.

BACKGROUND: CRDs are incompletely understood spontaneous needle EMG waveforms that can be seen in both myopathic and neurogenic disorders including radiculopathies.

DESIGN/METHODS: This case-control study randomly identified 100 patients with needle EMG evidence of radiculopathy demonstrating at least one CRD in the electrodiagnostically involved myotome between January 1, 2017 and January 1, 2022. These patients were compared with 100 randomly selected patients with EMG evidence of radiculopathy without CRDs matched to sex, age at EMG testing, and affected nerve root segment. Patient clinical symptoms, neurologic examination, EMG features, and imaging studies were analyzed. A paired sample t-test for continuous data and chi-square test for categorical data were used for statistical analysis with significance defined as p<0.05.

RESULTS: Patients with radiculopathies with CRDs had longer disease duration averaging 59 months (range 1-480) compared to patients with radiculopathies without CRDs averaging 26 months (range 1-192, p<0.01). Clinical symptoms of paresthesias and weakness were both significantly more common in patients with radiculopathies with CRDs than those patients without CRDs (p<0.01 and 0.01, respectively). Patients with radiculopathies with CRDs were referred more frequently for EMG testing specifically for a radiculopathy (p<0.01), had a higher average number of muscles with neurogenic motor unit potentials on EMG per radiculopathy (p=0.01), and had more evidence of active radiculopathies on EMG (p<0.01) compared with patients with radiculopathies without CRDs. Imaging studies of patients with radiculopathies with CRDs in the affected myotome were more likely to reveal evidence of potential nerve root compression (p<0.01).

CONCLUSIONS: The presence of CRDs in patients with radiculopathies is consistent with clinically more symptomatic radiculopathies and a longer duration of nerve root compromise. Disclosure: Dr. Skolka has nothing to disclose. Dr. Hass has nothing to disclose. Dr. Rubin has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Journal of Clinical Neurophysiology. Dr. Rubin has received intellectual property interests from a discovery or technology relating to health care. Dr. Rubin has received intellectual property interests from a discovery or technology relating to health care. Dr. Rubin has received publishing royalties from a publication relating to health care. Dr. Rubin has received publishing royalties from a publication relating to health care. Dr. Laughlin has nothing to disclose.

PMID:39977884 | DOI:10.1212/WNL.0000000000205091

Neurology. 2024 Apr 9;102(7_supplement_1):3371. doi: 10.1212/WNL.0000000000205092. Epub 2024 Apr 9.

ABSTRACT

OBJECTIVE: To collect real-world data to evaluate the effectiveness, safety, and tolerability of adding atogepant to onabotulinumtoxinA as combination preventive treatment for chronic migraine (CM).

BACKGROUND: Combination use of atogepant and onabotulinumtoxinA has the potential to be more effective than either alone for the preventive treatment of CM.

DESIGN/METHODS: This retrospective, longitudinal, multi-center chart review included adults with CM receiving ≥2 consecutive onabotulinumtoxinA cycles before ≥3mo of onabotulinumtoxinA and atogepant combination treatment. Charts at first atogepant prescription (index date) and 2 onabotulinumtoxinA injection visits (~3 and 6mo post-index) were reviewed for change from baseline in monthly headache days (MHDs), ≥50% reduction in MHDs, and rates and types of adverse events (AEs). Charts with CGRP agents for migraine prevention during baseline (~3mo pre-index) were excluded.

RESULTS: 31 charts met eligibility criteria (mean age 46.7 years, 94% female). Atogepant 60 mg and 30 mg were administered QD to 30 and 1 patients, respectively. Throughout the study, patients received a mean dose of 170U onabotulinumtoxinA. Pre-onabotulinumtoxinA, the mean MHD was 24.0d, reduced by a mean -8.15d (95%CI -11.44,-4.85; n=25) after onabotulinumtoxinA pre-index (mean 3.97yr). MHD additionally decreased by mean -4.53d [95%CI -7.44,-1.61] after ~3mo of combination treatment (n=31) and -8.75d total [95%CI -13.21, -4.29] after ~6mo of combination treatment in patients with data available (n=23). Nearly half of patients (n=14/31) achieved ≥50% reduction in MHDs ~3mo post-index. Overall, 95% CIs indicate that reductions from baseline were statistically significant. No new safety signals were identified when atogepant was added to onabotulinumtoxinA. The most commonly reported AEs (≥5%) were constipation and fatigue.

CONCLUSIONS: This real-world pilot study of patients with CM demonstrated clinically meaningful treatment benefit in the reduction of headache days with onabotulinumtoxinA alone and additive benefits with co-administration of atogepant. Safety results were consistent with the known safety profiles of onabotulinumtoxinA and atogepant. Disclosure: Dr. Blumenfeld has received personal compensation for serving as an employee of The Los Angeles Headache Center. Dr. Blumenfeld has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Allergan. Dr. Blumenfeld has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Best Doctors. Dr. Blumenfeld has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Guidepoint. Dr. Blumenfeld has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for GLG. Dr. Blumenfeld has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Theranica. Dr. Blumenfeld has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Aeon. Dr. Blumenfeld has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Revance. Dr. Blumenfeld has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Lilly. Dr. Blumenfeld has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Pfizer. Dr. Blumenfeld has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Lundbeck. Dr. Blumenfeld has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Teva. Dr. Blumenfeld has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Abbvie. Dr. Blumenfeld has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Allergan. Dr. Blumenfeld has received personal compensation in the range of $100,000-$499,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Aeon. Dr. Blumenfeld has received personal compensation in the range of $100,000-$499,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Revance. Dr. Blumenfeld has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Theranica. Dr. Blumenfeld has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Axsome. Dr. Blumenfeld has received personal compensation in the range of $100,000-$499,999 for serving on a Speakers Bureau for Allergan. Dr. Blumenfeld has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Amgen. Dr. Blumenfeld has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Teva. Dr. Blumenfeld has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Lilly. Dr. Blumenfeld has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Biohaven. Dr. Blumenfeld has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Lundbeck. Dr. Mechtler has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Jushi Inc. Dr. Mechtler has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Amgen. Dr. Mechtler has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Novartis. Dr. Mechtler has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Allergan. Dr. Mechtler has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Eli Lilly. Dr. Mechtler has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Teva. Dr. Mechtler has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Biohaven. Dr. Mechtler has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Lundbeck. Dr. Mechtler has received stock or an ownership interest from Jushi Co.. The institution of Dr. Mechtler has received research support from The Harry Dent Family Foundation, Inc. The institution of Dr. Mechtler has received research support from Amgen/Novartis. The institution of Dr. Mechtler has received research support from Alder/ Lundbeck. The institution of Dr. Mechtler has received research support from Abbvie/Allergan. The institution of Dr. Mechtler has received research support from Miles for Migraine. The institution of Dr. Mechtler has received research support from American Migraine Foundation. The institution of Dr. Mechtler has received research support from Charlotte’s Web. Dr. Cook has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Abbvie. Dr. Cook has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Teva. Dr. Cook has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Impel. The institution of Dr. Cook has received research support from Abbvie . The institution of Dr. Cook has received research support from Aeon. The institution of Dr. Cook has received research support from Axsome . The institution of Dr. Cook has received research support from Lilly . Dr. Rhyne has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie/Allergan. Dr. Rhyne has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abbvie/Allergan. Dr. Rhyne has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Abbvie/Allergan. Dr. Rhyne has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Amgen. Dr. Rhyne has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Teva. Dr. Rhyne has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Biohaven. Dr. Rhyne has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Lilly. Dr. Rhyne has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Theranica. Dr. Rhyne has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Lundbeck. Dr. Rhyne has received personal compensation in the range of $5,000-$9,999 for serving as a Speaker with Diamond Headache Clinic Research and Education Foundation. Dr. Rhyne has received personal compensation in the range of $500-$4,999 for serving as a Speaker with National Headache Foundation. Dr. Jenkins has received personal compensation for serving as an employee of Abbvie. Dr. Jenkins has received personal compensation for serving as an employee of Allergan. Dr. Jenkins has received personal compensation for serving as an employee of Teva. Dr. Jenkins has received personal compensation for serving as an employee of Biohaven. Dr. Jenkins has received personal compensation for serving as an employee of Lundbeck . Dr. Jenkins has received personal compensation for serving as an employee of Amgen and Novartis. Dr. Jenkins has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Abbvie. Dr. Jenkins has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Allergan . Dr. Jenkins has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Teva. Dr. Jenkins has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Biohaven . Dr. Jenkins has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Lundbeck . Dr. Jenkins has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Amgen and Novartis. Dr. Jenkins has stock in Prevacus. Dr. Jenkins has received intellectual property interests from a discovery or technology relating to health care. Ms. Hughes has received personal compensation for serving as an employee of ICON plc. Dr. Dabruzzo has received personal compensation for serving as an employee of AbbVie. Dr. Dabruzzo has stock in AbbVie. Dr. Manack Adams has received personal compensation for serving as an employee of Abbvie. Dr. Manack Adams has stock in Abbvie. Merle Diamond has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Allergan/AbbVie . Merle Diamond has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Lundbeck Pharmaceutical . Merle Diamond has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amgen. Merle Diamond has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Teva. Merle Diamond has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Impel NeuroPharma. Merle Diamond has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eli Lilly. Merle Diamond has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Promius. Merle Diamond has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Lundbeck Pharmaceuticals . Merle Diamond has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen. Merle Diamond has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Allergan/AbbVie. Merle Diamond has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Assertio. Merle Diamond has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eli Lilly . Merle Diamond has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Promius Pharma. Merle Diamond has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Supernus . Merle Diamond has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Teva Pharma. Merle Diamond has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Upsher-Smith . Merle Diamond has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Impel Neuro Pharma . Merle Diamond has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Axsome. Merle Diamond has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Assertio. Merle Diamond has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Amgen. Merle Diamond has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Axsome Pharma . Merle Diamond has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Assertio Therapeutics . Merle Diamond has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Eli Lilly . Merle Diamond has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Lundbeck . Merle Diamond has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Supernus Pharma. Merle Diamond has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Teva . Merle Diamond has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Upsher Smith. Merle Diamond has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Impel Neuro Pharma. Merle Diamond has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Allergan/AbbVie. Merle Diamond has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Lundbeck . Merle Diamond has received research support from Amgen . Merle Diamond has received research support from Lundbeck. Merle Diamond has received research support from Teva . Merle Diamond has received research support from Eli Lilly. Merle Diamond has received research support from Allergan. Merle Diamond has received personal compensation in the range of $500-$4,999 for serving as a Course Directory, Speaker with Diamond Research & Educational Foundation.

PMID:39977883 | DOI:10.1212/WNL.0000000000205092

Neurology. 2024 Apr 9;102(7_supplement_1):6861. doi: 10.1212/WNL.0000000000208139. Epub 2024 Apr 9.

ABSTRACT

OBJECTIVE: Our study aimed to determine a more precise treatment effect of balloon-expanding stents (BES) compared with self-expanding stents (SES) than be derived from considering each study with a small sample size individually.

BACKGROUND: There is limited data regarding the comparison of balloon-expanding stents (BES) and self-expanding stents (SES) for the treatment of intracranial arterial stenosis.

DESIGN/METHODS: We conducted a systematic review to identify studies that compared SES and BES in patients with symptomatic intracranial arterial stenosis. Data were extracted from relevant studies found through a search of PubMed, Scopus, and Web of Science until May 2023. Statistical pooling with random-effects meta-analysis was undertaken to compare the rates/severity of post-procedure stenosis, technical success, stroke and/or mortality, long-term events, and restenosis rates between BES and SES.

RESULTS: A total of 20 studies were included. The standardized mean difference (SMD) for post-procedure stenosis (%) was significantly lower (SMD: -0.52, 95% confidence interval [CI]: -0.79 to -0.24, p < 0.001, 10 studies involving 1515 patients) with BES. The odds for technical success were non-significantly lower (odds ratio [OR]: 0.99, 95% CI 0.43-2.26, p = 0.983, 9 studies involving 1001 patients) with BES. The odds for post-procedure 30-day stroke and/or death were significantly lower (OR 0.68, 95% CI: 0.50-0.94, p = 0.019, 15 studies involving 2431 patients), and stroke and/or death beyond 30 days were non-significantly lower (OR 0.64, 95% CI: 0.30-1.37, p = 0.250, 10 studies involving 947 patients) with BES. The odds for restenosis rate were significantly lower (OR 0.50, 95% CI: 0.31-0.80, p = 0.004, 13 studies involving 1115 patients) with BES.

CONCLUSIONS: Compared with SES, BES were associated with lower rates of post-procedure 30-day stroke and/or death presumably due to less severe post procedure stenosis in treatment of symptomatic intracranial arterial stenosis. Disclosure: Dr. Lodhi has nothing to disclose. Mr. Ma has nothing to disclose. Dr. Ahmed has nothing to disclose. Dr. Liaqat has nothing to disclose. Mr. Maqsood has nothing to disclose. Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Medtronic. Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Stryker. Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Penumbra. Dr. Hassan has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Cerenovus. Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Viz.ai. Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Genentech. Dr. Hassan has received research support from GE Healthcare. Dr. Siddiq has nothing to disclose. Dr. Gomez has nothing to disclose. Dr. Suri has nothing to disclose. Dr. Qureshi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for AstraZeneca.

PMID:39977881 | DOI:10.1212/WNL.0000000000208139

JMIR Res Protoc. 2025 Feb 20;14:e59842. doi: 10.2196/59842.

ABSTRACT

BACKGROUND: Standard lifestyle interventions have shown limited efficacy in preventing type 2 diabetes among individuals with isolated impaired fasting glucose (i-IFG). Hence, tailored intervention approaches are necessary for this high-risk group.

OBJECTIVE: This study aims to (1) assess the feasibility of conducting a high-intensity interval training (HIIT) study and the intervention acceptability among individuals with i-IFG, and (2) investigate the preliminary efficacy of HIIT in reducing fasting plasma glucose levels and addressing the underlying pathophysiology of i-IFG.

METHODS: This study is a 1:1 proof-of-concept randomized controlled trial involving 34 physically inactive individuals (aged 35-65 years) who are overweight or obese and have i-IFG. Individuals will undergo a 3-step screening procedure to determine their eligibility: step 1 involves obtaining clinical information from electronic health records, step 2 consists of completing questionnaires, and step 3 includes blood tests. All participants will be fitted with continuous glucose monitoring devices for approximately 80 days, including 10 days prior to the intervention, the 8-week intervention period, and 10 days following the intervention. Intervention participants will engage in supervised HIIT sessions using stationary “spin” cycle ergometers in groups of 5 or fewer. The intervention will take place 3 times a week for 8 weeks at the Aerobic Exercise Laboratory in the Rehabilitation Hospital at Emory University. Control participants will be instructed to refrain from engaging in intense physical activities during the study period. All participants will receive instructions to maintain a eucaloric diet throughout the study. Baseline and 8-week assessments will include measurements of weight, blood pressure, body composition, waist and hip circumferences, as well as levels of fasting plasma glucose, 2-hour plasma glucose, and fasting insulin. Primary outcomes include feasibility parameters, intervention acceptability, and participants’ experiences, perceptions, and satisfaction with the HIIT intervention, as well as facilitators and barriers to participation. Secondary outcomes comprise between-group differences in changes in clinical measures and continuous glucose monitoring metrics from baseline to 8 weeks. Quantitative data analysis will include descriptive statistics, correlation, and regression analyses. Qualitative data will be analyzed using framework-driven and thematic analyses.

RESULTS: Recruitment for the study is scheduled to begin in February 2025, with follow-up expected to be completed by the end of September 2025. We plan to publish the study findings by the end of 2025.

CONCLUSIONS: The study findings are expected to guide the design and execution of an adequately powered randomized controlled trial for evaluating HIIT efficacy in preventing type 2 diabetes among individuals with i-IFG.

TRIAL REGISTRATION: Clinicaltrials.gov NCT06143345; https://clinicaltrials.gov/study/NCT06143345.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/59842.

PMID:39977858 | DOI:10.2196/59842

J Med Internet Res. 2025 Feb 20;27:e59101. doi: 10.2196/59101.

ABSTRACT

BACKGROUND: Men who have sex with men (MSM) are at high risk for HIV infection and sexually transmitted diseases (STDs). However, there is a lack of accurate and convenient tools to assess this risk.

OBJECTIVE: This study aimed to develop machine learning models and tools to predict and assess the risk of HIV infection and STDs among MSM.

METHODS: We conducted a cross-sectional study that collected individual characteristics of 1999 MSM with negative or unknown HIV serostatus in Western China from 2013 to 2023. MSM self-reported their STD history and were tested for HIV. We compared the accuracy of 6 machine learning methods in predicting the risk of HIV infection and STDs using 7 parameters for a comprehensive assessment, ranking the methods according to their performance in each parameter. We selected data from the Sichuan MSM for external validation.

RESULTS: Of the 1999 MSM, 72 (3.6%) tested positive for HIV and 146 (7.3%) self-reported a history of previous STD infection. After taking the results of the intersection of the 3 feature screening methods, a total of 7 and 5 predictors were screened for predicting HIV infection and STDs, respectively, and multiple machine learning prediction models were constructed. Extreme gradient boost models performed optimally in predicting the risk of HIV infection and STDs, with area under the curve values of 0.777 (95% CI 0.639-0.915) and 0.637 (95% CI 0.541-0.732), respectively, demonstrating stable performance in both internal and external validation. The highest combined predictive performance scores of HIV and STD models were 33 and 39, respectively. Interpretability analysis showed that nonadherence to condom use, low HIV knowledge, multiple male partners, and internet dating were risk factors for HIV infection. Low degree of education, internet dating, and multiple male and female partners were risk factors for STDs. The risk stratification analysis showed that the optimal model effectively distinguished between high- and low-risk MSM. MSM were classified into HIV (predicted risk score <0.506 and ≥0.506) and STD (predicted risk score <0.479 and ≥0.479) risk groups. In total, 22.8% (114/500) were in the HIV high-risk group, and 43% (215/500) were in the STD high-risk group. HIV infection and STDs were significantly higher in the high-risk groups (P<.001 and P=.05, respectively), with higher predicted probabilities (P<.001 for both). The prediction results of the optimal model were displayed in web applications for probability estimation and interactive computation.

CONCLUSIONS: Machine learning methods have demonstrated strengths in predicting the risk of HIV infection and STDs among MSM. Risk stratification models and web applications can facilitate clinicians in accurately assessing the risk of infection in individuals with high risk, especially MSM with concealed behaviors, and help them to self-monitor their risk for targeted, timely diagnosis and interventions to reduce new infections.

PMID:39977856 | DOI:10.2196/59101