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Kidney dysfunction in spina bifida is usually detected by low estimated glomerular filtration rate or ultrasound based hydronephrosis. We assessed the diagnostic test characteristics of hydronephrosis for detecting low estimated glomerular filtration rate, hypothesizing that hydronephrosis has low sensitivity compared to cystatin C based estimated glomerular filtration rate.We conducted a single center, retrospective cohort study, including patients with spina bifida from 2012-2017 with 2 kidneys and complete data needed to calculate estimated glomerular filtration rate via multiple pediatric (age 1-17.9 years) or adult (age ≥18 years) estimating equations. We evaluated the association of hydronephrosis status (high grade, low grade or none) with estimated glomerular filtration rate, adjusting for small kidney size and scarring, and calculated diagnostic test characteristics of hydronephrosis for low estimated glomerular filtration rate.We analyzed 247 patients (176 children and 71 adults). Mean±SD age was 13.7±6.6 years, and 81% of patients had myelomeningocele. Hydronephrosis (77% low grade) was found in 35/176 children and 18/71 adults. Hydronephrosis was associated with low estimated glomerular filtration rate in stepwise fashion, independent of kidney size and scarring. However, across cystatin C based pediatric equations, any hydronephrosis (compared to none) had 23%-48% sensitivity, and high grade hydronephrosis (compared to none or low grade) had 4%-15% sensitivity for estimated glomerular filtration rate90 ml/min/1.73 mHydronephrosis was associated with low estimated glomerular filtration rate but had poor sensitivity for cystatin C based estimated glomerular filtration rate90 ml/min/1.73 m

Background: Increased blood pressure variability (BPV) has been associated with stroke risk, but no serum inflammatory markers have been identified associated with increased BPV, despite preclinical data suggesting a role. Methods: This is a post-hoc analysis of the Multi-Ethnic Study of Atherosclerosis (MESA) study. The study exposure was tertiles of serum level of interleukin-6 (IL-6) at the baseline study visit. The primary outcome was visit-to-visit BPV measured as the residual standard deviation (rSD) of at least 4 subsequent study visits (1999-2018). Two logistic regression models were fit to the top tertile (i.e. most variability) of rSD during follow-up: in Model 1, we adjusted for covariates chosen with restricted Least Absolute Shrinkage and Selection Operator (LASSO) and in Model 2, for all covariates. Results: Our analysis included 5,483 patients, of mean (SD) age 61.4 (10.0) years and with 52.9% female. Mean (SD) of IL-6 was 1.7 (1.2) (pg/mL) in the top tertile BPV rSD and 1.4 (1.1) in the bottom tertiles. The incidence of ischemic stroke and all major adverse cardiovascular event was higher in top tertile of BPV (Table 1). Elevated serum IL-6, but not other serum biomarkers of inflammation and clotting (see comment below), was associated with the highest tertile of BPV, independent of potential confounders (Table 2). Conclusion: Higher levels of serum IL-6 were associated with increased subsequent BPV in a large multiracial cohort. Further investigation is needed to better understand the relationship between chronic inflammation and BPV. Table 1. Baseline demographics, serum biomarkers, and clinical outcomes during follow-up (how long was follow-up on average?) in the full cohort, and stratified by the top versus lower tertiles of BPV. Table 2. Association of serum biomarkers at baseline with the highest tertile of blood pressure variability.*Model 1 adjusted for patient age categories ( **Model 2 (n=5,447) adjusted for patient age categories (

Background: Prior research with the National Inpatient Sample (NIS) has shown that women are less likely than men to receive to receive intravenous Alteplase (tPA) for acute ischemic stroke, but more recent analyses have found conflicting results and patient age has not been taken into account, nor has stroke severity. Methods: We included patients in the NIS from 2016-18 with a primary discharge diagnosis of ischemic stroke and who had an admission NIH Stroke Scale (NIHSS). The primary outcome was receipt of tPA and the exposure was patient sex. After survey weighting, we fit logistic regression models adjusted for age, race/ethnicity, NIHSS, patient income by ZIP code, hospital teaching status, hospital Census region, and hospital location according to the NCHS Urban-Rural Classification. We included interactions between our covariates and the exposure of sex. Results: After weighting, we included 384,700 patients, of which 15.1% received tPA and 49.1% were female. The rate of tPA was identical (15.1%) between male and female patients (p=0.880). In the multivariable logistic regression model, female sex had an odds ratio for tPA of 0.97 (95% CI 0.93, 1.01, p=0.163). The only covariate that had a significant interaction with sex was age (p Conclusion: In the most recent sample of the NIS, women with acute ischemic stroke are no longer less likely than men to receive tPA. We show this holds true after adjustment for stroke severity, although there is still a disparity in older patients aged ≥75, with women being 1.5% less likely than men to receive tPA.

AIMS Current estimated glomerular filtration rate (eGFR) equations may be inaccurate in patients with spina bifida (SB) because of reduced muscle mass and stature. Cross-sectional and longitudinal variability of eGFR were analyzed in these patients across multiple equations, hypothesizing greater variability in creatinine-based than cystatin-C (Cys-C)-based equations. METHODS This retrospective cohort study included children (age, 1-17.9 years) and adults (≥18 years) with SB from 2002-2017 at a large SB clinic. Those without all data needed to calculate eGFR were excluded. Four pediatric and three adult eGFR equations were compared for cross-sectional outcomes of eGFR and elevated office blood pressures using chronic kidney disease (CKD) stage classification, and for longitudinal outcome of eGFR slope over time using covariance pattern models accounting for repeated measures. RESULTS One hundred and eighty two children and 75 adults had greater than or equal to 1 set of data measurements; 118 and 52, respectively, had greater than or equal to 2 sets. The pediatric bedside Schwartz equation had the highest median eGFR and coefficient of variation. CKD stage classification by eGFR showed large differences across equations in children, with rates of eGFR

Background Clubfoot occurs in 30% to 50% of patients with spina bifida. The Ponseti casting method has changed treatment of idiopathic clubfoot to a primarily nonoperative regimen. The Ponseti method is now widely applied to clubfoot in spina bifida, however, few studies report treatment outcomes. Most available studies include heterogeneous diagnoses or short-term results. The purpose of this study is to report midterm outcomes in patients with spina bifida and clubfoot treated with the Ponseti method. Methods IRB-approved retrospective chart review of 17 consecutive patients (26 feet) below 1 year of age with spina bifida and clubfoot treated with Ponseti method. Charts reviewed for age at treatment initiation, number of casts, surgeries performed, recurrence of deformity, and further treatments. Primary outcome was recurrence of deformity requiring further treatment. Data were analyzed using t tests for means and χ tests for categorical data. Results Initial correction was achieved in 26 of 26 feet patients. A total of 23 of 26 feet patients underwent a surgical procedure for the tendo-Achilles at an average age of 105 days, 12 percutaneous tenotomies (percT) and 11 open tendonectomy (openT). At average follow-up of 5 (1.8 to 7.5) years, 11 feet (42.3%) in 8 patients were successfully treated with Ponseti method. Of the 15 feet (57.7%) with recurrence, 10 required posterior releases, 4 posterior-medial-lateral releases and 1 tendon transfers. Average age at further treatment was 1.5 years (0.9 to 3.1 y). Those with recurrence required more casts before tendon surgery (7.6 vs. 6.1, P=0.02). A total of 100% patients (12/12) with percT had recurrence of deformity, compared with 18% (2/11) of patients with openT (P Conclusions Midterm evaluation of Ponseti method for clubfoot in spina bifida shows a successful outcome in 42.3%. Recurrence with openT was significantly lower than percT and also substantially lower than previously published recurrence rates in spina bifida (33.3% to 68%). In spina bifida, Ponseti method leads to reliable initial correction and is useful to decrease extensive soft tissue release. An open excision of the Achilles should be performed. Families should be counseled about high risk of recurrence and potential need for further treatment. Level of evidence Level III-retrospective comparative study.

Creativity has been defined as the ability to produce work that is novel, high in quality, and appropriate to an audience. While the nature of the creative process is under debate, many believe that creativity relies on real-time combinations of known neural and cognitive processes. One useful model of creativity comes from musical improvisation, such as in jazz, in which musicians spontaneously create novel sound sequences. Here we use jazz musicians to test the hypothesis that individuals with training in musical improvisation, which entails creative generation of musical ideas, might process expectancy differently. We compare jazz improvisers, non-improvising musicians, and non-musicians in the domain-general task of divergent thinking, as well as the musical task of preference ratings for chord progressions that vary in expectation while EEGs were recorded. Behavioral results showed for the first time that jazz musicians preferred unexpected chord progressions. ERP results showed that unexpected stimuli elicited larger early and mid-latency ERP responses (ERAN and P3b), followed by smaller long-latency responses (Late Positivity Potential) in jazz musicians. The amplitudes of these ERP components were significantly correlated with behavioral measures of fluency and originality on the divergent thinking task. Together, results highlight the role of expectancy in creativity.

Creativity has been defined as requiring both novelty and effectiveness, but little is known about how this standard definition applies in music. Here, we present results from a pilot study in which we combine behavioral testing in musical improvisation and structural neuroimaging to relate brain structure to performance in a creative musical improvisation task. Thirty-eight subjects completed a novel improvisation continuation task and underwent T1 MRI. Recorded performances were rated by expert jazz instructors for creativity. Voxel-based morphometric analyses on T1 data showed that creativity ratings were negatively associated with gray matter volume in the right inferior temporal gyrus and bilateral hippocampus. The duration of improvisation training, which was significantly correlated with creativity ratings, was negatively associated with gray matter volume in the rolandic operculum. Together, results show that musical improvisation ability and training are associated with gray matter volume in regions that are previously linked to learning and memory formation, perceptual categorization, and sensory integration. The present study takes a first step towards understanding the neuroanatomical basis of musical creativity by relating creative musical improvisation to individual differences in gray matter structure.

INTRODUCTION AND OBJECTIVES:Emerging adults with spina bifida (SB) may face inaccurate kidney function assessment as they bridge the age gap between pediatric and adult equations for estimated glom...

Creativity is the ability to produce work that is novel, high in quality, and appropriate to an audience. One domain of creativity comes from musical improvisation, in which individuals spontaneously create novel auditory-motor sequences that are aesthetically rewarding. Here we test the hypothesis that individual differences in creative behavior are subserved by mesial and lateral differences in white matter connectivity. We compare jazz improvising musicians against classical (non-improvising) musicians and non-musician control subjects in musical performance and diffusion tensor imaging. Subjects improvised on short musical motifs and underwent DTI. Statistical measures of fluency and entropy for musical performances predicted expert ratings of creativity for each performance. Tract-Based Spatial Statistics (TBSS) showed higher Fractional Anisotropy (FA) in the cingulate cortex and corpus callosum in jazz musicians. FA in the cingulate also correlated with entropy. Probabilistic tractography from these mesial regions to lateral seed regions of the arcuate fasciculus, a pathway known to be involved in sound perception and production, showed mesial-to-lateral connectivity that correlated with improvisation training. Results suggest that white matter connectivity between lateral and mesial structures may integrate domain-general and domain-specific components of creativity.