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Purpose: We sought to evaluate the incidence, natural history, and management of cystic spinal lesions following myelomeningocele/myeloschisis closure. Methods: We performed a single-center retrospective review of all patients who underwent myelomeningocele/myeloschisis closure from 2013 to 2018 with follow-up to 5 years old. Results: We analyzed 100 fetal repairs and 81 postnatal closures from 305 total surgeries. Patients within this cohort systematically underwent serial MRI scans of the lumbar spine and had clinical follow-up until at least 5 years of age. Ninety-three (51.2%) developed radiographic evidence of cystic lesions with 28 (30.1%) requiring surgical intervention. Presence of cysts was higher in fetal repair (67/100, 67%) compared with postnatal (26/81, 32.1%; p < 0.01). Of the 93 patients with radiographic cysts, 28 (30.1%) underwent surgical resection at a median age of 27.6 months old ([Q1, Q3], [13.0, 48.6 months]). Fetal repair patients had a higher rate (26/67, 38.8%) of cysts requiring surgical resection compared with postnatal closure (2/26, 7.7%, p value < 0.01). Pathology demonstrated 18 of resected cysts were dermoid, 8 were epidermoid, and 2 were fibrous tissue. Post-operatively, no patients experienced a worsened ambulation status. Bladder compliance showed a non-significant trend toward improvement. Conclusions: Cystic lesions in myelomeningocele/myeloschisis patients are common findings that result in nerve root tethering. We propose regular screening in both symptomatic and asymptomatic patients to circumvent nerve injury. Most cystic lesions do not require surgical resection though fetal repair is associated with a higher incidence of operative cysts. However, these lesions can be safely surgically resected with maintenance of ambulation and urologic function. [ABSTRACT FROM AUTHOR]

Climate change is predicted to have significant impacts on aquatic ecosystems. When combined with other stressors such as environmental contaminants, increasing temperatures will have serious consequences to the physiology and behavior of aquatic organisms. Pharmaceuticals such as antidepressants from wastewater treatment plants have been shown to modify the behavior of non-target aquatic species. We tested over 2000 snails (Physa gyrina) from a creek in Pennsylvania, USA for their righting behavior when exposed to different combinations of temperature (12°, 20°, and 25 °C) and antidepressant (venlafaxine and fluoxetine) concentration for one week or 48 hours. Snails exposed for one week righted significantly faster in warmer temperatures and in almost all concentrations of both antidepressants compared to controls. Snails exposed for 48 hours showed similar responses to warmer temperature as they did when exposed for one week, but only at the highest antidepressant concentrations did they right significantly faster than the controls. Exposure to venlafaxine at low concentration (1.56 µg/L) for 48 hours resulted in significant inhibition of righting, indicative of a non-monotonic dose response. We discuss the possible consequences of increased water temperature combined with antidepressant contamination on snail behavior as well as the possible physiological mechanisms of action explaining non-monotonic dose responses. [ABSTRACT FROM AUTHOR]

Background: Audio-only (phone) telemental health care can increase access to care, but its lack of nonverbal information may negatively impact care quality as compared to video or in-person visits. The objective of this work was to understand patient and provider attitudes toward phone care via a review of qualitative research. Methods: A qualitative evidence synthesis was conducted of peer-reviewed qualitative research published between 2013 and 2023. Studies were required to include qualitative data regarding patient and/or provider attitudes toward audio-only telemental health care. Results pertinent to phone care were extracted and underwent coding followed by theme identification. Results: We identified 2,065 abstracts and 29 articles were ultimately included in the synthesis; 27 of these studies were conducted during the COVID-19 pandemic. Five themes described benefits of phone care, nine described drawbacks, and three themes were neutral. Phone care was seen as easy to use, particularly for briefer check-ins or as a back-up option if video calls failed, and some patients preferred the privacy of not being seen. However, the loss of visual information during phone visits was considered particularly challenging in the treatment of more complex or severe patients; providers questioned whether they were able to provide high quality care, and patients reported feeling less supported and understood by their providers. Conclusions: The relative benefits and drawbacks of audio-only telemental health care must be carefully weighed against the options of video or in-person treatment based on patient needs and severity. Future work should continue to examine patient and provider attitudes toward phone care as the mental health landscape evolves postpandemic. [ABSTRACT FROM AUTHOR]

The antibody response to SARS-CoV-2 does not follow the immunoglobulin isotype pattern of primary responses, conflicting with the current interpretation of COVID-19., Methods: Prospective cohort study of 191 SARS-CoV-2 infection cases and 44 controls from the second wave of COVID-19. The study stratified patients by severity and analyzed the trajectories of SARS-CoV-2 antibodies and multiple immune variables., Results: Isotype-specific antibody time course profiles to SARS-CoV-2 revealed a pattern of recall response in 94.2 % of cases. The time course profiles of plasmablasts, B cells, cTfh high-resolution subsets, and cytokines indicated a secondary response. The transcriptomic data showed that this cohort is strictly comparable to contemporary cohorts., Conclusions: In most cases, the immune response to SARS-CoV-2 is a recall response. This constitutes a favorable scenario for most COVID-19 cases to be subjected to immune imprinting by endemic coronavirus, which, in turn, can influence the immune response to SARS-CoV-2., Competing Interests: Declaration of competing interest All authors declare that they have no conflicts of interest., (Copyright © 2025. Published by Elsevier Inc.)

Objective: The natural history of cephaloceles is not well understood. The goal of this study was to better understand the natural history of fetal cephaloceles from prenatal diagnosis to the postnatal period., Methods: Between January 2013 and April 2023, all patients evaluated with a cephalocele at the Center for Fetal Diagnosis and Treatment were identified. All patients underwent prenatal and postnatal MRI. Demographic and imaging covariates were obtained from the electronic medical record. Volumetric analyses were performed to determine the percentage of neural tissue within the cephalocele. Progressive herniation was defined as an increase in cephalocele absolute neural tissue volume ≥ 5% or new herniation of an additional intracranial structure into the cephalocele., Results: A total of 25 patients met the inclusion criteria. Of these patients, 6 (24%) exhibited progressive cephalocele herniation from the prenatal to postnatal MRI. The median sac volume was 2.2 mL (mean 6.2 mL, range 0.3-40.5 mL). The median change in brain volume in the patients with cephalocele progression was a decrease of 1.5% (mean -7.3%, range -36.4% to 3.1%). Cephalocele sac volume at the time of fetal imaging was predictive of progressive herniation, which persisted on multivariate analysis when controlling for gestational age, sex, and percentage of herniated neural tissue. While 44% of the patients had ventriculomegaly, 56% ultimately required permanent CSF diversion., Conclusions: Progressive neural herniation from the fetal to postnatal period is not commonly seen in fetal cephaloceles. Sac volume is associated with an increased risk of progressive herniation into the cephalocele.

Background/aim: Despite the donor-exchange program implementation for highly sensitized (HS) patients, no improvement in waiting list in those HS patients with 100% calculated panel reactive of antibodies (cPRA) is observed. Recently, it has been published the treatment with imlifidase in desensitization algorithm. However, there are low-risk strategies to reduce cPRA. A cPRA of <99.95% increase donor offer chances, so delisting (DL) strategies should be addressed in cPRA reduction. We propose an integral approach for DL from low to intermediate risk to assess the 100% HS patients on waiting list., Methods: The common DL criteria for previously forbidden alleles were that they should neither have been present in previous transplants nor possess complement fixation ability. Low-risk phase of DL is based on historical mean fluorescence intensity (MFI) of <5000 in the last 2 years. The next phase risk is based on single-antigen test in 1/10 diluted serum with MFI value of <3000; without eplet mismatch (low-intermediate risk specificity), or with eplet mismatch from previous transplants (intermediate risk). The molecular mismatch may be assessed with the mismatch calculator tool from registry website (https://www.epregistry.com.br/)., Conclusions: Low-risk DL approaches are now widely used to reduce cPRA in HS patients; however, sometimes it is not enough to get transplanted and new tools are needed. Despite new treatments with imlifidase, some cases had anti-human leukocyte antigen rebound levels with a higher risk of rejection. Here, we propose a scaled DL approach would be a better therapeutic approach for HS patients whenever possible., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)