Nemours Children's Hospital

Abnormalities in cardiac wall motion are strong predictors of cardiovascular risk, making their accurate detection essential for early diagnosis and effective clinical management. Traditional imaging modalities such as echocardiography, magnetic resonance imaging (MRI), and computed tomography (CT) provide valuable insights but face limitations related to accessibility, cost, and the complexity of spatiotemporal analysis. Recent advances in machine learning (ML), particularly deep learning (DL), have enabled automated extraction of spatial and temporal features from medical imaging. They improved accuracy in segmentation, motion estimation, and detection of regional wall motion abnormalities. This paper reviews state-of-the-art methods for predicting cardiac wall motion, with emphasis on DL applications across echocardiography, 4D CT, and cine MRI datasets. Representative studies demonstrate the potential of convolutional neural networks, recurrent neural networks, and transformers to achieve performance comparable to expert clinicians, while also highlighting challenges such as data scarcity, model interpretability, and limited external validation. Addressing these issues will be critical for translating ML-based approaches into routine practice, and integration of advanced imaging with robust ML frameworks helps in developing a reliable cardiac wall motion simulators for personalized treatment planning and improved cardiovascular care.

To explore the understanding of osteoporosis in the context of adult spinal deformity (ASD) surgery with a focus on diagnosis, surgical risks, non-operative, and operative treatment techniques. A comprehensive literature search was performed. Articles were identified using the search terms “osteoporosis,” “adult spinal deformity,” “scoliosis,” and “spine surgery.” Relevant studies were selected based on their focus on the intersection of these topics with an emphasis on utility in spine surgery. This review discusses osteoporosis diagnosis, surgical risks, and non-operative, and surgical treatments in the context of ASD surgery with a focus on clinical applications. Areas for future growth are highlighted. As adult spinal deformity (ASD) patients increase globally, the Scoliosis Research Society (SRS) formed a task force to improve understanding of osteoporosis and its impact on this vulnerable population. This review brings together the latest research on the topic and highlights this area as one of critical importance and growth in the field.

OBJECTIVES:To update evidence-based management recommendations for clinicians caring for children (including infants, school-aged children, and adolescents) with sepsis or septic shock. DESIGN:A panel of 68 international experts, representing 13 international organizations, as well as six methodologists, was convened. A formal conflict-of-interest policy was developed at the onset of the process and applied throughout. Teleconferences and electronic-based discussion among the chairs, co-chairs, methodologists, and subgroup leads as well as within subgroups, served as an integral part of the guideline development process. METHODS:New priority topics and recommendations from the prior guideline iteration were used to identify Population, Intervention, Control, and Outcomes (PICO) questions likely to have new or updated evidence. We conducted a systematic review to identify the best available evidence, summarized the evidence, and then assessed the quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation approach. We used the evidence-to-decision framework to formulate recommendations as strong or conditional, or as a good practice statement. "In our practice," statements were included when evidence was inconclusive to issue a recommendation but the panel felt that some guidance based on practice patterns may be appropriate. RESULTS:The panel provided 61 statements on the management of children with sepsis or septic shock. Overall, five were strong recommendations, 24 were conditional recommendations, and ten were good practice statements. For 22 PICO questions, no recommendations could be made, but, for seven of these, "in our practice" statements were provided. Compared with the 2020 guidelines, 20 recommendations were new, 13 were updated for clarity and/or new evidence, six were reviewed but not changed, and 22 were carried forward based on consensus of the panel that new evidence was not available. Only three recommendations were based on high or moderate certainty of evidence. CONCLUSIONS:Updated management guidelines were issued by a panel of international experts for the best care of children with sepsis or septic shock, acknowledging that most aspects of care continue to have relatively low quality of evidence.

Fragile X Syndrome (FXS), the most common inherited cause of intellectual disability and a leading monogenic cause of autism, arises from the loss of Fragile X Messenger Ribonucleoprotein (Fmr protein), leading to synaptic and cognitive dysfunction. Here, we demonstrate that the frequency-specific electrical stimulation of the medial septum/diagonal band of Broca (MSDB) can restore cognitive and synaptic impairments in Fmr1 knockout mice, a validated model of FXS. Thirty minutes of 35 Hz MSDB stimulation significantly improved subsequent recognition memory, sociability, spatial learning, and fear memory, with recognition memory enhancements persisting for up to 7 days after daily 30 min stimulations for 10 days. Electrophysiological recordings revealed that MSDB stimulation restored basal synaptic transmission and facilitation, and long-term potentiation in hippocampal CA1 neurons. These findings demonstrate that frequency-specific MSDB stimulation can re-engage dysfunctional hippocampal circuits and restore cognitive function in FXS, offering a promising non-pharmacological therapeutic strategy for neurodevelopmental disorders.

Leadership and nontechnical skills are essential for anesthesiologists, yet structured leadership education remains inconsistent. We surveyed 124 anesthesiology trainees and junior faculty across six programs to identify leadership priorities and preferred teaching modalities. Respondents rated communication, teamwork, emotional intelligence, and problem-solving as most important, whereas business knowledge, scholarly communication, and teaching were valued less. Case-based learning and small-group discussions were preferred modalities for teaching. These findings highlight anesthesiology trainees' and junior faculty members' perceptions of leadership competencies they consider most important and can inform the development of leadership curricula that align with learner-identified priorities while addressing evolving academic and community healthcare demands.