Michael Wesley Daniels

Background: Cardiovascular disease (CVD) remains the leading cause of morbidity and death worldwide. Risk scores such as the pooled cohort equations often underpredict risk in individuals with low socioeconomic status. Methods: We used the Centers for Disease Control and Prevention Population Level Analysis and Community Estimates data set to obtain zip code–level prevalence of hypertension, obesity, stroke, diabetes, and coronary artery disease. The Distressed Communities Index (DCI) collates community socioeconomic status and social determinants/drivers of health metrics into a numerical score. Linear regression adjusted for region and rurality assessed associations between DCI and CVD prevalence. Results: We included 26 058 US zip codes (2016–2020). The median DCI was 50.9 (interquartile range, 25.4–75.9). Each 1‐unit increase in DCI was associated with increased prevalence of obesity (β=0.10 [95% CI, 0.09–0.10]), hypertension (β=0.08 [95% CI, 0.08–0.09]), diabetes (β=0.06 [95% CI, 0.06–0.06]), coronary artery disease (β=0.03 [95% CI, 0.03–0.03]), and stroke (β=0.02 [95% CI, 0.02–0.02]; all P <0.001). Rurality and region were independently associated with CVD and risk factor prevalence, with rural and southern zip codes having the highest prevalence. Conclusions: DCI, geographic region, and rurality are independently associated with greater prevalence of CVD and its risk factors in the United States. The DCI is a practical, scalable surrogate for socioeconomic status and social determinants/drivers of health that may enhance CVD risk stratification on the basis of an area's economic resilience or disadvantage. Using DCI with the Preventing Cardiovascular Events score may capture economic and social challenges it omits, warranting further study.

Background/Objectives: Gastroparesis is a disorder in which individuals experience dysfunctional gastric motor symptoms, but the underlying etiology is unclear. This exploratory study investigates autoimmune, inflammatory, metabolic, autonomic, and enteric (AIMAE) abnormalities in patients with gastroparesis symptoms to provide new insights into pathophysiology. The aim of this study is to further elucidate the potential associations between the different AIMAE measurements. Methods: Twenty-one patients with gastroparesis symptoms underwent a series of testing including assays for measurement of autoimmune, inflammatory, and metabolic markers; measurement of the autonomic nervous system; electrogastrography recordings; and gastric emptying measurements. Associations were evaluated using Spearman’s rank correlation with pairwise-complete observations. Benjamini–Hochberg false-discovery-rate correction was applied separately within each prespecified statistical family, with q ≤ 0.05 defining statistical significance. Results: Across 3432 planned correlations in 10 prespecified families, four associations met the false-discovery-rate threshold. DFS-70 was positively associated with C-peptide (q= 0.000330). Low-resolution EGG S1 mean amplitude was positively associated with insulin (q = 0.000172). IL-6 was inversely associated with baseline sympathetic LFa modulation (q = 0.000172) and standing sympathetic LFa modulation (q = 0.000172). Conclusions: This prospective pilot study identified strong associations among autoimmune, inflammatory, metabolic, enteric, and autonomic measurements. The findings were robust to leave-one-out analyses and generally retained their direction and magnitude after excluding participants with diabetes or a gastric electrical stimulator. However, the results of this study should be interpreted as hypothesis-generating rather than causal due to its limitations including a small cohort and incomplete confounder information.

Background: Faricimab is one of the most potent anti-vascular endothelial growth factors used in the management of diabetic macular edema (DME). However, real-world benefits regarding its timing and efficacy are still being explored. Methods: This retrospective non-randomized pilot study aimed to evaluate the efficacy of intravitreal faricimab in the treatment of DME. Eyes initially treatment-naïve for DME with a follow-up of 1 year were grouped as: group 1, where faricimab was introduced within the first six months after the start of treatment; group 2, where it was initiated six or more months after treatment with other drugs. Study parameters included changes in best corrected visual acuity (BCVA) and optical coherence tomography based structural parameters within the 6 × 6 mm optical coherence tomography (OCT) scan regions. Results: Forty-two eyes from 26 patients were analyzed. No statistically significant differences were observed between the groups in cluster-weighted proportions of intra- or sub-retinal fluid, retinal thickness or volume parameters, although group 1 showed modest numerical benefits. SRF showed a trend towards qualitative reduction in group 1, although IRF showed persistence in both groups. Adjusted linear mixed-effects modeling demonstrated no significant impact of early faricimab initiation on functional and anatomical outcomes, which appeared to be influenced by the baseline BCVA, glycemic control, and the number of injections, nullifying the benefits. Conclusions: Faricimab demonstrated modest anatomical improvements with earlier treatment in eyes initially treatment-naïve for DME. Further prospective studies are indicated to assess the treatment strategy and the timing of introduction with faricimab in such eyes.

Accurate modeling of the power–cadence relationship is essential for assessing maximal anaerobic power (Pmax) of the lower limbs. Experimental data points from Force–Velocity tests during cycling do not always reflect the maximal and cadence-specific power individuals can produce. The quality of the models and the accuracy of Pmax estimation is potentially compromised by the inclusion of non-maximal data points. This study evaluated a novel residual-based filtering method that selects five strategically located, maximal data points to improve model fit and Pmax prediction. Twenty-three recreationally active male participants (age: 26 ± 5 years; height: 178 ± 5 cm; body mass: 73 ± 11 kg) completed a Force–Velocity test consisting of multiple maximal cycling efforts on a stationary ergometer. Power and cadence data were used to generate third-order polynomial models: from all data points (High Number, HN), from the highest power value in each 5-RPM interval (Moderate Number, MN), and from five selected data points (Low Number, LN). The LN model yielded the best goodness of fit (R² = 0.995 ± 0.008; SEE = 29 ± 15 W), the most accurate estimates of experimentally measured peak power (mean absolute percentage error = 1.45%), and the highest Pmax values (1220 ± 168 W). Selecting a limited number of maximal data points improves the modeling of individual power–cadence relationships and Pmax assessment.

Background: The impact of SARS-CoV-2 on pregnancy outcomes is unclear, but evidence suggests increased perinatal loss due to placental damage and fetal oxygen deprivation. Objective: This study compared placental findings and fetal outcomes between pre-COVID-19 and COVID-19 periods to assess the association between COVID-19 and abnormal placental pathology and fetal complications. It was hypothesized that COVID-19-positive pregnancies would have higher rates of intrauterine fetal demise and fetal growth restriction due to virus-induced placental injury. Study Design: A retrospective analysis of 34,102 deliveries compared placental and fetal outcomes across two periods: pre-COVID-19 (April 1, 2018–September 30, 2019) and COVID-19 (April 1, 2020–September 30, 2021), with a washout period in between. Placental abnormalities (chorangiosis, chorioamnionitis, and villitis) and fetal outcomes (fetal growth restriction and intrauterine fetal demise) were analyzed using chi-squared tests with odds ratios (ORs) and 95% confidence intervals (CIs). Results: The COVID-19 period showed a significant increase in placental findings: chorangiosis, chorioamnionitis, villitis, and fetal growth restriction. Placentas from COVID-19-positive mothers had higher rates of these findings, though the increase in fetal growth restriction was not statistically significant. Intrauterine fetal demise rates were higher in COVID-19-negative pregnancies but did not differ between periods. Conclusion: Routine antenatal fetal testing for COVID-19 positivity alone is not warranted. We agree a follow-up fetal growth ultrasound 4 weeks post-infection is advisable per Society for Maternal-Fetal Medicine guidelines. The role of maternal comorbidities in chorangiosis remains unclear, warranting further investigation.

Background: The lateral antebrachial cutaneous nerve (LACN) is the terminal sensory branch of the musculocutaneous nerve and is rarely entrapped or injured. This study describes the electrodiagnostic (EDX) findings and etiologies of LACN neuropathy. Methods: This is a review of 49 patients with pain and/or paresthesia of the forearm who underwent EDX studies. The diagnosis of LACN neuropathy was based on clinical and sensory conduction abnormalities. Results: The most common etiology of LACN neuropathy was iatrogenic injury in 30 (61.2%) patients, primarily due to biceps tendon repair at the elbow (11 [36.7%]) and phlebotomy (5 [16.7%]). Fifteen (30.6%) patients sustained a non-iatrogenic injury at the proximal forearm/elbow, consisting of six (60%) laceration injuries and five (33.3%) stretch injuries. Four (8.2%) patients comprised the “other” etiology category, including two mass lesions causing LACN compression. Pain, paresthesia, and/or numbness in the LACN distribution were reported in 33 (67.3%), 27 (55.1%), and 23 (46.9%) patients, respectively. Hypoesthesia was detected in 45 (91.8%) patients, and dysesthesia in 7 (14.3%). The sensory nerve action potentials (SNAPs) of the LACN on the symptomatic side were absent in 44 (89.8%) patients. Of the five patients whose SNAPs of the LACN were detected, all had a decreased amplitude, and two had increased sensory latency. Conclusions: The most common etiology for LACN neuropathy in this series was iatrogenic injury; repair of biceps tendon at the elbow was the most frequent provoking cause. Protection of the LACN during surgical procedures at the elbow and forearm is vital to prevent iatrogenic injury.

Key Points: Neutrophil degranulation participates in glomerular injury in proliferative lupus nephritis. Urine excretion of neutrophil granule proteins is a potential diagnostic for proliferative lupus nephritis. Background: Lupus nephritis (LN) occurs in more than half of patients with systemic lupus erythematosus, but the cellular and molecular events that contribute to LN are not clearly defined. We reported previously that neutrophil degranulation participates in glomerular injury in mouse models of acute LN. This study tests the hypothesis that glomerular recruitment and subsequent activation of neutrophils result in urine excretion of neutrophil granule constituents that are predictive of glomerular inflammation in proliferative LN. Methods: Urine and serum levels of 11 neutrophil granule proteins were measured by antibody-based array in patients with proliferative LN and healthy donors (HDs), and the results were confirmed by ELISA. Glomerular neutrophil accumulation was assessed in biopsies of patients with LN who contributed urine for granule cargo quantitation and normal kidney tissue by microscopy. Degranulation was measured by flow cytometry in neutrophils isolated from patients with LN and HD controls by cell surface granule markers CD63 (azurophilic), CC66b (specific), and CD35 (secretory). Nonparametric statistical analyses were performed and corrected for multiple comparisons. Results: Eight granule proteins (myeloperoxidase, neutrophil elastase, azurocidin, olfactomedin-4, lactoferrin, alpha-1-acid glycoprotein 1, matrix metalloproteinase 9, and cathelicidin) were significantly elevated in urine from patients with active proliferative LN by array and/or ELISA, whereas only neutrophil elastase was increased in LN serum. Urine excretion of alpha-1-acid glycoprotein 1 declined in patients who achieved remission. The majority of LN glomeruli contained ≥3 neutrophils. Basal levels of specific granule markers were increased in neutrophils from patients with LN compared with HD controls. Serum from patients with active LN stimulated specific and secretory, but not azurophilic granule, release by HD neutrophils. Conclusions: Circulating neutrophils in patients with LN are primed for enhanced degranulation. Glomerular recruitment of those primed neutrophils leads to release and urine excretion of neutrophil granule cargo that serves as a urine marker of active glomerular inflammation in proliferative LN.

Frameless image-guided radiosurgery is an effective and non-invasive method of treating patients who are unresponsive to medical management for trigeminal neuralgia.

Background: During the SARS-CoV-2 pandemic, pregnancy outcomes remain in question with relationship to individuals who tested positive for COVID-19. There is a plethora of evidence that pregnant people who become infected with the SARS-CoV-2 virus may be at increased risk for perinatal loss. These losses are believed to be due to the destruction of the placenta, which then deprives the fetus of oxygen. Objective: This study aimed to compare placental findings and fetal outcomes between two 18-month periods, pre-COVID-19 and COVID-19, and to determine if there was an increase in abnormal placental findings and fetal complications during the COVID-19 period. The study hypothesized that pregnant individuals with COVID-19 positivity would have a higher risk of intrauterine fetal demise and FGR due to placental injury caused by the virus. Study Design: The placental findings and fetal outcomes of 34,102 deliveries were retrospectively compared between two equal seasonal 18-month timeframes. The COVID-19 period was April 1, 2020, to September 30, 2021. The pre-COVID-19 period was April 1, 2018, to September 30, 2019, with a wash-out period of October 1, 2019, to March 31, 2020. Chi-squared statistical tests with odds ratios and 95% confidence intervals were used to contrast three placental findings and two fetal outcomes. Results: The study found a significant increase in chorangiosis, chorioamnionitis, villitis, and FGR during the COVID-19 period compared to the pre-COVID-19 period. Additionally, there was a higher incidence of chorangiosis, chorioamnionitis, villitis, and marginally higher FGR in placentae from mothers with a history of COVID-19 infection compared to those without a positive test. There was no significant increase in intrauterine fetal demise among COVID-19-positive mothers. Conclusion: The study concludes that antenatal testing is not warranted solely for positive COVID-19 infection without other comorbidities present because there was no significant increase in intrauterine fetal demise. However, the study found a rise in FGR among pregnant individuals with a positive COVID-19 test. We agree with the Society for Maternal-Fetal Medicine's recommendations that a repeat fetal growth ultrasound should be conducted four weeks after a positive COVID-19 test. We acknowledge that chorangiosis can occur due to other maternal comorbidities. In the absence of data regarding maternal demographics, we cannot conclude whether chorangiosis occurred due to COVID-19 or other conditions.