Michigan Medicine

A multicenter multistate modeling on the natural history of liver decompensation: Longitudinal analysis of 1777 patients.

BACKGROUND: Cirrhosis often remains silent until decompensation, after which survival deteriorates sharply. Contemporary, transition-aware estimates are limited, especially in Asian-predominant cohorts. We analyzed trajectories from compensated advanced chronic liver disease (cAC...

Mild alkaline phosphatase elevation associates with increased mortality and major adverse liver outcomes in MASLD.

BACKGROUND: Alkaline phosphatase (ALP) elevation is commonly observed in patients with metabolic dysfunction-associated steatotic liver disease (MASLD), but its clinical implications in MASLD are unclear. We evaluated whether longitudinal patterns of mild ALP elevation are associ...

The Impacts of Marijuana Usage on Nerve Transfer Outcomes: A Retrospective Cohort Study.

BACKGROUND AND OBJECTIVES: Marijuana is often used by patients with peripheral nerve injuries for pain management, but its impact on nerve transfer surgery outcomes remains unexplored. METHODS: tests and analysis of variance. RESULTS: = .01). CONCLUSION: In patients undergoing ra...

The Childhood Liver Disease Research Network's prospective characterization of pediatric primary sclerosing cholangitis.

BACKGROUND: Primary sclerosing cholangitis (PSC) is a rare biliary fibrosing disease that leads to significant morbidity and the need for liver transplantation. The Childhood Liver Disease Research Network is conducting a prospective, observational longitudinal study to define th...

Patient Risk Factors for Incidental Pathology After Uterovaginal Surgery for Apical Prolapse: Systematic Review and Global Expert Consensus Statements

Abstract Introduction and Hypothesis Uterus preservation is increasingly used for uterovaginal prolapse (U-POP) repair despite ongoing concerns regarding future uterine, cervical, and adnexal pathology. We evaluated incidental pathology rates, associated risk factors, and created...

Efficacy of Technology-Augmented Behavioral Counseling for Risky Firearm Behaviors

Importance Firearm violence is a leading cause of morbidity and mortality for US adolescents and emerging adults (A/EAs). Health care visits are an important opportunity to provide preventive counseling addressing risky firearm behaviors (RFBs), which increase fatal and nonfatal...

Nascent Extracellular Matrix Converts Biomaterial Cues into Cell Fate Decisions

ABSTRACT Hydrogels serve as powerful models for investigating cell‐extracellular matrix (ECM) interactions. While chemical modifications are routinely used to tune hydrogel properties, it remains unclear whether these modifications mediate cell fate. Previous work has shown that...

“…If the Doctor Didn't Suggest it, Then I Would Probably Push the Idea Farther in My Head.”: Centering the Diverse Voices of Black Women to Understand PrEP Awareness and Access in the United States South

CONTEXT: In Atlanta, Georgia Black women account for most of new HIV diagnoses among women and 30% of Black women may benefit from pre-exposure prophylaxis (PrEP). Yet their PrEP knowledge, awareness, and access are low. METHODS: This study centers the voices of an economically d...

Optical microscopy predictions of focal recurrence in glioblastoma

A hallmark of glioblastoma (GBM) is disease recurrence that occurs in all patients despite resection, radiation, and chemotherapy. A critical challenge in GBM treatment is the management of recurrent disease for which no standard of care exists. Predicting the location of GBM rec...

Exercise as a Complementary Intervention for Adults with Attention Deficit Hyperactivity Disorder: A Neurobiological Analysis

Objective: Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by persistent inattention and/or hyperactivity-impulsivity that interferes with functioning or development. Stimulant medication remains its first-line treatment, but perceiv...

Long-term reprogramming of classical monocytes with altered ontogeny mediates enhanced lung injury in sepsis survivors

Patients who survive sepsis are predisposed to new hospitalizations for respiratory failure, but the underlying mechanisms are unknown. Using a murine model in which prior sepsis predisposes to enhanced lung injury, we previously discovered that classical monocytes persist in the...

A causal machine learning framework for treatment personalization in clinical trials: application to ulcerative colitis

Randomized controlled trials estimate average treatment effects, but treatment-response heterogeneity motivates personalized approaches that identify which patients benefit most from specific interventions. Causal machine learning methods offer a principled framework for estimati...

Conserved C-terminal residues adjacent to the canonical PDX1 homeodomain are required for chromatin occupancy and pancreas development

Essential roles for the PDX1 transcription factor in pancreatic development and β-cell function are well-known, yet the structure-function relationships of domains within its C-terminus remain incompletely defined. We identified a focal intrinsically disordered region (IDR) spann...

Zero-Waiting Load Balancing with Heterogeneous Servers in Heavy Traffic

We study the steady-state delay performance of load balancing in large-scale systems with heterogeneous servers in the heavy-traffic regimes. The system consists of N servers, each with a local buffer of size b − 1, serving jobs in the first-in-first-out (FIFO) order. Jobs arrive...

Effect of In-line Clinical Decision Support to Improve Accuracy of American Society of Anesthesiologists Physical Status Documentation: A Two Center Evaluation of a Quality Intervention

Background: American Society of Anesthesiologists Physical Status (ASA PS) classification is a widely used ordinal scale that captures comorbidity burden but has significant inter-rater variability. Previous efforts to enhance ASA PS documentation with Clinical Decision Support (...

Regulation of alanine glutamine asparagine catabolism is common to mouse models that extend lifespan

Previous work has shown that three interventions that extend mouse lifespan (acarbose, canagliflozin, or calorie restricted diet) as well as two genetic models (Snell and GHRKO) down-regulate MEK1-ERK and mTOR signaling and activate chaperone-mediated autophagy. Because of the co...

Margin Assessment in Breast-Conserving Surgery: A Comparative Analysis of Frozen Section and Cavity Shave Techniques

Abstract Background Margin status is a critical determinant of local recurrence after breast-conserving surgery (BCS). Achieving negative margins at the initial operation remains a key goal to optimize oncologic outcomes and minimize the need for additional surgery. Techniques to...

Factors Protecting Against Co-Occurring Pain, Psychological, and Somatic Symptom Trajectories in Adolescence

OBJECTIVE: To determine the relative impact of multilevel protective factors on co-occurring pain, psychological, and somatic symptom (co-PPSS) trajectories from late childhood through early adolescence. METHODS: We conducted secondary analyses of longitudinal Adolescent Brain Co...

Association of Community Factors, Firearm Laws, and Pediatric Firearm Injuries

OBJECTIVE: To conduct a zip code-level analysis of community measures and firearm legislation associated with pediatric fatal and nonfatal firearm injuries, ordered by strength of association. METHODS: This was an ecological study of 46 states and the District of Columbia from Ja...

Sharp cell type boundaries emerge from coordinated morphogen signaling

Classic models of the French flag problem depict sharp cell type boundaries emerging from threshold responses to morphogen gradients. How discrete cell type boundaries arise from morphogen signals that vary continuously across developing tissues remains incompletely understood. W...