Vanderbilt University Medical Center

Substrate-bound structures of yeast ALA synthase reveal protein dynamics initiating heme biosynthesis

Heme is an essential prosthetic group involved in multiple biological processes in nearly all organisms. Heme biosynthesis is initiated by the pyridoxal 5′-phosphate–dependent enzyme aminolevulinic acid synthase (ALAS). Mutations in ALAS cause multiple hematological diseases. Des...

Characterizing In-Home Safety Challenges and Strategies for Children With Medical Complexity

OBJECTIVES: Medical advances have allowed more children with medical complexity (CMC) to live at home, but previous research has linked implanted tubes to patient safety events. We aimed to characterize challenges and strategies parents use to deliver their children's tube-relate...

Effect of Vasopressin Initiation Threshold on Septic Shock Mortality

Importance The optimal vasopressor dose at which to initiate a second vasopressor in patients with septic shock is uncertain. Objective To compare the effects of hospital-level strategies initiating vasopressin infusion at a lower threshold vs a higher threshold on outcomes in pa...

Public Perceptions of Timeliness for AI Use and Human Oversight

This cross-sectional study assesses perceptions on use of artificial intelligence (AI) for medical patient portal messaging and mental health support, with opinions stratified by birth generation.

A Prospective Randomized Trial to Assess Early versus Delayed Weight Bearing Following Operatively Treated Ankle Fractures in the United States

OBJECTIVES: To determine the safety of early versus delayed weight bearing and effectiveness for improving return-to-work following ankle fracture repair. METHODS: Design : Prospective randomized study. Setting: 19 United States Trauma Centers Patient Selection Criteria: Adult pa...

Development and Validation of a Coronary Artery Calcium Volume and Density Score

BACKGROUND: Coronary artery calcium (CAC) scoring is a useful tool for coronary heart disease (CHD) risk prediction. The current standard method, the Agatston score, weights plaque area upward by density. However, higher density is inversely associated with CHD. We aimed to devel...

A living systematic review, meta-analysis, and open data resource of trials of MDMA-assisted therapy for PTSD

Abstract 3,4-Methylenedioxymethamphetamine (MDMA) has emerged as a potential treatment for post-traumatic stress disorder (PTSD). However, rapidly changing evidence in a fast-moving field can be challenging to integrate. Here, we present a living systematic review and open-data m...

A cross-sectional study of transplant clinicians’ moral distress and grit

BackgroundWhen transplant clinicians encounter ethical challenges and are constrained by their institution from acting in a manner within their professional ethical obligations, they may experience moral distress. Moral distress has been associated with negative effects such as b...

Increased neuroplastic activity is associated with cognitive decline in women but not men over an average 6-year follow-up period

Women are disproportionately affected by Alzheimer’s disease compared to men, a difference that may be partly explained by the role of female sex hormones. Estrogen, in particular, may play a key role in neuroplasticity. However, as women age and estrogen levels decline, high lev...

Nonadherence, Diversion, or Analytical Limitation? A Negative Urine Opiate Screen in a Patient Prescribed Hydrocodone

Urine drug testing is commonly used to assess adherence to prescribed opioid therapy. We describe a patient prescribed hydrocodone/acetaminophen who reported recent use but had negative urine opiate and oxycodone immunoassay screens, raising concerns regarding nonadherence or div...

Managing growth and puberty concerns in individuals with Duchenne muscular dystrophy: Updated guidance and future directions

Long-term glucocorticoid therapy is standard of care for individuals with Duchenne muscular dystrophy (DMD) but often results in impaired growth and delayed or incomplete puberty, impacting their physical and psychosocial health. Although DMD endocrine care has evolved, leading t...

From Classification to Cross-Modal Understanding: Leveraging Vision- Language Models for Fine-Grained Renal Pathology

Fine-grained glomerular subtyping is essential for kidney biopsy interpretation, yet it presents a harder setting than the broad organ- or disease-level recognition tasks commonly used in vision-language model (VLM) evaluation. In this task, all categories arise within the same r...

Assessing the Mucosal Inflammatory Endotype of Obesity in Chronic Rhinosinusitis

ABSTRACT Background Chronic rhinosinusitis (CRS) is a heterogeneous inflammatory syndrome of the paranasal sinuses that is defined phenotypically as either with nasal polyps (CRSwNP) or without nasal polyps (CRSsNP). More recently, inflammatory markers have been used to cluster p...

The circulating lipidome in severe obesity

Severe obesity (SevO; BMI ≥ 40 kg/m 2 ) is rising globally yet remains understudied mechanistically. To characterize lipidomic alterations at the species level, we analyzed Border Health Research Cohort participants with fasting plasma lipidomics and genetic data, comparing SevO...

Tobacco use moderates associations between cannabis use, psychiatric symptoms, and cognitive performance in psychosis spectrum disorders

Tobacco and cannabis use are highly prevalent among individuals with psychotic disorders. Tobacco use has been consistently linked to poorer clinical and cognitive outcomes, whereas findings regarding cannabis use remain mixed. The present study was a secondary analysis of cross-...

Clarifying the Concept of “Unanticipated Transfer to the ICU”: A Scoping Review

Unanticipated transfer to the intensive care unit (ICU), typically defined as an unscheduled escalation of care from inpatient general wards, is widely used in clinical research as a marker of adverse events, clinical deterioration, and system failure. However, its conceptual mea...

Validation of the International Working Group 2023 response criteria for higher risk myelodysplastic syndromes/neoplasms using the International Consortium for Myelodysplastic Syndromes VALIDATE database and a randomized phase III trial

Response assessment criteria in patients with higher-risk myelodysplastic syndromes/neoplasms (HR-MDS) have been updated in the 2023 International Working Group (IWG) criteria. However, validation of these criteria has been limited to date. We analyzed overall survival (OS) by be...

A multiomic atlas reveals distinct immune landscapes in preterm and term chronic placental inflammation

Chronic placental inflammation (CPI), an umbrella term encompassing chronic chorioamnionitis, chronic villitis, and chronic deciduitis, is associated with preterm birth (PTB), yet its cellular and molecular determinants across gestation remain poorly defined. Here, we constructed...

Individualized Treatment Effects of Cefepime vs Piperacillin-Tazobactam in Adults Hospitalized with Acute Infection

Abstract Rationale Among adults hospitalized with acute infection, a recent randomized trial observed no significant average treatment effect of cefepime versus piperacillin-tazobactam on acute kidney injury or death, but fewer days-alive-and-free-of delirium and coma with cefepi...

Epigenetic insights into extreme longevity in the world’s oldest terrestrial animal, Jonathan

Aldabra giant tortoises ( Aldabrachelys gigantea ) are exceptionally long-lived. We sequenced the genome and methylome of Jonathan, a 194-year-old Aldabra, to explore the molecular basis of his longevity. Relative to other giant tortoises ( A. gigantea and Chelonoidis abingdonii...