Non-invasive optical measurement of cerebral critical closing pressure in pediatric hydrocephalus

Hydrocephalus is a common disorder of cerebral spinal fluid (CSF) physiology that results in elevated intracranial pressure (ICP) and progressive expansion of cerebral ventricles.1 It affects 1-2 of every 1000 live births, making it the most common disease treated by pediatric neurosurgeons in the US.1 In roughly half of infants with hydrocephalus, ventricular expansion requires surgical intervention whereby a shunt is placed in the ventricles to divert CSF and relieve elevated ICP. Although timely treatment of elevated ICP is important for brain tissue viability, its implementation is hindered by the lack of tools for non-invasive ICP measurement. This study aims to validate non-invasive intracranial pressure (ICP) assessment with the near-infrared diffuse correlation spectroscopy (DCS) technique in infants with hydrocephalus. DCS employs near-infrared light to measure local, microvascular cerebral blood flow (CBF) continuously at the bedside. In addition to CBF, a novel approach for measurement of cerebral critical closing pressure (CrCP) based on DCS measurements of pulsatile CBF in arterioles was recently demonstrated.2-4 CrCP, which depends on ICP, defines the arterial blood pressure at which CBF approaches zero. Intraoperative non-invasive CrCP measurements with DCS on the prefrontal cortex were performed concurrently with invasive ICP measurements in 9 infants with hydrocephalus at the Children’s Hospital of Philadelphia. Invasive ICP was measured during surgical shunt placement. Please click Additional Files below to see the full abstract

Suicide Attempts Among a Cohort of Transgender and Gender Diverse People

INTRODUCTION: Transgender and gender diverse people often face discrimination and may experience disproportionate emotional distress that leads to suicide attempts. Therefore, it is essential to estimate the frequency and potential determinants of suicide attempts among transgender and gender diverse individuals. METHODS: Longitudinal data on 6,327 transgender and gender diverse individuals enrolled in 3 integrated healthcare systems were analyzed to assess suicide attempt rates. Incidence was compared between transmasculine and transfeminine people by age and race/ethnicity and according to mental health status at baseline. Cox proportional hazards models examined rates and predictors of suicide attempts during follow-up. Data were collected in 2016, and analyses were conducted in 2019. RESULTS: During follow-up, 4.8% of transmasculine and 3.0% of transfeminine patients had at least 1 suicide attempt. Suicide attempt rates were more than 7 times higher among patients aged45 years, more than 3 times higher among patients with previous history of suicide ideation or suicide attempts than among those with no such history, and 2-5 times higher among those with 1-2 mental health diagnoses and more than 2 mental health diagnoses at baseline than among those with none. CONCLUSIONS: Among transgender and gender diverse individuals, younger people, people with previous suicidal ideation or attempts, and people with multiple mental health diagnoses are at a higher risk for suicide attempts. Future research should examine the impact of gender-affirming healthcare use on the risk of suicide attempts and identify targets for suicide prevention interventions among transgender and gender diverse people in clinical settings