Neighborhood deprivation is not associated with abortion consideration or completion in patients with fetal myelomeningocele.

OBJECTIVE: The objective of this study was to evaluate whether patient-level neighborhood deprivation index (NDI) was associated with termination of pregnancy consideration and completion in patients presenting with fetal myelomeningocele. METHODS: This was a retrospective cohort analysis of patients with fetal myelomeningocele presenting to a fetal treatment center (FTC) in Illinois between 2018 and 2024. The exposure was NDI calculated from patient zip codes. The NDI was analyzed as both a dichotomous and ordinal exposure. The co-primary outcomes were abortion consideration prior to FTC consultation, ascertained by nurse intake, and abortion completion after consultation. Bivariate and log-binomial regression analyses were performed. Covariates were selected based on p < 0.10 on bivariate analyses. Otherwise, p < 0.05 indicated statistical significance. RESULTS: A total of 157 participants were included. Evaluation of neighborhood deprivation as a dichotomous exposure revealed no association with abortion consideration or completion. AdditionallLy, no association was found on log binomial modeling after controlling for gestational age at presentation to the FTC and maternal race or ethnicity for abortion consideration (aRR 0.87, 95% CI 0.59-1.28) or completion (aRR 0.86, 95% CI 0.59-1.28). These results were similar when treating the NDI as an ordinal exposure. CONCLUSIONS: Contrary to our hypothesis, NDI is not associated with abortion consideration or completion in patients with fetal myelomeningocele.

Prevalence of Abnormal Hemoglobin A1c Values in Single Ventricle Patients Following Fontan Palliation.

Fontan palliation has improved survival in single ventricle patients. However, Fontan patients are subject to long-term morbidity. A few previous studies suggest Fontan patients have an increased risk of abnormal glucose metabolism without a clear mechanism. We aim to evaluate the prevalence and severity of abnormal hemoglobin A1c (HbA1c) values in Fontan patients and identify associated factors. Single-center retrospective cross-sectional cohort study including Fontan patients and documented HbA1c testing. Univariate demographic, anthropometric, and laboratory variable comparisons were completed and a stepwise selection multivariate regression model was attempted. The study included 414 Fontan patients, median age of 19 years (range 3-59 years). Of these, 190 patients (60.5% male) had at least one HbA1c. Abnormal HbA1c (> 5.6%) was found in 36% (n = 70) and diabetic-range HbA1c (≥ 6.5%) in 4.7% (n = 9). Factors associated with abnormal HbA1c included non-white race (63% vs 45%, p = 0.018), female sex (49% vs 34%, p = 0.050), elevated adult BMI [29.6 (± 8.4) vs 24.8 (± 4.8), p = < 0.0001], elevated blood glucose [108.7 (± 47.3) vs 91.1 (± 17.9), p = < 0.0001], and elevated triglycerides [101.5 (± 52.9) vs 84.1 (± 50.9), p = 0.029]. There were no significant differences found between the two HbA1c groups regarding cardiac diagnoses or surgical factors including type of stage 1 procedure, type of stage 3 procedure, or fenestration of Fontan. Patient age at time of initial Fontan procedure and time since initial Fontan showed no association with abnormal glucose metabolism. Obesity (BMI z-score ≥ 1.6 in children and BMI ≥ 30 in adults) was correlated with abnormal HbA1c (p = 0.008, 95%CI 0.069-0.45). There is a high prevalence of elevated HbA1c values in Fontan patients with modifiable associated factors, such as obesity and hypertriglyceridemia. Further investigation is needed to identify additional associated factors for abnormal glucose metabolism and determine its clinical significance. Lastly, we propose a new management protocol to screen for abnormal glucose metabolism.

Discovery of Widespread Host Protein Interactions with the Pre-replicated Genome of CHIKV Using VIR-CLASP.

The primary interactions between incoming viral RNA genomes and host proteins are crucial to infection and immunity. Until now, the ability to study these events was lacking. We developed viral cross-linking and solid-phase purification (VIR-CLASP) to characterize the earliest interactions between viral RNA and cellular proteins. We investigated the infection of human cells using Chikungunya virus (CHIKV) and influenza A virus and identified hundreds of direct RNA-protein interactions. Here, we explore the biological impact of three protein classes that bind CHIKV RNA within minutes of infection. We find CHIKV RNA binds and hijacks the lipid-modifying enzyme fatty acid synthase (FASN) for pro-viral activity. We show that CHIKV genomes are N6-methyladenosine modified, and YTHDF1 binds and suppresses CHIKV replication. Finally, we find that the innate immune DNA sensor IFI16 associates with CHIKV RNA, reducing viral replication and maturation. Our findings have direct applicability to the investigation of potentially all RNA viruses.