Rapid Improvement Research Articles

Patient-Reported Outcomes After Switching to a 2-Drug Regimen of Fixed-Dose Combination Dolutegravir/Lamivudine: 48-Week Results from the SALSA Study.

Patient-reported outcomes (PROs) facilitate communication between patients and providers, enhancing patient-centered care. We report PROs for virologically suppressed people living with HIV-1 who switched to dolutegravir/lamivudine (DTG/3TC) or continued their 3- or 4-drug current antiretroviral regimen (CAR) in the phase 3 SALSA study. Secondary endpoints included change from baseline in HIV Treatment Satisfaction Questionnaire (status version; HIVTSQs) and HIV Symptom Distress Module (HIV-SDM) at Weeks 4, 24, and 48. A post hoc analysis assessed change in HIVTSQs and HIV-SDM by age (≥ 50 and < 50 years). Higher HIVTSQs scores represent greater treatment satisfaction (range, 0-60); lower HIV-SDM scores indicate less symptom bother (range, 0-80). Participants in the DTG/3TC (n = 246) and CAR (n = 247) groups reported comparable baseline HIVTSQs total scores (mean [SD], 55.2 [6.5] and 55.8 [5.5], respectively). Beginning at Week 4, mean HIVTSQs scores in the DTG/3TC group further increased vs. CAR and were sustained through Week 48. Baseline mean (SD) HIV-SDM symptom bother scores were comparable between the DTG/3TC (9.0 [9.9]) and CAR (7.9 [9.3]) groups. Small improvements in HIV-SDM scores favoring DTG/3TC were observed at Weeks 4 and 24 and sustained through Week 48 (though not significant between groups). Participants aged ≥ 50 and < 50 years who switched to DTG/3TC reported higher satisfaction and less symptom distress vs. CAR; these results were generally comparable between age groups. Participants who switched to DTG/3TC reported rapid and sustained improvements in treatment satisfaction compared with those who continued CAR, reinforcing the benefits of DTG/3TC beyond virologic suppression (NCT04021290; registration date, 7/11/2019).

A comprehensive review on the co-occurrence of scurvy and anorexia nervosa.

Scurvy, a rare disease resulting from vitamin C deficiency, can occur in individuals with restrictive eating disorders like anorexia nervosa (AN), leading to severe health complications. This review explores the complex relationship between scurvy and AN, highlighting the overlapping symptoms and challenges in diagnosis and treatment. Vitamin C is essential for collagen synthesis, immune function, and neurotransmitter production, and its deficiency manifests as fatigue, gingival bleeding, joint pain, and perifollicular hemorrhages. AN exacerbates these symptoms through extreme food restriction, causing severe nutritional deficiencies. Analyzing nine case reports, this review reveals that patients with co-occurring AN and scurvy often present with gastrointestinal, psychiatric, and dermatological symptoms. Treatment with vitamin C supplementation typically results in rapid symptom improvement. However, the malnutrition inherent in AN complicates the clinical picture, making timely diagnosis and intervention crucial. This review underscores the importance of a comprehensive, multidisciplinary approach to managing these conditions, emphasizing the need for early recognition and treatment to prevent severe complications. Future research should include a more diverse patient population to enhance understanding of the interplay between AN and scurvy, aiming to improve patient outcomes through tailored treatment strategies.

Genomic-inferred cross-selection methods for multi-trait improvement in a recurrent selection breeding program

The major drawback to the implementation of genomic selection in a breeding program lies in long-term decrease in additive genetic variance, which is a trade-off for rapid genetic improvement in short term. Balancing increase in genetic gain with retention of additive genetic variance necessitates careful optimization of this trade-off. In this study, we proposed an integrated index selection approach within the genomic inferred cross-selection (GCS) framework to maximize genetic gain across multiple traits. With this method, we identified optimal crosses that simultaneously maximize progeny performance and maintain genetic variance for multiple traits. Using a stochastic simulated recurrent breeding program over a 40-years period, we evaluated different GCS methods along with other factors, such as the number of parents, crosses, and progeny per cross, that influence genetic gain in a pulse crop breeding program. Across all breeding scenarios, the posterior mean variance consistently enhances genetic gain when compared to other methods, such as the usefulness criterion, optimal haploid value, mean genomic estimated breeding value, and mean index selection value of the superior parents. In addition, we provide a detailed strategy to optimize the number of parents, crosses, and progeny per cross that can potentially maximize short- and long-term genetic gain in a public breeding program.

Brain structure and activity predicting cognitive maturation in adolescence.

Cognitive abilities of primates, including humans, continue to improve through adolescence 1,2. While a range of changes in brain structure and connectivity have been documented 3,4, how they affect neuronal activity that ultimately determines performance of cognitive functions remains unknown. Here, we conducted a multilevel longitudinal study of monkey adolescent neurocognitive development. The developmental trajectory of neural activity in the prefrontal cortex accounted remarkably well for working memory improvements. While complex aspects of activity changed progressively during adolescence, such as the rotation of stimulus representation in multidimensional neuronal space, which has been implicated in cognitive flexibility, even simpler attributes, such as the baseline firing rate in the period preceding a stimulus appearance had predictive power over behavior. Unexpectedly, decreases in brain volume and thickness, which are widely thought to underlie cognitive changes in humans 5 did not predict well the trajectory of neural activity or cognitive performance changes. Whole brain cortical volume in particular, exhibited an increase and reached a local maximum in late adolescence, at a time of rapid behavioral improvement. Maturation of long-distance white matter tracts linking the frontal lobe with areas of the association cortex and subcortical regions best predicted changes in neuronal activity and behavior. Our results provide evidence that optimization of neural activity depending on widely distributed circuitry effects cognitive development in adolescence.

First case of autochthonous Angiostrongylus vasorum infection in a Norwegian dog

A fifteen-month-old Pembroke Welsh corgi with respiratory distress, exercise intolerance, and moderate regenerative anemia was referred to The Norwegian University of Life Sciences, Small Animal Hospital.Hematology revealed moderate regenerative anemia without evidence of hemolysis. Thoracic radiographs showed a generalized mixed interstitial to alveolar lung pattern and enlarged pulmonary arteries. Changes suggestive of moderate pulmonary hypertension were noted on echocardiography. Baermann fecal diagnostic flotation identified large numbers of Angiostrongylus vasorum larvae, and the AngioDetect serological antigen test was positive. The dog was treated with a two-week course with fenbendazole (51 mg/kg q24h po) and topical imidacloprid/moxidectin (250 mg/62.5 mg) and a one-week course with sildenafil (0.45 mg/kg q12h po). Complete clinical, clinicopathological and echocardiographic resolution was observed after only four weeks. Rapid improvement of echocardiographic abnormalities in cases with suspected pulmonary hypertension is not usually reported in cases with angiostrongylosis.Infection with A. vasorum should be considered in dogs with respiratory signs and bleeding tendencies, even in countries with no endemic history or reported cases.

Pengembangan Media Smart Flashcard pada Muatan Pembelajaran IPAS untuk Meningkatkan Hasil Belajar Peserta Didik Kelas V SDN Bandar 03 Batang

This study carried out has the aim of developing and testing Smart Flashcard learning media in the context of the Science and Social Studies (IPAS) curriculum for fifth-grade students at SDN Bandar 03 Batang. The background of this research is based on the need for a innovative approach in teaching to enhance students' learning outcomes more effectively. Things to home of this research is to evaluate the effectiveness of the Smart Flashcard media in improving students' understanding of complex natural resource materials. The research method involves collaboration with subject matter experts and media specialists in the development process, as well as testing this media with small and large groups of students to obtain valid and reliable data. The findings of this study indicate a rapid improvement in students' learning outcomes, particularly in understanding previously challenging natural resource materials. This research concludes that is the applicatioan of the Smart Flashcard learning media is effective in enhancing students' learning outcomes in the IPAS curriculum. These findings provide a strong foundation for the development of innovative interactive learning media in the future to create a more engaging, interactive, and effective learning environment for students in the learning process.

51558 Bimekizumab treatment resulted in rapid and sustained improvement in total and individual Bath Ankylosing Spondylitis Disease Activity Index components in patients with psoriatic arthritis: 1-year results from two phase 3 studies

51558 Bimekizumab treatment resulted in rapid and sustained improvement in total and individual Bath Ankylosing Spondylitis Disease Activity Index components in patients with psoriatic arthritis: 1-year results from two phase 3 studies

Commercial perspectives: Genome editing as a breeding tool for health and well-being in dairy cattle

Genome editing is the latest breeding tool capable of accelerating the rate of genetic improvement for health and well-being traits in food animals. It enables the introduction of beneficial alleles within a single generation, including those of low frequency or absent in the population, while effectively bypassing linkage drag. For the dairy industry, genome editing can be used to make rapid genetic improvements that are precise, efficient, and transgene-free for functional traits that are not practically addressed without disrupting conventional breeding goals for overall economic merit based on genomic selection. Herein, various case studies for dairy cattle breeding are presented that demonstrate applications of genome editing for enhancing heat stress tolerance, reduced disease susceptibility, and/or other qualitative traits absent in some breeds. One case highlights the success of simultaneous editing of multiple loci through recent advancements in embryonic stem cell biology. Multiplexed editing is crucial for addressing the polygenic nature inherent to many economically important traits in livestock. However, maximizing the benefits of genome editing depends on the continued discovery of targets for editing that are commercially important. Commercialization also depends on rapidly evolving regulatory statutes for risk assessment, where some countries already permit the commercialization of cattle with non-GMO genome alterations through existing regulations. New breeding technologies like genome editing are now poised to have significant impact in equipping elite performance cattle to be more resilient to infectious disease and climate change without the loss of production gains obtained from decades of selection.

An In-Vitro Study on the Impact of Light-Emitting Diode (LED) and Laser-Activated Bleaching Techniques on the Color Change of Artificially Stained Teeth at Varying Time Intervals.

Introduction Tooth color is a key factor in the perception of an attractive smile, making bleaching a widely sought-after cosmetic dental procedure. Valued for its minimally invasive approach, this technique effectively lightens teeth to achieve desired aesthetic outcomes. As the desire for immediate results grows among patients, various bleaching agents, and energy sources have been developed to expedite the bleaching process. The study aims to evaluate and compare the efficacy of 35% hydrogen peroxide activated by light-emitting diode (LED) and laser on artificially stained teeth, assessing color changes at different time intervals. Methodology Sixty maxillary central incisors with intact crowns were selected for the study. An artificial staining solution was prepared, and the samples were immersed in it for 15 days to simulate staining. After this period, the teeth were removed from the solution, rinsed with water, and dried. Baseline photographs of each tooth were taken for comparison. The teeth were then divided into two groups, one treated with LED activation and the other with laser activation of 35% hydrogen peroxide as the bleaching agent. The color changes were measured and recorded at different time intervals. Data were presented as mean and standard deviation, with statistical analysis conducted using independent sample t-test and repeated measures ANOVA to compare the efficacy of the two methods. Results Both LED and laser activation of 35% hydrogen peroxide demonstrated significant color changes in the stained teeth. The initial color improvement was noticeable in both groups, with LED and laser treatments producing comparable whitening effects. The mean color change values indicated that both activation sources were effective in enhancing the bleaching process, providing immediate and substantial results. Statistical analysis showed no significant difference between the two methods, suggesting their equivalency in clinical efficacy for tooth bleaching. Conclusion The study concludes that both LED and laser activation of 35% hydrogen peroxide are efficient methods for in-office tooth bleaching, providing immediate and enhanced whitening effects. The comparable results between the two energy sources indicate that can be effectively used to meet the increasing demand for rapid aesthetic improvements in a clinical setting. This finding supports the adoption of both LED and laser bleaching techniques as viable options for dental practitioners aiming to achieve optimal patient satisfaction with minimal invasiveness.

52650 Dupilumab Treatment Shows Rapid and Consistent Improvement in Atopic Dermatitis in All Anatomical Regions in Patients Aged 6 Months to 17 Years: Results From an Open-Label Extension Study

52650 Dupilumab Treatment Shows Rapid and Consistent Improvement in Atopic Dermatitis in All Anatomical Regions in Patients Aged 6 Months to 17 Years: Results From an Open-Label Extension Study

The effect of dupilumab on caregiver- and patient-reported outcomes in young children with moderate-to-severe atopic dermatitis: Results from a placebo-controlled, phase 3 study

Moderate-to-severe atopic dermatitis (AD) greatly impacts children/caregivers. Evaluate the impact of treatment with dupilumab on caregiver- and patient-reported AD symptoms and quality of life (QoL) in young children. In the LIBERTY AD PRESCHOOL (randomized, placebo-controlled) study, children aged 6months to 5years with moderate-to-severe AD received dupilumab or placebo plus low-potency topical corticosteroids for 16weeks. This posthoc analysis assessed the change from baseline to week 16 in caregiver-reported outcome measures of AD symptoms (eg, itch and sleep) and QoL of patients and their caregivers/families. Dupilumab (n=83) vs placebo (n=79) provided significant improvements in caregiver-reported AD symptoms and QoL. Significant improvements were seen as early as week 4 and sustained through the end of the study. Additionally, dupilumab vs placebo provided rapid and significant improvement in QoL measures for the patients' caregivers/families. Few patients aged <2years; significance only reported for prespecified endpoints; Infant's Dermatitis QoL Index severity strata adopted from Children's Dermatology Life Quality Index. Dupilumab improved AD symptoms and QoL in patients and their caregivers/families.

Abstract P406: Transforming Clinical Practices for Blood Pressure Management in Community Health Centers through Timely Data and Technical Support

Introduction: Blood pressure (BP) control can prevent major adverse cardiac events and is monitored through various means, including the Centers for Medicare and Medicaid Services 165 metric for BP control - an annual reporting metric for community health centers (CHCs) within the Uniform Data System framework that becomes accessible 6 months after the conclusion of the reporting period. In pursuit of more immediate indicators related to BP management, the National Hypertension Control Initiative (NHCI) initiated collaboration with a population health platform to support select CHCs with rapidly available data on 19 BP-related metrics. Hypothesis: With technical support and regular access to data, CHCs can implement timely clinical practice and process changes. Methods: To support CHCs in using the population health platform, NHCI staff provided technical assistance in a rapid cycle performance improvement (RCPI) to 10 interested CHCs. This opportunity allowed CHCs to partner with NHCI staff to review BP related metrics in the population health platform and to identify opportunities for clinical process and practice changes. Over an 8-week period from October to December 2023, 7 CHCs were actively involved in a series of 5-6 structured 30–60-minute meetings with both NHCI registered nurse and quality improvement staff. These meetings reviewed BP metrics, mapped clinical workflows for improvement, and supported data analytics. CHCs often chose 1-2 BP metrics for focus, concentrating on incremental change and short-term improvement. Results: Among participating CHCs that reported, they revealed successful or anticipated adjustments in team responsibilities and clinical processes, including leadership involvement and new methods. Limitations included CHC staff engagement, time, concerns with data reliability, and familiarity with the population health platform. Most reporting CHCs shared that their goals were greatly impacted by access to readily available performance data and that they plan to continue using the population health platform to affect performance moving forward. Conclusions: For participating CHCs, individualized guidance based on timely data may have been helpful in analyzing workflows and procedures, assessing clinical care practices, and implementing quality improvement plans. Frequent data may allow CHCs to make clinical practice and process changes to efficiently measure impact and more quickly improve BP control than standard methods.

Survival prognostic factors in nonsmall cell lung cancer patients with simultaneous brain metastases and poor performance status at initial presentation

PurposeAlthough the treatment of nonsmall cell lung cancer (NSCLC) has rapidly progressed recently, there is little evidence of treatment for patients with symptomatic brain metastases (BM) and poor performance status (PS). However, in symptomatic BM patients, appropriate upfront intracranial treatment can often lead to rapid improvement in PS and effective systemic therapy. Thus, this study investigated the prognostic factors for the survival of poor PS NSCLC patients with synchronous BM. MethodsData of patients with BM and Karnofsky PS (KPS) ≤70 at the first diagnosis of NSCLC who were treated in our hospital between January 2017 and December 2021 were reviewed. Patient survival was compared among patients stratified by type of first-line regimen of systemic treatment. Correlations between patient characteristics and survival were examined. ResultsFifty patients receiving aggressive treatment were enrolled. The median survival times for tyrosine kinase inhibitor (TKI), immune checkpoint inhibitor (ICI), and chemotherapy alone groups were 19 (95 % confidence interval [CI], 2.8–68.5), 19 (3.0–62.0), and 13 (1.2–24.8) months, respectively. Survival in the TKI and ICI groups was significantly longer than in the chemotherapy alone group (p = 0.046, TKI vs. chemo; p = 0.022, ICI vs. chemo; p = 0.023). Both sex and type of systemic treatment correlated to survival time on univariate analysis. Chemotherapy alone for systemic treatment [p = 0.034; hazard ratio (HR), 0.44 (0.20–0.94)] remained significant for predicting overall survival in the multivariate analysis. ConclusionEven in patients with poor PS and BM at the initial diagnosis of NSCLC, the ICI group had a survival time comparable to that of the TKI group when combined with tailor-made intracranial treatment. There is a subgroup in the patient population that was previously considered unsuitable for ICI, whose PS improves with individualized intracranial treatment, and who may benefit from immunotherapy.

A Rare Case Report of Thoracic Epidural Angiolipoma During Pregnancy: Differential Diagnosis and Treatment

Introduction. Spinal angiolipomas are benign tumors composed of adipocytes and vascular elements. There is a limited number of cases involving pregnant patients in the literature. Mostly located in the thoracic region, these tumors are usually expected to be seen in the fifth decade. To the best of our knowledge, we present the youngest reported case of a pregnant patient with angiolipoma. Case Report. We present a case of a 24-year-old pregnant woman who was referred to our clinic with complaints of gait disturbance and numbness in her legs. Paraplegia, hyperactive deep tendon reflexes, and hypoesthesia up to the umbilicus level were the first findings. Electromyographic tests, including F-waves, were normal. Spinal magnetic resonance imaging (MRI) revealed a thoracic spinal extradural tumor compressing the spinal cord posteriorly. Total tumor resection and histologic examination confirmed the diagnosis of angiolipoma. Postoperatively, the patient experienced rapid improvements in neurological deficits, with complete recovery in the following days. Conclusions. Spinal angiolipomas are very rare in pregnancy. At the time of initial admission, the symptoms and findings may mimic acute polyneuropathies and myelitis. Spinal MRI is essential to localize the lesion. Early angiolipoma removal may result in complete recovery and the procedure is safe and applicable even in the early postpartum period.

Assessment of the water footprint of the brewery industry: The case of Heineken, Addis Ababa, Ethiopia

The brewery industry is among the most water-intensive sectors, typically consuming 4–6 L of water for every liter of beer produced, necessitating a strong focus on water sustainability. Therefore, this study aimed to quantify the water footprint (WF) of the Heineken Ethiopian beer industry in Addis Ababa (Kilinto) over five consecutive years to identify water-intensive processes and areas. A stepwise accumulative and bottom-up approach was used to measure this WF, including calculations for both the final beer product and the spent grain byproduct. In 2019 and 2020, a significant portion of water consumption was attributed to spent grain extraction. By 2023, although the blue water footprint of both products remained within sustainable limits, more water was used in producing the final beer than in extracting spent grain. This suggests rapid improvements in water efficiency within the brewery, likely driven by effective water management practices such as leak detection and the use of water-efficient equipment and processes. The WF assessments also evaluated four sections of the brewery: utility, brewing, packaging, and general services. While utility, brewing, and packaging sections demonstrated improved water efficiency over time, the general services section saw a decrease. Given that general services are the most water-intensive area, prioritizing water management strategies in this section is crucial for overall sustainability.

Sunitinib-induced endocapillary proliferative glomerulonephritis with IgA2 deposit in addition to thrombotic microangiopathy: a case report

BackgroundSunitinib, a multi-targeted tyrosine kinase inhibitor, is used as a second-line therapy for gastrointestinal stromal tumors (GIST) resistant to imatinib. However, its impact on the vascular endothelial growth factor (VEGF) pathway can lead to significant toxicities, including hypertension and thrombotic microangiopathy (TMA).Case presentationThis case report describes a unique instance of a patient with metastatic GIST who developed endocapillary proliferative glomerulonephritis (EPGN) with IgA2 deposits and TMA following sunitinib treatment. The patient presented with severe hypertension, nephrotic syndrome, and acute kidney injury. Renal biopsy confirmed the diagnosis, revealing IgA2 deposits, which are not commonly associated with TMA. Discontinuation of sunitinib led to a rapid improvement in renal function and proteinuria. The potential mechanisms underlying sunitinib-induced glomerular injury may involve the blockade of VEGFR-1, affecting immune cell recruitment and function, and the disruption of the nitric oxide and endothelin systems, leading to endothelial damage and immune dysregulation. Management of these toxicities requires a personalized approach, with options ranging from symptomatic relief to drug discontinuation. The use of endothelin receptor antagonists and other therapeutic alternatives for GIST management is discussed.ConclusionsThis case highlights the complex interplay between the therapeutic effects of sunitinib and its potential renal and cardiovascular toxicities, emphasizing the need for close monitoring and effective management strategies to optimize patient outcomes.

Can minimally invasive transforaminal lumbar interbody fusion achieve a better clinical and radiological outcome than traditional open technique in isthmic spondylolisthesis?

BackgroundSpondylolisthesis is a prevalent condition in the lumbar spine that can cause low back pain, leg pain, neurogenic claudication, and impact health-related quality of life in symptomatic individuals.Aimto assess the results of minimally invasive TLIF (MIS-TLIF) versus open-TLIF and the impact of correcting spino-pelvic parameters on the Health-Related Quality of Life (HRQoL) in patients with low-grade isthmic spondylolisthesis. The primary objective was to compare the effectiveness of both methods in correcting spinopelvic parameters. The secondary objectives involved comparing clinical improvement, operating time, blood loss, complications, and postoperative hospital stays between the two procedures.Patients and methodsSeventy-two patients with low-grade isthmic spondylolisthesis were enrolled in this retrospective cohort-control study, with a minimum follow-up period of 18 months. Disability was assessed using the Oswestry Disability Index (ODI), while back and leg discomfort were rated using the Visual Analogue Scale (VAS) for each patient. The measurements comprised the sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), and Meyerding slip grades. We measured lumbar lordosis (LL), and segmental lordosis.ResultsThe seventy-two patients were 60 female and 12 males. There was no statistically significant difference in the duration of operation between the two groups. In the MIS group, there was a notable reduction in blood loss, higher radiation exposure, and a shorter hospital stay (P < 0.001). The back VAS showed more favorable outcomes in the MIS-TLIF, while the leg VAS showed better results in the Open-TLIF in the early outcome. Both procedures significantly reduced leg and back pain VAS scores and ODI, with no notable difference between the two groups at the final follow-up. Post-surgery, the pelvic incidence (PI) and lumbar lordosis (LL) matched properly in all patients, showing a rise in LL and sacral slope along with a decrease in pelvic tilt.ConclusionBoth open-TLIF and MIS-TLIF are effective methods for correcting spino-pelvic parameters and improving HRQoL in patients with low-grade isthmic spondylolisthesis. The rapid improvement in back pain experienced by these patients favored the use of MIS-TLIF. However, the cost-effectiveness of this approach must be carefully evaluated.

Stroke and Guillain-Barre syndrome secondary to spotted fever &amp;ndash;A case report

Rickettsial infection is an important differential diagnosis in prolonged febrile illness and in returned travellers.We report a 44-year-old male from Deraniyagala, Sri Lanka, with spotted fever Rickettsiosis presenting with stroke and Guillain-Barre syndrome. He presented with dysarthria, reduced sensorium, and acute renal failure on the background of a prolonged febrile illness over two weeks. Following admission there was rapid deterioration of consciousness due to renal failure requiring intubation and repeated haemodialysis. On brain imaging, there were bilateral basal ganglia and internal and external capsule infarctions. His serology was positive for spotted fever Rickettsial infection and there was rapid improvement following treatment with doxycycline. However, difficulty in weaning off from the ventilator due to poor respiratory effort and symmetrical flaccid quadriparesis with areflexia raised concerns of concomitant Guillain-Barre syndrome. Serial cerebrospinal fluid (CSF) studies showed the development of elevated CSF protein with cytoalbuminologic dissociation during his stay in the intensive care unit (ICU). A diagnosis of co-existing Guillain-Barre syndrome was supported by the neuro-physiological findings and marked motor improvement following therapeutic plasmapheresis. This unmasked the right-sided mild residual hemiparesis he suffered due to stroke.

Upadacitinib for Acute Severe Ulcerative Colitis: A Systematic Review.

Acute severe ulcerative colitis (ASUC) remains a clinical challenge associated with considerable morbidity, including colectomy. Upadacitinib (UPA), a selective Janus kinase (JAK)-1 inhibitor, is approved for moderate-to-severe ulcerative colitis in patients intolerant or not responding to tumor necrosis factor-alpha inhibitors. It has also increasingly been used off-label for ASUC. We performed a systematic review of all available literature on UPA in ASUC. We identified 11 studies, with a pooled total of 55 patients. Most patients experienced rapid and sustained improvement. Colectomy rate at 90 days was 16.3%. Among those who did not get colectomy, 80% were in steroid-free remission at follow-up. The reported adverse events were low, including 2 venous thromboembolic events. Overall, UPA appears to represent a safe and effective therapy for ASUC.

Highly compromised auditory spatial perception in aided congenitally hearing-impaired and rapid improvement with tactile technology

Spatial understanding is a multisensory construct while hearing is the only natural sense enabling the simultaneous perception of the entire 3D space. To test whether such spatial understanding is dependent on auditory experience, we study congenitally hearing-impaired users of assistive devices. We apply an in-house technology, which, inspired by the auditory system, performs intensity-weighting to represent external spatial positions and motion on the fingertips. We see highly impaired auditory spatial capabilities for tracking moving sources, which based on the "critical periods" theory emphasizes the role of nature in sensory development. Meanwhile, for tactile and audio-tactile spatial motion perception, the hearing-impaired show performance similar to typically hearing individuals. The immediate availability of 360° external space representation through touch, despite the lack of such experience during the lifetime, points to the significant role of nurture in spatial perception development, and to its amodal character. The findings show promise toward advancing multisensory solutions for rehabilitation.