Therapeutic Vision (United States)

Introduction: Infants with congenital heart disease (CHD) face challenges with feeding and nutrition. These infants have an increased rate of gastroesophageal reflux, delayed gastric emptying, and requiring tube feeding, in particular those who undergo surgical palliation. Our primary aim was to evaluate anti-reflux and pro-motility medication use among hospitalized infants with CHD. Methods: This was a retrospective multicenter analysis of infants <1 year of age with CHD at first admission to a center participating in the Pediatric Acute Care Cardiology Collaborative (PAC 3 ) registry. Patients with single ventricle (SV) and biventricular (BV) physiology were defined based on their surgical procedure codes for surgeries during the admission. Patients with extracardiac diagnoses relating to the gastrointestinal system were excluded. Groups were compared based on the use of the following medications at discharge: histamine H2 antagonists, proton pump inhibitors, antacids, metoclopramide, erythromycin ethylsuccinate, or amoxicillin/clavulanic acid. Summary and comparative statistics were performed. Results: From 2/2019 to 1/2025, 24,729 infants were included, of whom 9597 had undergone surgical intervention (16% SV, 84% BV). The overall frequency of anti-reflux or pro-motility medication use in this cohort of CHD patients was 38%. Patients discharged on these medications required elemental formula and tube-assisted feeds more frequently and had a longer acute care cardiology unit (ACCU) and total hospitalization length of stay (Table 1). SV patients were more likely to be on anti-reflux or pro-motility medications compared to BV patients. Similar findings were noted among SV patients receiving these medications at discharge compared to SV patients who were not (Table 2). SV patients discharged on anti-reflux or pro-motility medications had an increased growth velocity at the time of discharge compared to their counterparts. Conclusion: Patients with SV CHD, those on elemental formula, tube assisted feeding and those with longer length of stays are more likely to be discharged on anti-reflux or pro-motility medications. An interesting finding is the positive association of the use of these medications with growth velocity prior to discharge specifically among SV patients. This suggests that these infants may have additional benefit from utilization of these medications at discharge.

Although the battery systems continue to grow in electric vehicles, smart grids, and backup power systems due to their capability to supply power and energy, the current battery systems essentially are fixed which limits efficient energy usage. Recently, by employing the digital battery concept through energy digitization, traditional battery systems can be transformed into re-configurable battery networks (RBN). This RBN paradigm improves the inherent defects of the fixed battery system, which means the performance of the RBN will no longer be limited by the consistency of the cells. In this paper, an adaptive control framework with the asynchronous advantage actor-critic (A3C) paradigm on performing online optimization for the dynamical RBN system is proposed. By utilizing its policy and asynchronous learning property, the proposed paradigm is able to improve the learning performance and the battery pack capacity through an improvement of cell consistency. It is noted that the proposed method is verified by both the simulation and experiment with data from an RBN.

To study aldose reductase and the sorbitol pathway in periodontitis and diabetes, rats with experimental periodontitis with or without diabetes were treated with three structurally diverse aldose reductase inhibitors (ARIs). Periodontitis was induced with three consecutive palatal injections of Porphyromonas gingivalis lipopolysaccharide (LPS) at 48-hour intervals between the first and second molars on the right side in young, age-matched, streptozotocin-induced rats with and without diabetes 44 days after initiation of diets with and without the ARIs tolrestat, imirestat, and quercetin. As an internal control, phosphate-buffered saline (PBS) was similarly injected on the left side. Twenty-four days after the final injection, all rats were euthanized. Defleshed samples were stained with 5% toluidine blue and palatal digital images were traced to include the enamel crown and exposed root. The root/enamel ratios (to estimate alveolar bone loss) were analyzed with repeated measures analysis of variance. LPS injections resulted in significantly more bone loss versus PBS injections in both the rats with and without diabetes on normal diets (P <0.0001). All three ARIs significantly reduced LPS-induced periodontitis in the animals with and without diabetes (P ≤0.003) to the level where they were not different from PBS-injected sites in normal diet controls. All ARIs demonstrated efficacy in preventing alveolar bone loss because of periodontitis in both animals with and without diabetes, suggesting a role for the sorbitol pathway and the potential for ARIs to reduce inflammatory responses downstream from aldose reductase.