Digital Commons Network^™

Cross-National Comparison Of Two General Population Job Exposure Matrices For Physical Work Exposures, Bradley Evanoff, Marcus Yung, Skye Buckner-Petty, Matthew Baca, Johan Hviid Andersen, Yves Roquelaure, Alexis Descatha, Ann Marie Dale

Open Access Publications

OBJECTIVES: Job exposure matrices (JEMs) are increasingly used to estimate physical workplace exposures. We conducted a cross-national comparison of exposure estimates from two general population JEMs to aid the interpretation of exposure-outcome associations across countries and to explore the feasibility of cross-national application of JEMs to provide workplace physical exposure estimates.

METHODS: We compared physical exposure estimates from two general population JEMs created from the French

RESULTS: All variable pairs measuring similar physical exposures demonstrated positive correlations. Among the 50 matched pairs, 33 showed high correlation (ρ≥0.70) and 46 showed at least moderate agreement (κ≥0.41). Exposures expected to be mutually …

Quantification Of Image Texture In X-Ray Phase-Contrast-Enhanced Projection Images Of In Vivo Mouse Lungs Observed At Varied Inflation Pressures, Frank J Brooks, Sean P Gunsten, Sunil K Vasireddi, Steven L Brody, Mark A Anastasio

Open Access Publications

To date, there are very limited noninvasive, regional assays of in vivo lung microstructure near the alveolar level. It has been suggested that x-ray phase-contrast enhanced imaging reveals information about the air volume of the lung; however, the image texture information in these images remains underutilized. Projection images of in vivo mouse lungs were acquired via a tabletop, propagation-based, X-ray phase-contrast imaging system. Anesthetized mice were mechanically ventilated in an upright position. Consistent with previously published studies, a distinct image texture was observed uniquely within lung regions. Lung regions were automatically identified using supervised machine learning applied to summary measures …

Measurement Repeatability Of 18 F-Fdg Pet/Ct Versus 18 F-Fdg Pet/Mri In Solid Tumors Of The Pelvis, Tyler J Fraum, Kathryn J Fowler, John P Crandall, Richard A Laforest, Amber Salter, Hongyu An, Michael A Jacobs, Perry W Grigsby, Farrokh Dehdashti, Richard L Wahl

Open Access Publications

Knowledge of the within-subject variability of

Translocator Protein In Late Stage Alzheimer's Disease And Dementia With Lewy Bodies Brains, Jinbin Xu, Jianjun Sun, Richard J Perrin, Robert H Mach, Kelly R Bales, John C Morris, Tammie L S Benzinger, David M Holtzman

Open Access Publications

OBJECTIVE: Increased translocator protein (TSPO), previously known as the peripheral benzodiazepine receptor (PBR), in glial cells of the brain has been used as a neuroinflammation marker in the early and middle stages of neurodegenerative diseases, such as Alzheimer's disease (AD) and Dementia with Lewy Bodies (DLB). In this study, we investigated the changes in TSPO density with respect to late stage AD and DLB.

METHODS: TSPO density was measured in multiple regions of postmortem human brains in 20 different cases: seven late stage AD cases (Braak amyloid average: C; Braak tangle average: VI; Aged 74-88, mean: 83 ± 5 years), …

Precision Delivery Of Ras-Inhibiting Sirna To Kras Driven Cancer Via Peptide-Based Nanoparticles, Matthew S. Strand, Bradley A. Krasnick, Hua Pan, Xiuli Zhang, Ye Bi, Candace Brooks, Christopher Wetzel, Narendra Sankpal, Timothy Fleming, S Peter Goedegebuure, David G. Denardo, William E. Gillanders, William G. Hawkins, Samuel A. Wickline, Ryan C. Fields

Open Access Publications

Over 95% of pancreatic adenocarcinomas (PDACs), as well as a large fraction of other tumor types, such as colorectal adenocarcinoma, are driven by KRAS activation. However, no direct RAS inhibitors exist for cancer therapy. Furthermore, the delivery of therapeutic agents of any kind to PDAC in particular has been hindered by the extensive desmoplasia and resultant drug delivery challenges that accompanies these tumors. Small interfering RNA (siRNA) is a promising modality for anti-neoplastic therapy due to its precision and wide range of potential therapeutic targets. Unfortunately, siRNA therapy is limited by low serum half-life, vulnerability to intracellular digestion, and transient …

Spinal V2b Neurons Reveal A Role For Ipsilateral Inhibition In Speed Control, Rebecca A. Callahan, Richard Roberts, Mohini Sengupta, Yukiko Kimura, Shin-Ichi Higashijima, Martha W. Bagnall

Open Access Publications

The spinal cord contains a diverse array of interneurons that govern motor output. Traditionally, models of spinal circuits have emphasized the role of inhibition in enforcing reciprocal alternation between left and right sides or flexors and extensors. However, recent work has shown that inhibition also increases coincident with excitation during contraction. Here, using larval zebrafish, we investigate the V2b (Gata3+) class of neurons, which contribute to flexor-extensor alternation but are otherwise poorly understood. Using newly generated transgenic lines we define two stable subclasses with distinct neurotransmitter and morphological properties. These V2b subclasses synapse directly onto motor neurons with differential targeting …

Situating Dissemination And Implementation Sciences Within And Across The Translational Research Spectrum, Aaron L Leppin, Jane E Mahoney, Kathleen R Stevens, Stephen J Bartels, Laura-Mae Baldwin, Rowena J Dolor, Enola K Proctor, Linda Scholl, Justin B Moore, Ana A Baumann, Catherine L Rohweder, Joan Luby, Paul Meissner

Open Access Publications

The efficient and effective movement of research into practice is acknowledged as crucial to improving population health and assuring return on investment in healthcare research. The National Center for Advancing Translational Science which sponsors Clinical and Translational Science Awards (CTSA) recognizes that dissemination and implementation (D&I) sciences have matured over the last 15 years and are central to its goals to shift academic health institutions to better align with this reality. In 2016, the CTSA Collaboration and Engagement Domain Task Force chartered a D&I Science Workgroup to explore the role of D&I sciences across the translational research spectrum. This special …

Low-Carbohydrate Diets For Gestational Diabetes, Sarah S Farabi, Teri L Hernandez

Open Access Publications

Nutrition therapy provides the foundation for treatment of gestational diabetes (GDM), and has historically been based on restricting carbohydrate (CHO) intake. In this paper, randomized controlled trials (RCTs) are reviewed to assess the effects of both low- and higher CHO nutrition approaches in GDM. The prevailing pattern across the evidence underscores that although CHO restriction improves glycemia at least in the short-term, similar outcomes could be achievable using less restrictive approaches that may not exacerbate IR. The quality of existing studies is limited, in part due to dietary non-adherence and confounding effects of treatment with insulin or oral medication. Recent …

Targeting Sporadic And Neurofibromatosis Type 1 (Nf1) Related Refractory Malignant Peripheral Nerve Sheath Tumors (Mpnst) In A Phase Ii Study Of Everolimus In Combination With Bevacizumab (Sarc016), Brigitte C. Widemann, Anglea C. Hirbe, Et Al

Open Access Publications

No abstract provided.

Dupilumab Efficacy In Uncontrolled, Moderate-To-Severe Asthma With Self-Reported Chronic Rhinosinusitis, Jorge F Maspero, Mario Castro, Et Al

Open Access Publications

BACKGROUND: Dupilumab, a fully human monoclonal antibody, blocks the shared receptor component for IL-4 and IL-13 signaling, key drivers of type 2 inflammation. In the phase 3 study (NCT02414854), add-on dupilumab 200 mg/300 mg every 2 weeks, versus placebo, significantly reduced severe asthma exacerbations and improved pre-bronchodilator forced expiratory volume in 1 second (FEV

OBJECTIVE: To assess the efficacy and safety of dupilumab in patients with uncontrolled, moderate-to-severe asthma with or without self-reported comorbid chronic rhinosinusitis (CRS or non-CRS).

METHODS: Comorbid CRS was self-reported by patients using an e-diary. Annualized severe exacerbation rates, changes from baseline in pre- and post-bronchodilator …

Ml277 Specifically Enhances The Fully Activated Open State Of Kcnq1 By Modulating Vsd-Pore Coupling, Panpan Hou, Jingyi Shi, Kelli Mcfarland White, Yuan Gao, Jianmin Cui

Open Access Publications

Upon membrane depolarization, the KCNQ1 potassium channel opens at the intermediate (IO) and activated (AO) states of the stepwise voltage-sensing domain (VSD) activation. In the heart, KCNQ1 associates with KCNE1 subunits to form I

Functional Outcome Of Adulthood Selective Dorsal Rhizotomy For Spastic Diplegia, T. S. Park, So Yeon Uhm, Deanna M. Walter, Nicole L. Meyer, Matthew B. Dobbs

Open Access Publications

Objective The medical evidence supporting the efficacy of selective dorsal rhizotomy (SDR) on children with spastic diplegia is strong. However, the outcome of SDR on adults with spastic diplegia remains undetermined. The aim is to study the effectiveness and morbidities of SDR performed on adults for the treatment of spastic diplegia. Methods Patients who received SDR in adulthood for the treatment of spastic diplegia were surveyed. The survey questionnaire addressed the living situation, education level, employment, health outcomes, postoperative changes of symptoms, changes in ambulatory function, adverse effects of SDR and orthopedic surgery after SDR. Results The study included 64 …

Low Frequency Of Regulatory B-Cells And Increased Cd4+ And Cd8+ Interferon-Γ-Producing Cells In Patients With Tropical Spastic Paraparesis Associated With Human T-Cell Lymphotropic Virus Type, Yulieth Cristina Bermúdez Burbano, Angie Vanessa Caicedo Paz, Cristhian Camilo Rivera Caldon, Juan Sebastián Rodríguez Constain, Gloria Inés Ávila Gonzáles, Julio César Klínger Hernández, Nancy Marin-Agudelo, Rosa Amalia Dueñas-Cuellar, Victoria Eugenia Niño Castaño

Open Access Publications

INTRODUCTION: Tropical spastic paraparesis/HTLV-1 associated myelopathy (TSP/HAM) is a disease caused by human T-cell lymphotropic virus type 1 (HTLV-I) that mainly infects CD4 T cells-for example, those of the CD4+CD25hiFOXP3+ [Treg] phenotype-where it inhibits forkhead box protein P3 (FOXP3) expression and promotes interferon-γ (IFN-γ) expression. However, the role it exerts on regulatory B cells (CD19+CD24hiCD38hi; Breg) is unknown.

METHODS: The frequencies of Treg and Breg cells was evaluated and the Th1 profiles were assessed in TSP/HAM patients and healthy control subjects.

RESULTS: Low percentages of Breg cells and high production of IFN-γ were observed in patients compared to those in …

Low Frequency Of Regulatory B-Cells And Increased Cd4+ And Cd8+ Interferon-Γ-Producing Cells In Patients With Tropical Spastic Paraparesis Associated With Human T-Cell Lymphotropic Virus Type, Yulieth Cristina Bermúdez Burbano, Angie Vanessa Caicedo Paz, Cristhian Camilo Rivera Caldon, Juan Sebastián Rodríguez Constain, Gloria Inés Ávila Gonzáles, Julio César Klínger Hernández, Nancy Marin-Agudelo, Rosa Amalia Dueñas-Cuellar, Victoria Eugenia Niño Castaño

Open Access Publications

INTRODUCTION: Tropical spastic paraparesis/HTLV-1 associated myelopathy (TSP/HAM) is a disease caused by human T-cell lymphotropic virus type 1 (HTLV-I) that mainly infects CD4 T cells-for example, those of the CD4+CD25hiFOXP3+ [Treg] phenotype-where it inhibits forkhead box protein P3 (FOXP3) expression and promotes interferon-γ (IFN-γ) expression. However, the role it exerts on regulatory B cells (CD19+CD24hiCD38hi; Breg) is unknown.

METHODS: The frequencies of Treg and Breg cells was evaluated and the Th1 profiles were assessed in TSP/HAM patients and healthy control subjects.

RESULTS: Low percentages of Breg cells and high production of IFN-γ were observed in patients compared to those in …

Relationship Between Duration And Extent Of Oedema And Visual Acuity Outcome With Ranibizumab In Diabetic Macular Oedema: A Post Hoc Analysis Of Protocol I Data, Srinivas R Sadda, Joanna Campbell, Pravin U Dugel, Nancy M Holekamp, Szilárd Kiss, Anat Loewenstein, Albert J Augustin, Vanessa Shih, Xiaoshu Xu, Charles C Wykoff, Scott M Whitcup

Open Access Publications

BACKGROUND/OBJECTIVES: This post hoc analysis explores the relationship between residual oedema exposure after ranibizumab treatment initiation and long-term visual acuity outcome in eyes with centre-involved diabetic macular oedema (DMO).

SUBJECTS/METHODS: Eyes randomised to the ranibizumab + prompt or deferred laser treatment arms in the Protocol I trial and with observed central retinal thickness (CRT) readings at baseline and ≥1 follow-up visits (n = 367) were stratified by 1) oedema duration (number of study visits with CRT ≥ 250 µm during the first 52 weeks of ranibizumab treatment); and 2) oedema extent (amount of excess CRT [≥ 250 µm] at each …

Diagnostic And Clinical Experience Of Patients With Pantothenate Kinase-Associated Neurodegeneration, Randall D Marshall, Abigail Collins, Maria L Escolar, H A Jinnah, Thomas Klopstock, Michael C Kruer, Aleksandar Videnovic, Amy Robichaux-Viehoever, Colleen Burns, Laura L Swett, Dennis A Revicki, Randall H Bender, William R Lenderking

Open Access Publications

BACKGROUND: Pantothenate kinase-associated neurodegeneration (PKAN) is an autosomal recessive neurodegenerative disorder with brain iron accumulation (NBIA).

OBJECTIVES: To assess PKAN diagnostic pathway, history, and burden across the spectrum of PKAN severity from patient and/or caregiver perspectives.

METHODS: Caregivers of patients (n = 37) and patients themselves (n = 2) were interviewed in a validation study of the PKAN-Activities of Daily Living (ADL) scale. The current study used quartiles of the PKAN-ADL total score to divide patients by severity of impairment (Lowest, Second Lowest, Third Lowest, Highest). Diagnostic and treatment history, healthcare utilization, disease burden, and caregiver experience were compared between …

Effects Of Microbiota-Directed Foods In Gnotobiotic Animals And Undernourished Children, Jeanette L Gehrig, Siddarth Venkatesh, Hao-Wei Chang, Matthew C Hibberd, Vanderlene L Kung, Jiye Cheng, Robert Y Chen, Sathish Subramanian, Carrie A Cowardin, Martin F Meier, David O'Donnell, Michael Talcott, Larry D Spears, Clay F Semenkovich, Christopher Sawyer, Richard D Head, Michael J Barratt, Jeffrey I Gordon, Et Al

Open Access Publications

To examine the contributions of impaired gut microbial community development to childhood undernutrition, we combined metabolomic and proteomic analyses of plasma samples with metagenomic analyses of fecal samples to characterize the biological state of Bangladeshi children with severe acute malnutrition (SAM) as they transitioned, after standard treatment, to moderate acute malnutrition (MAM) with persistent microbiota immaturity. Host and microbial effects of microbiota-directed complementary food (MDCF) prototypes targeting weaning-phase bacterial taxa underrepresented in SAM and MAM microbiota were characterized in gnotobiotic mice and gnotobiotic piglets colonized with age- and growth-discriminatory bacteria. A randomized, double-blind controlled feeding study identified a lead MDCF …

A Sparse Covarying Unit That Describes Healthy And Impaired Human Gut Microbiota Development, Arjun S Raman, Jeanette L Gehrig, Siddarth Venkatesh, Hao-Wei Chang, Matthew C Hibberd, Sathish Subramanian, Michael J Barratt, Jeffrey I Gordon, Et Al

Open Access Publications

Characterizing the organization of the human gut microbiota is a formidable challenge given the number of possible interactions between its components. Using a statistical approach initially applied to financial markets, we measured temporally conserved covariance among bacterial taxa in the microbiota of healthy members of a Bangladeshi birth cohort sampled from 1 to 60 months of age. The results revealed an "ecogroup" of 15 covarying bacterial taxa that provide a concise description of microbiota development in healthy children from this and other low-income countries, and a means for monitoring community repair in undernourished children treated with therapeutic foods. Features of …

Identification Of An Alternating-Access Dynamics Mutant Of Emre With Impaired Transport, Chao Wu, Samantha A Wynne, Nathan E Thomas, Eva-Maria Uhlemann, Christopher G Tate, Katherine A Henzler-Wildman

Open Access Publications

Proteins that perform active transport must alternate the access of a binding site, first to one side of a membrane and then to the other, resulting in the transport of bound substrates across the membrane. To better understand this process, we sought to identify mutants of the small multidrug resistance transporter EmrE with reduced rates of alternating access. We performed extensive scanning mutagenesis by changing every amino acid residue to Val, Ala, or Gly, and then screening the drug resistance phenotypes of the resulting mutants. We identified EmrE mutants that had impaired transport activity but retained the ability to bind …

A Stem-Cell-Derived Platform Enables Complete Cryptosporidium Development In Vitro And Genetic Tractability, Georgia Wilke, Lisa J Funkhouser-Jones, Yi Wang, Soumya Ravindran, Qiuling Wang, Wandy L Beatty, Megan T Baldridge, Kelli L Vandussen, Bang Shen, Mark S Kuhlenschmidt, Theresa B Kuhlenschmidt, William H Witola, Thaddeus S Stappenbeck, L. David Sibley

Open Access Publications

Despite being a frequent cause of severe diarrheal disease in infants and an opportunistic infection in immunocompromised patients, Cryptosporidium research has lagged due to a lack of facile experimental methods. Here, we describe a platform for complete life cycle development and long-term growth of C. parvum in vitro using "air-liquid interface" (ALI) cultures derived from intestinal epithelial stem cells. Transcriptomic profiling revealed that differentiating epithelial cells grown under ALI conditions undergo profound changes in metabolism and development that enable completion of the parasite life cycle in vitro. ALI cultures support parasite expansion > 100-fold and generate viable oocysts that are transmissible …

De Novo Substitutions Of Trpm3 Cause Intellectual Disability And Epilepsy, David A Dyment, Paulien A Terhal, Cecilie F Rustad, Kristian Tveten, Christopher Griffith, Parul Jayakar, Marwan Shinawi, Sara Ellingwood, Rosemarie Smith, Koen Van Gassen, Kirsty Mcwalter, A Micheil Innes, Matthew A Lines

Open Access Publications

The developmental and epileptic encephalopathies (DEE) are a heterogeneous group of chronic encephalopathies frequently associated with rare de novo nonsynonymous coding variants in neuronally expressed genes. Here, we describe eight probands with a DEE phenotype comprising intellectual disability, epilepsy, and hypotonia. Exome trio analysis showed de novo variants in TRPM3, encoding a brain-expressed transient receptor potential channel, in each. Seven probands were identically heterozygous for a recurrent substitution, p.(Val837Met), in TRPM3's S4-S5 linker region, a conserved domain proposed to undergo conformational change during gated channel opening. The eighth individual was heterozygous for a proline substitution, p.(Pro937Gln), at the boundary between …

Effect Of Enhanced Medical Rehabilitation On Functional Recovery In Older Adults Receiving Skilled Nursing Care After Acute Rehabilitation: A Randomized Clinical Trial, Eric J. Lenze, Emily Lenard, Marghuretta Bland, Peggy Barco, J Philip Miller, Michael Yingling, Catherine E. Lang, Nancy Morrow-Howell, Carolyn M. Baum, Ellen F. Binder, Thomas L. Rodebaugh

Open Access Publications

Importance: Enhanced medical rehabilitation (EMR) is a systematic and standardized approach for physical and occupational therapists to engage patients. Higher patient engagement in therapy might lead to improved functional recovery in rehabilitation settings, such as skilled nursing facilities (SNFs).

Objective: To determine whether EMR improves older adults' functional recovery.

Design, Setting, and Participants: A double-blind, parallel-group, randomized clinical trial was conducted from July 29, 2014, to July 13, 2018, in 229 adults aged 65 years or older admitted to 2 US SNFs. Participants were randomized to receive EMR (n = 114) vs standard-of-care rehabilitation (n = 115). Intention-to-treat analysis was …

Estimating Implicit And Explicit Gender Bias Among Health Care Professionals And Surgeons, Arghavan Salles, Michael Awad, Laurel Goldin, Kelsey Krus, Jin Vivian Lee, Maria T. Schwabe, Calvin K. Lai

Open Access Publications

Importance: The Implicit Association Test (IAT) is a validated tool used to measure implicit biases, which are mental associations shaped by one's environment that influence interactions with others. Direct evidence of implicit gender biases about women in medicine has yet not been reported, but existing evidence is suggestive of subtle or hidden biases that affect women in medicine.

Objectives: To use data from IATs to assess (1) how health care professionals associate men and women with career and family and (2) how surgeons associate men and women with surgery and family medicine.

Design, Setting, and Participants: This data review and …

Trends In Medical Imaging During Pregnancy In The United States And Ontario, Canada, 1996 To 2016, Marilyn L. Kwan, James R. Duncan, Et Al

Open Access Publications

No abstract provided.

Is Duration Of Hospital Participation In Meaningful Use Associated With Value In Medicare?, Yanick N. Brice, Karen E. Joynt Maddox

Open Access Publications

Objectives: "Meaningful Use" (MU) of electronic health records (EHRs) is a measure used by Medicare to determine whether hospitals are comprehensively using electronic tools. Whether hospitals' engagement in value-based initiatives such as MU is associated with value-defined as high quality and low costs-is unknown. Our objectives were to describe hospital participation in MU, and determine whether duration of participation is associated with value.

Materials and Methods: We linked national Medicare data with MU and other hospital-level and market data. We analyzed bivariate relationships to characterize duration of participation. We estimated inverse probability-weighted multilevel logistic regressions to evaluate whether duration of …

The Future Is Open: Open-Source Tools For Behavioral Neuroscience Research, Samantha R White, Linda M Amarante, Alexxai V Kravitz, Mark Laubach

Open Access Publications

No abstract provided.

A Guinea Fowl Genome Assembly Provides New Evidence On Evolution Following Domestication And Selection In Galliformes, Alain Vignal, Simon Boitard, Noémie Thébault, Guiguigbaza-Kossigan Dayo, Valentine Yapi-Gnaore, Issaka Youssao Abdou Karim, Cécile Berthouly-Salazar, Nóra Pálinkás-Bodzsár, Daniel Guémené, Francoise Thibaud-Nissen, Wesley C Warren, Michèle Tixier-Boichard, Xavier Rognon

Open Access Publications

The helmeted guinea fowl Numida meleagris belongs to the order Galliformes. Its natural range includes a large part of sub-Saharan Africa, from Senegal to Eritrea and from Chad to South Africa. Archaeozoological and artistic evidence suggest domestication of this species may have occurred about 2,000 years BP in Mali and Sudan primarily as a food resource, although villagers also benefit from its capacity to give loud alarm calls in case of danger, of its ability to consume parasites such as ticks and to hunt snakes, thus suggesting its domestication may have resulted from a commensal association process. Today, it is …

Sox2 And Fgf20 Interact To Regulate Organ Of Corti Hair Cell And Supporting Cell Development In A Spatially-Graded Manner., Lu M. Yang, Kathryn S. E. Cheah, Sung-Ho Huh, David M. Ornitz

Open Access Publications

The mouse organ of Corti, housed inside the cochlea, contains hair cells and supporting cells that transduce sound into electrical signals. These cells develop in two main steps: progenitor specification followed by differentiation. Fibroblast Growth Factor (FGF) signaling is important in this developmental pathway, as deletion of FGF receptor 1 (Fgfr1) or its ligand, Fgf20, leads to the loss of hair cells and supporting cells from the organ of Corti. However, whether FGF20-FGFR1 signaling is required during specification or differentiation, and how it interacts with the transcription factor Sox2, also important for hair cell and supporting cell development, has been …

Organizational Supports For Research Evidence Use In State Public Health Agencies: A Latent Class Analysis, Hengrui Hu, Peg Allen, Yan Yan, Rodrigo S Reis, Rebekah R Jacob, Ross C Brownson

Open Access Publications

OBJECTIVE: Use of research evidence in public health decision making can be affected by organizational supports. Study objectives are to identify patterns of organizational supports and explore associations with research evidence use for job tasks among public health practitioners.

DESIGN: In this longitudinal study, we used latent class analysis to identify organizational support patterns, followed by mixed logistic regression analysis to quantify associations with research evidence use.

SETTING: The setting included 12 state public health department chronic disease prevention units and their external partnering organizations involved in chronic disease prevention.

PARTICIPANTS: Chronic disease prevention staff from 12 US state public …

Pituitary Adenoma In Pediatric And Adolescent Populations, Jie Chen, Robert E Schmidt, Sonika Dahiya

Open Access Publications

Pituitary adenomas are rare in children and adolescents and although mostly benign, they can sometimes be challenging to manage due to their locally invasive nature. In this study, we examined the clinicopathologic features of 42 pituitary adenomas in patients ≤21 years of age. The youngest patient was 8 years old (median age: 18 years), and the female-to-male ratio was 1.8:1. Five patients had recurrence after resection. There was no obvious difference between the recurrent rates in the typical (11.7%) and atypical adenomas (12.5%) based on the 2004 WHO classification. However, the recurrence rate was much higher in adenomas with an …