Medicine and Health Sciences Commons^™

A Novel Machine Learning Algorithm Selects Proteome Signature To Specifically Identify Cancer Exosomes, Bingrui Li, Fernanda G Kugeratski, Raghu Kalluri

Faculty, Staff and Student Publications

Non-invasive early cancer diagnosis remains challenging due to the low sensitivity and specificity of current diagnostic approaches. Exosomes are membrane-bound nanovesicles secreted by all cells that contain DNA, RNA, and proteins that are representative of the parent cells. This property, along with the abundance of exosomes in biological fluids makes them compelling candidates as biomarkers. However, a rapid and flexible exosome-based diagnostic method to distinguish human cancers across cancer types in diverse biological fluids is yet to be defined. Here, we describe a novel machine learning-based computational method to distinguish cancers using a panel of proteins associated with exosomes. Employing …

The Genomic And Evolutionary Landscapes Of Anaplastic Thyroid Carcinoma, Peter Y F Zeng, Stephenie D Prokopec, Stephen Y Lai, Nicole Pinto, Michelle A Chan-Seng-Yue, Roderick Clifton-Bligh, Michelle D Williams, Christopher J Howlett, Paul Plantinga, Matthew J Cecchini, Alfred K Lam, Iram Siddiqui, Jianxin Wang, Ren X Sun, John D Watson, Reju Korah, Tobias Carling, Nishant Agrawal, Nicole Cipriani, Douglas Ball, Barry Nelkin, Lisa M Rooper, Justin A Bishop, Cathie Garnis, Ken Berean, Norman G Nicolson, Paul Weinberger, Ying C Henderson, Christopher M Lalansingh, Mao Tian, Takafumi N Yamaguchi, Julie Livingstone, Adriana Salcedo, Krupal Patel, Frederick Vizeacoumar, Alessandro Datti, Liu Xi, Yuri E Nikiforov, Robert Smallridge, John A Copland, Laura A Marlow, Martin D Hyrcza, Leigh Delbridge, Stan Sidhu, Mark Sywak, Bruce Robinson, Kevin Fung, Farhad Ghasemi, Keith Kwan, S Danielle Macneil, Adrian Mendez, David A Palma, Mohammed I Khan, Mushfiq Shaikh, Kara M Ruicci, Bret Wehrli, Eric Winquist, John Yoo, Joe S Mymryk, James W Rocco, David Wheeler, Steve Scherer, Thomas J Giordano, John W Barrett, William C Faquin, Anthony J Gill, Gary Clayman, Paul C Boutros, Anthony C Nichols

Faculty, Staff and Student Publications

Anaplastic thyroid carcinoma is arguably the most lethal human malignancy. It often co-occurs with differentiated thyroid cancers, yet the molecular origins of its aggressivity are unknown. We sequenced tumor DNA from 329 regions of thyroid cancer, including 213 from patients with primary anaplastic thyroid carcinomas. We also whole genome sequenced 9 patients using multi-region sequencing of both differentiated and anaplastic thyroid cancer components. Using these data, we demonstrate thatanaplastic thyroid carcinomas have a higher burden of mutations than other thyroid cancers, with distinct mutational signatures and molecular subtypes. Further, different cancer driver genes are mutated in anaplastic and differentiated thyroid …

Identifying Potential Dietary Treatments For Inherited Metabolic Disorders Using Drosophila Nutrigenomics, Felipe Martelli, Jiayi Lin, Sarah Mele, Wendy Imlach, Oguz Kanca, Christopher K Barlow, Jefferson Paril, Ralf B Schittenhelm, John Christodoulou, Hugo J Bellen, Matthew D W Piper, Travis K Johnson

Faculty, Staff and Students Publications

Inherited metabolic disorders are a group of genetic conditions that can cause severe neurological impairment and child mortality. Uniquely, these disorders respond to dietary treatment; however, this option remains largely unexplored because of low disorder prevalence and the lack of a suitable paradigm for testing diets. Here, we screened 35 Drosophila amino acid disorder models for disease-diet interactions and found 26 with diet-altered development and/or survival. Using a targeted multi-nutrient array, we examine the interaction in a model of isolated sulfite oxidase deficiency, an infant-lethal disorder. We show that dietary cysteine depletion normalizes their metabolic profile and rescues development, neurophysiology, …

A Therapeutically Targetable Positive Feedback Loop Between Nc-Hlx-2-7, Hlx, And Myc That Promotes Group 3 Medulloblastoma, Keisuke Katsushima, Kandarp Joshi, Menglang Yuan, Brigette Romero, Mona Batish, Stacie Stapleton, George Jallo, Elayaraja Kolanthai, Sudipta Seal, Olivier Saulnier, Michael D Taylor, Robert J Wechsler-Reya, Charles G Eberhart, Ranjan J Perera

Faculty, Staff and Students Publications

Recent studies suggest that long non-coding RNAs (lncRNAs) contribute to medulloblastoma (MB) formation and progression. We have identified an lncRNA, lnc-HLX-2-7, as a potential therapeutic target in group 3 (G3) MBs. lnc-HLX-2-7 RNA specifically accumulates in the promoter region of HLX, a sense-overlapping gene of lnc-HLX-2-7, which activates HLX expression by recruiting multiple factors, including enhancer elements. RNA sequencing and chromatin immunoprecipitation reveal that HLX binds to and activates the promoters of several oncogenes, including TBX2, LIN9, HOXM1, and MYC. Intravenous treatment with cerium-oxide-nanoparticle-coated antisense oligonucleotides targeting lnc-HLX-2-7 (CNP-lnc-HLX-2-7) inhibits tumor growth by 40%-50% in an intracranial MB xenograft mouse …

Targeting Cxcr4, Vla-4, And Cxcr2 For Hematopoietic Stem Cell Mobilization, Daniel Cancilla, Michael P Rettig, Darja Karpova, Haresh Thakellapalli, Megh Singh, Marvin J Meyers, Peter G Ruminski, Stephanie Christ, Ezhilarasi Chendamarai, Feng Gao, Leah Gehrs, Julie K Ritchey, Michael Prinsen, John F Dipersio

2020-Current year OA Pubs

No abstract provided.

Intergenerational Protective Anti-Gut Commensal Immunoglobulin G Originates In Early Life, Brigida Rusconi, Adina K Bard, Ryan Mcdonough, Angel M Kindsvogel, Jacqueline D Wang, Sreeram Udayan, Keely G Mcdonald, Rodney D Newberry, Phillip I Tarr

2020-Current year OA Pubs

Maternal immunoglobulins of the class G (IgGs) protect offspring from enteric infection, but when, where, and how these antibodies are physiologically generated and confer protection remains enigmatic. We found that circulating IgGs in adult mice preferentially bind early-life gut commensal bacteria over their own adult gut commensal bacteria. IgG-secreting plasma cells specific for early-life gut bacteria appear in the intestine soon after weaning, where they remain into adulthood. Manipulating exposure to gut bacteria or plasma cell development before, but not after, weaning reduced IgG-secreting plasma cells targeting early-life gut bacteria throughout life. Further, the development of this anti-gut commensal IgG …

Next Generation Microfluidics: Fulfilling The Promise Of Lab-On-A-Chip Technologies, Umut A Gurkan, Jorge Di Paola, Et Al.

2020-Current year OA Pubs

Microfluidic lab-on-a-chip technologies enable the analysis and manipulation of small fluid volumes and particles at small scales and the control of fluid flow and transport processes at the microscale, leading to the development of new methods to address a broad range of scientific and medical challenges. Microfluidic and lab-on-a-chip technologies have made a noteworthy impact in basic, preclinical, and clinical research, especially in hematology and vascular biology due to the inherent ability of microfluidics to mimic physiologic flow conditions in blood vessels and capillaries. With the potential to significantly impact translational research and clinical diagnostics, technical issues and incentive mismatches …

Quality Improvement In Healthcare: A Practical Guide For Providers (Part 3), Jeremy Ellis

Transformative Medicine

No abstract provided.

Novel Drug Approvals 2023, Emily Wagner, Christina Swiger, Mary Hoang, Maley Zents

Transformative Medicine

This article provides an overview of the novel drugs approved for 2023. The Food and Drug Administration’s (FDA) Center for Drug Evaluation and Research (CDER) provides standards to drug developers. The CDER sets standards for required data needed in the drug development and application process. Every year a variety of new drugs and biological products are approved. Some are new molecular compounds while others are structurally similar to those already on the market. Therefore, products may not have been used in medical practice previously while others have already been used in practice. This article highlights medications that are new in …

“This Ekg Is Concerning For Ischemia!”, Muhammad M. Zafar

Transformative Medicine

No abstract provided.

Aortic Dissection: The Insidious Menace, Muhammad Umer Riaz Gondal, John Lemoine, Mohammad Baig, Prem Parajuli, Zainab Kiyani, Hamza Khan, Hassam Saif

Transformative Medicine

Introduction:

Aortic dissection represents a critical emergency characterized by the cleavage of aortic wall layers, creating a deceptive false lumen. Associated with high mortality rates, prompt diagnosis and intervention are needed to ensure survival.

Case:

A 63-year-old male with no significant medical history presented to the emergency with two days of worsening mid-sternal chest pain. Upon presentation, he was hemodynamically stable. Blood pressure was 130/85 mm Hg (similar in both arms), heart rate 90 bpm, and saturating 98 % on room air. Physical examination did not reveal any new murmurs. EKG showed normal sinus rhythm, no ischemic changes, and a …

New Onset Dyspnea In A Patient With Pacemaker, What Does The Ecg Tracing Show?, Jakob Nypaver, Robert Libera Do, Arun Kundra, Ravi Choxi

Transformative Medicine

Dual chamber pacemakers are programmed to allow for AV synchrony. Whenever a patient with a dual chamber pacemaker with underlying sinus rhythm presents with AV dissociation, the lack of AV synchrony should be questioned. The authors present a case of new onset dyspnea diagnosed as pacemaker syndrome. The diagnosis was initially delayed due to underlying ventricular paced rhythm as misidentified as normal pacemaker behavior.

A 69-year-old female with a past medical history of 2:1 atrioventricular block status post dual-chamber pacemaker implant presented with complaints of new onset shortness of breath and dyspnea. The ECG showed a ventricular rate of 66 …

Autoimmune Hemolytic Anemia: A Rare Presentation Of Mantle Cell Lymphoma, Ian Garrahy, Shoja Rahimian

Transformative Medicine

Autoimmune hemolytic anemia (AIHA) is a well-recognized phenomenon of non-Hodgkin lymphoma, albeit with only few cases described with mantle cell lymphoma (MCL). The characteristics of such cases can improve understanding and management of AIHA in this type of lymphoma. To that end, we describe herein two cases of patients with MCL who presented with AIHA, with comparison to nine previously described cases in literature.

Metformin Continuation Versus Holding Pre And Post Coronary Angiography With Normal Renal Function: A Systematic Review And Meta-Analysis, Mohammad Hamza, Yasar Sattar, Sadaf Fakhra, Neel Patel, Mubashar Karamat, Saman Razzaq, Aamir Saeed, Khaled M. Harmouch, Islam Elgendy, Mamas Mamas, Anand Prasad, Wael Aljaroudi, Ramesh Daggubati, M Chadi Alraies

Transformative Medicine

Background

It is common practice to withhold metformin prior to cardiac catheterization due to fear of developing lactic acidosis in the setting of contrast-associated acute kidney injury (AKI). The evidence behind this recommendation is currently weak.

Methods

We collected 851 articles from PubMed and Embase, of which 3 met our inclusion criteria. Inclusion criteria were age > 18 years, baseline use of long-term metformin with continued or interrupted metformin use in patients during diagnostic or interventional cardiac catheterization. The outcomes studied were differences between post-catheterization and pre-catheterization serum creatinine (SCr) and glomerular filtration rate (GFR). We excluded studies dealing with patients …

Lstm-Based Recurrent Neural Network Predicts Influenza-Like-Illness In Variable Climate Zones, Alfred Amendolara, Christopher Gowans, Joshua Barton, David Sant, Andrew Payne

Annual Research Symposium

Purpose: Influenza virus is responsible for a recurrent, yearly epidemic in most temperate regions of the world. For the 2021-2022 season the CDC reports 5000 deaths and 100,000 hospitalizations, a significant number despite the confounding presence of SARS-CoV-2. The mechanisms behind seasonal variance in flu burden are not well understood. Based on a previously validated model, this study seeks to expand understanding of the impact of variable climate regions on seasonal flu trends. To that end, three climate regions have been selected. Each region represents a different ecological region and provides different weather patterns showing how the climate variables impact …

Dissociating Reading And Auditory Comprehension In Persons With Aphasia, Rachel M. Harrington, Sigfus Kristinsson, Janina Wilmskoetter, Natalie Busby, Dirk Den Ouden, Chris Rorden, Julius Fridriksson Ph.D., Leonardo Bonilha

Faculty Publications

Language comprehension is often affected in individuals with post-stroke aphasia. However, deficits in auditory comprehension are not fully correlated with deficits in reading comprehension and the mechanisms underlying this dissociation remain unclear. This distinction is important for understanding language mechanisms, predicting long-term impairments and future development of treatment interventions. Using comprehensive auditory and reading measures from a large cohort of individuals with aphasia, we evaluated the relationship between aphasia type and reading comprehension impairments, the relationship between auditory versus reading comprehension deficits and the crucial neuroanatomy supporting the dissociation between post-stroke reading and auditory deficits. Scores from the Western Aphasia …

Playful Progress: A Parent's Guide To Growth And Development, Gabriella N. Lawrey

Honors Program: Senior Projects (Public)

This thesis presents a creative project aimed at empowering parents to recognize developmental achievements, as well as address potential developmental delays in their children. Grounded in the principles of child development, this project focuses on creating age-appropriate activities that facilitate the identification of developmental milestones. By utilizing foundational resources in the field of child development, this toolkit of engaging activities has been curated to support parental understanding and observation. The primary objective of this applied knowledge project is to better equip parents with the vocabulary and tools to facilitate their child’s development. Throughout these activities, parents are encouraged to engage …

Smoking Cessation In Primary Care Using The 5 A’S Model Of Motivational Interviewing: A Quality Improvement Project, Lauren M. Violette

DNP Projects

Significance and Background: Tobacco use is one of the leading causes of preventable death in the United States, greatly contributing to morbidity and mortality. Motivational Interviewing (MI), a counseling style, has been shown to increase motivation for change in people. Successful intervention for behavior modification starts with identifying a person’s readiness for change. The 5 A’s model is an established form of motivational interviewing that addresses the five major steps of intervention: Ask, Advise, Assess, Assist, and Arrange. The Center for Disease Control (CDC) endorses the use of the 5 A’s brief tobacco intervention to protect the public’s health from …

Lateropulsion Resolution And Outcomes Up To One Year Post-Stroke: A Prospective, Longitudinal Cohort Study, Jessica Nolan, Angela Jacques, Erin Godecke, Michael Bynevelt, Ferry Dharsono, Barbara Singer

Research outputs 2022 to 2026

Background: Post-stroke lateropulsion is prevalent and associated with poor rehabilitation outcomes; however, data regarding long-term function associated with lateropulsion are lacking.

Objectives: This study aimed to explore lateropulsion resolution and associations between lateropulsion, functional outcomes, and fall occurrence up to 12 months post-stroke.

Methods: Participants for this prospective, longitudinal cohort study were recruited from a Stroke Rehabilitation Unit (SRU). Assessments were conducted at SRU admission, at discharge, and at three, six, nine, and twelve months post-stroke. Outcomes included the Four-Point Pusher Score (4PPS), Functional Independence Measure (FIM), and fall occurrence. Longitudinal outcomes were modeled using generalized linear mixed-effects models. Results: …

Increased Nitrate Intake From Beetroot Juice Over 4 Weeks Affects Nitrate Metabolism, But Not Vascular Function Or Blood Pressure In Older Adults With Hypertension, Rebeka Fejes, Martin Lutnik, Stefan Weisshaar, Nina Pilat, Karl-Heinz Wagner, Hans-Peter Stüger, Jonathan M. Peake, Richard J. Woodman, Kevin D. Croft, Catherine P. Bondonno, Jonathan M. Hodgson, Michael Wolzt, Oliver Neubauer

Research outputs 2022 to 2026

The decline in vascular function and increase in blood pressure with aging contribute to an increased cardiovascular disease risk. In this randomized placebo-controlled crossover study, we evaluated whether previously reported cardiovascular benefits of plant-derived inorganic nitrate via nitric oxide (NO) translate into improved vascular function and blood pressure-lowering in 15 men and women (age range: 56-71 years) with treated hypertension. We investigated the effects of a single ∼400 mg-dose at 3 hours post-ingestion (3H POST) and the daily consumption of 2 × ∼400 mg of nitrate through nitrate-rich compared with nitrate-depleted (placebo) beetroot juice over 4 weeks (4WK POST). Measurements …

Evaluating Drowning Prevention Campaigns - The Challenge Of Getting The Right Information To The Right People At The Right Time: A Response To Calverley, Petrass, And Blitvich, Gemma Crawford, Meg Abercromby, Malena Della Bona, Justine E. Leavy Ph.D.

International Journal of Aquatic Research and Education

Evidence-informed decision making requires timely and readily available research and evaluation for policy and practice. In the context of drowning prevention, evaluation of interventions in the grey and peer reviewed literature is relatively scarce. Lack of evidence and associated barriers to access limits the scope of knowledge translation efforts and the application of research outcomes to initiatives designed to prevent drowning. The paper, Alcohol Focused Drowning Prevention Campaigns: What Do We Know and What Should We Do Now? highlights a lack of specific evaluation for alcohol-focused drowning prevention campaigns. We offer insights as evaluators of a youth water safety program …

Novel Frameless Linac Radiosurgery Solution For Uveal Melanoma, Louis Cappelli, Mehak Khan, Sudheshna Vemula, Christina Hum, Haisong Lui, Yan Yu, Yingxuan Chen, Yechi Zhang, Muhammad Sharif, Wenyin Shi

Department of Radiation Oncology Faculty Papers

INTRODUCTION: Radiation treatment has replaced enucleation as an organ-preservation treatment for patients with uveal melanoma (UM). We developed a novel non-invasive, frameless LINAC based solution for fractionated stereotactic radiosurgery (fSRS) treatment.

METHODS: We designed and constructed the a stereotactic ocular localization box that can be attached and indexed to a stereotactic LINAC tabletop. It contains adjustable LED lights as a gaze focus point and CCD camera for monitoring of the patient's eye position. The device also has 6 infrared spheres compatible with the ExacTRAC IGRT system. Treatment plans were developed using iPLAN Dose version 4.5, with conformal dynamic arcs and …

Financing Reforms To Meet A Pivotal Moment In Global Health, Kevin A. Klock, Alexandra Finch, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

2024 will be the most important moment for global health since the World Health Organization’s founding in 1948, but only if states give major reforms their full political and financial backing. Bold new commitments in disease surveillance, capacity building, and more equitable access to health products cannot be achieved without ample and sustainable funding. In this essay, we discuss major reforms found in the emerging pandemic agreement and reformed International Health Regulations and then explore the significant challenges and opportunities for financing them.

03.25.2024 Orsp Connect, Liz Williamson

ORED Newsletter

Cammi Thornton, Compliance Training Requirements

Consensus Pharmacophore Strategy For Identifying Novel Sars-Cov-2 Mpro Inhibitors From Large Chemical Libraries, Angel J Ruiz-Moreno, Raziel Cedillo-González, Luis Cordova-Bahena, Zhiqiang An, José L Medina-Franco, Marco A Velasco-Velázquez

The Brown Foundation: Institute of Molecular Medicine

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) main Protease (Mpro) is an enzyme that cleaves viral polyproteins translated from the viral genome and is critical for viral replication. Mpro is a target for anti-SARS-CoV-2 drug development, and multiple Mpro crystals complexed with competitive inhibitors have been reported. In this study, we aimed to develop an Mpro consensus pharmacophore as a tool to expand the search for inhibitors. We generated a consensus model by aligning and summarizing pharmacophoric points from 152 bioactive conformers of SARS-CoV-2 Mpro inhibitors. Validation against a library of conformers from a subset of ligands showed that …

Advocacy Connection Team-Now Educational Program For Headache Fellows And Patients/Caregivers: Assessment Of Educational Objectives, Courtney Seebadri-White, Hsiangkuo Yuan, William B. Young, Karissa N. Arca

Department of Neurology Faculty Papers

OBJECTIVE: To assess for improvement in comfort in participating in advocacy for migraine and headache disorders and knowledge needed for successful advocacy.

BACKGROUND: The Advocacy Connection Team (ACT)-Now program is an educational program offered through Miles for Migraine, a non-profit advocacy organization. It is designed to teach headache fellows and patients advocacy skills.

METHODS: In a cross-sectional pre-test-post-test design, the 2021 ACT-Now cohort of 98 participants were administered a set of 11 pre-course survey questions identifying their role (healthcare provider/headache fellow or patient/caregiver), baseline knowledge of migraine-related disability and stigma, and baseline engagement and comfort with advocating. The post-course survey …

Identification Of Nonfunctional Alternatively Spliced Isoforms Of Sting In Human Acute Myeloid Leukemia, Akash R Boda, Arthur J Liu, Susana Castro-Pando, Benjamin T Whitfield, Jeffrey J Molldrem, Gheath Al-Atrash, Maria Emilia Di Francesco, Philip Jones, Casey R Ager, Michael A Curran

Faculty, Staff and Student Publications

UNLABELLED: Lack of robust activation of Stimulator of Interferon Genes (STING) pathway and subsequent induction of type I IFN responses is considered a barrier to antitumor immunity in acute myeloid leukemia (AML). Using common human AML cell lines as in vitro tools to evaluate the efficacy of novel STING agonists, we found most AML lines to be poor producers of IFNs upon exposure to extremely potent agonists, suggesting cell-intrinsic suppression of STING signaling may occur. We observed unexpected patterns of response that did not correlate with levels of STING pathway components or of known enzymes associated with resistance. To identify …

Altered Lipid Metabolism In Apc-Driven Colorectal Cancer: The Potential For Therapeutic Intervention, Courtney O. Kelson, Yekaterina Y. Zaytseva

Markey Cancer Center Faculty Publications

Altered lipid metabolism is a well-recognized feature of solid cancers, including colorectal cancer. In colorectal cancer, upregulation of lipid metabolism contributes to initiation, progression, and metastasis; thus, aberrant lipid metabolism contributes to a poor patient outcome. The inactivating mutation of APC, a vital tumor suppressor in the Wnt signaling pathway, is a key event that occurs early in the majority of colorectal cancer cases. The potential crosstalk between lipid metabolism and APC-driven colorectal cancer is poorly understood. This review collectively highlights and summarizes the limited understanding between mutations in APC and the upregulation of Wnt/beta- catenin signaling and lipid metabolism. …

Dissociating Reading And Auditory Comprehension In Persons With Aphasia, Rachael M. Harrington, Sigfus Kristinsson, Janina Wilmskoetter, Natalie Busby, Dirk B. Den Ouden, Chris Rorden, Julius Fridriksson, Leonardo Bonilha

Communication Sciences and Disorders Faculty Articles and Research

Language comprehension is often affected in individuals with post-stroke aphasia. However, deficits in auditory comprehension are not fully correlated with deficits in reading comprehension and the mechanisms underlying this dissociation remain unclear. This distinction is important for understanding language mechanisms, predicting long-term impairments and future development of treatment interventions. Using comprehensive auditory and reading measures from a large cohort of individuals with aphasia, we evaluated the relationship between aphasia type and reading comprehension impairments, the relationship between auditory versus reading comprehension deficits and the crucial neuroanatomy supporting the dissociation between post-stroke reading and auditory deficits. Scores from the Western Aphasia …

A Clinical Practice Guideline For The Management Of Patients With Acute Spinal Cord Injury: Recommendations On Hemodynamic Management, Brian K. Kwon, Lindsay A. Tetreault, Allan R. Martin, Paul M. Arnold, Rex A.W. Marco, Virginia F.J Newcombe, Carl M. Zipser, Stephen L. Mckenna, Radha Korupolu, Chris J. Neal, Rajiv Saigal, Nina E. Glass, Sam Douglas, Mario Ganau, Vafa Rahimi-Movaghar, James S. Harrop, Bizhan Aarabi, Jefferson R. Wilson, Nathan Evaniew, Andrea C. Skelly, Michael G. Fehlings

Department of Neurosurgery Faculty Papers

STUDY DESIGN: Clinical practice guideline development following the GRADE process.

OBJECTIVES: Hemodynamic management is one of the only available treatment options that likely improves neurologic outcomes in patients with acute traumatic spinal cord injury (SCI). Augmenting mean arterial pressure (MAP) aims to improve blood perfusion and oxygen delivery to the injured spinal cord in order to minimize secondary ischemic damage to neural tissue. The objective of this guideline was to update the 2013 AANS/CNS recommendations on the hemodynamic management of patients with acute traumatic SCI, acknowledging that much has been published in this area since its publication. Specifically, we sought …