Gallbladder perforation due to the obstructing periampullary duodenal diverticulum (Lemmel's syndrome): a case report.

Lemmel's syndrome is a rare condition characterized by obstructive jaundice due to the periampullary duodenal diverticulum in the absence of choledocholithiasis or tumors. Its infrequent occurrence and non-specific clinical presentation can make it difficult to distinguish from other conditions. We present a case of Lemmel's syndrome in a 63-year-old male who exhibited symptoms of abdominal pain in right hypochondrium, vomiting, and fever.

Capturing Physiological Correlates of Stress-Induced Blood Pressure Elevation Using a Multimodal Wearable Sensing Patch in Patients with a History of Myocardial Infarction.

Persons who have experienced a prior myocardial infarction (MI) are at a greater risk of experiencing a secondary event. External factors, such as stress, can cause transient hypertension, further increasing cardiovascular disease risk. However, challenges to monitoring stress-induced hypertension include obtrusiveness of monitoring devices, unknown validity in high-risk populations, and unsubstantiated sensitivity in stressful environments.

Investigating Ultra-Short-Term Heart Rate Variability as an Indicator of Craving in Recently Treated Patients with Opioid Use Disorder.

Induced craving frequently leads to relapse in patients with a history of opioid use disorder (OUD). Quantifying the physiological manifestations of craving can enable caregivers of patients with OUD to continuously monitor craving and thus help inform treatment plans. Heart rate variability (HRV) is a promising candidate to capture the trends in such manifestations due to the ease of measuring changes in heartbeat intervals using the electrocardiogram.

Lower child opportunity index is associated with increased healthcare utilization following pediatric liver transplantation.

Social determinants of health (SDOH) are known to lead to adverse health outcomes, including high acute care utilization. The mechanisms underlying healthcare disparities among children who have undergone liver transplantation (LT) are poorly understood. To elucidate the relationship between SDOH and healthcare utilization among children (<18 y old at time of LT) who have undergone LT, we performed a retrospective study merging data from the Organ Procurement and Transplantation Network (OPTN) and the Pediatric Hospital Information System (PHIS) database.

A Comparison of Prescribing Guideline-Advocated Treatment for Heart Failure at Discharge from Cardiology and Non-Cardiology Wards.

Background: Adherence to heart failure (HF) management guidelines is important to optimise clinical outcomes but can be variable in practice. This study compared prescribing guideline-advocated pharmacological and non-pharmacological management of HF between patients discharged from cardiology and non-cardiology wards.

Method: A retrospective audit of electronic medical records was undertaken of patients discharged from cardiology (n=100) or non-cardiology wards (n=100) of a tertiary hospital with a primary diagnosis of HF.

Cardiovascular Reactivity to Mental Stress and Adverse Cardiovascular Outcomes in Patients With Coronary Artery Disease.

Background: Acute psychological stress may induce physiological changes predisposing individuals to adverse health outcomes through hemodynamic and vascular effects. We studied the association between the aggregated stress-induced changes in hemodynamic and vascular function tests with adverse cardiovascular outcomes in patients with coronary artery disease, after adjusting for sociodemographic and clinical factors.

Methods And Results: Individuals with stable coronary artery disease from 2 prospective cohort studies were studied.

Updated Geriatrics Competencies for Graduating Medical Students: Training Physicians to Provide Age-Friendly Care.

Purpose: Medical student education in geriatrics is a critical need for every doctor-in-training as the population ages, with fewer than 7,000 geriatricians, and older patients, who now approach 20% of the U.S. population, having unique health care needs.

Work-Related Stress Is Associated With Unfavorable Cardiovascular Health: The Multi-Ethnic Study of Atherosclerosis.

Background: Work-related stress is a psychosocial risk factor linked to a higher risk of cardiovascular disease. However, the association between work-related stress and cardiovascular health (CVH) is not well established. We estimated the association between work-related stress and CVH in a multiethnic sample of adults free of cardiovascular disease at baseline.

A novel GWAS locus influences microvascular response to mental stress and predicts adverse cardiovascular events.

Excessive peripheral microvascular constriction during acute psychological stress reflects similar changes in coronary blood flow and is a predictor of adverse cardiovascular outcomes. Among individuals with coronary artery disease (CAD), we sought to determine if genetic factors contribute to the degree of microvascular constriction during mental stress. A total of 580 stable CAD individuals from two prospective cohort studies underwent mental stress testing.

Biomarkers of atrial fibrillation-related pathways and left atrial structure and function in an overweight and obese population.

Background: Exploring longitudinal associations of blood biomarkers with left atrial (LA) structure and function can enhance our understanding of atrial fibrillation (AF) etiopathogenesis.

Methods: We studied 532 participants of the PREDIMED-Plus trial, a multicenter randomized trial in overweight and obese adults with metabolic syndrome. At baseline, 3 and 5 years after randomization, participants underwent transthoracic echocardiography and provided blood for serum biomarker measurements [propeptide of procollagen type I (PICP), high-sensitivity (hs) troponin T (hsTnT), hs C-reactive protein (hsCRP), 3-nitrotyrosine (3-NT), and N-terminal propeptide of B-type natriuretic peptide (NT-proBNP)].

Flap Fixation in Endoscopic Dacryocystorhinostomy: A Comparative Study.

Background: The usual procedure for nasolacrimal duct obstruction is dacryocystorhinostomy (DCR). Flap-based DCR techniques lead to better surgical outcome provided flaps do not dislocate in the post-operative period.

Objectives: This study was conducted to compare gelfoam with merocel tamponade for fixation of mucosal flaps in endoscopic DCR.

Medical Students as Teachers: A Student-Led Course in Developing Teaching Skills.

Students as Teachers is a 7-month student-led elective that equips first- and second-year medical students with teaching skills. Pre- and post-course surveys measured participants' knowledge and confidence level in the course's learning objectives such as creating lesson plans, engaging learners, and assessing understanding. Eleven students participated in the course and 10 students completed the pre- and post-course surveys.

Standardized reporting of spine and sacroiliac joints in axial spondyloarthritis MRI: from the ESSR-Arthritis Subcommittee.

Objectives: Apply a modified Delphi-based approach and produce a practical, radiology-specific set of definitions for interpretation and standardization of the multiple MRI findings in axial spondyloarthritis (ax-SpA), specifically to aid the general radiologist with a musculoskeletal interest, working with gold standard basic MRI protocols.

Materials And Methods: We report the results of a modified Delphi-based consensus of 35 experts from 13 countries in the Arthritis Subcommittee of the European Society of Musculoskeletal Radiology (ESSR). Seventeen definitions were created (i.

Screening and early treatment for osteoporosis: Who are we missing under age 65?

For women under age 65, varying recommendations and the need to apply clinical risk calculators can lead to underscreening for osteoporosis. The resulting undertreatment may lead to a risk of osteoporotic fractures with significant morbidity and impact on functional status. Factors that must be considered when deciding to screen a woman under age 65 include a history of fragility fractures, race, family history, body mass index, smoking, high alcohol use, and secondary causes of osteoporosis.

Long-Term Analysis of NRG Oncology RTOG 0415: A Randomized Phase III Noninferiority Study Comparing Two Fractionation Schedules in Patients With Low-Risk Prostate Cancer.

JCO NRG Oncology RTOG 0415 is a randomized phase III noninferiority (NI) clinical trial comparing conventional fractionation (73.8 Gy in 41 fractions) radiotherapy (C-RT) with hypofractionation (H-RT; 70 Gy in 28) in patients with low-risk prostate cancer. The study included 1,092 protocol-eligible patients initially reported in 2016 with a median follow-up of 5.

Pick-up and assembling of chemically sensitive van der Waals heterostructures using dry cryogenic exfoliation.

Assembling atomic layers of van der Waals materials (vdW) combines the physics of two materials, offering opportunities for novel functional devices. Realization of this has been possible because of advancements in nanofabrication processes which often involve chemical processing of the materials under study; this can be detrimental to device performance. To address this issue, we have developed a modified micro-manipulator setup for cryogenic exfoliation, pick up, and transfer of vdW materials to assemble heterostructures.