Hypercontractile Esophagus Causing Midesophageal Diverticulum.

Esophageal diverticulum (ED) is a rare condition with a clinical presentation that can be variable. Esophageal diverticulum has been associated with motility disorders; however, the association with mid-ED is less clear. Hypercontractile esophagus, also known as jackhammer esophagus, is a rare motility disorder of peristalsis diagnosed by esophageal high-resolution manometry after exclusion of mechanical obstruction.

The Art of Clinical Negotiation.

The art of clinical negotiation is an important, yet underappreciated aspect of medicine. Key components of negotiation include the need to consider principles over personalities, to explore all options before deciding on the best course, to realize if consensus cannot be achieved then compromise may still be possible, to work from evidence to incorporate contextual factors, and to stay evidence based. These principles can be helpful in many settings, including contract negotiation, drug pricing, and research.

Lung-kidney axis in cystic fibrosis: Early urinary markers of kidney injury correlate with neutrophil activation and worse lung function.

Background: Adult people with cystic fibrosis (PwCF) have a higher risk of end-stage kidney disease than the general population. The nature and mechanism of kidney disease in CF are unknown. This study quantifies urinary kidney injury markers and examines the hypothesis that neutrophil activation and lung infection are associated with early kidney injury in CF.

Trends in Screening for Social Risk in US Physician Practices.

Importance: A wealth of research on screening for social risks in health care has emerged, but evidence is lacking on how social risk screening among physician practices has changed over time.

Objectives: To evaluate trends in screening for social risks among US physician practices and examine practice characteristics associated with adoption of social risk screening.

Design, Setting, And Participants: The main analysis used a repeated cross-sectional design to analyze results from US physician practices that completed the National Survey of Healthcare Organizations and Systems, a nationally representative survey of physician practices, in 2017 and 2022.

Therapeutic potential of mesenchymal stem cells on cholesterol homeostasis-associated genes in AD-like rats.

Cholesterol is vital for nerve processes. Changes in cholesterol homeostasis lead to neurodegeneration and Alzheimer's disease (AD). In recent years, extensive research has confirmed the influential role of adipose tissue mesenchymal stem cells (MSCs) in managing AD.

Surface remodeling and inversion of cell-matrix interactions underlie community recognition and dispersal in Vibrio cholerae biofilms.

Biofilms are ubiquitous surface-associated bacterial communities embedded in an extracellular matrix. It is commonly assumed that biofilm cells are glued together by the matrix; however, how the specific biochemistry of matrix components affects the cell-matrix interactions and how these interactions vary during biofilm growth remain unclear. Here, we investigate cell-matrix interactions in Vibrio cholerae, the causative agent of cholera.

Perspectives of Older Patients on Speaking With an Anesthesia Provider Before the Day of Surgery: A Cross-Sectional Study.

Background: Evaluations performed before the day of surgery at perioperative clinics have been shown to reduce patient mortality and hospital lengths of stay. These clinics are becoming increasingly adopted worldwide. As the number of older patients undergoing surgery continues to increase, understanding the perspectives of this patient population regarding the preoperative evaluation process is essential to tailor care to their needs and preferences.

Belzutifan as the Primary Treatment of Bilateral Juxtapapillary Retinal Hemangioblastoma in a Patient With Von Hippel-Lindau Disease.

To describe the efficacy of belzutifan as a treatment for juxtapapillary retinal hemangioblastomas in patients with von Hippel-Lindau disease. A case and its findings were analyzed, and a systematic literature review was conducted using PubMed and Ovid MEDLINE. At a routine follow-up, a 63-year-old woman with a history of von Hippel-Lindau disease and slowly progressive bilateral juxtapapillary retinal hemangioblastomas presented with decreased visual acuity (VA) in the right eye resulting from significant lesion growth and an increase in central macular edema and exudate.

Developing and Comparing Four Families of Bayesian Network Autocorrelation Models for Binary Outcomes: Estimating Peer Effects Involving Adoption of Medical Technologies.

Despite the extensive use of network autocorrelation models in social network analysis, network autocorrelation models for binary dependent variables have received surprisingly scant attention. In this paper, we develop four network autocorrelation models for a binary random variable defined by whether the peer effect (also termed social influence or contagion) acts on latent continuous outcomes leading to an indirect effect under a normal or a logistic distribution or on the probability of the observed outcome itself under a probit or a logit link function defining a direct effect to account for interdependence between outcomes. For all models, we use a Bayesian approach for model estimation under a uniform prior on a transformed peer effect parameter ( ) designed to enhance model computation and compare results to those under the uniform prior for .

Phage-Encoded Virulence Factor, Gp05, Alters Membrane Phospholipids and Reduces Antimicrobial Susceptibility in Methicillin-Resistant Staphylococcus aureus.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a leading pathogen causing severe endovascular infections. The prophage-encoded protein Gp05 has been identified as a critical virulence factor that contributes to MRSA persistence during vancomycin (VAN) treatment in an experimental endocarditis model. However, the underlining mechanisms driving this persistence phenotype remain poorly understood.

A descriptive examination of rurality in the Environmental influences on Child Health Outcomes Cohort: Implications, illustrations, and future directions.

Purpose: The Environmental influences on Child Health Outcomes (ECHO) Cohort has enrolled over 60,000 children to examine how early environmental factors (broadly defined) are associated with key child health outcomes. The ECHO Cohort may be well-positioned to contribute to our understanding of rural environments and contexts, which has implications for rural health disparities research. The present study examined the outcome of child obesity to not only illustrate the suitability of ECHO Cohort data for these purposes but also determine how various definitions of rural and urban populations impact the presentation of findings and their interpretation.

Shared Decision-Making in Total Hip and Knee Arthroplasty: Understanding Surgeon and Patient Perspectives Regarding When It Is Time for Surgery.

Background: Although total hip and total knee arthroplasty are highly successful operations, the decision of whether and when to undergo surgery is highly subjective and discretionary, and specific guidelines regarding readiness for surgery remain elusive. The nature of these decisions underscores the importance of shared decision-making, which is founded on the concept that patients substantially contribute to determining their own readiness for surgery. The OPTION survey was developed as a conversation aid to facilitate shared decision-making in the context of total joint arthroplasty.

Keeping up with Recent Developments in Immunodeficiency.

Inborn Errors of Immunity are a rapidly expanding group of monogenetic disorders affecting the immune system. Advancements in genetic testing and functional validation studies have accelerated the pace of IEI gene discovery and mechanism of disease, particularly in the past five years. To keep up with this rapid expansion, the International Union of Immunological Societies (IUIS) Expert Committee has periodically, since 1999, released updated IEI classifications with corresponding genotypic and phenotypic catalogues with its most recent update in 2022.

Humoral correlate of vaccine-mediated protection from tuberculosis identified in humans and non-human primates.

Development of an effective tuberculosis (TB) vaccine has been challenged by incomplete understanding of specific factors that provide protection against (Mtb) and the lack of a known correlate of protection (CoP). Using a combination of samples from a vaccine showing efficacy (DarDar [NCT00052195]) and Bacille Calmette-Guerin (BCG)-immunized humans and nonhuman primates (NHP), we identify a humoral CoP that translates across species and vaccine regimens. Antibodies specific to the DarDar vaccine strain () sonicate (MOS) correlate with protection from the efficacy endpoint of definite TB.

Factors associated with care-resistant behavior in the National Alzheimer's Coordinating Center's Uniform Data Set.

Introduction: Little is known about the factors associated with care-resistant behavior in community-dwelling persons living with dementia.

Methods: Regression modeling was performed on 41,143 responses to a standardized questionnaire from the National Alzheimer's Coordinating Center's Uniform Data Set.

Results: In the fully adjusted mixed-effects regression model, collinearity was low, with no variance inflation factor above 1.

Just the Tip of the Iceberg: a Brief Report of the Tip-of-the-Tongue Score as an Embedded Validity Indicator for the Children's Auditory and Visual Naming Tests.

Objective: Explore the tip-of-the-tongue (TOT) scores from the Children's Auditory and Visual Naming Tests (cANT, cVNT) as embedded validity indicators (EVIs).

Method: A retrospective design of 98 consecutively referred youth aged 6-15 years (M = 11.28, SD = 2.

Synergic Integration of the miRNome, Machine Learning and Bioinformatics for the Identification of Potential Disease-Modifying Agents in Obstructive Sleep Apnea.

Introduction: Understanding the diverse pathogenetic pathways in obstructive sleep apnea (OSA) is crucial for improving outcomes. microRNA (miRNA) profiling is a promising strategy for elucidating these mechanisms.

Objective: To characterize the pathogenetic pathways linked to OSA through the integration of miRNA profiles, machine learning (ML) and bioinformatics.

Evolving Food Allergy Clinical Trials to Become More Patient-Centered.

The current FDA paradigm may not fully capture important patient-centered outcomes or measure a primary outcome that is truly meaningful to patients. Patient reported outcome measures (PROMs) are standardized tools measuring the patient's experience in food allergy clinical trials, which can help support shared decision-making (SDM) and further our understanding of treatment impact. Food allergy PROMs include quality of life (QoL), health state utility (HSU), severity, and self-efficacy measures.

Frailty as an independent risk factor for prolonged postoperative length of stay: A retrospective analysis of 2015-2019 ACS NSQIP data.

Background: Frailty, a syndrome of decreased resilience to physiologic stress, has been associated with increased postoperative length of stay (LOS) for specific procedures. Yet, the literature lacks large-scale analyses examining the relationship between frailty and LOS across surgical procedure.

Study Design: We conducted a retrospective cohort study of patients aged 65+ undergoing inpatient surgery including emergency procedures between 2015 and 2019 using American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) data.

High-Risk Opioid Prescribing and Nurse Practitioner Independence.

Importance: Concerns around excessive opioid prescribing have been used to argue against the expansion of the scope of practice of nurse practitioners (NPs), but the association of NP practice independence with high-risk opioid prescribing is not well understood.

Objective: To assess whether the rates of high-risk opioid prescribing changed in association with NP independence legislation.

Design, Setting, And Participants: This difference-in-differences analysis compared rates of high-risk opioid prescribing in 6 states over 2 years following the adoption of NP independence compared with 10 neighboring nonadopting states from January 2012 to December 2021.

Transsynaptic labeling and transcriptional control of zebrafish neural circuits.

Deciphering the connectome, the ensemble of synaptic connections that underlie brain function, is a central goal of neuroscience research. Here we report the in vivo mapping of connections between presynaptic and postsynaptic partners in zebrafish, by adapting the trans-Tango genetic approach that was first developed for anterograde transsynaptic tracing in Drosophila. Neural connections were visualized between synaptic partners in larval retina, brain and spinal cord and followed over development.

Social participation in health - case studies from primary health care in Kosovo.

Background: Participation and inclusion of service users in health governance impact the quality of care and citizen well-being. In developing countries, such as Kosovo, disadvantaged groups are particularly important due to deep exclusionary structures and multiple systemic barriers to participation and care provision.

Purpose: To investigate the effects of three interventions on social participation in decision-making in several primary healthcare sites among the population and particularly vulnerable groups, i.

A Compensated Clock: Temperature and Nutritional Compensation Mechanisms Across Circadian Systems.

Circadian rhythms are ∼24-h biological oscillations that enable organisms to anticipate daily environmental cycles, so that they may designate appropriate day/night functions that align with these changes. The molecular clock in animals and fungi consists of a transcription-translation feedback loop, the plant clock is comprised of multiple interlocking feedback-loops, and the cyanobacterial clock is driven by a phosphorylation cycle involving three main proteins. Despite the divergent core clock mechanisms across these systems, all circadian clocks are able to buffer period length against changes in the ambient growth environment, such as temperature and nutrients.