Clinical Problem Solving: Two Patients With Gait Instability and Difficulty With Hand Coordination.

Subacute-to-chronic gait instability has a broad differential diagnosis. The neurological exam can help elucidate the localization and suggest an underlying etiology of the symptomatology, which can lead to a more focused diagnostic approach. Two patients are described - 1 with a month of worsening difficulty with ambulation that evolved to bilateral hand discoordination and another with 18 months of progressive difficulty with ambulation that also then progressed to involve her bilateral hands.

Cryopreservation Method for Preventing Freeze-Fracture of Small Muscle Samples.

Histological techniques to study muscle are crucial for assessing skeletal muscle health. To preserve tissue morphology, samples are usually fixed in formaldehyde or cryopreserved immediately after excision from the body. Freezing samples in liquid nitrogen, using isopentane as a mediator for efficient cooling, preserves the tissue in its natural state.

Regional-specific trends of PM and O temperature sensitivity in the United States.

Climate change poses direct and indirect threats to public health, including exacerbating air pollution. However, the influence of rising temperature on air quality remains highly uncertain in the United States, particularly under rapid reduction in anthropogenic emissions. Here, we examined the sensitivity of surface-level fine particulate matter (PM) and ozone (O) to summer temperature anomalies in the contiguous US as well as their decadal changes using high-resolution datasets generated by machine learning.

Asian Pacific Society of Cardiology Position Statement on the Use of Transcatheter Aortic Valve Implantation in the Management of Aortic Stenosis.

Transcatheter aortic valve implantation (TAVI) has been established as an effective treatment modality in patients with severe aortic stenosis (AS) and the uptake of TAVI is rapidly growing in the Asia-Pacific region. However, there exist a heterogeneity in the management of aortic stenosis and the use of TAVI among countries in the region. Reasons for these differences include anatomic variations, disparity in healthcare resources and infrastructure, and the lack of consensus on the optimal management of AS in the Asia-Pacific region.

Brief Report: Clinical Characteristics and Outcomes of Patients With Thoracic SMARCA4-Deficient Undifferentiated Tumors.

Introduction: Thoracic SMARCA4-deficient undifferentiated tumors (SMARCA4-UTs) are a recently defined group of aggressive cancers in which the effectiveness of standard treatments for lung cancer is unknown.

Methods: We collected clinical, pathologic, and demographic variables from five institutions for patients whose tumors met criteria for SMARCA4-UTs (undifferentiated phenotype and loss of SMARCA4 (BRG1) by immunohistochemistry).

Results: We identified 92 patients with SMARCA4-UTs; 58 (63%) had stage IV disease at diagnosis and 16 (17%) developed recurrent or metastatic disease after initial diagnosis.

Academic Pursuits in Teleradiology: At the Crossroads of Technology, Radiology, and Implementation.

Teleradiology is an essential part of modern radiology practice. It enhances efficiencies in image interpretation by improving availability and accessibility of radiologists. Being at the crossroads of technology, diagnostic radiology, and complex workflows, teleradiology provides abundant opportunities for academic engagement and innovative workflows, and allows for research and publication encompassing these multiple facets.

Infant action understanding: the roles of active training and motor development.

Introduction: This study examined the potential interplay between motor development and intervention in support of action understanding.

Methods: Eighty nine-month-old infants completed a tool-use training session and goal imitation paradigm that assessed action understanding in counterbalanced order. A metric of motor development was obtained using the Early Motor Questionnaire.

Uncertainty estimation in diagnosis generation from large language models: next-word probability is not pre-test probability.

Objective: To evaluate large language models (LLMs) for pre-test diagnostic probability estimation and compare their uncertainty estimation performance with a traditional machine learning classifier.

Materials And Methods: We assessed 2 instruction-tuned LLMs, Mistral-7B-Instruct and Llama3-70B-chat-hf, on predicting binary outcomes for Sepsis, Arrhythmia, and Congestive Heart Failure (CHF) using electronic health record (EHR) data from 660 patients. Three uncertainty estimation methods-Verbalized Confidence, Token Logits, and LLM Embedding+XGB-were compared against an eXtreme Gradient Boosting (XGB) classifier trained on raw EHR data.

Impact of NAFLD-related SNPs on the carotid atherosclerosis development; a five-year prospective observational study.

Background And Aims: The prevalence of metabolic dysfunction associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease (NAFLD), has become a significant public health concern with an increased atherosclerotic cardiovascular disease risk. This study investigates the impact of NAFLD-related single nucleotide polymorphisms (SNPs) on carotid atherosclerosis development in a Japanese population without diabetes, dyslipidemia, and hypertension.

Methods: The prospective observational study, part of the Kyushu and Okinawa Population Study (KOPS), included 945 participants (median age 55 [47, 63]) without carotid atherosclerosis, increased alcohol intake, diabetes, dyslipidemia, hypertension, or chronic hepatitis at baseline.

Diversity, Equity, and Inclusion in Multiple Myeloma: A Call to Action.

Background: Although advancements in multiple myeloma therapy have rapidly evolved, pervasive racial and social inequities prevent uniform benefit across diverse patient populations. This affects access to US Food and Drug Administration-approved treatments and to clinical studies. The impact of health-care inequities is not well understood and thus, the development of effective strategies is inadequate.

How Can Oncology Nurses and Advanced Practice Providers Reduce the Burden of Chemotherapy-Induced Febrile Neutropenia in the US?

Background: Neutropenia and febrile neutropenia (FN) are serious complications of myelosuppressive chemotherapy and present a considerable burden to patients with cancer. Febrile neutropenia is associated with increased risks of infection and hospitalization, a particular concern during the coronavirus disease 2019 (COVID-19) pandemic. Oncology nurses and advanced practice providers (APPs; including nurse practitioners, physician assistants, advanced practice nurses, and pharmacists) play a vital role in the management of patients with cancer and the prevention of infections.

Impact of an Oncology Clinical Pharmacist Intervention on Clinical Trial Enrollment in The US Oncology Network's MYLUNG Consortium.

Introduction: The Molecularly Informed Lung Cancer Treatment in a Community Cancer Network: A Pragmatic Consortium™ (MYLUNG) clinical trial platform aims to advance the use of precision medicine in patients with non-small cell lung cancer through a series of prospective and iterative clinical trials. Timely patient accrual onto oncology clinical trials is a known practice challenge and impaired accrual rates can lead to premature trial closure or properly powered trial outcomes. The US Oncology Network recently implemented a clinical pharmacist (ClinReview) initiative to provide remote clinical services to screen patients for enrollment onto MYLUNG Protocol 2.

Optimizing Treatment of V600E-Mutant Metastatic NSCLC With Encorafenib and Binimetinib: A Practical Resource for Advanced Practice Providers.

The V600E mutation aberrantly activates the mitogen-activated protein kinase (MAPK) pathway, subsequently resulting in uncontrolled cellular proliferation, survival, and dedifferentiation. Approximately 2% of patients with non-small cell lung cancer (NSCLC) have a V600E mutation. BRAF and MEK inhibitor combination therapy targets two kinases within the MAPK pathway.

A standards-based application for improving platelet transfusion workflow.

Objective: Thrombocytopenia is a common complication of hematopoietic stem-cell transplantation (HSCT), though many patients will become immune refractory to platelet transfusions over time. We built and evaluated an electronic health record (EHR)-integrated, standards-based application that enables blood-bank clinicians to match platelet inventory with patients using data previously not available at the point-of-care, like human leukocyte antigen (HLA) data for donors and recipients.

Materials And Methods: The web-based application launches as an EHR-embedded application or as a standalone application.

Effect of information awareness on attitudes toward human papillomavirus vaccination intentions in Japan.

Background: The Human Papillomavirus (HPV) vaccination rate among Japanese high school girls remains critically low, reflecting ongoing public apprehension and misinformation. This study explores the relationship between information presentation and attitudes toward HPV vaccination in Japan.

Methods: We conducted a web-based survey of female high school students aged 15 to 16 and mothers of daughters of similar age across Japan.

Global, regional, and national trends in drug use disorder mortality rates across 73 countries from 1990 to 2021, with projections up to 2040: a global time-series analysis and modelling study.

Background: Drug use disorder (DUD) poses a major public health crisis globally, necessitating immediate attention to global trends and future projections to develop effective health policies and interventions. Thus, we aimed to estimate the global trends in DUD mortality rates from 1990 to 2021 and future projections of DUD deaths until 2040 across 73 countries.

Methods: In this time-series analysis and modelling study, we investigated the global trends in DUD mortality rates from 1990 to 2021 using the WHO Mortality Database and forecasted future trends through 2040.

Gastrointestinal cancer incidence after lung transplantation in sarcoidosis patients.

Background: The risk of gastrointestinal (GI) cancer after lung transplantation (LTx) in sarcoidosis patients is not well defined. Given the cancer risks linked to sarcoidosis and organ transplantation, this study investigated the incidence of GI malignancies (DNM), comparing LTx recipients with sarcoidosis or idiopathic pulmonary fibrosis (IPF).

Methods: We analyzed data from the United Network for Organ Sharing registry, including adults with sarcoidosis or IPF who underwent LTx between May 2005 and December 2018.

Peroral endoscopic myotomy (Z-POEM) versus flexible endoscopic septotomy (FES) for treatment of Zenker's diverticulum: does either make the cut? A systematic review and meta-analysis of outcomes.

Background: Endoscopic treatments of symptomatic Zenker's diverticulum (ZD) include flexible endoscopic septotomy (FES) and, more recently, peroral endoscopic myotomy (Z-POEM). Data comparing these techniques are limited. We conducted a meta-analysis evaluating FES vs.

Reshaping Our Understanding of Sensation and Pain Following Breast Reduction Surgery.

Background: This study evaluated the sensory and breast pain outcomes in inferior versus superomedial pedicle breast reduction.

Methods: Twenty patients undergoing the inferior pedicle technique were matched to 20 patients undergoing the superomedial pedicle technique based on age, BMI, and resection weight. Patients were evaluated preoperatively and postoperatively at 1, 3, 6, and 12 months.

Reimagining community engagement in TB elimination: a perspective from the field.

The role of community engagement (CE) in TB policy, care provision and research has been recognized as important, but most models of CE put communities at the periphery of these activities. In this Editorial, written by TB-impacted community members and care providers, we explore the meaning of CE and current barriers to its implementation. We present a model of CE that places community members at the center of TB policy, care provision and research.

Informational rescaling of PCA maps with application to genetic distance.

Principal Component Analysis (PCA) is a powerful multivariate tool allowing the projection of data in low-dimensional representations. Nevertheless, datapoint distances on these low-dimensional projections are challenging to interpret. Here, we propose a computationally simple heuristic to transform a map based on standard PCA (when the variables are asymptotically Gaussian) into an entropy-based map where distances are based on mutual information (MI).

The unseen animal behind medicine: exploring considerations of animal-derived medications and anaesthetics in today's landscape.

Requests for medical and anaesthetic care that is 'vegan' or free of animal-derived components are becoming increasingly common in the cultural landscape. Such requests are often rooted in religious beliefs and practices. There are currently no requirements for the disclosure of animal-derived components in medical items.