The association of state policies and opioid analgesic amount dispensed from retail pharmacies.

Importance: States have implemented multiple policies likely to influence opioid prescribing; few national general population studies examine those policies' effects on per-capita opioid morphine milligram equivalents (MME) dispensed.

Objective: To examine state policies' effects on opioids per-capita MMEs dispensed at retail pharmacies.

Design: A longitudinal study of associations between MME per capita and implementation of policy interventions at different times across states.

Clonal Hematopoiesis in Women With Breast Cancer.

Purpose: Clonal hematopoiesis (CH) has been associated with a variety of adverse outcomes, most notably hematologic malignancy and ischemic cardiovascular disease. A series of recent studies also suggest that CH may play a role in the outcomes of patients with solid tumors, including breast cancer. Here, we review the clinical and biological data that underlie potential connections between CH, inflammation, and breast cancer, with a focus on the prevalence and impact of clonal hematopoiesis of indeterminate potential in patients with breast cancer.

The nuclear localization signal of CPSF6 governs post-nuclear import steps of HIV-1 infection.

The early stages of HIV-1 infection include the trafficking of the viral core into the nucleus of infected cells. However, much remains to be understood about how HIV-1 accomplishes nuclear import and the consequences of the import pathways utilized on nuclear events. The host factor cleavage and polyadenylation specificity factor 6 (CPSF6) assists HIV-1 nuclear localization and post-entry integration targeting.

Motion-Compensated Multishot Pancreatic Diffusion-Weighted Imaging With Deep Learning-Based Denoising.

Objectives: Pancreatic diffusion-weighted imaging (DWI) has numerous clinical applications, but conventional single-shot methods suffer from off resonance-induced artifacts like distortion and blurring while cardiovascular motion-induced phase inconsistency leads to quantitative errors and signal loss, limiting its utility. Multishot DWI (msDWI) offers reduced image distortion and blurring relative to single-shot methods but increases sensitivity to motion artifacts. Motion-compensated diffusion-encoding gradients (MCGs) reduce motion artifacts and could improve motion robustness of msDWI but come with the cost of extended echo time, further reducing signal.

Affective, Behavioral, and Cognitive Symptoms Associated With Focal Impaired Awareness (Complex Partial) Seizures: Evaluation and Treatment.

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.

Spontaneous oxycodone withdrawal disrupts sleep, diurnal, and electrophysiological dynamics in rats.

Opioid dependence is defined by an aversive withdrawal syndrome upon drug cessation that can motivate continued drug-taking, development of opioid use disorder, and precipitate relapse. An understudied but common opioid withdrawal symptom is disrupted sleep, reported as both insomnia and daytime sleepiness. Despite the prevalence and severity of sleep disturbances during opioid withdrawal, there is a gap in our understanding of their interactions.

H-Dots: Renal Clearable Zwitterionic Nanocarriers for Disease Diagnosis and Therapy.

Nanocarriers have shown significant promise in the diagnosis and treatment of various diseases, utilizing a wide range of biocompatible materials such as metals, inorganic substances, and organic components. Despite diverse design strategies, key physicochemical properties, including hydrodynamic diameter, shape, surface charge, and hydrophilicity/lipophilicity, are crucial for optimizing biodistribution, pharmacokinetics, and therapeutic efficacy. However, these properties are often influenced by drug payload, presenting an ongoing challenge in developing versatile platform technologies for theranostics.

Assessing the impact of messages about reduced nicotine cigar products among people who use little cigar and cigarillo: Insights from a discrete choice experiment.

Introduction: The U.S. Food and Drug Administration's (FDA) pursuit of a low nicotine standard for cigarettes raises concerns that a focus on cigarettes may encourage people to use other combusted tobacco products, undermining the policy's effectiveness.

Identifying Risk Factors of Children Who Suffered Physical Abuse: A Systematic Review.

Background: Approximately 25% of children in the United States experience child abuse or neglect, 18% of whom are physically abused. Physicians are often in a position to differentiate accidental trauma from physical child abuse. Therefore, the aim of this study was to review recent literature for risk factors associated with physical child abuse.

Thought-Feeling Accuracy in Person Perception and Metaperception: An Integrative Perspective.

People often want to know what their interaction partners are thinking. How accurate are they, what information do they use, what predicts how accurate they will be, and does accuracy matter? We organize our review of thought-feeling accuracy, defined as the accuracy of individuals' judgments about the content of another person's thoughts and feelings in live interaction, around these questions. At the same time, we argue that often people are especially interested in what others are thinking about them, such that research on the accuracy of individuals' metaperceptions regarding others' views of them is highly relevant to understanding thought-feeling accuracy more broadly construed.

Ribosomal s6 kinase (RSK) is a mediator of aquaporin-2 S256 phosphorylation and membrane accumulation after EGFR inhibition with erlotinib.

Vasopressin (VP) activates protein kinase A (PKA), resulting in phosphorylation events and membrane accumulation of aquaporin-2 (AQP2). Epidermal growth factor receptor (EGFR) inhibition with erlotinib also induces AQP2 membrane trafficking with a phosphorylation pattern similar to VP, but without increasing PKA activity. Here, we identify the ribosomal s6 kinase (RSK) as a major mediator phosphorylating AQP2 in this novel, erlotinib-induced pathway.

Comparing demographic/clinical characteristics, health care resource utilization, and costs among patients with type 2 diabetes and established atherosclerotic cardiovascular disease with and without the use of cardioprotective medications.

Background: Type 2 diabetes (T2D) causes increased health care resource utilization (HCRU) and costs in the United States. People with T2D are more likely to have atherosclerotic cardiovascular disease (ASCVD), which is associated with significant morbidity and mortality. Medical associations recommend cardioprotective antidiabetic medications, including sodium-glucose cotransporter-2 inhibitors (SGLT2is) and glucagon-like peptide 1 receptor agonists (GLP-1 RAs), to reduce the risk of cardiovascular events in patients with T2D with established, or a high risk of, ASCVD, but not all eligible patients receive these medications.

Effectiveness of behavioural and psychological interventions for managing obesity in children and adolescents: A systematic review and meta-analysis framed using minimal important difference estimates based on GRADE guidance to inform a clinical practice guideline.

Objective: Conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) of behavioural and psychological interventions for managing paediatric obesity.

Methods: Eligible studies, published between 1985 and 2022, included 0 to 18 year olds with outcomes reported ≥3 months post-baseline, including patient-reported outcome measures (PROMs), cardiometabolic and anthropometric outcomes, and adverse events (AEs). We pooled data using a random effects model and assessed certainty of evidence (CoE) related to minimally important difference estimates for outcomes using GRADE.

Exploring the link between inflammation and brain function after metabolic-bariatric surgery: A year-long fMRI study.

Background: Metabolic-bariatric surgery (MBS) transcends weight loss and offers wide-ranging health benefits, including positive effects on brain function. However, the mechanisms behind these effects remain unclear, particularly in the context of significant postoperative changes in the inflammatory profile characteristic of MBS. Understanding how inflammation influences postoperative brain function can enhance our decision-making on patient eligibility for MBS and create new opportunities to improve the outcomes of this popular treatment.

Effects of HMG CoA reductase (HMGCR) deficiency on skeletal muscle development.

Pathogenic variants in HMGCR were recently linked to a limb-girdle muscular dystrophy (LGMD) phenotype. The protein product HMG CoA reductase (HMGCR) catalyzes a key component of the cholesterol synthesis pathway. The two other muscle diseases associated with HMGCR, statin-associated myopathy (SAM) and autoimmune anti-HMGCR myopathy, are not inherited in a Mendelian pattern.

Pain management after pediatric minimally invasive repair of pectus excavatum: a narrative review.

Background And Objective: Pectus excavatum is a common congenital chest wall abnormality characterized by a concave appearance of the chest, and minimally invasive repair of pectus excavatum (MIRPE) is the surgical treatment of choice. A rapidly growing field of research is pain management in children undergoing MIRPE, with many shifts in practice occurring over the last decade. The primary objectives of this narrative review are to describe current methods of perioperative pain management and the development of enhanced recovery after surgery (ERAS) to improve the experience of patients undergoing MIRPE.

The power of personas: Exploring an innovative model for understanding stakeholder perspectives in an oncology learning health network.

Introduction: Learning health networks (LHNs) improve clinical outcomes by applying core tenets of continuous quality improvements (QI) to reach community-defined outcomes, data-sharing, and empowered interdisciplinary teams including patients and caregivers. LHNs provide an ideal environment for the rapid adoption of evidence-based guidelines and translation of research and best practices at scale. When an LHN is established, it is critical to understand the needs of all stakeholders.

Perceptions of Palliative Care Among Patients With Kidney Allograft Dysfunction: A Qualitative Study.

Rationale & Objective: Nearly half of kidney transplant recipients develop allograft failure within 10 years of transplantation and experience high mortality, significant symptom burden, and complex communication challenges. These patients may benefit from palliative care, but palliative care is infrequently provided in this population. This study explores palliative care perceptions and needs among patients with poorly functioning and declining kidney allografts.

Treatment of rheumatoid arthritis-associated interstitial lung disease: An appraisal of the 2023 ACR/CHEST guideline.

Purpose Of Review: To summarize the current treatment landscape of rheumatoid arthritis-associated interstitial lung disease (RA-ILD) in the context of the recent 2023 American College of Rheumatology/American College of Chest Physicians guideline for ILD treatment in systemic autoimmune rheumatic diseases.

Recent Findings: The guideline conditionally recommends mycophenolate, azathioprine, and rituximab for first-line RA-ILD therapy, with cyclophosphamide and short-term glucocorticoids as additional options. For RA-ILD progression after first line, mycophenolate, rituximab, nintedanib, tocilizumab, cyclophosphamide, and pirfenidone are conditionally recommended, while long-term glucocorticoids are conditionally recommended against.

Improved patient reported outcomes with knotless double-row rotator cuff repair with and without lateral row biceps tenodesis at 2- and 5-years.

Background: The purpose of this study is to report outcomes of an arthroscopic knotless double-row (DR) rotator cuff repair (RCR) technique at 2- and 5- years postoperatively, and to compare clinical outcomes in patients undergoing knotless DR RCR with incorporated lateral row biceps tenodesis (LRT) vs. those without LRT.

Methods: All primary RCR surgeries were performed by a single surgeon at a single institution using a knotless transosseous equivalent (TOE) technique.

Intracardiac Teratoma in a Patient With Nonseminomatous Germ Cell Tumor.

This case report describes the management of a 30-year-old male patient with a history of an advanced nonseminomatous germ cell tumor, hip fracture complicated by extensive deep vein thrombosis and pulmonary embolism, and on apixaban presenting with asymptomatic intracardiac teratoma and abdominopelvic metastases. Multidisciplinary intervention, including successful surgical excision of the intracardiac mass, highlights the importance of coordinated care and vigilant follow-up in optimizing patient outcomes and preventing life-threatening complications.