Epistaxis Versus Nonepistaxis Bleeding in Anticoagulated Patients With Atrial Fibrillation: Results From the ENGAGE AF-TIMI 48 Trial.

Background: Epistaxis is common with antithrombotic therapy and is often troublesome to patients, yet its frequency, severity, and outcomes are poorly characterized.

Methods And Results: Effective Anticoagulation with Factor Xa Next Generation in Atrial Fibrillation-Thrombolysis in Myocardial Infarction 48 (ENGAGE AF-TIMI 48) randomized 21 105 patients with atrial fibrillation and CHADS2 risk score ≥2 to higher-dose edoxaban regimen (60 mg daily, dose-reduced to 30 mg), lower-dose edoxaban regimen (30 mg, dose reduced to 15 mg, daily), or warfarin. Bleeds were adjudicated using International Society on Thrombosis and Haemostasis criteria.

The Association of TSLP and IL-4 with Patient-Reported Outcome Measures in Chronic Rhinosinusitis with Nasal Polyps.

Background: Thymic stromal lymphopoietin (TSLP) plays an important role in mediating the type-2-inflammatory response. This study examined how TSLP and interleukin (IL)-4 levels in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) correlated with clinical and postoperative outcomes.

Methods: Solid-phase sandwich ELISA was used to analyze TSLP and IL-4 levels in mucus (n = 47), plasma (n = 17), polyp (n = 30), inferior (n = 25), and middle (n = 26) turbinate tissue collected during functional endoscopic sinus surgery (FESS) in CRSwNP patients (n = 76) and controls (n = 11).

Esophageal Carcinoma Cuniculatum.

Esophageal carcinoma cuniculatum is a rare histology and can be difficult to diagnose prior to resection. To date, there have been 28 cases of resected esophageal carcinoma cuniculatum reported. Herein we describe a case found in the stomach of a patient who previously underwent a Roux-en-Y gastric bypass surgery.

Secondary Esophageal Cancer After Hematopoietic Stem Cell Transplant: An Institutional Case Series.

Background: Development of secondary esophageal cancer after hematopoietic stem cell transplantation has been described; however, there is little consensus on treatment and surveillance for these patients. The objective of this study was to describe our experience treating patients with secondary esophageal cancer.

Methods: A retrospective chart review of prospectively collected data was performed to identify patients who underwent hematopoietic stem cell transplantation from 1997 to 2012 and in whom esophageal cancer developed later.

Concomitant Tricuspid Valve Surgery With Mitral Valve Surgery for Moderate Tricuspid Regurgitation.

Background: Tricuspid valve surgical procedures (TVS) concomitant with mitral valve (MV) surgical procedures for less than severe tricuspid regurgitation (TR) remains controversial. This study examined the long-term outcomes of patients with moderate or mild to moderate TR undergoing MV surgical procedures with or without TVS.

Methods: Patients with moderate or mild to moderate TR undergoing MV replacement or repair between January 2002 and June 2021 were included.

HIV and CKD in the Tenofovir Era: A Prospective Parallel-Group Cohort Study From Tanzania.

Rationale & Objective: Longitudinal research on chronic kidney disease (CKD) in sub-Saharan Africa is sparse, especially among people living with HIV (PLWH). We evaluated the incidence of CKD among PLWH compared with HIV-uninfected controls in Tanzania.

Study Design: Prospective cohort study.

Risk of Incident Cancer in Veterans with Diabetes Who Use Metformin Versus Sulfonylureas.

Prior research suggests metformin has anti-cancer effects, yet data are limited. We examined the association between diabetes treatment (metformin versus sulfonylurea) and risk of incident diabetes-related and non- diabetes-related cancers in US veterans. This retrospective cohort study included US veterans, without cancer, aged ≥ 55 years, who were new users of metformin or sulfonylureas for diabetes between 2001 to 2012.

Estimating the Early Transmission Inhibition of new treatment regimens for drug-resistant tuberculosis.

Introduction: Most drug-resistant tuberculosis (DR-TB) occurs due to transmission of unsuspected or ineffectively treated DR-TB. The duration of treatment to stop person-to-person spread of DR-TB is uncertain. We evaluated the impact of novel regimens, including BPaL, on DR-TB transmission using the human-to-guinea pig (H-GP) transmission model.

Mind the gap in kidney care: Translating what we know into what we do.

Historically, it takes an average of 17 years to move new treatments from clinical evidence to daily practice. Given the highly effective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. The time is now to narrow the gap between what we know and what we do.

Effect of daily alcohol intake on sex hormone levels among postmenopausal breast cancer survivors on aromatase inhibitor therapy: a randomized controlled crossover pilot study.

Background: Alcohol intake is associated with a higher risk of estrogen receptor-positive (ER+) breast cancer (BC), presumably through its confirmed ability to increase sex hormone levels. Whether consuming alcohol within the recommended limit of one serving per day increases sex hormone levels among postmenopausal women taking aromatase inhibitors (AI) to inhibit estrogen production remains unknown. Therefore, we compared sex hormone levels following white wine to levels following white grape juice among ER + BC survivors taking AIs.

Impact of COVID-19 Public Health Measures on Antiretroviral Therapy Use Among Ugandans Living with HIV in Sero-Different Couples.

Antiretroviral therapy (ART) use and HIV suppression among people living with HIV (PLHIV) are critical for HIV control and prevention. Extreme restrictions on movement early during the COVID-19 pandemic in Uganda may have impeded the ability to initiate and sustain access to and use of ART. From our stepped-wedge cluster-randomized trial of an integrated PrEP and ART intervention for HIV-serodifferent couples at 12 ART clinics in Uganda, we identified participants who enrolled and had a 6-month post-ART initiation viral load measured before the beginning of the first COVID-19 lockdown (Period 1), participants whose enrollment and 6-month viral load measurement straddled pre-COVID and COVID lockdown times (Period 2), and participants whose enrollment and 6-month viral load were quantified entirely during COVID-19 (Period 3).

Benign Soft Tissue Lesions Responsible for Pain: When and How Should the IR Intervene.

In most of the cases Interventional Radiology techniques and therapies are proposed for the management of symptomatic soft tissue benign tumors responsible for pain and/or compression symptoms aiming to offer a curative intent by means of tumor necrosis with subsequent symptoms' management and improvement of life quality. The ablative therapies include chemical, thermal and non-thermal approaches while, trans-arterial (chemo)embolization also has a distinct role. Adjunct ancillary techniques should be performed whenever necessary to increase efficacy and safety and avoid or reduce complications.

Continual Versus Occasional Blood Pressure (COOL-BP) in Remote Hypertension Management.

Background: Remote hypertension management programs have emerged as potential solutions to improve poor rates of blood pressure (BP) control. The Continual Versus Occasional Blood Pressure (COOL-BP) Study investigated the feasibility and efficacy of using a cuffless wrist BP monitor in a remote hypertension (HTN) program.

Methods: COOL-BP was a prospective single-arm study within a larger HTN management program at Mass General Brigham (MGB).

Immunogenomic determinants of exceptional response to immune checkpoint inhibition in renal cell carcinoma.

Immune checkpoint inhibitors can lead to 'exceptional', durable responses in a subset of persons. However, the molecular basis of exceptional response (ER) to immunotherapy in metastatic clear cell renal cell carcinoma (mccRCC) has not been well characterized. Here we analyzed pretherapy genomic and transcriptomic data in treatment-naive persons with mccRCC treated with standard-of-care immunotherapies: (1) combination of programmed cell death protein and ligand 1 (PD1/PDL1) and cytotoxic T lymphocyte-associated protein 4 inhibitors (IO/IO) or (2) combination of PD1/PDL1 and vascular endothelial growth factor (VEGF) receptor inhibitors (IO/VEGF).

Elevated lipoprotein(a) is independently associated with the presence of significant coronary stenosis in de-novo patients with stable chest pain.

Background: The role of lipoprotein(a) (Lp(a)) in the risk-assessment of patients with de-novo stable chest pain is sparsely investigated. We assessed the association between Lp(a) concentration and the presence of coronary stenosis on coronary computed tomography (CT) angiography in a broad population of patients referred with stable chest pain.

Methods: Lp(a) measurements and coronary CT angiography were performed in 4,346 patients with stable chest pain and no previous history of coronary artery disease.

SAFETY, PHARMACOKINETICS, AND CLINICAL EFFICACY OF ADS051, A NEUTROPHIL MODULATOR, IN ULCERATIVE COLITIS: RESULTS OF A RANDOMIZED PHASE 1B TRIAL.

Objectives: Ulcerative colitis (UC) is characterized by colonic inflammation, with neutrophils playing a key role in UC activity, prognosis, and response to therapies. Current UC therapeutics can have significant side effects and limited efficacy. ADS051 is a novel, oral, gut-restricted small molecule that modulates neutrophil migration and activation without in vitro suppression of T-cell activation.

Scaling and spreading age-friendly care: Early lessons from the VA National Age-Friendly Action Community.

Background: The Age-Friendly Health System (AFHS) initiative seeks to improve care for older adults through assessing and acting on the 4Ms (What Matters, Medication, Mentation, Mobility). The Department of Veterans Affairs (VA) joined the initiative in 2020, and from 2022 to 2023, VA led its first Age-Friendly Action Community, a 7-month online educational series to teach clinicians about implementing the 4Ms across VA care settings.

Methods: The VA Action Community was designed to spread awareness about Age-Friendly care for older Veterans, improve interprofessional team knowledge for providing care guided by the 4Ms, and support AFHS implementation across multiple care settings.

Ena-bile-ing liver cancer growth.

Bile acids differentially affect immune cell responses to liver cancer.

Effect of Hypoglycemia on QT Interval in Individuals with and without Type 2 Diabetes: A Randomized Crossover Trial.

Background: Our goal was to determine in healthy individuals and individuals with type 2 diabetes the impact of repeated episodes of hypoglycemia on the corrected QT (QTc) interval and the time course for QTc recovery. Further, since hypoglycemia increases aldosterone and patients with primary aldosteronism have prolonged QTc, we also determined whether mineralocorticoid receptor blockade prevents hypoglycemia-induced QTc alterations.

Methods: Twenty-seven healthy participants completed a double-blinded crossover trial contrasting 3 experimental conditions: 1) euglycemia, 2) hypoglycemia, and 3) hypoglycemia with mineralocorticoid receptor blockade pretreatment.

Developing an EEG-based model to predict awakening after cardiac arrest using partial processing with the BIS Engine.

Introduction: Accurate prognostication in comatose survivors of cardiac arrest is a challenging and high-stakes endeavor. We sought to determine whether internal EEG subparameters extracted by the Bispectral Index (BIS) monitor, a device commonly used to estimate depth-of-anesthesia intraoperatively, could be repurposed to predict recovery of consciousness after cardiac arrest.

Methods: In this retrospective cohort study, we trained a 3-layer neural network to predict recovery of consciousness to the point of command following versus not based on 48 hours of continuous EEG recordings in 315 comatose patients admitted to a single US academic medical center after cardiac arrest (Derivation cohort: N=181; Validation cohort: N=134).

Applying Natural Language Processing Techniques to Map Trends in Insomnia Treatment Terms on the r/Insomnia Subreddit: Infodemiology Study.

Background: People share health-related experiences and treatments, such as for insomnia, in digital communities. Natural language processing tools can be leveraged to understand the terms used in digital spaces to discuss insomnia and insomnia treatments.

Objective: The aim of this study is to summarize and chart trends of insomnia treatment terms on a digital insomnia message board.