Practice Advisory for Postoperative Pain Management of Cardiac Surgical Patients: A Report by Society of Cardiovascular Anesthesiologists.

Moderate to severe pain after cardiac surgery is relatively common, which increases the risk of postoperative cardiopulmonary complications and delays hospital discharge. Opioids have been useful agents for postoperative pain control after cardiac surgery, but are associated with serious adverse effects. As a result, multimodal analgesia has been adopted widely to decrease reliance on opioids for treating postoperative pain, reduce opioid-related adverse effects, and promote early recovery.

A Call for a Neoadjuvant Kidney Cancer Consortium: Lessons Learned from Other Cancer Types.

Neoadjuvant systemic treatment strategies have improved outcomes in several solid tumour types. This success has not yet been replicated in renal cell carcinoma (RCC). A consensus and international collaboration are urgently needed for the development of adaptive perioperative immunotherapy strategies for patients with RCC at high risk of recurrence.

Molecular classification of endometrial cancers (EC) and association with relapse-free survival (RFS) and overall survival (OS) outcomes: Ancillary analysis of GOG-0258.

Purpose: Determine if molecular classification using mismatch repair (MMR) and p53 protein expression predicts recurrence-free survival (RFS) and overall survival (OS) in endometrial cancer (EC) patients treated with chemotherapy and radiation (CRT) versus chemotherapy (CT).

Methods: GOG-0258, a phase III randomized trial (NCT00942357), compared CRT to CT. Immunohistochemistry assessed MMR and p53 status.

Diffuse expression of p16 in pancreatic neuroendocrine tumors (PanNETs) and the association of morphology variants.

Objective: Distinguishing grade 3 pancreatic neuroendocrine tumors (PanNETs) from neuroendocrine carcinomas (PanNECs) is sometimes challenging. Recently, a diffuse p16-positive pattern was reported in PanNECs but not in grade 3 PanNETs, suggesting that p16 could help differentiate these entities. This study aimed to investigate p16 expression in PanNETs of various grades and its association with clinicopathologic features.

How Often Is Rifampin Therapy Initiated and Completed in Patients With Periprosthetic Joint Infections?

Background: Rifampin therapy is indicated for the treatment of staphylococcal periprosthetic joint infection (PJI) in patients who have undergone debridement, antibiotics, and implant retention (DAIR) or one-stage revision as per the Infectious Diseases Society of America (IDSA) guideline. Given the well-established effectiveness of rifampin as adjunctive therapy in staphylococcal PJI, it is crucial to evaluate its utilization in practice and identify factors that contribute to its underuse or incomplete administration, as these deviations may undermine treatment efficacy and patient outcomes.

Questions/purposes: Among patients who met clear indications for rifampin use having undergone DAIR or one-stage revision for staphylococcal PJI, (1) what proportion of patients did not receive it? (2) What proportion of patients started it but did not complete the planned course? (3) Where documented in the medical record, what were the common reasons for not using it or prematurely discontinuing it, and in what percentage of the patients' charts was no reason given? (4) What proportion of patients were taking a medication that put them at risk for a drug-drug interaction (DDI)?

Methods: Using an institutional database, patients who underwent DAIR or revision arthroplasty for PJI from January 2013 to April 2023 were identified (n = 935).

Cutaneous dysbiosis characterizes the post-allogeneic hematopoietic stem cell transplantation period.

Gut dysbiosis is linked to mortality and the development of graft-versus-host disease (GVHD) after hematopoietic stem cell transplantation (HSCT), but the impact of cutaneous dysbiosis remains unexplored. We performed a pilot observational study and obtained retroauricular and forearm skin swabs from 12 adult patients prior to conditioning chemotherapy/radiation, and at 1-week, 1-month and 3-months after allogeneic HSCT, and performed shotgun metagenomic sequencing. The cutaneous microbiome among HSCT patients was enriched for gram-negative bacteria such as E coli and Pseudomonas, fungi, and viruses.

Lifetime stressors relate to invisible symptoms of multiple sclerosis.

Aim: Childhood stressors can increase adult stress perception and may accumulate over the lifespan to impact symptoms of multiple sclerosis (MS). Growing evidence links childhood stressors (e.g.

A Case of Rapid Transformation of a Nail Matrix Nevi to Melanoma After Messenger RNA COVID-19 Vaccine: A Cause or a Coincidence?

Subungual melanoma is a variant of acral lentiginous melanoma that arises from the nail matrix. Subungual melanomas present unique clinical challenges due to diagnostic difficulties and the lack of a standardized protocol for surveillance, also, there are no evidence-based studies that determine the ideal frequency and duration of clinical and dermoscopy follow-ups in patients with longitudinal melanonychia. This is highlighted by a case of longitudinal melanonychia in a 53-year-old patient who underwent malignant transformation to subungual melanoma after a biphasic growth.

Bridging the continuity: Practice-enhancing publications about the ambulatory care medication-use process in 2023.

Disclaimer: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

Relationship between handgrip strength and timed up-and-go test on hospitalization costs in older adults: a population-based study.

Background: Weak handgrip strength and slow timed up-and-go (TUG) time are known risk factors for hospitalization among older adults; however, few studies have investigated the relationships between these physical tests and future hospitalization costs.

Methods: We used data from 13,613 participants in the population-based Singapore Chinese Health Study who underwent assessment for handgrip strength and TUG time at a mean age of 74 years. Hospitalization costs for the subsequent year, among those who survived for at least one year thereafter, were ascertained via linkage with administrative healthcare finance data.

Study on the relationship between indoor ventilation frequency and anxiety and depression symptoms in older persons: based on the data of 2018 CLHLS.

Background: To investigate the association between indoor ventilation frequency and symptoms of depression and anxiety in older persons.

Methods: A binary logistic regression model was used to analyze the effects of indoor ventilation frequency on depression and anxiety by using data from the 2018 Chinese longitudinal healthy longevity survey (CLHLS).

Results: A total of 9,690 older persons with an average age of (83.

Rapid human oogonia-like cell specification via transcription factor-directed differentiation.

The generation of germline cells from human induced pluripotent stem cells (hiPSCs) represents a milestone toward in vitro gametogenesis. Methods to recapitulate germline development beyond primordial germ cells in vitro have relied on long-term cell culture, such as 3-dimensional organoid co-culture for ~four months. Using a pipeline with highly parallelized screening, this study identifies combinations of TFs that directly and rapidly convert hiPSCs to induced oogonia-like cells (iOLCs).

Sex-specific association between maternal childhood adversities and offspring's weight gain in a Brazilian cohort.

Maternal adverse childhood experiences (ACEs) are linked to negative health and developmental outcomes in offspring. However, whether maternal ACEs influence infant weight gain in the first months of life, and if this effect differs by infant sex, remains unclear. This study included 352 full-term newborns from low-risk pregnancies and their mothers in low-income settings in Brazil.

Malperfusion in Patients with Acute Type A Aortic Dissection: A Nationwide Analysis.

Background: This study describes in detail the clinical burden of malperfusion associated with acute Type A aortic dissection (ATAAD) in a large, national cohort and the effect of treatment strategy on outcomes.

Methods: All patients undergoing repair of ATAAD between 2017 and 2020 in the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database were studied. Malperfusion was defined using STS definitions based on imaging or surgeon's evaluation.

Embracing the Future of Clinical Trials in Radiotherapy: An NRG Oncology CIRO Technology Retreat Whitepaper on Pioneering Technologies and AI-Driven Solutions.

This white paper examines the potential of pioneering technologies and artificial intelligence (AI)-driven solutions in advancing clinical trials involving radiotherapy. As the field of radiotherapy evolves, the integration of cutting-edge approaches such as radiopharmaceutical dosimetry, FLASH radiotherapy, image-guided radiation therapy (IGRT), and AI promises to improve treatment planning, patient care, and outcomes. Additionally, recent advancements in quantum science, linear energy transfer/relative biological effect (LET/RBE), and the combination of radiotherapy and immunotherapy create new avenues for innovation in clinical trials.

Validation of the Portuguese version of the Movement Disorder Society non-motor rating scale (MDS-NMS) in Parkinson's disease.

Background: The Movement Disorder Society Non-Motor Rating Scale (MDS-NMS) serves as a comprehensive clinical assessment tool for non-motor symptoms in Parkinson's disease (PD) OBJECTIVES: This study aims to validate the Portuguese version of the MDS-NMS, addressing the critical need for culturally adapted rating scales in Portuguese-speaking populations.

Methods: This multicenter, cross-sectional study engaged native Portuguese-speaking PD patients from 16 Movement Disorders Centers across Portugal and Brazil. We conducted a meticulous translation process into Portuguese, including forward-backward translation and cognitive pretesting.

Outcomes of chronic limb-threatening ischemia revascularization in patients with chronic kidney disease in the BEST-CLI trial.

Background: Chronic limb-threatening ischemia (CLTI) in patients with chronic kidney disease (CKD) has a high risk of poor outcomes. We aimed to compare the outcomes of lower extremity revascularization in patients with CLTI stratified by CKD severity in patients enrolled in the prospective, randomized Best Endovascular vs Best Surgical Therapy in Patients with CLTI (BEST-CLI) trial.

Methods: The BEST-CLI trial dataset was queried to categorize patients into three groups according to CKD stage.

Reverse Time-to-Death as Time-Scale in Time-to-Event Analysis for Studies of Advanced Illness and Palliative Care.

Incidence of adverse outcome events rises as patients with advanced illness approach end-of-life. Exposures that tend to occur near end-of-life, for example, use of wheelchair, oxygen therapy and palliative care, may therefore be found associated with the incidence of the adverse outcomes. We propose a concept of reverse time-to-death (rTTD) and its use for the time-scale in time-to-event analysis based on partial likelihood to mitigate the time-varying confounding.

Comparison of Glenoid Bone Loss After Unidirectional Versus Combined Shoulder Instability in a Military Population.

Background: While glenoid bone loss (GBL) after anterior shoulder instability correlates with poor functional outcomes, the specific effects of GBL in posterior and combined-type shoulder instability remain poorly characterized, especially in a high-risk military population.

Purpose/hypothesis: The purpose of this study was to compare GBL between unidirectional anterior or posterior instability versus combined-type instability in active-duty servicemembers. It was hypothesized that total GBL and GBL in the direction of instability would be greater in those with combined-type instability compared with unidirectional instability.

Improvement of Recalcitrant Folliculitis Decalvans With Tirzepatide: A Case Report.

Folliculitis decalvans (FD) is a chronic inflammatory alopecia characterized by painful, scarring lesions and recurrent flares, often complicated by secondary bacterial infections. Despite the use of topical and systemic anti-inflammatory or antimicrobial therapies, FD remains challenging to manage, with limited therapeutic advancements. We report a case of recalcitrant FD in a man in his 40s who experienced significant symptom improvement and hair regrowth following the initiation of tirzepatide for weight management.

Lymph Node Staging and Treatment in Pediatric Patients With Soft Tissue Sarcomas: A Consensus Opinion from the Children's Oncology Group, European paediatric Soft tissue sarcoma Study Group, and the Cooperative Weichteilsarkom Studiengruppe.

Accurate staging of nodal involvement in pediatric sarcoma patients is important to determine correct systemic and local therapy, with the goal to reduce subsequent recurrences. However, differences in lymph node staging strategies, definitions, and treatment protocols between the Children's Oncology Group (COG), European paediatric Soft tissue sarcoma Study Group (EpSSG), and the Cooperative Weichteilsarkom Studiengruppe (CWS) complicate comparisons. In this article, we aim to establish internationally recognized recommendations for lymph node assessment and treatment of children and adolescents diagnosed with rhabdomyosarcoma (RMS) and non-rhabdomyosarcoma soft tissue sarcoma (NRSTS) according to the Consensus Conference Standard Operating Procedure methodology.