Management of Intraoperative Sickle Crisis During Kidney Transplant in a Patient With Sickle Cell Disease: A Case Report.

A 31-year-old male patient with a history of sickle cell disease (SCD) with stage V chronic kidney disease (CKD) presented for a deceased donor kidney transplant. During surgery, the transplanted kidney showed mottling and limited cortical flow, raising concerns for an intraoperative sickle cell crisis versus hyperacute rejection. Postoperative imaging revealed decreased vascularity, and the patient was treated with RBC exchange.

Brachial thromboembolectomy and retrograde innominate artery stenting in acute limb ischemia.

Acute limb ischemia is a critical vascular emergency often resulting from embolic sources, requiring prompt intervention to prevent significant morbidity and mortality. This paper presents a case of a 74-year-old female with acute limb ischemia due to a thromboembolus in the distal brachial artery and a nonocclusive mobile thrombus in the innominate artery. The patient underwent urgent brachial artery thromboembolectomy and subsequent retrograde innominate artery stenting via right open transcarotid approach.

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.

External Validation of SHAPE Score: A Score to Predict Low-Risk Lower Gastrointestinal Bleeding in the Emergency Department.

Lower gastrointestinal bleeding (LGIB) frequently leads to emergency department (ED) visits and hospitalizations, encompassing a spectrum of outcomes from spontaneous resolution to intrahospital mortality. The purpose of this study was to validate a scoring system designed to identify cases of low-risk LGIB, allowing for safe discharge from the ED. A retrospective analysis of all gastrointestinal bleeding cases presented at three EDs in 2020 was conducted, focusing specifically on patients with LGIB.

Development and Validation of a Postprocedure Stroke Screening Tool in Children With Cardiac Disease.

Background: Cardiac catheterization in children with heart disease is associated with an increased risk of arterial ischemic stroke. We created and evaluated the diagnostic performance of a bedside screening tool administered postprocedure to identify arterial ischemic stroke.

Methods: We developed a postprocedure stroke screen comprising history of stroke, responsiveness, command following, speech, facial and limb strength symmetry, new seizure, and caregiver concern.

Associations of fire smoke and other pollutants with incident rheumatoid arthritis and rheumatoid arthritis-associated interstitial lung disease.

Objective: Determine whether pollutants such as fire smoke-related particulate matter smaller than 2.5 microns (PM) are associated with incident rheumatoid arthritis (RA) and RA-associated interstitial lung disease (RA-ILD).

Methods: This case-control study used Veterans Affairs data 10/1/2009-12/31/2018.

Sensitivity and Specificity of a Signaling Question for Surveillance of Cognitive Functioning in Pediatric Sickle Cell Disease.

Background: Sickle cell disease (SCD) confers neurological risks that contribute to cognitive and academic difficulties. Clinical guidelines state that cognition should be monitored using signaling questions. However, evidence is lacking regarding the extent to which signaling questions accurately identify children with cognitive issues.

Time to weight plateau with tirzepatide treatment in the SURMOUNT-1 and SURMOUNT-4 clinical trials.

The rate of weight reduction during obesity treatment declines over time and eventually reaches a weight plateau. We investigated factors associated with time to weight plateau (TTWP) in tirzepatide-treated participants with obesity or overweight in a post-hoc analysis of SURMOUNT-1 and SURMOUNT-4 trials. Participants adherent to tirzepatide treatment and achieving ≥5% weight loss by primary endpoint (week 72 SURMOUNT-1; week 88 SURMOUNT-4) were included.

Diagnostic accuracy in coronary CT angiography analysis: artificial intelligence versus human assessment.

Background: Visual assessment of coronary CT angiography (CCTA) is time-consuming, influenced by reader experience and prone to interobserver variability. This study evaluated a novel algorithm for coronary stenosis quantification (atherosclerosis imaging quantitative CT, AI-QCT).

Methods: The study included 208 patients with suspected coronary artery disease (CAD) undergoing CCTA in Perfusion Imaging and CT Coronary Angiography With Invasive Coronary Angiography-1.

Tapinarof cream 1% once daily was well tolerated in adults and children with atopic dermatitis in two phase 3 randomized trials.

Tapinarof cream 1% once daily (QD) demonstrated significant efficacy in patients down to age 2 years with atopic dermatitis (AD) in the ADORING 1 and 2 phase 3 trials. We report local tolerability outcomes. Patients received Tapinarof or vehicle cream QD for 8 weeks.

Cannabis use characteristics and associations with problematic use outcomes, quitting-related factors, and mental health among US young adults.

Objective: Given the changes in trends of cannabis use (e.g., product types), this study examined latent classes of young adult use and associations with use-related outcomes.

Quantifying the Deficits of Body Water and Monovalent Cations in Hyperglycemic Emergencies.

Hyperglycemic emergencies cause significant losses of body water, sodium, and potassium. This report presents a method for computing the actual losses of water and monovalent cations in these emergencies. We developed formulas for computing the losses of water and monovalent cations as a function of the presenting serum sodium and glucose levels, the sum of the concentrations of sodium plus potassium in the lost fluids, and body water at the time of hyperglycemia presentation as measured by bioimpedance or in the initial euglycemic state as estimated by anthropometric formulas.

EM-AUC: A Novel Algorithm for Evaluating Anomaly Based Network Intrusion Detection Systems.

Effective network intrusion detection using anomaly scores from unsupervised machine learning models depends on the performance of the models. Although unsupervised models do not require labels during the training and testing phases, the assessment of their performance metrics during the evaluation phase still requires comparing anomaly scores against labels. In real-world scenarios, the absence of labels in massive network datasets makes it infeasible to calculate performance metrics.

Immune Checkpoint Inhibitor-Associated Cutaneous Adverse Events: Mechanisms of Occurrence.

Immunotherapy, particularly that based on blocking checkpoint proteins in many tumors, including melanoma, Merkel cell carcinoma, non-small cell lung cancer (NSCLC), triple-negative breast (TNB cancer), renal cancer, and gastrointestinal and endometrial neoplasms, is a therapeutic alternative to chemotherapy. Immune checkpoint inhibitor (ICI)-based therapies have the potential to target different pathways leading to the destruction of cancer cells. Although ICIs are an effective treatment strategy for patients with highly immune-infiltrated cancers, the development of different adverse effects including cutaneous adverse effects during and after the treatment with ICIs is common.

Why Do They Persist? Understanding Living Kidney Donors and Persistence.

Many participants persist through the living kidney donation process, although it is challenging, multifaceted, and burdensome, particularly during the predonation evaluation (PDE) phase. This study uses a constructivist grounded theory approach to analyze the experiences of living kidney donors (LKDs) undergoing evaluation who shared their perspectives in blog reflections. One hundred five (105) blog posts met the inclusion criteria.

Clinical features associated with self-reported food insecurity in people with cystic fibrosis.

Background: Food insecurity (FI) is more prevalent in people with cystic fibrosis (PwCF) than the reported national prevalence, but there are limited data on the relationship between FI and health outcomes in PwCF. The objective of this study was to analyze the relationship between FI in PwCF and pulmonary and nutritional status.

Methods: We leveraged an electronic cross-sectional survey that ascertained FI status and gave participants the option to link their survey data to their records in the Cystic Fibrosis Foundation Patient Registry (CFFPR).

Favorable 30-day outcomes of initial open inguinal hernia repair with local anesthesia among frail patients.

Background: Open inguinal hernia repair (OIHR) can be conducted under either general anesthesia (GA) or local anesthesia (LA). Despite a lack of evidence supporting improved perioperative outcomes, GA is the predominant anesthesia type used in OIHR. Frailty is defined as a clinically recognizable state of age-related increased vulnerability.

Right-lateralization of the visual word form area after left-hemisphere perinatal stroke.

In literate adults, an area along the left posterior fusiform gyrus that is often referred to as the "visual word form area" (VWFA) responds particularly strongly to written characters compared to other visually similar stimuli. Theoretical accounts differ in whether they attribute the strong left-lateralization of the VWFA to a left-hemisphere bias towards visual features used in script, to competition of visual word form processing with that of other visual stimuli processed in the same general cortical territory (especially faces), or to the well-established left-lateralization of the language system.Here we used functional magnetic resonance imaging to test the last hypothesis by investigating lateralization of the VWFA in participants (male and female) who have right-hemisphere language due to a large left-hemisphere perinatal stroke.

Acral Lentiginous Melanoma. Part I. Epidemiology, Etiology, Clinical Presentation, and Diagnosis.

This review article focuses on acral lentiginous melanoma (ALM), a rare cutaneous malignancy and the least common subtype of cutaneous malignant melanoma (CMM). ALM exhibits distinct characteristics, such as low overall mutation rates and increased chromosomal alterations. It is associated with worse prognosis, more advanced disease, and lower survival rates compared to other CMM subtypes.

Intraoperative Anesthetic Care During Emergent/Urgent Craniotomy or Craniectomy for Intracranial Hypertension or Herniation: A Systematic Review.

This systematic review aimed to identify and describe best practice for the intraoperative anesthetic management of patients undergoing emergent/urgent decompressive craniotomy or craniectomy for any indication. The PubMed, Scopus, EMBASE, and Cochrane databases were searched for articles related to urgent/emergent craniotomy/craniectomy for intracranial hypertension or brain herniation. Only articles focusing on intraoperative anesthetic management were included; those investigating surgical or intensive care unit management were excluded.

Long-Term Safety and Efficacy with Roflumilast Cream 0.15% in Patients Aged ≥6 Years with Atopic Dermatitis: A Phase 3 Open-Label Extension Trial.

Safety and efficacy of roflumilast cream 0.15% for atopic dermatitis (AD) were demonstrated in two 4-week phase 3 trials. Evaluate long-term safety, tolerability, and efficacy of roflumilast cream 0.

Acral Lentiginous Melanoma. Part II. Staging, Surgical Management, The Role of Systemic Therapy, Shortcomings and Future Directions.

This comprehensive review navigates the clinical management and challenges of acral lentiginous melanoma (ALM), including staging, surgical interventions, and systemic therapies. Multimodality treatment and clinical trials are recommended for advanced cases.

Opportunities in programs and policies to address the underlying drivers of sugary drink and water consumption in the Washington DC metro area: a qualitative community-based system dynamics approach.

Background: Though the Dietary Guidelines for Americans recommend that individuals drink water instead of sugar-sweetened beverages (SSBs), this behavior is influenced and reinforced by a complex network of structures and systems.

Objective: The objectives of this study were to develop a shared understanding among multiple stakeholders about the structural and underlying, interconnected drivers of SSB and water consumption in the Washington D.C.