Long-Term Cognitive Safety of Achieving Very Low LDL Cholesterol with Evolocumab.

Background: Concerns persist regarding the cognitive safety of achieving very low levels of low-density lipoprotein (LDL) cholesterol. Although short-term studies are reassuring, the long-term cognitive effects of sustained exposure to very low LDL cholesterol levels through combined proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibition and statin therapy remain unknown.

Methods: This prospective study enrolled a subset of adults with atherosclerotic cardiovascular disease who had completed a neurocognitive substudy (EBBINGHAUS) of a placebo-controlled randomized trial of evolocumab (FOURIER) and were eligible for a long-term open-label extension.

Fine particulate matter and nonaccidental and cause-specific mortality: Do associations vary by exposure assessment method?

Background: There is considerable heterogeneity in fine particulate matter (PM)-mortality associations between studies, potentially due to differences in exposure assessment methods. Our aim was to evaluate associations of PM predicted from different models with nonaccidental and cause-specific mortality.

Methods: We followed 107,906 participants of the Nurses' Health Study cohort from 2001 to 2016.

State-wise variation and inequalities in caesarean delivery rates in India: analysis of the National Family Health Survey-5 (2019-2021) data.

Background: India's caesarean delivery (CD) rate of 21.5% suggests adequate national access to CD but may mask significant disparities. We examined variation in CD rates across states (geography), wealth, and health care sector (public versus private).

Upper airway collapsibility during rapid eye movement sleep tracks the response to upper airway surgery for obstructive sleep apnea.

Objectives: Endotype-based intervention has shown promise in treatment for patients with obstructive sleep apnea, and upper airway surgery is an important therapeutic option. However, the response to surgery varies among patients with obstructive sleep apnea. This study aims to examine changes in endotypic traits following upper airway surgery and their association with surgical outcome.

Clinical and genetic associations for night eating syndrome in a patient biobank.

Objective: Night eating syndrome (NES) is an eating disorder characterized by evening hyperphagia. Despite having a prevalence comparable to some other eating disorders, NES remains sparsely investigated and poorly characterized. The present study examined the phenotypic and genetic associations for NES in the clinical Mass General Brigham Biobank.

Preventing Breast Cancer-Related Lymphedema: A Comprehensive Analysis of a 9-Year Single-Center Experience of Prophylactic Lymphovenous Bypass.

Background: Prophylactic lymphovenous bypass (pLVB) is a microsurgical technique aimed to prevent breast cancer-related lymphedema (BCRL) after axillary lymph node dissection (ALND) by redirecting lymphatic flow from the ligated lymphatics into neighboring veins. This report describes the authors' 9-year institutional experience of pLVB in patients undergoing ALND to prevent BCRL.

Methods: Patients who underwent ALND were reviewed.

Modularity-based mathematical modeling of ligand inter-nanocluster connectivity for unraveling reversible stem cell regulation.

The native extracellular matrix is continuously remodeled to form complex interconnected network structures that reversibly regulate stem cell behaviors. Both regulation and understanding of its intricate dynamicity can help to modulate numerous cell behaviors. However, neither of these has yet been achieved due to the lack of designing and modeling such complex structures with dynamic controllability.

Perioperative Geriatrician Assessment Is Associated with a Lower Risk of Emergency Department Visits After Total Joint Arthroplasty.

Background: Previous research has underscored the benefits of geriatrician consultation in improving outcomes for older patients undergoing hip fracture repair, highlighting enhanced functional outcomes and reduced morbidity. However, the impact of geriatrician care in outcomes for patients undergoing elective total joint arthroplasty (TJA) has yet to be described. We aimed to determine whether preoperative or postoperative geriatrician involvement was associated with differences in the length of hospital stay and emergency department (ED) visits after TJA.

Seroepidemiology of human leptospirosis in the Dominican Republic: A multistage cluster survey, 2021.

Little is known about the epidemiology of leptospirosis in the Dominican Republic, the second most populous country in the Caribbean. We report on findings from a multi-stage household survey across two regions in the country that reveals a previously under-estimated burden of human Leptospira infection. Our findings, based on the reference-standard microscopic agglutination test, indicate a complex picture of serogroup diversity, spatial heterogeneity in infection and risk, and a marked discrepancy between reported cases and serologically estimated infections.

Study protocol for a randomized controlled trial: Integrating the 'Time-limited Trial' in the emergency department.

Introduction: Time-limited trial (TLT) is a structured approach between clinicians and seriously ill patients or their surrogates to discuss patients' values and preferences, prognosis, and shared decision-making to use specific therapies for a prespecified period of time in the face of prognostic uncertainty. Some evidence exists that this approach may lead to more patient-centered care in the intensive care unit; however, it has never been evaluated in the emergency department (ED). The study protocol aims to assess the feasibility and acceptability of TLTs initiated in the ED.

Medical and Surgical Episodes Among Hospital Participants in the Bundled Payments for Care Improvement-Advanced Program.

Importance: Hospital participation in the Bundled Payments for Care Improvement-Advanced (BPCI-A) initiative has been associated with modest savings and stable clinical outcomes overall, but it is unknown whether the program performs differently for medical and surgical or procedural (henceforth, surgical) episodes.

Objective: To assess the association of BPCI-A participation with Medicare spending and clinical outcomes for medical and surgical episodes.

Design, Setting, And Participants: This retrospective difference-in-differences cohort study utilized 100% Medicare fee-for-service inpatient claims for episodes initiated between January 1, 2017, and September 30, 2019, and included 90 days of follow-up.

Pooled Nanoparticle Screening Using a Chemical Barcoding Approach.

We report the development of a small molecule-based barcoding platform for pooled screening of nanoparticle delivery. Using aryl halide-based tags (halocodes), we achieve high-sensitivity detection via gas chromatography coupled with mass spectrometry or electron capture. This enables barcoding and tracking of nanoparticles with minimal halocode concentrations and without altering their physicochemical properties.

The Mla pathway promotes re-expansion from stationary phase.

Unlabelled: Bacteria have evolved diverse strategies to ensure survival under nutrient-limited conditions, where rapid energy generation is not achievable. Here, we performed a transposon insertion site sequencing loss-of-function screen to identify genes that promote pathogen fitness in stationary phase. We discovered that the aintenance of ipid symmetry (Mla) pathway, which is crucial for transferring phospholipids from the outer to the inner membrane, is critical for stationary phase fitness.

The Alzheimer's Association clinical practice guideline for the Diagnostic Evaluation, Testing, Counseling, and Disclosure of Suspected Alzheimer's Disease and Related Disorders (DETeCD-ADRD): Executive summary of recommendations for specialty care.

US clinical practice guidelines for the diagnostic evaluation of cognitive impairment due to Alzheimer's disease (AD) or a related dementia (ADRD) are two decades old. This evidence-based guideline was developed to empower all clinicians to implement a structured approach for evaluating a patient with symptoms that may represent clinical AD/ADRD. An expert workgroup conducted a review of 7374 publications (133 met inclusion criteria) and developed recommendations as steps in an evaluation process.

Alzheimer's Association clinical practice guideline for the Diagnostic Evaluation, Testing, Counseling, and Disclosure of Suspected Alzheimer's Disease and Related Disorders (DETeCD-ADRD): Executive summary of recommendations for primary care.

US clinical practice guidelines for the diagnostic evaluation of cognitive impairment due to Alzheimer's disease (AD) or AD and related dementias (ADRD) are decades old and aimed at specialists. This evidence-based guideline was developed to empower all-including primary care-clinicians to implement a structured approach for evaluating a patient with symptoms that may represent clinical AD/ADRD. Through a modified-Delphi approach and guideline-development process (7374 publications were reviewed; 133 met inclusion criteria) an expert workgroup developed recommendations as steps in a patient-centered evaluation process.

The Alzheimer's Association clinical practice guideline for the diagnostic evaluation, testing, counseling, and disclosure of suspected Alzheimer's disease and related disorders (DETeCD-ADRD): Validated clinical assessment instruments.

US clinical practice guidelines for the diagnostic evaluation of cognitive impairment due to Alzheimer's Disease (AD) or AD and related dementias (ADRD) are decades old and aimed at specialists. This evidence-based guideline was developed to empower all-including primary care-clinicians to implement a structured approach for evaluating a patient with symptoms that may represent clinical AD/ADRD. As part of the modified Delphi approach and guideline development process (7374 publications were reviewed; 133 met inclusion criteria) an expert workgroup developed recommendations as steps in a patient-centered evaluation process.

Progress and Gaps in Respiratory Disease Research and Treatment: Highlights of the IRM 2024 in Shanghai.

Respiratory diseases pose a major public health challenge globally, necessitating collaborative efforts between basic researchers and clinicians for effective solutions. China, which is heavily impacted by a broad spectrum of respiratory disorders, has made notable strides in both research and clinical management of these diseases. The International Respiratory Medicine (IRM) meeting was organized with the primary goal of facilitating the exchange of recent research developments and promoting collaboration between Chinese and American scientists in both basic and clinical research fields.

Applying Health Systems Science Competencies to Contribute to the COVID-19 Pandemic Response.

In the first quarter of 2020, nearly all U.S. medical schools transitioned to virtual instruction and removed medical students from clinical settings because of the emerging COVID-19 pandemic.

AI-assisted human clinical reasoning in the ICU: beyond "to err is human".

Diagnostic errors pose a significant public health challenge, affecting nearly 800,000 Americans annually, with even higher rates globally. In the ICU, these errors are particularly prevalent, leading to substantial morbidity and mortality. The clinical reasoning process aims to reduce diagnostic uncertainty and establish a plausible differential diagnosis but is often hindered by cognitive load, patient complexity, and clinician burnout.

Ethical Considerations Regarding Psychedelics for Clinical Pain Research.

Psychedelics, substances with a long history of cultural and medicinal use, are experiencing a resurgence in clinical research, particularly in psychiatry. Despite their classification as Schedule I drugs, recent studies suggest therapeutic potential, particularly in treating refractory depression. With chronic pain representing a major health concern and with few non-opioid treatment options available, psychedelics are being explored as alternative treatment modalities.

Severe pulmonary hypertension in chronic obstructive pulmonary disease - From clinical perspective to histological evidence.

Severe pulmonary hypertension (PH) in chronic obstructive pulmonary disease (COPD) is currently defined by an elevated mean pulmonary arterial pressure and strongly elevated pulmonary vascular resistance >5 wood units. Clinically, these patients show a male predominance, and usually present with very severe dyspnea, severe hypoxemia, strongly decreased exercise capacity and poor prognosis, even though the clinical picture is frequently associated with less severe airflow obstruction. Explanted lung samples of patients with COPD and severe PH show severe remodeling of small pulmonary arterioles, predominantly in the intima and media of the vessels.

Gaining Insight into Operative Performance: Analysis of an Automated 360-Degree Feedback Tool Among Perioperative Staff.

Background: Surgery has seen limited adoption of 360-degree feedback tools, and no current tools evaluate intraoperative performance from a technical, nontechnical, or teaching skill perspective. We sought to evaluate the overall findings and perceived value of a novel 360-degree feedback tool for surgeons from their operating room colleagues.

Methods: The 'intraoperative 360' (i360) combined 3 previously validated scales of surgeon performance.