Food for thought: a qualitative assessment of medical trainee and faculty perceptions of nutrition education.

Background: The American Society of Clinical Nutrition recommends 37 to 44 h of undergraduate medical nutrition education. The Total Health Curriculum at Geisinger Commonwealth School of Medicine (GCSOM) contains 14 h of objective-based nutritional instruction. This study aimed to examine the perceptions of key stakeholders regarding the role of nutrition in medicine and to identify barriers, opportunities for improvement, and roles/responsibilities for innovative implementation of nutrition education.

Role of Altmetric Attention Scores in Evaluating the Influence of Spine Surgery Research.

Study Design: Retrospective cohort.

Objective: To analyze the annual trends in the most prevalent topics, journals, and geographic regions of the top 100 spine surgery articles, as determined by altmetric attention scores (AASs). We also describe the relationship between AAS and traditional article metrics.

Infantile Hemangioma With Aggressive, Early-Onset Ulceration, and Kasabach-Merritt-Like Phenomenon in a Newborn.

Infantile hemangiomas (IH) are the most common benign tumors of infancy and progress through recognized stages of evolution including early proliferation, plateau, and involution. Ulceration is a common complication of IHs typically observed during the early proliferative stage characterized by rapid growth. In rare cases, ulceration is the primary clinical manifestation of IHs.

Cold versus hot snare endoscopic mucosal resection of colorectal polyps: meta-analysis of randomized controlled trials.

Background And Aims: Interest in cold endoscopic mucosal resection (EMR) for colorectal polyps has been growing lately. We conducted a meta-analysis of RCTs to compare cold and hot EMR for colorectal polyps.

Methods: We reviewed several databases from inception to October 06, 2024.

Pancreaticoduodenectomy in trauma patients with grade IV-V duodenal or pancreatic injuries: a post hoc analysis of an EAST multicenter trial.

Introduction: The utility of pancreaticoduodenectomy (PD) for high-grade traumatic injuries remains unclear and data surrounding its use are limited. We hypothesized that PD does not result in improved outcomes when compared with non-PD surgical management of grade IV-V pancreaticoduodenal injuries.

Methods: This is a retrospective, multicenter analysis from 35 level 1 trauma centers from January 2010 to December 2020.

Efficacy and safety of fully covered self-expanding metal stents in the management of Post sphincterotomy bleeding: a Systematic Review and Meta-analysis.

Background And Aims: Fully covered self-expandable metallic stents (FCSEMS) are often used in the management of post-sphincterotomy bleeding which is refractory to conventional endoscopic treatments. In this meta-analysis, we have evaluated the efficacy and safety of FCSEMS in the management of post-sphincterotomy bleeding.

Methods: We reviewed several databases from inception to November 6, 2024 to identify studies that evaluated the efficacy, and/or safety of FCSEMS in the management of post sphincterotomy bleeding.

The Impact of Postprocedural Anticoagulant Use in Patients Undergoing Woven EndoBridge: A Multicenter Propensity Score-Matched Study.

The Woven EndoBridge (WEB) device has become a prominent treatment for wide-neck bifurcation intracranial aneurysms since its FDA approval in 2018. However, the impact of anticoagulant therapy on its efficacy and patient outcomes remains underexplored. This study aims to evaluate the effects of postoperative anticoagulant use on aneurysm occlusion, retreatment rates, and functional outcomes following WEB device implantation.

Xylazine-Associated Necrotic Upper-Extremity Wounds: A Single Hospital System's Experience with 82 Patients and 125 Wounds.

Background: The rise in xylazine-adulterated heroin and fentanyl poses novel challenges to hand surgeons and a rising epidemic of necrotic upper-extremity wounds. While prior case studies have focused on particularly severe and complex xylazine-associated necrotic (XAN) wounds, the aim of this consecutive case series was to characterize the variability of presentations (ranging from mild to severe) at a single institution at the epicenter of the xylazine epidemic.

Methods: Patients presenting to a tertiary referral center for XAN upper-extremity wounds were retrospectively identified from emergency department visits and hospital admissions between January 2021 and December 2023.

Deceased Donor Renal Allograft Utility in Adult Single and Multi-organ Transplantation in the United States.

Background: Deceased donor multiorgan transplants utilizing kidneys (MOTs) can improve outcomes for multiorgan recipients but reduces kidneys for chronic renal failure patients.

Methods: We reviewed the Organ Procurement and Transplantation Network database from 2015 through 2019, for adult deceased donor kidney transplants. Recipients were classified as kidney transplant alone (KTA) (n = 62,252) or MOTs pancreas-kidney, simultaneous pancreas-kidney (n = 3,976), liver-kidney, simultaneous liver-kidney (n = 3,212), heart-kidney, simultaneous heart-kidney (n = 808), and "other"-kidney, simultaneous "other" kidney (n = 73).

Trends, Risk Factors, and Outcomes of Selective Screening for Abdominal Aortic Aneurysms in At-Risk Patients.

Objectives: For men ages 65-75 without a smoking history and for women ages 65-75 with a smoking history, the US Preventative Service Task Force recommends that primary care providers (PCP) use their clinical judgement when offering abdominal aortic aneurysm (AAA) screening. This study describes the trends in screening for these cohorts, identify factors that may influence screening rates, and compare outcomes between screened and unscreened patients.

Methods: The TriNetX population database was queried for subjects with routine PCP visit between ages 65-75 from 2007-2023 to create cohorts of male smokers, male non-smokers, and female smokers.

Comparative analysis of safety and efficacy of flow diversion with and without surface modification technology, FRED-X, FRED, PED shield and PED in 386 patients: A single center experience with systematic review and network meta analysis.

Introduction: The FRED-X is a newer generation flow diverting stent (FDS) with surface modification that has demonstrated favorable efficacy in treating intracranial aneurysms. Our study provides an analysis of patients treated using FRED-X compared to FRED, PED Shield and PED.

Materials And Methods: This was a retrospective single center study and a systematic review with network meta analysis of patients who underwent flow diversion using FRED-X, FRED, PED Shield or PED.

Orbital Intraosseous Abscess After Lateral Bony Orbital Decompression.

A 66-year-old woman status post bony lateral orbital decompression for thyroid eye disease presented with recurrent episodes of left lateral canthal edema and erythema, despite repeated courses of oral antibiotics, titanium hardware removal, and repeated exploratory orbitotomies with debridement and curettage. MRI later revealed an intraosseous fluid collection in the left greater sphenoid wing. Another exploratory orbitotomy was performed and an intraosseous abscess was identified.

Patient-Reported Outcome Measures for Mohs Reconstruction: A Systematic Review.

Objective: Mohs micrographic surgery (MMS) and subsequent reconstructive procedures for the treatment of facial nonmelanoma skin cancers (NMSCs) significantly impact quality of life (QoL). A validated patient-reported outcome measure (PROM) for patients who undergo Mohs reconstruction is not yet established. This study aims to systematically assess the quality of existing PROMs to determine their effectiveness in capturing the challenges faced after Mohs reconstruction for facial NMSC.

Association Between Delayed/Forgone Medical Care and Resource Utilization Among Women with Breast Cancer in the United States.

Background: Although high treatment costs of breast cancer care are well documented, the relationship between delayed/forgone (D/F) care and resource utilization among patients with breast cancer is unknown. This study sought to investigate the relationship between D/F care, resource use, and healthcare expenditures among patients with breast cancer.

Methods: Data on adult female patients with breast cancer were obtained from the Medical Expenditure Panel Survey to assess resource utilization and expenditures in the United States from 2007 to 2017.

Flow-diverting stents for the treatment of unruptured distal anterior cerebral artery aneurysms: analysis of the CRETA Registry.

Background: Data about the safety and the efficacy of flow diversion for distal anterior cerebral artery (DACA) aneurysms are limited. We present the largest multicenter analysis evaluating the outcomes of flow diversion in unruptured DACA aneurysm treatment.

Methods: Databases from 39 centers were retrospectively reviewed for unruptured DACA aneurysms treated with flow-diverting stents.

Hypermucoviscous presenting as sternocleidomastoid pyomyositis with subsequent lower extremity necrotising fasciitis.

Necrotising fasciitis (NF) is a severe, rapidly progressing infection of the muscular fascia and subcutaneous tissue. Monomicrobial NF from hypermucoviscous (hvKP-NF) is rare but highly virulent, most common in East Asia. This report reviews a unique case of hvKP-NF in a US male in his 40s with undiagnosed diabetes mellitus, presenting with severe sepsis, neck swelling and calf pain.

The impact of frailty on patient selection and outcomes for open versus endovascular treatment of unruptured intracranial aneurysms: A propensity-score matched analysis.

Background And Objectives: Endovascular treatment (EVT) has been demonstrated to have improved post-operative outcomes and fewer complications compared to open microsurgical clipping of unruptured intracranial aneurysms (UIAs). Our study analyzes patient selection and outcomes for open versus EVT stratified by frailty measured using the Risk Analysis Index (RAI).

Methods: This was a retrospective study of patients who underwent open or EVT for an UIA at our institution between March 2017 and June 2022.

Tumor infiltrating T-cells and loss of expression of SWI/SNF genes in varying stages of clear cell renal cell carcinoma.

Background: Patients with clear cell renal cell carcinoma (ccRCC) metastases face poor prognoses, even with adjuvant therapies. Tumor-infiltrating T-cells and macrophages are critical in targeting tumor cells within the renal microenvironment. Beyond VHL mutations, loss-of-function mutations in SWI/SNF complex genes, including PBRM1, BAP1, ARID1A, SETD2, SMARCA4 (BRG1), and SMARCA2 (BRM), have been implicated in ccRCC progression.

Oculomotor nerve palsy recovery following microsurgery vs. endovascular treatment of posterior communicating artery aneurysms: a comparative meta-analysis of short- and long-term outcomes.

Recent advancements in endovascular treatment (EVT) and different views on optimal management for posterior communicating artery (PComA) aneurysms with oculomotor nerve palsy (ONP) highlight a need to compare recovery timelines between microsurgery and EVT; heterogeneous outcomes and influencing factors may also affect results. A comprehensive systematic review and meta-analysis were conducted by searching PubMed, Embase, Scopus, and Web of Science databases. The extracted data encompassed patient demographics, details on treatment modalities and timing, and characteristics of PComA aneurysms ONP caused by either unruptured or ruptured aneurysms.

Concomitant epidural and longitudinal anterior spinal artery contrast spread in a lumbar transforaminal epidural steroid injection (TFESI).

A 78-year-old female with a remote history of L3-4 decompression and fusion presented with several months of low back and radicular leg pain. MRI revealed moderate L2-L3 spinal canal stenosis, ligamentum flavum infolding, moderate bilateral foraminal stenosis, and a grade I retrolisthesis. A right sided L2-L3 TFESI was performed using multiplanar fluoroscopic imaging with a subpedicular supraneural approach.

Association of type 2 diabetes mellitus with sensorineural hearing loss - A population-based analysis.

Objective: To test the hypothesis that patients with poorly controlled type 2 diabetes mellitus are more likely to develop sensorineural hearing loss (SNHL) than non-diabetic patients.

Study Design: Retrospective cohort study.

Setting: TriNetX US Collaborative Network (2003-2022).

Skin necrosis following digital wart intralesional injection of cantharidin.

A right-hand-dominant female presented 5 weeks following a right middle finger intralesional cantharidin injection for a common wart by a dermatologist. The patient experienced progressive stiffness, blistering, swelling, pain, and ultimately, full-thickness skin necrosis surrounding the injection site. Careful debridement followed by a full-thickness skin graft was performed with no evidence of involvement of the germinal matrix or terminal extensor tendon.