Top-Funded Digital Health Companies And Their Impact On High-Burden, High-Cost Conditions.

Digital health companies hold promise to address major health care challenges, though little has been published on their impact. We identified the twenty top-funded private US-based digital health companies to analyze their products and services, related peer-reviewed evidence, and the potential for impact on patients with high-burden conditions. Data analytics (including artificial intelligence and big data) was the most common company type.

Outcomes of a Statewide Learning Collaborative to Implement Mental Health Services in Pediatric Primary Care.

Objective: Mental health concerns are common in pediatric primary care, but practitioners report low levels of comfort managing them. A primary care intervention addressing organizational and individual factors was developed to improve the management of common mental health conditions.

Methods: Twenty-nine practices participated in a statewide learning collaborative over 18 months.

Obstructive sleep apnoea and hypoventilation in an adult with congenital myasthenic syndrome.

In this case report, we describe an adult male with congenital myasthenic syndrome due to mutations in muscle-specific receptor tyrosine kinase (, c.79+2 T>G; IVS1 +2 T>G, c.2368 G>A, Val790Met) presenting with sleep apnoea and hypercapnic respiratory failure.

The prevalence and outcome of children with failure to thrive after pediatric kidney transplantation.

Background: Prior to transplantation, effects of advanced CKD contribute to malnutrition and impaired growth. After transplant, children are expected to thrive, however, in a subset of transplant recipients this does not occur. Factors associated with post-transplant FTT are poorly understood.

Cutaneous Complications in Recipients of Lung Transplants: A Pictorial Review.

Lung transplant is now an established modality for a broad spectrum of end-stage pulmonary diseases. According to the International Society for Heart and Lung Transplantation Registry, more than 50,000 lung transplants have been performed worldwide, with nearly 11,000 recipients of lung transplants alive in the United States. With the increasing use of lung transplant, pulmonologists must be cognizant of the common as well as the unique posttransplant dermatologic complications.

Germline and Somatic Alterations Are Linked to Increased HER2 Expression in Breast Cancer.

germline mutation predisposes to breast cancer. mutations have also been proposed as oncogenic drivers in sporadic breast cancers. To understand the genomic and histologic characteristics of these breast cancers, we analyzed the tumors with germline mutations and also examined the genomic and proteomic profiles of unselected tumors.

Double-positive with positive anti-glomerular basement membrane antibody and ANCA-positive disease in a patient with dermatomyositis.

Approximately one in four patients (23.3%) with inflammatory myositis including dermatomyositis can require evaluation for acute kidney injury. The main cause of kidney injury is acute tubular necrosis from medications or myoglobinuria, though clinicians should be aware of a wide variety of possible aetiologies.

An Examination of Blood Cell Membrane Potential as a Diagnostic Test of Attention Deficit Disorder in Children.

To reexamine previous findings that reported that blood cells' membrane potential ratios (MPRs™) differ between youth with ADHD and controls and to determine whether psychostimulants affect MPRs™. Forty-four youth (ages 6-17) with ADHD (not currently taking psychostimulants; = 24) and controls ( = 20) completed the Mini-International Neuropsychiatric Interview 7 (MINI 7) and a blood draw to determine MPR™. Youth with ADHD provided another blood draw 30 days after receiving psychostimulants.

Bilateral chylothorax following reoperative central neck dissection for metastatic papillary thyroid cancer.

Locoregional recurrence of papillary thyroid cancer (PTC) can occur in up to 30% of patients within 10 years after initial treatment. Reoperative surgery can be challenging due to scarring, fibrosis and distorted anatomy and may be associated with increased complications compared with initial operations. Chylothorax is an extremely rare and potentially life-threatening complication that can be associated with neck dissections and thyroid surgery.

Treatment of hemorrhagic head and neck lesions by direct puncture and n-BCA embolization.

Life-threatening bleeding in the head and neck region requires urgent management. These hemorrhagic lesions, for example, a ruptured pseudoaneurysm, are often treated by transarterial embolization (TAE), but prior intervention or surgery, inflammation, anatomic variants, and vessel tortuosity may render an endovascular approach challenging, time-consuming, and sometimes impossible. We report two cases of severe head and neck hemorrhages successfully embolized with -butyl cyanoacrylate via direct puncture, and propose this approach as a fast, safe, and effective alternative to TAE.

Uncommon presentation, rare complication and previously undescribed oncologic association of pheochromocytoma; the great masquerader.

We describe the case of a 67-year-old man presenting with ventricular tachycardia (VT) and systolic heart failure secondary to a left adrenal phaeochromocytoma. After treatment with amiodarone, the patient's VT resolved. However, his course was complicated by femoral deep venous thrombosis secondary to an incidentally discovered dedifferentiated liposarcoma of the thigh, for which he was prescribed a course of enoxaparin.

An advance care plan decision support video before major surgery: a patient- and family-centred approach.

Objective: Video-based advanc care planning (ACP) tools have been studied in varied medical contexts; however, none have been developed for patients undergoing major surgery. Using a patient- and family-centredness approach, our objective was to implement human-centred design (HCD) to develop an ACP decision support video for patients and their family members when preparing for major surgery.

Design And Methods: The study investigators partnered with surgical patients and their family members, surgeons and other health professionals to design an ACP decision support video using key HCD principles.

Associations of osteoprotegerin with coronary artery calcification among women with systemic lupus erythematosus and healthy controls.

Objective We tested the hypothesis that higher circulating levels of osteoprotegerin (OPG) are related to higher levels of coronary artery calcification (CAC) among women with systemic lupus erythematosus (SLE) compared with healthy controls (HCs). Methods Among 611 women in two age- and race-matched SLE case-control studies, OPG was assayed in stored blood samples (HEARTS: plasma, n cases/controls = 122/124, and SOLVABLE: serum, n cases/controls = 185/180) and CAC was measured by electron beam computed tomography. Results In both studies, SLE patients had higher OPG and CAC levels than HCs.

Child Mortality In The US And 19 OECD Comparator Nations: A 50-Year Time-Trend Analysis.

The United States has poorer child health outcomes than other wealthy nations despite greater per capita spending on health care for children. To better understand this phenomenon, we examined mortality trends for the US and nineteen comparator nations in the Organization for Economic Cooperation and Development for children ages 0-19 from 1961 to 2010 using publicly available data. While child mortality progressively declined across all countries, mortality in the US has been higher than in peer nations since the 1980s.

Novel mutation in the KCNJ10 gene in three siblings with seizures, ataxia and no electrolyte abnormalities.

We report a consanguineous family with three affected siblings with novel mutation in the KCNJ10 gene. All three presented with central nervous system symptoms in the form of infantile focal seizures, ataxia, slurred speech with early developmental delay and intellectual disability in two siblings. None had any associated electrolyte abnormalities and no symptomatic hearing deficits were observed.

Oral sampling methods are associated with differences in immune marker concentrations.

Objective: To determine whether the concentration and distribution of immune markers in paired oral samples were similar.

Study Type: Clinical research.

Study Design: Cross-sectional study.

Treatment of hemorrhagic head and neck lesions by direct puncture and nBCA embolization.

Life-threatening bleeding in the head and neck region requires urgent management. These hemorrhagic lesions, for example, a ruptured pseudoaneurysm, are often treated by transarterial embolization (TAE), but prior intervention or surgery, inflammation, anatomic variants, and vessel tortuosity may render an endovascular approach challenging, time-consuming, and sometimes impossible. We report two cases of severe head and neck hemorrhages successfully embolized with -butyl cyanoacrylate via direct puncture, and propose this approach as a fast, safe, and effective alternative to TAE.

Neuropathic Pain Medication Use Does Not Alter Outcomes of Spinal Cord Stimulation for Lower Extremity Pain.

Introduction: Spinal cord stimulation (SCS) for the treatment of lower extremity pain is believed to the result of increased activity in the descending inhibitory and decreased activity in the ascending excitatory tracts. Evidence suggests that the analgesia afforded by SCS may be altered using certain neuropathic pain medications that also modulate neurotransmitters in these sensory tracts. We hypothesize that neuropathic pain medications may alter the response to SCS therapy.

Breast cancer risk and germline genomic profiling of women with neurofibromatosis type 1 who developed breast cancer.

NF1 mutations predispose to neurofibromatosis type 1 (NF1) and women with NF1 have a moderately elevated risk for breast cancer, especially under age 50. Germline genomic analysis may better define the risk so screening and prevention can be applied to the individuals who benefit the most. Survey conducted in several neurofibromatosis clinics in the United States has demonstrated a 17.

Clinical genomics, big data, and electronic medical records: reconciling patient rights with research when privacy and science collide.

Widespread use of medical records for research, consent, attracts little scrutiny compared to biospecimen research, where concerns about genomic privacy prompted recent federal proposals to mandate consent. This paper explores an important consequence of the proliferation of electronic health records (EHRs) in this permissive atmosphere: with the advent of clinical gene sequencing, EHR-based secondary research poses genetic privacy risks akin to those of biospecimen research, yet regulators still permit researchers to call gene sequence data 'de-identified', removing such data from the protection of the federal Privacy Rule and federal human subjects regulations. Medical centers and other providers seeking to offer genomic 'personalized medicine' now confront the problem of governing the secondary use of clinical genomic data as privacy risks escalate.

A garden of parathyroid adenomas.

Despite improvements in parathyroidectomy success rates, patients with persistent primary hyperparathyroidism (PHPT) after initial surgery continue to challenge clinicians. Some of the challenges are due to ectopic parathyroid adenomas, including thymic, intrathyroidal, carotid sheath and mediastinal glands, and others are because of supernumerary glands. While uncommon in PHPT, multigland disease is also an important consideration in patients requiring reoperative surgery for persistent disease.