Real-world evidence regarding cancer, mortality, and graft failure risk with de novo belatacept use among kidney transplant recipients in the United States.

Belatacept is a selective T-cell co-stimulation blocker used in maintenance immunosuppression for kidney transplant recipients (KTRs), but evidence on cancer risk and other outcomes is limited. This retrospective cohort study used linked US transplant and cancer registry data on KTRs treated with belatacept (N=1514) or tacrolimus (N=7570) as initial maintenance therapy. We used multivariable Cox regression models to compare incidence of invasive cancer, cutaneous squamous cell carcinoma (cSCC), posttransplant lymphoproliferative disorder (PTLD), death, and graft failure/retransplantation (GF/RT) between belatacept and tacrolimus users.

Factorial Mendelian randomization of lipoprotein (a) lowering, low-density lipoprotein cholesterol lowering, and lifestyle improvements: joint associations with cardiovascular risk.

Background: High levels of lipoprotein(a) [Lp(a)] have been associated with an increased risk of cardiovascular disease (CVD); however, the effects of Lp(a)-lowering therapy in combination with low-density lipoprotein cholesterol (LDL-C)-lowering treatment or lifestyle improvements on CVD risk remain unexplored.

Methods: We conducted a factorial Mendelian randomization study among 385 917 participants in the UK Biobank. Separate genetic scores were constructed to proxy the effects of Lp(a) lowering, LDL-C lowering through different targets [HMG-CoA reductase, NPC1-like intracellular cholesterol transporter 1, proprotein convertase subtilisin/kexin Type 9, and low-density lipoprotein receptor (LDLR)], as well as improvements in body mass index (BMI), systolic blood pressure (SBP), and lifestyle factors (cigarette smoking, alcohol consumption, and physical activity).

Novel Versus Conventional Sequencing of β-Blockers, Sodium/Glucose Cotransportor 2 Inhibitors, Angiotensin Receptor-Neprilysin Inhibitors, and Mineralocorticoid Receptor Antagonists in Stable Patients With Heart Failure With Reduced Ejection Fraction (NovCon Sequencing Study): Protocol for a Randomized Controlled Trial.

Background: Chronic heart failure has high morbidity and mortality, with approximately half of the patients dying within 5 years of diagnosis. Recent additions to the armamentarium of anti-heart failure therapies include angiotensin receptor-neprilysin inhibitors (ARNIs) and sodium/glucose cotransporter 2 inhibitors (SGLT2is). Both classes have demonstrated mortality and morbidity benefits.

Incidence, healthcare-seeking behavior and barriers associated with seeking care for severe childhood pneumonia in rural Bangladesh: A prospective study.

Globally, childhood pneumonia is one of the leading causes of under-five mortality especially in low-and middle-income countries. This study aimed to estimate the incidence, healthcare-seeking behavior, and barriers associated with seeking care for children suffering from severe pneumonia in rural Bangladesh. A prospective study was conducted in two districts at 81 randomly selected villages in rural Bangladesh.

Populations of large-diameter trees are increasing across the United States.

Large-diameter trees provide vital ecological functions in forested ecosystems. Old, large-diameter trees may also be vulnerable to climate-driven mortality events, but past work on large tree populations has been geographically limited. Here, we characterize the population of large-diameter trees from two size categories, 50 to 100 cm diameter at breast height (DBH) (medium) and >100 cm DBH (big), within the United States using Forest Inventory and Analysis data.

First record of species associated with in Australia.

In the wake of the detection of polyphagous shot hole borer () in Perth, Western Australia, in 2021 (Cook and Broughton 2023), and ongoing surveillance for Fusarium dieback associated with ambrosia beetles in New South Wales (NSW) (Callaghan et al. (2024), there is a growing need to characterize fungal associates of already-established species in Australia. Historically, plant health diagnostics targeting fungi vectored by tea shot hole borer, , in Australia has focused on , with only and reported to date (Aoki et al.

Albuminuria in Cardiovascular, Kidney, and Metabolic Disorders: A State-of-the-Art Review.

Albuminuria-increased urine albumin excretion-is associated with cardiovascular mortality among patients with diabetes, hypertension, chronic kidney disease, or heart failure, as well as among adults with few cardiovascular risk factors. Many authors have hypothesized that albuminuria reflects widespread endothelial dysfunction, but additional work is needed to uncover whether albuminuria is directly pathologic or causative of cardiovascular disease. Urinary albumin-to-creatinine ratio is an attractive, unifying biomarker of cardiovascular, kidney, and metabolic conditions that may be useful for identifying and monitoring disease trajectory.

Comparative effectiveness of different surgical timings on neurological outcomes for cranioplasty: Protocol for a prospective non-randomized controlled trial.

Background: Cranioplasty (CP), a surgical procedure that restores cranial integrity and potentially enhances neurological outcomes, is commonly performed following decompressive craniectomy for various reasons. However, there is considerable controversy and variation regarding the optimal timing for cranioplasty, particularly concerning its impact on neurological functional outcomes. This paper outlines the protocol for a multicenter, non-randomized controlled trial designed to investigate whether the timing of cranioplasty influences neurological outcomes.

Urgent Transcatheter Mitral Edge-to-Edge Repair Is Associated With Worse in-Hospital Outcomes: A Nationwide Analysis.

Background: To assess in-hospital outcomes in patients undergoing urgent versus non-urgent transcatheter mitral edge-to-edge repair (TEER).

Methods: We used the NIS database 2016-2019 to include admissions who underwent TEER. Inverse probability of treatment weighting (IPTW) was used to compare urgent versus non-urgent groups.

Sickle cell disease and opioid overdose outcomes in the United States: a nationwide analysis.

Sickle cell disease (SCD) predominantly affects individuals of African descent and is characterized by frequent painful vaso-occlusive crises, often requiring opioid management. With the opioid epidemic raising concerns about opioid overdose, this study examines in-hospital outcomes among SCD and non-SCD patients hospitalized for opioid overdose. Using the National Inpatient Sample (NIS) from 2016 to 2021, we analyzed 479,175 opioid overdose hospitalizations, including 1,315 (0.

Examining Practices for Youth Illegal Sexual Behaviors which May Warrant De-Implementation: Overview and Recommendations.

Youth problem sexual behaviors (PSBs), and particularly youth illegal sexual behaviors, have deleterious consequences for youth who engage in them, including removal from the home, perpetration of non-sexual offenses, and chronic involvement with the child welfare and juvenile legal systems (Lussier, Juvenile sex offending through a developmental life course criminology perspective: An agenda for policy and research). Further, individuals who are victims of youth PSBs also experience poor mental and physical health outcomes, resulting in a significant public health expenditure (Hailes et al., Long-term outcomes of childhood sexual abuse: An umbrella review).

Implementing Accuracy, Completeness, and Traceability for Data Reliability.

Importance: While it is well known that data quality underlies evidence validity, the measurement and impacts of data reliability are less well understood. The need has been highlighted in the 21st Century Cures Act of 2016 and US Food and Drug Administration (FDA) Real-World Evidence Program framework in 2018, draft guidance in 2021 and final guidance in 2024. Timely visibility into implementation may be provided by the Transforming Real-World Evidence With Unstructured and Structured Data to Advance Tailored Therapy (TRUST) study, a Verantos Inc-led FDA-funded demonstration project to explore data quality and inform regulatory decision-making.

The utility of brain biomarkers in predicting survival and neurological outcomes in pediatric patients after cardiac arrest: A systematic review and meta-analysis.

Background: Cardiac arrest in children is associated with high morbidity and mortality, primarily due to neurological injury. Biomarkers linked to brain injury, released into circulation from compromised elements of the neurovascular unit, act as significant prognostic indicators in patients suffering from hypoxic-ischemic brain injury (HIBI) subsequent to the restoration of spontaneous circulation (ROSC) after pediatric cardiac arrest. The aim of this systematic review and meta-analysis is to evaluate the prognostic utility of brain injury biomarkers in predicting neurological outcomes and survival in patients following cardiac arrest in the pediatric population.

Understanding COMLEX-USA Level-1 as a Pass/Fail examination: impact and opportunities.

Context: In late 2020, the National Board of Osteopathic Medical Examiners (NBOME) announced that the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) Level 1 would discontinue reporting numeric scores, only providing a Pass/Fail designation. The National Board of Medical Examiners (NBME) changed the core reports for the United States Medical Licensing Examination (USMLE) Step-1 to Pass/Fail in early 2020. Subsequently, residency program directors were reported to migrate toward increased reliance on COMLEX-USA Level 2CE and USMLE Step 2CK scores, the prestige of medical schools, and the status of the authors of letters of reference during their review of residency applicants.

Failure to rescue in acute liver failure: A multicenter cohort study.

Introduction: The concept of failure to rescue has been used to measure the quality of care for complications developed following surgery. The concept of failure to rescue has been poorly studied in patients with primary medical diseases, such as sepsis or acute liver failure (ALF).

Methods: Retrospective multicenter cohort including consecutive patients with ALF within the United States ALF Study Group (USALFSG) prospective registry from 2010 to 2016.

A Model of the Determinants of Maternal Mortality for Indigenous Women.

Aims: To present a model of the determinants of maternal mortality for Indigenous women-social, structural, political and biological.

Design: Non-Indigenous academicians and an Indigenous tribal citizen and scholar partnered to amplify Indigenous women's voices.

Method: With epistemic decolonisation and Indigenist feminism as our theoretical basis, we used theory derivation to create a model of the determinants of Indigenous maternal mortality.

Mind the gut: Navigating the complex landscape of gastroprotection in neurosurgical patients.

Neurosurgical patients, including those with severe traumatic brain injury, spinal cord injury, stroke, or raised intracranial pressure, are at heightened risk for stress ulcers and aspiration pneumonitis, leading to significant morbidity and mortality. These patients are typically managed through both pharmacological interventions [, proton pump inhibitors (PPIs), histamine 2 (H2) antagonists, sucralfate] and non-pharmacological measures (, nasogastric decompression, patient positioning) to mitigate adverse outcomes. The pathogenesis of stress ulcers in neurosurgical patients is multifactorial, but the routine use of stress ulcer prophylaxis remains controversial.

Hyperkalemia and Pneumonia: A Retrospective Study on Mortality Outcomes in Southwest Missouri.

Background: Pneumonia stands as a widely known contributor to hospitalization and mortality among adults in the United States. Meanwhile, disruptions in potassium homeostasis such as hyperkalemia may have an impact on in-patient mortality. This study seeks to examine the presence of hyperkalemia and its association with in-patient mortality among pneumonia patients.

Apolipoprotein A1 Gene Polymorphism and Its Association With TNF-Alpha and Interleukin-6 Levels in Uncomplicated Plasmodium Falciparum Malaria in Nigerian Children.

Malaria remains a significant health challenge, particularly in sub-Saharan Africa, where it contributes substantially to morbidity and mortality among children. The role of genetic polymorphisms in modulating host responses to malaria has gained attention, with apolipoprotein A1 (APOA1) emerging as a candidate due to its anti-inflammatory and immunomodulatory properties. This study investigates the association between two APOA1 gene polymorphisms (G-75A and C+83T), APOA1 levels, and inflammatory markers (tumor necrosis factor-alpha and interleukin-6) in Nigerian children with uncomplicated Plasmodium falciparum malaria.

Commercial hybrid graft versus traditional arch replacement with frozen elephant trunk: A multi-institutional comparison.

Objective: Traditional total arch replacement with frozen elephant trunk requires 2 separate grafts in the descending thoracic aorta and arch, and frequently requires a graft-to-graft anastomosis, which is prone to bleeding. The Thoraflex (Terumo Aortic) device treats the arch and descending thoracic aorta in a single device but has not been compared directly to traditional total arch replacement with frozen elephant trunk and has not been studied in a real-world context in the United States.

Methods: A consecutive sample of total arch replacement with frozen elephant trunk patients across 5 different institutions between January 2018 and January 2024, identified 438 patients of which 83 out of 438 (18.

National race and socioeconomic disparities in access to minimally invasive lung resection for early-stage lung cancer: Impact on mortality.

Background: Adoption of minimally invasive surgery (MIS) for early-stage non-small cell lung cancer (NSCLC) is increasing in the United States. We examined the relationship between sociodemographic factors and receipt of MIS among these patients.

Methods: Patients undergoing surgical resection for stage I and II NSCLC between 2010 and 2018 were identified in the National Cancer Database and stratified by surgical approach.

Epidemiology, Pathogenesis, Clinical Manifestations, and Management Strategies of Tuberculous Meningitis.

Tuberculous meningitis (TBM), the most severe manifestation of extrapulmonary tuberculosis, poses significant global health challenges due to its high mortality rates and complex pathophysiology. This review synthesizes recent findings on TBM, covering epidemiology, pathogenesis, clinical manifestations, diagnostics, and management strategies. TBM disproportionately affects immunocompromised populations, including individuals with HIV, with the highest mortality observed in low-resource settings.

The overlooked impact of background diet and adherence in nutrition trials.

Importance: Randomized controlled trials in nutrition (RCTN) face unique challenges such as the influence of participants' background diets and varying adherence to the intervention, factors that are difficult to quantify and can mask true intervention effects. However, the exact impact of these factors remains unclear.

Objective: To quantify the impact of background diet and adherence, estimated using validated nutritional biomarkers of flavanol intake, on the outcomes of a large-scale RCTN.

Implementation of antepartum preterm birth interventions: A scoping review.

While antenatal recommendations regarding preterm birth are essential to preventing neonatal morbidity and mortality, implementation of these recommendations underscore how health system capacity and systemic factors, such as access and quality, greatly influence their utilization. To date, there is limited synthesis focused on the implementation of antenatal preterm birth interventions. Our objectives were to focus on implementation science studies intended to 1) increase referral mechanisms of pregnant people to higher levels of care where the management of preterm labor or delivery is possible and 2) map the implementation of preterm birth interventions, including the administration of antenatal corticosteroids, magnesium sulfate, and antibiotics.

Building HOPE: Integrating community-based doula care in public hospitals in New York City.

Maternal morbidity and mortality in the United States is an urgent public health issue, and there are stark differences by race and ethnicity. Community-based doula care is an evidence-based strategy to improve maternal health through accompaniment, health care engagement, addressing social needs, and promoting respectful care. Yet, there is a gap in access to doula care for people who are low-income or publicly insured, due to cost and availability.