Evaluating the Accuracy of Relative Value Unit and Operative Time Changes in Breast Reconstruction.

Background: As part of the 2021 changes to breast reconstruction CPT codes, the Relative Value Scale Update Committee (RUC) recommended adjustments to work RVUs (wRVUs) based on newly surveyed intraoperative times. Our objective was to gauge the accuracy of operative time and wRVU adjustments using national data as a benchmark.

Methods: We queried the National Surgical Quality Improvement Program (NSQIP) database for operative times from 2005-2021 for reevaluated CPT codes.

Patient Perceptions of Pessaries for Treatment of Pelvic Organ Prolapse.

Importance: A vaginal pessary is a highly effective treatment for patients with pelvic organ prolapse (POP). Patient views of pessaries and how their beliefs affect whether they choose pessary treatment is unknown.

Objective: Our objective of this study was to describe the knowledge, understanding, and patient concerns regarding pessary use for POP management.

Surgical Site Infection After Sacral Neuromodulation: Impact of Postoperative Antibiotics.

Importance: There are limited data to guide practices to reduce surgical site infections following sacral neuromodulation; however, many surgeons prescribe prophylactic postoperative antibiotics after device implantation.

Objective: The aim of the study was to compare the proportion of patients with sacral neuromodulation device-associated surgical site infections after use of prophylactic postoperative antibiotics versus none.

Study Design: This was a multicenter retrospective cohort study of patients undergoing sacral neuromodulation device implantation at 11 institutions from January 2014 to December 2023, comparing outcomes in patients who did versus did not receive prophylactic postoperative antibiotic treatment.

Collaboration encourages innovation: setting new standards in wound care with the Wound Care Collaborative Community expert panel consensus Recommendations.

Background: The Wound Care Collaborative Community (WCCC) assesses shortcomings and unmet needs in wound care by partnering with key stakeholders, such as the National Institutes of Health, the US Food and Drug Administration (FDA), industry leaders, and expert health care providers and researchers, to advance the study of wound healing. Through this work, the WCCC has identified a few key barriers to innovation in wound care. The WCCC aims to accelerate the development of science-based, patient-centered solutions and address public policy challenges related to ensuring patients receive early access to innovative treatment options.

Plasma anti-CD4 IgG levels are associated with poor immune recovery in people with HIV initiating antiretroviral therapy.

A segment of people with HIV on effective antiretroviral therapy (ART) continue to experience poor immune recovery, leaving them at heightened risk of non-AIDS-defining events (NAEs). The production of anti-CD4 IgG autoreactive antibodies is suggested as one contributing mechanism to these complications. Here, we found that plasma anti-CD4 levels do not discriminate immunological responders from nonresponders nor predict the occurrence of NAEs, suggesting it is unlikely a contributing immunopathological factor associated with these complications.

Cultural Factors, Social Structures, and Social Determinants of Health: The Need for Clarity in Assessing Psychopathology.

Over the past decade, researchers translating anthropological theories for clinical use have debated how practitioners should assess cultural factors, social structures, and social determinants of health with patients. Advocates of structural competency have suggested that clinical cultural competency programs demonstrate limited effects on health outcomes because of the static understanding of culture employed. They recommend that cultural factors be reformulated with an emphasis on social structures.

The Paradise Renal Denervation System: An FDA-approved catheter-based treatment option for resistant hypertension.

Resistant hypertension is defined as office blood pressure >140/90 mm Hg with a mean 24-hour ambulatory blood pressure of >130/80 mm Hg in patients who are compliant with 3 or more antihypertensive medications. Those who persistently fail pharmaceutical therapy may benefit from interventional treatment, such as renal denervation. Sympathetic nervous activity in the kidney is a known contributor to increased blood pressure because it results in efferent and afferent arteriole vasoconstriction, reduced renal blood flow, increased sodium and water reabsorption, and the release of renin.

Sociodemographic Disparities in the Use of Hospice by U.S. Nursing Home Residents: A Systematic Review.

Hospice can improve end-of-life (EOL) outcomes in U.S. nursing homes (NHs).

Built to remove carbon.

Building materials could facilitate long-term removal of atmospheric carbon dioxide.

Superstable lipid vacuoles endow cartilage with its shape and biomechanics.

Conventionally, the size, shape, and biomechanics of cartilages are determined by their voluminous extracellular matrix. By contrast, we found that multiple murine cartilages consist of lipid-filled cells called lipochondrocytes. Despite resembling adipocytes, lipochondrocytes were molecularly distinct and produced lipids exclusively through de novo lipogenesis.

Bile acid synthesis impedes tumor-specific T cell responses during liver cancer.

The metabolic landscape of cancer greatly influences antitumor immunity, yet it remains unclear how organ-specific metabolites in the tumor microenvironment influence immunosurveillance. We found that accumulation of primary conjugated and secondary bile acids (BAs) are metabolic features of human hepatocellular carcinoma and experimental liver cancer models. Inhibiting conjugated BA synthesis in hepatocytes through deletion of the BA-conjugating enzyme bile acid-CoA:amino acid -acyltransferase (BAAT) enhanced tumor-specific T cell responses, reduced tumor growth, and sensitized tumors to anti-programmed cell death protein 1 (anti-PD-1) immunotherapy.

Evaluation and adaptation of a two-way text messaging intervention in the WIC breastfeeding peer counseling program: A qualitative analysis.

Breastfeeding (BF) is vital for maternal and infant health, yet post-hospital discharge support remains a challenge. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides BF peer counseling prenatally and up to 1-year postpartum among low-income women in the United States. The Lactation Advice Through Texting Can Help (LATCH) intervention is an evidence-based two-way text messaging intervention that provides BF education and support in the WIC peer counseling program.

VARX Granger analysis: Models for neuroscience, physiology, sociology and econometrics.

Complex systems, such as in brains, markets, and societies, exhibit internal dynamics influenced by external factors. Disentangling delayed external effects from internal dynamics within these systems is often difficult. We propose using a Vector Autoregressive model with eXogenous input (VARX) to capture delayed interactions between internal and external variables.

Human TRMT1 and TRMT1L paralogs ensure the proper modification state, stability, and function of tRNAs.

The tRNA methyltransferase 1 (TRMT1) enzyme catalyzes the N2,N2-dimethylguanosine (m2,2G) modification in tRNAs. Intriguingly, vertebrates encode an additional tRNA methyltransferase 1-like (TRMT1L) paralog. Here, we use a comprehensive tRNA sequencing approach to decipher targets of human TRMT1 and TRMT1L.

Restrictive or Liberal Blood Transfusion in Patients with Myocardial Infarction and CKD.

Background: Chronic kidney disease (CKD) is associated with higher risk of myocardial infarction and anemia. Among patients with anemia and CKD who experience myocardial infarction, it remains uncertain if a liberal red blood cell transfusion threshold strategy (hemoglobin cutoff [Hgb] < 10 g/dL) is superior to a restrictive transfusion threshold (Hgb 7-8 g/dL) strategy.

Methods: Among the 3,504 patients enrolled in the Myocardial Ischemia and Transfusion (MINT) trial with non-missing creatinine, we compared baseline characteristics and 30-day and 6-month outcomes of patients without CKD (N = 1279), CKD with eGFR 30-60 mL/min/1.

Effect of a Narrative-Based Online Course Aimed at Reducing Stigma Toward Transgender Children and Adolescents: Longitudinal Observational Study.

Background: Stigma toward transgender children and adolescents negatively impacts their health and educational outcomes. Contact with members of stigmatized groups can dismantle stereotypes and reduce stigma by facilitating exposure to the unique cognitive and emotional perspectives of individuals within the group. Recent evidence suggests that video-based contact interventions can be as effective as face-to-face encounters, but challenges lie in protecting the identities of transgender youth, since many of them live in stealth.

Children's executive functioning and health behaviors across pediatric life stages and ecological contexts.

Executive functioning (EF) has been linked to chronic disease risk in children. Health behaviors are thought to partially explain this association. The current cross-sectional study evaluated specific domains of EF and varied health behaviors in three pediatric life stages.

Unidirectional and bidirectional causation between smoking and blood DNA methylation: evidence from twin-based Mendelian randomisation.

Cigarette smoking is associated with numerous differentially-methylated genomic loci in multiple human tissues. These associations are often assumed to reflect the causal effects of smoking on DNA methylation (DNAm), which may underpin some of the adverse health sequelae of smoking. However, prior causal analyses with Mendelian Randomisation (MR) have found limited support for such effects.

Implementation of carceral medicaid suspension and enrollment programs: perspectives of carceral and medicaid leaders.

Background: Medicaid expansion via the Affordable Care Act, more recent legislation and Medicaid 1115 waivers offer opportunity to increase health care access among individuals involved in the carceral system. Effective enrollment of new beneficiaries and temporary suspension and reactivation of existing Medicaid benefits upon release is key to the success of these efforts. This study aims to characterize how jails, prisons and Medicaid agencies are implementing Medicaid suspension and enrollment programs and identifies barriers and facilitators to implementation.

Expert Rater Agreement for Symptoms and Diagnosis of Bipolar Disorder in Youth.

The diagnosis of bipolar disorder (BD) in young children has been a topic of debate, in part owing to varied interpretation of manic-like symptoms. We examined how expert academic clinicians participating in the pediatric bipolar biobank varied in their interpretation and application of Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria and diagnoses. Study co-investigators reviewed 12 standardized narratives and for each marked a visual analog scale with their confidence in the presence of manic episodes and criteria.

The Challenging Problems of Cancer and Serious Mental Illness.

PURPOSE OF REVIEW: Patients with Serious Mental Illness (SMI) are reported to be at higher risk for somatic disorders (e.g. cardiovascular and metabolic diseases) and higher mortality, compared to the general population, because of the consequences of SMI including psychotropic medication side effects, sedentary and unhealthy lifestyle, difficult access to physical health care.