Metabolic Adaptation and Its Determinants in Adolescents Two Years After Sleeve Gastrectomy.

Weight loss is associated with reductions in resting energy expenditure (REE), which are impacted by changes in body composition following sleeve gastrectomy (SG). Current data regarding changes in measured REE (mREE) and metabolic adaptation in adolescents after SG are limited. We evaluated changes in mREE, metabolic adaptation, and body composition in youths after SG vs.

The α-synuclein seed amplification assay: Interpreting a test of Parkinson's pathology.

The α-synuclein seed amplification assay (αSyn-SAA) sensitively detects Lewy pathology, the amyloid state of α-synuclein, in the cerebrospinal fluid (CSF) of patients with Parkinson's disease (PD). The αSyn-SAA harnesses the physics of seeding, whereby a superconcentrated solution of recombinant α-synuclein lowers the thermodynamic threshold (nucleation barrier) for aggregated α-synuclein to act as a nucleation catalyst ("seed") to trigger the precipitation (nucleation) of monomeric α-synuclein into pathology. This laboratory setup increases the signal for identifying a catalyst if one is present in the tissue examined.

Pilot training for clinical research professionals in using empathy to recognize and respond to implicit bias in research recruitment and retention.

Recruiting and retaining research participants is challenging because it often requires overcoming structural barriers and addressing how histories of mistrust and individuals' lived experiences affect their research engagement. We describe a pilot workshop designed to educate clinical research professionals on using empathy skills to recognize and mitigate bias to improve recruitment and retention. In a post-workshop survey (22/31 participants completed), 94% agreed the workshop helped them practice perspective-taking, recognize implicit bias, and identify opportunities for empathy.

New Technique of Commissural Reconstruction: "Ship Technique" in Rheumatic Mitral Repairs.

The commissures are the supporting unit for the leaflets, and they play a vital role in the diastolic and systolic functioning of the mitral valve. This report describes the "ship technique" of commissural reconstruction in rheumatic mitral stenosis repairs. The technique overcomes gradients that are often encountered with limited commissurotomy and residual leaks observed with extended commissurotomy.

Occlusion of Abnormal Circumflex Coronary Artery During Mitral Valve Repair.

We describe a rare but interesting complication of totally endoscopic robotic mitral valve repair in a patient with severe mitral regurgitation. The mitral valve was repaired robotically by standard techniques, and the intraoperative transesophageal echocardiogram demonstrated no residual mitral regurgitation. However, there was unexpected hypokinesia of the posterior and lateral walls of the left ventricle, with subsequent electrocardiography showing acute ST elevations of the lateral segment.

Phase I-II study of prone hypofractionated accelerated breast and nodal intensity modulated radiation therapy.

Background: In patients with breast cancer, prone radiation therapy (RT) has been shown to reduce heart and lung dose. Though prone positioning is routinely used for whole breast RT, its use when treating the regional lymph nodes (RLNs) is not widespread.

Methods: In this phase I-II trial for stage IB-IIA breast cancer treated with lumpectomy or mastectomy, patients received 40.

Evaluating ADHD medication trial representativeness: a Swedish population-based study comparing hypothetically trial-eligible and trial-ineligible individuals.

Background: Randomised controlled trials (RCTs) evaluating ADHD medications often use strict eligibility criteria, potentially limiting generalisability to patients in real-world clinical settings. We aimed to identify the proportion of individuals with ADHD who would be ineligible for medication RCTs and evaluate differences in treatment patterns and clinical and functional outcomes between RCT-eligible and RCT-ineligible individuals.

Methods: We used multiple Swedish national registries to identify individuals with ADHD, aged at least 4 years at the age of diagnosis, initiating pharmacological treatment between Jan 1, 2007, and Dec 31, 2019, with follow-up up to Dec 31, 2020.

Radical Resection of a Radial Ewing Sarcoma and Ulnar Centralization in a 10-Month-Old Girl: A Case Report.

Case: We outline the management of a 10-month-old girl with an Ewing sarcoma involving the entire radius. The patient was treated with neoadjuvant chemotherapy resulting in almost a complete response. A limb-sparing procedure was performed consisting of a radical resection of the entire radius and centralization of the carpus to the ulna.

Cardiovascular Disease and Cancer: A Dangerous Liaison.

The field of cardio-oncology has traditionally focused on the impact of cancer and its therapies on cardiovascular health. Mounting clinical and preclinical evidence, however, indicates that the reverse may also be true: cardiovascular disease can itself influence tumor growth and metastasis. Numerous epidemiological studies have reported that individuals with prevalent cardiovascular disease have an increased incidence of cancer.

"Gender-Affirming Vaginoplasty Using Robotic Peritoneal Flap Method: Long Term Outcomes of 500 Cases".

Objective: The objective of this study was to determine the outcomes of robotic peritoneal flap vaginoplasty.

Background: There is a lack of long-term outcomes data for gender-affirming vaginoplasty to inform patient decision-making.

Methods: A retrospective cohort of 500 consecutive patients undergoing robotic peritoneal flap vaginoplasty from 2017-2023 were reviewed.

Medical students' perceptions of mentorship in cardiothoracic surgery: A Thoracic Surgery Medical Student Association Nationwide Survey.

Objective: The study objective was to explore medical students' perceptions of mentorship in cardiothoracic surgery in the United States.

Methods: A voluntary, anonymous electronic survey was distributed to medical students through the Thoracic Surgery Medical Student Association. The survey included 28 questions across 4 domains: demographic information, current mentorship status, goals and qualities sought in mentorship, and self-reported barriers to mentorship.

The TRIPOD-LLM reporting guideline for studies using large language models.

Large language models (LLMs) are rapidly being adopted in healthcare, necessitating standardized reporting guidelines. We present transparent reporting of a multivariable model for individual prognosis or diagnosis (TRIPOD)-LLM, an extension of the TRIPOD + artificial intelligence statement, addressing the unique challenges of LLMs in biomedical applications. TRIPOD-LLM provides a comprehensive checklist of 19 main items and 50 subitems, covering key aspects from title to discussion.

Medical large language models are vulnerable to data-poisoning attacks.

The adoption of large language models (LLMs) in healthcare demands a careful analysis of their potential to spread false medical knowledge. Because LLMs ingest massive volumes of data from the open Internet during training, they are potentially exposed to unverified medical knowledge that may include deliberately planted misinformation. Here, we perform a threat assessment that simulates a data-poisoning attack against The Pile, a popular dataset used for LLM development.

Management of alcohol withdrawal syndromes in general hospital settings.

The covid-19 pandemic was associated with an unprecedented increase in alcohol consumption and associated morbidity, including hospitalizations for alcohol withdrawal. Clinicians based in hospitals must be ready to identify, assess, risk-stratify, and treat alcohol withdrawal with evidence based interventions. In this clinically focused review, we outline the epidemiology, pathophysiology, clinical manifestations, screening, assessment, and treatment of alcohol withdrawal in the general hospital population.

Impact of Locum Tenens Providers on Delivery of Pediatric Surgical Care.

Introduction: We sought to understand the impact of locum tenens surgeons on pediatric surgical care delivery.

Methods: We conducted a cross-sectional survey of Children's Hospital Association pediatric surgical practices. Anonymous electronic surveys were used to investigate locum tenens utilization, primary reason for use, limitations on clinical activities, and variations in practice standards or quality.

Visions by WIMIN: Imposter Phenomenon.

The imposter phenomenon (IP) is a destructive set of beliefs, traits, and experiences in which high-achieving individuals fail to internalize their accomplishments and falsely perceive themselves as frauds. IP is a function of underrepresentation and contributes to and perpetuates a cycle of low self-worth, perfectionism, and anxiety, all of which negatively affect job performance and reinforce the IP cycle. Mitigating the deleterious effects of IP requires first naming this phenomenon and recognizing the patterns of IP.

Mental Health Care Utilization and Prescription Rates Among Children, Adolescents, and Young Adults in France.

Importance: Amid escalating mental health challenges among young individuals, intensified by the COVID-19 pandemic, analyzing postpandemic trends is critical.

Objective: To examine mental health care utilization and prescription rates for children, adolescents, and young adults before and after the COVID-19 pandemic.

Design, Setting, And Participants: This population-based time trend study used an interrupted time series analysis to examine mental health care and prescription patterns among the French population 25 years and younger.

Rehabilitation at Home Using Mobile Health for Older Adults Hospitalized for Ischemic Heart Disease: The RESILIENT Randomized Clinical Trial.

Importance: Among older adults with ischemic heart disease, participation in traditional ambulatory cardiac rehabilitation (CR) remains low. While mobile health CR (mHealth-CR) provides a novel opportunity to deliver care, age-specific impairments to technology use may limit uptake, and efficacy data are currently lacking.

Objective: To test whether mHealth-CR improves functional capacity in older adults.

The Use of Retinal Imaging Including Fundoscopy, OCT, and OCTA for Cardiovascular Risk Stratification and the Detection of Subclinical Atherosclerosis.

Purpose Of Review: Cardiovascular disease (CVD) is a leading cause of preventable morbidity and mortality globally, and retinal imaging modalities (old and new) are being explored as noninvasive tools to predict latent atherosclerosis and cardiovascular disease. This review focuses on the emerging promise of fundoscopy, optical coherence tomography (OCT), and optical coherence tomography angiography (OCTA) in CVD prognostication.

Recent Findings: High-quality studies have established the utility of vessel-based parameters and discrete conditions diagnosable via fundoscopy in subclinical atherosclerosis detection or CVD prediction.

Enhanced D614G and Omicron Variants Antibody Persistence in Infants at 2 Months of Age Following Maternal mRNA Booster Vaccination During Pregnancy or Postpartum.

Background: Following maternal COVID-19 vaccination, the persistence of antibodies in sera and breast milk for mothers and infants is not well characterized. We sought to describe the persistence of antibodies through 2 months after delivery in maternal and infant serum and breast milk following maternal COVID-19 mRNA vaccination and to examine differences by receipt of booster dose during pregnancy or postpartum.

Methods: This is a prospective cohort study with enrollment from July 2021 to January 2022 at 9 US academic sites.

An implementation trial to mAnage siCkle CELl disEase through incReased AdopTion of hydroxyurEa in Nigeria (ACCELERATE): Study protocol.

Background: Despite the proven efficacy of evidence-based healthcare interventions in reducing adverse outcomes and mortality associated with Sickle Cell Disease (SCD), a vast majority of affected individuals in Africa remain deprived of such care. Hydroxyurea (HU) utilization among SCD patients in Sub-Saharan Africa (SSA) stands at less than 1%, while in Nigeria, approximately 13% of patients benefit from HU therapy. To enhance HU utilization, targeted implementation strategies addressing provider-level barriers are imperative.

Perseverance of Optimal Realignment is Associated With Improved Cost-utility in Adult Cervical Deformity Surgery.

Background: Early-term complications may not predict long-term success after adult cervical deformity (ACD) correction.

Objective: Evaluate whether optimal realignment results in similar rates of perioperative complications but achieves longer-term cost-utility.

Study Design: Retrospective cohort study.

Gaps in Physical Medicine and Rehabilitation for Blindness and Low Vision: The Imperative of Rehabilitation for Visual Disability.

Persons with blindness and low vision experience increased fall and injury risk beyond atypical biomechanics and balance impairments. Falling risk doubles with blindness, and more than triples with depth perception losses. Despite this, physical therapy focuses on musculoskeletal injuries postevent rather than taking a proactive and preventative approach for persons with blindness and low vision.

A Perspective on the MARS2 Trial.

Introduction: The phase 3 randomized controlled trial of extended pleurectomy decortication and chemotherapy versus chemotherapy alone for pleural mesothelioma (PM) (MARS2) reported "extended pleurectomy decortication was associated with worse survival to 2 years, and more serious adverse events for individuals with resectable PM, compared with chemotherapy alone." These results have led to considerable discourse regarding the future role of surgery for PM, and there has not been unanimity in the mesothelioma surgical community regarding the trial interpretation. This "perspective" evaluates MARS2 using internationally renowned PM experts who either agreed with the trial interpretation or who found issues with its conduct which may have influenced the results.