Proposed Immunopathogenetic Mechanisms Underlying Lyme Arthritis.

Lyme disease is commonly associated with musculoskeletal features, inflammatory and noninflammatory. The precise pathogenesis of the clinical features of this infection are complex and often multiple. A better understanding of how Borrelia burgdorferi causes these musculoskeletal manifestations is necessary in order to determine the proper treatment and eschew that which is unlikely to work, often associated with toxicities.

Changes in Medication Complexity and Post-Hospitalization Outcomes in Older Adults Hospitalized for Heart Failure.

Introduction: Medication regimen complexity may be an important risk factor for adverse outcomes in older adults with heart failure. However, increasing complexity is often necessary when prescribing guideline-directed medical therapy at the time of a heart failure hospitalization. We sought to determine whether increased medication regimen complexity following a heart failure hospitalization was associated with worse post-hospitalization outcomes.

Neurovascular Complications Following Clavicle Fracture Fixation: Timing, Mechanisms, and Clinical Implications.

This review addresses the neurovascular complications associated with the surgical treatment of clavicle fractures through open reduction and internal fixation (ORIF). Despite being a generally safe procedure, it can lead to severe complications including brachial plexopathy, pseudoaneurysm, arteriovenous fistulas (AVF), deep vein thrombosis (DVTs), and thoracic outlet syndrome (TOS). One significant observation, not often highlighted in previous literature, is that neurovascular complications are more common in cases involving delayed fixation, nonunion, or malunion, compared to those treated acutely.

The MPCETT: Assessing the Safety and Utility of Exercise Tolerance Testing in Children With Concussion Ages 6 to 12.

Objective: Treadmill test protocols for concussion assessment have been validated for patients aged 13 years and older; however, no evidence-based guidelines exist for younger children. We designed and assessed the safety and utility of the Morahan Pediatric Concussion Exercise Tolerance Test (MPCETT) for assessing exercise tolerance in symptomatic children (SC) and recovered, asymptomatic children (AC) from 6 to 12 years of age.

Design: Retrospective case series.

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.

Urinary Catheter Utility in Laparoscopic Appendectomy: Risk Benefit Analysis of Post-Operative Urinary Tract Complications.

Catheter-associated urinary tract infections (CAUTIs) account for 1 million nosocomial infections annually and 75% of all hospital-acquired UTIs. A risk factor for CAUTI is prolonged urinary catheterization (UC); therefore, transitory UC during laparoscopic appendectomy (LA), a common practice justified to avoid iatrogenic bladder injury, is believed to be safe. However, data on the incidence of post-operative UC-related complications, including CAUTI, following LA or their avoidance are limited.

Restrictive versus Liberal Transfusion in Myocardial Infarction - A Patient-Level Meta-Analysis.

Background: Clinical guidelines have concluded that there are insufficient data to provide recommendations for the hemoglobin threshold for the use of red cell transfusion in patients with acute myocardial infarction (MI) and anemia. After the recent publication of the Myocardial Infarction and Transfusion (MINT) trial, we performed an individual patient-level data meta-analysis to evaluate the effect of restrictive versus liberal blood transfusion strategies.

Methods: We conducted searches in major databases.

AI-assisted human clinical reasoning in the ICU: beyond "to err is human".

Diagnostic errors pose a significant public health challenge, affecting nearly 800,000 Americans annually, with even higher rates globally. In the ICU, these errors are particularly prevalent, leading to substantial morbidity and mortality. The clinical reasoning process aims to reduce diagnostic uncertainty and establish a plausible differential diagnosis but is often hindered by cognitive load, patient complexity, and clinician burnout.

Oral Microbiome Signatures as Potential Biomarkers for Gastric Cancer Risk Assessment.

Background: Gastric cancer (GC) is the fifth leading cause of cancer-related death worldwide. The oral microbiota was investigated for distinguishable characteristics between GC, premalignant gastric conditions (Pre-GC), and control participants.

Methods: Mouthwash samples from GC, Pre-GC, and control participants at a tertiary care center were prospectively collected.

Current Utilization of Bupropion Treatment in Children, Young Adults, and Adults in the United States.

While available for decades, the use of bupropion has increased in recent years. To provide an updated review on the use of bupropion, this article aimed to describe bupropion prescription details, potential indication, and treatment duration in children, young adults, and adults starting bupropion treatment. Individuals aged 6-64 newly initiating bupropion hydrochloride treatment were identified from commercial claims data (MarketScan, 1/1/2016-12/31/2022).

Parents' perspectives and behaviors regarding their child's access to alcohol: Variation by race/ethnicity, socioeconomic status, and neighborhood.

Background: Setting rules about alcohol use and minimizing its availability in the home are known effective parent-level strategies for reducing underage drinking risk. However, parents' restrictions and their perceptions of their child's alcohol access have rarely been considered in combination (e.g.

Effectiveness of ceftazidime-avibactam versus ceftolozane-tazobactam for multidrug-resistant Pseudomonas aeruginosa infections in the USA (CACTUS): a multicentre, retrospective, observational study.

Background: Ceftolozane-tazobactam and ceftazidime-avibactam are preferred treatment options for multidrug-resistant Pseudomonas aeruginosa infections; however, real-world comparative effectiveness studies are scarce. Pharmacokinetic and pharmacodynamic differences between the agents might affect clinical response rates. We aimed to compare the effectiveness of ceftolozane-tazobactam and ceftazidime-avibactam for treatment of invasive multidrug-resistant P aeruginosa infections.

Landscape and prognostic significance of oncogene drivers in metastatic castration sensitive prostate cancer.

Background: Tumor suppressors are well known drivers of cancer invasion and metastasis in metastatic castration sensitive prostate cancer (mCSPC). However, oncogenes are also known to be altered in this state, however the frequency and prognosis of these alterations are unclear. Thus, we aimed to study the spectrum of oncogene mutations in mCSPC and study the significance of these alteration on outcomes.

Bladder sparing management for muscle-invasive bladder cancer after a complete clinical response: ready for prime time?-a narrative review.

Background And Objective: A standard of care for muscle-invasive bladder cancer (MIBC) is cisplatin-based neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC). Given recent improvements in NAC and the morbidity associated with RC, bladder-sparing therapy has been investigated as a promising treatment for patients with MIBC who experience a complete clinical response (CCR) to systemic therapy. However, clinical staging is unreliable, making it challenging to determine ideal candidates for bladder-sparing therapy.

Five Year Outcomes in Low-Risk Patients Undergoing Surgery in the PARTNER 3 Trial.

Background: Surgery remains an important treatment for low-risk patients with severe symptomatic aortic stenosis (AS). We evaluated 5-year outcomes in low-risk patients undergoing isolated surgical aortic valve replacement (SAVR) or SAVR with concomitant procedures within the randomized PARTNER 3 trial.

Methods: In the PARTNER 3 trial, 454 patients underwent surgery for severe, symptomatic, tri-leaflet AS and were followed for 5 years.

eEF2K regulates pain through translational control of BDNF.

mRNA translation is integral to pain, yet the key regulatory factors and their target mRNAs are unclear. Here, we uncover a mechanism that bridges noxious insults to multiple phases of translational control in murine sensory neurons. We find that a painful cue triggers repression of peptide chain elongation through activation of elongation factor 2 kinase (eEF2K).

Disseminated histoplasmosis with oral involvement and co-infection with Pneumocystis in a patient with HIV: A case report.

Oral manifestations of disseminated histoplasmosis are rare but can present in immunocompromised individuals. We report a case of disseminated Histoplasmosis presenting with presumed oral involvement and pneumonia in a seropositive HIV individual. A 32-year-old male with HIV presented to the emergency department for a two-week history of abdominal pain and a tongue ulcer in the setting of significant weight loss, blood-tinged sputum, and non-adherence with antiretroviral therapy for three years.

Dependence of clot structure and fibrinolysis on apixaban and clotting activator.

Background: Anticoagulants prevent the formation of potentially fatal blood clots. Apixaban is a direct oral anticoagulant that inhibits factor (F)Xa, thereby impeding the conversion of prothrombin into thrombin and the formation of blood clots. Blood clots are held together by fibrin networks that must be broken down (fibrinolysis) to restore blood flow.

Single-Position Prone Lateral Interbody Fusion is Associated with Improved Radiographic and Clinical Outcomes at One Year compared to Single-Position Lateral Interbody Fusion: A Single Institution Experience.

Background: Recent studies highlight the increasing adoption of single-position prone lateral(SP-PL) and single-position lateral decubitus(SP-LD) in Minimally Invasive Spine Surgery(MISS) to reduce operative time, enhance patient safety, and improve surgical accessibility.

Objective: To assess the differences between SP-PL and SP-LD achievement of optimal postoperative outcomes and post-operative complication rates.

Study Design: Retrospective review of prospectively collected MIS database.