Regional Variations in the Management of Cerebral Arteriovenous Malformations: A Nationwide Inpatient Sample Analysis of Surgical Excision and Endovascular Embolization.

Introduction: Cerebral arteriovenous malformations (AVMs) represent a complex neurosurgical challenge with management strategies that vary significantly across regions. The decision to treat unruptured AVMs, in particular, is controversial, with options ranging from conservative management to surgical excision or endovascular embolization. This study investigates regional variations in treating unruptured and ruptured AVMs in the United States.

Repetitive Overuse Injury Causes Entheseal Damage and Palmar Muscle Fibrosis in Older Rats.

Overuse injury is a frequent diagnosis in occupational medicine and athletics. Using an established model of upper extremity overuse, we sought to characterize changes occurring in the forepaws and forelimbs of mature female rats (14-18 months of age). Thirty-three rats underwent a 4-week shaping period, before performing a high-repetition low-force (HRLF) task for 12 weeks, with the results being compared to 32 mature controls.

L-type calcium channel blockade attenuates the anxiogenic-like effects of cocaine abstinence in female and male rats.

Cocaine abstinence and withdrawal are linked to relapse and heightened anxiety. While L-type calcium channels (LTCCs) have been associated with cocaine use disorders in humans and drug-seeking in rodents, their role in mood-related symptoms during cocaine abstinence remains unclear. We addressed this by investigating the ability of LTCC blockade with isradipine to alter the mood-related behavioral phenotypes induced by cocaine abstinence.

TPC2 controls MITF expression and metastasis in melanoma.

Recent findings by Abrahamian et al. (2024) provides new insights into the relationship between Two Pore Channel 2 (TPC2) activity and the development and progression of melanoma. Melanocyte inducing transcription factor (MITF) is a critical regulator of both melanocyte and melanoma behavior.

Rare variants in cardiomyopathy genes predispose to cardiac injury in severe COVID-19 patients of African or Hispanic ancestry.

In one of the earliest reports from China during COVID-19, it was noted that over 20% of patients hospitalized with the disease had significant elevations of troponin, a marker of myocardial tissue damage, that put them at a higher risk. In a hypothesis-independent whole exome sequencing (WES) study in hospitalized COVID-19 patients of diverse ancestry, we observed putative enrichment in pathogenic variants in genes known to be involved in the pathogenesis of cardiomyopathy. This observation led us to hypothesize that the observed high morbidity and mortality in these patients might be due to the presence of rare genetic factors that had previously been silent but became relevant as a consequence of the severe stress inflicted by an infection with SARS-CoV-2.

Mapping the Impact of Anti-LGBT Legislation on Graduate Surgical Education.

Background: LGBTQ medical students and surgery residents face myriad structural barriers. The American Civil Liberties Union (ACLU) reports 492 pieces of state-level legislation targeting Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) people in the past year. These bills including bans on medical care, "don't say gay" bills, exclusion from anti-discrimination protections, and more.

Real-world effectiveness and causal mediation study of BNT162b2 on long COVID risks in children and adolescents.

Background: The impact of pre-infection vaccination on the risk of long COVID remains unclear in the pediatric population. We aim to assess the effectiveness of BNT162b2 on long COVID risks with various strains of the SARS-CoV-2 virus in children and adolescents, using comparative effectiveness methods. We further explore if such pre-infection vaccination can mitigate the risk of long COVID beyond its established protective benefits against SARS-CoV-2 infection using causal mediation analysis.

Dual mini-fragment plate fixation of midshaft clavicle fractures demonstrates fewer union complications but similar patient-reported outcomes compared to nonoperative management: a cohort study with mean 3.4-year follow-up.

Background: Although open reduction and internal fixation is the gold standard treatment for displaced midshaft clavicle fractures, recent studies have advocated for nonoperative management, citing high rates of reoperation associated with operative intervention. However, no studies have compared nonoperative management to open reduction and internal fixation with dual-plate fixation, which may be associated with lower rates of reoperation compared to single-plate fixation. The purpose of this study was to compare the complications and patient-reported outcomes of dual mini-fragment plate fixation to nonoperative management for displaced midshaft clavicle fractures.

Computational deconvolution of cell type-specific gene expression in COPD and IPF lungs reveals disease severity associations.

Background: Chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrosis (IPF) are debilitating diseases associated with divergent histopathological changes in the lungs. At present, due to cost and technical limitations, profiling cell types is not practical in large epidemiology cohorts (n > 1000). Here, we used computational deconvolution to identify cell types in COPD and IPF lungs whose abundances and cell type-specific gene expression are associated with disease diagnosis and severity.

Prescription Medication Use and Expenditure for Atrial Fibrillation in the United States.

Objectives: To study the national trends of anticoagulants, antiarrhythmic drugs (AADs), and expenditures in the civilian noninstitutionalized atrial fibrillation (AF) population.

Methods: The Medical Expenditure Panel Survey was queried from January 2016 to December 2021 to identify adults (age ≥18 years) with a diagnosis of AF utilizing the International Classification of Diseases, Tenth Revision, Clinical Modification code I48. Prevalence of anticoagulants (AAD) and its expenditure and AF expenditure across clinical settings in the United States were estimated.

Underappreciated Effects of Delayed Graft Function in Pediatric Kidney Transplantation.

Purpose: In kidney transplantation (KT), delayed graft function (DGF) is associated with worse outcomes. However, it is unclear what effect DGF plays in long-term survival compared to the impact of the various transplant, donor, and recipient risk factors associated with DGF. This study aims to determine the effect of DGF alone on long-term survival in pediatric deceased donor kidney transplant recipients (DDKTRs).

Evidence-Based Medicine in Otolaryngology Part 15: Introduction to Peer Review-A Framework for Clinicians.

Peer review is an essential cornerstone of scientific advancement. This process involves understanding study design, data analytics, and interpretation of the evidence. For clinicians who are performing their initial peer reviews, and even for seasoned reviewers who assess complex manuscripts, it can be helpful to have a standard approach.

Caregiver Experiences with Prescribed Antibiotic Access After a Pediatric Emergency Department Visit: A Qualitative Study.

Objective: Approximately one third of caregivers do not obtain a prescribed medication after their child's pediatric emergency department visit. We sought to explore the facilitators and barriers that caregivers experience in accessing prescribed antibiotics after their child's pediatric emergency department visit.

Methods: We conducted semi-structured interviews with caregivers of children who presented to a quaternary academic pediatric emergency department and were discharged with prescribed antibiotics.

Choice of dialysis access: Catheter, peritoneal, or hemodialysis.

The most recent National Kidney Foundation Kidney Disease Outcomes Quality Initiative guidelines shifted emphasis to kidney replacement modality selection and vascular access planning and creation of the Endstage Kidney Disease Life-Plan, which promotes a patient-centered approach. The Life-Plan is intended to be created through discussions between the patient and their multidisciplinary care team to ultimately develop a lifelong kidney replacement therapy strategy. The focus of the Life-Plan is to engage the patient in a multidisciplinary patient-centered approach.

Systematic Review of the Comparative Studies of Image-Guided Thermal Ablation, Stereotactic Radiosurgery, and Sublobar Resection for Treatment of High-Risk Patients with Stage I Non-Small Cell Lung Cancer: The American Association for Thoracic Surgery Expert Consensus Document.

The Clinical Practice Standards Committee of the American Association for Thoracic Surgery assembled an expert panel and conducted a systematic review of the literature detailing studies directly comparing treatment options for high-risk patients with stage I non-small cell lung cancer (NSCLC). A systematic search was performed to identify publications comparing outcomes following image-guided thermal ablation (IGTA), stereotactic ablative radiotherapy (SABR; also called stereotactic body radiation therapy [SBRT] and stereotactic radiosurgery [SRS]), and sublobar resection-the main treatment options applicable to high-risk patients with stage I NSCLC. There were no publications detailing completed randomized controlled trials comparing these treatment options.

Dismal adherence to lung cancer screening in a diverse urban population.

Objectives: High-risk populations for lung cancer, including Black men and those with lower socioeconomic status, experience worse outcomes when treated. The mortality benefit of lung cancer screening cannot be realized without adherence to annual screening. Our study aims to understand annual adherence to lung cancer screening in a population traditionally experiencing health disparities, thus identifying lung cancer screening's impact on lung cancer disparities.

Systematic Review of Stereotactic Ablative Radiotherapy (SABR)/Stereotactic Body Radiation Therapy (SBRT) for Treatment of High-Risk Patients with Stage I Non-Small Cell Lung Cancer: The American Association of Thoracic Surgery Expert Consensus Document.

Stereotactic ablative radiotherapy (SABR) has emerged as an alternative, non-surgical treatment for high-risk patients with stage I non-small cell lung cancer (NSCLC) with increased use over time. The American Association for Thoracic Surgery (AATS) Clinical Practice Standards Committee (CPSC) assembled an expert panel and conducted a systematic review of the literature evaluating the results of SABR, which is also referred to as stereotactic body radiation therapy (SBRT) or stereotactic radiosurgery (SRS), prior to developing treatment recommendations for high-risk patients with stage I NSCLC based on expert consensus. Publications detailing the findings of 16 prospective studies of SABR and 14 retrospective studies of SABR for the management of early-stage lung cancer in 54,697 patients were identified by systematic review of the literature with further review by members of our expert panel.

Systematic Review of Sublobar Resection for Treatment of High-Risk Patients with Stage I Non-Small Cell Lung Cancer: The American Association for Thoracic Surgery Expert Consensus Document.

Sublobar resection offers a parenchymal-sparing surgical alternative to lobectomy and includes wedge resection and segmentectomy. Sublobar resection has been historically utilized in high-risk patients with compromised lung function; however, the technique is becoming more prevalent for normal-risk patients with peripheral stage IA non-small cell lung cancer (NSCLC) <2 cm. In this article, we summarize the technique of sublobar resection, the importance of surgical margins and lymph node sampling, patient selection, perioperative complications, outcomes, and the impact of sublobar resection on the quality of life.

Economic evaluation of expanding inguinal hernia repair among adult males in Sierra Leone.

Sierra Leone faces a substantial backlog of patients with inguinal hernia in need of repair due to a shortage of surgical providers. The current mitigation strategy includes task-sharing with associate clinicians and non-specialist medical doctors, and the economic impact of this approach needs assessment for potential scale-up. This study aimed to assess the cost-effectiveness of open mesh repair of inguinal hernias by associate clinicians and non-specialist medical doctors in adult males (>18 years) compared to no treatment, as well as between the two provider types and to estimate the budget impact of clearing the backlog in Sierra Leone.

Treatment Selection for the High-Risk Patient with Stage I Non-Small Cell Lung Cancer: Sublobar Resection, Stereotactic Ablative Radiotherapy or Image-Guided Thermal Ablation? The American Association for Thoracic Surgery Expert Consensus Document.

A significant proportion of patients with stage I non-small cell lung cancer (NSCLC) are considered at high risk for complications or mortality after lobectomy. The American Association for Thoracic Surgery (AATS) previously published an expert consensus document detailing important considerations in determining who is at high risk. The current objective was to evaluate treatment options and important factors to consider during treatment selection for these high-risk patients.

Systematic Review of Image-Guided Thermal Ablation for Treatment of High-Risk Patients with Stage I Non-Small Cell Lung Cancer: The American Association for Thoracic Surgery Expert Consensus Document.

Image-guided thermal ablation (IGTA) applied to pulmonary pathology is an alternative to surgery in high-risk patients with stage I non-small cell lung cancer (NSCLC). Its application to lung neoplasm was first introduced in 2001 and has been implemented to treat metastatic disease to the lung or in select medically inoperable patients with peripheral stage I NSCLC. IGTA may also be an alternative to treat stage I NSCLC in non-operable patients with interstitial lung disease in whom a radiation modality is deemed too high risk.

Perspective: Pathological transdifferentiation-a novel therapeutic target for cardiovascular diseases and chronic inflammation.

Pathological transdifferentiation, where differentiated cells aberrantly transform into other cell types that exacerbate disease rather than promote healing, represents a novel and significant concept. This perspective discusses its role and potential targeting in cardiovascular diseases and chronic inflammation. Current therapies mainly focus on mitigating early inflammatory response through proinflammatory cytokines and pathways targeting, including corticosteroids, TNF-α inhibitors, IL-1β monoclonal antibodies and blockers, IL-6 blockers, and nonsteroidal anti-inflammatory drugs (NSAIDs), along with modulating innate immune memory (trained immunity).