Combined intrathecal baclofen pump revision to the cervical level and lumbosacral ventral-dorsal rhizotomy for severe medically refractory hypertonia: illustrative cases.

Background: Medically refractory hypertonia (MRH) within the pediatric population causes severe disability and is difficult to treat. Neurosurgery for mixed MRH includes intrathecal baclofen (ITB) and lumbosacral ventral-dorsal rhizotomy (VDR). Surgical efficacy limitations can be mitigated by combining the two into a multimodal strategy.

Clinical Activity of Mitogen-Activated Protein Kinase Inhibitors in Patients With MAP2K1 (MEK1)-Mutated Metastatic Cancers.

Purpose: MAP2K1/MEK1 mutations are potentially actionable drivers in cancer. MAP2K1 mutations have been functionally classified into three groups according to their dependency on upstream RAS/RAF signaling. However, the clinical efficacy of mitogen-activated protein kinase (MAPK) pathway inhibitors (MAPKi) for MAP2K1-mutant tumors is not well defined.

Menthol cigarette use in US pregnancies: Prevalence, racial/ethnic disparities, and associated characteristics from the 2010-2019 National Survey on Drug Use and Health (NSDUH).

Introduction: Pregnant people who smoke constitute a uniquely vulnerable population likely to be impacted by a menthol cigarette (MC) ban. However, there are no published reports of prevalence of prenatal MC use in a nationally-representative US sample including racial-ethnic disparities and associated characteristics.

Methods: Participants were 1245 US pregnant people who smoked MC or non-MC (NMC) in the past 30-days from the 2010-2019 National Survey on Drug Use and Health.

Case of a Young Male Recruit With Chest Pain Leading to Entry-Level Separation and Career Termination.

This is a case of a young, 20-year-old, male Navy recruit who was admitted to our healthcare facility with intermittent atypical chest pain and limiting exertional symptoms and was diagnosed with myocardial bridging (MB) as the most likely etiology of his chest after the complete cardiac workup, leading to his career limitations due to potential risks. Our patient presented with atypical chest pain and limiting exertional symptoms. Chest pain was non-radiating.

Lipid-Modulated, Graduated Inhibition of N-Glycosylation Pathway Priming Suggests Wide Tolerance of ER Proteostasis to Stress.

Protein N-glycosylation is a cotranslational modification that takes place in the endoplasmic reticulum (ER). Disruption of this process can result in accumulation of misfolded proteins, known as ER stress. In response, the unfolded protein response (UPR) restores proteostasis or responds by controlling cellular fate, including increased expression of activating transcription factor 4 (ATF4) that can lead to apoptosis.

NumSimEX: A method using EXX hydrogen exchange mass spectrometry to map the energetics of protein folding landscapes.

Hydrogen exchange mass spectrometry (HXMS) is a powerful tool to understand protein folding pathways and energetics. However, HXMS experiments to date have used exchange conditions termed EX1 or EX2 which limit the information that can be gained compared to the more general EXX exchange regime. If EXX behavior could be understood and analyzed, a single HXMS timecourse on an intact protein could fully map its folding landscape without requiring denaturation.

P3 site-directed mutagenesis: An efficient method based on primer pairs with 3'-overhangs.

Site-directed mutagenesis is a fundamental tool indispensable for protein and plasmid engineering. An important technological question is how to achieve the efficiency at the ideal level of 100%. Based on complementary primer pairs, the QuickChange method has been widely used, but it requires significant improvements due to its low efficiency and frequent unwanted mutations.

The Real-World Clinical Outcomes of Heavily Pretreated HER2+ and HER2-Low Metastatic Breast Cancer Patients Treated with Trastuzumab Deruxtecan at a Single Centre.

Background: Trastuzumab deruxtecan (TDXd) is an antibody-drug conjugate that has demonstrated impressive activity in randomized controlled clinical trials in the context of patients with HER2-amplified and HER2-low metastatic breast cancer. We aimed to review the activity and adverse event profile of TDXd in heavily pretreated breast cancer patients in real practice.

Methods: We describe a single-center retrospective case series of metastatic breast cancer patients who were treated with TDXd.

Gonadal Hormone Changes with Aging and Their Impact on Chronic Pain.

Chronic pain, pain that lasts beyond three months, is a common finding in the elderly. It is often due to musculoskeletal conditions but can be precipitated by other factors as well. While physiological systems decline with aging, chronic pain is influenced by changes in hormone profiles as men and women enter into andropause and menopause, respectively.

Effect of Adapted Ergometer Setup and Rowing Speed on Lower Extremity Loading in People with and Without Spinal Cord Injury.

Background: Functional electrical stimulation-assisted rowing (FES rowing) is a rehabilitation exercise used to prevent disuse osteoporosis, which is common in people with spinal cord injury (SCI). However, its effect on bone loss prevention varied in SCI patients, potentially due to inconsistent loading. This study investigates the effect of ergometer setup and rowing speed on lower extremity loading during rowing.

Bi+ Men's Explanations for Substance Use Disparities in Their Community.

Bi+ men are more likely to use alcohol and drugs than heterosexual and often gay men. The minority stress model is the predominant framework for understanding these disparities, but it is unknown whether this framework is consistent with bi+ men's perspectives. As part of an online survey, 69 bi+ young men (ages 18-29; 29% transgender) were asked why they think bisexual men are more likely to use alcohol and drugs than other men (including gay men).

Ethnic and racial differences in children and young people with respiratory and neurological post-acute sequelae of SARS-CoV-2: an electronic health record-based cohort study from the RECOVER Initiative.

Background: Children from racial and ethnic minority groups are at greater risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but it is unclear whether they have increased risk for post-acute sequelae of SARS-CoV-2 (PASC). Our objectives were to assess whether the risk of respiratory and neurologic PASC differs by race/ethnicity and social drivers of health.

Methods: We conducted a retrospective cohort study of individuals <21 years seeking care at 24 health systems across the U.

Association of anti-phosphatidylserine/prothrombin antibodies with adverse in vitro fertilization outcomes.

Anti-phosphatidylserine/prothrombin antibodies (aPS/PT) are classified as non-criteria antiphospholipid antibodies (aPL), and are strongly associated with thrombosis and pregnancy complications linked to antiphospholipid syndrome (APS). This study aimed to investigate whether aPS/PT positivity is associated with adverse outcomes in vitro fertilization (IVF). The study included infertile women who tested positive aPS/PT and underwent IVF cycles, as well as infertile controls with pure tubal etiology.

The Relationship Between Subjective Cognitive Complaints, Invalid Symptom Reporting, and Neurocognitive Test Performance Validity Among Adults Being Evaluated for ADHD.

Objective: Subjective cognitive complaints are common among patients presenting for evaluation of attention-deficit/hyperactivity disorder (ADHD). Despite these complaints, research overwhelmingly suggests that reported cognitive deficits do not align with objective neurocognitive performance. This study explored the relationship between subjective cognitive complaints, objective neuropsychological functioning, and performance and symptom validity testing in adult patients referred for evaluation due to concern about ADHD.

Ocular Biometry OCR: a machine learning algorithm leveraging optical character recognition to extract intra ocular lens biometry measurements.

Given close relationships between ocular structure and ophthalmic disease, ocular biometry measurements (including axial length, lens thickness, anterior chamber depth, and keratometry values) may be leveraged as features in the prediction of eye diseases. However, ocular biometry measurements are often stored as PDFs rather than as structured data in electronic health records. Thus, time-consuming and laborious manual data entry is required for using biometry data as a disease predictor.

Analysis of skew, examination of intercorrelations, and determining the optimal threshold for performance invalidity when 10 performance validity tests are administered during a neuropsychological evaluation.

Introduction: This study cross-validates and expands upon previous research by examining the optimal number of PVT failures necessary to determine invalid performance when 10 PVTs are administered during a neuropsychological evaluation. Additionally, the study assessed the degree of skewness of individual PVTs and PVT intercorrelations for the overall sample and by validity group.

Method: Participants were 283 adult neuropsychology outpatients evaluated at an academic medical center.

Nr4a1 and Nr4a3 redundantly control clonal deletion and contribute to an anergy-like transcriptome in auto-reactive thymocytes to impose tolerance in mice.

The Nr4a nuclear hormone receptors are transcriptionally upregulated in response to antigen recognition by the T cell receptor (TCR) in the thymus and are implicated in clonal deletion, but the mechanisms by which they operate are not clear. Moreover, their role in central tolerance is obscured by redundancy among the Nr4a family members and by their reported functions in Treg generation and maintenance. Here we take advantage of competitive bone marrow chimeras and the OT-II/RIPmOVA model to show that Nr4a1 and Nr4a3 are essential for the upregulation of Bcl2l11/BIM and thymic clonal deletion by self-antigen.

Electrical Heterogeneity in Hispanic Background Subpopulations: The HCHS/SOL.

Background: The Hispanic/Latino population is not uniform. Prevalence and clinical outcomes of cardiac arrhythmias in ethnic background subgroups are variable, but the reasons for differences are unclear. Vectorcardiographic Global Electrical Heterogeneity (GEH) has been shown to be associated with adverse cardiovascular outcomes.

Ecstasy, molly, MDMA: What health practitioners need to know about this common recreational drug.

3,4-methylenedioxymethamphetamine (MDMA; commonly referred to as "ecstasy" or "molly") is a substituted amphetamine drug that is used recreationally for its acute psychoactive effects, including euphoria and increased energy, as well as prosocial effects such as increased empathy and feelings of closeness with others. Acute adverse effects can include hyperthermia, dehydration, bruxism, and diaphoresis. Post-intoxication phenomena may include insomnia, anhedonia, anxiety, depression, and memory impairment, which can persist for days following drug cessation.

Symptom Profiles and Intensive Treatment Outcomes in Sexual Minority and Heterosexual Patients With OCD.

Sexual minority (SM) individuals appear to be at greater risk for obsessive-compulsive disorder (OCD). Despite this, little is known about OCD presentation and treatment outcomes among SM individuals. Although some research has suggested that SM individuals may be more likely to endorse intrusive thoughts related to violence/sex/religion compared to heterosexual individuals, extant literature has neglected to examine potential differences across different SM groups, a notable limitation given the apparent differences in the types of minority stress that each group experiences and the unique health disparities affecting each group.

Factors associated with willingness to perform expedited excisional treatment for patients at high risk for cervical precancer.

Background: The 2019 ASCCP Risk-Based Management Consensus Guidelines prefer expedited treatment, defined as proceeding to excisional treatment without first performing colposcopic biopsy, for patients with screening results indicating a high risk of cervical precancer. In this mixed methods study, we explored clinician attitudes toward expedited treatment.

Methods: In 2021, a national sample of 671 clinicians who performed colposcopy completed surveys; a subset (n = 41) of clinicians who performed colposcopy and/or directed patient treatment completed qualitative interviews.

Community Implementation and Evaluation of the Chicago Parent Program.

The purpose of this study was to describe and evaluate the implementation of the Chicago Parent Program (CPP) in a community setting. Included are details of the co-designed implementation by academic and community partners, and parenting and child behavior outcomes. Two hundred eighty caregivers of children aged 2-5 years participated in the CPP in seven community sites.

On Merit and Equity in Admission to US Physical Therapist Education Programs: A Qualitative Analysis of Faculty Habitus.

Introduction: In contrast to the increased diversity of the US population, historically excluded racial and ethnic groups remain underrepresented in the physical therapist profession. As decision-makers, faculty exert direct influence on enrollment through evaluating applications and determining which applicants are deserving of admission to physical therapist programs.

Review Of Literature: Faculty decision-making in admissions is a cultural process which can reproduce inequities and perpetuate underrepresentation if faculty fail to recognize systemic disparities in legitimized forms of merit.