Community Racial and Ethnic Representation Among Physicians in US Internal Medicine Residency Programs.

Importance: Increasing underrepresented in medicine (URIM) physicians among historically underserved communities helps reduce health disparities. The concordance of URIM physicians with their communities improves access to care, particularly for American Indian and Alaska Native, Black, and Hispanic or Latinx individuals.

Objectives: To explore county-level racial and ethnic representation of US internal medicine (IM) residents, examine racial and ethnic concordance between residents and their communities, and assess whether representation varies by presence of academic institutions or underserved settings.

Real-world application of CCTA with CT-FFR for coronary assessment pre-TAVI: the CT2TAVI study.

This study aims to evaluate the implementation of concomitant CAD assessment on pre-TAVI (transcatheter aortic valve implantation) planning CTA (CT angiography) aided by CT-FFR (CT-fractional flow reserve) [The CT2TAVI protocol] and investigates the incremental value of CT-FFR to coronary CT angiography (CCTA) alone in the evaluation of patients undergoing CT2TAVI. This is a prospective observational real-world cohort study at an academic health system on consecutive patients who underwent CTA for TAVI planning from 1/2021 to 6/2022. This represented a transition period in our health system, from not formally reporting CAD on pre-TAVI planning CTA (Group A) to routinely reporting CAD on pre-TAVI CTA (Group B; CT2TAVI protocol).

Ovarian function after COVID-19: long-term effects and vaccine safety in ART patients.

Purpose: This study aimed to evaluate the long-term impact of mild COVID-19 infection and COVID-19 vaccination on ovarian function in patients undergoing assisted reproductive technology (ART). Specifically, we assessed ovarian outcomes between 9 and 18 months post-infection and investigated the effects of COVID-19 vaccines (inactivated virus and adenovirus) on reproductive parameters.

Methods: The study included two objectives: (a) examining ovarian function in post-COVID-19 patients (9-18 months post-infection) compared to a control group and (b) comparing reproductive outcomes in vaccinated versus unvaccinated patients.

A Statistically-Robust Model of the Axomyelin Unit under Normal Physiologic Conditions with Application to Disease States.

Despite tremendous progress in characterizing the myriad cellular structures in the nervous system, a full appreciation of the interdependent and intricate interactions between these structures is as yet unfulfilled. Indeed, few more so than the interaction between the myelin internode and its ensheathed axon. More than a half-century after the ultrastructural characterization of this axomyelin unit, we lack a reliable understanding of the physiological properties, the significance and consequence of pathobiological processes, and the means to gauge success or failure of interventions designed to mitigate disease.

Early events in G-quadruplex folding captured by time-resolved small-angle X-ray scattering.

Time-resolved small-angle X-ray experiments are reported here that capture and quantify a previously unknown rapid collapse of the unfolded oligonucleotide as an early step in the folding of hybrid 1 and hybrid 2 telomeric G-quadruplex structures. The rapid collapse, initiated by a pH jump, is characterized by an exponential decrease in the radius of gyration from 24.3 to 12.

Awaiting insurance coverage: Medicaid enrollment and post-acute care use after traumatic injury.

Background: Lack of insurance after traumatic injury is associated with decreased use of postacute care and poor outcomes. Insurance linkage programs enroll eligible patients in Medicaid at the time of an unplanned admission. We hypothesized that Medicaid enrollment would be associated with increased use of postacute care, but also with prolonged hospital length of stay (LOS) while awaiting insurance authorization.

Efficacy and safety of risankizumab for the treatment of patients with plaque type psoriasis.

Risankizumab (Skyrizi, Abbvie, North Chicago, IL, USA) is a humanized immunoglobulin (Ig) G1 monoclonal antibody targeting the p19 subunit of IL-23, thereby inhibiting IL-23-dependent releasing of proinflammatory cytokines in plaque psoriasis. Risankizumab is licensed is most countries for the treatment of patients with moderate-to-severe plaque psoriasis, and in Japan for generalized pustular psoriasis, erythrodermic psoriasis and palmoplantar pustulosis. Risankizumab showed higher efficacy and favorable safety profiles in patients with moderate-to-severe plaque psoriasis, compared with adalimumab, secukinumab and ustekinumab in several randomized controlled phase 3 pivotal studies and among real-life data in large retrospective studies.

Discovery of DCAF16 Binders for Targeted Protein Degradation.

Conventional small-molecule drugs primarily operate by inhibiting protein function, but this approach is limited when proteins lack well-defined ligand-binding pockets. Targeted protein degradation (TPD) offers an alternative approach by harnessing cellular degradation pathways to eliminate specific proteins. Recent studies have expanded the potential of TPD by identifying additional E3 ligases, with DCAF16 emerging as a promising candidate for facilitating protein degradation through both proteolysis-targeting chimera (PROTAC) and molecular glue mechanisms.

Emergent Carotid Stenting During Thrombectomy in Tandem Occlusions Secondary to Dissection: A STOP-CAD Secondary Study.

The optimal endovascular management of cervical carotid dissection causing tandem occlusion remains uncertain. We investigated the impact of emergent carotid stenting during endovascular treatment (EVT) for acute ischemic stroke (AIS) in patients with tandem occlusion secondary to cervical carotid artery dissection. This was a secondary analysis of patients treated with EVT for AIS due to occlusive carotid artery dissection and tandem occlusion included in the retrospective international Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection (STOP-CAD) study.

US general population food allergy treatment preferences: a discrete choice experiment.

Objective: To quantify treatment preferences for food allergy management options (oral immunotherapy, biologic therapy, and allergen avoidance), overall and by sociodemographic strata.

Methods: A US general population (≥13 years) discrete choice experiment (DCE) conducted comprised of 12 treatment-feature focused DCE choice sets; the Intolerance of Uncertainty─12 Scale (IUS-12); and clinical/demographic questions. Conditional logistic regression analyses were conducted overall and by age, income, urbanization, educational attainment, food and other sociodemographic factors, and presented as odds ratios (ORs) with 95% confidence intervals (CIs).

Mentorship in Plastic Surgery: A Systematic Review of the Current Literature and Elucidation of Recurring Themes.

Background: Mentorship is an integral part of developing competent, passionate, and successful plastic surgeons and is an important element of surgeons' wellness. Although mentorship programs have been described in the literature, this study aimed to elucidate the specific qualities of an effective mentor in plastic surgery.

Methods: Preferred Reporting Items for Systematic Reviews and Meta-analyses methodology was utilized to conduct a systematic review of the literature.

Career Planning and Maintaining Well-being in Academic Plastic Surgery.

Success in academic plastic surgery is based on the traditional pillars of promotion: clinical excellence, teaching, research, leadership, and service to the university and community. The time commitment and workload for career advancement are highly demanding and, therefore, well-being is essential to avoid burnout. A congruent healthy work environment that meets institutional goals and surgeons' objectives can be established through inclusive, transparent, strategic, and operational planning.

A Case of Subungual Exostosis Mimicking Verruca Vulgaris.

Subungual exostosis is a benign bone tumor causing nail deformities and possibly pain for the patient. Etiology includes trauma, infection, and activation of a cartilaginous cyst, more commonly seen in adult patients. Here, we present a case of subungual exostosis in a pediatric patient that initially mimicked subungual verruca vulgaris.

The Impact of Lifestyle Intervention Programs on Long-Term Cardiac Event-Free Survival in Patients With Established Coronary Artery Disease.

Coronary artery disease (CAD) is a leading global cause of morbidity and mortality, necessitating comprehensive approaches for its management. This systematic review evaluates the long-term impact of structured lifestyle intervention programs on cardiac event-free survival in patients with established CAD. A total of eight studies, including randomized controlled trials (RCTs) and prospective cohort studies, were analyzed, encompassing diverse interventions such as cardiac rehabilitation, dietary modifications, exercise programs, and psychosocial support.

Comparative main effects, mediators, and moderators of cognitive behavioral therapy, acceptance and commitment therapy, and emotional awareness and expression therapy for chronic spinal pain: Randomized controlled trial rationale and protocol.

Background: Chronic spinal (back/neck) pain is common and costly. Psychosocial treatments are available but have modest effects. Knowledge of treatment mechanisms (mediators and moderators) can be used to enhance efficacy.

Developing a Novel Integrative Health Equity and Anti-racism Tool (IHEART) for Pilot Application in a Multicenter Integrative Health Elective for Medical Students and Resident Physicians: A Study Protocol.

Background: This study protocol introduces the Integrative Health Equity and Anti-Racism Tool (IHEART), an innovative instrument designed to infuse equity, diversity, and inclusion (EDI) into Integrative Health (IH) education. Recognizing the gaps in current IH training that fail to address social and systemic inequities adequately, the IHEART is intended to respond to the growing need for inclusivity in IH practices and educational materials. The tool is mainly focused on addressing issues such as accessibility of complementary and integrative health (CIH) therapies, cultural misappropriation, anti-racism, gender diversity, disability justice, trauma-informed care, weight inclusivity, and planetary health, which are currently inconsistently covered in IH training.

Trends in Formulary Restrictions for Long-Acting Injectable Antipsychotic Medications Among Medicare Drug Plans, 2019-2023.

Objective: Long-acting injectable antipsychotics (LAIAPs) enable safe and effective long-term management of chronic psychotic disorders but are underused in clinical practice. The authors examined whether Medicare formulary restrictions (prior authorization [PA] or step therapy) impose barriers to LAIAP uptake.

Methods: The authors analyzed formulary restrictions and patient cost-sharing for several LAIAPs and estimated the percentage of plans (N=2,494 were available per year) applying formulary restrictions.

Use of a Continuum-Based Framework to Advance General Health Integration in Community Behavioral Health Clinics.

Objective: This study assessed the utility and effectiveness of the new general health integration (GHI) framework among community behavioral health organizations designated as certified community behavioral health clinics (CCBHCs) or in the process of applying to become a CCBHC.

Methods: Nineteen licensed community behavioral health clinics, 18 of which had CCBHC status, participated in a 12-month learning collaborative. They used the GHI framework to assess their integration stage for 15 subdomains within eight domains of evidence-based practice.

Positive STEPS: Enhancing Medication Adherence and Achieving Viral Load Suppression in Youth Living with HIV in the United States - Results from a Stepped-Care Randomized Controlled Efficacy Trial.

Background: In the U.S. and worldwide, there is a significant number of young people acquiring and living with HIV.

Ulinastatin treatment mitigates glycocalyx degradation and associated with lower postoperative delirium risk in patients undergoing cardiac surgery: a multicentre observational study.

Background: Ulinastatin (UTI), recognized for its anti-inflammatory properties, holds promise for patients undergoing cardiac surgery. This study aimed to investigate the relationship between intraoperative UTI administration and the incidence of delirium following cardiac surgery.

Methods: A retrospective analysis was performed on a retrospective cohort of 6,522 adult cardiac surgery patients to evaluate the relationship between UTI treatment and the incident of postoperative delirium (POD) in patients ongoing cardiac surgery.

Increased serum GM-CSF at diagnosis of biliary atresia is associated with improved biliary drainage.

Background: The immune heterogeneity of biliary atresia (BA) presents a challenge for development of prognostic biomarkers. This study aimed to identify early immune signatures associated with biliary drainage after Kasai Portoenterostomy (KPE).

Methods: Serum samples, liver slides, and clinical data were obtained from patients enrolled in the NIDDK-supported Childhood Liver Disease Research Network.

Triaging mammography with artificial intelligence: an implementation study.

Purpose: Many breast centers are unable to provide immediate results at the time of screening mammography which results in delayed patient care. Implementing artificial intelligence (AI) could identify patients who may have breast cancer and accelerate the time to diagnostic imaging and biopsy diagnosis.

Methods: In this prospective randomized, unblinded, controlled implementation study we enrolled 1000 screening participants between March 2021 and May 2022.

Hallmark discoveries in the biology of non-Wilms tumour childhood kidney cancers.

Approximately 20% of paediatric and adolescent/young adult patients with renal tumours are diagnosed with non-Wilms tumour, a broad heterogeneous group of tumours that includes clear-cell sarcoma of the kidney, congenital mesoblastic nephroma, malignant rhabdoid tumour of the kidney, renal-cell carcinoma, renal medullary carcinoma and other rare histologies. The differential diagnosis of these tumours dates back many decades, when these pathologies were identified initially through clinicopathological observation of entities with outcomes that diverged from Wilms tumour, corroborated with immunohistochemistry and molecular cytogenetics and, subsequently, through next-generation sequencing. These advances enabled near-definitive recognition of different tumours and risk stratification of patients.