Incidental neutropenia: An emergency medicine focused approach.

Introduction: Neutropenia is defined as an absolute neutrophil count (ANC) < 1500 cells/microL and may be discovered incidentally in an asymptomatic, afebrile patient.

Objective: This narrative review provides an approach to the afebrile emergency department patient with incidental neutropenia.

Discussion: Neutropenia is an ANC < 1500 cells/microL, with mild neutropenia defined as an ANC ≥ 1000 to <1500 cells/microL, moderate ≥500 to <1000 cells/microL, severe <500 cells/microL, and agranulocytosis <200 cells/microL.

Do Risk Factors for HCC Impact the Association of CT/MRI LIRADS Major Features With HCC? An Individual Participant Data Meta-Analysis.

Guidelines suggest the Liver Imaging Reporting and Data System (LI-RADS) may not be applicable for some populations at risk for hepatocellular carcinoma (HCC). However, data assessing the association of HCC risk factors with LI-RADS major features are lacking. To evaluate whether the association between HCC risk factors and each CT/MRI LI-RADS major feature differs among individuals at-risk for HCC.

Injectable Intravitreal Fluocinolone Acetonide Implant for Chronic Postoperative CME in the Presence of Silicone Oil Tamponade.

Purpose: This report describes the use of the injectable intravitreal fluocinolone acetonide 0.18mg implant (FAI) for chronic postoperative cystoid macular edema (CME) in an eye with a silicone oil-filled vitreous cavity.

Methods: A retrospective chart review was performed including surgical, clinical, and imaging data.

Harvey Cushing: France Military Hospital Surgical Unit Head and World War I U.S. Army Medical Corps Commissioner.

Background: This historical account reviews the course and lasting impact of Dr. Harvey Cushing (1869-1939) in neurosurgery.

Methods: The writing of this project was sparked by the discovery of original scientific and bibliographical information about Cushing.

Ferredoxin 2 Is Critical for Tumor Suppression and Lipid Homeostasis but Dispensable for Embryonic Development.

Ferredoxin 1 and 2 (FDX1/2) constitute an evolutionarily conserved FDX family of iron-sulfur cluster-containing proteins. FDX1/2 are cognate substrates of ferredoxin reductase and serve as conduits for electron transfer from NADPH to a set of proteins involved in biogenesis of corticosteroids, hemes, iron-sulfur cluster, and lipoylated proteins. Recently, we showed that Fdx1 is essential for embryonic development and lipid homeostasis.

Updates on the MR safety guidelines - Essentials for radiologists.

Magnetic Resonance Imaging (MRI) is a sophisticated diagnostic tool that utilizes the magnetic properties of biological tissue to generate detailed images of internal structures without the use of ionizing radiation. Despite its benefits in providing high-contrast images of soft tissues, the strong magnetic fields used in MRI present a unique safety challenge. Increasing MRI-related accidents and the prevalence of patients with metallic implants in recent years underscore the critical need for stringent MR safety protocols.

Defining the needle in a haystack: A compendium of genomic, pathologic, and clinical characteristics of rare pulmonary tumors.

A major paradigm shift in the diagnosis, management, and survival outcomes of early and advanced non-small cell lung cancer has transpired over the past few decades in thoracic oncology with the incorporation of molecular testing, targeted therapy, immunotherapy, neoadjuvant, and adjuvant approaches. However, transformation in the management and survival outcomes of rare lung tumors is lacking. Given the scarcity of these tumor types, randomized trials are rarely performed, and treatment is extrapolated from case series, tumor-agnostic trials, or cancers with similar histology.

Tramadol as a fentanyl adulterant: Prevalence and management in a ToxIC Fentalog study prospective cohort.

Background: Tramadol is an adulterant of illicit opioids. As it is a serotonin-norepinephrine reuptake inhibitor as well as a μ-opioid agonist, tramadol adulteration may worsen overdose signs and symptoms or affect the amount of naloxone patients receive.

Methods: This is a multicenter, prospective cohort of adult patients with suspected opioid overdoses who presented to one of eight United States emergency departments and were included in the Toxicology Investigators Consortium's Fentalog Study.

Factors that Influence Recovery From Concussion in Young Children and Preadolescents.

Objective: To examine differences in the presentation and management of concussion in younger children (aged 4-8 years) versus preadolescents (9-12 years) and identify factors that influence recovery time.

Design: Retrospective analysis of prospectively collected data.

Setting: Pediatric sports medicine and orthopedics clinic.

Adults With Head and Neck Burns Experience Worse Long-Term Outcomes and Require More Reconstructive Surgeries: A Burn Model System Study.

Background: Adults living with head and neck burn injuries experience psychosocial consequences due to scarring as well as functional disabilities. However, the impact of head and neck burns on long-term self-reported psychosocial outcomes, return to work, and need for reconstructive surgery has not been well described. This study investigates the unique longitudinal problems in psychosocial and functional recovery faced by adults with head and neck burn injuries.

Retinoblastoma and beyond: pediatric orbital mass lesions.

Various space occupying lesions can arise in the orbit, ranging from developmental anomalies to malignancies, and many of the diseases occurring in children are different from the pathologies in the adult population. As the clinical presentation is frequently nonspecific, radiologic evaluation is essential for lesion detection and characterization as well as patient management. While orbital masses may in some cases involve multiple compartments, a simple compartmental approach is the key for the diagnosis on imaging studies, and MRI is the modality of choice.

Unraveling the clinical-pathological correlations of subjects with isolated and mixed neurodegenerative processes in the National Alzheimer's Coordinating Center dataset.

Although Alzheimer disease neuropathologic change (ADNC) is the most common pathology underlying clinical dementia, the presence of multiple comorbid neuropathologies is increasingly being recognized as a major contributor to the worldwide dementia burden. We analyzed 1051 subjects with specific combinations of isolated and mixed pathologies and conducted multivariate logistic regression analysis on a cohort of 4624 cases with mixed pathologies to systematically explore the independent cognitive contributions of each pathology. Alzheimer disease neuropathologic change and limbic-predominant age-related TDP-43 encephalopathy neuropathologic change (LATE-NC) were both associated with a primary clinical diagnosis of Alzheimer disease (AD) and were characterized by an amnestic dementia phenotype, while only ADNC associated with logopenic variant primary progressive aphasia (PPA).

Relationship Between Sleep Disturbances and Chronic Pain: A Narrative Review.

Sleep disturbances and chronic pain are prevalent and interrelated conditions that have significant impact on individuals' quality of life. Understanding the intricate dynamics between sleep and pain is crucial for developing effective treatments that enhance the well-being of affected individuals and reduce the economic burden of these debilitating conditions. This narrative review examines the complex relationship between sleep disturbances and chronic pain.

Volumetric Patch-Based Super-Resolution Reconstruction of Hyperpolarized C Cardiac MRI.

The achievable spatial resolution of C metabolic images acquired with hyperpolarized C-pyruvate is worse than H images typically by an order of magnitude due to the rapidly decaying hyperpolarized signals and the low gyromagnetic ratio of C. This study is to develop and characterize a volumetric patch-based super-resolution reconstruction algorithm that enhances spatial resolution C cardiac MRI by utilizing structural information from H MRI. The reconstruction procedure comprises anatomical segmentation from high-resolution H MRI, calculation of a patch-based weight matrix, and iterative reconstruction of high-resolution multi-slice C MRI.

Building Research Capacity (BRC): Purposes, Components, and Activities to Date.

The Building Research Capacity (BRC) initiative was founded in 2015 as a collaboration between the Association of Departments of Family Medicine (ADFM) and the North American Primary Care Research Group (NAPCRG). It aims to enhance family medicine research engagement by helping develop researchers, research educators, and research leaders. Through consultations, a fellowship, tailored presentations at national conferences, and ongoing assessment, BRC addresses the dynamic needs of various stakeholders in family medicine research.

Non-Allergist Delabeling - Should penicillin allergy delabeling only be performed by allergists?

Penicillin allergy labels (PAL) are common but rarely correspond with a patient's likelihood to tolerate penicillin. This results in unnecessary penicillin avoidance in many patients, driving numerous negative health outcomes. Evaluation strategies for PAL are driven by risk stratification and include a spectrum of modalities such as delabeling without any testing, direct oral challenge, and skin testing followed by challenge testing.

Quantitative pupillometry as a potential biomarker in early concussion assessment.

Background: There are limited objective methods when it comes to identifying and diagnosing concussion. Pupil assessment is performed routinely as a standard-of-care following traumatic brain injury (TBI). Unlike the highly subjective and limited reliability of pupil assessment using penlights and flashlights, Quantitative pupillometry (QP) is an established, valid, and reliable method of pupillary assessment.

Cardiovascular-Liver-Metabolic Health: Recommendations in Screening, Diagnosis, and Management of Metabolic Dysfunction-Associated Steatotic Liver Disease in Cardiovascular Disease via Modified Delphi Approach.

There is a new awareness of the widespread nature of metabolic dysfunction-associated steatotic liver disease (MASLD) and its connection to cardiovascular disease (CVD). This has catalyzed collaboration between cardiologists, hepatologists, endocrinologists, and the wider multidisciplinary team to address the need for earlier identification of those with MASLD who are at increased risk for CVD. The overlap in the pathophysiologic processes and parallel prevalence of CVD, metabolic syndrome, and MASLD highlight the multisystem consequences of poor cardiovascular-liver-metabolic health.

Neighborhood Factors Related to Cancer Screening in Texas: A Spatioecological Study.

Introduction: The purpose of this study is to examine the associations of neighborhood socioeconomic status, ethnic enclaves, and residential Black segregation with screening for breast, cervical, and colorectal cancers across the state of Texas.

Methods: Using an ecologic study design, spatial clustering of low breast, cervical and colorectal cancer screening rates were identified across Texas census tracts using local Moran's I statistics. Binomial spatial probit regression was used to estimate the associations between nSES, Hispanic/Latino and Asian American ethnic enclave neighborhoods and residential Black segregation with geospatial clusters of low screening, adjusting for behavioral characteristics.

Unbiased Drug Target Prediction Reveals Sensitivity to Ferroptosis Inducers, HDAC and RTK Inhibitors in Melanoma Subtypes.

Background: The utilization of PD1 and CTLA4 inhibitors has revolutionized the treatment of malignant melanoma (MM). However, resistance to targeted and immune-checkpoint-based therapies still poses a significant problem.

Objective: Here, we mine large-scale MM proteogenomic data to identify druggable targets and forecast treatment efficacy and resistance.

The role of neoadjuvant systemic therapy for high grade upper tract urothelial carcinoma: Results from the upper tract collaborative network (UCAN).

Introduction: Utilization of neoadjuvant systemic therapy (NAT) prior to radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) is inconsistent, and optimal patient selection for NAT is unclear. The purpose of this study was to evaluate the clinical benefit of NAT in high grade UTUC undergoing RNU.

Materials And Methods: The UTUC Collaborative Network (UCAN) identified patients who underwent RNU for high grade UTUC between 2000 and 2022.