Management of Persistent Hypernasality After Pharyngeal Flap by Revision Palatoplasty With Use of MRI to Aid Surgical Decision Making.

Objective: Describe surgical decision making and outcomes in a series of patients with persistent VPI after pharyngeal flap placement that were all treated with revision palatoplasty.

Design: Retrospective, case series.

Participants: Five patients with nonsyndromic cleft palate and persistent hypernasality following a pharyngeal flap.

Relationship Between Left Ventricular Ejection Fraction and ICD-10 Codes Among Patients Hospitalized With Heart Failure.

Introduction: While left ventricular ejection fraction (LVEF) represents an important means by which to classify patients with heart failure (HF), relatively little is known about the distribution of LVEFs among patients hospitalized for HF based on their International Classification of Disease (ICD)-10 code.

Methods: We performed a retrospective cross-sectional analysis of patients admitted to a large integrated health system within the western US between January 1, 2018 and October 1, 2022 with a principal diagnosis of HF (defined by ICD-10 codes: I50.2, systolic HF; I50.

How I Do It: Managing Cavitary Coccidioidomycosis Expert Opinions for Improving Patient Outcomes.

Coccidioidomycosis (CM), caused by the dimorphic fungi Coccidioides immitis (C. immitis) and C. posadasii, is recognized as an increasing threat both nationally and worldwide.

Neighborhood Social Determinants of Health are Associated With Metabolic Dysfunction-associated steatotic Liver Disease Outcomes.

Background & Aims: Significant health disparities exist in metabolic dysfunction-associated steatotic liver disease (MASLD), driven by social determinants of health (SDOH). Few studies have explored neighborhood-level SDOH in MASLD.

Methods: This is a retrospective cohort study of patients with MASLD at a multi-state healthcare institution.

Neurologic adverse events associated with BRAF and MEK inhibitor therapy in patients with malignant melanoma: a disproportionality analysis using the Food and Drug Administration Adverse Event Reporting System.

BRAF and MEK inhibitor (BRAFi + MEKi) therapy has improved the treatment of solid tumors with BRAF mutation. However, their neurologic adverse events (nAEs) have been largely unexplored. This study aimed to provide clinicians with more updated knowledge on nAEs associated with BRAFi + MEKi therapy in patients with malignant melanoma compared with nonmelanoma cancers.

Advisory on delayed fading caused by the use of a xylene substitute for frozen tissue specimen staining in micrographic surgery.

Background: The use of xylene substitutes is becoming more common in the setting of micrographic surgery frozen tissue section staining, and dermatologic surgeons need to be aware of possible undesirable delayed effects of using these agents and the possibility of modifying H&E staining protocols to prevent delayed fading. This report demonstrates an undesirable outcome of using an isoparaffinic aliphatic hydrocarbon as a xylene substitute, implementation of a quality improvement intervention to eliminate frozen section slide fading in the setting of micrographic surgery tissue processing, and recommendations for the modification of protocol when using a xylene substitute.

Clinical And Laboratory Information: Frozen section slides processed with xylene and xylene substitute were analyzed by histotechnicians, a dermatopathologist, and a micrographic surgery surgeon at 1-week and 1-month intervals.

An international Delphi consensus on patient preparation for metabolic and bariatric surgery.

Global obesity rates have risen dramatically, now exceeding deaths from starvation. Metabolic and bariatric surgery (MBS), initially for severe obesity (BMI ≥35 kg/m), is performed globally over 500 000 times annually, offering significant metabolic benefits beyond weight loss. However, varying eligibility criteria globally impact patient care and healthcare resources.

Evaluation of a Digital Home Weight Monitoring Program for Infants With Cleft Palate.

Objective: Evaluate the effectiveness of a digital home monitoring program for infants with cleft palate with or without cleft lip (CP ± L), compared to monitoring through in-person clinic visits.

Design: Retrospective cohort study.

Setting: One metropolitan pediatric hospital.

The impact of internet resources and artificial intelligence on information on myringotomy tubes.

Purpose: To compare the quality and readability of patient education materials on myringotomy tubes from artificial intelligence and Google search.

Methods: Three questions were posed to ChatGPT and Google Gemini addressing "Condition," "Investigation," and "Treatment" domains. Google was queried for "Ear tubes," "Myringotomy and tubes," and "Tympanostomy tubes.

Racial disparities in length of hospitalization and systemic medication utilization in patients with psoriasis.

The growing evidence of chronic inflammation and sequelae caused by psoriasis indicates the need for systemic treatment, including biologics and conventional treatments like methotrexate. However, unconscious racial bias may lead to discrepancies in systemic medication prescription. Racial identity is also suspected to affect comorbidity and hospitalization rates in patients with psoriasis.

Longevity of Deep Brain Stimulation in Essential Tremor: A Comparison of Omnidirectional and Directional Leads.

Background And Objectives: Patients undergoing thalamic ventral intermediate nucleus stimulation to treat essential tremor (ET) develop tolerance over time, requiring higher stimulation amplitudes that lead to more frequent battery changes and suboptimal tremor control. The study objective is to determine whether amplitude tolerance differs between patients with omnidirectional vs directional leads.

Methods: We conducted a retrospective analysis of ET patients with omnidirectional and directional leads implanted between 2005 and 2022.

Growth hormone/insulin-like growth factor I axis in health and disease states: an update on the role of intra-portal insulin.

Growth hormone (GH) is the key regulator of insulin-like growth factor I (IGF-I) generation in healthy states. However, portal insulin delivery is also an essential co-player in the regulation of the GH/IGF-I axis by affecting and regulating hepatic GH receptor synthesis, and subsequently altering hepatic GH sensitivity and IGF-I generation. Disease states of GH excess (e.

Images: Combined positive air way pressure and atomoxetine-oxybutynin for the treatment of severe obstructive sleep apnea.

Obstructive sleep apnea (OSA) is one of the most common sleep disorders. Positive airway pressure therapy (PAP) is considered the gold standard for treating OSA. Yet, optimal therapy might not be achieved in some cases of severe OSA, despite using maximum settings.

Long-term Effects of COVID-19 on Sleep Patterns.

To examine the long-term impact of Coronavirus Disease 2019 (COVID-19) on sleep patterns and prevalence of sleep disorders and to increase public health awareness of long COVID. MATERIAL AND Using the centralized Massachusetts General Brigham Research Patient Data Registry (RPDR), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients were surveyed about their sleep patterns before and after the viral infection. Information related to co-morbid conditions and medications was obtained through chart review.

Guidance on Preoperative Management of Hand Surgery Patients Taking GLP-1 Receptor Agonists.

Glucagon-like peptide-1 (GLP-1) receptor agonists are medications used to treat type 2 diabetes and may aid in weight loss efforts. The surgical management of patients taking GLP-1 agonists differs from others due to the slowed gastric emptying effects of GLP-1 medications. Patients taking these medications may have a higher risk of pulmonary aspiration during hand surgery than other patients, which affects their presurgical management.

The Survey of Barriers for Vaginal Access Surgery Study.

Study Objective: The primary objective of this study was to describe vaginal hysterectomy practice patterns as well as facilitators and inhibitors to performing vaginal hysterectomy among gynecologic surgeons. Secondary objectives were to describe facilitators and inhibitors to the teaching and training of vaginal hysterectomy.

Design: A quantitative analysis of an online survey and qualitative analyses of the one-on-one interviews with gynecologic surgeons were conducted.

Factors Associated With Increased Sex Diversity in Orthopaedic Trauma Association-Accredited Fellowship Training.

Introduction: This study quantifies the state of sex diversity in orthopaedic trauma training and analyzes fellowship program characteristics associated with greater sex diversity among trainees. We hypothesized that greater sex diversity among orthopaedic trauma fellows would be associated with the presence of female faculty.

Methods: This was a retrospective, cross-sectional study of orthopaedic trauma faculty (2023 to 2024) and fellows (2009 to 2024).

Sexual Dysfunction in Chronic Urticaria: A Systematic Review.

Introduction: Chronic urticaria (CU) is frequently a debilitating skin condition characterized by recurrent and spontaneous wheal and flares with significant impact on quality of life. This systematic review examines the impact of CU on sexual health.

Methods: A systematic review using PubMed, Embase, Web of Science, and Cochrane library databases was conducted for articles on sexual health in chronic urticaria.

Burden of Hospitalization for Coccidioidal Meningitis: An Analysis of the National Inpatient Sample, 2019-2021.

Coccidioidal meningitis (CM) requires lifelong aggressive management, often necessitating hospitalization. In the National Inpatient Sample (2019-2021), CM hospitalizations (N = 2305) were associated with frequent CM-related procedures (63.6% [95% confidence interval {CI}, 59.

Brick Walls and Broken Hearts: Physicians Draw how they Feel About Treating Pain and Addiction.

As part of a continuing medical education activity, primary care physicians in Arizona were asked to draw how they feel about treating patients with chronic pain and addiction. Their drawings, complete with cliffs, walls, torn-out hair, and connected hearts, make for a harrowing look at burnout, angst, and empathy among physicians who treat this subset of patients. Public health and exercise facilitators were troubled, leading them to publish this essay along with a selection of the drawings that depict the feelings of the physicians who feel ill-prepared to treat this patient population, which is only growing in number and needs.

The multifaceted helical net of amphipathic alpha-helices; the next dimension of the helical peptide wheel.

The amphipathic nature of helical proteins is crucial to their binding features across a broad spectrum of physiological examples, including heat-shock proteins and hyaluronic acid (HA) receptor binding. By taking advantage of the amphipathic balance of amino acids and their presentation in helical faces, novel synthetic peptides can be designed to improve biofunctionality. We present a new approach for designing synthetic alpha helical peptides using a multifaceted analysis, which allows for new bioengineering designs of amphipathic alpha helices.

Placental extracellular vesicles from women with severe preeclampsia alter calcium homeostasis in cardiomyocytes: an ex vivo study.

Women with severe preeclampsia (sPE) exhibit a heightened risk of postpartum cardiovascular disease compared with those with normotensive pregnancies (NTP). Although placental extracellular vesicles (EVs) play a crucial role in feto-maternal communication, their impact on cardiomyocytes, particularly in the context of sPE, remains unclear. This study investigated the effect of sPE-associated placental EVs (sPE-Plex EVs) on cardiomyocyte calcium dynamics.