A National Assessment of Pediatric Surgical Critical Care Fellowship Structure: Defining the Training Experience.

Background: Pediatric Surgical Critical Care (PSCC) is a unique specialty incorporating fundamental principles of surgical, neonatal, and pediatric critical care. This study aims to characterize the current landscape of PSCC training to identify opportunities for educational standardization and improvement.

Methods: An anonymous electronic survey-based assessment was distributed to the program directors (PDs) of all current ACGME-accredited PSCC fellowships (n = 14).

Investigating the origins of the mutational signatures in cancer.

Most of the risk factors associated with chronic and complex diseases, such as cancer, stem from exogenous and endogenous exposures experienced throughout an individual's life, collectively known as the exposome. These exposures can modify DNA, which can subsequently lead to the somatic mutations found in all normal and tumor tissues. Understanding the precise origins of specific somatic mutations has been challenging due to multitude of DNA adducts (i.

Neuromodulation Strategies in Lennox-Gastaut Syndrome: Practical Clinical Guidance from the Pediatric Epilepsy Research Consortium.

Lennox-Gastaut syndrome (LGS) is a severe developmental and epileptic encephalopathy characterized by multiple drug-resistant seizure types, cognitive impairment, and distinctive electroencephalographic patterns. Neuromodulation techniques, including vagus nerve stimulation (VNS), deep brain stimulation (DBS), and responsive neurostimulation (RNS), have emerged as important treatment options for patients with LGS who do not respond adequately to antiseizure medications. This review, developed with input from the Pediatric Epilepsy Research Consortium (PERC) LGS Special Interest Group, provides practical guidance for clinicians on the use of these neuromodulation approaches in patients with LGS.

Impact of Locum Tenens Providers on Delivery of Pediatric Surgical Care.

Introduction: We sought to understand the impact of locum tenens surgeons on pediatric surgical care delivery.

Methods: We conducted a cross-sectional survey of Children's Hospital Association pediatric surgical practices. Anonymous electronic surveys were used to investigate locum tenens utilization, primary reason for use, limitations on clinical activities, and variations in practice standards or quality.

Recommended Elements of a Musculoskeletal Course for Fourth-Year Medical Students: A Modified Delphi Consensus.

Background And Objectives: A recognized gap exists between primary care physicians' training in musculoskeletal (MSK) medicine and the burden of MSK complaints in primary care. Family medicine interns often lack adequate baseline MSK physical exam skills, which prompted a proposal to introduce a fourth-year preceptorship to reinforce MSK education. The aim of this study was to prioritize the most important elements to include in this new clinical rotation.

Clinico-Dermoscopic Findings of Jacquet's Erosive Dermatitis in Adults: A Report of Two Cases.

Jacquet's erosive dermatitis (JED) is a severe irritant dermatitis characterized by erosive genital and perianal lesions, often misdiagnosed due to overlapping clinical features. This case report presents two adult cases of JED with distinct clinical and dermoscopic findings. Dermoscopy revealed a characteristic polymorphic vascular pattern, including short linear, curved, coiled, dotted, and globular vessels, aiding in the diagnosis and differentiation from similar conditions.

Vaccination with a Replication-Dead Murine Gammaherpesvirus Lacking Viral Pathogenesis Genes Inhibits WT Virus Infection.

Gammaherpesviruses are oncogenic pathogens that establish lifelong infections. There are no FDA-approved vaccines against Epstein-Barr virus or Kaposi sarcoma herpesvirus. Murine gammaherpesvirus-68 (MHV68) infection of mice provides a system for investigating gammaherpesvirus pathogenesis and testing vaccine strategies.

Directional and Strain-Specific Interaction Between and .

The interaction between and strains FRI-1169 and MN8, two original isolated strains from menstrual toxic shock syndrome (mTSS) cases, is a key focus for developing non-antibiotic strategies to control -related infections. While the antagonistic effects of species on through mechanisms like organic acid and bacteriocin production are known, the molecular dynamics of these interactions remain underexplored. This study employs a proteomic approach to analyze the interactions between WCFS1 and strains, FRI-1169 and MN8, during co-culture.

The Long-Term Cardiovascular Risks of Duloxetine Use in Older Adults: A Retrospective Medical Record-Based Adverse Drug Reaction Assessment.

Duloxetine, a Serotonin-Norepinephrine Reuptake Inhibitor (SNRI), is frequently used to treat diabetic peripheral neuropathy, depression, and fibromyalgia. However, its long-term cardiovascular implications in older individuals remain underexplored, particularly in those with pre-existing cardiovascular diseases. This medical record assessment aimed to evaluate the potential cardiovascular risks of duloxetine use in older persons after prolonged use.

Sex-Based Disparities in Treatment and Healthcare Utilization in Patients with Ulcerative Colitis: A Systematic Review and Meta-Analysis.

: Sex-related treatment disparities are well-documented across various medical conditions, yet their impact on the management of inflammatory bowel disease (IBD) remains underexplored. This study aims to investigate sex-based differences in the management of ulcerative colitis (UC), focusing on both medical and surgical approaches and examining whether biological sex correlates with variations in healthcare utilization. : A systematic search was conducted across multiple databases, including MEDLINE (via PubMed), Google Scholar, the Cochrane Library, and ScienceDirect, to identify studies on sex differences in ulcerative colitis (UC) management up to April 2024.

Mural Cells Initiate Endothelial-to-Mesenchymal Transition in Adjacent Endothelial Cells in Extracranial AVMs.

Extracranial arteriovenous malformations (eAVMs) are complex vascular lesions characterized by anomalous arteriovenous connections, vascular instability, and disruptions in endothelial cell (EC)-to-mural cell (MC) interactions. This study sought to determine whether eAVM-MCs could induce endothelial-to-mesenchymal transition (EndMT), a process known to disrupt vascular integrity, in the eAVM microenvironment. eAVM and paired control tissues were analyzed using RT-PCR for EC (, , and ) and EndMT-specific markers (, , , /.

MnSOD Mimetics in Therapy: Exploring Their Role in Combating Oxidative Stress-Related Diseases.

Reactive oxygen species (ROS) are double-edged swords in biological systems-they are essential for normal cellular functions but can cause damage when accumulated due to oxidative stress. Manganese superoxide dismutase (MnSOD), located in the mitochondrial matrix, is a key enzyme that neutralizes superoxide radicals (O), maintaining cellular redox balance and integrity. This review examines the development and therapeutic potential of MnSOD mimetics-synthetic compounds designed to replicate MnSOD's antioxidant activity.

In-Hospital Mortality by Race and Ethnicity Among Hospitalized COVID-19 Patients Using Data From the US National COVID Cohort Collaborative.

Background: Studies examining racial and ethnic disparities in-hospital mortality for patients hospitalized with COVID-19 had mixed results. Findings from patients within academic medical centers (AMCs) are lacking, but important given the role of AMCs in improving health equity.

Objective: The purpose of this study is to assess whether minority patients hospitalized with COVID-19 in National COVID Cohort Collaborative (N3C) institutions, which consist predominantly of AMCs, have higher mortality rates relative to White patients.

The association of workforce configurations with length of stay and charges in hospitalized patients with congestive heart failure.

Introduction: Clinicians are the conduits of high-quality care delivery. Clinicians have driven advancements in pharmacotherapeutics, devices, and related interventions and improved morbidity and mortality in patients with congestive heart failure over the past decade. Yet, the management of congestive heart failure has become extraordinarily complex and has fueled recommendations from the American Heart Association and the American College of Cardiology to optimize the composition of the care team to reduce the health, economic, and the health system burden of high lengths of stay and hospital charges.

IL-1β-driven NF-κB transcription of ACE2 as a Mechanism of Macrophage Infection by SARS-CoV-2.

Coronavirus disease 2019 (COVID-19), caused by infection with the enveloped RNA betacoronavirus, SARS-CoV-2, led to a global pandemic involving over 7 million deaths. Macrophage inflammatory responses impact COVID-19 severity; however, it is unclear whether macrophages are infected by SARS-CoV-2. We sought to identify mechanisms regulating macrophage expression of ACE2, the primary receptor for SARS-CoV-2, and to determine if macrophages are susceptible to productive infection.

Beyond symptom reduction: Veterans' goals for posttraumatic stress disorder treatment.

Despite a varied selection of available trauma-focused evidence-based psychotherapies (TF-EBPs) for posttraumatic stress disorder (PTSD), few veterans receive a full course of an evidence-based treatment. A better understanding of and alignment with veterans' PTSD treatment goals could be one way to improve treatment engagement and adherence, consistent with veteran-oriented care within the U.S.

Weight change and cardiovascular disease incidence in breast cancer survivors: a nationwide cohort study.

Background: Breast cancer survivors (BCS) face a higher risk of cardiovascular disease (CVD) due to treatment-related cardiotoxicity and pre-existing conditions. We investigated how post-diagnosis weight changes and obesity impact CVD risk in this population.

Method: Using the Korean National Health Insurance Service database (2010-2019), BCS without previous history of CVD were enrolled.

Impact of extended-course oral nirmatrelvir/ritonavir in established Long COVID: a case series.

Background: Prior case series suggest that a 5-day course of oral Paxlovid (nirmatrelvir/ritonavir) benefits some people with Long COVID, within and/or outside of the context of an acute reinfection. To the best of our knowledge, there have been no prior case series of people with Long COVID who have attempted longer courses of nirmatrelvir/ritonavir.

Methods: We documented a case series of 13 individuals with Long COVID who initiated extended courses (>5 days; range: 7.

Excess mortality due to COVID-19 in Thailand between the pandemic and post-pandemic periods.

The coronavirus disease 2019 (COVID-19) pandemic had a significant effect on mortality rates worldwide, with Thailand being no exception. Gaining insights into the impact of pandemic-related mortality is essential for assessing its broader consequences on public health. This study aimed to analyze excess deaths during the pandemic (January 1, 2020-September 30, 2022) and post-pandemic period (October 2022-December 2023) at regional and national levels in Thailand.

Gut microbes metabolize strawberry phytochemicals and mediate their beneficial effects on vascular inflammation.

Evidence suggests that a healthy gut microbiome is essential for metabolizing dietary phytochemicals. However, the microbiome's role in metabolite production and the influence of gut dysbiosis on this process remain unclear. Further, studies on the relationship among gut microbes, metabolites, and biological activities of phytochemicals are limited.

Flow-Through Flaps as a Robust Method for Advanced Free Flap Reconstruction in the Head and Neck: A Multi-Institutional Experience.

Background: Flow-through flaps (FTFs) are an advanced technique in which a free flap is anastomosed to the pedicle of another free flap to reconstruct extensive head and neck defects when recipient vessels are scarce.

Methods: A multi-institutional cohort of FTFs used for head and neck reconstruction were reviewed. For comparison, FTF outcomes were compared to free flaps that required vein grafts (VG) to reach distant recipient vessels.

A Combined Approach for Rapid Dereplication of Herb-Drug Interaction Causative Agents in Botanical Extracts-A Molecular Networking Strategy To Identify Potential Pregnane X Receptor (PXR) Modulators in Yohimbe.

Despite promising preliminary biology, natural products isolation efforts may be confounded when the active compound is not isolated during bioassay-guided purification or classical pharmacognostic research investigations. A more rational isolation procedure connecting the polypharmacology of an herb to its individual constituents must be applied to better detect bioactive molecules before tedious analytical steps are considered. While (yohimbe) has been traditionally used in herbal medicine as a general tonic, an aphrodisiac, a performance enhancer, and an integral part of various dietary supplements, the hydroethanolic extract of yohimbe was identified to possess at least 3-4-fold induction of the pregnane X receptor (PXR) at 30 μg/mL, a key nuclear receptor implicated in adverse interactions, .

Enhancing immune response and survival in hepatocellular carcinoma with novel oncolytic Jurona virus and immune checkpoint blockade.

Members of the genus including Jurona virus (JURV) have emerged as promising immunotherapeutic agents, characterized by their tumor selectivity, fast kinetics, low seroprevalence, and minimal toxicity in humans. Here, we demonstrate that the administration of JURV leads to tumor regression in both hepatocellular carcinoma (HCC) xenograft and syngeneic models. Furthermore, our findings indicate that combining JURV and anti-PD-1 therapy reduced tumor burden and improved survival rates over JURV or anti-PD-1 alone in an orthotopic HCC model.

Functional Connectivity to the Amygdala in the Neonate Is Impacted by the Maternal Anxiety Level During Pregnancy.

Background And Purpose: Anxiety during pregnancy is common, and exposure to heightened anxiety during pregnancy may influence children's brain development and functioning. However, it is unclear if exposure to low levels of anxiety in utero would also impact the developing brain. The current prospective and longitudinal study included 40 healthy pregnant women without pregnancy complications or previous diagnosis of anxiety disorders.

A review of literature of a functional, congenital intrathoracic kidney.

Introduction: The rarest form of renal ectopia, the thoracic kidney, has been documented in only about 200 cases worldwide. There are four recognized causes of congenital thoracic renal ectopia: renal ectopia with an intact diaphragm, diaphragmatic eventration, diaphragmatic hernia, and traumatic diaphragmatic rupture. This condition often presents as an incidental finding in asymptomatic patients.