Single- versus two-test criteria for cognitive impairment: associations with CSF and imaging markers in former American football players.

 Cognitive impairment is a core feature of traumatic encephalopathy syndrome (TES), the putative clinical syndrome of chronic traumatic encephalopathy-a neuropathological disease associated with repetitive head impacts (RHI). Careful operationalization of cognitive impairment is essential to improving the diagnostic specificity and accuracy of TES criteria. We compared single- versus two-test criteria for cognitive impairment in their associations with CSF and imaging biomarkers in male former American football players.

Latent Trajectories of Change in Dietary Restriction During Treatment in Avoidant/Restrictive Food Intake Disorder and Anorexia Nervosa.

Objective: Outcomes for low-weight restrictive eating disorders, including anorexia nervosa, restricting type (AN-R) and avoidant/restrictive food intake disorder (ARFID), are sub-optimal. Reducing dietary restriction is a key treatment target. Understanding heterogeneity in patterns of change in dietary restriction may aid in improving outcomes.

Mentoring Fellows into Career Educators through a Multispecialty Clinician-Educator Course.

Background: Subspecialty fellows are a unique group of trainees for whom there currently exist few opportunities to pursue formal training as clinician-educators, as singular fellowship programs often face significant obstacles to implementing such coursework.

Objective: To develop, implement, and assess a clinician-educator course for fellows from multiple subspecialty fellowships at a single large academic medical center.

Methods: Our course, entitled Fellow as Clinician-Educator, was initiated across numerous fellowship programs from August 2021 to April 2023 at University of California San Diego Health.

YAP-driven malignant reprogramming of oral epithelial stem cells at single cell resolution.

Tumor initiation represents the first step in tumorigenesis during which normal progenitor cells undergo cell fate transition to cancer. Capturing this process as it occurs in vivo, however, remains elusive. Here we employ spatiotemporally controlled oncogene activation and tumor suppressor inhibition together with multiomics to unveil the processes underlying oral epithelial progenitor cell reprogramming into tumor initiating cells at single cell resolution.

The Impact of Socioeconomic Status on Decision on Withdrawal of Life-sustaining Treatments in Aneurysmal Subarachnoid Hemorrhage.

Background: Socioeconomic status affects outcomes in cerebrovascular disease, although its role in the withdrawal of life-sustaining treatments (WLST) remains uncertain. We aim to examine the impact of socioeconomic factors on outcomes including WLST in aneurysmal subarachnoid hemorrhage (aSAH).

Methods: We conducted a retrospective study of a cohort of consecutive patients with aSAH who were admitted to an academic center from 2016 to 2023.

Editorial: Climate change is a children's health hazard.

As temperatures defy heat records, it is difficult to ignore the implications of climate change for public health, including impacts on population health more specifically. In short, climate change is happening now and presents an immediate hazard to human health on a global scale. Age-related health effects are an inalienable truth; physiology is relatively universal, and so are the ways in which our bodies respond to different types and levels of exposures to environmental stressors at different lifestages.

Breaking the guidelines: how financial unawareness fuels guideline deviations and inefficient DVT diagnostics.

Objectives: To examine factors impacting diagnostic evaluation of suspected deep vein thrombosis (DVT) by analyzing the test ordering patterns and provider decision-making within a universal health coverage system in Hungary.

Methods: We analyzed test orders for suspected DVT between 2007 and 2020, and the financial framework influencing diagnostic practices. An anonymous survey was also conducted among Emergency Department physicians to explore factors influencing diagnostic decision-making.

Alternate definitions of adverse pathology to predict a very high risk of metastasis in men with intermediate- and low-risk prostate cancer.

Background: Adverse pathology (AP) is often used as an intermediate end point for long-term outcomes in men with prostate cancer (PCa) who are active surveillance candidates. The association between a commonly used AP definition and long-term outcomes was tested, which identified definitions more strongly linked to a high risk of metastasis.

Methods: Data were reviewed from the Shared Equal Access Regional Cancer Hospital cohort of men undergoing radical prostatectomy (RP) from 1988 to 2020 at nine Veterans Affairs hospitals.

The Orbitomalar Ligament: A Cleavage Plane in Oculofacial Trauma.

We describe an oculofacial injury phenotype manifesting as a cleavage plane following the orbitomalar ligament in 5 cases. Across these cases, curvilinear wounds followed the course of the orbitomalar ligament, running clean planes through orbicularis oculi down to the infraorbital rim and arcus marginalis. One case involved bilateral orbitomalar ligaments, and 1 case involved the inferior canaliculus.

Leveraging Lean Methodology to Improve Compliance With Work-Hour Restrictions.

Importance: Since work-hour restrictions were instituted in 2003, sustainably complying with duty-hour regulations remains a challenge for general surgery residency programs across the nation.

Objective: To determine whether industry-based process improvement techniques could be leveraged to increase compliance with work-hour restrictions within a general surgery residency.

Design, Setting, And Participants: This quality improvement project using Lean methodology was conducted from October to November of the 2021 to 2022 academic year.

Morbidity and Mortality Risk Among People With Human Immunodeficiency Virus and Central or Visceral Adiposity: A Targeted Literature Review.

Background: Given the known relationship between human immunodeficiency virus (HIV), antiretroviral therapies, and excess visceral adipose tissue (VAT), this review sought to characterize risk of negative health outcomes associated with excess VAT and increased waist circumference (WC) in people with HIV (PWH).

Methods: Comprehensive targeted literature searches were conducted in Medline/Embase (27 June 2022), identifying peer-reviewed articles and conference abstracts reporting on cohorts of PWH. Screening was guided by PECOS (Population, Exposure, Comparator, Outcomes, Study design) criteria.

ERBB2/ERBB3-mutated S100/SOX10-positive uterine sarcoma: something new.

A distinctive subset of uterine mesenchymal tumors display recurrent genetic fusions involving receptor tyrosine kinases, including NTRK, PDGFB, FGFR1, and RET, presumably leading to aberrant pathway activation. A pair of recent studies have highlighted the existence of a genetic fusion-negative uterine sarcoma that is characterized by activating mutations in ERBB2/ERBB3, CDKN2A deletion, inactivating ATRX mutation, and a S100 + /SOX10 + immunohistochemical profile. This report describes another case of this emerging entity that was diagnosed in a 57-year-old woman.

Transcutaneous Tibial Nerve Stimulation for Urge Incontinence: A Randomized Clinical Trial.

Importance: Overactive bladder is a distressing syndrome that significantly affects quality of life. Transcutaneous tibial nerve stimulation (TTNS) has been proposed as a home-based, patient-centered therapy that could improve access to treatment for this condition.

Objective: We aimed to determine the efficacy of 12 weeks of TTNS versus sham therapy in reducing symptomatic bother in ambulatory women with urgency urinary incontinence.

Racial Differences in Systemic Immune Parameters in Individuals With Lung Cancer.

Introduction: Racial and ethnic disparities in the presentation and outcomes of lung cancer are widely known. To evaluate potential factors contributing to these observations, we measured systemic immune parameters in Black and White patients with lung cancer.

Methods: Patients scheduled to receive cancer immunotherapy were enrolled in a multi-institutional prospective biospecimen collection registry.

Distributed, immutable, and transparent biomedical limited data set request management on multi-capacity network.

Objective: Our study aimed to expedite data sharing requests of Limited Data Sets (LDS) through the development of a streamlined platform that allows distributed, immutable management of network activities, provides transparent and intuitive auditing of data access history, and systematically evaluated it on a multi-capacity network setting for meaningful efficiency metrics.

Materials And Methods: We developed a blockchain-based system with six types of smart contracts to automate the LDS sharing process among major stakeholders. Our workflow included metadata initialization, access-request processing, and audit-log querying.

Machine Learning in Vascular Medicine: Optimizing Clinical Strategies for Peripheral Artery Disease.

Purpose Of Review: Peripheral Artery Disease (PAD), a condition affecting millions of patients, is often underdiagnosed due to a lack of symptoms in the early stages and management can be complex given differences in genetic and phenotypic characteristics. This review aims to provide readers with an update on the utility of machine learning (ML) in the management of PAD.

Recent Findings: Recent research leveraging electronic health record (EHR) data and ML algorithms have demonstrated significant advances in the potential use of automated systems, namely artificial intelligence (AI), to accurately identify patients who might benefit from further PAD screening.

Challenges in Cardiomyopathy Gene Therapy Clinical Trial Design.

Gene therapy has emerged as a possible treatment for progressive, debilitating Mendelian cardiomyopathies with limited therapeutic options. This paper arises from discussions at the 2023 Cardiovascular Clinical Trialists Forum and highlights several challenges relevant to gene therapy clinical trials, including low prevalence and high phenotypic heterogeneity of Mendelian cardiomyopathies, outcome selection complexities and resulting regulatory uncertainty, and immune responses to the adeno-associated viral vectors that are being used in ongoing studies. Avenues to address these challenges such as natural history studies, external controls, novel regulatory pathways, and immunosuppression are discussed.

Randomized trial of low intensity shockwave therapy for erectile dysfunction utilizing grayscale ultrasound for analysis of erectile tissue homogeneity/inhomogeneity.

Background: Electrohydraulic shockwave devices have been Food and Drug Administration-cleared for improved blood flow and connective tissue activation and have been used to treat erectile dysfunction (ED). In this study, the main focus was to evaluate improvement in erectile tissue quality after low intensity shockwave therapy (LiSWT).

Methods: A single-blind, sham-controlled, randomized, prospective study, was performed in men with ED naïve to shockwave or radial ballistic pressure wave therapy.

Neighborhood Socioeconomic Disadvantage Increases Risk of Severe Acute Respiratory Syndrome Coronavirus 2-Mediated Otologic Dysfunction.

Objectives: We aim to use the Area Deprivation Index (ADI) to investigate the correlations between neighborhood socioeconomic disadvantage (NSD), SARS-CoV-2 vaccination rates, infection severity, and subsequent audiovestibular symptoms.

Methods: In this retrospective cohort study, surveys were administered to participants ≥18 years of age who received a SARS-CoV-2 vaccination and/or tested positive for SARS-CoV-2 infection between January 2020 and September 2022. ADI scores were calculated for each patient to quantify NSD.