Omega-3 index improves upon the pooled cohort equation in predicting risk for CVD.

Background: Accurate predictive tools are crucial for identifying patients at increased risk for atherosclerotic cardiovascular disease (ASCVD). The Pooled Cohort Equation (PCE) is commonly used to predict 10-year risk for ASCVD, but its accuracy remains imperfect.

Objective: This study examined the extent to which the omega-3 index (O3I; the proportion of eicosapentaenoic acid+docosahexaenoic acid in erythrocyte membranes) improved the predictive capability of PCE.

Type A Aortic Dissection Following Abdominal Solid Organ Transplantation: Population-Level Outcomes in the United States.

Background: This study aims to analyze the patient characteristics, clinical outcomes, and contemporary trends concerning type A aortic dissection (TAAD) in previous recipients of abdominal solid organ transplantation (ASOT) in the United States.

Methods: The National Inpatient Sample was queried to identify all patients aged ≥18 with TAAD and a history of ASOT (TAAD-ASOT) between 2002 and 2015Q3 using ICD-9 diagnosis and procedure codes. Baseline characteristics and in-hospital outcomes were compared between TAAD-ASOT patients and TAAD patients without a history of ASOT (TAAD-non-ASOT).

Connecting Underrepresented Medical Students to Resources and Role Models in Orthopaedic Surgery: A Virtual Diversity, Equity, Inclusion, and Accessibility Summit.

Introduction: Limited access to resources and stereotypes about orthopaedic surgeons may contribute to the low percentage of women and people of underrepresented in medicine (URiM) backgrounds in orthopaedic surgery. Several organizations have created resources to address these barriers, but medical students are unlikely to be exposed to the initiatives through traditional curricula. The purpose of this study was to (1) evaluate the ability of a 1-day virtual Diversity, Equity, Inclusion, and Accessibility (DEIA) summit to effectively reach URiM medical students, (2) increase medical students' knowledge of DEIA resources, and (3) augment the perception of diverse backgrounds in orthopaedic surgery.

Novel Controlled Metabolic Accelerator for Obesity-Related HFpEF: The HuMAIN-HFpEF Randomized Clinical Trial.

Importance: Excess body fat plays a pivotal role in the pathogenesis of heart failure with preserved ejection fraction (HFpEF). HU6 is a novel, controlled metabolic accelerator that enhances mitochondrial uncoupling resulting in increased metabolism and fat-specific weight loss.

Objective: To assess efficacy and safety of HU6 in reducing body weight, improving peak volume of oxygen consumption (VO2) and body composition among patients with obesity-related HFpEF.

Ophthalmology Examinations in Children With Skull Fractures and Underlying Focal Hemorrhage.

Objectives: To assess the frequency and yield of retinal examination in children below 2 years old undergoing abuse evaluations in the setting of skull fracture(s) and small underlying intracranial hemorrhage.

Methods: This cross-sectional study used CAPNET, a multicenter child physical abuse network, to identify children below 2 years with a skull fracture(s) and intracranial injury limited to an underlying small focal intracranial hemorrhage undergoing subspeciality child abuse evaluations. Our outcomes of interest were (1) the performance of a retinal examination, (2) the identification of retinal hemorrhages, and (3) associations of clinical factors and CAPNET site with the performance of retinal examinations.

CNM-Au8 in Amyotrophic Lateral Sclerosis: The HEALEY ALS Platform Trial.

Importance: Bioenergetic failure has been proposed as a driver of amyotrophic lateral sclerosis (ALS). CNM-Au8 is a suspension of gold nanocrystals that catalyzes the conversion of nicotinamide adenine dinucleotide hydride into NAD+, resulting in an increase of cellular adenosine triphosphate production.

Objective: To determine the effects of CNM-Au8 on ALS disease progression.

Pridopidine in Amyotrophic Lateral Sclerosis: The HEALEY ALS Platform Trial.

Importance: Amyotrophic lateral sclerosis (ALS) is a fatal disease. The sigma-1 (σ1) receptor emerged as a target for intervention.

Objective: To determine the effects of pridopidine, a σ1-receptor agonist, in ALS.

Verdiperstat in Amyotrophic Lateral Sclerosis: Results From the Randomized HEALEY ALS Platform Trial.

Importance: Myeloperoxidase is one of the most abundant peroxidase enzymes in activated myeloid cells. Myeloperoxidase inhibitors may have a clinical benefit in amyotrophic lateral sclerosis (ALS) by slowing neurodegeneration via reduced neuroinflammation and oxidative stress.

Objective: To determine the safety, tolerability, and efficacy of verdiperstat, a selective myeloperoxidase inhibitor, in ALS.

Early Readmissions of Necrotizing Pancreatitis in the US: Where Do We Stand?

Background: Necrotizing pancreatitis (NP), a severe form of pancreatitis characterized by necrosis of pancreatic tissue, is associated with a significant health care burden worldwide. In this study, we assess early readmissions of NP in the US.

Methods: The National Readmission Database from 2016 to 2020 was utilized to identify all index and 30-day readmissions of NP in the US.

Awake Prone Positioning in Adults With COVID-19: An Individual Participant Data Meta-Analysis.

Importance: The impact of awake prone positioning (APP) on clinical outcomes in patients with COVID-19 and acute hypoxemic respiratory failure (AHRF) remains uncertain.

Objective: To assess the association of APP with improved clinical outcomes among patients with COVID-19 and AHRF, and to identify potential effect modifiers.

Data Sources: PubMed, Embase, the Cochrane Library, and ClinicalTrials.

Evaluation of Institutional Prophylactic Open Fracture Antibiotic Guidelines on Infection Development.

Background: Open fracture wounds are associated with a high risk of infection, though the outcomes are dependent on the fracture location, prophylactic antibiotics utilized, and time to antibiotic intervention. Although several institutions have provided guidelines for appropriate prophylaxis in open fractures, there is currently no consensus on antibiotic selection and duration. Reducing inappropriate prophylactic antibiotic use for open bone fractures is a potential stewardship opportunity within pharmacy departments.

Network Localization of Pediatric Lesion-Induced Dystonia.

Objective: Dystonia is a movement disorder defined by involuntary muscle contractions leading to abnormal postures or twisting and repetitive movements. Classically dystonia has been thought of as a disorder of the basal ganglia, but newer results in idiopathic dystonia and lesion-induced dystonia in adults point to broader motor network dysfunction spanning the basal ganglia, cerebellum, premotor cortex, sensorimotor, and frontoparietal regions. It is unclear whether a similar network is shared between different etiologies of pediatric lesion-induced dystonia.

Perceived barriers to neurodevelopmental follow-up among cardiac neurodevelopmental outcome collaborative institutional and affiliated members.

Objective: Neurodevelopmental follow-up programmes for children with CHD help identify neurodevelopmental impairments and support the delivery of recommended interventions. The Cardiac Neurodevelopmental Outcome Collaborative, Diversity, Equity, and Inclusion Special Interest Group surveyed members to assess perceived patient barriers to neurodevelopmental follow-up, previous diversity and inclusion education, and confidence in caring for historically marginalised populations.

Methods: A link to a Redcap online survey was emailed to Cardiac Neurodevelopmental Outcome Collaborative members on 23 April 2022, with 4 weeks given to complete.

Genome-wide profiling of highly similar paralogous genes using HiFi sequencing.

Variant calling is hindered in segmental duplications by sequence homology. We developed Paraphase, a HiFi-based informatics method that resolves highly similar genes by phasing all haplotypes of paralogous genes together. We applied Paraphase to 160 long (>10 kb) segmental duplication regions across the human genome with high (>99%) sequence similarity, encoding 316 genes.

Implementing a pre-exposure prophylaxis (PrEP) promotion intervention among persons who inject drugs: Perspectives from community and research implementation partners.

Background: Clinical guidelines recommend pre-exposure prophylaxis (PrEP) to prevent HIV among persons who inject drugs (PWID), yet few are reached by this evidence-based intervention. To address this challenge, we are conducting a clinical trial to evaluate the impact of contingency management (CM) with stepped care to PrEP adherence and support services (PASS) among PWID. We sought to elicit perspectives from community- and research-based implementation partners on barriers and facilitators to implementing this intervention package as well as describe perspectives around evidence-based research practices in general.

Discussing the interplay of social determinants of health, aging and Alzheimer's biomarkers in U.S. Latinos.

This perspective examines the impact of Social Determinants of Health (SDoH) on biological age-related decline and Alzheimer's Disease and Related Dementias (ADRD) biomarker trajectories in U.S. Latino populations, emphasizing the need for comprehensive multilevel research frameworks tailored to the community.

Trends in Respiratory Pathogen Testing at US Children's Hospitals.

Importance: Respiratory pathogen testing has been a common deimplementation focus. The COVID-19 pandemic brought new considerations for respiratory testing; recent trends in testing rates are not well understood.

Objective: To measure trends in respiratory testing among encounters for acute respiratory infections among children and adolescents (aged <18 years) from 2016 to 2023, assess the association of COVID-19 with these trends, and describe associated cost trends.

Diagnosis and Treatment of Hypophosphatasia.

Hypophosphatasia (HPP) is a rare inherited metabolic disorder characterized by deficient activity of tissue-nonspecific alkaline phosphatase (TNAP) caused by variants in the ALPL gene. Disease manifestations encompass skeletal hypomineralization with rickets and lung hypoplasia, vitamin B6-dependent seizures, craniosynostosis, and premature loss of deciduous teeth. The clinical presentation can comprise failure to thrive with muscular hypotonia, delayed motor development, and gait disturbances later in childhood.

Severe Heart Failure and Treatment With Dapagliflozin Across the Ejection Fraction Spectrum: DAPA-HF and DELIVER.

Background: Patients with severe heart failure (HF) experience debilitating clinical symptoms and worse cardiovascular (CV) outcomes with an excess mortality risk.

Objectives: The authors aimed to assess the prevalence, CV outcome risk, and treatment response to the sodium-glucose cotransporter 2 inhibitor (SGLT2i) dapagliflozin among patients with severe HF across the spectrum of left ventricular ejection fraction (LVEF) in DAPA-HF and DELIVER.

Methods: Severe HF was adapted from the ESC (European Society of Cardiology) HFA (Heart Failure Association) definition: NYHA functional class III/IV, evidence of HF with reduced, mildly reduced, or preserved LVEF, HF hospitalization within the previous 12 months, and adverse patient-reported symptom burden (Kansas City Cardiomyopathy Questionnaire-Total Symptoms Score <75).

Development of a pharmacodynamic biomarker of opioid antagonism in adolescents with eating disorders: Study protocol for the naltrexone neuroimaging randomized controlled trial (NN-RCT).

Eating disorders (ED) affect 5 % of youth, are associated with reward system alterations, and lead to substantial morbidity. Naltrexone, an opioid antagonist, is used to treat ED behaviors such as binge eating and purging. However, not all patients respond, and the optimal dose is unknown.

Developing and implementing Pediatric Nephrology Milestones 2.0 as an efficient tool for trainee evaluation and just-in-time feedback.

In 2013, the Accreditation Council for Graduate Medical Education (ACGME) implemented Milestones 1.0 as a tool to assess trainee progress towards readiness for independent practice. Critiques of Milestones 1.

Efficacy and safety of bromocriptine in peripartum cardiomyopathy: A systematic review and meta-analysis.

Background: Peripartum cardiomyopathy (PPCM) is a rare but potentially serious pregnancy complication. The use of bromocriptine in addition to standard treatment has been recommended; however, the evidence supporting its efficacy remains limited.

Methods: A systematic search was conducted across 4 databases including PubMed, Embase, Web of Science, and Cochrane CENTRAL, from inception to September 13, 2024, without language restrictions.

Teletherapy Ethics.

This manuscript focuses on regret as a significant moral experience in surgical professionalization. It distinguishes between constructive regret, which encourages self-reflection and growth, and destructive regret, which can lead to emotional withdrawal and impaired decision-making. This article also offers recommendations for how both colleagues and organizations should respond to each type of regret, especially regret over poor outcomes, to nourish professional formation.