Medicaid and the Promise for Cure.

Importance: Cell and gene therapies are revolutionizing the treatment landscape for children and adults with rare diseases and can be life-changing for patients and their families. Successful implementation of these new therapies into clinical practice depends on their accessibility and affordability, particularly through publicly funded Medicaid agencies, which cover many children and adults with rare diseases.

Objective: To provide a framework to broadly assess cell and gene therapies, evaluate payment options, and ensure equitable access through the lens of publicly funded Medicaid programs.

Long-term risk of adverse limb outcomes in older patients after endovascular femoral artery revascularization: The Boston femoral artery endovascular revascularization outcomes (Boston FAROUT) study.

Introduction: Older patients may be denied endovascular revascularization of the superficial femoral artery (SFA) for peripheral artery disease (PAD) due to concerns of worse limb outcomes than younger patients.

Methods: We assessed adverse outcomes in patients after an index revascularization stratified by age (age < 65, 65-75 years, and > 75 years) from two centers between 2003 and 2011 and followed a median 9 (25 %-75 %: 7, 11) years. Outcomes included major adverse limb events (MALE) or minor repeat revascularization, death, and major adverse cardiac and cerebrovascular events (MACCE).

Identifying the Brain Circuits that Regulate Pain-Induced Sleep Disturbances.

Pain therapies that alleviate both pain and sleep disturbances may be the most effective for pain relief, as both chronic pain and sleep loss render the opioidergic system, targeted by opioids, less sensitive and effective for analgesia. Therefore, we first studied the link between sleep disturbances and the activation of nociceptors in two acute pain models. Activation of nociceptors in both acute inflammatory (AIP) and opto-pain models led to sleep loss, decreased sleep spindle density, and increased sleep fragmentation that lasted 3 to 6 hours.

An older man with progressive short-term memory loss and confusion.

A 72-year-old man with progressive memory loss and confusion presented to a neurology clinic for evaluation. He initially had difficulty remembering names and misplaced objects; however, his memory deficits had progressed, and more recently he had numerous car accidents and difficulty managing his own medications and finances. Cognitive testing revealed significant memory deficits reflecting moderate-stage dementia, and his brain MRI showed several cortical microbleeds and an area of siderosis consistent with the diagnosis of cerebral amyloid angiopathy (CAA).

Deep learning algorithm enables automated Cobb angle measurements with high accuracy.

Objective: To determine the accuracy of automatic Cobb angle measurements by deep learning (DL) on full spine radiographs.

Materials And Methods: Full spine radiographs of patients aged > 2 years were screened using the radiology reports to identify radiographs for performing Cobb angle measurements. Two senior musculoskeletal radiologists and one senior orthopedic surgeon independently annotated Cobb angles exceeding 7° indicating the angle location as either proximal thoracic (apices between T3 and T5), main thoracic (apices between T6 and T11), or thoraco-lumbar (apices between T12 and L4).

Impact of Tumor Response After Neoadjuvant Treatment on Overall Survival Among Patients With Pancreatic Ductal Adenocarcinoma: National Cancer Database Analysis.

Background Complete pathologic response following neoadjuvant therapy (NAT) for pancreatic ductal adenocarcinoma (PDAC) is rare; alternative markers associated with survival are needed. The aim of this study was to evaluate the impact of tumor response to NAT on overall survival (OS) in PDAC patients who received NAT and curative-intent surgery. Methods A retrospective study utilizing the 2006-2018 National Cancer Database identified 6,960 adult patients with PDAC who received NAT.

Sinusitis and rhinitis among US veterans deployed to Southwest Asia and Afghanistan after September 11, 2001.

Background: Post-9/11 veterans were exposed to environmental and occupational pollutants during deployment.

Objective: Our aim was to determine associations between deployment-related exposures and sinusitis and rhinitis.

Methods: Between April 2018 and March 2020, veterans with land-based deployment after 9/11 who were living within 25 miles of 6 Department of Veteran Affairs medical centers were randomly chosen by using a Defense Manpower Data Center roster.

Embracing Inclusion, Diversity, Equity and Access (IDEA): Cultivating understanding internally to foster external change.

Context: Healthcare institutions acknowledge the value of diverse workforces for enhancing programs and meeting the varied needs of individuals with Spinal Cord Injury. This survey conducted at the 2023 Academy of Spinal Cord Injury Professions (ASCIP) conference assesses healthcare professionals' views on workplace Diversity, Equity, and Inclusion (DEI) and their support for integrating related educational content in future events.

Methods: : The survey was distributed digitally to ASCIP attendees, ensuring anonymity and voluntary participation.

Abnormal spirometry in individuals with a smoking history and no known obstructive lung disease: current understanding and clinical implications.

Purpose Of Review: Recent recognition of the importance of abnormal spirometry without obstruction has generated interest in its epidemiology, risk factors, longitudinal outcomes, and clinical implications.

Recent Findings: Preserved ratio impaired spirometry (PRISm), defined as an forced expiratory volume in 1 s (FEV 1 )/ forced vital capacity (FVC) ≥0.7 with an FEV 1 <80% predicted, has a high prevalence globally (2.

Religion and Spirituality in Lifestyle Medicine.

Decades of research now support the positive relationship of religion/spirituality (R/S) with physical health, mental health, morbidity, and mortality. While lifestyle medicine (LM) practitioners often recognize R/S as important, they can face common challenges of how to integrate R/S into their holistic, patient-centered care. To help, this article presents a faith-practice framework, as a starting point for considering incorporating R/S into LM practice-in light of common concerns and challenges, as a guide for patient-centered care through adjusting lifestyle prescriptions to accommodate individualized R/S beliefs and practices for improved health behavior and outcomes, and as an encouragement to stimulate openness for positive, thoughtful discussion into the future of R/S in LM practice and research.

Polygenic and transcriptional risk scores identify chronic obstructive pulmonary disease subtypes in the COPDGene and ECLIPSE cohort studies.

Background: Genetic variants and gene expression predict risk of chronic obstructive pulmonary disease (COPD), but their effect on COPD heterogeneity is unclear. We aimed to define high-risk COPD subtypes using genetics (polygenic risk score, PRS) and blood gene expression (transcriptional risk score, TRS) and assess differences in clinical and molecular characteristics.

Methods: We defined high-risk groups based on PRS and TRS quantiles by maximising differences in protein biomarkers in a COPDGene training set and identified these groups in COPDGene and ECLIPSE test sets.

Osteoarthritis year in review 2024: Imaging.

Objective: To review recent literature evidence describing imaging of osteoarthritis (OA) and to identify the current trends in research on OA imaging.

Method: This is a narrative review of publications in English, published between April, 2023, and March, 2024. A Pubmed search was conducted using the following search terms: osteoarthritis/OA, radiography, ultrasound/US, computed tomography/CT, magnetic resonance imaging/MRI, DXA/DEXA, and artificial intelligence/AI/deep learning.

Trend of ambulatory benign prostatic obstruction surgeries during COVID-19 pandemic.

Introduction: Benign prostatic obstruction (BPO) is one of the most common causes of male lower urinary tract symptoms. Some institutions routinely perform BPO surgeries in ambulatory setting, while others elect for overnight hospitalization. With the COVID-19 pandemic limiting resources and hospital space for elective surgery, we investigated the time trend of ambulatory BPO procedures performed around the COVID-19 outbreak.

Lymphopenia predicts poor outcomes in newly diagnosed multiple myeloma.

Bone marrow microenvironment plays an important role in promoting growth and survival of multiple myeloma (MM) cells. The tumor-promoting immune microenvironment is augmented while antitumor immune responses are inhibited. Although clinical and genomic markers of high-risk MM have been described, the immune status is just being recognized as a potential mediator of disease behavior.

B cell immune repertoire sequencing in tobacco cigarette smoking, vaping, and chronic obstructive pulmonary disease in the COPDGene cohort.

Rationale: Cigarette smoking (CS) impairs B cell function and antibody production, increasing infection risk. The impact of e-cigarette use ('vaping') and combined CS and vaping ('dual-use') on B cell activity is unclear.

Objective: To examine B cell receptor sequencing (BCR-seq) profiles associated with CS, vaping, dual-use, COPD-related outcomes, and demographic factors.

T-cell Clonality in Pleomorphic Dermal Sarcoma in Male Veterans: A Report of 2 Cases and a Review of the Literature.

The standard treatment of choice for pleomorphic dermal sarcoma (PDS), a relatively uncommon soft tissue sarcoma and 1 morphologically similar to atypical fibroxanthoma, is wide local excision with close clinical follow-up. Studies regarding management of advanced/metastatic PDS with immune checkpoint inhibitors are limited as most STSs have historically been viewed as being immunologically inert. Contradicting this belief, in this report, we describe 2 cases of PDS with a robust host response.

Therapeutic Potentials of Near-Infrared II Photobiomodulation to Treat Cerebrovascular Diseases via Nitric Oxide Signalling.

Endothelial dysfunction featuring insufficient endothelial nitric oxide synthase (eNOS) and accompanying nitric oxide (NO) deficiency is implicated in the pathogenesis of cardiovascular diseases. Restoring endothelial NO represents a promising approach to treating cerebrovascular diseases, including stroke. Low-power near-infrared (NIR) light shows diverse beneficial effects, broadly defined as photobiomodulation (PBM).

Profiles of Black Emerging Adults Exposure to Racism-Based Police Violence and Associated Mental Health Outcomes.

This study characterizes the profile of Black emerging adults aged 18-29 generated from sociodemographic characteristics and indicators of police contact and exposure to racism-based police violence (RPV), and the relationship between profiles and traumatic stress symptoms. A purposive sample of 300 Black emerging adults was recruited for this exploratory study. Cluster analysis (CA) was performed to generate profiles of this sample.

Optogenetic targeting of cortical astrocytes selectively improves NREM sleep in an Alzheimer's disease mouse model.

Alzheimer's disease (AD) is a progressive neurodegenerative condition marked by memory impairments and distinct histopathological features such as amyloid-beta (Aβ) accumulations. Alzheimer's patients experience sleep disturbances at early stages of the disease. APPswe/PS1dE9 (APP) mice exhibit sleep disruptions, including reductions in non-rapid eye movement (NREM) sleep, that contribute to their disease progression.