Spreading depolarization triggers pro- and anti-inflammatory signalling: a potential link to headache.

Cortical spreading depolarization (CSD), the neurophysiological event believed to underlie aura, may trigger migraine headaches through inflammatory signaling that originates in neurons and spreads to the meninges via astrocytes. Increasing evidence from studies on rodents and migraine patients supports this hypothesis. The transition from pro-inflammatory to anti-inflammatory mechanisms is crucial for resolving inflammation.

Incomplete Ascertainment of Mortality in a Nationally Representative Longitudinal Study of Community-Living Older Americans.

Background: In longitudinal studies of older persons, complete ascertainment of mortality is needed to minimize potential biases. To ascertain mortality in the National Health and Aging Trends Study (NHATS), investigators are advised to use its Sensitive files, which include month and year of death on most decedents who had not dropped out of the study. Because losses to follow-up are not insubstantial, ascertainment of mortality is likely incomplete.

Predictors of Venous Thromboembolism Following Geriatric Distal Femur Fracture Fixation: Are These Patients at Higher Risk Compared With Hip Fracture Patients?

Introduction: Venous thromboembolism (VTE) following injury and subsequent fixation of a distal femur fracture (DFFx) is associated with considerable morbidity. However, the incidence of VTE, associated factors, and the relative risk compared with hip fracture (HFx) fixation remains poorly characterized.

Methods: Retrospective cohort study using the PearlDiver M165 database to identify geriatric patients who underwent DFFx and HFx fixation.

Feasibility of In-Hospital Administration of a Tool to Predict Persistent Post-ICU Functional Impairment Among Older ICU Survivors: A Pilot Study.

Background: A recent international consensus conference called for the development of risk prediction models to identify ICU survivors at increased risk of each of the post-ICU syndrome domains. We previously developed and validated a risk prediction tool for functional impairment after ICU admission among older adults.

Research Question: In this pilot study, we assessed the feasibility of administering the risk prediction tool in the hospital to older adults who had just survived critical illness.

Services and payments associated with the medicare new technology add-on payment program.

In 2001, the Centers for Medicare and Medicaid Services established the New Technology Add-On Payment (NTAP) program to incentivize access to costly new technologies for Medicare beneficiaries. These technologies, authorized by the Food and Drug Administration (FDA), must demonstrate "substantial clinical improvement" when compared to existing technologies. However, in FY2021, the FDA introduced two expedited authorization pathways, allowing technologies with either designation to bypass the "substantial clinical improvement" criterion.

Sacral tumors: a comprehensive review of imaging, diagnostic challenges, and tumor mimics.

The sacrum can harbor a diverse group of both benign and malignant tumors, including metastases. Primary tumors of the sacrum can arise from bone, cartilage, marrow, notochordal remnants, or surrounding nerves and vessels. Among a variety of primary tumors of the spine, chordoma, germ cell tumors and Ewing's sarcoma are recognized for their propensity to occur in the sacrum.

Psychosocial Support Needs and Preferences Among Family Caregivers of ICU Patients with Severe Acute Brain Injury: A Qualitative Thematic Analysis.

Background: Family caregivers of patients with severe acute brain injury (SABI) are at risk for clinically significant chronic emotional distress, including depression, anxiety, and posttraumatic stress. Existing psychosocial interventions for caregivers of intensive care unit (ICU) patients are not tailored to the unique needs of caregivers of patients with SABI, do not demonstrate long-term efficacy, and may increase caregiver burden. In this study, we explored the needs and preferences for psychosocial services among SABI caregivers to inform the development and adaptation of interventions to reduce their emotional distress during and after their relative's ICU admission.

Neural Variability and Cognitive Control in Individuals With Opioid Use Disorder.

Importance: Opioid use disorder (OUD) impacts millions of people worldwide. Prior studies investigating its underpinning neural mechanisms have not often considered how brain signals evolve over time, so it remains unclear whether brain dynamics are altered in OUD and have subsequent behavioral implications.

Objective: To characterize brain dynamic alterations and their association with cognitive control in individuals with OUD.

Simultaneous Symmetrizing Surgery on the Contralateral Breast in Unilateral Autologous Breast Reconstruction is Cost-Effective.

BACKGROUND Simultaneous symmetrizing surgery at the time of unilateral free flap reconstruction has been described as a method to facilitate single stage breast reconstruction. However, the impact on cost and number of additional procedures is not well described. METHODS Patients with unilateral free flap reconstruction were identified in national administrative data from 2017-2021 and followed for one year.

Clinical Implications of Breast Cancer Intrinsic Subtypes.

Estrogen receptor-positive (ER+) and estrogen receptor-negative (ER-) breast cancers have different genomic architecture and show large-scale gene expression differences consistent with different cellular origins, which is reflected in the luminal (i.e., ER+) versus basal-like (i.

Success of Bone Ossification After Posterior Vault Distraction Osteogenesis in Patients With Craniosynostosis.

Background: Posterior vault distraction osteogenesis (PVDO) is an effective treatment for multisuture and syndromic craniosynostosis. It remains unclear how well the calvarium ossifies after PVDO, especially in older patients when they have plateaued in their cranial growth phase. The purpose of this study is to report outcomes associated with PVDO across a wide range of ages at our institution.

Alterations in Gut Microbiome-Host Relationships After Immune Perturbation in Patients With Multiple Sclerosis.

Background And Objectives: Gut microbial symbionts have been shown to influence the development of autoimmunity in multiple sclerosis (MS). Emerging research points to an important relationship between the microbial-IgA interface and MS pathophysiology. IgA-secreting B cells are observed in the MS brain, and shifts in gut bacteria-IgA binding have been described in some patients with MS.

Workforce Attrition Among Emergency Medicine Non-Physician Practitioners.

Study Objective: Non-physician practitioners, including nurse practitioners and physician assistants, increasingly practice in emergency departments, especially in rural areas, where they help mitigate physician shortages. However, little is known about non-physician practitioner durability and demographic trends in emergency departments. Our objective was to examine attrition rates and ages among non-physician practitioners in emergency medicine.

Hepatic adverse events associated with ketamine and esketamine: A population-based disproportionality analysis.

Background And Objective: To determine whether there is disproportionate reporting of hepatobiliary disorders in the United States (US) FDA Adverse Event Reporting System (FAERS) for individuals prescribed ketamine or esketamine.

Design: We identified Medical Dictionary for Regulatory Activities (MedDRA) terms in the FAERS related to hepatobiliary disorders.

Main Measures: Formulations of ketamine and esketamine were evaluated for the proportionality of reporting for each hepatobiliary disorder parameter using the reporting odds ratio (ROR).

Material Goods Provided in Pediatric Primary Care Clinics: A Landscape Analysis.

Objectives: To characterize the 1) types of material goods (non-medical items) offered in pediatric residency continuity clinics, 2) consistency of good availability, 3) funding sources used to support supply, 4) whether goods are provided in response to social needs screening, and 5) common challenges with provision. To assess the extent to which provision of goods varied by clinic size and proportion of publicly insured patients.

Methods: Faculty and staff members from clinics in the Academic Pediatric Association's Continuity Research Network (APA CORNET) completed an online survey about material goods provided in their clinic in the preceding 12 months.

Promotion of Cardiovascular Health in Africa: The Alliance for Medical Research in Africa (AMedRA) Expert Panel.

This proposed scientific statement is focused on providing new insights regarding challenges and opportunities for cardiovascular health (CVH) promotion in Africa. The statement includes an overview of the current state of CVH in Africa, with a particular interest in the cardiometabolic risk factors and their evaluation through metrics. The statement also explains the main principles of primordial prevention, its relevance in reducing noncommunicable disease and the different strategies that have been effective worldwide.

Implementation of a Virtual Cardiology Curriculum to Address the Deficit of Cardiovascular Education in Haiti.

Background: Cardiovascular disease (CVD) is the leading cause of death in low- and middle-income countries such as Haiti. Our team has demonstrated in a pilot study the implementation of a virtual cardiology curriculum to address the deficit of cardiology education in Haiti among medicine residents.

Objectives: The objective of this study was to determine if cardiology education can be delivered nationwide in Haiti via a virtual platform with quantifiable improvement.

Blueprint for destigmatizing depression and increasing openness to treatment among adolescents using brief social contact-based videos: a qualitative study.

Background: Depression is a major public health concern for adolescents, who exhibit low rates of connection to care despite significant needs. Although barriers to help-seeking such as stigma are well documented, interventions to address stigma and to increase help-seeking behavior are insufficient. Dissemination of short videos in social media offer a promising approach, but designing effective stimuli requires better insight into adolescents' perspectives of their own experiences, barriers, and possible interventions.

Evaluating the impact of stratification on the power and cross-arm balance of randomized phase 2 clinical trials.

Background/aims: Randomized clinical trials often use stratification to ensure balance between arms. Analysis of primary endpoints of these trials typically uses a "stratified analysis," in which analyses are performed separately in each subgroup defined by the stratification factors, and those separate analyses are weighted and combined. In the phase 3 setting, stratified analyses based on a small number of stratification factors can provide a small increase in power.