Routine cell-free DNA prenatal screening identifies pregnancies at high risk for cystic fibrosis that may benefit from fetal therapy.

Recent improvements in cell-free DNA technology have enabled non-invasive prenatal testing (NIPT) to screen for fetal single-gene autosomal recessive conditions from maternal blood as early as the first trimester. This technique can determine the fetal risk for cystic fibrosis (CF) with a single blood sample from a pregnant person without the need for a partner sample, which is required for traditional carrier screening. A retrospective review of 100,106 consecutive general-risk pregnant patients who underwent CF carrier screening was completed.

Advances, challenges, and future directions in trauma-related Findable, Accessible, Interoperable, Reusable (FAIR) data efforts.

Findable, Accessible, Interoperable, and Reusable (FAIR) data advances are becoming more common and more important across research fields given the large amount of research data in need of synthesis and application. Many novel methods improve the efficiency and accuracy of data reuse, combination, and synthesis, which is necessary given that there are over 500 published randomized controlled trials of posttraumatic stress disorder treatments in adults; however, these methods are still relatively new to the field of traumatic stress research. We provide a brief overview of relevant FAIR data efforts from other fields and within trauma health care and research; share examples of trauma-related FAIR data efforts to demonstrate recent advances and challenges; and suggest potential next steps to continue making trauma data more FAIR.

How much Improvement in Patient Reported Outcomes after Isolated Medial Patellofemoral Ligament Reconstruction is associated with Surgeon-defined Satisfactory Outcomes? A JUPITER study.

Introduction: The extent of change in Patient Reported Outcome Measures (PROs) required to meet surgeon-defined satisfactory outcomes after isolated Medial Patellofemoral Ligament Reconstruction (MPFL-R) has not been reported. The primary aim of the study was to define the threshold value of maximal outcome improvement (MOI) in PROs associated with surgeon-defined satisfactory postoperative outcomes. The secondary aim was to identify the most effective PRO in predicting these outcomes and to evaluate the factors associated with it.

Effect of early versus delayed middle meningeal artery embolization on clinical outcomes in chronic subdural hematoma: A propensity score-matched cohort study.

Background: Chronic subdural hematoma (cSDH) is a common neurosurgical condition with a high recurrence rate following surgical evacuation. Middle meningeal artery embolization (MMAE) has emerged as an adjunctive or standalone treatment, but the optimal timing of embolization remains unclear. We evaluated whether early MMAE (≤2 days) versus delayed MMAE (3-7 days) is associated with improved clinical outcomes.

Pediatric Lymph Node Biopsy: Indications, Techniques, and Complications.

Lymph node biopsy is a key component in the workup and diagnosis of pediatric hematologic malignancies. There are numerous pre-operative and operative considerations for safe and effective lymph node sampling. Core needle biopsy, lymph node excision, and laparoscopic approaches may all be utilized for lymph node biopsy, depending on these considerations.

Nuclear cGAS mediated Replication Stress and Mitotic Catastrophe can Overcome Gemcitabine Resistance.

Gemcitabine, a ribonucleotide reductase (RNR) inhibitor, is active in pancreatic ductal carcinoma (PDAC) patients, but unfortunately has a limited impact on long term outcomes. Gemcitabine induces nucleotide deficiency, DNA damage including single stranded DNA (ssDNA) and replication stress (RS). DNA damage can activate cyclic GMP-AMP synthase (cGAS), leading to genome instability, micronucleus generation, and immune activation.

Phenotyping and Clinical Utility of Phagocytic Polyploid Giant Cancer Macrophages in Blood.

Historically, polyploid giant cancer cells (PGCCs) within tumors have been ignored as superfluous inflammatory refuse with no intrinsic clinical or biological relevance. However recently, multiple studies have described the existence PGCCs in solid tumor masses that appear to correlate with tumor progression, and can also appear in blood circulation as cancer associated macrophage like cells (CAMLs). In an effort to understand the clinical and biological role of CAMLs (i.

Defining the Clinical Informatics Knowledge Gap in General Surgery: Evaluation of Resident Experience and Perspectives.

Objective: Despite the growing prominence of clinical informatics (CI) in surgical practice, general surgery residents receive limited formal training in this field. We aimed to define key educational opportunities by assessing general surgery resident knowledge, perceptions, and experience in CI.

Design: Survey study assessing resident demographics, prior informatics experience, perception of CI's importance in key areas of surgical practice, and interest in informatics education topics.

A longitudinal qualitative study exploring how workplace factors impact family physicians' provision of spiritual care during comprehensive patient care: implications for burnout prevention and policy.

Background: Family physicians (FPs) endorse the value of spiritual care (SC) as part of comprehensive, patient-centered care. However, a mismatch exists between patients' desire to have spiritual needs addressed and physicians' SC provision. Studies explore physician barriers, but few examine workplace barriers/facilitators.

Bovine-derived collagen matrix as an adjunct in stage 3 pressure injuries: a case series of lower extremity wounds.

Objective: Hard-to-heal (chronic) stage 3 pressure injuries (PIs) in medically complex patients are often refractory to standard treatments, and pose significant risks of infection, limb loss and diminished quality of life. Adjunctive use of advanced biologic materials, such as bovine-derived collagen matrices, may support more efficient wound resolution in these high-risk populations.

Method: In this retrospective case series, patients with hard-to-heal stage 3 PIs of the lower extremity were treated with a single application of a bovine-derived collagen matrix as part of a multidisciplinary wound care protocol.

Risk of Stroke Recurrence Following Isolated Retinal Artery Occlusion Versus Minor Stroke or Transient Ischemic Attack.

Background: Retinal artery occlusion (RAO) is a form of ischemic stroke per the American Heart Association, yet high-level evidence guiding management and prognostication is limited. The risk of future cerebral infarction following nonarteritic isolated RAO (iRAO; without concomitant cerebral infarction) is unclear. This study compares the risk of stroke recurrence following iRAO versus nondisabling ischemic cerebrovascular events (NICEs), including transient ischemic attacks and minor ischemic strokes.

COVID-19 pandemic effects on seminal fluid analysis parameters: A prospective cohort study.

Objective: To investigate the effects of the Coronavirus disease 2019 (COVID-19) virus on seminal fluid analysis (SFA) parameters in patients who have had the infection.

Background: COVID-19 is caused by severe acute respiratory syndrome coronavirus 2 and has had a significant global impact. Recent studies suggest a potential relationship between COVID-19 and male reproductive health, particularly in its effects on semen quality.

Perinephric Myxoid Pseudotumor of Fat: A Series of 29 Cases Demonstrating Inconsistent Associations With Underlying Kidney Disease.

Perinephric myxoid pseudotumor of fat (PMPTF) is a recently characterized lesion typically associated with non-neoplastic renal disease. Its pathogenesis is thought to result from chronic renal "irritation," either due to mass effect from renal carcinoma or inflammation related to benign renal conditions. Prompted by several cases arising in the absence of underlying renal pathology, we conducted a multi-institutional study of 29 mass-forming cases with detailed clinical, histologic, and molecular characterization.

Psychiatric Care Checklist: A Novel Aid to Improve Psychiatric Care in the Emergency Department.

Introduction: Emergency department (ED) patients requiring inpatient psychiatric admission experience prolonged boarding times due to a nationwide deficit in inpatient bed capacity. These extended boarding times, which can last hours to days, introduce additional risks of harm, including missed home medications and omissions in care essential to chronic disease management. The overall aim is to reduce missed care components in ED patients with psychiatric illness awaiting inpatient psychiatry admission by using our novel checklist and mnemonic, SHEDS (sugar control, home medications, expiration time, documentation, social work, and psychiatry consults), coupled with an educational campaign.

Efficacy and Safety of Upadacitinib in Patients With Moderate-to-Severe Atopic Dermatitis: Phase 3 Randomized Clinical Trial Results Through 140 Weeks.

Background: Upadacitinib is an oral selective Janus kinase inhibitor approved to treat moderate-to-severe atopic dermatitis (AD) in adults and adolescents; long-term efficacy and safety data beyond 1 year are needed.

Objective: The aim was to evaluate the long-term efficacy and safety of upadacitinib treatment through 140 weeks in patients with moderate-to-severe AD.

Methods: Measure Up 1 (MeUp1; NCT03569293), Measure Up 2 (MeUp2; NCT03607422), and AD Up (NCT03568318) are ongoing, phase 3, randomized clinical trials evaluating upadacitinib 15 mg (UPA15) and 30 mg (UPA30) in adults and adolescents with moderate-to-severe AD.

Middle meningeal artery embolization for chronic subdural hematoma: Does statin therapy improve outcomes? A propensity score-matched analysis.

BackgroundChronic subdural hematoma (cSDH) is a common condition in older adults, often treated with surgical-evacuation, though recurrence rates can reach 30%. Middle meningeal artery embolization (MMAE) has emerged as a treatment alternative. Statins have been explored as adjunct therapies, but literature regarding their combined use with MMAE is limited.

Does Back Pain Improve Following Lumbar Decompression Alone?

Study Design: Retrospective cohort study of a prospectively collected database at an academic institution.

Objective: (1) Evaluate if low back pain (LBP) improves following decompression for neurogenic claudication or radiculopathy, (2) use the least absolute shrinkage and selection operator (LASSO) methodology to identify preoperative predictors for improvement in LBP, and (3) develop a pilot nomogram to guide clinical planning and postoperative expectations.

Summary Of Background Data: LBP is a common complaint for patients with degenerative lumbar spine disease.

ACR-ABS-ACNM-ARS-SIR-SNMMI Practice Parameter for Radioembolization of Liver Malignancies.

Objectives: The practice parameter was revised collaboratively by the American College of Radiology (ACR), the American Brachytherapy Society (ABS), the American College of Nuclear Medicine (ACNM), the American Radium Society (ARS), the Society of Interventional Radiology (SIR), and the Society of Nuclear Medicine and Molecular Imaging (SNMMI). This document summarizes current evidence-based guidelines for the administration of Yttrium radioembolic therapy to the liver, including training requirements, evidence-based guidelines for administration, and safe practice for administration.

Methods: This practice parameter was revised according to the process described under the heading The Process for Developing ACR Practice Parameters and Technical Standards on the ACR website (https://www.

SputOMICs identifies common and distinct markers in cystic fibrosis and chronic obstructive pulmonary disease.

Cystic fibrosis (CF) and chronic obstructive pulmonary disease (COPD) are muco-obstructive lung diseases. Knowledge of molecular processes has much improved therapeutic options in CF, whereas much less is known for COPD, a disease affecting an increasing number of patients. Here, we report a multilayer workflow integrating microbiome, inflammation and proteome profiling with clinical data to identify disease specific characteristics in sputum.

Preoperative middle meningeal artery embolization is associated with reduced reoperation rates in chronic subdural hematoma.

BackgroundMiddle meningeal artery embolization (MMAE) has recently emerged as a promising adjunctive therapy to surgical evacuation for patients with chronic subdural hematoma (cSDH). However, the optimal timing of MMAE relative to surgery remains poorly defined. Therefore, this large retrospective cohort study aimed to assess the impact of MMAE timing (preoperative vs.

Path to parenthood for medical residents and fellows: the impact of leave policies on parent trainees at Oregon Health and Science University.

Background: Residents and fellows in graduate medical education (GME) programs across the USA often complete training during childbearing years, presenting challenges for pregnant and parenting trainees balancing work and family. Institutional policies must better support these trainees. Previous studies show supported trainees experience reduced burnout, better health, and improved patient outcomes.

Aficamten or Metoprolol Monotherapy for Obstructive Hypertrophic Cardiomyopathy.

Background: Beta-blockers have been the initial treatment for symptomatic obstructive hypertrophic cardiomyopathy (HCM) despite limited evidence of their efficacy. Aficamten is a cardiac myosin inhibitor that reduces left ventricular outflow tract gradients, improves exercise capacity, and decreases HCM symptoms when added to standard medications. Whether aficamten as monotherapy provides greater clinical benefit than beta-blockers as monotherapy remains unknown.

Developing personalized treatment strategies for Parkinson's disease based on disease subtypes.

Introduction: Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by classic motor symptoms such as tremor, bradykinesia, rigidity, and postural instability as well as several non-motor symptoms. The heterogenous nature of PD has increased interest in classifying patients into subtypes based on clinical and/or pathologic features. This approach might allow for personalized therapies ranging from non-medical interventions to disease modifying therapies.

Home-Based Primary Care in the Department of Veterans Affairs: Past, Present, and Future.

Launched in 1970, the Department of Veterans Affairs (VA) Home-Based Primary Care (HBPC) Program is a unique, well-resourced model that has influenced the development of HBPC practice more broadly. VA HBPC delivers team-based, comprehensive care in the homes of medically complex Veterans. As the population ages, VA is committed to supporting a continuum of age-friendly care.