Decreasing Trend in Medicare Physician Reimbursements for Flap and Microvascular Surgery Procedures From 2002 to 2023.

Purpose: This study aimed to evaluate how major US health care policy changes have influenced long-term Medicare reimbursement trends for upper-extremity flap and microvascular procedures from 2002 to 2023.

Methods: Reimbursement data for 28 common flap and microvascular procedures were extracted from the Medicare Physician Fee Schedule database using Current Procedural Terminology codes. Adjustments for inflation were made using the Consumer Price Index.

The contributions of social functioning and emotion dysregulation to depression severity in patients with depressive disorders.

Background: Emotion dysregulation and social functioning are important predictors of depression severity. It remains unclear whether these factors independently or interactively contribute to depression severity amongst psychiatric patients with depressive disorders.

Method: 340 psychiatric outpatients with a principal depressive disorder were interviewed using the Structured Clinical Interview for DSM-IV (SCID).

FLAIR extending beyond a quadrant (FEQ) of the cerebrum as a qualitative imaging biomarker: a conceptual proposition and proof-of-principle.

Significant variability exists in the use of corticosteroids for treating adverse radiation effects (ARE) after stereotactic radiosurgery (SRS) of brain metastasis (BM). Here, we determine the diagnostic utility of a quadrant-based, visual assessment of magnetic resonance (MR) FLAIR as an imaging biomarker for steroid-dependent ARE. FLAIR was assessed at four axial levels along the rostral-caudal axis of the cerebrum, defined by standard landmarks of superior temporal line, third ventricle, temporal horn, and fourth ventricle.

Deep brain stimulation for treatment-resistant major depressive disorder: a network meta-analysis of stimulation targets.

Objective: Major depressive disorder is a significant cause of disability, impacting an estimated 193 million individuals worldwide. Forty percent are estimated to have little to no response to standard pharmacological therapies. Deep brain stimulation (DBS) has emerged as a favorable neuromodulation therapy for treatment-resistant depression, but it remains unclear which brain targets are optimal.

The Nephrologist's Perspective in Evaluation and Management of Localized Renal Masses: Core Curriculum 2025.

The evaluation and management of renal masses, predominantly of the clear cell renal cell carcinoma subtype, have been evolving over the past several years and demanding greater attention from nephrologists. Oncologic survival of localized tumors approaches 100%, where survival is more closely tied to underlying comorbidities including chronic kidney disease (CKD). Early diagnosis and thus increasing prevalence related to incidental discovery of renal masses allows greater emphasis on nephron-sparing procedures and for residual kidney function preservation.

Allostatic Load Mediates Associations Between Race and Ethnicity and Hypertensive Disorders of Pregnancy.

Objective: To evaluate whether chronic stress exposure, measured by allostatic load (a biological measure of chronic stress embodiment, including stressors exacerbated by structural inequities [eg, structural racism]) and patient-reported perceived stress in the first trimester of pregnancy, mediates the association between self-identified race and ethnicity and hypertensive disorders of pregnancy (HDP).

Methods: This was a secondary analysis of data from nuMoM2b (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be), a large prospective cohort study. We evaluated self-identified race and ethnicity as an independent variable (non-Hispanic Black, Hispanic, Asian, non-Hispanic White), and our outcome of interest was HDP (ie, gestational hypertension, preeclampsia or eclampsia).

The Genetics and Evolution of Human Pigmentation.

Human skin pigmentation is one of the most visible and variable traits among populations and has been shaped primarily by natural selection in response to ultraviolet (UV) radiation. This review synthesizes the current understanding of the genetic and evolutionary mechanisms that underlie pigmentation differences across the globe. The roles of key pigmentation-related genes, such as MC1R, SLC24A5, TYR, and OCA2, are examined in terms of how different versions of these genes have been favored in different UV environments to balance the need for photoprotection and vitamin-D synthesis.

Show Me the Money: A Movement Towards Transparency in Pediatric Emergency Medicine Compensation.

Background: National studies report sustained gender-based differences in physician compensation, even after adjustment for workplace factors such as academic rank, specialty type, and work hours. This study examines differences in compensation among pediatric emergency medicine (PEM) fellows' first job after training.

Methods: Between May 2023 and June 2023, we distributed an electronic survey to all United States PEM fellowship program directors (FPDs), requesting they forward it to their graduating fellows.

Association of Glucagon-like Peptide-1 Receptor Agonist Use with Complications Following Thoracic and/or Lumbar Spinal Fusion for Degenerative Spine Disease: A BMI-Stratified Retrospective Study.

Study Design: Retrospective Cohort.

Summary Of Background Data: Spinal fusions are common interventions for degenerative spine disease (DSD), with increasing utilization in obese and metabolic syndrome populations. Glucagon-like peptide-1 (GLP-1) receptor agonists (RA), widely adopted for diabetes and weight management, may offer systemic benefits that exert a parallel influence on surgical outcomes.

Time to Acute Treatment in Intracerebral Hemorrhage Lags Significantly Behind Ischemic Stroke: A Multicenter, Observational Retrospective Study.

Background: Time-to-treatment goals for acute ischemic stroke (AIS) have substantially improved outcomes, yet similar metrics have not been studied in patients with intracerebral hemorrhage (ICH), where mortality rates are much higher.

Methods: Multicenter, observational retrospective study of patients with ICH and AIS between January 1, 2017, and December 31, 2022, in 11 comprehensive stroke centers across the United States participating in Get With The Guidelines. We included patients with ICH who received antihypertensive therapy and anticoagulation reversal, and patients with AIS requiring intravenous thrombolytic and mechanical thrombectomy.

Listhesis and Spinopelvic Inclination of Upper Instrumented Vertebra Region and the Implications on Proximal Junctional Kyphosis.

Study Design: Retrospective analysis of prospective data.

Objective: Evaluate the impact of radiographic and morphologic configuration of the uppermost instrumented vertebrae (UIV) region on proximal junctional kyphosis (PJK) rates.

Background: Literature is limited on evaluation of the preoperative landing zone (UIV-1 to UIV +2 levels) and its impact on development of PJK.

Noonan Syndrome and Rett Syndrome in An 8-Year-Old Girl With A Tectal Neoplasm.

Individuals with Noonan syndrome (NS) are predisposed to hematologic cancers, solid tumors, and low-grade gliomas. We report an 8-year-old girl originally referred at age 14 months for short stature, developmental delay, and failure to thrive who was subsequently found to have pathogenetic variants both in and Family history included a maternal half-sister with NS and a mother carrying the mutation. Familial single-gene testing showed a heterozygous pathogenic variant in (c.

Global trends and hotspots related to complications following total knee arthroplasty.

This bibliometric analysis aims to assess the global research landscape on the topic of complications of knee arthroplasty. Understanding the research being done on knee arthroplasty can help identify prominent areas in the field. Over the past two decades, knee arthroplasty has become one of the most common surgical procedures done to treat knee osteoarthritis.

Examining the moderating role of adverse childhood experiences on the link between executive functioning and depressive/anger rumination among adolescents.

Introduction: Adverse childhood experiences (ACEs) are theorized to amplify the effects of poor executive functioning (EF) leading to rumination. Though, few studies test this hypothesis among adolescents. Rumination is a transdiagnostic risk factor linked to mental health problems.

Apixaban and Recurrent Stroke Risk With Left Ventricular Dysfunction: A Secondary Analysis of the ARCADIA Trial.

Background: Major uncertainty remains about the relationship between left ventricular (LV) systolic dysfunction, recurrent stroke, and the optimal antithrombotic therapy for secondary stroke prevention in patients with recent stroke and LV systolic dysfunction.

Methods: We performed a post hoc analysis of data from the ARCADIA trial (Atrial Cardiopathy and Antithrombotic Drugs in Prevention After Cryptogenic Stroke), a randomized trial comparing apixaban versus aspirin for secondary stroke prevention in patients with cryptogenic stroke and atrial cardiopathy. Echocardiograms were sent from 185 enrolling sites in the United States and Canada for central review at the trial echocardiography laboratory.

A Comparison of Growth on Rough and Smooth Titanium Surfaces.

Purpose: The textured titanium surfaces used in many total hip arthroplasty (THA) implants are designed to promote osseointegration. However, these surface types may also facilitate bacterial adherence and risk of infection. This aim of this study is to characterize the bacterial growth and viability on the different titanium surfaces used in THA implants.

Integrating HIV prevention services into care settings for people with opioid use disorder (OUD): a study protocol for implementation strategy development and modeling.

Background: The overlapping epidemics of opioid use disorder (OUD) and HIV present a critical public health challenge. Although people with OUD frequently engage with healthcare settings, uptake of HIV prevention services such as pre-exposure prophylaxis (PrEP) remains low. Integrating HIV prevention into routine OUD care could reduce new infections, but scalable, evidence-based strategies are lacking.

Analyzing SARS-CoV-2 case numbers and clustering to predict a nursing home outbreak.

The COVID-19 pandemic devastated nursing homes, highlighting the urgent need for effective outbreak control measures. This study analyzed twice-weekly PCR surveillance data from 134 Veteran Affairs Community Living Centers (December 2021-June 2022) to identify early predictors of SARS-CoV-2 outbreaks. Among 16,353 residents (mean age 74, 96% male, 68% white), we identified 1,868 infections and evaluated neighborhood ward-level case counts and their association with subsequent infections over two-week periods.

Stigma intersectionality and its impact on an epilepsy stigma self-management program.

Introduction: Perceived stigma is a common and distressing experience among people with epilepsy (PWE), particularly those with additional marginalized identities. Our team developed RISE ABOVE, a self-paced online stigma self-management program, to reduce stigma-related distress. This secondary analysis of pilot data examined how intersecting stigmas (i.