Citations

ABSTRACT Background The impact of psychosocial health and socioeconomic status (SES) on long‐term lung transplant survival remains unclear. Methods We conducted a single‐center, retrospective 2:1 matched case‐control study of adult lung transplant recipients (1999–2019). Cases survived ≥6 years post‐transplant; controls survived <6 years. Matching was based on transplant year (±5 years) and indication. Psychosocial health and SES were assessed using the Psychosocial Assessment of Candidates for Transplant (PACT) score, Mayo Clinic Housing‐Based Socioeconomic Status (HOUSES) index, and Area Deprivation Index (ADI). Secondary covariates included insurance, marital status, employment, caregiver relationship, and proximity to the transplant center. Conditional logistic regression adjusted for age and gender was used. Results Among 189 patients (63 cases, 126 controls), PACT score, HOUSES index, and ADI were not significantly associated with long‐term survival. Patients with non‐family caregivers had lower odds of survival compared to those with a spouse or partner (OR = 0.16, p = 0.022). Regional residents had lower odds of long‐term survival compared to local recipients (OR = 0.55, p = 0.001). Conclusions Pre‐transplant psychosocial and SES measures were not significantly associated with long‐term survival. Caregiver relationships and geographic proximity may have a greater impact on outcomes, highlighting the importance of support systems and access to care.

Abstract INTRODUCTION Preclinical Alzheimer's disease (AD) can be described relative to biomarker positivity onset time. METHODS We estimated time from amyloid positivity (A+) using sampled iterative local approximation (SILA) in a longitudinal autosomal dominant AD (ADAD) sample ( N = 379) with amyloid positron emission tomography. We compared (1) predicted age at A+ to imputed age, (2) estimated age at A+ to estimated age at symptom onset, and (3) variance in cognitive performance explained. RESULTS Mean error between imputed and SILA‐estimated age at A+ ( N = 26) was 1.15 years. Age at A+ explained 39% of estimated years to symptom onset (EYO) variance. Time from A+ explained 19% of cognitive composite variance and 14% of Clinical Dementia Rating Sum of Boxes CDR‐SB variance; EYO explained 43% and 57%, respectively. DISCUSSION SILA estimates A+ age in ADAD with reasonably good accuracy. SILA‐estimated time from A+ describes the start of pathology, but the time from A+ onset to symptoms is variable in ADAD and better described by EYO. Highlights Amyloid chronicity predicts a 14‐year preclinical AD phase in ADAD. SILA accurately estimates age at A+ (MAE < 2 years). EYO outperforms chronicity in predicting symptom onset. APP mutation carriers show atypical amyloid accumulation. Chronicity models help reveal AD heterogeneity in preclinical stages.

OBJECTIVE Cervical dystonia (or spasmodic torticollis) is a neurological condition that results in abnormal movements and head posture, for which initial surgical intervention typically involves selective denervation of the sternocleidomastoid (SCM) and paraspinal muscles. However, muscle reactivation of the distal SCM stump can result in recurrent symptoms. In this study, the authors present their preliminary experience with distal SCM stump resection following selective denervation, with the aim of evaluating the effectiveness of the procedure and identifying patients who may benefit from this technique. METHODS This is a retrospective single-center cohort study of patients who underwent SCM stump resection as revision surgery for cervical dystonia. RESULTS A total of 18 patients (10 males [56%]) were included with a median (range) age of 54 (40–70) years. All patients received selective denervation of the SCM at the authors’ institution prior to SCM stump resection at a median (range) time of 12 (3–198) months between surgical procedures. At preoperative baseline, 13 patients (72%) possessed a rotational torticollis component to their head deviation, 12 (67%) possessed a laterocollis component, and 2 (11%) possessed a retrocollis component. At the most recent follow-up (median [range] 16 [4–119] months), 6 patients had complete resolution of their cervical dystonia (33%), while 10 had residual deviation (56%) and 2 had recurrent deviation (11%). However, compared to their post–selective denervation head position, 12 patients experienced improvement in their head position (67%), 4 patients had no change in their head position (22%), and 2 had worsening of their cervical dystonia (11%) following SCM stump resection. Importantly, 12 patients experienced improvement in their pain following SCM stump resection (67%). Patients who had a history of other movement/spasmodic disorders were more likely to have improvement in head position and improvement in pain after SCM stump resection, though neither of these results achieved statistical significance (p = 0.054). Additionally, patients who experienced full resolution of their cervical dystonia had shorter time between initial selective denervation surgery and SCM stump resection, though this result also did not achieve statistical significance (p = 0.068). CONCLUSIONS Distal SCM stump resection following selective denervation is a simple, safe, and effective option for many patients in treating refractory cervical dystonia. Patients with more severe preoperative presentations may experience greater benefit from SCM stump resection, though additional investigations are needed.

We appreciate Dr Akcay's insightful comments. His observations provide valuable context and highlight important considerations for future research. We hope our work will serve as a foundation for further investigation into sex-associated risks in peritoneal dialysis and contribute to optimizing high-quality patient care for all individuals. Looking ahead, future studies should integrate dialysis-specific measures, explore mechanistic pathways, and incorporate patient-centered outcomes to better characterize sex-associated differences in peritoneal dialysis.

Case: We present 3 cases of brachial plexus injuries (BPI) secondary to compressive hematomas during extracorporeal membrane oxygenation (ECMO), with follow-up ranging from 18 months to 12 years. Patients exhibited profound upper extremity deficits and underwent variable interventions, including surgical decompression. All demonstrated meaningful neurologic recovery. Conclusion: BPI is a rare but serious complication of ECMO. These cases highlight the importance of early recognition and hematoma evacuation, emphasizing the need for clinical vigilance to optimize neurologic outcomes following hematoma-induced nerve injury.

Migraine is one of the most disabling diseases worldwide, especially when it transforms into chronic migraine, which is often associated with medication overuse and can become resistant or even refractory to treatments. Molecular, neuroimaging and neurophysiological changes have been described in chronic migraine, some of which might not be fully reversible with preventive treatment. For these reasons, we should aim to prevent this transition, and initiate preventive treatment before disease becomes refractory and burden increases. Preventive migraine treatments are often delayed because of access to care, stigma leading to undertreatment and patients’ reluctance as a result of fear of side effects and, in some cases, fear of being labeled as chronically ill. With the availability of effective and well-tolerated preventive treatments, we must shift our mindset and take advantage of new opportunities to initiate preventive treatment earlier. In this International Headache Society position statement, we propose a migraine preventive strategy under the idea of shifting from reactive treatment once disability is established (prevention of attacks), to proactive, individualized prevention initiated early with safe, effective and tolerable therapies (prevention of disease progression). This approach is based on 1) promoting the early initiation of effective and tolerable preventive therapies, starting from two to four monthly migraine days in line with the majority of current guidelines and recommendations and 2) fostering longitudinal studies to gather more evidence on the potential benefit of early prevention, with the final goal of improving patient outcomes, promoting excellent migraine care, enhancing individual and social well-being, and, ultimately, preventing migraine progression and preserving brain health.

Objective To explore current approaches to evaluation and treatment decision-making for velopharyngeal insufficiency (VPI) following cleft palate repair. Design Cross-sectional, qualitative study. Setting/participants Participants included 28 surgeons and 17 speech-language pathologists (SLPs) from 12 cleft teams in the United States and Canada. Interventions Semi-structured, qualitative interviews were conducted exploring participants’ current approaches to VPI evaluation and treatment decision-making. Data were analyzed using thematic analysis. Results Participants viewed VPI evaluation as a joint effort of surgeons and SLPs. SLPs were entrusted to conduct formal speech evaluations. All teams completed a perceptual evaluation of speech resonance that included spontaneous speech and phrase repetition. Teams varied in their use of patient questionnaires and nasometry. Most teams performed nasoendoscopy as part of their evaluation, although providers noted limited cooperation in younger children and those with developmental delay. Treatment decision-making occurred either as a joint effort between the evaluating surgeon and SLP or exclusively by the surgeon. Most surgeons employed a personalized approach to treatment decision-making, with 19 distinct approaches described. Elements frequently considered in surgical procedure selection included velopharyngeal gap size and closure pattern as seen on nasoendoscopy. Providers were satisfied with their current approach, although most identified opportunities for improvement. Conclusions Cleft teams have individualized approaches to VPI evaluation and treatment decision-making, with the only common element being completion of a perceptual speech evaluation by an SLP. These findings suggest that efforts to implement new approaches will need to be customized to each team's current process.