Citations

In this letter, the authors evaluate the potential of suzetrigine, a newly U.S. Food and Drug Administration-approved selective NaV1.8 sodium channel inhibitor, as a novel nonopioid alternative for managing moderate-to-severe pain. By targeting peripheral sensory neurons and avoiding the central nervous system, suzetrigine offers a favorable safety profile that bypasses typical opioid-related risks such as respiratory depression, sedation, and tolerance. While clinical trials demonstrate its noninferiority to hydrocodone/acetaminophen in acute postsurgical settings, the authors highlight significant barriers to its use in palliative and hospice care. These limitations include a lack of evidence in patients with serious illness, a current safety restriction of 14 days of use, and a high cost of approximately $15.50 per tablet. Consequently, while suzetrigine represents a significant pharmacological advancement, its current utility is likely limited to short-term acute pain crises until further data support its long-term application in serious illness management.

Avoidant/restrictive food intake disorder (ARFID) is an eating disorder characterized by persistent restriction or avoidance of food intake leading to clinically significant nutritional, medical, and/or psychosocial consequences, without associated body-image disturbance. Although historically described in pediatric populations, ARFID is increasingly recognized in adults, particularly among patients with gastrointestinal (GI) disorders. Emerging data demonstrate a strong bidirectional relationship between ARFID and GI disease—especially disorders of gut–brain interaction—where fear of GI symptoms commonly drives restrictive eating, and chronic undernutrition may worsen GI motility, visceral sensitivity, and symptom severity, reinforcing a self-perpetuating cycle. Despite growing recognition of ARFID in adult gastroenterology patients, evidence guiding nutritional management and the use of nutrition support therapies in this population remains limited. This narrative review synthesizes the current literature on the epidemiology, clinical features, and nutritional consequences of ARFID in adults with GI disease, with a focus on screening and diagnostic considerations relevant to GI clinicians and principles of multidisciplinary management. Particular attention is given to the role of nutrition support therapies, including oral nutritional supplementation, enteral nutrition, and parenteral nutrition. While oral strategies are foundational to nutritional rehabilitation, available evidence supporting enteral or parenteral nutrition in adults with ARFID is sparse and largely extrapolated from pediatric or retrospective studies. Expert guidelines caution against routine or prolonged use of invasive nutrition support due to risks of reinforcing food avoidance, medical complications, and poor long-term outcomes, recommending their use only in carefully selected, medically necessary, and time-limited circumstances. Overall, ARFID represents an underrecognized but clinically significant contributor to malnutrition and symptom burden in adult patients with GI disorders, underscoring the need for routine screening, individualized multidisciplinary care, and high-quality prospective research to inform evidence-based treatment guidelines.

Abstract Objective: This study aimed to develop a machine learning model for the diagnosis of chronic renal failure (CRF) with spleen–kidney qi deficiency (SKQD) syndrome by investigating facial chromatic biomarkers based on traditional Chinese medicine (TCM) theory. Materials and Methods: This cross-sectional study analyzed TCM-defined facial regions in 303 patients with CRF (166 SKQD and 137 non-SKQD) and 25 healthy controls using active appearance models and RGB/Lab color spaces. Key chromatic features were selected using Chi-square automatic interaction detection (CHAID) decision trees to construct a multibranch deep convolutional neural network (CNN), nomogram, and hybrid model. The model performances were compared using the DeLong test. Results: The SKQD group showed a higher glomerular filtration rate, albumin level, and facial R-value with a lower serum creatinine level (all P < 0.05), accompanied by a higher prevalence of shortness of breath with reluctance to speak, and cold extremities ( P < 0.05) compared with the non-SKQD group. Chromatic analysis revealed elevated R/a values in the kidney region using the natural facial color region method ( P < 0.05), and distinctively higher R -values in the bladder-uterus region and a -values in the right small intestine region using the Mingtang facial color region method ( P < 0.05). The CHAID algorithm selected four diagnostic determinants, including the overall facial R -values. The CNN achieved superior discriminative performance (test area under the receiver operating characteristic curve = 0.74 vs. nomogram 0.68, DeLong test P < 0.001) with no added benefit from model integration ( P > 0.05). Conclusions: Facial chromatic biomarkers effectively differentiated SKQD in patients with CRF when analyzed using TCM-defined regions. The superior performance of the CNN validates AI-driven TCM diagnostics as a clinically actionable tool for precise syndrome classification.

Background: Understanding personal and geographic factors associated with smoking is important to design and implement interventions focused on reducing cancer health disparities. Scant research has been published recently regarding factors associated with smoking history associations within rural communities. Purpose: To examine demographic factors and rural residence history for associations with smoking history. Methodology: In a cross-sectional study of cancer-related behaviors, 1,786 adults (mean age 47.9 ± 17.5 years; 53% female, 84% White) completed an online survey in 2020. We examined factors associated with smoking history (having smoked at least 100 cigarettes) using independent t-tests, chi-square tests, and logistic regression. Results: Of the participants, 36% had a rural residence history and 49% had a smoking history. A larger proportion of men than women (61% vs. 37%; p < .001), White than Black participants (50% vs. 39%; p = .001), and rural than nonrural residents (53% vs. 46%; p = .005) had a smoking history. Logistic regression analysis revealed that the young age group (18–30) was less likely ( p = .002), whereas the middle age group (31–50) was more likely ( p < .001) to have a smoking history than those older than 50 years. Rural residence was associated with a smoking history among women ( p < .001), but not among men ( p = .70) in this sample. Conclusions: Tobacco control efforts are needed to focus on middle-aged men in general and women with rural residence history. Implications: Nurse practitioners are uniquely positioned to directly contribute to future research with self-identified rural populations that could help inform future public health policy.

Dynamic fluid and solute transportation across the arachnoid barrier in the meninges of healthy participants was measured by tracking intravenous gadolinium-based contrast agent entering cerebrospinal fluid from dural blood vessels using dynamic dual-spin-echo perfusion MRI.

Background: Sodium–glucose cotransporter 2 inhibitors (SGLT2i) are nephroprotective but are associated with early eGFR decline, also termed “eGFR dip.” Despite elevated risk of kidney disease, this phenomenon is understudied among people with HIV (PWH). Methods: In a 1:1 propensity score–matched cohort study using data from 9 Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) sites, we compared new SGLT2i users with new users of other antihyperglycemic classes. We estimated adjusted hazard ratios (aHRs) for time to ≥10% and ≥30% eGFR decline using multivariable Cox proportional hazards models and analyzed eGFR change using multivariable linear mixed models. In addition, longer-term eGFR trends over 24 months were visualized using locally weighted scatterplot smoothing (LOWESS) curves. Results: Among 1554 eligible PWH, we obtained 295 matched pairs. Over 6 months, eGFR decline incidence of ≥10% and ≥30% was higher among users of SGLT2i versus other antihyperglycemic classes (58.2% vs. 37.4%; aHR: 1.79; 95% CI: 1.40%–2.28%; and 17.3% vs. 9.8%; aHR: 1.69; 95% CI: 1.05–2.73; respectively). The adjusted mean eGFR change at 6 months was −2.62 mL/min/1.73 m 2 for SGLT2i versus 0.05 mL/min/1.73 m 2 for other classes. Long-term eGFR trends revealed an expected initial decline after SGLT2i initiation, followed by stabilization and a slower subsequent decline compared with other classes. Conclusions: Acute eGFR dips were more common among PWH initiating SGLT2i relative to other antihyperglycemic classes, although overall declines were small, transient, and consistent with the general population. Further research is needed to explore the long-term effects of SGLT2i in PWH.

BACKGROUND: Pectus deformities are common chest wall abnormalities, with surgical correction recommended for severe cases. Female patients undergoing repair may have a history of breast implants or seek concurrent augmentation. This retrospective study examines clinical implications of pectus repair in patients with breast implants and provides recommendations. STUDY DESIGN: A retrospective review of female patients undergoing pectus repair at Mayo Clinic Arizona (January 1, 2010 to February 1, 2025) was conducted. Outcomes and complications were analyzed in patients with and without breast implants. RESULTS: In total, 456 female patients were included (447 excavatum, 7 arcuatum, and 2 carinatum; median age 32.7). Most patients (78.5%) underwent primary minimally invasive repairs (MIRPE); 6.6% underwent primary hybrid MIRPE, 5.5% underwent redo MIRPE, and 9.4% underwent primary redo open and complex reconstructions. In total, 104 patients (22.8%) had a history of breast implants, with 68 patients having breast implant-related procedures at the time of pectus surgery. At 12 months, the cumulative incidence of infection was significantly higher in patients with implants present at the time of pectus repair than in those without (8.8% vs 1.8%; log rank, p = 0.0015). A 4.9-fold increase in overall infection was seen in patients with indwelling or placed implants during pectus surgery. Deep infections were significantly more common in patients with implants (4.4%) than without (1.0%; p = 0.035). Similarly, superficial infections were more frequent in patients with implants (4.4%) than without (0.8%; p = 0.016). At 30 days, patients with implants had higher rates of infection (p = 0.032), pneumothorax (p = 0.008), and hematoma (p = 0.027), with no significant differences in other complications. CONCLUSIONS: Breast implants at the time of pectus repair were associated with increased risk of postoperative infection, pneumothorax, and hematoma. Removal of implants before pectus repair is recommended with delayed replacement, if desired.

Abstract Aims Calcium release channel deficiency syndrome (CRCDS) results from loss-of-function (LOF) variants in the RYR2-encoded type 2 ryanodine receptor (RyR2), predisposing patients to sudden cardiac arrest/death (SCA/SCD) without abnormalities on a stress electrocardiogram (ECG). Undetected CRCDS may underlie idiopathic ventricular fibrillation (IVF) and sudden unexplained death in the young (SUDY). We aimed to determine the prevalence of potential CRCDS-causative RYR2 variants in IVF and SUDY. Methods and results We reviewed clinical evaluation and RYR2 genetic analysis of 169 IVF patients and 279 SUDY victims. Only ultra-rare (&lt;0.005% in gnomAD) nonsynonymous RYR2 variants were considered potentially pathogenic. Among IVF patients, 6/169 (3%) overall—and 6/67 (9%) with exertion-related SCA—harboured an RYR2 variant and represent potential CRCDS cases. All exhibited normal resting and stress ECGs. Genetic analysis revealed six distinct RYR2 variants, two previously characterized as LOF. In SUDY, 31/279 victims (11%) had a RYR2 variant (30 unique variants), predominantly observed in exertion-related SCD 20/83 (24%) vs. rest-related 11/196 (6%). Of the 14 SUDY victims with functionally characterized RYR2 variants, five (2% of total cohort) had a LOF variant; among the 56 exertion-related SUDY cases, four (7%) had a LOF variant. Conclusion CRCDS may account for 3% of IVF overall and 9% of exertion-related SCA in IVF. Ultra-rare RYR2 variants may underlie up to 11% of SUDY, with 65% of RYR2-positive cases occurring during exertion. LOF-RYR2 variants may contribute to ≥7% of exercise-associated SUDY. Accurate identification of the underlying ryanodinopathy is essential for clinical management of affected patients.