Citations

ABSTRACT Background Transvenous lead removal (TLR) is a Class I indication for patients with cardiac implantable electronic device (CIED) infections. However, disparities in the utilization of TLR have not been fully explored, particularly concerning demographic and socioeconomic factors. Objectives This study aims to examine whether disparities exist among patients hospitalized for CIED infections with respect to the utilization of TLR, focusing on sex, race, and income characteristics. Methods We utilized the 2019 National Inpatient Sample (NIS) to assess patients hospitalized with CIED infections and identify those who underwent TLR. Multiple logistic regression was used to examine risk factors for TLR utilization, including age, sex, race/ethnicity, and socioeconomic characteristics. Results A total of 56 709 patients were hospitalized for CIED infection in the United States in 2019, of which 9867 (17.4%) underwent TLR. On an adjusted analysis, females and Black patients were found to have lower odds of undergoing TLR compared to males and White patients (OR: 0.62; 95% CI: 0.59–0.78; p < 0.01; and OR: 0.47; 95% CI: 0.39–0.57; p < 0.01, respectively). Hispanic patients also had reduced odds of TLR (OR: 0.73; 95% CI: 0.58–0.93; p = 0.01). No significant associations were observed between income or insurance status and the likelihood of receiving TLR after adjustment. Conclusions This study identified significant disparities in the utilization of TLR among patients hospitalized for CIED infections. Female, Black, and Hispanic patients were significantly less likely to receive TLR.

Abstract Measles virus (MeV) is a highly contagious pathogen capable of infecting immune cells and thereby causing immunosuppression and immune amnesia. A live-attenuated MeV vaccine is highly efficacious and has been safely administered for over 60 years. However, a detailed mechanistic understanding of the mode of its attenuation remains elusive. Here, we determined the molecular mechanisms underlying MeV vaccine attenuation in primary human immune cells. Enhanced infection of innate immune cells resulting in uncontrolled viral RNA synthesis and reduced ability to evade host antiviral responses induced a strong type-I interferon signature that arrested replication of the vaccine strain. In contrast, the wild type virus replicated slowly but steadily, avoiding detection by innate immunity.

Abstract Full waveform inversion (FWI) is one of the advanced inversion-based ultrasound computed tomography (USCT) techniques that can identify the material properties and produce high-resolution inverted images of the specimen, making it promising for applications in nondestructive evaluation (NDE) and structural health monitoring (SHM). However, this process is computationally expensive and time-consuming due to its ill-posed nature and inherent nonlinearity. To mitigate these challenges and enhance the efficiency of FWI, this study explores an alternative approach using artificial intelligence (AI) as a data-driven regularization. However, one of the major challenges in such a data-driven approach is the inadequate amount of data to train the neural network. To address this bottleneck, 2D numerically generated samples are used to train the neural network in this study. In addition, two different source time functions (STF) were used for FWI simulations to understand the effect of using different waveforms on the deep-learning (DL) based solution. The first STF was numerically generated and the second was acquired by inverting experimental data using a multi-channel data acquisition system from the Verasonics. For evaluation, the structural similarity index measure (SSIM) and peak-signal noise ratio (PSNR) metrics are used to compare the predicted images with the ground truth images. The results demonstrate the efficacy of the DL-based approach, with improvements of 22.5% and 78% in SSIM and 47% and 73% in PSNR over the classical FWI simulations for the first and second STFs, respectively. The DL-based adjoint tomography architecture for USCT presented in this work has a strong potential for material characterization and detecting internal defects and variations.

Kidney organoids are an increasingly established model of polycystic kidney disease (PKD). Derived from human pluripotent stem cells (hPSCs), organoids may be generated from induced pluripotent stem cells (iPSCs) of patients that bear naturally occurring mutations or from CRISPR mutant hPSCs by virtue of their genetic tractability. PKD is the leading inheritable cause of kidney failure (KF), accounting for ∼5%–10% of the kidney transplant and dialysis needs worldwide. PKD is a disorder of considerable genetic heterogeneity, composed of typical adult-onset autosomal dominant (ADPKD) and fetal-onset autosomal recessive (ARPKD) forms, which share pathomechanisms. Despite advances in our understanding of the genetic and molecular underpinnings of PKD, the limited clinical treatment options have raised concerns regarding the faithfulness of preclinical models. Kidney organoids have emerged as a promising platform to study PKD by mimicking human-specific responses, enabling personalized medicine, and supporting high-throughput screens. Yet, valid criticisms have related to the relative immaturity of kidney organoids for modeling adult-onset forms of PKD, the faithfulness of organoids in modeling the cystic distribution of afflicted patients, and their batch-to-batch variability limiting experimental reproducibility. Here, we summarize a decade of kidney organoid models of PKD, emphasizing their role in advancing translational and therapeutic applications while addressing their limitations and future potential.

Purpose: To describe an exceedingly rare presentation of vitreoretinal involvement of metastatic tonsillar squamous cell carcinoma and illustrate the utility of therapeutic and diagnostic epiretinal membrane biopsy. Methods: Case report. Results: A 57-year-old man presented with new vitreous opacities in the left eye. He had a history of tonsillar squamous cell carcinoma status postsurgical excision and was undergoing chemotherapy and radiation therapy. The patient underwent vitreous biopsy that revealed scant cellularity with concern for squamous neoplasia. Soon after, the patient developed a rapidly progressive epiretinal membrane. Membrane peel surgery with en-bloc removal of the epiretinal membrane was performed. Hematoxylin and eosin stain of the sample revealed multiple squamous eddies and mitotic figures, and cytokeratin AE1/AE3 marker was strongly positive, confirming the diagnosis of metastatic squamous cell carcinoma. Intravitreal melphalan injections were started in the left eye. The patient achieved anatomic and visual improvement. Conclusion: Intraocular squamous cell metastasis is rare, and diagnosis can be challenging. Despite initial inconclusive vitreous biopsy cytology in this case, an epiretinal membrane en-bloc sample was obtained, which confirmed involvement by the squamous cell carcinoma and prompted appropriate treatment.

Aims To synthesize healthcare experiences of victims of sex trafficking, identify common challenges, and inform improvements for healthcare. Methods Using Arksey and O′Malley’s framework and the PRISMA-ScR checklist, we reviewed CINAHL, Embase, and PubMed databases for studies published between 2010 and 2024 involving interviews with trafficked individuals and were categorized for thematic synthesis. Results Of 155 articles, 16 met inclusion criteria, and involved 669 people who had experienced trafficking. Participants across studies identified reasons for and barriers to seeking healthcare, and their perceptions and recommendations about clinicians’ attitudes, law enforcement, and recognizing trafficking. Participants emphasized the need for better clinician training, stronger policies, greater patient autonomy, and a more supportive clinical environment. Conclusions Gaps persist in healthcare for trafficked individuals. Collaboration among healthcare workers, especially forensic nurses, is essential, along with enhancing trauma-informed interventions and closing gaps in quality care.

The NCCN Guidelines for Survivorship include screening, evaluation, and treatment recommendations for common physical and psychosocial problems resulting from adult-onset cancer and its treatment and provide a framework for coordination of survivorship care. They also include recommendations to help cancer survivors enhance their wellness and maintain a healthy lifestyle. These NCCN Guidelines Insights summarize the panel’s current recommendations and recent updates regarding physical activity, nutrition, and weight management for cancer survivors.

Patients with familial adenomatous polyposis (FAP) are at increased risk of developing cancer, with the most common sites being colorectal, duodenal/ampullary and thyroid. In the last decade, an alarming increase in gastric cancer has been reported in the Western FAP population. These cancers are often diagnosed at an advanced stage with poor prognosis, even in patients undergoing regular upper endoscopic surveillance. Most gastric cancers in Western patients with FAP occur in the proximal stomach, where a carpeting of fundic gland polyposis hampers visualization of gastric cancer and its precursor lesions during endoscopic surveillance. Although fundic gland polyps are the most prevalent proximal polyp, several different dysplastic lesions can be found in the stomachs of patients with FAP. including fundic gland polyps with dysplasia, foveolar-type adenomas, pyloric gland adenomas, and intestinal-type adenomas. Although adenomas are the most likely precursors to gastric cancer, the exact lesions responsible for gastric cancer in FAP are not yet fully understood. This review focuses on gastric polyposis and the characteristics of gastric cancer in Western patients with FAP, including risk factors, lesion detection, surveillance and management of gastric polyposis, and areas for future research.