Citations

Abstract Aim Growing evidence suggests that immune/inflammatory pathways play a crucial role in the persistence of symptoms in diverticular disease (DD). We hypothesize that chronic diverticulitis triggers a self‐sustained inflammatory status which can be detected by measuring the levels of tumor necrosis factor‐α (TNF‐α) and interleukin‐6 (IL‐6). The aim of this study was to investigate the systemic levels of TNF‐α and IL‐6 before and after elective surgery in patients with DD, and their relationship with the gastrointestinal quality of life index (GIQLI) score. Method This prospective multicentric study enrolled patients from the Diverticular Disease Registry (DDR‐Trial, NCT04907383). All adult patients diagnosed with symptomatic uncomplicated diverticular disease (SUDD), uncomplicated recurrent diverticulitis (URD) and smouldering diverticulitis (SmD) between 1st December 2022 and 31st December 2023 were included in this study. Exclusion criteria were as follows: no surgery, a concurrent chronic immunomodulated systemic disease, a SARS‐CoV‐2‐positive test in the previous 12 months, a history of cancer in the previous 5 years, patients treated with immunomodulators, an American Society of Anesthesiologists category of class IV, and complicated acute diverticulitis. Results Seventy‐two patients were included: 52 (72%) with URD, 11 (15%) with SUDD, and nine (13%) with SmD. The median postsurgery – presurgery (Δ)IL‐6 and ΔTNF‐α levels were −16.8 and −17.3 pg/mL, respectively ( p < 0.001 for both; Wilcoxon test). Spearman correlation revealed a significant, negative association between the ΔGIQLI and the ΔIL‐6, as well as the ΔTNF‐α ( p < 0.001 for both). Greater reduction in the levels of IL‐6 and TNF‐α following surgery are associated with higher GIQLI scores postoperatively. Conclusion Patients with chronic diverticulitis may experience persistent systemic inflammation driven by a colonic trigger. Surgical removal of this trigger appears to enhance GIQLI outcomes reducing IL‐6 and TNF‐α across surgery.

Abstract Background Geographic cohorting (GCh) is a popular model of care that localizes physician teams to a single hospital unit. Objectives We conducted a scoping review identifying the aims, implementation strategies, study methods, and measured outcomes of GCh. Methods We searched the medical literature analysis and retrieval system online, Embase, and Scopus databases. Eligible citations included English language reports of interventions including GCh in adult patients. Included studies were screened for their aim, GCh implementation strategy, study method, and outcomes measured. Results Of 1863 identified citations, 30 met inclusion criteria, representing 27 interventions. Implementation aims varied from specific goals measured by a single metric to multiple outcomes intended to capture wide‐ranging effects of GCh. A majority of studies ( n = 13, 48.1%) used a pre‐post cohort design. GCh was implemented in one of four ways: (1) as a stand‐alone intervention, (2) bundled with accountable care unit elements, (3) bundled with care components that did not include all ACU elements, (4) GCh bundled with ACU elements and additional components (“enhanced” ACU). The measured outcomes sorted to eight different categories: patient outcomes, patient safety, patient experience, work flow, workload, clinician experience, communication/team work, and cost. Conclusions The current literature on GCh describes implementation as both a stand‐alone intervention and bundled with other care elements. Current research has not delineated whether the degree to which GCh is implemented matters, nor what impact it has as part of a bundled care intervention. Future work would benefit from a prospective design that clarifies these questions, facilitating care models tailored to the needs of the practice ecosystem.

Disease response and progression assessment in multiple myeloma (MM) is based on various measurements of monoclonal protein (serum and urine protein electrophoresis, serum free light chain (FLC, and or quantitative immunoglobulins). Currently, the IMWG consensus response criteria require two sequential assessments of any one marker made at any time before confirmation of disease progression and the institution of any new therapy. However, this can be cumbersome in clinical trials. Herein, we hypothesized that if two markers meet the progression criteria simultaneously, a repeat of either will not be necessary for confirmation. We retrospectively studied all sequential patients with myeloma enrolled in clinical trials at Mayo Clinic. We identified 583 episodes of confirmed progression in our study. Among the 583 progression episodes, nearly 70% (sensitivity of the simultaneous criteria) met the two simultaneous variable criteria at the first testing, indicating progression. Conversely, among 413 patients who met progression criteria by two simultaneous values, 98% (specificity of the simultaneous criteria) of patients subsequently had confirmed progression by sequential values. In summary, for patients with two disease burden markers meeting the simultaneous progression criteria, sequential assessment either one for confirmation may not be necessary to determine disease progression.

Breast cancer is one of the most common cancers in females. In low- and middle-income countries like Pakistan, reported incidence and prevalence remain unreliable. The aim was to evaluate Pakistani women’s knowledge, attitude, and perception of breast cancer. This cross-sectional study was conducted among Pakistani women from Punjab, Pakistan. A self-administered online questionnaire was formulated to collect data from the participants from September 24, 2022, to October 24, 2022. The questionnaire included sociodemographic data, knowledge questions regarding breast cancer risk factors, knowledge questions about symptoms of breast cancer, and questions assessing the participants’ attitudes toward mammography screening. For knowledge questions, a score of more than 7 out of 13 was considered good knowledge. For attitude questions, regression analysis was done and a score of more than 5 out of 11 was considered a positive attitude. Data was analyzed using SPSS version 25 (Chicago). 796 women participated in this study. Out of 796 participants, 543 (68.2%) were between 20 and 30 years of age, and 43 (5.4%) were more than 40 years old. The level of knowledge regarding breast cancer risk factors was suboptimal. 523 (65.7%) of the participants thought that breast cancer risk increases with advancing age and 218 (27.4%) thought that early menarche increases the risk of developing breast cancer. 471 (59.2%) mentioned that mammography is an effective tool for detecting breast cancer, and 30 (3.8%) thought that there is a cure for breast cancer. According to regression analysis, higher education, higher monthly household income, and married marital status were significantly associated with good knowledge related to breast cancer. Although most of the population is aware of breast cancer’s risk factors and symptoms, they avoid screening such as mammography. Public awareness projects could help increase women’s knowledge of breast cancer signs, symptoms, and screening.

Abstract INTRODUCTION Robust plasma-based biomarkers to distinguish Lewy body disease (LBD) and Alzheimer’s disease (AD) are currently lacking. We applied track-etch magnetic nanopore (TENPO) sorting for enrichment of brain-derived extracellular vesicle (EV) signatures as potential biomarkers to address this gap. METHODS We analyzed plasma from 137 autopsy-confirmed patients [30 LBD, 31 AD, 30 AD/LBD, 19 AD with amygdala Lewy bodies (AD/ALB), and 27 controls], sequencing miRNAs from TENPO-isolated GluR2-positive (neuron-enriched) and GLAST-positive (astrocyte-enriched) EVs, and measuring plasma proteins (Aβ40, Aβ42, tau, p-Tau181, p-Tau231) via SIMOA. RESULTS We identified 16 GluR2+, 8 GLAST+, and 4 protein biomarkers with differential expression (false discovery rate-corrected P value < .1) between LBD and AD. A multimodal 15-feature panel classified LBD versus AD with 10-fold cross-validated accuracy = 0.95 and area under the curve (AUC) = 0.96. DISCUSSION Brain-derived EVs offer accurate and accessible miRNA biomarkers for the differential diagnosis of LBD and AD.

Intracerebral hemorrhage (ICH), caused by the rupture of small blood vessels, remains the least treatable subtype of stroke. The pathophysiology of ICH involves immediate mechanical compression from the hematoma, followed by secondary injuries such as cerebral edema, inflammation, and neuronal damage. Management aims to prevent hematoma expansion, enable safe and effective hematoma evacuation, and mitigate secondary injuries. Recent advancements in clinical management, including blood pressure control, hemostatic therapy, surgical and minimally invasive hematoma removal, and complication management, offer new hope. This review synthesizes these advancements, integrating insights from recent research and clinical trials, and highlights significant progress in evidence-based approaches that pave the way for precise and personalized treatment strategies. Nonetheless, further research is necessary to enhance our understanding of ICH mechanisms and develop more effective clinical interventions.

Despite significant improvements in survival of patients with multiple myeloma (MM), outcomes remain heterogeneous, and a significant proportion of patients experience suboptimal outcomes. Importantly, traditional prognostic factors based on data from patients treated with older therapies no longer capture prognosis accurately in the contemporary era of novel triplet or quadruplet therapies. Therefore, risk stratification requires refinement in the context of available and investigational treatment options in routine practice and clinical trials, respectively. The current identification of high-risk MM (HRMM) in routine practice is based on the Revised International Staging System, which stratifies patients using a combination of widely available serum biomarkers and chromosomal abnormalities assessed via fluorescence in situ hybridization. In recent years, a substantial body of evidence concerning additional clinical, biological, and molecular/genomic prognostic factors has accumulated, along with new MM risk stratification tools and consensus reports. The International Myeloma Society, along with the International Myeloma Working Group, convened an Expert Panel with the primary aim of revisiting the definition of HRMM and formulating a practical and data-driven consensus definition, based on new evidence from molecular/genomic assays, updated clinical data, and contemporary risk stratification concepts. The Panel proposes the following Consensus Genomic Staging (CGS) of HRMM which relies upon the presence of at least one of these abnormalities: (1) del(17p), with a cutoff of >20% clonal fraction, and/or TP53 mutation; (2) an IgH translocation including t(4;14), t(14;16), or t(14;20) along with 1q+ and/or del(1p32); (3) monoallelic del(1p32) along with 1q+ or biallelic del(1p32); or (4) β2 microglobulin ≥5.5 mg/L with normal creatinine (<1.2 mg/dL).

Background: Periarticular local infiltration analgesia has become an important mainstay of multimodal analgesia after elective total hip arthroplasty (THA). However, the role of novel motor-sparing fascial plane blocks—with or without periarticular local infiltration analgesia—has not been fully elucidated for patients undergoing THA. The authors conducted a network meta-analysis evaluating the relative analgesic effectiveness of motor-sparing fascial plane blocks (quadratus lumborum, erector spinae, and pericapsular nerve group blocks) and periarticular local infiltration analgesia for adult patients undergoing THA. Methods: Randomized trials examining single-injection quadratus lumborum, erector spinae, or pericapsular nerve group blocks, or periarticular local infiltration analgesia, for THA were sought. The primary outcome was area under the curve (AUC) rest pain scores during the period from 0 to 24 h. Secondary outcomes included rest pain scores at 0, 6, 12, and 24 h; postoperative function at 6, 12, and 24 h; analgesic consumption at 0 to 24 h; incidence of opioid-related side effects; and incidence of block-related complications. Network meta-analysis was performed using a frequentist approach. Results: A total of 44 trials (3,579 patients) evaluating the quadratus lumborum block, erector spinae block, pericapsular nerve group block, or periarticular local infiltration analgesia for THA were considered. Network meta-analysis was used to derive the probability of each intervention being the most effective as compared to the others (P score). For AUC 0 to 24 h rest pain, periarticular local infiltration analgesia was the most effective intervention, as demonstrated by a P score of 89%. For postoperative analgesic consumption, the quadratus lumborum block was the most effective intervention, with a P score of 88%. This was followed by the pericapsular nerve group block (74%), the erector spinae block (38%), and periarticular local infiltration analgesia (42%). Conclusions: Periarticular local infiltration analgesia alone provides the most consistent improvements in postoperative rest pain, analgesic consumption, and functional recovery after THA. The addition of a quadratus lumborum block or pericapsular nerve group block to periarticular local infiltration may further improve analgesic outcomes.

Inflammatory bowel disease (IBD), including ulcerative colitis and Crohn's disease, are disorders caused by inflammation in the gastrointestinal tract leading to a wide variety of symptoms. The presence of symptoms may not always correlate with active intestinal inflammation, and the lack of symptoms does not always indicate control of inflammation. Owing to the variable correlation between clinical symptoms and active intestinal inflammation, the targets for IBD management have been updated to include objective measures of inflammation to complement clinical end points. In addition to clinical remission, these targets include improvements in biochemical markers and endoscopic measures to objectively measure and monitor disease remission. In this review, we will discuss the different strategies for assessing disease activity and the timing of evaluation for each treatment target for outpatient IBD care. We will also highlight the role of radiographic assessment with a focus on intestinal ultrasound for monitoring these treatment end points.