Citations

Abstract Consumption of a Western diet and high body mass index (BMI) are risk factors for progression from premalignant phenotypes to multiple myeloma, a hematologic cancer. In the NUTRIVENTION trial (NCT04920084), we administered a high-fiber, plant-based diet (HFPBD; meals for 12 weeks, coaching for 24 weeks) to 23 participants with myeloma precursor states and elevated BMI. The intervention was feasible and improved quality of life and modifiable risk factors: metabolic (BMI, insulin resistance), microbiome (diversity, composition), and immune (inflammation, monocyte subsets). Disease progression trajectory improved (n = 2) or was stable. Findings were translated to Vk*MYC mice modeling the myeloma precursor state, in which a high-fiber diet (HFD) delayed disease progression through improved metabolism and microbiome composition, leading to increased short-chain fatty acid production that reinvigorated antitumor immunity and inhibited tumor growth. These effects from fiber consumption were independent of calorie restriction and weight loss. A HFD is a low-risk intervention that may delay progression to myeloma. Significance: A HFPBD in participants with precursor plasma cell disorders and an elevated BMI improved metabolic, microbiome, and immune biomarkers of disease. In a subset, it may delay progression to myeloma. In mouse models, a HFD delayed progression to myeloma independent of calorie restriction. See related commentary by Fairfield and Reagan, p. 623

This essay describes diagnostic criteria for and thoracic imaging appearances of acute and chronic coccidioidal pneumonia, unusual disease manifestations, and disseminated disease appearances.

Quantitative imaging is an innovative noninvasive tool for interstitial lung disease evaluation, providing objective, reproducible metrics for diagnosis, monitoring, and prognostic assessment.

Abstract Amiodarone is known to cause thyroid dysfunction, due to both direct cytotoxicity and high iodine content. Due to its lipophilic properties, amiodarone gets stored in the adipose tissue and may induce delayed amiodarone-induced thyrotoxicosis (AIT), months after discontinuation. We present the case of a 60-year-old man admitted with new-onset atrial fibrillation. He had a history of ventricular tachycardia, treated with amiodarone that was discontinued 14 months earlier. On admission, thyrotropin was undetectable, with markedly elevated free thyroxine and total triiodothyronine. He had no previous history of thyroid dysfunction or recent exposure to iodinated contrast. Additional history revealed that the patient had been taking tirzepatide 10 mg weekly resulting in a 54-kg weight loss over the previous 12 months. With this information, a spot urine iodine/creatinine (Cr) was measured and found to be significantly increased at 2323 µg/g Cr (SI: 2075 µmol/mol Cr) (normal reference range <584 µg/g Cr, [SI: <521 µmol/mol Cr]). He was treated with prednisone and methimazole with eventual resolution of hyperthyroidism. Delayed AIT should be considered in the differential diagnosis of new-onset thyrotoxicosis in patients previously treated with amiodarone who experience significant weight loss.

Study Design Retrospective cohort study of a national database. Objectives This study investigates the association between preoperative antidepressant use and postoperative opioid utilization as well as overall outcomes following primary anterior cervical fusion (ACF) and posterior cervical fusion (PCF). Methods We conducted parallel retrospective cohort analyses utilizing TriNetX for patients aged ≥18 years old with ≥2-year follow-up undergoing primary ACF and PCF between December 31, 2006, and December 31, 2022. Cohorts were thoroughly matched resulting in 4575 ACF and 3497 PCF pairs. Medical outcomes, opioid abuse, healthcare utilization, mechanical and surgical outcomes were assessed through risk ratios (RR), risk differences, P -values, and Kaplan-Meier analysis. Results Antidepressant use was associated with increased new opioid prescriptions from 2 weeks to 2 years (ACF RR 1.090-1.130, P < 0.001; PCF RR 1.060-1.078, P < 0.001), higher hospital readmissions (RR 1.484, P < 0.001), prolonged inpatient stays (RR 1.329, P < 0.001), and ED visits from 6 weeks to 2 years (ACF RR 1.150-1.184, P < 0.001; PCF RR 1.092-1.144, P ≤ 0.034). Postoperative infections were elevated at 2 years (ACF RR 1.679-2.060, P ≤ 0.008; PCF RR 1.375-1.677, P ≤ 0.020). Opioid abuse was higher at 2 years (ACF RR 2.8000, P = 0.003; PCF RR 2.667, P = 0.001), and pulmonary embolism increased in ACF at 2 years (RR 1.633, P = 0.032). Reoperations were elevated at 1 and 2 years (RR 1.238-1.371, P ≤ 0.045), with reduced 2-year reoperation-free survival in ACF ( P = 0.001) and PCF ( P = 0.045). Conclusion Preoperative antidepressant use is associated with significantly increased risks of postoperative opioid utilization and both medical and surgical complications, including sepsis, infections, adjacent segment disease, and reoperations, up to 2 years after primary anterior or posterior cervical fusion.