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Emotion identification and emotion sensitivity following interpersonal and non-interpersonal traumatic experiences: Results from the AURORA study
No full textSocial cognition is an important mechanism linking trauma to psychopathology; however, current models fail to explain individual differences in social cognition after trauma exposure. We investigated whether the interpersonal nature of trauma exposure helps to explain variability in social cognitive outcomes. Our sample was derived from the AURORA study, a national initiative involving intensive follow-up of trauma survivors for one year. We analyzed data from 2241 participants (M(age) = 35.12, 64% female, 54% Black) who experienced an assault (n = 262) or a motor vehicle collision (n = 1979). Social cognition was assessed with the Multiracial Emotion Identification Task and the Belmont Emotion Sensitivity Test. Overall emotion identification accuracy declined over time among participants who experienced interpersonal trauma (β = -.10, p = .03), but not non-interpersonal trauma (β = .00, p = .83). These results may help to enhance the prediction of psychopathological outcomes following trauma exposure
gwSPADE: gene frequency-weighted reference-free deconvolution in spatial transcriptomics
No full textMost spatial transcriptomics (ST) technologies (e.g. 10× Visium) operate at the multicellular level, where each spatial location often contains a mixture of cells with heterogeneous cell types. Thus, effective deconvolution of cell type compositions is critical for downstream analysis. Although reference-based deconvolution methods have been proposed, they depend on the availability of reference data, which may not always be accessible. Additionally, within a deconvolved cell type, cellular heterogeneity may still exist, requiring further deconvolution to uncover finer structures for a better understanding of this complexity. Here, we present gwSPADE, a gene frequency-weighted reference-free SPAtial DEconvolution method for ST data. gwSPADE requires only the gene count matrix and utilizes appropriate weighting schemes within a topic model to accurately recover cell type transcriptional profiles and their proportions at each spatial location, without relying on external single-cell reference information. In various simulations and real data analyses, gwSPADE demonstrates scalability across various platforms and shows superior performance over existing reference-free deconvolution methods such as STdeconvolve
Treatment of severe bleeds with eptacog beta in hemophilia A or B with inhibitors: a post hoc analysis of the PERSEPT 1 and 2 trials
No full textSevere bleeding episodes (BEs) in persons with hemophilia A or B and inhibitors (PwHABIs) represent challenging clinical situations and can require treatment regimens lasting days or weeks before hemostatic control is achieved. Eptacog beta is a recombinant activated human factor VII bypassing agent approved for treating and controlling bleeding in PwHABIs aged ≥12 years. The aim of this study is to assess the efficacy and safety of eptacog beta for severe bleed treatment in PwHABIs during 2 phase 3 trials (PERSEPT 1 and PERSEPT 2). Patients could treat severe BEs with initial doses of 75 or 225 μg/kg eptacog beta at home, followed by subsequent 75 μg/kg eptacog beta infusions administered at predefined intervals in a hospital or hemophilia treatment center. Satisfactory treatment responses to eptacog beta were typically defined in this post hoc analysis by physician- and patient-reported hemostasis evaluations of excellent or good. Hemostatic control of an intracranial hemorrhage (ICH) in 1 patient was assessed by computed tomography. Seven PwHABIs (aged 1-50 years) treated 8 BEs considered severe or otherwise life threatening with eptacog beta during PERSEPT 1 and PERSEPT 2. Hemostatic control of 7 of these BEs (including 3 ICH events) was achieved. Eptacog beta treatment durations ranged from 25 minutes to 96 hours. No thrombotic events were reported, and eptacog beta was well tolerated. Most severe BEs resolved with eptacog beta treatment during PERSEPT 1 and PERSEPT 2. The PERSEPT 1 and PERSEPT 2 trials were registered at www.clinicaltrials.gov as #NCT02020369 and #NCT02448680, respectively
Lung Carcinoid Tumors With Potentially Actionable Genomic Alterations and Responses to Targeted Therapies
No full textBACKGROUND: Effective treatments for patients with advanced lung carcinoids remain limited. The prevalence of potentially actionable genomic alterations (AGAs) among lung carcinoids is not well-understood.
MATERIALS AND METHODS: Lung carcinoids submitted for next-generation sequencing (NGS) at a Clinical Laboratory Improvement Amendments (CLIA)-certified genomics laboratory from September 2013 to March 2024 were retrospectively investigated to determine prevalence of AGAs. We evaluated outcomes with genotype-matched targeted therapies in patients with advanced lung carcinoids with AGAs identified across 3 institutions and comprehensive literature search.
RESULTS: Among 321 cases of lung carcinoids profiled by NGS, 8 (2.5%) harbored potential AGAs (4 [1.2%] with commercially available targeted therapies), including KRAS mutations (n = 4, 1.2%: G12C, G12D, G12R, G12V), ALK fusions (n = 2, 0.6%), BRAF D594N (n = 1, 0.3%), and RET fusion (n = 1, 0.3%). None of the 24 typical carcinoids harbored an AGA. Collectively across these database-identified patients, our multi-institutional cohort, and literature review, we identified 36 cases of lung carcinoids with potential AGAs (24 with commercially available targeted therapies), predominantly comprising fusions of ALK (n = 14), RET (n = 5), and NTRK (n = 2). Of 27 with known disease stage, 19 had stage 4 disease, and 13 (68.4%) had outcomes reported following targeted therapies. Median treatment duration was 12.0 months (95% CI: 6.7-16.0). Median progression-free survival (PFS) was 10.6 months (95% CI: 6.7-16.0) across all targeted therapy lines and 14.0 months (95% CI: 1.3-NA) with first-line targeted therapies. Objective response rate with at least one targeted therapy was 61.5%.
CONCLUSIONS: Patients with advanced lung carcinoids harboring AGAs can derive meaningful benefit from genotype-matched targeted therapies, highlighting potential role for NGS in patients with advanced carcinoids
Implementation of Intravascular Coronary Lithotripsy in the United States: Social Determinants of Health
No full textBACKGROUND: Disparities in health care access persist in cardiovascular interventions. Coronary lithotripsy, a novel treatment for calcified coronary lesions, shows variability in utilization by sociodemographic factors.
OBJECTIVES: This study examines the impact of sex, race, income, and hospital characteristics on lithotripsy use in the United States.
METHODS: Using the 2021 Nationwide Inpatient Sample, patients undergoing percutaneous coronary intervention were identified. Lithotripsy was defined by the International Classification of Diseases-10th Revision codes. Multivariable logistic regression assessed the impact of sociodemographic factors, adjusting for comorbidities and hospital characteristics. Outcomes were compared using propensity score matching, with P \u3c 0.05 considered significant.
RESULTS: Of 261,260 percutaneous coronary intervention patients, 1,000 (0.38%) underwent lithotripsy. Adjusted analyses revealed that women were less likely to receive lithotripsy than men (adjusted OR [aOR]: 0.65; 95% CI: 0.53-0.79; P \u3c 0.001). African American patients had lower odds of receiving lithotripsy than Whites (aOR: 0.66; 95% CI: 0.48-0.93; P = 0.016). Medicaid patients were less likely to receive lithotripsy (aOR: 0.20; 95% CI: 0.11-0.36; P \u3c 0.001) compared to Medicare beneficiaries. Higher-income quartiles increased odds of receiving lithotripsy compared to lower quartiles (aOR: 1.38-1.6; P \u3c 0.05). Regional disparities were noted, with lower use in the South (aOR: 0.66; 95% CI: 0.47-0.94; P = 0.022).
CONCLUSIONS: Disparities in lithotripsy utilization persist, driven by sex, race, insurance status, income, and geographic region. These findings emphasize the need for targeted interventions to promote equitable access to advanced cardiovascular therapies. While some disparities may reflect differences in disease prevalence, persistent inequities in treatment allocation warrant further investigation
Platelet function testing does not predict hemorrhage progression in mild traumatic brain injury
No full textBACKGROUND: Antiplatelet medications are frequently assumed to increase the risk of radiographic progression following traumatic intracranial hemorrhage (ICH), influencing guidelines that recommend prolonged observation and repeat imaging. However, antiplatelet use does not uniformly result in functional platelet inhibition, and the clinical relevance of therapeutic response remains unclear.
METHODS: We conducted a retrospective cohort study of adult patients with traumatic ICH and a Glasgow Coma Scale (GCS) score of 13-15 who were on antiplatelet therapy and underwent platelet function testing (VerifyNow PRU or PFA) on admission. Patients were classified as therapeutic or non-therapeutic based on test thresholds. All patients received follow-up CT imaging within 24 h. Clinical variables and outcomes, including radiographic progression, surgical intervention, and mortality, were compared between groups. A sensitivity analysis excluded patients with hematocrit \u3c 30 % or platelet count \u3c 100,000.
RESULTS: A total of 239 patients were included: 190 in the non-therapeutic group and 49 in the therapeutic group. Radiographic progression occurred in 17.6 % of patients overall, with no significant difference between therapeutic and non-therapeutic groups (20.4 % vs. 16.8 %; p = 0.53). Surgical intervention (p = 0.57) and mortality (p = 0.38) rates were similarly low and comparable. Sensitivity analyses confirmed these findings (p = 0.81).
CONCLUSIONS: Therapeutic platelet inhibition was not associated with increased risk of radiographic or clinical worsening in patients with mild traumatic ICH. These findings challenge current assumptions regarding antiplatelet risk and suggest that platelet function testing may have limited utility in this setting. These findings support the need to reevaluate current guidelines and validate risk stratification approaches through prospective multicenter studies
Technical and Clinical Overview: Spinal Cord Stimulation
No full textINTRODUCTION: Spinal cord stimulation (SCS) has evolved from simple systems with limited waveforms and electrode configurations to modern, complex systems developed to exert specific effects on the central nervous system. The growth in this space has focused on improving therapy delivery, enhancing tolerance, increasing longevity, and expanding indications.
MATERIALS AND METHODS: Members of the American Association of Neurological Surgeons/Congress of Neurological Surgeons Pain Section evaluate current technologies on the market to define the state of implants and devices. The study also discusses each manufacturer\u27s scientific evidence and waveforms, in addition to reviewing their current publications and support data.
RESULTS: The SCS devices of all Food and Drug Administration-approved companies are reviewed, including Medtronic, Abbott, Boston Scientific, Saluda, Biotronik, and Nevro.
CONCLUSION: Technology and innovation are evolving rapidly in the field of spinal neuromodulation space. Clinical trials providing level 1 evidence have followed suit and indicated the superiority of this therapy to medical management in treating patients with different painful conditions
Calculating Value in Hand and Wrist Care: A Systematic Review on the Current Literature
No full textPurpose: Global health care systems are shifting toward value-based care models, with the hand and wrist field presenting a notable opportunity to enhance quality and efficiency because of large patient volumes, a variety of pathologies, and diversity in treatment options. This systematic review aimed to investigate the literature on calculations of value between different treatment options in hand and wrist care.
Methods: Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, two reviewers searched three databases to identify, screen, and evaluate research articles within hand and wrist care comparing the value between treatment groups based on real-world clinical data.
Results: Nineteen of 181 hand and wrist articles screened met our predetermined inclusion criteria. Studies primarily employed the EuroQol 5-Dimension survey for quality metrics with the payer or societal cost perspective. The incremental cost-effectiveness ratio formula was the most used value calculation. The majority of included studies originate from Europe. Studies assessing distal radius fracture care highlighted reduced imaging strategies as more cost effective than traditional methods and bandaging as more cost effective than rigid immobilization. Studies assessing scaphoid fractures identified immediate magnetic resonance imaging intervention to outperform standard care and cast treatment combined with early fixation to be superior to standalone surgery or no treatment.
Conclusions: Global literature on value-based comparative studies in hand and wrist care demonstrates variability in methodology, limiting direct comparisons. Most real-world studies were conducted within single-payer systems, highlighting the potential for further investments in value analysis protocols in multipayer systems.
Clinical relevance: Establishing a standardized methodology for value assessment, will enable better comparisons and improvements in hand and wrist care. As global health care costs continue to rise, conducting research that identifies high-value care across diverse health care systems is essential to ensure sustainable, effective, and patient-centered care for all stakeholders
Protecting our patients\u27 future through perioperative sustainability: Action and advocacy for the pediatric surgeon
No full textClimate change is a significant threat to human health and health equity. Marginalized populations, including children, are most impacted by our rapidly changing environment. Both the prevalence of pediatric surgical disease, as well as the ability to deliver surgical care, are affected by climate change. Ironically, healthcare systems have a significant, deleterious effect on the planet. However, there are many proven mitigation strategies to reduce the injurious climate impact of the delivery of surgical services, augment equity, and improve health. We describe five domains through which pediatric surgical care providers can act to generate more sustainable healthcare systems: reduce, repurpose, reuse, refuse, and recycle. We highlight successful examples instituted through various healthcare organizations and provide recommendations that pediatric surgical care providers can use to support the health of our planet through their daily work. These actions can increase sustainability, reduce cost, and promote equity for our patients and future generations
