Recent ucideptmed_oapdeposits items

Navigating the Complex Interplay of Metabolic Health and Perioperative Risk

Fri, 19 Jun 2026 00:00:00 +0000

Corresponding Author

The Evolving Landscape of Systemic Therapy for Liposarcoma.

Thu, 18 Jun 2026 00:00:00 +0000

Background/objectives

Liposarcoma represents a heterogeneous group of mesenchymal malignancies with distinct molecular profiles and clinical behaviors. While localized disease is managed with surgical resection, advanced or metastatic liposarcoma poses a significant therapeutic challenge due to limited response to traditional cytotoxic chemotherapy. This review summarizes current evidence-based systemic therapies and highlights recent advances in subtype-driven treatment strategies.

Methods

We review key clinical trials supporting the use of anthracycline regimens, trabectedin, eribulin, and nuclear export inhibition with selinexor, as well as emerging targeted approaches directed at MDM2 and CDK4 amplification. In addition, we discuss the evolving role of immunotherapy, including checkpoint inhibitors and engineered T-cell receptor therapies targeting cancer-testis antigens.

Results

Integrating molecular biology with therapeutic development, we emphasize...

New Investigations of Stellate Ganglion Block With ABP-450 (PrabotulinumtoxinA) in Rats

Wed, 17 Jun 2026 00:00:00 +0000

New Investigations of Stellate Ganglion Block With ABP-450 (PrabotulinumtoxinA) in Rats

Characterization and clinical management of adverse events following treatment with repotrectinib: a TRIDENT-1 analysis.

Mon, 15 Jun 2026 00:00:00 +0000

Background

Repotrectinib, a next-generation ROS1/TRK tyrosine kinase inhibitor, is approved for ROS1 fusion-positive non-small cell lung cancer and NTRK fusion-positive solid tumors. Its side effects and safety management strategies require further characterization.

Patients and methods

The safety profile of repotrectinib (treatment-emergent/related adverse events [TEAEs/TRAEs]) was established in patients who initiated treatment at the recommended dose (160 mg daily [QD] for 14 days, then 160 mg twice daily [BID]) across all cohorts of the global, multicenter phase 1/2 TRIDENT-1 study. AE management strategies were outlined.

Results

In 472 patients, the most common TRAEs (dizziness [58%] and dysgeusia [50%]) were likely TRK inhibition-related. Median relative dose intensity was 90%; 14% (n = 66/472) of patients did not increase their initial QD dose to BID (mostly due to CNS AEs). Rates of dizziness (median onset, 7 days) were similar in patients with/without...

Clinical Effectiveness of Sodium-Glucose Cotransporter-2 Inhibitors Among Older Patients Hospitalized for Heart Failure With Reduced Ejection Fraction.

Wed, 3 Jun 2026 00:00:00 +0000

BACKGROUND: SGLT2 (sodium-glucose cotransporter-2) inhibitors (SGLT2i) reduce cardiovascular events in randomized controlled trials of patients with heart failure with reduced ejection fraction (HFrEF), but these trials enrolled outpatient, relatively younger patients (median age 66-67). The effectiveness of SGLT2i in older patients hospitalized for HFrEF in routine US clinical practice is not well studied. METHODS: This study included Medicare beneficiaries aged ≥65 years hospitalized for HFrEF and eligible for SGLT2i in Get with the Guidelines-Heart Failure between July 1, 2021 and June 30, 2023. Primary outcomes were 30-day and 1-year all-cause mortality, all-cause readmission, and HF readmission. Association between SGLT2i and outcomes was assessed with Cox regression and overlap weighting using propensity score estimates. RESULTS: A total of 8847 patients were eligible for but not prescribed SGLT2i at hospital admission (Median age 77; 40% women; median left ventricular EF...

Addition of pulsed electric field ablation to SBRT for lung tumors: effect on health-related quality of life

Wed, 3 Jun 2026 00:00:00 +0000

INTRODUCTION: Treatment indications for oligometastatic/oligoprogressive lung tumors are growing. Safety and lack of detrimental effect on patients' quality of life are critical for novel local therapies. METHODS: We tested that the additive effect of pulsed electric field (PEF) ablation with lower-dose stereotactic body radiation therapy (SBRT) on health-related quality of life (HRQoL) as a secondary endpoint in a prospective clinical trial. FACT-Lung Cancer Subscale (FACT-LCS) and FACT-General domain surveys were collected at screening, 3 months, and 12 months. Functional clinical data included forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and diffusing capacity of the lung for carbon monoxide (DLCO). RESULTS: Six patients with eight tumors were enrolled. Baseline well-being domain scores were: Physical 25.9 (Std Dev 2.3), Social 21.0 (Std Dev 6.9), Emotional 17.3 (Std Dev 4.7), Functional 21.2 (Std Dev 5.8), and LCS 19.4 (Std Dev 5.3). There were...

Multi-Country Human-to-Human Andes Virus Outbreak on a Cruise Ship: A Disaster Report on Prehospital, Healthcare Facility, and Public Health System Challenges – Essential Knowledge for Frontline Clinicians

Fri, 22 May 2026 00:00:00 +0000

The Andes Virus (ANDV) outbreak reported on 2 May 2026 aboard a luxury vessel departing from Ushuaia, Patagonia, Argentina, was caused by an Orthohantavirus that is unique in its person-to-person transmissibility in contrast to zoonotic transmission characteristic of better-known hantaviruses. Outbreak containment requires coordinated international management because passengers and crew embarked and disembarked at several international ports of call prior to outbreak recognition, resulting in cross-border transmission potential. Among those who disembarked, several traveled on flights to various international destinations. Cases have subsequently been identified in multiple countries, including the Tristan da Cunha (United Kingdon territory), Spain, France, Switzerland, South Africa, and Canada. International health authorities implemented containment measures once notified, including contact tracing, quarantine, and isolation.

ANDV poses unique risks due to...

PFKM governs metabolic shifts throughout skeletal muscle differentiation

Mon, 18 May 2026 00:00:00 +0000

Metabolism is known to influence cell identity, but the underlying mechanisms remain unclear. Here we reveal spatiotemporal dynamics of phosphofructokinase 1 (PFK1), a key glycolytic enzyme, within the skeletal muscle lineage. The expression of PFKM (the muscle isoform of PFK1) is low in muscle stem cells and increases during differentiation. Mechanistically, Wnt signalling rapidly induces lysosomal degradation of PFKM through a methyl arginine degron motif, which gets selectively methylated by the protein arginine methyltransferase (PRMT1) and delivered to lysosomes through microautophagy. PFKM degradation shifts glucose metabolism from glycolysis to the pentose phosphate pathway. PFKM overexpression increases glycolysis and promotes differentiation into terminally differentiated myofibres. On the other hand, PFKM knockdown blunts differentiation, which can be rescued by supplementation with the downstream glycolytic intermediate 3-phosphoglycerate. In sum, our findings highlight...

Language barriers and pain disparities in pediatric emergency settings: A call for action

Fri, 15 May 2026 00:00:00 +0000

Language barriers and pain disparities in pediatric emergency settings: A call for action

Electroacupuncture improves cognitive function and neuropsychiatric symptoms in breast cancer survivors: a pilot randomized controlled trial

Fri, 24 Apr 2026 00:00:00 +0000

BACKGROUND: We conducted a randomized, double-blinded pilot trial to compare the impact of two electroacupuncture (EA) regimens on co-occurring neuropsychiatric symptoms among breast cancer survivors (BCS). METHODS: BCS who self-reported cognitive impairment, fatigue, insomnia, or psychological distress were randomized (1:1) to receive ten weekly EA to target either neuropsychiatric-specific (nEA) or non-neuropsychiatric-specific (sEA) acupoints. Primary endpoints were the within-group pre-post effect sizes (Glass's Δ) in symptom severities, adjusted for multiple comparisons (p-adjusted). Outcomes were assessed using neurocognitive tests (CANTAB®), PROs (FACT-Cog, MFSI-SF, EORTC QLQ-C30), plasma biomarkers, and neuroimaging. Responders were defined by reliable change index (for objective cognition) or MCID (for PROs). RESULTS: Thirty-five were recruited, with 30 (86%) completing all sessions. The mean (±SD) age was 58.2 (±12.2) years, and 86% reported co-occurring symptoms. Following...

Chronic Thromboembolism Phenotypes after Acute Pulmonary Embolism: Identification with the SEARCH Algorithm.

Thu, 23 Apr 2026 00:00:00 +0000

RATIONALE: Chronic dyspnea and exercise impairment are common after acute pulmonary embolism but poorly characterised. OBJECTIVES: We performed a prospective observational study to validate an algorithm to diagnose discrete post-pulmonary embolism outcomes, including chronic thromboembolism phenotypes. METHODS: Six pulmonologists independently reviewed records from 150 consecutive patients three or more months after acute pulmonary embolism who had undergone a stepwise diagnostic algorithm (SEARCH): symptom screen, cardiopulmonary exercise testing, pulmonary arterial perfusion scans, resting echocardiography, confirmatory imaging, and hemodynamic measurements by rest and exercise right heart catheterisation. Clinical data were reviewed after the first post-pulmonary embolism evaluation and then six months later. MEASUREMENTS AND MAIN RESULTS: Symptomatic recovery was most common and occurred in 66.2% of patients during the final evaluation. Dyspnea without discernable physiological...

Cost-Effectiveness of Medical Therapy for Heart Failure With Mildly Reduced and Preserved Ejection Fraction

Thu, 23 Apr 2026 00:00:00 +0000

BACKGROUND: Three medications are now guideline-recommended treatments for heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF), however, the cost-effectiveness of these agents in combination has yet to be established. OBJECTIVES: The purpose of this study was to determine the cost-effectiveness of mineralocorticoid receptor antagonists (MRA), angiotensin receptor-neprilysin inhibitors (ARNIs), and sodium glucose co-transporter 2 inhibitors (SGLT2is) in individuals with HFmrEF/HFpEF. METHODS: Using a 3-state Markov model, we performed a cost-effectiveness study using simulated cohorts of 1,000 patients with HFmrEF and HFpEF. Treatment with 1-, 2-, and 3-drug combinations was modeled. Based on a United States health care sector perspective, outcome data was used to calculate incremental cost-effectiveness ratios (ICERs) in 2023 United States dollars based on a 30-year time horizon. RESULTS: Treatment with MRA, MRA+SGLT2i, and MRA+SGLT2i+ARNI therapy resulted...

Circulating Asprosin Concentrations and Body Weight Changes in Postmenopausal Women: Findings from the Women’s Health Initiative

Thu, 23 Apr 2026 00:00:00 +0000

BACKGROUND: Weight changes after menopause contribute to cardiometabolic risk, yet hormonal determinants of long-term weight trajectories remain incompletely understood. Asprosin, a fasting-induced adipokine involved in hepatic gluconeogenesis and appetite regulation, has been associated with metabolic disease, although its prospective role in affecting weight change remains unknown. OBJECTIVES: This study aimed to examine whether plasma asprosin concentrations are directly and prospectively associated with changes in body weight and body composition among postmenopausal women. METHODS: In a case-control study of 4020 postmenopausal women (1987 newly developed/incident diabetes cases and 2033 matched controls) nested within the Women's Health Initiative, we prospectively evaluated participants' baseline plasma concentrations of asprosin in relation to 3-y changes in weight, measures of central obesity, and the risk of major weight gain or loss (≥7% of baseline weight). Associations...

Are high residual chlorhexidine skin concentrations associated with improved clinical outcomes? Lessons from the CLEAR trial

Thu, 9 Apr 2026 00:00:00 +0000

Residual chlorhexidine gluconate (CHG) skin concentrations are thought to improve disease prevention. In the Changing Lives by Eradicating Antibiotic Resistance (CLEAR) trial, posthospitalization decolonization of MRSA carriers reduced MRSA infection and all-cause infection, but higher residual CHG concentrations did not improve outcomes. CHG concentration may indicate bathing quality, but high residual concentrations may not be necessary for benefit.

Sexual dimorphism shapes renal metabolic adaptation to a ketogenic diet

Wed, 8 Apr 2026 00:00:00 +0000

While kidneys are essential for maintaining systemic metabolic homeostasis and exhibit sexual dimorphism, the effects of sex and environmental factors, such as diet, on renal metabolism remain unclear. Using kidney-specific arteriovenous (AV) metabolomics, in vivo isotope tracing, and transcriptomics, we discover profound sex differences in kidney metabolic reprogramming under ketogenic diet (KD) in C57BL/6J mice. Tissue metabolomics shows the accumulation of aldosterone and acylcarnitines exclusively in female kidneys under a normal chow (NC) diet, suggesting basal sex differences in sodium and fatty acid metabolism. Under KD, AV metabolomics reveals that only female kidneys activate ketogenesis and gluconeogenesis, supported by transcriptional sex differences in related rate-limiting enzymes and transporters. Given the widespread public and clinical interest in KD for treating epilepsy, metabolic disorders, and cancers, our findings underscore the importance of considering sex...

Evaluating the potential of acupuncture for Alzheimer’s disease treatment: A meta-analysis and systematic review of mouse model studies

Wed, 8 Apr 2026 00:00:00 +0000

Acupuncture is an ancient practice that was developed within the framework of traditional Chinese medicine. While acupuncture has been recently proposed as a therapy for Alzheimer’s disease (AD), acupuncture effects are not well understood in terms of neural mechanisms. Here, we review and examine the studies that used AD mouse models and analyze the experiments where researchers administered electroacupuncture (EA) to AD mice to assess the potential therapeutic impact of acupuncture on disease pathology and cognitive function in controlled laboratory settings. We analyzed 29 relevant PubMed articles published between January 2014 and July 2025. Our results reveal that EA significantly reduces both amyloid-beta (Aβ) and phosphorylated tau (p-tau) levels and neuroinflammatory biomarkers, including molecular signatures for activated microglia and astrocytes in the brain. EA also enhances cognitive functions. While no study directly compared acupoint strategies, the indirect comparisons...

Editorial: Lipids in immunometabolism

Thu, 26 Mar 2026 00:00:00 +0000

Editorial: Lipids in immunometabolism

Editorial: Transforming vaccine strategies: co-delivery systems for robust immunity and disease control

Thu, 26 Mar 2026 00:00:00 +0000

Editorial: Transforming vaccine strategies: co-delivery systems for robust immunity and disease control

When AI Writes Back: Ethical Considerations by Physicians on AI-Drafted Patient Message Replies.

Wed, 11 Mar 2026 00:00:00 +0000

The increasing burden of responding to large volumes of patient messages has become a key factor contributing to physician burnout. Generative AI (GenAI) shows great promise to alleviate this burden by automatically drafting patient message replies. The ethical implications of this use have however not been fully explored. To address this knowledge gap, we conducted a qualitative interview study with 21 physicians who participated in a GenAI pilot program. We found that notable ethical considerations expressed by the physician participants included oversight as ethical safeguard, transparency and patient consent of AI use, patient misunderstanding of AI's role, and patient privacy and data security as prerequisites. Additionally, our findings suggest that the physicians believe the ethical responsibility of using GenAI in this context primarily lies with users, not with the technology. These findings may provide useful insights into guiding the future implementation of GenAI in...

Chronic IL-21 exposure reshapes pulmonary environment, elevating risk of respiratory diseases

Thu, 26 Feb 2026 00:00:00 +0000

Age-related pulmonary diseases pose a significant health burden, yet the underlying mechanisms remain poorly understood. This study investigates the role of interleukin-21 (IL-21) in driving age-associated changes in lung function and immune responses. Using both murine models and human samples, we demonstrate that IL-21 induces a pro-inflammatory state in the lungs, characterized by increased levels of key inflammatory cytokines including TNF-α, IL-6, IL-33, CXCL-10, and IL-18. IL-21 exposure also promoted cellular senescence, evidenced by upregulation of senescence-associated genes and increased frequencies of KLRG1-positive T cells. Notably, IL-21 treatment led to significant alterations in lung macrophage phenotype and function. We observed increased lipid accumulation in macrophages, accompanied by upregulation of lipid uptake receptors TREM-2 and CD36. These changes were associated with elevated TGF-β secretion, suggesting a potential mechanism for IL-21-induced pulmonary...

HF STATS 2025: Heart Failure Epidemiology and Outcomes Statistics An Updated 2025 Report from the Heart Failure Society of America

Wed, 25 Feb 2026 00:00:00 +0000

HF STATS 2025: Heart Failure Epidemiology and Outcomes Statistics An Updated 2025 Report from the Heart Failure Society of America

National Trends and Disparities in Heart Failure Hospitalizations and Inpatient Outcomes Between 2010-2022

Wed, 25 Feb 2026 00:00:00 +0000

BACKGROUND: Limited data exist on trends and differential heart failure (HF) hospitalization rates, particularly when appropriate statistical age standardization is applied. OBJECTIVES: This study aimed to assess temporal trends in age-standardized hospitalization rates and in-hospital mortality for primary HF hospitalizations among younger (<65 years) and older (>64 years) patients, stratified by sex, race/ethnicity, insurance status, and urban/rural hospital location. METHODS: The National Inpatient Sample database was analyzed to identify adults who were hospitalized for HF between 2010 and 2022. HF hospitalization rates and in-hospital mortality trends were then examined across demographic strata. RESULTS: In total, 14,287,733 weighted hospitalizations for HF were identified. Overall, age-standardized HF hospitalizations per 100,000 U.S. population showed a nonsignificant change from 406 in 2010 to 381 in 2014 (P = 0.14), followed by an increase to 447 in 2018 (P = 0.002)...

Tenofovir-induced Fanconi syndrome: a case report and literature review.

Wed, 25 Feb 2026 00:00:00 +0000

Abstract: Tenofovir disoproxil fumarate (TDF) is an antiviral medication with potential nephrotoxicity side effects. In this case report, a patient who had been taking TDF for five years was referred to nephrology clinic for hypophosphatemia. Additional labs demonstrated urinary phosphate wasting, glucosuria, hypokalemia, and hyperchloremic metabolic acidosis. Imaging revealed occult fractures. She was diagnosed with tenofovir-induced Fanconi syndrome with hypophosphatemic osteomalacia. TDF was switched to tenofovir alafenamide (TAF) and electrolyte deficiencies were treated with supplementation. However, phosphaturia and glucosuria persisted, prompting TAF switch to entecavir, which improved serum electrolytes and quality of life. Mild Fanconi syndrome was present at 6 months after TAF discontinuation, which highlights that tenofovir can have prolonged effects on proximal tubule dysfunction. Delays in the diagnosis of tenofovirinduced tubular toxicity can...

Molecular Characterization and Clinical Outcomes of Pancreatic Neuroendocrine Neoplasms Harboring PAK4-NAMPT Alterations.

Thu, 19 Feb 2026 00:00:00 +0000

Purpose

The mammalian target of rapamycin (mTOR) inhibitor everolimus is US Food and Drug Administration-approved for advanced pancreatic neuroendocrine neoplasms (pNENs), yet resistance is common, necessitating the identification of resistance mechanisms for effective treatment strategies. Previous studies suggest that targeting the aberrant expression of mTOR regulators p21-activated kinase 4 (PAK4) and nicotinamide phosphoribosyl transferase (NAMPT) sensitizes pNENs to everolimus. In this study, we queried a large real-world data set of pNENs, characterizing the molecular and immune landscapes, as well as the clinical outcomes associated with aberrant PAK4 and NAMPT expression.

Methods

Two-hundred and ninety-four pNEN cases were analyzed using next-generation sequencing and whole-exome/whole-transcriptome sequencing. We stratified patients into clusters on the basis of median cutoff.

Results

High expression of genes activated in response to mTOR activation...

Irradiation with a mixed heavy ion beam induces ovarian follicle loss and dose-dependent mixed ovarian tumor development

Thu, 12 Feb 2026 00:00:00 +0000

Over 25% of active NASA astronauts are women who will be exposed to low daily doses and dose rates of galactic cosmic rays (GCR) in space. We hypothesized that exposing mice to a preliminary simulated GCR mixed heavy ion beam composed of iron, silicon, and titanium ions induces follicle depletion and dose-dependent ovarian tumors. Female mice were exposed to 10, or 20 cGy each of Fe, Si, and Ti ions or sham-irradiation in quick succession within 15 min for total doses of 0, 30, or 60 cGy of the three beams. 16 months later, their ovaries were removed. Hyperplasia of the ovarian surface epithelium (OSE) was noted in 13%, 59%, and 22% of the 0, 30, and 60 cGy irradiated mice, respectively. The prevalence of mixed ovarian tumors was 0, 6, and 89%, respectively, in the 0, 30, and 60 cGy groups. Low numbers of Ki67 positive OSE and tumor cells supported a benign tumor phenotype. In a separate study, Si ion irradiation alone at 32 cGy did not induce...

S4001 A Bowel Invader: Endometriosis Causing Partial Colon Obstruction

Tue, 10 Feb 2026 00:00:00 +0000

S4001 A Bowel Invader: Endometriosis Causing Partial Colon Obstruction

Naloxegol, an Oral Peripherally Acting Opioid Receptor Antagonist, Administered Concurrently with First-Line Systemic Therapy for Advanced Lung Adenocarcinoma (Alliance A221504): A Feasibility and Safety Study

Tue, 3 Feb 2026 00:00:00 +0000

Background: Mu opioid receptors (MORs) in peripheral tissues mediate adverse effects of opioids that impair health-related quality of life (HRQoL) and may stimulate cancer progression via mitogenic signaling. Naloxegol, a peripherally acting MOR antagonist (PAMORA), is approved for opioid-induced constipation. Safety and efficacy of naloxegol have not been evaluated concurrently with systemic cancer therapy. Methods: We conducted a randomized, double-blind, placebo-controlled trial of naloxegol in patients with advanced lung adenocarcinoma starting first-line systemic therapy. Results: Only 50 patients were enrolled; the trial was terminated early due to slow accrual. Two of the three components of the feasibility primary endpoint were not met (accrual and PRO completion). At 6 months, FACT-L emotional well-being was better with naloxegol (p = 0.0113). There were trends towards better Trial Outcome Index (p = 0.0505) and physical well-being (p = 0.0628) with naloxegol. Bowel function...

Adequate Catchment Area Representation in Cancer Clinical Trials at NCI Designated Cancer Centers: The University of California Irvine Experience

Tue, 3 Feb 2026 00:00:00 +0000

BACKGROUND: Ensuring that clinical trial enrollment reflects the demographics and disease burden of a cancer center's catchment area is essential for improving trial accrual and the generalizability of research findings. We hypothesized that aligning the clinical trial portfolio with the needs of the catchment area can enhance enrollment and access to novel therapeutics. METHODS: A retrospective cohort study was conducted at the University of California Irvine Chao Family Comprehensive Cancer Center (CFCCC), an National Cancer Institute-designated cancer center serving Orange County (OC), California-the 6th largest populous county in the United States. Clinical trial enrollment data from 2015 to 2023 were analyzed using the CFCCC clinical research database. Patient demographics, tumor types, and trial enrollment patterns were compared with population-level data from NIH SEER for both OC and the United States. RESULTS: Between 2015 and 2023, 2317 participants were enrolled in clinical...

Extended-Spectrum β-Lactamase-Producing Escherichia coli and Pediatric UTIs: A Review of the Literature and Selected Experimental Observations

Wed, 28 Jan 2026 00:00:00 +0000

Urinary tract infections (UTIs) are common in children and are predominantly caused by uropathogenic Escherichia coli (UPEC). An increasing proportion of these strains produce extended-spectrum β-lactamases (ESBLs), which render β-lactam antibiotics ineffective. Interestingly, some patients with ESBL-producing UTIs improve clinically following treatment with antibiotics like cephalexin, despite demonstrated in vitro resistance. Working alongside and at times synergistically with antibiotics, host immune factors, such as the antimicrobial peptide cathelicidin (LL-37), contribute to bacterial clearance through direct killing and inhibition of biofilm formation. In this review, we summarize the current understanding of pediatric ESBL-producing UPEC infections and present selected in vitro and in vivo experimental data evaluating the combined effects of LL-37 and cephalexin on clinical isolates. Although no synergy was observed, ESBL-producing isolates demonstrated reduced bacterial...

Azithromycin: An Underappreciated Quinolone-Sparing Oral Treatment for Pseudomonas aeruginosa Infections

Wed, 28 Jan 2026 00:00:00 +0000

Outpatient treatment of Pseudomonas aeruginosa infections is challenged by increasing rates of resistance to fluoroquinolones, the only class of antibiotics which offers an established oral route of administration against this organism. Azithromycin does not demonstrate activity against P. aeruginosa when evaluated under standard methods of susceptibility testing with bacteriologic media. However, growing evidence shows that azithromycin is very active against P. aeruginosa when using physiologic media that recapitulate the in vivo milieu and is supported by animal models of infection and various clinical settings, including cystic fibrosis. We present three cases of outpatient management of P. aeruginosa otolaryngological infections successfully treated with oral azithromycin, 500 mg daily ranging from 3-8 weeks, where use of fluoroquinolones was not possible due to either resistance or patient intolerance. We review the previous data supporting this...

Rapid valve sterilization with meropenem plus ceftolozane/tazobactam combination therapy for Pseudomonas aeruginosa prosthetic valve endocarditis

Wed, 28 Jan 2026 00:00:00 +0000

Background: Pseudomonas aeruginosa infective endocarditis (IE) presents a significant clinical challenge, leading to high rates of treatment failure and mortality. Even with the use of antipseudomonal β-lactams combined with aminoglycosides or fluoroquinolones, these therapies often fail to provide clinical resolution and are frequently accompanied by severe adverse effects. Methods: We report a case of P. aeruginosa prosthetic valve endocarditis successfully treated with a combination of meropenem and ceftolozane/tazobactam. To investigate the synergistic effects of this combination, we conducted checkerboard, time-kill, human whole blood killing, and biofilm assays, as well as a simulated endocardial vegetation (SEV) model. Results: Meropenem plus ceftolozane/tazobactam combination therapy successfully bridged the patient to cardiac surgery, achieving rapid microbiological clearance and sterile intraoperative valve cultures. While checkerboard assays showed additivity,...

Ticagrelor Increases Platelet-Mediated Staphylococcus aureus Killing, Resulting in Clearance of Bacteremia

Wed, 28 Jan 2026 00:00:00 +0000

Platelets are a critical immune defense against Staphylococcus aureus bloodstream infections. Staphylococcus aureus α-toxin is a virulence factor that decreases platelet viability and accelerates platelet clearance. It has been shown that ticagrelor blocks α-toxin-mediated platelet injury and resulting thrombocytopenia, protecting mice in a lethal S. aureus sepsis model. We now present the use of ticagrelor as adjunctive therapy in a patient with a S. aureus endovascular infection and thrombocytopenia, associated with restoration of platelet count and bacteremia clearance. Ticagrelor enhanced platelet killing of the S. aureus bloodstream isolate from the treated patient in vitro.

Overcoming Ceftaroline Resistance in MRSA Using Ceftaroline–Carbapenem Combination Therapy

Wed, 28 Jan 2026 00:00:00 +0000

The limited but rising threat of ceftaroline-resistant MRSA poses a therapeutic challenge. We show that ceftaroline plus carbapenems restores activity against a resistant strain both in vitro and in a murine bacteremia model. These findings support combination therapy as a potential strategy for difficult MRSA infections, warranting further clinical investigation.

Ethylenediaminetetraacetic Acid Enhances Vancomycin and Reactive Oxygen Species–Mediated Killing of Vancomycin-Intermediate Staphylococcus aureus

Wed, 28 Jan 2026 00:00:00 +0000

Background: The emergence of antibiotic-tolerant staphylococcal strains, such as vancomycin-intermediate Staphylococcus aureus (VISA), poses a significant healthcare challenge and complicates treatment regimens. VISA often exhibits mutations in Krebs cycle enzymes, promoting anaerobic metabolism under physiological conditions and reducing susceptibility to antibiotics and innate immune defenses-factors not typically captured in standard susceptibility testing. Building on these findings, we investigated ethylenediaminetetraacetic acid (EDTA), a chelator that enhances reactive oxygen species (ROS) production, as an adjunct to vancomycin for combating VISA infections. Methods: RNA sequencing analysis compared gene expression of a well-characterized VISA strain (D712) under physiological versus nutrient-rich conditions. Hydrogen peroxide (H₂O₂) killing assays were conducted with and without the hydroxyl radical quencher thiourea, while neutrophil killing...

Potent Activity of Ertapenem Plus Cefazolin Within Staphylococcal Biofilms: A Contributing Factor in the Treatment of Methicillin-Susceptible Staphylococcus aureus Endocarditis

Wed, 28 Jan 2026 00:00:00 +0000

Background: Besides antistaphylococcal beta-lactams and source control, there are limited validated antimicrobial salvage options in patients with prolonged methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia, including infective endocarditis (IE). Methods: MSSA IE cases treated with ertapenem (ETP) plus cefazolin (CZ) were compared with matched IE cases treated with standard beta-lactam monotherapy. The bactericidal activity of ETP plus CZ was also compared with nafcillin (NAF), CZ, and ETP alone using an in vitro MSSA biofilm model. Results: The median duration of bacteremia experienced by patients (n = 12) while on CZ or NAF was 4 days (range 1-16 days) compared with 1 day (range 1-3 days) for patients (n = 5) treated with ETP + CZ (P = .01, Mann-Whitney U test). Cefazolin and NAF alone or in combination did not achieve biofilm eradication at clinically relevant concentrations. However, the addition of ETP to CZ led to bactericidal eradication...

Impact of Clopidogrel on Clinical Outcomes in Patients with Staphylococcus aureus Bacteremia: a National Retrospective Cohort Study

Wed, 28 Jan 2026 00:00:00 +0000

Activated platelets have known antimicrobial activity against Staphylococcus aureus. Accelerated clearance of platelets induced by S. aureus can result in thrombocytopenia and increased mortality in patients. Recent studies suggest that P2Y12 inhibition protects platelets from accelerated clearance. We therefore evaluated the effect of P2Y12 inhibition on clinical outcomes in patients with S. aureus bacteremia across a large national cohort. Our retrospective cohort (2010 to 2018) included patients admitted to Veterans Affairs (VA) hospitals with blood cultures positive for S. aureus and treated with standard-of-care antibiotics. Employing propensity score-matched Cox proportional hazards regression models, we compared clinical outcomes in patients treated with clopidogrel for at least the 30 days prior to admission and continuing for at least 5 days after admission to patients without any P2Y12 inhibitor use in the year preceding admission. Mortality was significantly lower among...

Cefazolin and Ertapenem Salvage Therapy Rapidly Clears Persistent Methicillin-Susceptible Staphylococcus aureus Bacteremia

Wed, 28 Jan 2026 00:00:00 +0000

Cefazolin and ertapenem combination therapy was used successfully to salvage 11 cases (6 endocarditis) of persistent methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia, including immediate clearance (≤24 hours) in 8 cases. While in vitro synergy was modest, cefazolin plus ertapenem exhibited synergistic action in a rat model of MSSA endocarditis. The combination of cefazolin and ertapenem provides potent in vivo activity against MSSA beyond what is predicted in vitro and warrants further clinical study in the treatment of refractory MSSA bacteremia and endocarditis.

Pediatric COVID-19 Health Disparities and Vaccine Equity

Wed, 28 Jan 2026 00:00:00 +0000

While most children with coronavirus 2019 (COVID-19) experience mild illness, some are vulnerable to severe disease and develop long-term complications. Children with disabilities, those from lower-income homes, and those from racial and ethnic minority groups are more likely to be hospitalized and to have poor outcomes following an infection. For many of these same children, a wide range of social, economic, and environmental disadvantages have made it more difficult for them to access COVID-19 vaccines. Ensuring vaccine equity in children and decreasing health disparities promotes the common good and serves society as a whole. In this article, we discuss how the pandemic has exposed long-standing injustices in historically marginalized groups and provide a summary of the research describing the disparities associated with COVID-19 infection, severity, and vaccine uptake. Last, we outline several strategies for addressing some of the issues that can give rise to vaccine inequity...

Gut dysbiosis and brain microhemorrhages in young vs. aged mice with chronic kidney disease

Mon, 26 Jan 2026 00:00:00 +0000

Intestinal dysbiosis and gut-derived toxins in chronic kidney diseases (CKD) are associated with vascular injury. This study examined the relationship between gut dysbiosis and cerebral microhemorrhages (CMH) in young and aged CKD mice (3 vs. 16 months of age) in both sexes. CKD was induced in C57BL/6J mice using a nephrotoxic adenine diet. Serum creatinine, trimethylamine N-oxide (TMAO), indoxyl sulfate (IS) and p-cresyl sulfate (pCS) were measured. CMH was quantified via brain histology, and gut microbial sequencing was analyzed from fecal pellets. Creatinine and uremic toxins were elevated in both young and aged CKD mice compared with controls, and microbial populations were altered by age, sex and CKD status. Age was the most significant factor in microbial variance, with higher levels of IS and pCS in aged CKD mice. Aged male mice had significantly higher creatinine, TMAO and IS than aged females. Males had higher CMH counts than females, and aged CKD males had the highest...

1179: THE VITAMIN B12 ANALOG COBINAMIDE: EFFICACY EVALUATION AS A MULTICHEMICAL AGENT ANTIDOTE

Mon, 26 Jan 2026 00:00:00 +0000

1179: THE VITAMIN B12 ANALOG COBINAMIDE: EFFICACY EVALUATION AS A MULTICHEMICAL AGENT ANTIDOTE

Genes Encoding Multiple Modulators of the Immune Response Are Methylated in the Prostate Tumor Microenvironment of African Americans

Thu, 15 Jan 2026 00:00:00 +0000

Background/Objectives: Prostate cancer (PCa) is diagnosed at an earlier median age, more advanced stage, and has worse clinical outcomes in African American (AA) men compared to European Americans (EA). Methods: To investigate the role of aberrant DNA methylation in tumor-adjacent stroma (TAS), methyl binding domain sequencing (MBD-seq) was performed on AA (n = 17) and EA (n = 15) PCa patients. This was independently confirmed using the long interspersed nuclear element-1 (LINE-1) assay. Pathway analysis was performed on statistically significantly differentially methylated genes for AA and EA TAS. DNA methylation profiles of primary cultured AA and EA carcinoma-associated fibroblasts (CAFs) were compared with AA and EA TAS. AA and EA CAFs were treated with demethylating agent 5-Azacytidine (5-AzaC). Results: AA TAS exhibited higher global DNA methylation than EA TAS (p-value < 0.001). Of the 3268 differentially methylated regions identified...

Incretin Receptor Agonist, Semaglutide, as a Treatment for Alectinib-Induced Excessive Weight Gain. A Case Report.

Thu, 8 Jan 2026 00:00:00 +0000

Alectinib is a second-generation anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitor (TKI) that has been widely used as first-line (1L) treatment of advanced ALK+ non-small cell lung cancer (NSCLC) ever since its approved indication on November 17, 2017, based on the ALEX trial and its perceived well-tolerability. Lorlatinib, a third-generation ALK TKI, achieved 1L indication on March 3, 2021, but is generally associated with adverse events including weight gain in up to 44% of patients from the recent update of the CROWN study; hence its use as 1L treatment has lagged behind alectinib. Recently, alectinib has also been reported to cause significant weight gain. Incretin receptor agonists such as glucagon-like peptide-1 receptor (GLP-1) agonists semaglutide have been approved to treat obesity (body mass index [BMI] ≥ 30). Here, we report a patients case who had gained significant weight during still on-going 12-year treatment with alectinib and achieved weight loss...

Health Care Expenditures and Length of Disability Across Medical Conditions

Mon, 29 Dec 2025 00:00:00 +0000

OBJECTIVE: To describe the relationship between the length of short-term disability (STD) and health care spending. METHODS: Medical claims for insured US employees on STD were evaluated to describe the distribution of disability durations and health expenditures across major diagnostic categories and common medical conditions. Correlations between health expenditures and disability durations were examined. RESULTS: The most expensive 10% of cases accounted for more than half of total health spending. The longest 10% of cases accounted for more than one-third of total disability time. Only one-third of the most expensive cases were also among the longest in duration. Disability durations were moderately correlated with medical spending and this relationship was modified by comorbid conditions and age. CONCLUSION: Psychosocial barriers, in addition to biomedical factors, should be considered to achieve optimal functional outcomes and well-being of patients.

A Collaborative Approach in Mechanistic Music-Based Intervention and Pain Research: NCCIH Research Networks

Fri, 19 Dec 2025 00:00:00 +0000

Abstract This paper describes three research networks funded by the U.S. National Center for Complementary and Integrative Health (NCCIH) and the National Endowment for the Arts (NEA). The networks seek to advance the mechanistic understanding of music-based interventions (MBIs) for pain management. The networks address critical gaps hindering MBI research, including inconsistent terminology, lack of mechanistic understanding, and insufficient objective measures. The Music4Pain Network focuses on the development of a taxonomy, a mechanistic framework, and research priorities; the ENSEMBLE Network promotes cross-disciplinary collaboration, collation of real-world data from clinical settings, and biomarker identification; and the Audio Analgesia Network emphasizes computational methods and innovative technologies to advance mechanistic research in MBIs. Together, these networks form the Music and Health Consortium, conducting collaborative research through specialized working groups,...

Neural mechanisms of declarative memory.

Fri, 19 Dec 2025 00:00:00 +0000

Neural mechanisms of declarative memory.

Relational learning with and without awareness: Transitive inference using nonverbal stimuli in humans

Fri, 19 Dec 2025 00:00:00 +0000

Learning complex relationships among items and representing them flexibly have been shown to be highly similar in function and structure to conscious forms of learning. However, it is unclear whether conscious learning is essential for the exhibition of flexibility in learning. Successful performance on the transitive inference task requires representational flexibility. Participants learned four overlapping premise pairs (A > B, B > C, C > D, D > E) that could be encoded separately or as a sequential hierarchy (A > B > C > D > E). Some participants (informed) were told prior to training that the task required an inference made from premise pairs. Other participants (uninformed) were told simply that they were to learn a series of pairs by trial and error. Testing consisted of unreinforced trials that included the nonadjacent pair, B versus D, to assess capacity for transitive inference. Not surprisingly, those in the informed condition outperformed those...

The use of heart rate in a driving simulator as an indicator of age-related differences in driver workload

Fri, 19 Dec 2025 00:00:00 +0000

The degree to which driving complexity affects cognitive performance remains an area of great interest. Older adults do not necessarily perform as well as younger adults on complex cognitive tasks alone or when combined with different driving environments. Since the next generation of older adults is expected to drive more frequently than previous cohorts, we conducted an experiment in which subjects were presented with cognitive performance tasks during simulated driving involving four levels of environmental complexity. We monitored a physiological index, heart rate, to assess task impact on workload capacity. A total of 18 active younger drivers (19-23 years old) and 17 older drivers (51-66 years old) completed different cognitive tasks including: a simulated cellular telephone conversation (easy task), two paragraphs from the Wechsler Memory Scale (easy task), segments of the Continuous Performance Task (hard task), and Multiple Interference Task (hard task). Driving performance...

The Evaluation of a Mind/Body Intervention to Reduce Psychological Distress and Perceived Stress in College Students

Fri, 19 Dec 2025 00:00:00 +0000

The authors examined the effect of a 6-week mind/body intervention on college students' psychological distress, anxiety, and perception of stress. One hundred twenty-eight students were randomly assigned to an experimental group (n = 63) or a waitlist control group (n = 65). The experimental group received 6 90-minute group-training sessions in the relaxation response and cognitive behavioral skills. The Symptom Checklist-90-Revised, Spielberger State-Trait Anxiety Inventory, and the Perceived Stress Scale were used to assess the students' psychological state before and after the intervention. Ninety students (70% of the initial sample) completed the postassessment measure. Significantly greater reductions in psychological distress, state anxiety, and perceived stress were found in the experimental group. This brief mind/body training may be useful as a preventive intervention for college students, according to the authors, who called for further research to determine whether...

Chapter 23 Hypertension

Fri, 19 Dec 2025 00:00:00 +0000

Chapter 23 Hypertension

Psychological interventions and pregnancy rates. Dropouts—random or non-random?

Fri, 19 Dec 2025 00:00:00 +0000

Psychological interventions and pregnancy rates. Dropouts—random or non-random?

Study of the therapeutic effects of intercessory prayer (STEP): Study design and research methods

Fri, 19 Dec 2025 00:00:00 +0000

BACKGROUND: The effect of intercessory prayer (IP) on outcome in cardiac cases has been evaluated previously, but results are controversial. The goals of the Study of the Therapeutic Effects of Intercessory Prayer (STEP) are to evaluate the effects of receipt of additional study IP and awareness of receipt of additional study IP on outcomes in patients undergoing coronary artery bypass graft surgery. STEP is not designed to determine whether God exists or whether God does or does not respond to IP. METHODS: STEP is a multicenter, controlled trial of 1802 patients in 6 US hospitals, randomized to 1 of 3 groups. Two groups were informed that they may or may not receive 14 consecutive days of additional IP starting the night before coronary artery bypass graft surgery; Group 1 received IP, Group 2 did not. A third group (Group 3) was informed that they would receive additional IP and did so. Three mainstream religious sites provided daily IP for patients assigned to receive IP. At...

Impact of Vitamin D Deficiency on the Productivity of a Health Care Workforce

Thu, 18 Dec 2025 00:00:00 +0000

OBJECTIVE: To define the relationship between vitamin D status and employee presenteeism in a large sample of health care employees. METHODS: Prospective observation study of 10,646 employees of a Midwestern-integrated health care system who completed an on-line health risk appraisal questionnaire and were measured for 25-hydroxyvitamin D. RESULTS: Measured differences in productivity due to presenteeism were 0.66, 0.91, and 0.75 when comparing employees above and below vitamin D levels of 20 ng/mL, 30 ng/mL, and 40 ng/mL, respectively. These productivity differences translate into potential productivity savings of 0.191%, 0.553%, and 0.625%, respectively, of total payroll costs. CONCLUSIONS: Low vitamin D status is associated with reduced employee work productivity. Employee vitamin D assessment and replenishment may represent a low-cost, high-return program to mitigate risk factors and health conditions that drive total employer health care costs.

Psychological and Biological Outcomes: Long-Term Versus Short-Term Relaxation Response Practice

Thu, 18 Dec 2025 00:00:00 +0000

Psychological and Biological Outcomes: Long-Term Versus Short-Term Relaxation Response Practice

Study of the Therapeutic Effects of Intercessory Prayer (STEP) in cardiac bypass patients: A multicenter randomized trial of uncertainty and certainty of receiving intercessory prayer

Thu, 18 Dec 2025 00:00:00 +0000

BACKGROUND: Intercessory prayer is widely believed to influence recovery from illness, but claims of benefits are not supported by well-controlled clinical trials. Prior studies have not addressed whether prayer itself or knowledge/certainty that prayer is being provided may influence outcome. We evaluated whether (1) receiving intercessory prayer or (2) being certain of receiving intercessory prayer was associated with uncomplicated recovery after coronary artery bypass graft (CABG) surgery. METHODS: Patients at 6 US hospitals were randomly assigned to 1 of 3 groups: 604 received intercessory prayer after being informed that they may or may not receive prayer; 597 did not receive intercessory prayer also after being informed that they may or may not receive prayer; and 601 received intercessory prayer after being informed they would receive prayer. Intercessory prayer was provided for 14 days, starting the night before CABG. The primary outcome was presence of any complication...

Psychobiological Changes from Relaxation Response Elicitation: Long-Term Practitioners vs. Novices

Thu, 18 Dec 2025 00:00:00 +0000

OBJECTIVE: The relaxation response (RR) is a physiological state that is the counterpart to the stress response. We investigate the psychological and biological effects, as well as the correlation between these two effects that are associated with short-term vs. long-term practice of techniques that elicit the RR ("RR practice"). METHODS: The study comprised both a cross sectional and an 8-week prospective design. The study sample included individuals with a long-term RR practice ("long-term practitioners" n = 28) and those with no prior RR practice experience ("novices" n = 28). The novices received 8 weeks of RR-elicitation training ("RR training") for the prospective analysis (short-term practice). RESULTS: Long-term practitioners reported lower levels of psychological distress than the novices before they received RR training. As a result of the 8-week RR training, novices significantly reduced their psychological distress to levels comparable to that of long-term practitioners....

Stress reduction correlates with structural changes in the amygdala

Thu, 18 Dec 2025 00:00:00 +0000

Stress has significant adverse effects on health and is a risk factor for many illnesses. Neurobiological studies have implicated the amygdala as a brain structure crucial in stress responses. Whereas hyperactive amygdala function is often observed during stress conditions, cross-sectional reports of differences in gray matter structure have been less consistent. We conducted a longitudinal MRI study to investigate the relationship between changes in perceived stress with changes in amygdala gray matter density following a stress-reduction intervention. Stressed but otherwise healthy individuals (N = 26) participated in an 8-week mindfulness-based stress reduction intervention. Perceived stress was rated on the perceived stress scale (PSS) and anatomical MR images were acquired pre- and post-intervention. PSS change was used as the predictive regressor for changes in gray matter density within the bilateral amygdalae. Following the intervention, participants reported significantly...

The relaxation response: Reducing stress and improving cognition in healthy aging adults

Thu, 18 Dec 2025 00:00:00 +0000

Aging adults are vulnerable to the effects of a negative emotional state. The relaxation response (RR) is a mind-body intervention that counteracts the harmful effects of stress. Previous studies with relaxation techniques have shown the non-pharmacological benefit of reducing stress and improving the memory of healthy older adults. Our pilot study evaluated whether a RR training program would decrease anxiety levels, improve attention, declarative memory performance and/or decrease salivary cortisol levels in healthy older adults. Fifteen adults participated and were randomly assigned to a RR training or control groups. Mean age was 71.3 years and mean education level was 17.9 years. Reaction time on a simple attention/psychomotor task was significantly improved (p<0.0025) with RR training, whereas there was no significant improvement on complex tasks of attention, verbal, or visual declarative memory tests. Self-reported state anxiety levels showed a marginally significant...

Relaxation response and spirituality: Pathways to improve psychological outcomes in cardiac rehabilitation

Thu, 18 Dec 2025 00:00:00 +0000

OBJECTIVES: Studies have shown beneficial effects from practicing the relaxation response (RR). Various pathways for these effects have been investigated. Previous small studies suggest that spirituality might be a pathway for the health effects of the RR. In this study, we tested the hypothesis that increased spiritual well-being by eliciting the RR is one pathway resulting in improved psychological outcomes. METHODS: This observational study included 845 outpatients who completed a 13-week mind/body Cardiac Rehabilitation Program. Patients self-reported RR practice time in a questionnaire before and after the 13-week program. Similarly, data on spiritual well-being, measured by the subscale of Spiritual Growth of the Health-Promoting Lifestyle Profile II, were collected. The psychological distress levels were measured by the Symptom Checklist-90-Revised. We tested the mediation effect of spiritual well-being using regression analyses. RESULTS: Significant increases in RR practice...

Stress Management Versus Lifestyle Modification on Systolic Hypertension and Medication Elimination: A Randomized Trial

Thu, 18 Dec 2025 00:00:00 +0000

Isolated systolic hypertension is common in the elderly, but decreasing systolic blood pressure (SBP) without lowering diastolic blood pressure (DBP) remains a therapeutic challenge. Although stress management training, in particular eliciting the relaxation response, reduces essential hypertension its efficacy in treating isolated systolic hypertension has not been evaluated. We conducted a double-blind, randomized trial comparing 8 weeks of stress management, specifically relaxation response training (61 patients), versus lifestyle modification (control, 61 patients). Inclusion criteria were >or=55 years, SBP 140-159 mm Hg, DBP <90 mm Hg, and at least two antihypertensive medications. The primary outcome measure was change in SBP after 8 weeks. Patients who achieved SBP <140 mm Hg and >or=5 mm Hg reduction in SBP were eligible for 8 additional weeks of training with supervised medication elimination. SBP decreased 9.4 (standard deviation [SD] 11.4) and 8.8 (SD 13.0)...

The hippocampus and memory for orderly stimulus relations

Thu, 18 Dec 2025 00:00:00 +0000

Human declarative memory involves a systematic organization of information that supports generalizations and inferences from acquired knowledge. This kind of memory depends on the hippocampal region in humans, but the extent to which animals also have declarative memory, and whether inferential expression of memory depends on the hippocampus in animals, remains a major challenge in cognitive neuroscience. To examine these issues, we used a test of transitive inference pioneered by Piaget to assess capacities for systematic organization of knowledge and logical inference in children. In our adaptation of the test, rats were trained on a set of four overlapping odor discrimination problems that could be encoded either separately or as a single representation of orderly relations among the odor stimuli. Normal rats learned the problems and demonstrated the relational memory organization through appropriate transitive inferences about items not presented together during training....

Exploring the Effectiveness of a Comprehensive Mind–Body Intervention for Medical Symptom Relief

Thu, 18 Dec 2025 00:00:00 +0000

OBJECTIVE: The objective of this study was to describe possible changes in physical and psychologic symptoms among outpatients completing a 12-week mind-body medical symptom reduction program related to chronic medical conditions. DESIGN: The cornerstone of the program is elicitation of the relaxation response, and the curriculum also incorporates trainings on mind-body interactions, cognitive restructuring, nutrition, and physical activity. The Medical Symptom Checklist (MSCL), Health Promoting Lifestyle Profile-II (HPLP-II) and Symptom Checklist-90R (SCL-90-R) were used to assess 331 patients' physical and psychologic symptoms before and after the intervention. RESULTS: Significant post-treatment improvements in symptom frequency occurred for 12 individual symptoms on the MSCL, all 6 of the HPLP-II subscales, and 8 of the 9 SCL-90-R subscales from pre- to post-treatment. CONCLUSIONS: The results from this uncontrolled study suggest that a comprehensive mind-body intervention...

Association between oxygen consumption and nitric oxide production during the relaxation response.

Thu, 18 Dec 2025 00:00:00 +0000

BACKGROUND: Mind/body practices that elicit the relaxation response (RR) are currently practiced by over 30% of American adults. RR elicitation reduces volumetric oxygen consumption (VO(2)) from rest and counteracts the effects of stress, although the mechanisms mediating the RR remain unknown. This study was designed to investigate whether RR elicitation is mediated by nitric oxide (NO). We developed a method to quantify depth of RR using change in VO(2) (slope) during RR elicitation. We evaluated whether depth of RR elicitation was correlated with changes in NO, as measured by percentage changes in fractional exhaled nitric oxide (F(E)NO). MATERIAL/METHODS: We conducted a randomized, controlled trial, in which 46 subjects were randomized to either 8-weeks of RR training using audiotapes (n=34) or 8-weeks of exposure to a control condition--receiving health-education by audiotapes (n=12). Prior to randomization, VO(2) and F(E)NO were measured while subjects listened to a control...

Inpatient Pain Management

Thu, 18 Dec 2025 00:00:00 +0000

Inpatient Pain Management

The Hippocampus and Transverse Patterning Guided by Olfactory Cues

Thu, 18 Dec 2025 00:00:00 +0000

Normal rats and rats with hippocampal system damage were trained on a novel, olfactory version of the transverse-patterning task that involved the concurrent learning and continued performance of 3 partially ambiguous discrimination problems (A+B-, B+C-, C+A-). Animals with lesions of the fornix or perirhinal-entorhinal cortex acquired at least as rapidly as normal rats these problems presented in sequential blocks of trials involving the same stimulus pair. All groups also performed well on an initial test session when the order of stimulus pair presentations was randomized. Normal rats continued to discriminate appropriately in additional testing sessions with trials presented in random order. By contrast, both groups with hippocampal system damage performed poorly in continued random-order testing. These results extend the generality of the deficit in transverse patterning to the olfactory modality and demonstrate that the deficit is equivalent in magnitude after fornix or...

A Comparison of the Effect of a Low to Moderately Demanding Cognitive Task on Simulated Driving Performance and Heart Rate in Middle Aged and Young Adult Drivers

Thu, 18 Dec 2025 00:00:00 +0000

The goal of this study was to assess heart rate and driving performance while middle age and younger adults engaged in a naturalistic hands free phone task that was structured to place objectively equivalent cognitive demands on all participants. Although heart rate measures have been used in evaluating driver workload, prior studies had not compared responses in middle age and younger adults. Younger and middle age subjects performed equally well on the cellular telephone task. Middle age subjects drove more slowly overall and, as a group, did not demonstrate heart rate acceleration in response to the phone conversation that was seen in younger drivers. Both age groups showed a drop in speed control during the task. Late middle age adults appear as capable as young adults of managing the additional workload of a low to moderately demanding cognitive task while driving.

Optimizing Patient-Reported Outcome Collection and Documentation in Medical Music Therapy: Process-Improvement Study (Preprint)

Thu, 18 Dec 2025 00:00:00 +0000

BACKGROUND

To measure the effectiveness of nonpharmacologic interventions delivered during clinical care, investigators need to ensure robust and routine data collection without disrupting individualized patient care or adding unnecessary documentation burden.

OBJECTIVE

A process-improvement study was undertaken to improve documentation consistency and increase the capture of patient-reported outcomes (PROs; ie, stress, pain, anxiety, and coping) within a medical music therapy (MT) team.

METHODS

We used 2 Plan-Do-Study-Act (PDSA) cycles to improve documentation processes among an MT team (13.3 clinical full-time equivalent staff). Trainings focused on providing skills and resources for optimizing pre- and postsession PRO collection, specific guidelines for entering session data in the electronic health record, and opportunities for the team to provide feedback. Two comparisons of therapists’ PRO collection rates were conducted: (1) between the 6 months before...

Meditation experience is associated with increased cortical thickness

Thu, 18 Dec 2025 00:00:00 +0000

Previous research indicates that long-term meditation practice is associated with altered resting electroencephalogram patterns, suggestive of long lasting changes in brain activity. We hypothesized that meditation practice might also be associated with changes in the brain's physical structure. Magnetic resonance imaging was used to assess cortical thickness in 20 participants with extensive Insight meditation experience, which involves focused attention to internal experiences. Brain regions associated with attention, interoception and sensory processing were thicker in meditation participants than matched controls, including the prefrontal cortex and right anterior insula. Between-group differences in prefrontal cortical thickness were most pronounced in older participants, suggesting that meditation might offset age-related cortical thinning. Finally, the thickness of two regions correlated with meditation experience. These data provide the first structural evidence for experience-dependent...

A Model for Integrating a Mind/Body Approach to Cardiac Rehabilitation

Thu, 18 Dec 2025 00:00:00 +0000

PURPOSE: Although cardiac rehabilitation programs have been shown to decrease cardiovascular risk, morbidity, and mortality, few programs have integrated a balanced mind/body approach in which patients are taught the relaxation response and utilize cognitive behavior skills for stress management, along with diet and exercise. We examined the medical and psychological outcomes of patients treated in such a cardiac rehabilitation program in a general hospital setting. METHODS: From 1997 to 2005, outcomes were measured in 637 patients with coronary artery disease at baseline and after a 3-month program. Components of the intervention included smoking cessation, moderate aerobic exercise, nutrition counseling, relaxation response training, and cognitive/behavioral skills. RESULTS: Men and women improved significantly with respect to medical outcomes (blood pressure, lipids, weight, exercise conditioning, frequency of symptoms of chest pain and shortness of breath) and psychological...

Stress and Workplace Productivity Loss in the Heart of New Ulm Project

Thu, 18 Dec 2025 00:00:00 +0000

OBJECTIVE: The impact of stress in conjunction with lifestyle factors on workplace productivity is understudied, thus the relationship between these variables was examined. METHODS: Negative binomial regression was used to test the cross-sectional association between stress and productivity loss in a sample of 2823 adults. RESULTS: After body mass index adjustment, there was an interaction between stress and physical activity (β ± SE = 0.002 ± 0.001, P = 0.033). Active participants with low stress had 2% estimated productivity loss, whereas active participants with high stress had more than 11% productivity loss. Other lifestyle factors were not significant. CONCLUSIONS: Higher stress generally predicted greater productivity loss, but this association varied. At low stress, more activity was associated with less productivity loss. At high stress, more activity was associated with more productivity loss, perhaps indicating that individuals cope by exercising more and working less.

The Impact of Integrative Medicine on Pain Management in a Tertiary Care Hospital

Thu, 18 Dec 2025 00:00:00 +0000

BACKGROUND: Optimal inpatient pain management remains a major institutional and therapeutic challenge. Nontoxic, nonpharmacological approaches to treating pain show promise but have not been widely implemented, nor has their effectiveness been evaluated. AIMS: To evaluate the effectiveness of an inpatient integrative medicine consult service for pain management in 6 settings across an entire tertiary care hospital. DESIGN: Retrospective, observational study. SETTING: Abbott Northwestern Hospital, a 629-bed tertiary-care hospital in Minneapolis, Minn, that is part of Allina Hospitals & Clinics. PARTICIPANTS: Approximately 1837 patients hospitalized between January 1, 2008, and June 30, 2009. MEASUREMENTS: Pretreatment and posttreatment pain scores on a verbal scale of 0 to 10. RESULTS: Most patients (66%) had never previously received integrative services. Provision of integrative services had immediate and beneficial effects on pain scores. The average reduction in pain scores...

Clinical Trials of Meditation Practices in Health Care: Characteristics and Quality

Thu, 18 Dec 2025 00:00:00 +0000

OBJECTIVE: To provide a descriptive overview of the clinical trials assessing meditation practices for health care. DESIGN: Systematic review of the literature. Comprehensive searches were conducted in 17 electronic bibliographic databases through September 2005. Other sources of potentially relevant studies included hand searches, reference tracking, contacting experts, and gray literature searches. Included studies were clinical trials with 10 or more adult participants using any meditation practice, providing quantitative data on health-related outcomes, and published in English. Two independent reviewers assessed study relevance, extracted the data, and assessed the methodological quality of the studies. RESULTS: Four hundred clinical trials on meditation (72% described as randomized) were included in the review (publication years 1956-2005). Five broad categories of meditation practices were identified: mantra meditation, mindfulness meditation, yoga, t'ai chi, and qigong....

06. Facilitating Collection of Research and Quality Data in Integrative Medicine Clinical Settings: Views from Academic, Health System and Private Clinics

Thu, 18 Dec 2025 00:00:00 +0000

Focus Areas: Integrative Approaches to Care The purpose of this panel discussion is to share successful efforts from a practice-based research network (PBRN) including ten integrative medicine clinics. The BraveNet PBRN includes integrative medicine clinics with academic health centers, large health systems, and a stand-alone private practice clinic. While clinical care is prioritized across all of these centers, introducing research into clinical sites oriented to providing care poses challenges that vary by clinic environment. We will highlight some of the unique issues encountered when trying to standardize data collection in sites practicing a patient-centered, whole-systems approach to healing as well as the solutions used to overcome these issues. We will present some operational solutions and data collected from the PBRN's ongoing data registry, entitled PRIMIER. The panel will engage attendees in a dialogue centering on potential for future analyses of existing results,...

Meditation Training Leads to Changes in Regional Gray Matter Concentration

Thu, 18 Dec 2025 00:00:00 +0000

Meditation Training Leads to Changes in Regional Gray Matter Concentration

Evaluation of a Residential Kundalini Yoga Lifestyle Pilot Program for Addiction in India

Thu, 18 Dec 2025 00:00:00 +0000

Previously reported substance abuse interventions incorporating meditation and spiritual approaches are believed to provide their benefit through modulation of both psychological and pyschosocial factors. A 90-day residential group pilot treatment program for substance abuse that incorporated a comprehensive array of yoga, meditation, spiritual and mind-body techniques was conducted in Amritsar, India. Subjects showed improvements on a number of psychological self-report questionnaires including the Behavior and Symptom Identification Scale and the Quality of Recovery Index. Application of comprehensive spiritual lifestyle interventions may prove effective in treating substance abuse, particularly in populations receptive to such approaches.

Effects of complementary therapies on clinical outcomes in patients being treated with radiation therapy for prostate cancer

Thu, 18 Dec 2025 00:00:00 +0000

BACKGROUND: This pilot randomized controlled trial (RCT) examined the clinical effects of 2 complementary (CAM) therapies, relaxation response therapy (RRT) and Reiki therapy, in men being treated with external beam radiotherapy (EBRx) for prostate cancer. METHODS: Study participants were randomly assigned to weekly RRT, Reiki therapy twice weekly, or wait-list control. Well-validated instruments measured anxiety (STAI), depression (CES-D), and quality of life in cancer patients (FACT-G) at randomization and 3 subsequent time points. RESULTS: Fifty-four men were randomized, and 16 of 18 (89%) of RRT and 15 of 18 (83%) of Reiki patients completed the intervention protocol. No statistically significant difference was found between the RRT, Reiki, and control groups on total scores for the STAI, CES-D, or FACT-G instruments at any time point. However, at the end of the intervention, significant improvement was found on the emotional well-being subscale of the FACT-G quality of life...

P03.11. Relaxation response intervention induces respiration and heart rate variability changes in hypertensives

Thu, 18 Dec 2025 00:00:00 +0000

P03.11. Relaxation response intervention induces respiration and heart rate variability changes in hypertensives

Relaxation Response Induces Temporal Transcriptome Changes in Energy Metabolism, Insulin Secretion and Inflammatory Pathways

Thu, 18 Dec 2025 00:00:00 +0000

The relaxation response (RR) is the counterpart of the stress response. Millennia-old practices evoking the RR include meditation, yoga and repetitive prayer. Although RR elicitation is an effective therapeutic intervention that counteracts the adverse clinical effects of stress in disorders including hypertension, anxiety, insomnia and aging, the underlying molecular mechanisms that explain these clinical benefits remain undetermined. To assess rapid time-dependent (temporal) genomic changes during one session of RR practice among healthy practitioners with years of RR practice and also in novices before and after 8 weeks of RR training, we measured the transcriptome in peripheral blood prior to, immediately after, and 15 minutes after listening to an RR-eliciting or a health education CD. Both short-term and long-term practitioners evoked significant temporal gene expression changes with greater significance in the latter as compared to novices. RR practice enhanced expression...

Evaluation of an 8-Week Resilience Training Program in Moderate to Severely Depressed Patients

Thu, 18 Dec 2025 00:00:00 +0000

Evaluation of an 8-Week Resilience Training Program in Moderate to Severely Depressed Patients

Mind-body medicine: a model of the comparative clinical impact of the acute stress and relaxation responses.

Thu, 18 Dec 2025 00:00:00 +0000

Although the physiological and biochemical changes that occur during the acute stress response have been well-characterized, the contrasting changes that underlie the relaxation response evoked by various mind-body techniques are less understood. To help guide future mind-body research, we present a conceptual model that integrates patterns of change at the physiological and molecular levels. In addition, we point to future research opportunities and discuss how repeated elicitation of these responses could influence the health of patients.

Mind/body interventions for hot flashes

Thu, 18 Dec 2025 00:00:00 +0000

Mind/body interventions for hot flashes

The impact of a naturalistic hands-free cellular phone task on heart rate and simulated driving performance in two age groups

Thu, 18 Dec 2025 00:00:00 +0000

Heart rate and driving performance were assessed while late middle age (51–66) and younger adults (19–23) engaged in a naturalistic hands free phone task that was designed to place objectively equivalent cognitive demands on all participants. Although heart rate measures have been used in evaluating driver workload, prior studies had not compared responses in late middle age and younger adults with samples of sufficient size to begin to explore possible age relationships. In an evaluation of 37 participants, the two age groups displayed equivalent performance on the cellular telephone task and concurrent decrements in speed control (SD velocity). It was observed that the late middle age subjects drove more slowly overall and, as a group, did not demonstrate heart rate acceleration in response to the phone conversation that was seen in younger drivers. The possibility that age group differences in heart rate response are related to individual differences in attentional focus is...

Acupuncture in multidisciplinary treatment of post-COVID-19 Syndrome: A Case Report

Thu, 18 Dec 2025 00:00:00 +0000

Background: Post-COVID syndrome (PCS) is a complex, multisystem illness that may follow SARS-CoV-2/COVID-19 infection. As there is limited evidence for individual therapies and no singular treatment for PCS, guidelines endorse a multidisciplinary approach. This case describes a post-COVID patient benefiting from acupuncture within a comprehensive approach alongside symptom-titrated physical activity (STPA).

Case: A 50-year-old woman presented upon Long-COVID Clinic referral to an outpatient hospital-affiliated acupuncturist with 8 months of fatigue, anosmia, chest pressure, palpitations, and other symptoms following mild assay-confirmed COVID-19. Prior/concurrent medical testing demonstrated multisystem-inflammatory involvement (pericardial effusion, thyroid dysfunction, elevated D-dimers). Cardiology/pulmonology cleared the patient for exercise to tolerance considering serious pathology was absent. The acupuncturist’s Traditional Chinese Medicine impression was of Qi...

Patients Seek Integrative Medicine for Preventive Approach to Optimize Health

Thu, 18 Dec 2025 00:00:00 +0000

CONTEXT: Despite the tremendous growth of integrative medicine (IM) in clinical settings, IM has not been well characterized in the medical literature. OBJECTIVE: To describe characteristics and motivation of patients seeking care at an IM clinic. DESIGN, SETTING, AND PARTICIPANTS: Patients from a nine-site practice-based research network participated in this cross-sectional survey. Clinicians documented patients' medical conditions. MAIN OUTCOME MEASURES: Patients provided information on demographics, lifestyle factors, and reasons for seeking care at an IM center. Clinicians documented the medical condition treated and procedures performed at the visit. RESULTS: A total of 4,182 patients (84.5% white; 72.7% college-educated; and 73.4% female) reported their most important reasons for seeking IM. Top-ranked reasons were (1) "to improve health and wellness now to prevent future problems" (83.9%); (2) "to try new options for health care" (76.7%); and (3) "to maximize my health...

Defining a Complex Intervention: The Development of Demarcation Criteria for “Meditation”

Thu, 18 Dec 2025 00:00:00 +0000

The authors used a 5-round Delphi study with a panel of 7 experts in meditation research to achieve agreement on a set of criteria for a working definition of “meditation” for use in a comprehensive systematic review of the therapeutic use of meditation. Participants agreed that essential to a meditation practice is its use of (a) a defined technique, (b) logic relaxation, and (c) a self-induced state. Participants also agreed that a meditation practice may (d) involve a state of psychophysical relaxation somewhere in the process; (e) use a self-focus skill or anchor; (f) involve an altered state/mode of consciousness, mystic experience, enlightenment or suspension of logical thought processes; (g) be embedded in a religious/spiritual/philosophical context; or (h) involve an experience of mental silence. The results of this study provide insight into the challenges faced by researchers who want to demarcate meditative practices from nonmeditative practices, and they describe an...

Impact of Incremental Increases in Cognitive Workload on Physiological Arousal and Performance in Young Adult Drivers

Thu, 18 Dec 2025 00:00:00 +0000

This study examined the sensitivity of heart rate, skin conductance, and respiration rate as measures of mental workload in a simulated driving environment. Workload was systematically manipulated by using increasingly difficult levels of a secondary cognitive task. In a sample of 121 young adults, heart rate increased incrementally with increasing task demand. Significant elevations in skin conductance and respiration rate were also observed. At the lower levels of added workload, secondary task performance was nearly perfect and changes in indices of driving performance were negligible. At the highest level of workload, all three physiological measures appeared to plateau, and a subtle drop in simulated driving performance became detectable. Taken together, the pattern of results indicates that physiological measures can be sensitive to changes in workload before the appearance of clear decrements in driving performance. These findings further highlight a role for physiological...

Self-Reported Health, and Illness and the Use of Conventional and Unconventional Medicine and Mind/Body Healing by Christian Scientists and Others

Thu, 18 Dec 2025 00:00:00 +0000

A cross-sectional national telephone survey was used to determine whether Christian Scientists (N = 230), a religious group that uses mind/body (including spiritual) healing, self-report more or less illness than non-Christian Scientists (N = 589). The primary outcome measure was the proportion of Christian Scientists and non-Christian Scientists that, during the previous 12 months: a) experienced any of 13 common medical conditions or symptoms; and b) used conventional medicine, unconventional medicine, and mind/body (including spiritual) healing. Fewer Christian Scientists experienced an illness or symptom than non-Christian Scientists (73% vs. 80%, respectively, p = .05). A multivariate analysis showed that Christian Scientists were less likely to have experienced illness than non-Christian Scientists (odds ratio [OR] .66, 95% confidence interval [CI] .44 to .99, p = .04). Similar proportions of Christian Scientists and non-Christian Scientists used some type of conventional...

The stress and distress of infertility: Does religion help women cope?

Thu, 18 Dec 2025 00:00:00 +0000

In this evaluation of nearly 200 infertile women, high levels of religiosity and spirituality are significantly correlated with low levels of psychological distress. Clinicians should be prepared to discuss religious and spiritual issues with their patients, as those issues may play an important role in the psychological health of infertile women—and in their response to infertility treatment.

Healing prayer outcomes studies: consensus recommendations.

Thu, 18 Dec 2025 00:00:00 +0000

Healing prayer outcomes studies: consensus recommendations.

Spontaneous Normal Sinus Rhythm Conversion Using Integrative Medicine in Atrial Fibrillation

Thu, 18 Dec 2025 00:00:00 +0000

The relationship between acute life stress and the development of atrial fibrillation (AF) has been noted in the literature. However, the use of integrative medicine (IM) in restoring cardiac rhythm has not been adequately studied. This case report describes how an IM approach was used in a patient with atrial fibrillation and acute pain. Spontaneous cardioversion to normal sinus rhythm occurred during the IM session, in addition to marked decreases in self-reported pain, anxiety, and nausea at the conclusion of IM treatment. These results provide initial support that for some cases of AF, IM therapies can help to reduce costs via avoidance of additional hospitalization, electrocardioversion, and general anesthesia.

Impact of group psychological interventions on pregnancy rates in infertile women

Thu, 18 Dec 2025 00:00:00 +0000

OBJECTIVE: To determine the efficacy of two different group psychological interventions on viable pregnancy rates in women experiencing infertility of less than 2 years' duration. DESIGN: Prospective, controlled, single-blind, randomized study. SETTING: Large tertiary-care teaching hospital. PATIENT(S): One hundred eighty-four women who had been trying to get pregnant for 1 to 2 years. INTERVENTION(S): Participants were randomized into a 10-session cognitive-behavioral group, a standard support group, or a routine care control group. They were followed for 1 year. MAIN OUTCOME MEASURE(S): Viable pregnancy. RESULT(S): Sixty-four [corrected] women discontinued participation in the study within the first year. There were a total of 47 in the cognitive-behavioral group, 48 in the support group, and 25 in the control group. There were statistically significant differences between participants in the two intervention groups versus the control group. CONCLUSION(S): Group psychological...

17. The Business of Integrative Medicine: Panel Discussion

Thu, 18 Dec 2025 00:00:00 +0000

Focus Area: Sustainable Business Models In this session, panelist members of the Consortium of Academic Health Centers for Integrative Medicine (CAHCIM) share what has been successful in the implementation of integrative healthcare across different health systems and academic health centers. Some use what may be termed a “vertical” model, or one that is a stand-alone entity that operates outside of the health system or academic health center. Others use “horizontal” business models, which reach across and are built from within existing departments and divisions. Funding and revenue streams play a major role in the decision-making process and evolution of a center, so funding sources—philanthropic, internal, and operational budgets—also will be discussed.

Chapter 22 Prayer and Cardiovascular Disease

Fri, 12 Dec 2025 00:00:00 +0000

Chapter 22 Prayer and Cardiovascular Disease

Integrative Medicine Patients Have High Stress, Pain, and Psychological Symptoms

Fri, 12 Dec 2025 00:00:00 +0000

CONTEXT: Integrative medicine (IM) is a rapidly growing field whose providers report clinical success in treating significant stress, chronic pain, and depressive and anxiety symptoms. While IM therapies have demonstrated efficacy for numerous medical conditions, IM for psychological symptoms has been slower to gain recognition in the medical community. OBJECTIVE AND DESIGN: This large, cross-sectional study is the first of its kind to document the psychosocial profiles of 4182 patients at 9 IM clinics that form the BraveNet Practice-Based Research Network (PBRN). RESULTS: IM patients reported higher levels of perceived stress, pain, and depressive symptoms, and lower levels of quality of life compared with national norms. Per provider reports, 60% of patients had at least one of the following: stress (9.3%), fatigue (10.2%), anxiety (7.7%), depression (7.2%), and/or sleep disorders (4.8%). Pain, having both physiological and psychological components, was also included and is...

A 3-Day residential yoga-based program improves education professionals’ psychological and occupational health in a single arm trial

Fri, 12 Dec 2025 00:00:00 +0000

OBJECTIVE: This study examined changes in psychological and occupational health in urban education professionals after attending a brief yoga-based program. METHODS: Education professionals from the New York City Department of Education (NYC DOE) who were attending a residential 3-day yoga-based program at Kripalu Center for Yoga & Health were recruited to participate in the study. Measures of psychological and occupational health and health-related behaviors were completed before (baseline), after (post), and two months after the program (follow-up). Paired samples t-tests were used to compare scores between time points. RESULTS: At post, participants (N = 74) showed improvements in stress, resilience, affect, mindfulness, empowerment, self-compassion, satisfaction with life, work engagement, burnout, exercise, and vegetable intake (all p values < 0.05) compared to baseline. At the follow-up (N = 33), showed improvements in resilience, affect, mindfulness, empowerment,...

Improvements in Psychological Health Following a Residential Yoga-Based Program for Frontline Professionals

Fri, 12 Dec 2025 00:00:00 +0000

OBJECTIVE: The purpose of this pilot study was to examine the effects of a residential yoga-based program on psychological health and health behaviors in frontline professionals. METHODS: Frontline professionals from education, health care, human services, and corrections participated in the RISE (Resilience, Integration, Self-awareness, Engagement) program and completed questionnaires at baseline, post-program, and 2 months following RISE. RESULTS: Paired samples t tests revealed improvements in mindfulness, stress, resilience, affect, and sleep quality from baseline to post-program (all Ps < 0.001, N = 55), which were sustained at the 2-month follow-up (all Ps < 0.01, N = 40). Participants also reported increases in exercise, fruit, and vegetable consumption post-program (all Ps < 0.001), all of which persisted at the 2-month follow-up (all Ps < 0.01) except exercise. CONCLUSION: These findings suggest that RISE improved indices of psychological health and healthy...

Diagnosis and Management of Sciatic Endometriosis at the Greater sciatic Foramen: a Case Report

Fri, 12 Dec 2025 00:00:00 +0000

Sciatic endometriosis is a rare condition in which endometrial tissue invades or compresses the lumbosacral plexus and/or sciatic nerve and causes sciatic pain, which is often cyclical. Its diagnosis depends on the recognition of signs and symptoms atypical to common degenerative lumbar disorders and its treatment requires timely and coordinated care. A 26-year-old woman presented to a chiropractor at a hospital-based outpatient clinic with a 6-month exacerbation of radiating pain and paresthesia from the right gluteal region into the leg and foot. She was previously treated for over 3 months for suspected lumbosacral radiculopathy with physical therapy. Multisegmental neurologic deficits inconsistent with her prior lumbar imaging prompted further investigation. Pelvis and hip MRI identified a 7×5 cm mass extending through the greater sciatic foramen which compressed and infiltrated the lumbosacral plexus, sciatic nerve, and superior gluteal nerve, and was confirmed via biopsy...

Conservative management of pediatric temporomandibular disc displacement presenting as juvenile idiopathic arthritis: A case report

Fri, 12 Dec 2025 00:00:00 +0000

This case highlights the lack of a standardized treatment algorithm and the shortcomings of diagnostic imaging for adolescent TMD. The combination of these factors can allow for possible misdiagnosis and escalation of treatment, such as in the current case when advanced imaging findings suggestive of JIA prompted recommendations for methotrexate, corticosteroid injection, and arthrocentesis. However, the success of chiropractor-led management in this case highlights the potential utility of a stepped care model in which early conservative therapies are provided as both a diagnostic and therapeutic trial for those with TMD and an uncertain diagnosis of JIA. We suggest that this care pathway can inform the clinical decision-making prior to the use of higher levels of care such as disease-modifying antirheumatic drugs and/or injections. Chiropractors, acupuncturists, and medical specialists have an opportunity to collaborate within integrative settings to optimize the treatment for...

Impact of Integrative Health and Medicine on Costs Associated with Adult Health System Beneficiaries with Musculoskeletal Conditions: A Retrospective Cohort Study

Fri, 12 Dec 2025 00:00:00 +0000

Objective: Owing to perceived additional costs, patients may avoid integrative health and medicine (IHM) treatments, while insurers may not cover IHM. We hypothesized that adult beneficiaries of a health system's employee insurance plan with musculoskeletal (MSK) conditions receiving covered outpatient IHM would have reduced total allowed costs over the 1-year follow-up compared with matched controls, secondarily exploring medical and pharmaceutical cost subsets. Methods: We queried medical records and claims spanning 2018-2023 for beneficiaries aged 18-89 years with a new MSK episode. Patients were divided into cohorts: (1) IHM within 3 months after MSK diagnosis and (2) no IHM after initial primary care. After inflation adjustment and trimming, propensity score matching was used to balance cohorts on demographics, comorbidity, health care utilization, and prior 12-month spend. Least-squares mean total, medical, and pharmaceutical allowed costs (United...

Pain screening in youth with sickle cell disease: A quality improvement study

Fri, 12 Dec 2025 00:00:00 +0000

BACKGROUND: Youth with sickle cell disease (SCD) face several challenges as they age, including increased pain frequency, duration, and interference. The purpose of this study was to (i) determine the feasibility of routine pain screening; (ii) identify and describe various clinical pain presentations; and (iii) understand preferences/resources related to engaging in integrative health and medicine (IHM) modalities within an outpatient pediatric SCD clinic. METHODS: During routine outpatient visits, patients aged 8-18 completed measures of pain frequency, duration, and chronic pain risk (Pediatric Pain Screening Tool [PPST]). Participants screening positive for (i) persistent or chronic pain or (ii) medium or high risk for persistent symptoms and disability on the PPST were asked to complete measures of pain interference, pain catastrophizing, and interest in/resources for engaging in IHM modalities. RESULTS: Between March 2022 and May 2023, 104/141 (73.8%) patients who attended...

Rationale for routine collection of patient reported outcomes during integrative medicine consultation visits

Fri, 12 Dec 2025 00:00:00 +0000

OBJECTIVES: Integrative medicine (IM) is whole-person care utilizing complementary health approaches to address numerous physical or emotional influences that can impact an individual's health. Patient-reported outcomes (PRO) are subjective measures that quantify patients' perception of their quality of life. While PRO measures have been routinely assessed in specific oncology clinics, our objective was to assess the ability and utility of routine collection of PRO measures in an IM clinic. DESIGN/SETTING/MAIN OUTCOME: Patients receiving a clinical consultation in an ambulatory IM clinic completed the PROMIS Global Health Form in the clinic waiting room. RESULTS: From November 2013 through October 2016, the PROMIS Global Health Form (PROMIS-10) was administered during 59% of IM provider consultation visits (7172/12,207), representing 3473 unique patients. Most patients were female (81%), White (93%), middle-aged (49.2; SD 15.4) and had commercial health insurance (66%). Baseline...