Levoatriocardinal vein is a rare venous anomaly occasionally presenting as a bidirectional shunt in structurally normal hearts. We describe two unique systemic connections of levoatriocardinal vein without intracardiac defects, one causing paradoxical embolism via the hemiazygos vein, and the other draining from the left jugular vein to the pulmonary vein, requiring surgical correction to preserve cerebral venous return.

Rural America remains deeply under-represented in clinical trials. St Lawrence Health (SLH) was the sole rural site and one of the top recruiters in the Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV)-1 trial, which was a large international trial that studied the efficacy of three immune modulators in hospitalized patients with COVID-19. In this article, we analyze the structural and clinical factors that enabled SLH’s success in the context of previously described barriers to research participation in rural areas. We conclude with lessons learned from the SLH experience and offer a broader replicable model for developing clinical research capacity in rural areas. SLH’s success in ACTIV-1 can be attributed to early and sustained support from the ACTIV-1 network, a small and integrated inpatient COVID-19 treatment team, regular and consistent communication between this team and the clinical research team at SLH, and SLH’s ongoing support and development of its clinical research department. SLH was, in turn, able to overcome several known barriers to implementation of clinical trials at community sites, including lack of provider time and a lack of trained research and clinical staff, and its experience in ACTIV-1 offers a replicable model for developing clinical research capacity in rural communities.

Previous studies have shown that low-fat diet (LFD) is associated with various health benefits, and that lipid and fatty acid metabolism is linked to telomere shortening. However, no epidemiological studies have examined the association between LFD and telomere length (TL). Dietary information was collected using 24-h recalls among 6981 adults from a nationwide cross-sectional study. Diet quality was assessed using overall LFD, healthful LFD (hLFD) and unhealthful LFD (uLFD). TL was measured using quantitative PCR. Linear regression was employed to evaluate the association between LFD and log-transformed TL, and ordinal logistic regression was performed to assess the association of LFD with ordinal quintiles of TL in descending order. In both fully adjusted linear and ordinal regression models, higher overall LFD (Tertile 3 v. Tertile 1: percentage change = 2·48 %, 95 % CI: 0·60 %, 4·40 %, Ptrend = 0·003; OR = 0·79, 95 % CI: 0·68, 0·93; Ptrend = 0·001) and hLFD (Tertile 3 v. Tertile 1: percentage change = 2·71 %, 95 % CI: 0·87 %, 4·58 %; Ptrend = 0·002; OR = 0·84, 95 % CI: 0·72, 0·97; Ptrend = 0·003) scores were significantly associated with longer TL. The positive association between hLFD and TL was observed in other racial/ethnic groups, but not in non-Hispanic whites (Pinteraction < 0·005). There was no significant association between uLFD and TL in all the models. Our results suggest that LFD rich in high-quality carbohydrates, unsaturated fat and plant protein is associated with longer TL and underscore the need to consider the quality and dietary sources of the macronutrients.

Low enrollment of racial/ethnic minorities in clinical trials is a persistent problem. This study explores community health workers’ (CHWs) potential to increase research participation by Black people. We interviewed 12 CHWs and 12 Black community members, and after multidisciplinary analysis, held a CHW focus group to refine themes and make recommendations. Most participants mistrusted research, but many valued its potential for generativity. CHW involvement in research was seen as an opportunity to bring community relationships and context to all aspects of research, including recruitment. Participants proposed steps to build trustworthy research experiences and develop CHWs as full research team members.

Alpha-ketoglutarate (AKG) is a well-known intermediate of the tricarboxylic acid cycle and plays an important role in the catabolism of branched-chain amino acids (BCAAs: leucine, isoleucine, and valine). While previous study suggested that AKG enhances glucose metabolism, its effect on the adaptation of muscles and adipocytes has not been well studied in diabetic condition. This study aimed to determine whether AKG improves glucose metabolism in the skeletal muscles and adipose tissues in diabetic mice. Male institute of cancer research mice were divided into control, diabetic, and diabetic + AKG groups. Diabetes (DM) was induced by a high fat diet consumption and streptozotocin (STZ) injection. Mice in the DM + AKG group were administered 1% AKG in drinking water for 6 weeks. The non-fasting plasma glucose level was significantly higher in the diabetic group than that in the control and DM + AKG groups (P < 0.05). No significant difference was observed in glucose transporter 4 (GLUT4) protein levels in the muscles between the DM and DM + AKG groups. AKG supplementation attenuated the decrease in peroxisome proliferator-activated receptor γ coactivator 1 alpha and GLUT4 protein levels in inguinal and epididymal adipose tissues in diabetic condition. In conclusion, the study findings suggested that AKG supplementation increased protein levels related to mitochondrial biogenesis and glucose transporters in adipocyte tissue accompanied with improved whole-body glucose metabolism in STZ and high-fat diet-induced diabetic mice.

Cognitive problems represent one of the most common symptom dimensions in functional neurological disorder (FND; >80% of patients) and are frequently associated with distress, disability, and difficulties engaging in evidence-based treatments such as psychotherapy. Cognitive difficulties occur across the FND subtypes (eg, seizures, movement disorders, dizziness) but are largely underrecognized and undertreated by healthcare providers. That is, although a variety of interventions are available for primary functional symptoms and mental health comorbidities, there have not been any systematic efforts to date to specifically target cognitive functioning in FND, leaving an important gap in the literature.

Cognitive rehabilitation is a flexible approach utilizing diverse techniques aimed at improving cognition and enhancing functional independence in people with neuropsychiatric disorders. Cognitive rehabilitation can have positive impacts (moderate effect sizes) on cognition and everyday functioning across a variety of conditions, including traumatic brain injury, mild cognitive impairment, long COVID, PTSD, and others. Given the transdiagnostic clinical utility of cognitive rehabilitation, it has potential for benefit in many patients with FND if adapted and applied appropriately.

In this review, we highlight the utility of cognitive rehabilitation for FND, with a focus on clinically actionable advice and guidance. We describe fundamental principles of cognitive rehabilitation, evidence for its efficacy and effectiveness across neuropsychiatric disorders, and methods for avoiding potential pitfalls when applying it in FND. We then discuss a Case Vignette in order to emphasize the application of cognitive rehabilitation principles in an individual patient. We conclude with future directions for research and clinical care.

There is a gap in the understanding of meal patterns offered to students targeted by the National School Feeding Programme (PNAE). This study aimed to identify and analyse the menu patterns planned in schools participating in the PNAE. This observational cross-sectional study was carried out from a database consisting of 557 weekly menus from primary schools across Brazilian municipalities. We used factor analysis (FA) with principal components analysis (PCA) to identify menu patterns. Nutritional quality assessment of the menus was based on the Revised School Feeding Menu Quality Index (IQCAE-R). Differences in nutritional quality and associations with sociodemographic factors were analysed using the Kruskal–Wallis test, followed by Wilcoxon post hoc testing with Bonferroni correction. Two menu patterns were identified: (1) ‘Traditional’, predominantly composed of cereals and pasta, roots and tubers, legumes, vegetables, and meats and eggs; and (2) ‘Snack’, with a higher occurrence of bread, cakes, and biscuits, milk and dairy products, chocolate powder, and coffee and tea. The ‘Traditional’ pattern, consisting of food items commonly found in Brazilian food culture, and the ‘Snack’ pattern, characterised by the presence of sweets and highly processed foods, showed significant relationships with sociodemographic variables and nutritional quality of menus. Stimulating schools to provide meals that resemble the ‘Traditional’ pattern may contribute to the adoption of healthier dietary patterns, thus benefiting and strengthening health promotion through PNAE.

In this post hoc analysis of a quasi-experimental pilot/feasibility trial, a bundled diagnostic stewardship intervention safely reduced respiratory culturing rates without increasing ventilator-associated events (VAEs). Using difference-in-differences methodology, we observed a significant reduction in possible ventilator-associated pneumonia (PVAP) events, suggesting the intervention may reduce pneumonia overdiagnosis without compromising patient safety.

Cancer clinical research networks (CRNs) play a vital role in medical research globally by generating investigator-initiated research, pooling expertise, and enabling recruitment across multiple sites. Completing clinical trials is challenging. Delays can slow the generation of evidence needed to refine the best patient treatments. The aim of this review was to identify factors that have been either proposed or shown by research to influence the performance of cancer CRNs to improve trial success, outcomes and impact. A scoping review was conducted using a systematic search across five databases [PROSPERO CRD42023414241]. Records were screened for eligibility. For included articles, data on factors and research methods were extracted independently by up to three reviewers, and disagreements resolved by discussion. 1928 articles were returned, 13 were included. Articles reported on 11 membership-based cancer CRNs with headquarters in four countries (eight in the USA). Factors influencing CRN performance broadly fell into six categories: site, CRN, patient, regulatory, policy and industry factors, with subcategories in each case. These findings may help to inform future research to prioritize and improve the day-to-day performance of membership-based cancer CRNs and other trial sponsors to optimize clinical trial success. Further research is warranted.

Through an integrative approach that combined microscopy and molecular analyses of the 18S rDNA gene, this study describes a novel haemococcidian species, Lankesterella nucleoflexa sp. nov., and presents data on another Lankesterella sp. Both parasites were found in the green iguana (Iguana iguana) from Eastern Amazonia, Brazil. Lankesterella nucleoflexa sp. nov. is characterized by a unique nuclear plasticity; its nucleus exhibits variable shapes and condensation states, appearing condensed and seemingly divided when adjacent to the host cell nucleus and elongated when positioned opposite. This species infects erythrocytes, monocytes and heterophils, inducing significant nuclear deformities. Phylogenetic analysis placed both Lankesterella sequences in a clade with other Lankesterella parasites from lizards, highlighting the genetic diversity of this genus within this host group. These findings expand the knowledge about parasitic biodiversity in Neotropical reptiles and underscore the necessity of integrating morphological and molecular methodologies to elucidate the taxonomy of understudied groups such as haemococcidians.