Clinical
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When the Aortic Annulus Is Small, Does TAVR Valve Type Matter?
In this propensity-matched analysis of transcatheter aortic valve replacement (TAVR) registry patients with small aortic annuli, the hemodynamic advantage of self-expanding TAVR valves was not associated with better clinical outcomes compared with balloon-expandable valves up to five years.
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Diagnosis of Myasthenia Gravis May Be Challenging
Mimics of myasthenia gravis, including functional neurologic disorder, progressive external ophthalmoplegia, chronic ptosis, oculopharyngeal muscular dystrophy, mitochondrial cytopathy, or low-grade myositis, can make the diagnosis of myasthenia gravis difficult.
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Is the Long-Term Use of Low-Dose Opioids for the Treatment of Refractory RLS Safe and Effective?
A review of two-year longitudinal data regarding efficacy and dose stability in refractory restless legs syndrome (RLS) patients treated with low-dose opioids shows that patients do not escalate their opiate dosage and that there is clinical and therapeutic stability in the treatment of RLS with this therapeutic regimen. Methadone is the preferred opiate for the treatment of RLS because of its single-dose, long-acting profile and lack of euphoric effects.
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Viral Exposure and Risk of Neurodegenerative Disease
Twenty-two pairs of viral exposures associated with an increased risk of neurodegenerative diseases were identified and replicated across two national European biobanks.
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Can EEG and fMRI Help Predict Who Will Recover Consciousness After Brain Injury?
In conjunction with serial clinical examinations, electroencephalogram and functional magnetic resonance imaging may be helpful in predicting who will recover consciousness after an acute brain injury. However, in this study, early withdrawal of care leaves much uncertainty regarding the probability of eventual recovery.
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The Effect of Peripheral Neuropathy in Parkinson’s Disease on Gait and Balance
In this cohort study of 99 patients with Parkinson’s disease (PD), 40% were found to have peripheral neuropathy, with the majority meeting criteria for small fiber neuropathy. Gait and balance were worse in PD patients with neuropathy compared to those without.
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Stroke Prevention in Nonvalvular Atrial Fibrillation: A Review of the Past, Present, and Future
Nonvalvular atrial fibrillation is a highly prevalent cardiac arrhythmia in the United States and often can be complicated by a thromboembolic phenomenon, the most concerning of which is stroke. This article reviews the current evidence for the use of various anticoagulants, surgical techniques, and the left atrial appendage occlusion devices currently available for stroke prevention in atrial fibrillation.
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More Daily Steps Lowers Cardiovascular Disease Risk Among Older Adults
Researchers reported that for every additional 500 steps per day, the risk for heart disease, heart failure, and stroke declined by 14% among adults age 70 years and older.
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Opioid Use Disorders During Pregnancy
Currently, the United States faces an enormous opioid crisis, with opioid use disorder (OUD) being the leading cause of morbidity and mortality in some states. The number of pregnant people with OUD increased from 1.5 cases per 1,000 hospital deliveries to 6.5 cases per 1,000 hospital deliveries in the United States between 1999 and 2014, a more than four-fold rise. Proper identification and management of pregnant and postpartum people with OUD is crucial.
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The Efficacy of Prenatal Patients Using a Mindfulness App
This randomized trial conducted early in the pandemic with women from an obstetric and gynecologic practice found use of a mobile app promoting mindfulness practice (such as meditation) was associated with a decrease in perceived stress, self-reported anxiety and depression, and sleep disturbance in the intervention group.