Background
Proton therapy is an advanced radiation treatment that uses a beam of protons to destroy cancer cells while better sparing adjacent tissue compared to conventional X-ray treatments. As of July 2024, there are only 45 operating proton therapy centers in the United States, with an additional 6 member centers in development. 25 states and the District of Columbia have at least 1 proton therapy center, while 25 states do not have a proton therapy center. With patients using Google to learn more about their medical conditions and available treatments, the purpose of this study is to determine the relationship between access to a proton therapy center
and search interest for proton therapy.

Methods
2004-2023 Google trends data for the search term “proton therapy” was analyzed by state using the Health filter. Google Trends used a scale of 0-100 to analyze search interest, with 0 representing the lowest search interest and 100 representing the highest search interest. A two tailed unpaired t-test was utilized to assess differences in search interest between states with a proton therapy center in comparison to states without a proton therapy center.

Results
There is a statistically significant difference in search interest for proton therapy between states with a proton therapy center versus states without a proton therapy center (p<0.0001). On a scale of 0-100, states with a proton therapy center had a mean search interest of 48.46 with a standard deviation of 18.37, while states without a proton therapy center had a mean search interest of 30.44 with a standard deviation of 11.80. Four states had a statistically significant higher search interest in proton therapy compared to other states (p<0.05): Tennessee, Oklahoma, Kansas, and Delaware. Of these four, only Delaware does not have a proton therapy center. Among the 16 states and District of Columbia with the highest search interest in proton therapy, only Delaware did not have a proton therapy center. Among the 15 states with the lowest search interest in proton therapy, only Utah had a proton therapy center.

Conclusion
This study highlights the association between proton therapy search interest and availability. The expansion of this novel treatment will likely impact distribution of patient resources for proton therapy.

Proton Therapy: Probing the Relationship Between Interest and Availability of Proton Therapy Centers

Introduction: Obesity is associated with a number of comorbidities which deteriorate health status and are costly to manage. We are interested in assessing the cost-effectiveness of the two most common bariatric procedures, the sleeve gastrectomy, and roux-en-y gastric bypass (RYGB) for reducing comorbidity rates and costs. With the entry of new weight-loss medications to market, this long-term data will serve as a benchmark to compare therapies as outcome data become available.

Methods: A meta-analysis was submitted to PROSPERO and performed utilizing Ovid Medline. A total of 53 articles were identified which met quality and inclusion criteria. Data were extracted for a total of 113,762 patients. Utility values, procedural and annual comorbidity cost data were extracted from literature and adjusted for inflation. A cost-utility analysis model was constructed for each of these data trends, to a maximal of 20-years post-operatively.

Results: At 10 years post-RYGB or sleeve, patients had significant and sustained BMI decreases of 15.9 and 11.1 points respectively as compared to 1.3 points for mixed medical/diet control. RYGB data at 20 years, demonstrated a sustained decrease of 17.8 points, compared to control at 1.9. At 10 years RYGB patients had a 12.3% reduction in DM, sleeve a 10.5% reduction, compared to a 12.8% increase in the control group. At 12 years, DM prevalence in RYGB was decreased by 14.9% whereas the control group had increased by 16.1%. At 10 years there was a net-positive cost of $946 for RYGB and $7,623 for sleeve, with QALY gain of 1.04 and 0.74 and ICER of $909/QALY and $10,262/QALY respectively. BMI and DM data were available for RYGB at 12 years, where a net cost-savings for RYGB of $6,129 per patient and 1.28 utility gain was observed.

Conclusion: While bariatric surgery may be viewed as having a high initial cost, this study demonstrates that these procedures are not only cost-effective, they are cost sparing. At 10 years this study demonstrates ICER at $909/QALY for RYGB and $10,262/QALY for sleeve gastrectomy, qualifying them as extremely cost-effective procedures. At the 12-year mark, RYGB was cost negative with a net savings of $6,129 per patient. In addition to these cost-savings, both procedures demonstrate a major reduction in type 2 diabetes and BMI, which cannot be overstated for the unquantified subjective impact on quality of life. Future work will include addition of other comorbidities and the impact of complications of both medical and surgical therapy.


Cost Utility Analysis of Long-Term Outcomes of Bariatric Surgery as Compared to Medical Therapy for Obesity Management

Abstract Title:
Exploring the Link Between Smoking and Short-Term Mortality in Hospitalized COVID-19 Patients: Insights from Population Data
Background
Smoking cigarettes represents a prevalent form of tobacco consumption, with cigarette smoke containing harmful substances like nicotine, tar, and various carcinogens, which contribute to a spectrum of health issues. This study extends the discussion of smoking in the context of the COVID-19 pandemic, where data suggests that non-smokers hospitalized with the COVID-19 virus are more vulnerable to complications.
Methods
To investigate the relationship between smoking history and short-term mortality among COVID-19 patients, publicly accessible deidentified statewide hospitalization records of individuals aged ≥18 from Q2 2020 to Q1 2022 in Texas were utilized. Identification of smokers was performed using ICD-10-CM codes F17200, Z8789, and U071. Three models were employed to assess this link: multilevel logistic regression with propensity adjustment, supported by alternative analyses including propensity score matching and multivariable logistic regression.
Results
Nicotine administration has been observed to increase nAChR7 expression and inhibit pro-inflammatory cytokines like TNF-α, IL-1, and IL-6, while stimulating anti-inflammatory cytokines such as IL-10. Moreover, nicotine's potential dual effect on ACE2 receptors—increasing expression while reducing available binding sites for the COVID-19 virus—has been highlighted. Additionally, nicotine has been shown to inhibit NF-κB, a critical transcription factor in the activation of inflammation in various immune cells, and as an agonist of α7nAChRs, it can reduce cytokine storm mediators such as HMGB1. Notably, smoking has been associated with reduced furin (PCSK3) levels.
Conclusion
In conclusion, nicotine, widely consumed as tobacco smoking and recognized as an addictive substance, may harbor therapeutic potential that necessitates further exploration. Analogous pharmacological agents with high addictive potential are presently utilized for therapeutic purposes with appropriate pharmaceutical protocols. Further research into nicotine's standard processing, therapeutic index, dosing, and other aspects is imperative. Despite the inherent limitations of retrospective studies, nicotine has demonstrated mortality benefits, underscoring the importance of further investigation through prospective studies.

Exploring the Paradoxical Relationship Between Smoking and Short-Term Mortality in Hospitalized COVID-19 Patients: Insights from a Population-Based Cohort Study

Abstract Title
Loss of BCLAF1 impairs AML pathogenesis
Background
Acute myelogenous leukemia (AML) pathologically activates self-renewal programs of normal hematopoietic stem cells (HSCs) to promote proliferation and prevent differentiation. We identified that BCLAF1, a transcriptional repressor, has critical roles regulating HSC self-renewal. Both fetal and adult Bclaf1-deficient HSCs have impaired repopulation activity in competitive transplantation experiments. BCLAF1 is upregulated in pediatric and adult AML, and previous literature demonstrated that BCLAF1 suppression is detrimental to AML. We aim to define the function of BCLAF1 in AML transformation and progression, and we hypothesized that BCLAF1 is essential for AML pathogenesis.
Methods
Wild-type and Bclaf1-deficient hematopoietic progenitors were transduced with a retrovirus expressing MLL-AF9 to generate AML, then transferred into recipients. Hematopoietic progenitor cells from Mx-Cre:Bclaf1fl/fl mice, which inducibly delete Bclaf1 after pIpC treatment, were transduced with the MLL-AF9 construct and transplanted. Additionally, primary haploinsufficient Mx-Cre:Bclaf1fl/- and wild-type Bclaf1fl/fl AMLs were transferred into new recipients and treated with pIpC two weeks later. Haploinsufficient Mx-Cre:Bclaf1fl/- cells were also treated with Tat-Cre
recombinase to delete the remaining floxed allele. Lastly, Bclaf1-depletion was performed in human K562 AML cells.
Results
All mice receiving transduced wild-type cells developed AML, while only 50% of mice that received Bclaf1-deficient cells developed AML. Interestingly, mice that received Bclaf1fl/fl or Mx-Cre:Bclaf1fl/fl transduced cells developed AML at similar incidences; genotyping demonstrated all Mx-Cre:Bclaf1fl/fl AMLs were haploinsufficient for Bclaf1. No Bclaf1-deficient AMLs propagated from Mx-Cre:Bclaf1fl/fl, despite 85% of hematopoietic progenitors losing both floxed alleles after pIpC treatment. AML progressed equivalently in recipients of Bclaf1fl/fl or Mx-Cre:Bclaf1fl/- AML cells, and genotyping showed all Mx-Cre:Bclaf1fl/- AMLs remained haploinsufficient. Tat-Cre treatment of Mx-Cre:Bclaf1fl/- cells generated Bclaf1-/- cells (confirmed via genotyping). These Bclaf1-deficient AML cells had reduced colony formation in semisolid culture compared to haploinsufficient (Mx-Cre:Bclaf1fl/-) AML cells. K562 cells expressing shBclaf1 were selectively depleted in culture compared to cells expressing a non-targeting shRNA. Additionally, using an
inducible CRISPR-Cas9 system, K562 cells expressing a guide RNA against Bclaf1 formed fewer colonies after single-cell subcloning than cells expressing a non-targeting guide RNA. Recovered colonies predominantly expressed BCLAF1 despite loss of BCLAF1 in the bulk CRISPR-generated BCLAF1-depleted K562 cells prior to subcloning.
Conclusion
Collectively, these studies demonstrate that BCLAF1 has critical functions in AML and will define its functions in AML transformation and maintenance. Ongoing studies will define chromatin binding patterns of BCLAF1 and BCLAF1-mediated transcriptional programs in AML.

Loss of BCLAF1 impairs AML pathogenesis

Abstract Title
Extensive Pneumorrhachis Using Loss-of-Resistance to Air Technique During Implantation of a Spinal Cord Stimulator

Background
Pneumorrhachis (PR) is a rare condition characterized by the presence of air within the spinal canal, which can be either intradural or extradural. Typically, PR is asymptomatic and self-resolving, but it can occasionally present with neurological symptoms. Most cases of PR are iatrogenic, resulting from procedures such as epidural injections, lumbar punctures, or surgical interventions. This case report discusses a symptomatic epidural PR following the implantation of a spinal cord stimulator (SCS) using the loss-of-resistance to air (LOR-air) technique.

Case Presentation
A 78-year-old female with a history of scoliosis, sciatica, hypertension, and hyperlipidemia presented with severe lower back pain and bilateral hip pain radiating to her legs and feet following an SCS exchange procedure. Despite intravenous pain medications, her pain persisted. CT imaging revealed significant air volume in the posterior central canal at T12-L1, causing moderate compression of the thecal sac at L2, and extending into the left psoas muscle. Upon examination, the patient was neurologically intact but exhibited significant pain and hypersensitivity in the lower extremities. Laboratory results were within normal limits. The patient was treated non-operatively, with the air expected to resorb over time. She made a full recovery and resumed use of her SCS.

Discussion
This case underscores the potential risks associated with the LOR-air technique in spinal procedures. The introduction of air into the epidural space can act as a space-occupying lesion, causing significant pain and neurological symptoms. While both LOR-air and LOR-saline techniques are used to locate the epidural space, the LOR-air technique poses a unique risk of PR, which is not seen with saline. Despite the rarity of symptomatic PR, the potential for severe complications warrants a preference for the LOR-saline technique in clinical practice to minimize risk. This case highlights the importance of careful technique selection in spinal procedures to avoid complications such as pneumorrhachis. The LOR-saline technique should be preferred over LOR-air to reduce the risk of air introduction into the epidural space. Although rare, practitioners should be aware of the potential for symptomatic epidural PR and take appropriate precautions.


Extensive Pneumorrhachis Using Loss-of-Resistance to Air Technique During Implantation of a Spinal Cord Stimulator

Background: 
Pulmonary embolism (PE) is a life-threatening condition characterized by the blockage of a pulmonary artery or one of its branches. The intricate relationship between substance abuse and thromboembolic events has emerged as a significant concern in clinical medicine. Cocaine, a potent vasoconstrictor, has been associated with both arterial and venous thrombotic events due to its prothrombotic effects on the coagulation cascade and its impact on the vascular endothelium. We present a case of a 42-year-old male with a history of cocaine abuse who presented with a life-threatening PE. 
Case Presentation: 
A 42-year-old male with a past medical history of cocaine abuse presented after a syncopal episode. He described the episode as passing out from a standing position and regaining consciousness quickly on the ground. He endorsed a 3 day history of worsening dyspnea and lightheadedness. On examination, the patient was experiencing mild respiratory distress and was found to be tachycardic. ECG revealed sinus tachycardia with evidence concerning for right heart strain. Laboratory findings were significant for elevated troponin and pro-BNP. 
A ventilation/perfusion lung scan was ordered which showed a high probability of PE. A subsequent CT angiography of the chest was performed which confirmed acute bilateral pulmonary emboli with moderate-large clot burden and evidence of right heart strain with a right ventricle to left ventricle size ratio of 1.35. Lower extremity doppler ultrasound was positive for deep vein thrombosis in the right popliteal vein. 
The patient was evaluated by the interventional cardiology team and was taken for mechanical thrombectomy of the pulmonary emboli. Pre-intervention right heart catheterization was significant for a mean pulmonary artery pressure of 47 mmHg and a pulmonary capillary wedge pressure of 23 mmHg. The clot burden was reduced by greater than 90% and excellent filling with a good venous phase of all pulmonary arteries was noted. The patient improved symptomatically after the procedure. 
Discussion: 
Cocaine's prothrombotic properties are multifaceted, involving the activation of the coagulation process and the secretion of von Willebrand factor (VWF), among other factors, which collectively contribute to thrombus formation. The presence of adulterants in cocaine, such as levamisole, further complicates its pathophysiological impact, potentially exacerbating pulmonary damage and fibrosis, thus predisposing individuals to thromboembolic events. The reported case emphasizes the need for a high index of suspicion for cocaine-induced PE in patients with a history of substance abuse presenting with symptoms suggestive of thromboembolic events.

BEYOND TRADITIONAL RISK FACTORS: COCAINE ABUSE AND PULMONARY
EMBOLISM

Background: Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, and Asexual (LGBTQIA+) individuals are less likely to afford medical care, have higher rates of depression, and are more likely to feel discriminated against by medical providers based on their sexual orientation or gender identity. These health disparities introduce a need for medical providers to be practiced in both LGBTQIA+ cultural competence and unique healthcare concerns; however, currently in the United States, there is no required pre-clinical medical education regarding LGBTQIA+ healthcare. Previous studies have shown that discussion-based learning and virtual patient interactions are effective in improving the knowledge and skills of medical students. Our purpose is to determine if a medical skills-based workshop utilizing simulated patient scenarios will improve medical students’ self-perceived knowledge and competence when providing care to members of the LGBTQIA+ community. 

Methods: A workshop was presented to 100 first-year medical students at one medical institution introducing LGBTQIA+ concepts, terminology, and unique healthcare concerns. An anonymous survey was administered after the workshop to determine participants’ self-perceived knowledge of LGBTQIA+ concepts and self-perceived competence in caring for members of this population. Knowledge was scored on a scale from 0 (low knowledge) to 10 (high knowledge); competence was determined by participants' level of agreement to several Likert-styled statements. A paired t-test was conducted to determine the significance (p < 0.05) of the difference in self-perceived knowledge before and after the workshop.

Results: Results indicated a significant increase (p < 0.001) of mean self-perceived knowledge in both LGBTQIA+ unique healthcare concerns and terminology in first-year medical students who completed the workshop. In addition, 84% of participants agreed or strongly agreed they felt more competent in their ability to use inclusive language when speaking with LGBTQIA+ patients. Particularly, participants who do not identify as LGBTQIA+ members demonstrated a benefit in their self-perceived competence of LGBTQIA+ terminology and knowledge of healthcare concerns. 

Conclusions: The results of this study demonstrate how an informational workshop utilizing interactive practice scenarios regarding LGBTQIA+ terminology and healthcare concerns strongly correlates with the improvement of self-perceived knowledge and competence of first-year medical students. Considering there is no standardized curriculum for LGBTQIA+ medical education, the pedagogy demonstrated can be extended to other medical institutions with the goal of molding future physicians who can provide quality care to members of the LGBTQIA+ community.

Improving Self-perceived Competence in LGBTQIA+ Healthcare in Medical School Preclinical Education

Background
POEMS syndrome (Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal gammopathy, and Skin changes) is a rare condition first described in 19561. It is characterized by clonal plasma cell proliferation and peripheral neuropathy due to increased inflammatory and angiogenic mediators. Misdiagnosis as Acute or Chronic Inflammatory Demyelinating Polyneuropathy (AIDP/CIDP) often occurs due to overlapping neuropathic features. We present a rare case of POEMS syndrome initially misdiagnosed as Guillain-Barre syndrome(GBS), highlighting diagnostic challenges of this rare condition.
Case Presentation
A 44-year-old male presented with fatigue, lower extremity weakness, numbness, and tingling for 1-2 months. Previously, he experienced abdominal pain and tested positive for enteroaggregative E. coli (EAEC) diarrhea. Lumbar puncture revealed elevated protein and normal cell count in cerebrospinal fluid (CSF), leading to a presumptive diagnosis of GBS. Intravenous immunoglobulin (IVIG) was administered with mild improvement. However, after discharge, his lower extremity numbness and weakness worsened and developed numbness and weakness of the upper extremities. Additionally, he exhibited hyperpigmentation on both hands and feet and double vision without papilledema. He was admitted to the hospital with a tentative diagnosis of CIDP and was treated with intravenous solumedrol and plasmapheresis without improvement.
Further tests and imaging were conducted: Thyroid function test indicated hypothyroidism, blood tests revealed normocytic anemia, thrombocytosis, negative HIV and hepatitis B/C panels. Vascular endothelial growth factor (VEGF) was elevated to 929 pg/mL.Immunofixation detected an M spike with IgA lambda and kappa monoclonal proteins. Abdominal CT showed splenomegaly, and a skeletal survey was negative for any bone lesions. Bone marrow biopsy revealed 10-15% plasma cell myeloma with plasmablastic features and atypical megakaryocytic hyperplasia. A formal diagnosis of POEMS syndrome was confirmed. Genomic pathology shows a missense mutation of exon 17 of CSF3R at amino acid position 755, converting wild-type arginine to glutamine. 
Following the diagnosis, weekly treatment with daratumumab, cyclophosphamide, bortezomib, and dexamethasone (CyBorD) was initiated, leading to improvement. The patient’s VEGF decreased to 226 pg/mL(not normalized), thrombocytosis resolved, and lower extremity weakness improved. Despite the improvement, he remained unable to ambulate and was discharged to acute rehabilitation for further functional recovery.
Discussion
This case illustrates classic signs of POEMS syndrome initially mimicking GBS, diagnosed months after symptoms onset. POEMS syndrome should be considered in differential diagnoses for patients presenting with peripheral neuropathy and monoclonal gammopathy, especially when unresponsive to IVIG and steroids. Early recognition is crucial, as treatment for POEMS differs significantly from AIDP/CIDP, and delayed treatment can lead to progressive, debilitating neuropathy, paralysis, and ultimately, cardiorespiratory failure2.



Reference

1 Crow RS. "Peripheral neuritis in myelomatosis." Br Med J. 1956;2(5000):802-804.

2 Dispenzieri, A. (2023). POEMS syndrome. In S. V. Rajkumar & R. F. Connor (Eds.), UpToDate. 





Diagnostic Pitfalls: POEMS Syndrome's GBS Mimicry


Selective mutism (SM), categorized under anxiety disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), presents challenges in timely identification and treatment, which is especially crucial for pediatricians as early intervention can significantly improve a child’s social and emotional development. SM is characterized by a child’s inability to speak in certain situations but speaks adequately in other settings. While recorded SM diagnoses may not be largely prevalent within the US, affecting approximately 0.2-1.6% of people. SM's significance lies in its potential impact on a child's social, academic, and emotional well-being. This retrospective observational study explores pediatrician referrals to a specialized program for adolescents with SM, aiming to address awareness gaps and improve early intervention. Findings reveal a notable 11.5% contribution from pediatricians, compared to the other referring parties-- searching online (33.7%), other (32.6%), psychologist (8.6%), friend (8.5%), other therapist (4.6%), and recruitment event (0.5%)--emphasizing the need for targeted clinician awareness initiatives. Recognizing the potential benefits of early intervention, this research underscores the importance of collaborative efforts, education, and specialized programs in enhancing referral patterns by pediatricians for improved outcomes in selective mutism, as children are more likely to see their pediatrician before any of the other previously listed referral parties. The study acknowledges limitations in its design and suggests avenues for future research to explore factors influencing clinician awareness and the long-term outcomes of early SM treatment.

Retrospective Analysis of Pediatrician Referral Patterns for Selective Mutism Intervention: Unveiling Silent Echoes in Clinical Practice

Introduction: 
Medical education utilizes standard clinical practice and recommends clinical
algorithms to inform trainee curricula. The use of race and ethnicity as a medical screening tool impacts medical outcomes by associating race with genetics without considering that race incorporates social, economic, and cultural variables that influence outcomes.
Methods: 
To evaluate underlying factors contributing to differences in hypertension prevalence, control, and treatment recommendations across race/ethnicities, a two-week elective course was developed for third- and fourth-year medical students. In this elective course, students performed self-directed literature-based research on hypertension health disparities. We then developed three videos that addressed the racial/ethnic impact on hypertension prevalence and control and incorporated the students’ research findings. The videos were presented at a lunch-and-learn
session open to the medical students and health professionals that was focused on health care inequities in hypertension. Pre- and post-survey data was collected to assess how the discussion changed participant knowledge and impressions of the role race plays in hypertension prevalence, control, and treatment.
Results: 
Survey results denoted that 100% of lunch-and-learn participants increased their
understanding of the impact of health inequities on hypertension. Overall, there were significant differences in knowledge gained and understanding of health disparities that influence hypertension treatment across participants from all genders and racial or ethnic groups. Notably, pre-survey results indicated that participants tended to agree that treatment guidelines incorporating race improve equity in the treatment of hypertension whereas post-session results
showed that participants were less likely to agree with this assertion.
Conclusions: 
Developing educational opportunities to discuss health inequities can influence
perceptions of patient care.


Addressing Health Disparities in Hypertension: A comprehensive medical elective and survey study among medical students and professionals.

Background
Adverse childhood experiences (ACEs) are traumatic events like abuse or neglect that are associated with dangerous behaviors like violence and substance abuse during adulthood. ACEs contribute to the development of chronic non-communicable diseases like cardiovascular diseases, diabetes, and mental health disorders, which collectively account for over 70% of global deaths yearly. Research on ACEs has been limited in low-to-middle-income countries, like Honduras, which is ranked 5th globally in violence and 131st out of 191 in healthcare. The lack of studies on the driving factors behind violence and health disparities in Honduras has hindered the understanding of the relationship between ACES, violence, and health outcomes. Thus, this cross-sectional study aims to assess the impact of ACEs on violence and poor health outcomes amongst Honduran university students. 

Methods
This cross-sectional study comprised randomly selected students from Universidad Nacional Autónoma de Honduras which participated in a baseline eligibility screening survey followed by three self-administered Spanish questionnaires completed from 11/01/2023 to 11/05/2023. Questionnaires included ACEs, Maudsley Violence Questionnaire (MVQ), and Tobacco, Alcohol, Prescription Medications, and Other Substances (TAPS) questionnaires. The sample size of 287 Honduran University students comprised 101 males (SD=2.6) and 186 females (SD=2.6) with ages between 17-33 (M=21; SD=2.7). The relationship between ACEs and MVQ was assessed through correlation analyses (Pearson r). The relationship between ACEs or MVQ and TAPS was assessed using Spearman correlations (rho). The statistical significance was set at p<0.05.

Results
Participants completed the ACEs questionnaire, reporting experiencing 0 ACEs (14.2%), 1 ACE (12.8%), 2 ACEs (13.2%), 3 ACEs (20.2%), 4 ACEs (16.3%), 5 ACEs (9.75%), and 6+ ACEs (13.2%).

A positive correlation was observed between the number of ACEs and MVQ macho (Pearson’s r=0.16, P=0.0083). Tobacco usage showed a positive correlation with MVQ macho (rho=0.19) and total scores (rho=0.19, p-value=0.0015).
Drug usage was positively correlated with ACEs total (rho=0.12, p-value=0.0491), MVQ macho (rho=0.09, p-value=0.1327), MVQ acceptance (rho=0.12, p-value=0.0486), and MVQ total (rho=0.19, p-value=0.0014).

Medication usage showed positive correlations with total ACEs (rho=0.22, p-value=0.0001), MVQ macho (rho=0.17, p-value=0.0041), MVQ acceptance (rho=0.22, p-value=0.0002), and MVQ total (rho=0.19, p-value=0.0011).

Conclusion
This study identified a significant positive correlation between ACEs scores, MVQ scores, and TAPS scores. Over 80% of participants reported experiencing one ACE, aligning with research suggesting higher ACE scores in marginalized populations. The novelty of this research in Honduras offers insights that can inform national programs aimed at violence reduction and public health initiatives focused on preventing childhood trauma.

A Cross-Sectional Assessment of the Effects of Adverse Childhood Experiences (ACEs) on the Prevalence of Violence and Substance Abuse in Honduran University Students

Introduction: 
Aortic calcification is a significant pathological process associated with various cardiovascular diseases. While the sympathetic nervous system's influence on bone remodeling via β2-adrenergic receptors (β2-ARs) is well-established, its impact on vascular calcification remains relatively unexplored. Previous research suggests β2-ARs play a critical role in regulating valve calcification but have yet to be studied in aortic calcification. Thus, we aim to characterize the expression patterns of both β1-ARs and β2-ARs to elucidate the downstream signaling mediators in human aortic tissue and determine the effects of selective β2-AR agonists on aortic smooth muscle cell phenotype and function. 

Methods: 
Calcified and non-calcified abdominal aortic wall segments from 6 patients with abdominal aortic aneurysm (AAA) were collected during elective open aortic repair at Northwestern Memorial Hospital (Chicago, IL). Samples were fixed, decalcified, and embedded in paraffin. Sections of 5 μm thickness were used for immunostaining of alpha-smooth muscle actin, β1-AR, and β2-AR. Human aortic smooth muscle cells (HAoSMC) were cultured in osteogenic media and treated with one of the following β-AR agonists (1 - 100 μmol/L): salmeterol, isoproterenol, norepinephrine, or an antagonist (0.3 – 30 μmol/L): ICI-118,551 or CGP-20712A. Cells were fixed for immunocytochemical staining of osteogenic markers (osteocalcin, osteopontin, and Runx2) and β-ARs. HAoSMCs were treated with salmeterol (1 μmol/L, β2-AR agonist) in the presence of either growth media or osteogenic media for up to 14 days. Metabolic and alkaline phosphatase (ALP) activity were measured with resazurin (n=8) and ALP assays (n=3), respectively, on days 7 and 14. 

Results: 
Samples of abdominal aortic wall segments show differential expression of β2-adrenergic receptors between patients with abdominal aortic aneurysms. Culturing human aortic smooth muscle cells (hAoSMCs) in osteogenic (OST) media for 21 days successfully induced an osteogenic phenotype as evidenced by increased alkaline phosphatase (ALP) activity over time. Delivery of β2 agonist salmeterol to human aortic smooth muscle cells cultured in both growth media and osteogenic media showed no significant difference in metabolic activities after 21 days. Osteogenic cells treated with salmeterol demonstrate less alkaline phosphatase activity at day 21. Osteogenic differentiation of human aortic smooth muscle cells downregulates β2-adrenergic receptor expression. Stimulation of osteogenic smooth muscle cells with a β2 agonist, salmeterol, further downregulates receptor expression. Osteopontin expression decreased in osteogenic human aortic smooth muscle cells treated with salmeterol.

Conclusions: 
We observed a differential expression of β2-ARs across sections of human calcified aortas, suggesting a role of these receptors in areas subjected to different calcific stresses. In vitro experiments also demonstrated an impact on the calcification process. Further in vitro experiments with HAoSMCs treated with β-AR agonists and antagonists will help to elucidate the influence of β-adrenergic signaling on vascular calcification pathways. 


Underline digital video library

Proton Therapy: Probing the Relationship Between Interest and Availability of Proton Therapy Centers

Cost Utility Analysis of Long-Term Outcomes of Bariatric Surgery as Compared to Medical Therapy for Obesity Management

Exploring the Paradoxical Relationship Between Smoking and Short-Term Mortality in Hospitalized COVID-19 Patients: Insights from a Population-Based Cohort Study

Loss of BCLAF1 impairs AML pathogenesis

Extensive Pneumorrhachis Using Loss-of-Resistance to Air Technique During Implantation of a Spinal Cord Stimulator

BEYOND TRADITIONAL RISK FACTORS: COCAINE ABUSE AND PULMONARY EMBOLISM

Improving Self-perceived Competence in LGBTQIA+ Healthcare in Medical School Preclinical Education

Diagnostic Pitfalls: POEMS Syndrome's GBS Mimicry

Retrospective Analysis of Pediatrician Referral Patterns for Selective Mutism Intervention: Unveiling Silent Echoes in Clinical Practice

Addressing Health Disparities in Hypertension: A comprehensive medical elective and survey study among medical students and professionals.

A Cross-Sectional Assessment of the Effects of Adverse Childhood Experiences (ACEs) on the Prevalence of Violence and Substance Abuse in Honduran University Students

Characterization of Beta-Adrenergic Receptors in Human Aortic Abdominal Aneurysm Tissue and Human Aortic Smooth Muscle Cells

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