This narrative review highlights neurologic disorders that mimic or worsen degenerative spine disease and provides key clinical clues for recognition in spine surgery practice. A focused review examined amyotrophic later...This narrative review highlights neurologic disorders that mimic or worsen degenerative spine disease and provides key clinical clues for recognition in spine surgery practice. A focused review examined amyotrophic lateral sclerosis, normal pressure hydrocephalus, multiple sclerosis, Parkinson's disease, Guillain-Barré syndrome, peripheral neuropathies, and transverse myelitis. These conditions frequently overlap with structural spinal pathology through motor, sensory, and gait disturbances. Amyotrophic lateral sclerosis presents with combined upper and lower motor neuron signs. Normal pressure hydrocephalus is characterized by gait impairment, urinary incontinence, and cognitive decline. Multiple sclerosis often causes relapsing multifocal deficits that do not localize to a single spinal level. Parkinson's disease is identified by bradykinesia, rigidity, tremor, and progressive postural deformity. Other mimics including Guillain-Barré syndrome, small and large fiber neuropathies, and transverse myelitis further complicate evaluation. Careful history and neurologic examination remain central, while disease-specific tools such as the 2017 McDonald criteria and the Dubousset Functional Test improve recognition. Early identification is essential to avoid unnecessary surgery, guide multidisciplinary referral, improve risk stratification, and optimize patient outcomes.
INTRODUCTION: We hypothesized that SGLT-2 inhibitors (SGLT-2is) may have beneficial effects on portal hypertension in patients with cirrhosis. METHODS: Using TriNetX, we identified adults with cirrhosis treated with SGLT...INTRODUCTION: We hypothesized that SGLT-2 inhibitors (SGLT-2is) may have beneficial effects on portal hypertension in patients with cirrhosis. METHODS: Using TriNetX, we identified adults with cirrhosis treated with SGLT-2is. Patients prescribed SGLT-2is within 12 months of a cirrhosis diagnosis were examined (vs. no treatment). Three subgroups were examined: MASH cirrhosis, alcohol-associated cirrhosis, and "other" cirrhosis. To control for liver disease severity/etiology, propensity score matching (PSM) incorporating 47 variables was performed within each subgroup. RESULTS: PSM resulted in a total of 10,976 cirrhosis patients (compensated and decompensated together; 5488 each SGLT-2i/control), composed of three matched subgroups (MASH (6052); alcohol (2864); other (2060)). After matching, baseline characteristics were similar in patients prescribed SGLT-2is and controls. Patients receiving SGLT-2is developed significantly fewer new portal hypertensive complications, including ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, and hepatorenal syndrome (any portal hypertensive complication risk; MASH: HR 0.73, 95%CI 0.64-0.83; alcohol: HR 0.58, 95%CI 0.49-0.68; other: HR 0.60, 95%CI 0.47-0.76; all P < 0.001). The complication with the greatest reduction was ascites. In sensitivity analyses of decompensated cirrhosis patients, the development of a new portal hypertension complication was lower in those prescribed SGLT-2is. Patients prescribed SGLT-2is had a reduced risk of all-cause mortality (MASH: HR 0.57, 95%CI 0.49-0.66; alcohol: HR 0.65, 95%CI 0.55-0.77; other: HR 0.49, 95%CI 0.39-0.62; all P < 0.001). CONCLUSION: Cirrhosis patients prescribed SGLT-2is had decreased portal hypertensive complications and increased survival compared to those not receiving SGLT-2is.
The principal cellular energy-generating pathways of mitochondria used to produce adenosine triphosphate (ATP) are oxidative phosphorylation and β-oxidation of fatty acids. Under anaerobic conditions, glycolysis in the c...The principal cellular energy-generating pathways of mitochondria used to produce adenosine triphosphate (ATP) are oxidative phosphorylation and β-oxidation of fatty acids. Under anaerobic conditions, glycolysis in the cytoplasm is an alternative mechanism for production of ATP. Mitochondrial diseases result from one or more of the over 350 mutations in mitochondrial DNA (10%) or nuclear DNA (90%) that cause defective mitochondrial ATP production. The most common manifestations in adults with mitochondrial DNA mutations are diminished vision, myopathy, cardiomyopathy, neuropathy, encephalopathy and diabetes. Uncommonly there are stroke-like syndromes. The most common manifestations in adults with nuclear DNA mutations are neuropathy with prominent ataxia, ophthalmoplegia, dysarthria, myopathy, cardiomyopathy, liver disease, neuroendocrine and renal cell tumors, and hypoglycemia. Adults, especially the elderly, may only develop manifestations in the course of stressful illnesses that unmask these mutations. Children may require mitochondrial transfer or gene editing therapy. These mutations should be sought in leukocytes or muscle tissue in adults who do not respond to usual treatment for severe stressful illnesses as they may benefit from newly-approved medications.
Elderly-onset seronegative inflammatory arthritis encompasses a heterogenous group of inflammatory joint disorders presenting in older adults (>60 years) in the absence of rheumatoid factor and/or anti-cyclic citrullinat...Elderly-onset seronegative inflammatory arthritis encompasses a heterogenous group of inflammatory joint disorders presenting in older adults (>60 years) in the absence of rheumatoid factor and/or anti-cyclic citrullinated peptide antibodies. Its recognition is increasingly important in a rapidly aging global population in whom seronegative disease is more common. In older adults, immune senescence, inflammaging and multimorbidity may alter disease phenotype and complicate diagnosis and management. Careful clinical evaluation of nature and distribution of joint pains, constitutional, extra-articular/systemic features and patient-specific risk factors, with adjunctive laboratory, imaging and joint fluid analyses is necessary to distinguish diagnostic mimics. In this article, we describe the common causes of elderly-onset seronegative inflammatory arthritis and describe a practical diagnostic approach and treatment framework for such cases. In elderly persons, management should be tailored to the patient's premorbid health, functional status and goals-of-care, to balance therapeutic benefit with vulnerability to adverse effects such as glucocorticoid toxicity, immunosuppression-related infections and cytopenias. A "start low, go slow" approach to glucocorticoids and disease-modifying antirheumatic drugs based on shared decision-making on established treatment goals is recommended in frail older adults.
In June 2025, the End Prescription Drug Ads Now Act, introduced by Senators Sanders and King, noted concerns regarding direct to consumer (DTC) advertising and called for its abolition. DTC advertising for pharmaceutical...In June 2025, the End Prescription Drug Ads Now Act, introduced by Senators Sanders and King, noted concerns regarding direct to consumer (DTC) advertising and called for its abolition. DTC advertising for pharmaceuticals adversely drives up costs for prescription medications and also leads to time wastage for busy physicians. However, the Act did not address the supplement market of which there are now over 95,000 products for which DTC ads are also common despite the fact that evidence suggests that the majority do not work, are of uncertain value, or do not have significant scientific support. Additionally, some have been sanctioned for making false claims; some have significant mislabeling; some have resulted in hospitalizations; and several have had contaminants. Supplements are approved by the FDA as foods, rather than as medications, an entirely different and less rigorous process. Yet many are not advertised as foods nor do patients treat them as such. We believe the supplement approval process as well as DTC advertising for all pharmaceuticals should be reevaluated. Our manuscript below provides more details.
Aortic stenosis affects millions globally and untreated disease approaches a one-year mortality of 50%. While surgical aortic valve replacement (SAVR) was historically the only life-prolonging treatment, transcatheter ao...Aortic stenosis affects millions globally and untreated disease approaches a one-year mortality of 50%. While surgical aortic valve replacement (SAVR) was historically the only life-prolonging treatment, transcatheter aortic valve replacement (TAVR) has revolutionized management, initially for inoperable patients and now extending to lower-risk populations. This review provides an overview of aortic stenosis, from pathophysiology through diagnosis. Disease progression, emerging pharmacological therapies, and surveillance strategies are discussed. Finally, the approach to intervention has evolved from surgical risk-based decision-making to a framework centered on age, life expectancy, and valve durability. Timely recognition and referral to a multidisciplinary heart team remain essential for shared decision making.
BACKGROUND: For patients with asymptomatic severe aortic stenosis, optimal timing of aortic valve replacement remains unclear. We investigated the natural history of asymptomatic severe aortic stenosis and analyzed the i...BACKGROUND: For patients with asymptomatic severe aortic stenosis, optimal timing of aortic valve replacement remains unclear. We investigated the natural history of asymptomatic severe aortic stenosis and analyzed the impact of early aortic valve replacement versus conservative management using a meta-analysis. METHODS: PubMed, Embase, Cochrane, and Web Of Science were searched through June 24, 2025 for randomized controlled trials (RCTs) and observational studies comparing patients with asymptomatic severe aortic stenosis receiving early aortic valve replacement versus conservative management. A random-effects meta-analysis estimated risks of all-cause mortality, cardiovascular mortality, heart failure hospitalization, stroke, myocardial infarction, atrial fibrillation, and thromboembolic events. RESULTS: Thirteen studies were included (4 RCTs, 9 observational studies; 3960 patients: 1868 early aortic valve replacement, 2092 conservative management). Seven of these studies (1620 patients) were aggregated to investigate the natural history of asymptomatic severe aortic stenosis. Over a mean follow-up of 5.6 years [5 studies]/median follow-up of 4.1 years [2 studies], 710 (44%) patients developed symptoms while 910 patients remained asymptomatic (319 undergoing aortic valve replacement, 591 managed conservatively). Of the 591 asymptomatic patients managed conservatively, 194 (33%) died. Across all 13 studies, aortic valve replacement was associated with lower all-cause mortality (RR 0.51 [95% CI 0.35-0.75], P < 0.001), cardiovascular mortality (RR 0.45 [0.37-0.67], P < 0.001), and heart failure hospitalization (RR 0.40 [0.20-0.82], P = 0.012). CONCLUSIONS: Approximately half of all patients with asymptomatic severe aortic stenosis developed symptoms within five years, and one-third of asymptomatic patients managed conservatively died. Aortic valve replacement was associated with lower all-cause mortality, cardiovascular mortality, and heart failure hospitalization, suggesting pre-symptom aortic valve replacement is reasonable in selected patients with asymptomatic severe aortic stenosis.
BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) following acute myocardial infarction is common, yet evidence-based pharmacotherapy remains limited. This study aims to evaluate the efficacy of spironol...BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) following acute myocardial infarction is common, yet evidence-based pharmacotherapy remains limited. This study aims to evaluate the efficacy of spironolactone among patients with HFpEF following acute myocardial infarction. METHODS: We conducted a multicenter retrospective cohort study using data from 82 hospitals across China between January 2010 and March 2024. Patients were stratified into spironolactone users versus non-users. Propensity score matching (PSM) was performed to balance baseline covariates. The primary endpoint was a composite of 1-year heart failure rehospitalization or cardiac death. Time-to-event outcomes were analyzed using Kaplan-Meier curves with log-rank tests. Cox proportional hazards models with cluster-robust variance estimation were used to estimate hazard ratios (HRs). Restricted mean survival time (RMST) analysis was applied to assess survival differences when the proportional hazards assumption was violated. Prespecified subgroup analyses were conducted by age (<65 versus. ≥65 years), sex, hypertension, and diabetes mellitus. RESULTS: Among 4,507 eligible patients, 1,171 matched pairs were included after PSM. Kaplan-Meier analysis showed no significant difference between groups (log-rank P = 0.26). Cox regression yielded an HR of 1.18 (95% CI: 0.89-1.58; P = 0.25). RMST analysis revealed a non-significant difference of - 0.6 days (P = 0.845). All secondary endpoints and subgroup analyses were consistent with the null findings for the primary endpoint. CONCLUSIONS: In this large multicenter retrospective cohort study, spironolactone use was not associated with improved clinical outcomes in patients with HFpEF following acute myocardial infarction.
BACKGROUND: Multiple sclerosis is a chronic autoimmune condition that impairs quality of life. While disease-modifying therapies are the primary treatment, resistance training has emerged as a non-pharmacological interve...BACKGROUND: Multiple sclerosis is a chronic autoimmune condition that impairs quality of life. While disease-modifying therapies are the primary treatment, resistance training has emerged as a non-pharmacological intervention to enhance both physical and mental health aspects of quality of life. OBJECTIVE: This systematic review and meta-analysis evaluated effects of resistance training on physical and mental health components of quality of life, as well as overall quality of life, in people with multiple sclerosis. METHODS: A comprehensive literature search was conducted across Scopus, Medline, and SPORTDiscus to identify randomized and non-randomized trials assessing the impact of resistance training on quality of life in people with multiple sclerosis. Data from 13 studies were synthesized with random-effects meta-analyses. RESULTS: Resistance training improved overall quality of life (standardized mean difference = 1.25; 95% confidence interval: 0.03 to 2.47, P = 0.045), physical health (standardized mean difference = 0.29; 95% confidence interval: 0.05 to 0.53, P = 0.017), and mental health (standardized mean difference = 0.23; 95% confidence interval: -0.11 to 0.56, P = 0.184). No association was found between study duration and effect size in the meta-regression. CONCLUSIONS: Resistance training shows potential to improve quality of life in individuals with multiple sclerosis, particularly in physical and mental health domains. However, the effects were inconsistent and not statistically significant for mental health. Further high-quality, standardized, and adequately powered trials are needed to confirm these findings and inform clinical practice.
OBJECTIVE: Lung cancer remains a major global health issue, potentially influenced by allergic diseases like asthma and allergic rhinitis via mast cell-driven inflammation. Due to the limited availability of direct mast...OBJECTIVE: Lung cancer remains a major global health issue, potentially influenced by allergic diseases like asthma and allergic rhinitis via mast cell-driven inflammation. Due to the limited availability of direct mast cell-targeted therapies, the study investigated whether leukotriene receptor antagonists (LTRAs), glucocorticoids (GCs), alone or with H1 antihistamines (H1AHs), impact lung cancer risk compared to H1AHs alone. METHODS: The retrospective cohort study was conducted using data from the TriNetX Global Collaborative Network and enrolled patients aged 18-90 years diagnosed with asthma or allergic rhinitis. Patients were categorized based on medication usage lasting more than 28 days, which defined the index date. Cox proportional hazards regression models, adjusted for multivariable factors, were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the incidence of primary lung cancer. RESULTS: We found that patients treated with H1AHs alone had a significantly higher risk of developing lung cancer compared to those using LTRAs alone (HR,1.88; 95% CI, 1.32-2.67) or a combination of H1AHs and LTRAs (HR, 1.49; 95% CI, 1.12-1.98). Conversely, patients treated with H1AHs alone had a significantly lower risk of developing lung cancer compared to those receiving GCs alone (HR, 0.34; 95% CI, 0.20-0.56) or a combination of H1AHs and GCs (HR, 0.22; 95% CI, 0.14-0.36). These associations remained consistent at medication durations of six and eight weeks of medication usage. CONCLUSION: LTRAs, particularly when combined with H1AHs, reduce the risk of lung cancer in patients with asthma or allergic rhinitis, whereas GCs should be prescribed with careful consideration due to their potential association with increased cancer risk.
BACKGROUND: Millions of Americans experience chronic pain. Integrative Group Medical Visits (IGMVs) often improve access to pain care and patient outcomes. This study assessed the feasibility of novel collection methods...BACKGROUND: Millions of Americans experience chronic pain. Integrative Group Medical Visits (IGMVs) often improve access to pain care and patient outcomes. This study assessed the feasibility of novel collection methods for intra-visit clinical information and the PROMIS-29 at three time-points throughout an 8-week pain-focused IGMV series called Easing Pain Holistically (EPH). Outcomes focused on clinically meaningful improvements in participants' pain and pain-related symptoms. METHODS: Three variations of EPH were piloted with six cohorts within Minnesota's largest safety-net hospital system. Participants completed the PROMIS-29 at baseline, week 4, and week 8. Weekly progress sheets were administered to gather participants' intra-visit clinical changes. The percentage of participants demonstrating clinically meaningful differences on each PROMIS-29 subscale was calculated. RESULTS: Weekly progress sheet and PROMIS-29 collection was feasible. Positive shifts in intra-visit themes from the beginning to the end of each visit were observed. Seven PROMIS-29 mean domain scores improved at week 8, with ∼50% of participants reporting clinically meaningful improvements for Fatigue, Anxiety and Ability to Participate in Social Roles and Activities. CONCLUSIONS: Collection of outcomes was feasible and provided a novel viewpoint to assess intra-visit and longitudinal clinical changes. Improvements in function and positive qualitative themes were observed. Future studies could explore the validation of intra-visit patient-reported outcomes, such as the weekly progress sheets, in IGMVs for chronic pain care.