Susan C Kelly

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This study explored whether converting numeric patient survey data into plain-language text summaries (called vignettes) could help both patients and clinicians better understand health status information. Using data from a health literacy questionnaire in patients with chronic lung disease, the researchers developed and refined text summaries through interviews, finding that both patients and clinicians found the vignettes accurate and recognizable. The approach offers a way to make patient-reported data more accessible, though language and layout challenges remain.

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This study examined whether a fourth dose of the AstraZeneca COVID-19 vaccine (ChAdOx1 nCoV-19) produces a strong enough immune response to justify continued use. In 172 Brazilian adults, antibody levels after the fourth dose were at least as high as after the third dose, and the vaccine remained effective against multiple virus variants with no new safety concerns. The results support continued use of this vaccine platform as part of pandemic preparedness planning.

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Researchers studied whether a liver clock gene called Period 1 (Per1) helps explain why time-restricted feeding — eating only during an 8-hour window — improves metabolic health, and whether this differs between male and female mice. In males, restricting eating hours reduced fat accumulation and improved blood sugar regardless of whether Per1 was present, but in females, the liver Per1 gene was required for those same improvements. The findings reveal that the metabolic benefits of intermittent fasting are partly sex-dependent and tied to this specific liver clock gene.

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Researchers tested a protein called FSTL1 as a treatment for heart attacks in obese, diabetic pigs, which more closely mimic human metabolic disease than standard animal models. Two weeks of injections starting one month after the heart attack reduced scar tissue, restored blood flow, and improved heart function. This finding supports FSTL1 as a potential therapy for heart attack patients with obesity or diabetes, a group that responds poorly to current treatments.

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Researchers investigated exactly how the liver enzyme arginase 2 (Arg2) improves blood sugar control in obese, diabetic mice by engineering versions of the enzyme with specific functional defects. They found that Arg2 reduces liver fat through a mechanism independent of its enzymatic activity, but that its location inside mitochondria and its ability to process urea are both required for it to lower fasting blood sugar and improve insulin sensitivity in the rest of the body. The results define a precise molecular mechanism and identify mitochondrial urea processing in the liver as a key controller of how the body burns glucose.

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Researchers created mice missing a urea cycle enzyme called arginase 2 in liver cells to study how the urea cycle connects to energy metabolism. The mice had subtle urea cycle defects that led to impaired mitochondrial function, and when challenged with a high-fat diet in middle age they developed worsened blood sugar and fat metabolism. Analysis of over 100,000 patient records confirmed that blood markers of urea and energy cycle dysfunction predict liver disease nearly a decade before diagnosis, pointing to this pathway as both a disease mechanism and an early warning signal.

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Researchers identified that a gene called Period 1 (Per1) in liver cells is specifically activated during fasting and is required for the liver to switch from burning sugar to burning fat. Mice without liver Per1 failed to produce ketones, break down fat, or make a key fasting hormone (FGF21), and this failure was reversible by giving them FGF21 or blocking a specific metabolic enzyme. Notably, disrupting other circadian clock genes did not have the same effect, positioning Per1 as a distinct link between the body's internal clock and how it responds to food deprivation.

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An enzyme called MMP14, found on the surface of liver cells, drives diet-induced weight gain, fat accumulation in the liver, and inflammation not just in the liver but also in muscle and fat tissue throughout the body. Removing MMP14 specifically from liver cells in mice protected against these effects and reduced inflammatory immune cell infiltration across multiple organs. Blocking MMP14 activity in the liver could be a therapeutic strategy to interrupt the spread of obesity-related inflammation to distant organs.

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This study used existing heart failure pig experiments to examine how exercise, sex, and diet affect levels of ACE2 and TMPRSS2, the proteins that SARS-CoV-2 uses to enter cells. Exercise at intensities tolerable for heart failure patients did not change these protein levels, but sex and a high-fat Western diet altered them in ways that varied by tissue type. The results suggest that metabolic and hormonal factors — not exercise — are the main drivers of cardiovascular vulnerability to COVID-19 in heart failure.

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Researchers used a computer model of cardiovascular physics to predict how changes in heart function would show up in ballistocardiography (BCG), a technique that measures the tiny body movements caused by blood pumping through the heart. The model predicted that weakening heart function would change specific features of the BCG signal, and these predictions were confirmed in pig experiments before and after heart attack. This provides a scientific foundation for using BCG as a non-invasive home monitoring tool for heart disease.

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Researchers tested how well gene therapy vectors (AAV9) delivered heart-targeting genetic payloads to pigs via two routes: directly into the coronary arteries and through a vein. Both delivery methods successfully reached the heart muscle at similar levels without causing detectable toxicity, even though the vectors also spread to the liver and other organs. These results are an important step toward using gene therapy to treat heart failure in large animals and eventually humans.

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Researchers analyzed gene activity in the right ventricle of pigs with cardiometabolic heart failure (caused by a high-fat diet plus surgical stress) to understand the molecular basis of right-sided heart damage. They identified a network of genes centered on JNK1 that promotes buildup of fibronectin, a structural protein, in the right coronary artery, stiffening the blood vessel wall. This molecular signature links right ventricular remodeling to coronary vascular stiffness and identifies potential targets for treatment.

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Researchers examined brain tissue from deceased individuals with varying degrees of cognitive decline to understand why some people with high Alzheimer's pathology remain mentally sharp (resilient) while others develop impairment. They found that reduced blood flow in the brainstem and increased oxidative damage in the locus coeruleus — a brain region that regulates alertness and memory — distinguished cognitively impaired people from resilient ones, even when overall levels of Alzheimer's proteins were similar. These findings suggest that vascular and metabolic health in this brain region may protect against cognitive decline despite the presence of Alzheimer's pathology.

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A 29-year-old man suffered a near-complete muscle tear through the belly of his chest (pectoralis major) muscle, which is an uncommon injury location. The muscle was surgically repaired using a specific stitching technique, and at a six-year follow-up the patient had full shoulder function, normal strength, and no cosmetic deformity. The case demonstrates that direct repair of this unusual injury can achieve excellent long-term results.

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Hip fractures in elderly patients are increasingly common, and the standard treatment — inserting a metal implant with bone cement — can cause dangerous fat embolism and requires more operating time. This review examines evidence showing that cementless implants achieve similar long-term function and survival in elderly patients, with the trade-off of a higher risk of fracture during surgery. The findings support cementless fixation as a viable and potentially safer alternative for this fragile patient population.

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Researchers found that muscle cells use a process called trans-plasma membrane electron transport (tPMET) — where electrons are passed from inside the cell to outside — in a manner that tracks with glucose availability. The process depends on NADPH oxidase enzymes and the pentose phosphate pathway (a branch of glucose metabolism), and it activates a protein called p70S6K that promotes cell growth in response to both glucose and insulin. This describes a previously unrecognized way that muscle cells sense how much glucose is available.

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Researchers destroyed the nerve fibers that carry norepinephrine from the locus coeruleus to the prefrontal cortex in Alzheimer's disease rats to determine how this brain connection affects disease progression. Rats with this loss performed worse on memory tasks, had more amyloid plaques and inflammation, and showed breakdown of the blood-brain barrier along with thickening of blood vessel walls. The results identify degeneration of this norepinephrine brain circuit as an early driver of both vascular damage and memory loss in Alzheimer's disease.

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Nail gun injuries are common in construction workers and typically affect the hands and feet, resulting in a wide range of treatment costs and time off work. Proper training on nail gun use has been shown to reduce these injuries, and most cases do not result in lasting disability when treated correctly. Surgeons evaluating these injuries should be alert to contamination from foreign material driven in with the nail, which requires cleaning and antibiotics.

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Researchers evaluated whether a set of standardized RNA samples could serve as quality controls for laboratories measuring microRNAs across the entire genome, a technique used to discover cancer biomarkers. Using samples from multiple labs and measurement platforms, they developed performance metrics and an online dashboard to help labs track and compare how accurately their measurement processes work. The reference samples and metrics provide a practical quality assurance framework for microRNA biomarker research.

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This paper describes laboratory methods for measuring trans-plasma membrane electron transport (tPMET) — the process by which cells export electrons to the outside environment — using simple color-change assays in muscle cells. The approach allows real-time tracking of electron export, and adding specific enzymes to the assay can distinguish between two different export mechanisms: one using ascorbate (vitamin C) and one using superoxide. These methods offer a reliable, high-throughput way to study a poorly understood cellular process.

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An elderly woman with a history of aortic valve surgery developed recurrent strokes, and imaging revealed a rare complication: a pseudoaneurysm (a false bulge) on the sinus of Valsalva, a pocket near the aortic valve. This case illustrates that sinus of Valsalva pseudoaneurysms — though rare — can act as a source of repeated strokes and should be considered in patients with unexplained recurrent stroke and prior valve surgery.

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Researchers counted neurons in the locus coeruleus — a brain region that supplies the chemical norepinephrine to memory areas — in postmortem brain tissue from people with no cognitive impairment, early memory problems (mild cognitive impairment), or Alzheimer's disease. They found a 30% neuron loss in the transition from normal cognition to early memory impairment, with an additional 25% loss in Alzheimer's, and that gene expression in surviving neurons showed reduced energy production and structural repair capacity. The findings establish that damage to this brain region begins at the earliest detectable stage of disease and may contribute directly to memory decline.

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Researchers studied how laser pulses deliver molecules into cells by heating carbon nanoparticles, which vaporize surrounding water and create bubbles and pressure waves near cell membranes. They determined that heat and physical force from the collapsing bubbles — rather than chemical reactions or sound waves alone — are the main mechanisms that temporarily open cell membranes to allow molecules in. Understanding these mechanisms is important for designing safer and more effective laser-based drug delivery systems.

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Researchers found that a protein called GDF15 is released into the fluid inside the eye when retinal nerve cells (ganglion cells) die, in both a mouse model of glaucoma and in glaucoma patients. Elevated GDF15 levels in the eye fluid were linked to worse visual field loss in patients, suggesting the protein tracks how much nerve damage has occurred. GDF15 may serve as an objective, measurable marker of glaucoma progression, which is currently difficult to assess reliably.

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A 79-year-old woman with recurrent strokes was found to have five pulmonary arteriovenous malformations — abnormal blood vessel connections in the lungs that allow blood to bypass the lungs' normal filtering, enabling clots to reach the brain. All five were successfully sealed with minimally invasive catheter-based treatment, resolving her breathing problems and closing the shunt. The case emphasizes that these rare vascular abnormalities should be considered in patients with unexplained strokes and that screening for related hereditary conditions is important.

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Researchers tested whether skeletal muscle — the body's largest organ by mass — exports electrons and the antioxidant ascorbate (vitamin C) to the outside of cells through a process called tPMET. They confirmed this in both cultured muscle cells and actual muscle tissue, and found that the transport depends on a specific glucose transporter (GLUT1) but not on insulin. The findings suggest that resting muscle continuously releases antioxidants into the bloodstream, which could be relevant to conditions like insulin resistance where oxidative stress is elevated.

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A 65-year-old woman suffered three separate heart attacks within three weeks caused by a coronary artery dissection — a tear in the artery wall — that kept spreading and forming blood clots. The case describes an unusual sequence of events and a technique for clearing a blocked stent using an inflated balloon. This report highlights the challenges of managing spontaneous coronary artery dissection, where standard stenting can worsen the problem.

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Researchers investigated why eating protein reduces the body's response to insulin, looking at a valine breakdown product (3-HIB) and the hormone FGF21 as potential mediators. Protein ingestion blocked the normal insulin-driven decrease in 3-HIB and increase in FGF21, while leucine alone did not affect insulin sensitivity. This implicates 3-HIB and FGF21 as part of the mechanism by which protein in the diet can temporarily blunt insulin action in humans.

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Researchers developed a technique using an automated contrast injector to dramatically reduce the amount of dye used during coronary artery procedures (angiography and stenting) in patients with kidney disease, who are at high risk of contrast-induced kidney damage. In 123 patients, the median contrast dose was only 18 mL — far below conventional amounts — and only 3.3% of patients developed kidney damage. The approach offers a practical way to perform these essential cardiac procedures while protecting kidney function.

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Fish oil omega-3 fatty acid supplementation for six months changed the activity of multiple gene pathways in the skeletal muscle of older adults, with increases in genes supporting mitochondrial function and extracellular matrix organization and decreases in genes that break down muscle. The changes in individual gene expression were small, but they were coordinated across interconnected pathways. These transcriptional shifts may explain how omega-3 supplementation improves muscle mass and function in older people.

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Eating a high-protein diet (1.2 g per kg per day) during weight loss in postmenopausal women with obesity reduced lean mass loss by about 45% compared to the standard recommended protein intake — but it also completely blocked the improvements in muscle insulin sensitivity and glucose uptake that weight loss normally produces. High protein intake also prevented beneficial changes in muscle oxidative stress and structural pathways. The protein content of a weight-loss diet matters: more protein preserves lean mass but appears to come at the cost of metabolic improvements.

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A clinical trial tested the metabolic benefits of losing 5%, 11%, and 16% of body weight in people with obesity. Even 5% weight loss improved insulin sensitivity in the liver, muscle, and fat tissue, as well as insulin secretion, without reducing inflammation. Each additional increment of weight loss produced further dose-dependent improvements, especially in fat tissue gene activity, showing that meaningful metabolic gains begin with modest weight loss.

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Researchers studied mice lacking a specific enzyme (NAMPT) in their fat cells to understand why obesity causes insulin resistance and metabolic problems throughout the body. They found that without this enzyme, the mice developed severe insulin resistance in fat, liver, and muscle tissue, along with unhealthy fat cell function—their fat cells released more harmful fatty acids and less of a protective hormone called adiponectin. The researchers reversed these problems by giving the mice two different treatments: an existing diabetes drug (rosiglitazone) or a natural compound (NMN) that compensates for the missing enzyme.

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Researchers found that adding poloxamer, a type of detergent-like molecule, dramatically improved the survival of cancer cells during laser-based intracellular drug delivery while maintaining high uptake of delivered molecules. Under strong laser conditions that normally kill most cells, poloxamer kept nearly 90% of cells alive with over 80% successfully taking up molecules, likely by helping reseal cell membranes after they are temporarily opened. This discovery could make laser-based drug delivery far more practical for laboratory and medical applications.

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This article explains the 2013 ACC/AHA cholesterol guidelines, which shifted the focus from hitting a specific LDL number to ensuring the highest-risk patients receive the most effective statin therapy. A new risk calculator was introduced to identify who needs treatment, and routine stopping of statins solely due to mild side effects was discouraged. The review is designed to help clinicians put these updated guidelines into practice.

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This article summarizes the 2014 JNC 8 blood pressure guidelines, which updated treatment targets based on patient risk category. Patients at lower risk (over 60 without major complications) now have a target of 150/90 mmHg, while high-risk patients (those with kidney disease, diabetes, or under 60) target 140/90 mmHg, with first-line drug options including diuretics, calcium channel blockers, ACE inhibitors, and ARBs. The practical review helps clinicians apply these changes in everyday care.

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Researchers used nanosecond laser pulses on carbon nanoparticles mixed with cells to deliver large molecules into the cells while keeping them alive. Under the best conditions, 88% of cells took up the delivered molecule and nearly 100% survived, a marked improvement over conventional physical delivery methods that typically damage cells. The technique works across different cell types and delivered molecules, making it a broadly applicable tool for cell biology and potential drug delivery.

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A patient was found to have a rapidly growing benign tumor (myxoma) in the right side of the heart, a rare location since most of these tumors grow on the left side. The case documents growth faster than previously reported for this type of tumor and notes that right-sided tumors may not present with the classic symptoms described for left-sided ones. The report adds to the very limited literature on right atrial myxoma growth and presentation.

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Researchers built a freely searchable online database cataloging the three-dimensional shapes of structural loops in RNA molecules, which are important for how RNA folds and interacts with proteins. The database covers internal, bulge, and hairpin loops found across thousands of known RNA structures and is updated weekly with new entries. This resource supports researchers designing RNA-based drugs and studying how RNA structure influences function.

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Researchers tested the Hib conjugate vaccine in 90 Nepali infants to determine whether it produces protective antibody levels before its national introduction. All infants reached protective thresholds after three doses, and though antibody levels declined over the first year, a booster dose at 12 months restored strong protection in 98.5% of children. The results confirm that the standard immunization schedule works well in this population and that a booster dose is important for sustained protection.

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Researchers implemented and validated a computational method that simultaneously models blood flow and vessel wall movement in abdominal aortic aneurysms — bulges in the main abdominal artery that can rupture fatally. The simulation correctly predicted how blood pressure causes the aneurysm wall to deform and where mechanical stress concentrates, matching experimental data. This validated computational tool can help predict rupture risk and guide treatment planning for individual patients.

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Researchers tested whether using an alcohol-based antibacterial gel instead of mineral oil during skin examination with a dermatoscope could prevent bacterial contamination. After 31 patient exams using the gel, no bacteria were found on any of the three dermatoscopes tested, and the gel provided optical clarity equal to standard oil. The approach offers a simple way to prevent potential hospital-acquired infections during routine dermatologic procedures.

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Researchers identified a new mutation in the connexin 43 gene (GJA1) in a patient with oculo-dento-digital dysplasia, a rare genetic disorder affecting the eyes, teeth, and skeleton. The patient also had unusual features including curly hair, early hair fragility, and mild skin thickening, which broadened the recognized spectrum of the condition. The findings suggest that this disorder should be classified alongside ectodermal dysplasias given its effects on skin, hair, and nails.

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A 10-year-old girl developed lichen sclerosus — a chronic inflammatory skin condition usually seen in the genitals of older women — exclusively on her lip, an exceptionally rare presentation. Biopsy confirmed the diagnosis, and treatment with a potent topical steroid appeared to halt the condition. This case is among the very few documented instances of oral lichen sclerosus in a child and highlights that this condition can appear in unusual locations.

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An autopsy report describes a fatal case of bupivacaine — a local anesthetic — toxicity in a man who injected the drug into his genitals as part of sexual practices. High drug levels were found in multiple body fluids, with evidence of repeated prior injections. The case illustrates that bupivacaine, used medically for pain control, can be lethally toxic when self-injected, and documents an unusual cause of accidental overdose.

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A 44-year-old man had recurring painful sores on his lower lip for three years, and biopsy confirmed lichen planus — a common inflammatory skin condition — limited entirely to that location. This is one of very few documented cases of lichen planus confined exclusively to the lower lip. The case extends knowledge of where this condition can appear and underscores that unusual presentations can be confirmed with biopsy.