VA Pittsburgh Healthcare System

Diseases of the pancreas-such as pancreatic ductal adenocarcinoma (PDAC) and pancreatitis-have long been a challenge to treat. The study of lymphatics within the pancreas can provide some additional insights and offer new therapeutic targets. Here, we explore the development of pancreatic lymphatics and their connections to the nervous system and individual disease states, as well as the potential for therapeutic interventions. Lymphangiogenesis pathways in PDAC, driven by VEGF-C and other mediators, have been extensively explored, but specific therapeutic interventions are lacking. Furthermore, due to the emergence of PDAC with pancreatitis, insights could improve treatment in both settings. The role of neuroimmune interactions and control, as in other organ sites, appears as critical to both lymphatic and immune processes. With a better understanding of the lymphatic environment within the pancreas, we can develop more effective treatments for patients.

Abstract People with Down syndrome (DS) develop Alzheimer’s disease (AD) neuropathology by the age of 40 years, with cognitive decline common after age 50. While amyloid precursor protein overexpression due to trisomy 21 is a major driver of AD pathology, increasing evidence indicates that DS-related white matter aging involves broader mechanisms beyond amyloid. This review synthesizes neuropathological, neuroimaging, molecular, and fluid biomarker studies linking white matter pathology to cognition in DS.

The Food and Drug Administration's warning that transmucosal buprenorphine, a partial opioid agonist used to treat opioid use disorder and chronic pain, may cause dental disease opens questions about potential class-wide adverse effects involving more widely prescribed opioid analgesics. This was a retrospective matched national cohort study of patients in care at the Department of Veterans Affairs (VA) between October 2010-September 2019. Patients prescribed LTOT were matched 1:2 to patients not prescribed LTOT on age, sex, service region, and VA dental coverage. Cox regression models estimated the association between LTOT and a composite infection-related dental outcome (CIDO). Sensitivity analyses excluded patients with cancer, restricted to patients with comprehensive dental coverage, and to patients with ≥180 days of follow-up time, respectively. The cohort comprised 2,173,435 patients including 787,825 (36%) receiving LTOT; 612,101 (28%) experienced CIDO. In both simple and multivariable regression models, LTOT exposure was associated with greater CIDO risk; HR (95% CI) =1.24 (1.23, 1.25); aHR (95% CI) =1.08 (1.07, 1.08), respectively; p < 0.001. Sensitivity analyses showed similar results except among patients with full dental coverage for whom CIDO rates were substantially higher and LTOT was not statistically significantly associated with risk. he observed positive association between LTOT and CIDO in this large VA sample may inform patient-provider discussions and decision-making around use of LTOT. High CIDO rates among patients with full VA dental coverage may reflect their unique vulnerability to dental infection associated with service-related dental or disabling conditions. Limitations include risk for ascertainment bias, unclear generalizability to a broader clinical population, and the potential for residual confounding.

The Society of Surgical Oncology (SSO) oversees both the Breast and Complex General Surgical Oncology (CGSO) fellowship programs. Even though, for many trainees, the time frame of surgical and subspecialty training is also the most suitable time to become parents, SSO does not have a parental leave policy for these programs to guide fellows and program directors regarding leave allowances and graduation requirements. In 2020, the American Board of Medical Specialties (ABMS) released a progressive leave policy,1 which was thereafter incorporated into American Board of Surgery (ABS) policies.

Plasma amyloid-β (Aβ) peptides, alone or in ratio with p-tau217, show strong potential as Alzheimer's disease biomarkers. While immunoprecipitation-mass spectrometry (IP-MS) is the preferred method for plasma Aβ quantification, current assays are resource- and time-intensive. Here, we developed a streamlined IP-MS method using a cost-effective instrument that significantly improved the efficiency of an original assay by incorporating a single immunoprecipitation step, an optimized buffer system, and approximately 75% reductions in antibody and sample volume requirements. Technical validation revealed excellent dilution linearity (r²>0.99), high precision (< 10% variation), enhanced sensitivity, improved Aβ recovery, and markedly increased signal-to-noise ratios. In a large cohortof cognitively normal older adults (n = 317), the plasma Aβ1-42/Aβ1-40 ratio achieved stronger concordance with Aβ-PET and superior accuracies to identify abnormal scans (AUC 0.81 vs. 0.65 for the original assay). Notably, accuracies remained high even with plasma volumes as low as 100 μL. The improved IP-MS method enables robust and simplified plasma Aβ assessment in Alzheimer's disease, with implications for prognosis, diagnosis and intervention trials.

Research on couple typologies has advanced our understanding of the communication patterns that distinguish happy from distressed partners. However, this work has suffered from a lack of conceptual and methodological cohesion and replication in large, heterogeneous samples, resulting in idiosyncratic typologies with limited generalizability beyond their initial development. The present study replicates and extends prior research by testing the external validity of previous communication typologies in a multisite sample of couples. We combined data from 13 studies that used the Rapid Marital Interaction Coding System to observe communication during mixed-gender couples' 10-min conflict interactions (N = 1,957). We used latent profile analysis to examine men's and women's (a) positive, negative, and neutral behavior and (b) positive and negative reciprocity. Groups were compared on relationship satisfaction and intimate partner violence to further characterize differences among couple subtypes. A five-class solution revealed couples whose communication can be described as (a) task-oriented (low positivity/negativity, high neutral problem discussion; 53%), (b) warm (high positivity/low negativity; 24%), (c) hostile (low positivity/high negativity; 9%), (d) expressive (high positivity/negativity; 7%), and (e) warm-but-reactive (high positivity/low negativity, high negative reciprocity; 6%). Men and women reported the highest levels of satisfaction in the warm, task-oriented, and warm-but-reactive groups. Intimate partner violence was highest in the hostile and expressive groups. These outcomes are largely concordant with the previous findings and should increase the field's confidence in the generalizability of earlier typologies. Our findings also raise new questions about the heterogeneous nature of communication among happy couples. We discuss these questions and their clinical implications. (PsycInfo Database Record (c) 2026 APA, all rights reserved).