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Patients presenting with excessive sleepiness are frequently using antidepressant medication(s). While practice parameters recommend discontinuation of antidepressants prior to multiple sleep latency testing (MSLT), data examining the impact of tapering these medications on MSLT results are limited.

Adult patients who underwent MSLT at Mayo Clinic Rochester, Minnesota, between 2014 and 2018 were included. Clinical and demographic characteristics, medications, including use of rapid eye movement-suppressing antidepressants (REMS-ADs) at assessment and during testing, actigraphy, and polysomnography data were manually abstracted. The difference in number of sleep-onset rapid eye movement periods (SOREMs), proportion with ≥2 SOREMs, and mean sleep latency in patients who were using REMS-ADs and discontinued prior to testing versus those who remained on REMS-ADs were examined. At our center, all antidepressants are discontinued 2 weeks prior to MSLT, wherever feasible; fluoxetine is stopped 6 weeks prior. Reg preferably withdraw REMS-ADs before MSLT. If this is not done, the test interpretation should include a statement regarding the potential effect of the drugs on the results.

Patients who taper off REMS-ADs prior to MSLT are more likely to demonstrate ≥2 SOREMs and have a shorter mean sleep latency. Pending further prospective investigations, clinicians should preferably withdraw REMS-ADs before MSLT. If this is not done, the test interpretation should include a statement regarding the potential effect of the drugs on the results.In international studies, higher prevalence of persistent pain has been reported in indigenous populations compared to majority populations. The present study aimed to determine the prevalence of persistent pain within a Sami and a non-Sami population in northern Norway, with adjustment for the confounding factors of age, sex, marital status, education, income, mental health, smoking status and ethnic background. Using SAMINOR 2 survey data including Sami and non-Sami populations, we analysed 5,546 responses, from individuals aged 40-79 years, to questions concerning persistent pain (≥ 3 months). In total, 2,426 (43.7%) participants reported persistent pain with differences between Sami women and non-Sami women (44.1% versus 51.1%, respectively), but none between Sami men and non-Sami men (38.7% versus 38.2%, respectively). Elderly Sami women were less likely to report persistent pain than were elderly non-Sami women. In men, no ethnic differences in pain were observed according to age-group. Marital status, education levels, household income, psychological distress, and smoking status did not influence the association between ethnicity and pain. Pain severity and location did not differ between Sami and non-Sami participants. In this study, we found only minor ethnic differences in persistent pain. Similar living conditions and cultural features may explain these findings.Background Intermediate stage hepatocellular carcinomas (HCCs) are treated by inducing ischemic cell death with transarterial embolization (TAE) or transarterial chemoembolization (TACE). Eganelisib mTOR inhibitor A subset of HCCs harbor nuclear factor E2-related factor 2 (NRF2), a major regulator of the oxidative stress response implicated in cell survival after ischemia. NRF2-mutated HCC response to TAE and/or TACE is unknown. Purpose To test whether ischemia resistance is present in individuals with NRF2-mutated HCC and if this resistance can be overcome by means of NRF2 inhibition in HCC cell lines. Materials and Methods This was a combined retrospective review of an institutional database (from January 2011 to December 2018) and prospective study (from January 2014 to December 2018) of participants with HCC who underwent TAE and a laboratory investigation of HCC cell lines. Imaging follow-up included liver CT or MRI at 1 month after the procedure followed by 3-month interval scans. Tumor radiologic response was assessed on the ba of NRF2-overexpressing HCC cell lines. Dose response curves of ML385, an NRF2 inhibitor, showed that ischemia induces addiction to NRF2 in cells with NRF2 alterations. Conclusion Hepatocellular carcinoma with nuclear factor E2-related factor 2 (NRF2) alterations showed resistance to ischemia, but ischemia simultaneously induced sensitivity to NRF2 inhibition. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Weiss and Nezami in this issue.Background Body composition data from abdominal CT scans have the potential to opportunistically identify those at risk for future fracture. Purpose To apply automated bone, muscle, and fat tools to noncontrast CT to assess performance for predicting major osteoporotic fractures and to compare with the Fracture Risk Assessment Tool (FRAX) reference standard. Materials and Methods Fully automated bone attenuation (L1-level attenuation), muscle attenuation (L3-level attenuation), and fat (L1-level visceral-to-subcutaneous [V/S] ratio) measures were derived from noncontrast low-dose abdominal CT scans in a generally healthy asymptomatic adult outpatient cohort from 2004 to 2016. The FRAX score was calculated from data derived from an algorithmic electronic health record search. The cohort was assessed for subsequent future fragility fractures. Subset analysis was performed for patients evaluated with dual x-ray absorptiometry (n = 2106). Hazard ratios (HRs) and receiver operating characteristic curve analyses we for any fragility fracture and 0.76 for hip fractures, respectively (P ≥ .73 compared with FRAX). For the subset with dual x-ray absorptiometry T-scores, 2-year AUC was 0.74 for bone attenuation and 0.65 for FRAX (P = .11). Conclusion Automated bone and muscle imaging biomarkers derived from CT scans provided comparable performance to Fracture Risk Assessment Tool score for presymptomatic prediction of future osteoporotic fractures. Muscle attenuation alone provided effective hip fracture prediction. © RSNA, 2020 See also the editorial by Smith in this issue.

The purpose of the study was to examine the associations between patient dissatisfaction and diabetes outcomes among patients with type 2 diabetes.

Primary data from 615 adults with type 2 diabetes from 2 adult primary care clinics completed validated questionnaires. Patient dissatisfaction was measured by asking participants to what degree over the past 12 months were they very dissatisfied with the care they received from their primary care provider. Diabetes outcomes included self-care behaviors, quality of life, and A1C. A1C was abstracted from the medical record. Multiple linear regression models were used to assess associations between patient dissatisfaction, self-care, blood glucose, and quality of life.

After adjusting for covariates, this study demonstrated that higher patient dissatisfaction was significantly associated with poor general diet, worse blood glucose levels, and lower mental component score for quality of life.

In patients with type 2 diabetes, patient dissatisfaction had a significant association with higher blood glucose levels, poor general diet, and low quality of life.