Targeted proximal hypoglossal nerve stimulation (THN, pHGNS) improved sleep-disordered breathing, sleep architecture, and quality of life (QOL) with a favorable safety profile over 1 year in the THN3 randomized, controlled trial. Herein, THN3 pHGNS 3-year safety and efficacy are profiled with reference to distal HGNS (dHGNS) from the STAR trial.

Persistent tachypnea of infancy (PTI), also known as neuroendocrine cell hyperplasia of infancy (NEHI), represents one of the most common childhood interstitial lung diseases. Despite its frequency, standardized management protocol is lacking, and long-term outcome data remain limited.

The historic National Lung Screening Trial (NLST) reported lung cancer-specific and all-cause mortality reductions associated with low-dose CT (LDCT) imaging, and nearly all relevant authoritative organizations established guidelines and policies supporting implementation and insurance coverage for individuals who meet eligibility criteria. The immediate challenge became translating results into community settings. Early translation showed substantial challenges to delivery of quality lung cancer screening (LCS). The Kentucky LEADS (Lung Cancer Education Awareness Detection Survivorship) Collaborative developed a comprehensive system to evaluate and support LCS delivery in community contexts with an emphasis on supporting rural and low-resource settings. The QUILS System 1.0 (Quality Implementation of Lung Cancer Screening) featured 4 key components: (1) the QUILS Index 1.0, a quantitatively driven evaluation system assessing quality across 6 essential LCS implementation domains; (2) the QUILS Audit and Feedback Process 1.0, a strategy for providing feedback and guidance to bridge the QUILS Index and the QUILS Resource Portal; (3) the QUILS Resource Portal 1.0, online tools and trainings that are directly tied to components within the QUILS Index 1.0; and (4) the QUILS Technical Assistance and Coaching 1.0, providing additional problem-solving and support upon request. The 6 essential domains included: (1) Screening Eligibility; (2) Radiology Operations; (3) Team Operations; (4) Prevention Efforts; (5) Patient Education; and (6) Community Outreach. To collect initial feedback and evaluate the QUILS System 1.0, the investigative team planned and conducted a rigorous evaluation of this initial framework across 10 sites in Kentucky over an 18-month period.

Patients with neuromuscular disease and other thoracic restrictive disorders are at increased risk of hypoxia during high-altitude travel due to an ineffective hypoxic ventilatory response. Efforts to identify clinical parameters that successfully predict the need for hypoxic challenge testing, a tool used to assess the risk of hypobaric hypoxia, and its outcomes in this population have been inconsistent and limited mainly to small, retrospective studies. Consequently, recommendations regarding the evaluation and management of these patients prior to high-altitude travel have been uncertain and differ across medical societies. We provide a clinical management algorithm for this patient population that draws on the available data.

A 63-year-old woman presented to the emergency room with sudden-onset abdominal pain and vomiting. She had a medical history of estrogen receptor/progesterone receptor positive-, human epidermal growth factor receptor 2-negative breast intraductal carcinoma status after partial mastectomy with adjuvant radiation on hormone-based chemotherapy. Presenting vital signs included a heart rate of 80 beats/min, BP of 149/84 mm Hg, and 94% oxygen saturation on room air.

A 62-year-old man with a history of primary central nervous system lymphoma first presented with diplopia, diagnosed 2 years ago. A brain MRI showed multiple solid enhancing mass lesions located at the midline bilateral dorsal medulla to both cervicomedullary junction and right flocculus with edema of the ventrolateral medulla. The brain biopsy confirmed relapsed diffuse large B cell lymphoma. Remission was achieved after a course of high-dose methotrexate, rituximab, and whole-brain radiotherapy. He was referred to the sleep clinic because of snoring, witnessed apnea, and severe daytime sleepiness. He had no dyspnea, cough, or history of aspiration pneumonia. Medications included levetiracetam and midodrine.

A 36-year-old man with medical history of inferior vena cava thrombus and recurrent pulmonary embolism (PE) presents to the emergency room with fever, malaise, and night sweats for 3 days and hemoptysis (approximately half a tablespoon) in the last 24 hours. He reports the first diagnosis of inferior vena cava thrombus in December 2022, when he presented with similar symptoms and was started on apixaban. Since then, he had 3 additional episodes in the following 6 months in which he was found to have recurrent PEs despite compliance with anticoagulation and changes in regimen (warfarin then enoxaparin). However, this is the first episode of hemoptysis. Patient has never smoked and denies personal and family history of coagulopathies or cancer.