The thoracic outlet syndromes (TOSs) are a group of etiologically and clinically distinct disorders with 1 feature in common: compression of 1 or more neurovascular elements as they traverse the thoracic outlet. The medical literature reflects 5 TOSs: arterial; venous; traumatic neurovascular; true neurogenic; and disputed. Of these, the first 4 demonstrate all of the features expected of a syndrome, whereas disputed TOS does not, causing many experts to doubt its existence altogether. Thus, some categorize disputed TOS as a cervicoscapular pain syndrome rather than as a type of TOS. To better understand these disorders, their distinctions, and the reasoning underlying the categorical change of disputed TOS from a form of TOS to a cervicoscapular pain syndrome, a thorough understanding of the pertinent anatomy, pathology, pathophysiology, and the electrodiagnostic manifestations of their pathophysiologies is required. This review of the TOSs is provided in 2 parts. In this first part we address information pertinent to all 5 TOSs and reviews true neurogenic TOS. In part 2 we review the other 4 TOSs. Muscle Nerve 55: 782-793, 2017.

The thoracic outlet syndromes (TOSs) are a group of etiologically and clinically distinct disorders with 1 feature in common: compression of 1 or more neurovascular elements as they traverse the thoracic outlet. The medical literature reflects 5 TOSs: arterial; venous; traumatic neurovascular; true neurogenic; and disputed. Of these, the first 4 demonstrate all of the features expected of a syndrome, whereas disputed TOS does not, causing many experts to doubt its existence altogether. Thus, some categorize disputed TOSs as cervicoscapular pain syndrome rather than as a type of TOS. To better understand these disorders, their distinctions, and the reasoning underlying the categorical change of disputed TOS from a form of TOS to a cervicoscapular pain syndrome, a thorough understanding of the pertinent anatomy, pathology, pathophysiology, and electrodiagnostic manifestations of these pathophysiologies is required. This review of the TOSs is provided in 2 parts. In part 1 we covered general information pertinent to all 5 TOSs and reviewed true neurogenic TOS in detail. In part 2, we review the arterial, venous, traumatic neurovascular, and disputed forms of TOS. Muscle Nerve 56: 663-673, 2017.

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A controversial issue in the transplant community is whether or not to provide deceased donor liver transplantation (DDLT) to noncitizen/nonresidents (NCNRs) who travel for liver transplantation (LT). The expectation is that transplantation of NCNRs will not compromise access for US citizens/residents (USCRs), and that NCNRs would have similar post-LT follow-up. This has never been formally assessed. The United Network for Organ Sharing (UNOS) data from February 27, 2002 to December 31, 2016 were used to identify NCNRs and compare to USCRs, excluding Status 1 adults. Multivariable logistic regression was used to analyze waitlist outcomes, and competing risk analysis was used to assess rates of lost to follow-up post-LT. From February 27, 2002 to December 31, 2016, 1260 NCNRs were listed for LT (0.86% of listings). Adjusted probability of DDLT was not significantly different for NCNRs and USCRs (P > .5), but NCNRs were significantly less likely to be removed from the waitlist for death or clinical deterioration (aOR: 0.80, 95% CI: 0.69-0.93, P = .003). In multivariable competing risk models, NCNRs had an 11-fold higher risk of being lost to follow-up after accounting for the competing risk of death (SHR: 11.44, 95% CI: 8.72-15.01, P < .001), as well as lower rates of posttransplant mortality (SHR: 0.67, 95% CI: 0.49-0.91, P = .012). Our findings speak to the need to standardize practices for NCNRs and set expectations for post-LT care.

Background Periodic surveillance of the hepatitis C virus (HCV) care cascade is important for tracking progress towards HCV elimination goals, identifying gaps in care, and prioritizing resource allocation. In the pre-direct acting antiviral (DAA) era, it was estimated that 50% of HCV-infected individuals were diagnosed and 16% prescribed interferon-based therapy. Since then, few studies utilizing nationally representative data from the DAA era have been conducted in the United States. Methods We performed a cross-sectional study to describe the HCV care cascade in the US using the Optum de-identified Clinformatics® Data Mart Database to identify a nationally representative sample of commercially-insured beneficiaries between January 1, 2014 and December 31, 2019. We estimated the number of HCV-viremic individuals in Optum based on national HCV prevalence estimates and determined the proportion who had: 1) recorded diagnosis of HCV infection, 2) recorded HCV diagnosis and HCV RNA testing, 3) DAA treatment dispensed, and 4) assessment for cure. Results Among 120,311 individuals estimated to have HCV viremia in Optum during the study period, 109,233 (90.8%; 95%CI, 90.6-91.0%) had a recorded diagnosis of HCV infection, 75,549 (62.8%; 95%CI, 62.5-63.1%) had a recorded diagnosis of HCV infection and underwent HCV RNA testing, 41,102 (34.2%; 95%CI, 33.9-34.4%) were dispensed DAA treatment, and 25,760 (21.4%; 95%CI, 21.2-21.6%) were assessed for cure. Conclusions Gaps remain between the delivery of HCV-related care and national treatment goals among commercially-insured adults. Efforts are needed to increase HCV treatment among people diagnosed with chronic HCV infection to achieve national elimination goals.