bluuebunny/crossref_metadata_2025 huggingface dataset:
Pathogenesis of psoriatic arthritis: new insights from a bone marrow perspective
Authors: Saeed Fatima , Adamopoulos Iannis E.
Published: October 2024

Purpose of review

Psoriatic arthritis is an immune-mediated disease that primarily affects the skin and joints. It falls under the umbrella term of rheumatic diseases, which describes a group of closely related yet distinct disorders with many common underlying molecular pathways. Despite the distinct clinical manifestation of each disorder, the shared therapeutic strategies attest to the commonality of cellular and molecular underpinnings. Herein we provide a concise yet comprehensive overview of the interleukin (IL)-23/IL-17 axis and its involvement in mechanistic pathways leading to the pathogenesis of this dual skin and joint clinical manifestation which is characteristic of psoriatic arthritis and other rheumatic diseases.

Recent findings

The interconnection between activated innate immune cells and adaptive immunity has transformed current thinking to include other organs such as the bone marrow as potential tissue of disease origin. A plethora of animal models and genetic studies converge on the critical role of IL-23/IL-17 axis, and highlight the importance of myeloid cell activation as common pathways between autoinflammatory and autoimmune diseases and chronic inflammation. These findings underscore the intricate immune mechanisms involved in inflammatory arthritis and highlight molecular mechanisms in disease pathogenesis.

These insights pave the way for the development of novel diagnostic and therapeutic strategies, with a focus on translating these findings into improved clinical practice.
Opportunistic Computed Tomography
Authors: Reid Jared , Tobin Jacqueline , McCrosson Matthew , Rivas Gabriella , Rothwell Stacey , Ravinsky Robert , Lawrence James
Published: October 2024

Study Design:

Retrospective review.

Objective:

To use opportunistic computed tomography (CT) screening to determine the prevalence of osteoporosis (OP) in patients presenting with spinal fractures and the rate of identification and treatment at our institution.

Background:

OP remains a highly underdiagnosed and undertreated disease. Opportunistic abdominopelvic CT scans offer a feasible, accessible, and cost-effective screening tool for OP.

Methods:

Retrospective review of 519 patients presenting as trauma activation to the emergency department of a Level 1 Trauma Center after a spinal fracture. Patients were excluded if under the age of 18 or lacking a CT scan upon arrival in the emergency department. Hounsfield Units (HU) were measured at the L1 vertebral level on CT scans to determine bone density levels. Values of ≤100 HU were considered osteoporotic, whereas 101–150 HU were osteopenic.

Results:

A total of 424 patients were included. The average HU was 204.8 ± 74.3 HU. Of the patients, 16.7% were diagnosed as osteopenic and 9.9% as osteoporotic. The mean age was 65 ± 14 years for osteopenic patients and 77 ± 11 years for osteoporotic. A statistically significant inverse relationship was found between age and bone density. Of the patients, 42.5% with low bone density HU measurements had a previously documented history of OP/osteopenia. There was a statistically significant association between females and low bone density. Patients injured in a fall were statistically significantly more likely to have lower bone densities than those in motor vehicle accidents. Of the osteoporotic patients, 9.5% were treated by our institution’s fragility fracture team.

Conclusions:

Our study shows that among a cohort of patients with spinal fractures, 58% of patients with radiographic signs of OP are currently undiagnosed, resulting in a low treatment rate of OP. Increasing and standardizing the use of opportunistic CT scans would allow an increase in the diagnosis and treatment of OP in patients with spinal fractures. Further, opportunistic CT scans could also be useful for a broader orthopedic population at high risk of fragility fractures.

Level of Evidence:

Level II—therapeutic.
Influence of Right and Left Bundle Branch Block in Patients With Cardiogenic Shock and Cardiac Arrest
Authors: Rusnak Jonas , Schupp Tobias , Weidner Kathrin , Ruka Marinela , Egner-Walter Sascha , Forner Jan , Schmitt Alexander , Akin Muharrem , Tajti Péter , Mashayekhi Kambis , Ayoub Mohamed , Akin Ibrahim , Behnes Michael
Published: October 2024

OBJECTIVES:

The study investigates the prognostic impact of right bundle branch block (RBBB) and left bundle branch block (LBBB) in patients with cardiogenic shock (CS) compared with no bundle branch block (BBB). In patients with heart failure, existence of RBBB and LBBB has influence on prognosis.

DESIGN:

Prospective registry-study.

SETTING:

ICU of a tertiary academic hospital in Germany.

PATIENTS:

Adult patients with CS.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Consecutive patients with CS were included. The prognostic impact of RBBB and LBBB on 30-day all-cause mortality was tested within the entire cohort and in the subgroup of CS patients with cardiac arrest at admission. The final study cohort comprised 248 patients. Patients with RBBB showed the highest 30-day all-cause mortality followed by LBBB and no BBB (72.5% vs. 52.9% vs. 50.0%; log-rank p = 0.015). These findings were consistent even after solely including CS patients with cardiac arrest (90.0% vs. 73.3% vs. 62.2%; log-rank p = 0.008). After adjustment for lactate, norepinephrine, troponin I, Acute Physiology Score, Society of Cardiovascular Angiography & Interventions shock stage, and heart rate in a multivariable Cox regression analysis, RBBB still revealed a negative impact on 30-day all-cause mortality (hazard ratio [HR], 1.807; 95% CI, 1.107–2.947; p = 0.018), whereas LBBB was not associated with 30-day all-cause mortality. In this multivariable Cox regression model lactate (HR, 1.065; 95% CI, 1.018–1.115; p = 0.006), troponin I (HR, 1.003; 95% CI, 1.001–1.005; p = 0.001), and Acute Physiology Score (HR, 1.033; 95% CI, 1.001–1.066; p = 0.041) were as well associated with 30-day all-cause mortality. Finally, no association of RBBB was found with the incidence of liver or severe renal failure.

CONCLUSIONS:

Besides the Acute Physiology Score, lactate, and troponin levels, RBBB was associated with an increased 30-day all-cause mortality in consecutive CS patients with and without cardiac arrest, whereas LBBB showed no prognostic impact.
Drug treatment for metabolic dysfunction-associated steatotic liver disease: Progress and direction
Authors: Zhou Da , Fan Jiangao
Published: October 2024

Metabolic dysfunction-associated steatotic liver disease (MASLD), also called non-alcoholic fatty liver disease, is the most epidemic chronic liver disease worldwide. Metabolic dysfunction-associated steatohepatitis (MASH) is the critical stage of MASLD, and early diagnosis and treatment of MASH are crucial for reducing the incidence of intrahepatic and extrahepatic complications. So far, pharmacotherapeutics for the treatment of MASH are still a major challenge, because of the complexity of the pathogenesis and heterogeneity of MASH. Many agents under investigation have shown impressive therapeutic effects by targeting different key pathways, including the attenuation of steatohepatitis or fibrosis or both. It is notable that thyroid hormone receptor-β agonist, resmetirom has become the first officially approved drug for treating MASH with fibrosis. Other agents such as peroxisome proliferator-activated receptor agonists, glucagon-like peptide-1 analogs, and fibroblast growth factor 21 analogs are awaiting approval. This review focuses on the current status of drug therapy for MASH and summarizes the latest results of new medications that have completed phase 2 or 3 clinical trials, and presents the future directions and difficulties of new drug research for MASH.
The influence of biophysical niche on tumor-associated macrophages in liver cancer
Authors: Zhang Ying , Rao Ying , Lu Jiahuan , Wang Jiyu , Ker Dai Fei Elmer , Zhou Jingying , Wang Dan Michelle
Published: October 2024

HCC, the most common type of primary liver cancer, is a leading cause of cancer-related mortality worldwide. Although the advancement of immunotherapies by immune checkpoint inhibitors (ICIs) that target programmed cell death 1 or programmed cell death 1-ligand 1 has revolutionized the treatment for HCC, the majority is still not beneficial. Accumulating evidence has pointed out that the potent immunosuppressive tumor microenvironment in HCC poses a great challenge to ICI therapeutic efficacy. As a key component in tumor microenvironment, tumor-associated macrophages (TAMs) play vital roles in HCC development, progression, and ICI low responsiveness. Mechanistically, TAM can promote cancer invasion and metastasis, angiogenesis, epithelial-mesenchymal transition, maintenance of stemness, and most importantly, immunosuppression. Targeting TAMs, therefore, represents an opportunity to enhance the ICI therapeutic efficacy in patients with HCC. While previous research has primarily focused on biochemical cues influencing macrophages, emerging evidence highlights the critical role of biophysical signals, such as substrate stiffness, topography, and external forces. In this review, we summarize the influence of biophysical characteristics within the tumor microenvironment that regulate the phenotype and function of TAMs in HCC pathogenesis and progression. We also explore the possible mechanisms and discuss the potential of manipulating biophysical cues in regulating TAM for HCC therapy. By gaining a deeper understanding of how macrophages sense and respond to mechanical forces, we may potentially usher in a path toward a curative approach for combinatory cancer immunotherapies.
In vivo selection of hepatocytes
Authors: Vonada Anne , Grompe Markus
Published: October 2024

The liver is a highly regenerative organ capable of significant proliferation and remodeling during homeostasis and injury responses. Experiments of nature in rare genetic diseases have illustrated that healthy hepatocytes may have a selective advantage, outcompete diseased cells, and result in extensive liver replacement. This observation has given rise to the concept of therapeutic liver repopulation by providing an engineered selective advantage to a subpopulation of beneficial hepatocytes. In vivo selection can greatly enhance the efficiency of both gene and cell transplantation therapies for hepatic diseases. In vivo hepatocyte selection has also enabled the expansion of human hepatocytes in animals, creating novel models of human liver disease and biology. Finally, recent work has shown that somatic mutations produce clonal expansion of injury-resistant hepatocytes in most chronic liver diseases. In this review, we will address the role of hepatocyte selection in disease pathophysiology and therapeutic strategies.
Multimodal corneal imaging before refractive cataract surgery
Authors: Andrade de Carvalho Karolyna , Esporcatte Louise Pellegrino G. , Gomes Rachel L.R. , Ambrósio Renato
Published: October 2024

Purpose of review

To prospectively review the advances in diagnostics for refractive cataract surgery, focusing on multimodal corneal analysis.

Recent findings

The article explores the considerations related to planning refractive cataract surgery, emphasizing its potential to enhance patients’ vision performance and quality of life. This review explores preoperative analysis in cataract surgery, focusing on assessing the cornea and ocular surface using multimodal diagnostics, including Placido disk-based corneal topography, Scheimpflug tomography OCT (optical coherence tomography), and biomechanical assessment. Wavefront technology, gene therapy, and artificial intelligence are also relevant in enhancing surgical precision and outcomes. It highlights the importance of preoperative thorough evaluations and technological advancements in ophthalmology.

The rapid evolution and advancement of technology enable excellent refractive outcomes in most cases following cataract surgery. Consideration of appropriate preoperative factors is essential for achieving the desired postoperative outcome.
Screening for Eye Disease in Ebola Virus Disease Survivors: Program Implementation During an Active Outbreak in the North Kivu and Ituri Provinces, Democratic Republic of the Congo
Authors: Mwanza Jean-Claude , Shantha Jessica G. , Legand Anaïs , Hartley Caleb , Si-Mehand Massi , Kahatane Alexis K. , Mumbere Telesphore M. , Ngona Listo B. , Kanza Eric M. , Kavuo Aldy T. , Kabesha Theophile A. , Kelekele Joseph K. , Kahumba Francine M. , Muhindo Dieudonne M. , Djoza Benjamin S. , Kitenge Richard O. , Formenty Pierre , Crozier Ian , Yeh Steven
Published: October 2024

First identified in the Democratic Republic of the Congo (DRC, formerly Zaire) in 1976, Ebola virus disease (EVD) outbreaks have afflicted thousands of Congolese over the past several decades. The nation’s largest outbreak of EVD in 2018-2020 was complicated by security challenges as well as large case numbers across an expansive geographic region. These factors provided challenges for logistical considerations as well as clinical coverage. In conjunction with the EVD survivor care program spearheaded by the Ministry of Health in DRC, the DRC Intitut National de Recherche Biomédicale, (DRC Institut National de Recherche Biomedicale, DRC National Institute of Biomedical Research) and others, we launched a multidimensional effort to provide ophthalmic care to EVD survivors.

During the engagement period, 237 EVD survivors were screened, 56% of which were women. The 237 EVD survivors constituted ∼75% of the total EVD survivors who were discharged at the time of the intervention. The mean time from EVD symptom onset to evaluation was 4.6 months ± 1.8 SD (range: 24 d to 8.5 mo). Ninety-seven (41%) of EVD survivors screened reported ocular symptoms during or after acute illness, such as itchy eyes (49%), eye pain (25%), and tears (24%). Ophthalmic findings, including retinal scarring, active uveitis, dry eye disease, cataracts, and glaucoma, were also identified.

The need for continued monitoring and longitudinal care for EVD survivors is evident from the expanding body of literature pertaining to post-acute sequelae, including ophthalmic manifestations. Initiatives for such care should be conducted across and in conjunction with multidisciplinary stakeholders for contextualization and effectiveness.
Update on Epidemiologic Trends in Causes of Childhood Blindness and Severe Visual Impairment in East Africa
Authors: Ashby Nathaniel , Miller Chase , Yeh Caleb , Huang Crystal , Song Helen , Dingalele Merveille , Kindundu Grace , Fashina Tolulope , Hartley Caleb D. , Mwanza Jean-Claude
Published: October 2024

Objective:

The initiative 2030 In Sight and the International Agency for the Prevention of Blindness have developed a plan to mitigate the global burden of preventable sight loss. One priority of this initiative is obtaining population eye health data. East Africa is a region that has historically been plagued by high rates of vision loss, and it is imperative to understand what causes are at play. Two large cross-sectional studies were previously published in 1995 and 2009, reporting the causes of childhood blindness (BL) and severe visual impairment (SVI) in East Africa. An update regarding more recent causes is warranted to better understand the trends of childhood BL/SVI in this region.

Methods:

A search strategy was developed a priori to identify relevant terms and align them with a standardized definition of East Africa. This strategy was then employed across PubMed, Google Scholar, and Scopus, with the yield of the overall search depicted in a Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 flow diagram. In the articles gathered by the search, causes of BL/SVI were typically categorized by anatomy and etiology.

Results:

Eight articles met the criteria, with data from 6 countries, consisting of 534 cases of childhood BL/SVI. Common anatomic locations identified included the cornea, lens, and whole globe. Among the most common etiologies were corneal scarring/opacity and cataract. Systemic etiologies and disease associations included measles, toxoplasmosis, and prematurity. Presumptive infectious disease and hereditary conditions were also identified as a category, but specific identification of etiologies and genetic diagnosis was largely unavailable.

Conclusions:

BL/SVI due to the cornea was among the common anatomic sites of disease in our study. The identification of measles as an associated systemic etiology requires further understanding in the context of increased vaccination programs. Multiple articles acknowledged that cataract has become the predominant cause of BL/SVI owing to increased measles vaccination and vitamin A supplementation. Additional research should be conducted to gain a complete understanding of childhood BL/SVI in East Africa, and responses at regional and national levels are likely necessary to address treatable causes of vision impairment.
Association Between Risk of Obstructive Sleep Apnea and Intraocular Pressure Based on the Korea National Health and Nutrition Examination Survey VIII
Authors: Kim Jung Lim , Lee Kayoung
Published: October 2024

Précis:

A higher screening tool for obstructive sleep apnea risk (STOP-BANG) score and loud snoring observed breathing interruptions during sleep, hypertension, and wide neck circumference (NC) were individually and in combination associated with high intraocular pressure (IOP) in Koreans aged 40 years and older.

Objective:

To evaluate the relationship between IOP and the risk of obstructive sleep apnea (OSA).

Methods:

In this population-based, cross-sectional study, we included Korean adults aged 40 years or above recruited between 2019 and 2021. A total of 6315 subjects were included in the Korea National Health and Nutrition Examination Survey Ⅷ database. The risk of OSA was measured by the STOP-BANG questionnaire. The IOPs were measured using a rebound tonometer. Logistic regression was used to analyze the association between IOP quartiles (highest quartile vs lower first to third quartiles) with OSA risk after adjusting for sociodemographic characteristics, lifestyle, and diabetes.

Results:

The adjusted odds ratio for high IOP was 1.27 (95% CI: 1.12–1.43) for participants with a STOP-BANG score of 3–8 compared with those with a score of 0–2. Participants with loud snoring observed breathing interruptions during sleep, hypertension, or wide NC had 24%–40% higher odds of high IOP than those without these components. The odds ratio for high IOP in the group with all 4 factors was 2.09 times higher (95% CI: 1.26–3.46) than in the group without these factors.

Conclusions:

A higher STOP-BANG score was associated with an increased risk of high IOP in Koreans aged 40 years and older. Furthermore, among the STOP-BANG components, loud snoring observed breathing interruptions during sleep, hypertension, and wide NC were individually and in combination associated with high IOP.
Association of Peripapillary Arterial Circle of Zinn-Haller With Glaucoma in Highly Myopic Eyes
Authors: Kim Ji Hong , Yoon Jooyoung , Na Kyeong Ik , Hong Rim Kyung , Lee Won June
Published: October 2024

Précis:

The visualization of circle of Zinn-Haller (CZH) on optical coherence tomography angiography (OCTA) or its pattern does not have a clear effect on glaucoma, whereas the location of CZH is associated with axial length (AXL) in highly myopic eyes.

Purpose:

To investigate the association between the CZH and the presence of glaucoma using swept-source optical coherence tomography angiography (SS-OCTA) images of the optic nerve of patients with high myopia (HM).

Methods:

This retrospective case series included 227 eyes with HM, comprising 134 and 93 eyes with and without glaucoma, respectively. The characteristics of CZH, including visualization, pattern, and location, were assessed using SS-OCTA. Vascular parameters, such as vessel density and microvascular dropout (MvD), were quantified. The factors affecting the presence of glaucoma and the correlations between the CZH distance and AXL were identified using logistic regression analysis and Pearson correlation analysis, respectively.

Results:

CZH was detected more frequently in HM patients with glaucoma (71.6%) than in patients without glaucoma (51.6%) (P<0.002). However, the visualization of CZH was not related to the presence of glaucoma in multivariate regression analysis (odds ratio [OR], 0.688; 95% confidence interval [CI], 0.328–1.444; P=0.322). Moreover, compared with the annular pattern used as a reference, triangular and irregular patterns were not associated with the presence of glaucoma (OR: 1.043, 95% CI: 0.101–10.763, P=0.971; OR: 0.527, 95% CI: 0.255–1.092, P=0.085, respectively). MvD was significantly higher in patients with glaucoma (61.2%) than that in patients without glaucoma (2.2%) (P<0.001) and was identified as a significant factor affecting the presence of glaucoma (OR, 42.120; 95% CI, 9.416–188.413; P<0.001). AXL showed a significant correlation with CZH distance in all patients (R=0.399; P<0.001).

Conclusions:

CZH was more commonly detected in HM patients with glaucoma. However, no clear associations of glaucoma with the visualization, pattern, or location of CZH were observed in the present study. The correlation between AXL and CZH distance in eyes with HM warrants further investigation. These results may offer insights into the pathogenesis of glaucoma in eyes with HM as OCTA technology advances.
Professional Advancement Models for Nurse Practitioners and Physician Associates/Assistants: A historical overview and opportunities for future growth
Authors: Hillel Liza , Lasker Lauren
Published: October 2024

Professional advancement models (PAM) are paramount in the growth of nurse practitioners (NP) and physician associates/assistants (PA) who seek professional challenges, clinical recognition, job satisfaction, upward mobility, and incentives for retention. Professional advancement models for NPs and PAs were born out of literature on clinical career ladders that date back to the 1970s for the nursing work force. Over time, PAMs have evolved to offer NPs and PAs structured pathways to guide and reward professional growth, education, advocacy, research, and quality improvement (QI). Although the first institutional account of PAM development for NPs and PAs was published in 1998, there has been a recent spike in case reports of PAMs from individual medical centers. This article (1) provides a historical timeline of published data on the development and implementation of PAMs for NPs and PAs, (2) critiques features of existing PAMs, and (3) offers recommendations regarding PAM innovation for more uniform adoption in medical institutions across the country.
The effect of unhealthy lifestyle on the pathogenesis of sick sinus syndrome: A life-guiding review
Authors: Chang Xing , Zhang Qin , Pu Xiangyi , Liu Jinfeng , Wang Yanli , Guan Xuanke , Wu Qiaomin , Zhou Siyuan , Liu Zhiming , Liu Ruxiu
Published: October 2024

Sick sinus syndrome (SSS), also known as sinoatrial node dysfunction, has been widely concerned by the medical community. The incidence rate of SSS is increasingly, which poses a great threat to public health. Through decades of repeated research in the medical field, great progress has been made in the pathogenesis of SSS and the interaction mechanism between SSS and other cardiovascular diseases. In this paper, we pay special attention to the mental stimulation factors under various pressures such as society and work, and the influence of smoking, drinking, and unhealthy diet on the pathogenesis of SSS. It also explains the mechanism of negative factors in the pathogenesis of SSS. These unhealthy lifestyle will lead to the occurrence of sinoatrial node disease and arrhythmia, and then induce SSS. Therefore, in the premise of increasing incidence rate of SSS and difficult to cure, how to avoid these harmful factors and ensure a healthy lifestyle is extremely important for preventing and treating SSS. This study also has guiding significance for the daily life of high-risk population of SSS and reducing the mortality of SSS patients.
The impact of digital technology use on adolescents’ subjective well-being: The serial mediating role of flow and learning engagement
Authors: Shao Yanhong , Wu Jingtao , Xu Weili , Zhang Chao
Published: October 2024

While existing research has established the influence of digital technology use, flow, and learning engagement on students’ subjective well-being, there remains a gap in understanding the interrelationships among these factors and the serial mediating role of flow and learning engagement in the relationship between digital technology use and adolescents’ subjective well-being. This study examined the potential indirect roles of flow and learning engagement in the association between digital technology use and adolescents’ subjective well-being. A paper-based survey was conducted among 1289 adolescents (M = 16.33, SD = 1.688) in Shandong Province. All participants completed a structured self-report questionnaire, including measures of digital technology use, flow, learning engagement, and subjective well-being. Data analyses were conducted using structural equation modeling via Amos 24.0 and SPSS 24.0. The results are as follows: (1) digital technology use has a significant and positive effect on adolescents’ subjective well-being; (2) digital technology use significantly and positively affects adolescents’ subjective well-being through flow; (3) digital technology use significantly and positively affects adolescents’ subjective well-being through learning engagement; (4) digital technology use significantly and positively affects the subjective well-being of adolescents through both flow and learning engagement. This study underscores the benefits of digital technology in boosting adolescents’ well-being and identifies flow and learning engagement as key mediators. Our findings equip educators and policymakers with insights to craft interventions that optimize digital technology’s role in fostering adolescent development, presenting a fresh view on the intricate dynamics linking digital interaction with psychological health.
Successfully intravenous thrombolytic therapy in systemic lupus erythematosus-related ischemic stroke: A case report
Authors: Liu Guanglin , Wang Yong , Guan Hongjian
Published: October 2024

Rationale:

Stroke is a relatively frequent complication occurring in patients with systemic lupus erythematosus (SLE). The increasing number of patients with Ischemic Stroke secondary to SLE aroused the clinician’s concern. SLE thrombosis markers, diagnostic high-resolution magnetic resonance image (HR-MRI), and therapeutic interventions for acute ischemic stroke were recently coming into focus perspectives from the field.

Patient concerns:

A 42-year-old female with slurred speech and numbness in her left limb was admitted to our hospital.

Diagnoses:

Magnetic resonance imaging (MRI) revealed right thalamic infarction with diffusion-weighted lesions. Prior to admission, the patient had a National Institute of Health Stroke Scale (NIHSS) score of 3.

Interventions:

In light of the clinical manifestation, the American Heart Association/American Stroke Association (AHA/ASA) Guidelines for Intravenous Thrombolysis in Acute Ischemic Stroke (2019) should be referred to. The patient was treated with thrombolytic alteplase (rt-PA).

Outcomes:

The patient was hospitalized for 2 weeks and discharged after his symptoms improved.

Lessons:

After thrombolysis, the NIHSS score of the patient decreased to zero. The computed tomography scan was reexamined 24 hours later, and no acute changes or hemorrhage were identified in the infarcted area. Subsequent imaging and serological analyses indicated that HR-MRI of the responsible vessel was negative, but the infarction in this patient was still regarded as being caused by vasculitis of the right posterior cerebral artery in the region supplying the thalamus. This is the first case of successful intravenous thrombolytic therapy with rt-PA in a patient with SLE secondary to stroke with an NIHSS score of 3. This provides further evidence for expanding the reference of indications with rt-PA intravenous thrombolysis.
Contribution of cognitive status on admission to mobility and balance at discharge from acute rehabilitation for stroke
Authors: Campo Marc , Toglia Joan , Jaywant Abhishek , O’Dell Michael W.
Published: October 2024

Acute inpatient rehabilitation is crucial for improving mobility and balance for individuals with stroke. A potentially important factor in the recovery of mobility and balance is cognition. The purpose of this study was to determine the effect of cognition on mobility and balance in acute stroke rehabilitation. This was a longitudinal cohort study based on an inpatient rehabilitation unit at a large academic medical center. Participants were individuals with stroke admitted to acute rehabilitation after an acute care hospital stay (N = 281). Demographic data and predictor variables were collected on admission to the unit. Outcomes were collected at discharge from the unit. Multiple regression analyses were used to determine the associations between cognition (Montreal Cognitive Assessment) on mobility (Functional Independence Measure mobility subscale) and balance (Berg Balance Scale). Subtests from the Montreal Cognitive Assessment were also examined to determine if specific dimensions of cognition could predict balance after controlling for covariates. Dominance analysis was used to determine the relative importance of baseline predictors. In separate models, cognition was a significant predictor of mobility (B = 0.19) and balance (B = 0.28) at discharge after adjusting for admission mobility and balance, as well as age, sex, and length of stay. The most important predictors in both models were baseline mobility and balance, but cognition contributed to the models independently of baseline scores. Cognition was generally more important than age and sex while about equally important as length of stay. In separate models, the visuospatial/executive (B = 0.42) and the delayed recall (B = 0.37) subtests were also significant predictors of mobility. The models’ most important predictors were baseline mobility and balance scores. Cognition is a clinically relevant predictor of mobility and balance in acute stroke rehabilitation. Specific dimensions of cognition, such as executive function, visuospatial function, and delayed recall, may be especially important. Cognitive challenges and meta-cognitive strategies should be included in mobility and balance tasks when possible. Studies that evaluate the efficacy of dual-task training and meta-cognitive approaches are needed.
COVID-19 is associated with high blood glucose levels: diabetic neuropathy during the SARS-CoV-2 pandemic: a case report
Authors: Bereda Gudisa
Published: October 2024

Introduction and Importance:

The nerves in the legs and feet are most frequently damaged by diabetic neuropathy. The COVID-19 infection is associated with a high risk of neuropathy symptoms.

Case Presentation:

On 12 July 2022, a 58-year-old black female retiree with significant symptoms of numbness and muscle weakness in the hands and legs was brought into the emergency room. Seventeen years prior, she was diagnosed with type 2 diabetes mellitus. Metformin 1.5 g twice a day and glibenclamide 10 mg twice a day were part of her therapy regimen. When she was admitted to the emergency room, she described a one-day history of shortness of breath, frequent urination, excessive thirst, hyperglycemia, excessive appetite, fever, headache, and dehydration. A chest radiograph showed bilateral diffuse, patchy airspace opacities that could be caused by multifocal pneumonia or viral pneumonia. She started receiving 1000 ml of fluid resuscitation (0.9% normal saline) as soon as she was moved to an ICU, along with a drip-in insulin infusion.

Clinical Discussion:

Diabetes, infections like COVID-19, poor vitamin levels, and other factors can all contribute to diabetic neuropathies. According to the Centers for Disease Control and Prevention, patients with type 2 diabetes mellitus are much more likely to experience severe morbidity and death from coronavirus disease.

Conclusion:

Symptoms of diabetic neuropathy continued for months after a COVID-19 infection test resulted in a positive result.
Grounding Your “Flight Risk” Newly Licensed Nurses
Authors: Nazal Cheryl , Rimmele Debbie , Adams Vickie , Garcher Dana
Published: October 2024

Transition into practice is plagued by personal, work, and patient-related stress leading to burnout and turnover of newly licensed nurses. Leaders must recognize transition shock and moral distress and act immediately. Nursing professional development practitioners at a healthcare organization in Illinois developed the “Flight Risk” Program to recognize, address, and escalate turnover risks as a leadership team. This resulted in retaining 47% of identified “flight risks” and contributed over $3.9 million in cost avoidance.
SIFT-ing Through Misinformation
Authors: Spracklin Emily , Espina Christine R.
Published: October 2024

Background:

The COVID-19 infodemic revealed nurses are not immune from disseminating health misinformation. Furthermore, the 2021 American Association of Colleges of Nursing (AACN) Essentials require competency in social media literacy. Nurse educators need to prepare students to identify credible information online for safe and ethical practice.

Problem:

Vertical reading, a traditional evaluation strategy used in nursing education, is insufficient for identifying online health misinformation.

Approach:

A librarian and nursing faculty member developed an innovative reflection notebook assignment to teach lateral reading—a professional fact-checking technique—and facilitate critical self-reflection among RN-to-BSN students.

Outcomes:

Reflection notebook responses demonstrated that students use online information in various ways; online information habits require active, ongoing professional development; and lateral reading can promote a more compassionate approach to patient education.

Conclusions:

The reflection notebooks equip students with critical knowledge, skills, and attitudes to practice safely and ethically while demonstrating some of the AACN Essentials requirements.
Emergency Medical Services and Police Utilization for Pediatric Mental and Behavioral Health Concerns Within a Large Hospital System
Authors: Hartwell Victoria , Riney Lauren , Cheetham Alexandra , Pomerantz Wendy J. , Lee Sang Hoon , Bensman Rachel , Schwartz Hamilton , Zhang Yin , Babcock Lynn ,   Cincinnati Children's Prehospital Care Committee
Published: October 2024

Objective

This study aimed to compare emergency medical services (EMS) and police utilization trends, epidemiology, and emergency department (ED) outcomes between pediatric patients with mental or behavioral health (MBH) emergencies and those with non-MBH concerns transported to a large children's hospital system.

Methods

This was a retrospective cohort study of patients aged 5 to 18 years transported via EMS and police to two EDs affiliated with a children's hospital from January 2012 through December 2020. Data were abstracted from electronic hospital records. Encounters for MBH emergencies were identified using diagnostic codes and chief complaints. Trends of EMS and police transports of patients with MBH emergencies were examined. Patient demographics and ED outcomes were compared between children presenting with MBH emergencies and those with non-MBH concerns.

Results

During the 9-year study period, out of 40,663 transports to the EDs, 36,137 (89%) arrived via EMS, and 4,526 (11%) arrived via police. A total of 10,250 (28.4%) EMS transports were for MBH emergencies. The volume of patients transported by EMS for MBH emergencies increased by 1.4% per year (P < 0.01) with no significant change in total EMS patient volumes. Patients with MBH emergencies transported by EMS were more likely to be older, female, of White race, and publicly insured; require restraint in the ED; and be admitted (P < 0.001). Of police transports, 4153 (91.8%) were for MBH emergencies, with no statistical change in the proportion of police transports that were for MBH emergencies. Police-transported MBH patients compared to non-MBH police-transported patients were more likely to be younger, female, and of White race (P < 0.001); 8.7% required mechanical/physical restraints in ED, 6.7% required pharmacologic restraint medications in ED, and 53% were admitted.

Conclusions

The proportion of pediatric transports for MBH emergencies by EMS is rising and comprises the majority of police transports. Distinct from non-MBH pediatric patients transported, MBH patients necessitate significant ED resources, including ED-administered restraints and admission, highlighting their unique burden on the prehospital and ED systems.
2D Facial Analysis Performed by a Human Operator Versus an Artificial Intelligence Software
Authors: Muñoz Gonzalo , Brito Leonardo , de Moraes Marcio , Olate Sergio
Published: October 2024

Background:

Artificial intelligence (AI) has been a contribution in recent years to the development of new tools for dental, surgical, and esthetic treatment. In the case of image diagnosis, AI allows automated analysis of some facial parameters. The aim of this study was to evaluate the precision and reproducibility of these IA analyses compared with a human operator.

Methods:

Thirty subjects were selected, and frontal and profile photographs were taken of each. The photographs were previously calibrated and then analyzed by a human operator and an AI for vertical, horizontal, symmetry parameters, and facial profile angles.

Results:

Statistically significant differences were found in at least 1 vertical, horizontal, symmetry, and facial profile measurement.

Conclusions:

The 2D facial analysis performed on photographs using AI is an interesting and constantly evolving tool. However, there are still many differences with the analysis performed by the human operator, so it should be used carefully. Further studies using metric measurements should be performed to contrast the values obtained by human operators and AI and to analyze the accuracy of point selection in facial soft tissues.
Plastic Surgeons and Portraits Before the Invention of Photography
Authors: Hwang Kun
Published: October 2024

The aim of this paper is to review portraits from the Renaissance to the Romantic eras, created before the invention of photography, and to discuss their usefulness to plastic surgeons. Before photography and film were invented, portraits played a critical role in documenting individuals, conveying power, and immortalizing people’s appearance and identity. Portraits were not merely simple representations of a person’s physical appearance; they played a crucial role in conveying the subject’s inner qualities and social position, as well as the cultural values of the era. Artists often idealized or embellished certain features to align with the cultural and aesthetic ideals of their time. Portraits of the Renaissance to Romantic eras could have a significant impact on plastic surgeons’ understanding of beauty and aesthetics. A plastic surgeon drawing on Renaissance ideals might prioritize symmetry and balanced facial features, which continue to be regarded as attractive in contemporary beauty standards. Beauty standards during these times favored curvaceous and lively figures, potentially inspiring modern plastic surgeons to focus on creating more dramatic or unique appearances. A plastic surgeon inspired by Romantic art might value uniqueness and avoid rigid beauty standards, focusing instead on enhancing a person’s natural traits rather than conforming to a singular “ideal” appearance. Plastic surgeons could gain a richer, more classical perspective on aesthetics by studying historical art, potentially leading to more personalized and balanced outcomes. However, integrating these classical ideals into modern practice must also consider the diverse and varying definitions of beauty prevalent in today’s multicultural society.
Multifaceted Control Interventions for Healthcare-associated Infections in a Kidney Transplant Intensive Care Unit: Clinical Outcome Improvement and Bundle Adherence
Authors: Calegari Luana Oliveira , Peruzzo Maria Bethânia , Foresto Renato Demarchi , Tedesco-Silva Helio , Medina Pestana José , Requião-Moura Lúcio R.
Published: October 2024

Background.

Healthcare-associated infections (HAIs) are preventable complications that overwhelm the healthcare system. The implementation of multifaceted control intervention actions in the intensive care setting modifies clinical outcomes, but its effectiveness has not been specifically investigated for high-risk patients, such as kidney transplant recipients (KTRs).

Methods.

This observational retrospective natural experiment evaluated the effectiveness of multifaceted control interventions (bundles) in reducing HAIs in a KTR intensive care unit. We also measured the bundle adherence rate during 16 mo in the after era.

Results.

We included 1257 KTRs, 684 before and 573 in the postintervention period. After the bundle implementation, the incidence density of device-associated HAIs decreased from 8.5 to 3.9 per 1000 patient-days (relative risk [RR] = 0.46; 95% confidence interval [CI], 0.25-0.85; P = 0.01), primarily because of the reduction in central line-associated bloodstream infection from 8.0 to 3.4 events per 1000 catheter-days (RR = 0.43; 95% CI, 0.22-0.83; P = 0.012). Reductions in catheter-associated urinary tract infection (2.5 versus 0.6 per 1000 catheter-days; RR = 0.22; 95% CI, 0.03-1.92; P = 0.17) and ventilator-associated pneumonia (3.4 versus 1.0 per 1000 ventilator-days; RR = 0.29; 95% CI, 0.03-2.63; P = 0.27) were not significant. Central venous (P = 0.53) and urinary catheter (P = 0.47) insertion adherence were stable during 16 mo, whereas central venous (P < 0.001) and urinary catheter (P = 0.004) maintenance gradually increased. Finally, ventilator-associated pneumonia prevention bundle adherence slightly decreased over time (P = 0.06).

Conclusions.

The implementation of comprehensive multifaceted control intervention actions in an intensive care unit dedicated to KTR care was effective in significantly reducing device-associated infections. The impact was in line with the reductions observed in populations that have not undergone transplantation, underscoring the effectiveness of these interventions across different patient groups.
Methods for detecting and monitoring Salmonella infection and chronic carriage in living mice using bioluminescent in vivo imaging
Authors: Bennett Aliyah Nicole , Laipply Baileigh , Gunn John Spencer
Published: October 2024

Salmonella enterica serovar Typhi primarily persists in chronic carriers by forming biofilms on gallstones in the gallbladder. We have developed a gallstone mouse model to study chronic carriage. To better understand the infection timeline and differentiate between mice that have maintained long-term gallbladder carriage from those that have cleared infection, we utilized bioluminescent S. Typhimurium and in vivo imaging to detect and track the organ-specific presence of bacteria in living mice. The mice infected with our bioluminescent S. Typhimurium showed luminescence in the abdomen as early as three days by comparison to the mice infected with non-luminescent wild type S. Typhimurium. With our methods, we achieve image resolution such that we can confidently identify the presence of S. Typhimurium in the gallbladder at >60 days post-infection. Using these methods we have determined that the minimum number of bacteria necessary to detect luminescence in the mice is 103 colony forming units (CFUs), and that 1 out of 6 initially infected mice will remain persistently infected for greater than 60 days, with gallbladder bacterial loads reaching upwards of 103 per mg of tissue. Given that our limit of detection of luminescence is 103 CFUs, our sensitivity is robust enough to identify the bacterial loads present in the average chronically infected mouse. Quantification of individual organs’ bacterial CFUs and comparison of luminescence between WT and luminescent S. Typhimurium validates that our technique is specific and sensitive enough to detect organ specific infection in our model of typhoidal chronic carriage.
Effect of the incubation time on blood culture results and bacterial pathogens causing bloodstream infections among children attending Sekou Toure Regional Referral Hospital in Mwanza, Tanzania
Authors: Thomas James , Wasira Albert , Maarafu Darus , Igogo Faustin , Emmanuel Eunice , Ernest Roza , Mushi Martha F. , Mshana Stephen E.
Published: October 2024

Background: One-hour delay in initiating appropriate antimicrobial treatment increases the mortality rate of patients with bloodstream infections by 2%. This highlights the risk associated with manual blood culture methods, as they tend to have long turn-around time with initial incubation period of 18-24 hours leads to delays in obtaining diagnostic results. This study examined the impact of incubation time on blood culture results and analyzed the patterns of the pathogens causing bloodstream infections (BSIs) among children attending Sekou Toure Regional Referral Hospital, Mwanza, Tanzania
Methodology: A hospital-based, descriptive cross-sectional study was conducted at Sekou Toure Regional Referral Hospital from May to July 2024. The conventional blood culture method, using in-house prepared brain heart infusion broth with slight modifications on the initial time of the blind subculture (at 8 hours, 24 hours and 120 hours) was done to isolate the pathogens causing BSIs. Descriptive data analysis was performed using STATA software version 15.
Results: The study enrolled 302 children with clinical diagnosis of BSI. Of these, 160 (53%) were male, with a median age of 6 years (IQR: 1-7 years). Fever was the predominant clinical sign reported in 259 (85.8%) children. Microbiologically confirmed bloodstream infections were detected in 90 (29.8%) children. Among them, 51.1% (46/90) were detected through blind subculture after 8 hours of initial incubation. An additional 31 (34.4%) were detected after 24 hours, and 13 (14.4%) were identified after 120 hours of incubation.
The most frequently isolated pathogens were Klebsiella pneumoniae (25.6%, 23/90) and Staphylococcus aureus (24.4%, 22/90). Gram-negative bacteria formed the majority, (71.1% 64/90) of the isolated pathogens, with 62.5% (40/64) showing resistance to third-generation cephalosporins. Additionally, 45.5% (10/22) of the Staphylococcus aureus strains were methicillin-resistant (MRSA).
Conclusion: Blind subculture after 8 hours of initial incubation correctly detected more than half of the children with microbiological confirmed bloodstream infections. Incorporating blind subculture on MacConkey agar supplemented with cefotaxime 2µg/ml (MCA-C) after 8 hours of incubation resulted in the correct treatment of half of the children with bloodstream infections caused by Gram-negative bacteria within 24 hours. In areas with high prevalence of third-generation cephalosporin resistance, blind subculture within 8 hours should include MacConkey agar supplemented with cefotaxime 2µg/ml for appropriate treatment within 24 hours.