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Management and Perinatal Outcomes in Pregnant Individuals with Implantable Cardiac Defibrillators
No full textPhase separation of NELFE modulates chromatin accessibility to promote dichotomous signaling pathways in hepatocellular carcinoma.
No full textBiomolecular condensates partition various cellular processes including transcription, DNA repair, and RNA metabolism. We report NELFE, a member of the Negative Elongation Factor complex required for Polymerase II (Pol II) pausing, forms distinct foci mediated by two low complexity sequences. We show NELFE is oncogenic in hepatocellular carcinoma (HCC) by undergoing liquid-liquid phase separation (LLPS) with SMARCB1 to modulate chromatin accessibility to downregulate pro-apoptotic genes through Pol II pausing while activating pro-growth signals to promote HCC progression. Our work highlights the importance of NELFE LLPS as a mechanism of chromatin accessibility to regulate both paused and non-paused genes to drive tumorigenesis in hepatocellular carcinoma
Improving Cadaver Selection for Surgical Training: Training NonClinicians in Point-of-Care Ultrasound (POCUS)
No full textOrganizing Trauma Alerts in the Emergency Department: Improving Role Clarity and Efficiency for Nurses and Techs
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Short-term outcomes of transcatheter aortic valve implantation in patients with concomitant mitral or tricuspid regurgitation.
No full textMitral regurgitation (MR) or tricuspid regurgitation (TR) is often an indicator of poor prognosis in patients with aortic stenosis (AS). Our study aims to compare transcatheter aortic valve implantation (TAVI) outcomes in patients with and without concomitant MR or isolated TR. Using the national readmission database (2016-2020), we identified patients with severe AS undergoing TAVI. We used multivariable regression for adjusted analysis and the Propensity Score Matching (PSM) model. Among 315,163 hospitalizations for TAVI, 14,577 (4.6 %) had concomitant MR, while 3859 (1.2 %) had isolated TR. On PSM, TAVI in concomitant MR was associated with higher acute CHF (50.1 % vs 43.7 %, p-value \u3c 0.001), mechanical circulatory support (MCS) need (1.5 % vs 0.9 %, p-value: 0.001), acute myocardial infarction (5.6 % vs. 4.3 %, p-value \u3c 0.001) and net adverse events (61.5 % vs. 59.2 %, p-value: 0.002) while the mortality difference was not significant (p \u3e 0.05). Higher total costs (55,183, p-value \u3c 0.001), 90- (22.8 % vs. 21.2 %), and 180-day readmission rates (32.1 % vs. 29.4 %) were also observed [p-value \u3c 0.05]. Similarly, TAVI in the presence of isolated TR was associated with higher cardiogenic shock (3.2 % vs. 1.8 %, p: 0.004) and MCS need (1.5 % vs 0.7 %, p: 0.009). TAVI with coexisting TR showed higher rates of 30-day (13.4 % vs. 11.2 %), 90-day (26 % vs. 21.2 %), and 180-day (34.3 % vs 29.1 %) readmission rates [p \u3c 0.05]. A higher median length of stay (3 vs. 2 days) and total cost (55,183) [p-value \u3c 0.001] were also observed. TAVI in concomitant MR or TR was associated with higher periprocedural adverse events, increased healthcare burden & readmission rates
Recurrent Ascites Beyond the Usual Suspects: Uncovering an Overlooked Culprit.
No full textHepatic amyloidosis is a rare condition that leads to progressive liver dysfunction. Diagnosis is often challenging since clinical presentation may be highly varied and is dependent upon the extent of liver involvement, underlying etiology of amyloid deposition, as well as concomitant extrahepatic manifestations. Ascites, although uncommon, can be a presenting feature of hepatic amyloidosis and pose diagnostic challenges as it can occur in a variety of liver and nonliver-related conditions. Herein, we present a case of hepatic amyloidosis in a patient with recurrent ascites, emphasizing the importance of considering this condition in the differential diagnosis of individuals presenting with unexplained ascites
Psychomotor speed from minimal hepatic encephalopathy testing is associated with physical frailty in patients with advanced chronic liver disease.
No full textBACKGROUND: Physical frailty and minimal hepatic encephalopathy (MHE) are common in advanced chronic liver disease (AdvCLD). While the Psychometric Hepatic Encephalopathy Score is used for MHE diagnosis, its complexity limits routine use. The Stroop EncephalApp (StE) offers a simpler method for MHE diagnosis. We aimed to investigate the association between MHE using the StE and physical frailty by the Liver Frailty Index (LFI), in patients with AdvCLD.
METHODS: This multicenter study analyzed data from patients with AdvCLD awaiting liver transplantation. Patients were categorized into two groups based on the presence or absence of MHE and compared using the LFI and its components. To identify factors influencing the various StE modalities and MHE diagnosis, we utilized Spearman\u27s rank correlation coefficient and logistic regression models.
RESULTS: Out of the 267 patients, 73% were diagnosed with MHE, and 18% of the total cohort were classified as frail . Patients with MHE demonstrated poorer LFI scores and were more likely to be categorized as prefrail or frail. Notably, there was a significant correlation between StE time modalities, especially off-time, and the LFI score (rho = 0.438, P \u3c 0.001). Further, multivariable analyses indicated that the LFI was independently associated with MHE (OR 2.41, 95% CI 1.52-3.82).
CONCLUSION: The findings suggest that the LFI score in this population reflects its ability to capture the crucial role of psychomotor speed, particularly evident in off-time performance, thus connecting neurocognitive and physical function. Further research is warranted to investigate the effectiveness of interventions targeting cognitive and physical impairments to enhance clinical outcomes in patients with AdvCLD
Evaluation of a Novel Virtual Reality Simulated Alternate Cover Test to Assess Strabismus: A Prospective, Masked Study.
No full textPURPOSE: A sensorimotor examination is the gold standard for strabismus diagnosis and quantification but requires a highly skilled examiner and may be limited by a child\u27s cooperation. Virtual reality (VR) employs eye-tracking technology to monitor eye position and may be able to measure strabismus. The aim of this study was to assess a prototype VR-simulated alternate cover test to detect and measure strabismus.
DESIGN: Prospective, masked diagnostic test study.
METHODS: Patients aged 5-18 years with visual acuity of 20/80 or better were prospectively enrolled to undergo strabismus measurements using a VR simulated alternate cover test (Olleyes, Inc., Summit, NJ) followed by an alternate cover test performed by a masked pediatric ophthalmologist or orthoptist. The main outcome measure was correlation between gold standard and VR-obtained strabismus measurements (in prism diopters [PD]) in primary gaze at near using Pearson correlation coefficients and Bland-Altman analysis with limits of agreement (LOA). A secondary measure was the diagnostic accuracy for the VR headset to detect strabismus.
RESULTS: A total of 85 participants were enrolled, mean ± standard deviation age was 10.8 ± 3.8 years, 45.9% (39/85) male. 40.0% (34/85) had strabismus: 17.7% (15/85) esotropia, 22.4% (19/85) exotropia, and 5.9% (5/85) vertical strabismus. 52.9% (18/34) of strabismus was intermittent. The overall correlation between VR and gold standard strabismus measurements was moderate but significant (r = 0.42, 95% CI 0.22, 0.58, P \u3c .001), and correlation was strong for esotropia and constant deviations (r = 0.74, 95% CI 0.38, 0.91, P = .001 and r = 0.74, 95% CI 0.39, 0.91, P \u3c .001, respectively). In participants with horizontal strabismus, Bland-Altman analysis showed a mean difference between standard and VR measurements of 3.55 ± 8.33 PD for esotropia (upper and lower LOA 19.89, -12.78 PD) and 17.15 ± 11.20 PD for exotropia (LOA 39.09 and -4.79 PD). Sensitivity for detecting strabismus was low: 27.6% (95% CI 12.7, 47.2), but specificity was high: 87.5% (95% CI 75.9, 94.8).
CONCLUSIONS: A prototype VR simulated alternate cover test showed a moderate but significant correlation with the gold standard sensorimotor examination and correlation was strong in those with esotropia and constant deviations. While the level of agreement demonstrated by this novel VR technology is promising, further improvements are needed before clinical deployment. However, this study demonstrates that VR has the potential to expand our ability to detect, measure, and monitor strabismus