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Identifying Overdose Risk Factors for People Hospitalized with Injection Drug Use-Associated Infections in Maine
Get PDFIntroduction: The overdose crisis continues to be a significant problem, particularly in rural states such as Maine. The objectives of this study were to: 1) describe demographic and health characteristics and 2) identify overdose risk factors among people in Maine hospitalized with injection drug use (IDU)-associated infections.
Methods: We performed descriptive analysis of demographics, health characteristics, and injection practices, stratified by lifetime history of overdose. We conducted an exploratory logistic regression analysis, controlling for gender, homelessness, having experienced an emergency department (ED) visit in the past 3-months, and endorsement of injecting alone in the past 30 days to examine predictors of lifetime overdose risk.
Results: Of the 101 participants in the study, 54 (53%) had a lifetime history of overdose. A significantly greater proportion of participants with a history of overdose reported experiencing homelessness (n=31 (57%) versus n=15 (32%), p = 0.010) and an ED visit in the past 3-months (n=32 (59%) versus n=15 (32%), p = 0.006) compared to participants without a history of overdose. In multivariable analysis, having an ED visit in the past 3 months was associated with an increased risk of overdose (aOR 3.55, 95% CI: 1.45-8.66).
Discussion: In this study, a greater proportion of participants with a history of overdose were experiencing homelessness as compared to those without a history of overdose. We found that a having visited an ED in the past 3-months was an important risk factor for drug overdose.
Conclusions: The ED may be an important setting to identify people, particularly unhoused individuals, at risk for overdose and to offer harm reduction and other supportive resources
January 3rd, 2024: Autoinflammatory Disease: Attack of the Inflammasome
No full textZoom Passcode: 5dd!A0*3https://knowledgeconnection.mainehealth.org/medicine_gr/1012/thumbnail.jp
Exploratory Mass Spectrometry of Cerebrospinal Fluid from Persons with Autopsy-Confirmed LATE-NC
No full textCommon neuropathologies associated with dementia include Alzheimer\u27s disease neuropathologic change (ADNC) and limbic-predominant age-related TDP-43 encephalopathy neuropathologic change (LATE-NC). Biofluid proteomics provides a window into the pathobiology of dementia and the information from biofluid tests may help guide clinical management. Participants (n = 29) had been autopsied and had antemortem CSF draws in a longitudinal cohort of older adults at the University of Kentucky AD Research Center. Cases were designated as LATE-NC + if they had LATE-NC stage \u3e 1 (n = 9); the remaining 20 cases were designated LATE-NC-. This convenience sample of CSF specimens was analyzed in two separate processes: From one group, aliquots were depleted of highly abundant proteins using affinity spin columns. Tryptic digests of sample proteins were subjected to liquid chromatographic separation and mass spectrometry. Relative quantification was performed using Sciex software. Peptides referent to a total of 949 proteins were identified in the samples depleted of abundant proteins, and 820 different proteins were identified in the non-depleted samples. When the Bonferroni/false-discovery statistical correction was applied to account for having made multiple comparison tests, only 4 proteins showed differential expression (LATE-NC + vs LATE-NC-) in the non-depleted samples (RBP4, MIF, IGHG3, and ITM2B). Post hoc western blots confirmed that RBP4 expression was higher in the LATE-NC + cases at the group level. In summary, an exploratory assessment of proteomes of autopsy-confirmed LATE-NC and non-LATE-NC CSF did not demonstrate a clear-cut proteomic fingerprint that distinguished the two groups. There was, however, an increase in RBP4 protein levels in CSF from LATE-NC cases
HELP Programs Impact on Delirium
Get PDFBackground: Delirium is a condition that affects 1/3 of patients in the hospital. It is a condition that is preventable and reversible.https://knowledgeconnection.mainehealth.org/nurseresidency/1012/thumbnail.jp
Variation in Demographics, Hospital, and Patient-Reported Outcomes following Total Hip Arthroplasty According to Biological Sex
No full textBACKGROUND: The effect of biological sex on the outcomes of total hip arthroplasty (THA) remains unclear. Accounting for biological sex in research is crucial for reproducibility and accuracy. Average combined data may mask sex-related variation and obscure clinically relevant differences in outcomes. The aim of this study is to investigate hospital and patient-reported outcome measures (PROMs) after THA by biological sex to elucidate differences and ultimately provide more equitable care. METHODS: We performed a retrospective review of patients undergoing primary THA at a single large academic center between January 2013 and August 2020. Demographics, operative variables, hospital outcomes, and PROMs were compared between men and women patients. The PROMs included preoperative, 6-week, 6-month, and 1-year Single Assessment Numeric Evaluation (SANE), Visual Analog Scale (VAS), Hip Disability and Osteoarthritis Outcome Score Joint Replacement (HOOS JR), University of California, Los Angeles (UCLA), and Patient-Reported Outcomes Measurement Information System (PROMIS) mental and physical scores, as well as satisfaction scores. RESULTS: A total of 6,418 patients were included (55% women). Women were older (P \u3c 0.001), had a lower body mass index (P \u3c 0.001), and were more likely to have public insurance (P \u3c 0.001). Fewer women were discharged to home or self-care (P \u3c 0.001). Women had higher rates of cementation (P \u3c 0.001) and fracture within 90 days (P \u3c 0.001), and these associations remained significant with adjusted multivariable analyses. Women had significantly higher pain and lower functional scores preoperatively; postoperatively, most PROMs were equivalent. CONCLUSION: Important differences were observed in several areas. Demographic parameters differed, and a variable effect of biological sex was observed on surgical and hospital outcomes. Women had an increased incidence of cemented femoral components (indicated for osteoporotic bone) and postoperative fractures. Women\u27s PROMs demonstrated globally lower functional scores and higher pain preoperatively. Differences attributed to sex should continue to be investigated and accounted for in risk-stratification models. Future studies are needed to elucidate the underlying causes of observed biological sex differences and are essential for equitable arthroplasty care
Clinical features and outcomes of young patients with low-grade non-rhabdomyosarcoma soft tissue sarcomas treated with a risk-based strategy: A report from Children\u27s Oncology Group study ARST0332
No full textBACKGROUND: In retrospective analyses, the Pediatric Oncology Group [POG) and the Federation National des Centres de Lutte Contre le Cancer (FNCLCC) histologic grade predict outcome in pediatric non-rhabdomyosarcoma soft tissue sarcoma (NRSTS), but prospective data on grading, clinical features, and outcomes of low-grade NRSTS are limited. METHODS: We analyzed patients less than 30 years of age enrolled on Children\u27s Oncology Group (COG) study ARST0332 (NCT00346164) with POG grade 1 or 2 NRSTS. Low-risk patients were treated with surgery alone. Intermediate-/high-risk patients received ifosfamide/doxorubicin and radiotherapy, with definitive resection either before or after 12 weeks of chemoradiotherapy. RESULTS: Estimated 5-year event-free and overall survival were 90% and 100% low risk (n = 80), 55% and 78% intermediate risk (n = 15), and 25% and 25% high risk (n = 4). In low-risk patients, only local recurrence was seen in 10%; none with margins greater than 1 mm recurred locally. Sixteen of 17 intermediate-/high-risk patients who completed neoadjuvant chemoradiotherapy underwent gross total tumor resection, 80% with negative margins. Intermediate-/high-risk group events included one local and seven metastatic recurrences. Had the FNCLCC grading system been used to direct treatment, 29% of low-risk (surgery alone) patients would have received radiotherapy ± chemotherapy. CONCLUSIONS: Most low-risk patients with completely resected POG low-grade NRSTS are successfully treated with surgery alone, and surgical margins greater than 1 mm may be sufficient to prevent local recurrence. Patients with intermediate- and high-risk low-grade NRSTS have outcomes similar to patients with high-grade histology, and require more effective therapies. Use of the current FNCLCC grading system may result in overtreatment of low-risk NRSTS curable with surgery alone
March 20th, 2024: Increasing Healthcare System Empathy in Patients with Cirrhosis: Future Directions for Palliative Hepatology
No full textPresented by: Dr. Kneka Ufere, MD, MSCE, Transplant Hepatologist at Massachusetts General Hospital. Presented at The Department of Medicine Grand Rounds at Maine Medical Center, Portland, ME
Zoom Passcode: .cn5E!HKhttps://knowledgeconnection.mainehealth.org/medicine_gr/1020/thumbnail.jp
Endothelial cells increase mesenchymal stem cell differentiation in scaffold-free 3D vascular tissue
No full textIn this study, we present a versatile, scaffold-free approach to create ring-shaped engineered vascular tissue segments using human mesenchymal stem cell-derived smooth muscle cells (hMSC-SMCs) and endothelial cells (ECs). We hypothesized that incorporation of ECs would increase hMSC-SMC differentiation without compromising tissue ring strength or fusion to form tissue tubes. Undifferentiated hMSCs and ECs were co-seeded into custom ring-shaped agarose wells using four different concentrations of ECs: 0, 10, 20, and 30%. Co-seeded EC and hMSC rings were cultured in SMC differentiation medium for a total of 22 days. Tissue rings were then harvested for histology, western blotting, wire myography, and uniaxial tensile testing to examine their structural and functional properties. Differentiated hMSC tissue rings comprised of 20 and 30% ECs exhibited significantly greater SMC contractile protein expression, endothelin-1 (ET-1)-meditated contraction, and force at failure compared to the 0% EC rings. On average, the 0, 10, 20, and 30% EC rings exhibited a contractile force of 0.745 ± 0.117, 0.830 ± 0.358, 1.31 ± 0.353, and 1.67 ± 0.351 mN (mean ± SD) in response to ET-1, respectively. Additionally, the mean maximum force at failure for the 0, 10, 20, and 30% EC rings was 88.5 ± 36.2, 121 ± 59.1, 147 ± 43.1, and 206 ± 20.8 mN (mean ± SD), respectively. Based on these results, 30% EC rings were fused together to form tissue engineered blood vessels (TEBVs) and compared to 0% EC TEBV controls. The addition of 30% ECs in TEBVs did not affect ring fusion but did result in significantly greater SMC protein expression (calponin and smoothelin). In summary, co-seeding hMSCs with ECs to form tissue rings resulted in greater contraction, strength, and hMSC-SMC differentiation compared to hMSCs alone and indicates a method to create functional 3D human vascular cell co-culture model