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Candida auris: A Continuing Threat
No full textCandida auris is a World Health Organization critical-priority fungal pathogen that has variable resistance to antifungal treatments. Multiple clades have been identified through genomic analysis and have appeared in different geographic locations simultaneously. Due to a combination of factors including antifungal resistance, ability to colonize and persist in the environment, and thermotolerance, it can thrive. Infected patients are associated with a high mortality rate, especially those with multiple health risk factors like those associated with other Candida species. This review highlights the current situation of this pathogen to help provide guidance for future work
Open Treatment of Mandible Angle Fractures and the Role for Maxillomandibular Fixation
No full textBACKGROUND: Maxillomandibular fixation (MMF) remains a mainstay in the treatment algorithm of bony injuries involving the lower facial skeleton to help restore premorbid occlusion.
PURPOSE: To compare postoperative open reduction and internal fixation outcomes in dentate patients with noncomminuted, isolated angle fractures of the mandible between patients that underwent postoperative MMF and those who did not.
METHODS: Retrospective review of 224 patients treated for isolated, noncomminuted mandible angle fractures between January 1997 and December 2023. Patients were either kept in occlusion with intraoperative maxillomandibular (MMF) or with bimanual reduction. Patients either remained in MMF or not postoperatively.
RESULTS: There was not a significant overall association of surgery group on complications (P=0.44). The odds of complications were lower for the intraoperative bimanual reduction group without MMF compared with patients that underwent intraoperative and postoperative MMF (odds ratio=0.48, P=0.26).
CONCLUSION: This study describes similar surgical outcomes after open reduction and internal fixation of isolated, noncomminuted mandible angle fractures with or without postoperative MMF. This study helps show that in appropriately selected cases, postoperative MMF may not be necessary in this specific mandible fracture pattern
Unraveling the Prognostic Significance of BRCA1-Associated Protein 1 (BAP1) Expression in Advanced and Castrate-Resistant Prostate Cancer
No full textProstate cancer (PCa) is ranked as one of the top cancers affecting men in Western societies. BRCA1-associated protein 1 (BAP1) expression significance has been observed in various cancers, including prostate cancer. The search for prognostic models allowing better risk stratification and prediction of disease progression in prostate cancer patients is still of major clinical need. Our data showed that nuclear BAP1 expression is the most associated with cancer clinical outcomes and other biomarkers. The data confirmed that decreased BAP1 nuclear expression is linked to aggressive tumors and poorer prognosis. We assessed BAP1 expression in 202 cases, including advanced and castrate-resistant PCa (CRPCa). Our data indicated low BAP1 nuclear expression in advanced and castrate-resistant disease (CRPCa). Furthermore, there was a significant difference between high and low BAP1 nuclear expression relative to the patient\u27s clinical outcome. In the present cohort, decreased BAP1 intensity exhibited a significant association with unfavorable overall survival (OS) (HR 2.31, CI: 1.38-3.86, p = 0.001) and cause-specific survival (CSS) (HR 2.44, CI: 1.24-4.78, p = 0.01). Additionally, this association was more pronounced when low BAP1 expression (high risk) was combined with other common PCa genomic alterations such as phosphatase and tensin homolog (PTEN) loss or ETS-related gene (ERG)-positive cases, resulting in higher unfavorable OS and CSS. Conversely, high BAP1 nuclear expression (moderate and high intensity) combined with no ERG expression or PTEN (moderate or high expression), p53 (wild type), and androgen receptor (AR) (low/moderate intensity) showed better association with higher survival rates. All these data support the notion that BAP1 functions as a tumor suppressor. Integrating BAP1 status with other genomic alterations offers a more comprehensive understanding of disease aggressiveness
Bridging the gap: empowering patients as research partners through a structured training program
No full textBACKGROUND: Engaging patients as partners in the research process is a mutually beneficial endeavor. However, patients may need skills training in order to meaningfully contribute to a project. The present paper describes the training program A Front Row SEAT to Research, which equipped patient partners to independently lead focus groups and interpret their associated data. The focus groups were an aim of a larger project evaluating the face validity of a scale measuring patient engagement in research.
MAIN BODY: The nine-week training program, created by Patient Engaged Research Center qualitative research experts, empowered patient partners to conduct qualitative research. The structure of the program included asynchronous video lessons, workbook exercises, and live sessions for practice. Topics covered included a comprehensive overview of the scientific process, qualitative research methods, focus group moderation, planning, coding, data interpretation, and dissemination of findings. A hands-on approach to learning, coupled with the collection of continuous feedback, were hallmarks of the program.
CONCLUSION: The training program emphasized clear expectations, accessibility, and providing resources to build the capacity of patient partners. Trust was established through a dedicated support person, a collaborative group dynamic, and regular engagement, ensuring patient partners felt valued and empowered. This approach allowed patients to meaningfully contribute to the research and develop a sense of shared ownership in the project
Transfusion of Fresh Frozen Plasma and Platelets in Critically Ill Adults: An American College of Chest Physicians Clinical Practice Guideline
No full textBACKGROUND: Platelets and fresh frozen plasma (FFP) are frequently administered to critically ill patients. Considering the variability in indications and thresholds guiding these transfusions, a comprehensive review of current evidence was conducted to provide guidance to critical care practitioners. This American College of Chest Physicians guideline examined the literature on platelet transfusions in critically ill patients with thrombocytopenia, with and without active bleeding, as well as data on prophylactic platelet and FFP transfusions for common procedures in the critical care setting.
STUDY DESIGN AND METHODS: A panel of experts developed seven Population, Intervention, Comparator, and Outcome questions addressing platelet and FFP transfusions in critically ill patients and performed a comprehensive evidence review. The panel applied the Grading of Recommendations, Assessment, Development, and Evaluations approach to assess the certainty of evidence, and to formulate and grade recommendations. A modified Delphi technique was used to reach consensus on the recommendations.
RESULTS: The initial search identified a total of 7,172 studies, and after the initial screening, 100 articles were reviewed. Sixteen studies met inclusion criteria, comprising 1 randomized controlled trial and 15 observational studies. Overall, the certainty of the evidence for all questions was very low. The panel formulated seven conditional recommendations.
CONCLUSIONS: In critically ill patients with thrombocytopenia or coagulopathy, a risk/benefit assessment should be made by providers prior to transfusion of platelets or FFP. Given the known risks of blood product transfusion, and the limited data regarding the benefits from platelet or FFP transfusion, most patients will benefit from avoiding transfusion of these blood products. In patients at high risk of bleeding, or where the bleeding complication may be catastrophic, transfusion should be considered
Therapeutic Use of γ-Hydroxybutyrate: History and Clinical Utility of Oxybates and Considerations of Once- and Twice-Nightly Dosing in Narcolepsy
No full textNarcolepsy is a rare and chronic hypersomnolence disorder characterized by excessive daytime sleepiness, disrupted nighttime sleep, sleep paralysis, and hypnagogic hallucinations and occurs with or without cataplexy. Orexin neuron loss has been implicated in the underlying pathophysiology of narcolepsy type 1 through dysregulation of sleep/wake patterns and rapid eye movement sleep. γ-Aminobutyric acid (GABA) has been shown to play a role in modulation of orexin neuronal activity during transitions from wakefulness to sleep. γ-Hydroxybutyrate (GHB), an endogenous analog of GABA, has demonstrated therapeutic benefit in treatment of narcolepsy through early investigations, but use has historically been limited owing to existing stigma related to illicit use and abuse risk. Initial regulatory approval of its sodium salt derivative, sodium oxybate (SXB), for cataplexy in patients with narcolepsy occurred in 2002, and additional formulations have been developed. The efficacy and safety of SXB in narcolepsy have been supported by decades of clinical use and research. This review discusses the history and clinical application of GHB and its SXB derivatives in the treatment of individuals with narcolepsy, including clinical safety and effect on sleep
A practical technique for optimal visualization of popliteal artery in patients with prior knee arthroplasty
No full textA practical technique to visualize popliteal artery in patients with prior knee arthroplasty is described using ipsilateral lateral knee flexion and contralateral oblique position of the image intensifier. This position is well-tolerated without any risk of kinking of the femoral sheath
Reply to: Photodynamic Diagnosis-Guided Ureteroscopic Laser Ablation of Upper Tract Urothelial Carcinoma: Some Concerns and Future Direction
No full textUtilization and Cancer Control Outcomes of Active Surveillance Amongst Black and White Men with Intermediate Risk Prostate Cancer in a Population-Based Analysis
No full textINTRODUCTION: To assess the utilization and prostate cancer (PCa)-specific mortality (PCSM) between non-Hispanic Black (NHB) and non-Hispanic White (NHW) on active surveillance (AS) with intermediate risk PCa (iPCa).
METHODS: The Surveillance, Epidemiology, and End Results database was queried between 2010-2016. The rate of AS was calculated per year between NHB and NHW using univariable logistic analysis (UVA) and multivariable logistic analysis (MVA). Next, inverse probability of treatment weighting was performed on those that underwent watchful waiting (WW) and competing-risks cumulative incidence function (CIF) and MVA were used to assess the impact of race on other-cause mortality (OCM) and PCSM. Statistical significance defined as p \u3c 0.05, but some observations were deemed non-statistically significant per our Benjamini-Hochberg procedures, RESULTS: 50,315 patients had iPCa, and 3,310 underwent AS/WW. The rate of AS increased amongst NHB (+ 3.1%) and NHW (+ 5.7%) from 2010 - 2016. UVA did not show an association with race, but MVA showed a negative association, based on our Benjamini-Hochberg correction, between NHB and AS [OR 0.68 (95% CI: 5.4-0.87; p = 0.002)]. On CIF, NHB and NHW had non-significant differences in OCM in the weighted cohort (p = 0.03), due to the Benjamini-Hochberg correction, and that was confirmed with MVA with a HR of 1.23 (95% CI: 1.02-1.49; p = 0.03). However, the CIF on PCSM showed NHB had a higher risk of PCSM (p \u3c 0.0001), and that was confirmed with MVA with a HR of 3.01 (95% CI: 2.00-4.53; p \u3c 0.001).
CONCLUSION: The utilization of AS for iPCa increased amongst NHB and NHW patients. Unfortunately, NHB race was associated with increased risk of PCSM from one year to the next compared to NHW patients
Impact of post-traumatic stress disorder symptoms, childhood adversities and stressful life events on depressive and anxiety symptoms: insights from the UK Biobank
No full textBACKGROUND: Childhood adversities (CAs) and stressful life events (SLEs) are linked to depressive, anxiety, and PTSD symptoms. However, their interrelationships are not well studied. We aimed to examine the potential role of PTSD symptoms as risk factors for both outcomes, test the stress sensitization hypothesis, and investigate the pathways linking CAs, stressful life events (SLEs) and PTSD symptoms, and depressive and anxiety symptoms.
METHODS: We conducted a cross-sectional study using data from adult participants at baseline (2006-2010) and online follow-up (2016) in the UK Biobank. Data analysis was performed from February 24, 2023, to July 12, 2023. Linear regression and serial mediation analyses were performed.
RESULTS: PTSD symptoms was significantly associated with depressive (β = 0.567, p\u3c .001) and anxiety symptoms (β = 0.558, p\u3c .001). The interaction between CAs and SLEs was still significantly associated with depressive symptoms when accounting for those of PTSD as covariates (β = 0.017, p\u3c .001), but not for anxiety symptoms. The serial mediation analyses revealed that SLEs and PTSD symptoms were both significant sequential mediators between CAs and symptoms of depression and anxiety (proportion mediated: 75.14% and 84.27%, respectively, p\u3c 0.05).
CONCLUSIONS: Our study provided further evidence for stress sensitization hypothesis only among participants with depressive symptoms and found that SLEs and PSTD symptoms partly mediated the association between CAs and depressive and anxiety symptoms. These findings may provide new evidence to better understand the pathogenesis of depression and anxiety and will help to guide future prevention and intervention for both diseases