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03 - Near Death to Bring Life Hyperemesis Gravidarum during Pregnancy
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Only 3% of pregnant women have hyperemesis gravidarum which is morning sickness to an extreme level. When I experienced it with my first child, I was told it was unlikely to happen again. However, I experienced it with my second and third pregnancies as well. I was told there is not much you can do. I felt hopeless. I hope to share the story of how something difficult can bring life into the world and how my mental/emotional road to recovery is still in process.
About Andrea
Andrea Swett, M.S., NASM-CPT
Director for the Center of Healthy Living and Central Scheduling at UNMC*
*At time of recording.https://digitalcommons.unmc.edu/livinglibrary2024/1003/thumbnail.jp
Dying Right: Supporting Anti-Cancer Therapy Through Immunogenic Cell Death
Get PDFThe primary goal of most anti-cancer therapy is to eradicate neoplastic cells. Simultaneously, neoplastic cell death is the first step of the cancer-immunity cycle, which starts with the release of antigens from cancer cells and ends with T-cell directed killing of cancer cells, in addition to long-standing memory to tumor antigens encountered. Immunogenic damage-associated-molecular patterns (DAMPs) are endogenous cell molecules repurposed in times of insurmountable cell stress (e.g., CALR, ATP, HMGB1) to facilitate communication between dying cells and adaptive immune cells, acting as adjuvants for the cancer-immunity cycle, in a cellular fate termed immunogenic cell death (ICD). It is hypothesized that immunogenic DAMP release, and thus ICD, can be induced through focal endoplasmic reticulum (ER) stress and reactive oxygen species (ROS) generation. Previously, our lab has investigated how a three-carbon-linker spirocyclic dimer (SpiD3) promotes futile activation of the unfoleded protein response (UPR) in chronic lymphocytic leukemia (CLL) cells through immense misfolded-protein mimicry, culminating to insurmountable ER stress and programmed cell death1. In turn, we hypothesize that this insurmountable ER stress may confer SpiD3 the unique ability to promote immunogenic DAMP release and propagate ICD in B-cell malignancies, such as CLL. Through the course of this project, we use CLL as a disease model to consider the relationship between novel therapeutics, manners of cancer cell death, and their contributions to adaptive immune cell engagement, as a means for improving anti-cancer therapy
International Consensus on Sleep Problems in Pediatric Palliative Care: Paving the Way
Get PDFOBJECTIVE: Sleep problems constitute a common and heterogeneous complaint in pediatric palliative care (PPC), where they often contribute to disease morbidity and cause additional distress to children and adolescents and their families already facing the burden of life-threatening and life-limiting conditions. Despite the significant impact of sleep problems, clinical evidence is lacking. The application of general pediatric sleep recommendations appears insufficient to address the unique challenges of the PPC dimension in terms of disease variability, duration, comorbidities, complexity of needs, and particular features of sleep problems related to hospice care. Therefore, we initiated an international project aimed at establishing a multidisciplinary consensus.
METHODS: A two-round Delphi approach was adopted to develop recommendations in the areas of Definition, Assessment/Monitoring, and Treatment. After selecting a panel of 72 worldwide experts, consensus (defined as ≥75% agreement) was reached through an online survey.
RESULTS: At the end of the two voting sessions, we obtained 53 consensus recommendations based on expert opinion on sleep problems in PPC.
CONCLUSIONS: This study addresses the need to personalize sleep medicine\u27s approach to the palliative care setting and its peculiarities. It provides the first international consensus on sleep problems in PPC and highlight the urgent need for global guidance to improve sleep-related distress in this vulnerable population and their caregivers. Our findings represent a crucial milestone that will hopefully enable the development of guidelines in the near future
Trends, Predictors, and Outcomes of Hepatic Encephalopathy Treatment at a Quaternary Transplant Center From 2012-2022
No full textBackground: Hepatic encephalopathy (HE) is a devastating complication of cirrhosis that increases mortality. Many patients do not receive guideline recommended HE treatment.
Our aim is to evaluate trends in HE treatment over time, variables associated with receiving treatment, and outcomes based on the type of treatment received.
Methods: Retrospective single-center cohort study of hospitalized patients with HE from July 2012 – June 2022. HE treatment was defined as receiving lactulose, rifaximin, or combination therapy.
Results: A total of 1,683 unique patients were included, 72% of patients received HE treatment. Fewer HE patients received any treatment in 2022 (65.9%) compared to 2012 (72%). Predictors of receiving any treatment included: Medicare use (p = 0.02), increasing MELD-Na score (p \u3c 0.0001), having portal hypertension (p \u3c 0.0001), hepatocellular carcinoma (p = 0.03), alcohol-related cirrhosis (p \u3c 0.0001), and being seen by gastroenterology/ hepatology (p = 0.003) or internal medicine (p \u3c 0.0001). Predictors of receiving combination therapy included: having alcohol- related (p = 0.002), biliary (p = 0.01), or other cirrhosis (p \u3c 0.0001), and portal hypertension (p = 0.04). Any HE treatment was associated with higher 30-day readmission (p \u3c 0.0001) and 1-year mortality (p = 0.0005). Combination therapy was associated with a longer median length of stay (7.8 vs. 6.6 days, p = 0.01).
Conclusion: HE treatment rates decreased from 2012 to 2022, especially among patients of older age, with autoimmune cirrhosis, lower MELD-Na scores, and infection while hospitalized. Increasing access to care from gastroenterology/hepatology is a modifiable factor that may increase HE treatment
Community Hospital Psychiatric Length of Stay Compared to Academic Center Psychiatric Length of Stay
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Comparison of Injuries Sustained on Grass and Artificial Turf by USL1 Men’s Soccer Team. Part 1: Match Related Injuries
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Quality Improvement – Optimizing Dermatology Post-discharge Care: Evaluating an EHR Intervention in Dermatology Post-discharge Follow-up
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