194341 research outputs found
Sort by
The Physical Therapist's Role in the Management of the Multisystem Effects Associated With Chronic Kidney Disease: A Case Simulation Based on Clinical Practice Guidelines
No full textChronic kidney disease (CKD) affects approximately 37 million Americans and is a leading cause of mortality. Chronic kidney disease is a systemic, progressive disease that impacts multiple bodily systems, including bone, skeletal muscle, heart, and vasculature, leading to conditions such as osteoporosis, sarcopenia, frailty, and heart failure. Despite these impairments, physical therapists (PTs) are not commonly integrated into the interdisciplinary care team. This simulated case study aims to provide PTs with plan of care recommendations for patients with CKD and to facilitate interdisciplinary collaborations between primary care physicians, nephrologists, and PTs.
Multiple clinical practice guidelines (CPGs) related to pathophysiological changes in CKD were identified and synthesized to direct PT-guided care and inform nephrologists of key indicators warranting physical therapy referral. Recommendations include exercise prescription, screening, assessment, and promotion of interdisciplinary care. The study emphasizes the importance of early intervention and episodic care to manage musculoskeletal health and improve quality of life for patients with CKD.
The case simulation presents a 58-year-old woman with stage 4 CKD who was referred to PT. The tests, measures, and interventions utilized were guided by the synthesized recommendations from multiple CPGs. The case highlights the need for principles of geriatric physical therapy regardless of age, proactive episodic care, and a tailored exercise program to mitigate musculoskeletal deterioration. The case underscores the necessity of integrating PTs into the CKD care team to address the multisystem effects of the disease and improve patient outcomes.
There is a greater need for better communication and involvement across the medical specialties that manage those with CKD. Patients with CKD experience a multitude of changes in their bodily systems that impact their mobility and quality of life. This simulated case study provided direction on the management of musculoskeletal health where one does not currently exist by synthesizing recommendations across multiple CPGs. Although these guidelines were not originally developed with this population in mind, they provide direction for clinicians to treat these patients
Lebrikizumab Improves Clinical Manifestations, Symptoms, and Quality of Life in Patients with Moderate-to-Severe Atopic Dermatitis Previously Treated with Dupilumab: Results from the ADapt Study
No full textPatients with moderate-to-severe atopic dermatitis (AD) who discontinue dupilumab need additional therapeutic options. Lebrikizumab's distinct mechanism of action may provide that alternative treatment. We evaluated efficacy and safety of lebrikizumab in adults and adolescents with moderate-to-severe AD previously treated with dupilumab.
In the open-label ADapt trial, patients who discontinued dupilumab due to inadequate response, adverse events (AEs)/intolerance, or other reasons received lebrikizumab 250-mg every 2 weeks (Q2W) following 500-mg loading dose at baseline/week 2, through week 16, with optional topical therapy. From weeks 16-24, responders (≥ 75% improvement in Eczema Area and Severity Index [EASI 75] or Investigator's Global Assessment score 0/1 with ≥ 2-point improvement from baseline) received lebrikizumab every 4 weeks; inadequate responders continued lebrikizumab Q2W. The primary endpoint was EASI 75 at week 16 in the intent-to-treat population; EASI 75 was also analyzed by reason for dupilumab discontinuation. Secondary and exploratory efficacy endpoints were assessed throughout.
Among the 86 patients enrolled, primary reasons for stopping dupilumab were inadequate response (n = 48, 55.8%), AEs/intolerance (n = 14, 16.3%), and other reasons (n = 24, 27.9%). Fifty-nine patients (68.6%) completed week 16; 52 patients (60.5%) completed week 24. At weeks 16 and 24, respectively, response rates were 57.4% (35/61) and 60.0% (33/55) for EASI 75; 53.2% (25/47) and 61.5% (24/39) for Pruritus Numeric Rating Scale ≥ 4-point improvement; and 83.0% (44/53) and 83.0% (39/47) for Dermatology Life Quality Index ≥ 4-point improvement. Most treatment-emergent AEs were mild/moderate. Serious AEs and discontinuations due to AEs were reported by 2 (2.3%) and 5 (5.8%) patients, respectively. Of the 10 patients who discontinued dupilumab due to eye-related events, facial dermatitis, or inflammatory arthritis, none reported similar events with lebrikizumab.
Results suggest that lebrikizumab provides meaningful improvements in skin clearance, itch, and quality of life in dupilumab-experienced patients with moderate-to-severe AD, with a safety profile consistent with other lebrikizumab phase 3 trials.
ClinicalTrials.gov identifier, NCT05369403
Development and Evaluation of Knowledge-Based Treatment Plans for Chest Wall and Regional Lymph Node Irradiation
Get PDFPreserved Adrenal Function After Left Renal Cell Carcinoma With Tumor Thrombus Resection and Right Adrenal Vein Ligation: A Case Report
Get PDFAdrenal insufficiency is a recognized complication following adrenalectomy and, less commonly, nephrectomy due to the anatomical and functional relationship between the adrenal glands and kidneys. While unilateral adrenalectomy is typically well tolerated due to compensation by the contralateral adrenal gland, adrenal insufficiency may still occur, particularly in cases involving bilateral disease. Recognizing and managing this risk is critical in postoperative care to prevent life-threatening adrenal crises.
We present a case of left renal cell carcinoma (RCC) with tumor thrombus (TT) level IV (extending into the right atrium). The surgery was completed exclusively through an abdominal approach without cardiopulmonary bypass (CPB). The surgical approach involved a left radical nephrectomy, left adrenalectomy, and removal of a large TT, which included a segment of the inferior vena cava (IVC) and the right adrenal vein. As a result, the right adrenal vein was sacrificed, and adrenal insufficiency was expected due to ligation of the right adrenal vein and removal of the left adrenal gland. However, one year after the procedure, adrenal insufficiency was not seen, perhaps due to venous collaterals draining the right adrenal gland.
This case highlights that in the case of complete obstruction of the IVC by the TT of an RCC, the remaining adrenal vein can be sacrificed without causing adrenal insufficiency, perhaps due to the presence of multiple venous collaterals that developed from chronic obstruction of the IVC
Soda consumption and risk of dementia: The Northern Manhattan study
No full textBackgroundSoda consumption is associated with vascular risk, but little is known about soda in relation to dementia.ObjectiveWe hypothesized that both regular and diet soda consumption were associated with increased dementia risk.MethodsWe utilized data from longitudinal population-based Northern Manhattan Study. Regular and diet soda consumption were assessed by food frequency questionnaire. Dementia was adjudicated during follow-up after a series of comprehensive neuropsychological and functional assessments. Cox proportional hazards models examined the associations between regular and diet soda consumption and dementia risk, adjusting for demographics and vascular risk factors.ResultsOf 947 dementia-free participants (mean baseline age=64 ± 8 years, 41% men, 64% Hispanic, 16% non-Hispanic White, 18% non-Hispanic Black), 20% developed dementia during follow-up, 4.8% drank regular soda >1/day and 2.3% drank diet soda >1/day. Diet soda was associated with increased dementia risk (per diet soda/day aIRR=1.39, 95% CI = 1.09-1.75), specifically among non-Hispanic White and Black participants but not among Hispanics. Those who consumed >1 diet soda per day had a 4.15- fold increased risk versus ≤1/day (95% CI = 1.81-9.49), adjusting for sociodemographics and behavioral risk factors. The association was not apparent after excluding those with obesity or diabetes, highlighting a potential for reverse causation. Although no significant association was observed between regular soda consumption and dementia, a nonstatistically significant trend was observed (unadjusted p = 0.07).ConclusionsThe results support a potential increased dementia risk associated with frequent consumption of diet soda. Further study is needed into the impacts of obesity and diabetes
Impact of intraprocedural antiplatelet therapy on stent patency and safety after emergent intracranial stenting in acute ischaemic stroke: insights from the RESISTANT registry
No full textIntroduction Emergent intracranial stenting (EIS) is increasingly employed in the context of the acute ischaemic stroke treatment, but requires intraprocedural antiplatelet therapy (APT), which may raise haemorrhagic risk. This study aimed to evaluate the safety and effectiveness of different APT regimens during EIS. Patients and methods This is a subanalysis of the RESISTANT registry, which is a multicenter retrospective registry of patients with acute ischaemic stroke treated with intracranial EIS between 2016 and 2023. Patients receiving intraprocedural antithrombotics were included. Primary efficacy outcomes were stent patency (intraprocedural and within 24 hours) and 3-month mRS. Secondary outcome was successful reperfusion (modified thrombolysis in cerebral infarction >= 2b), and the safety outcome was sICH. Multivariable and propensity score-matched analyses were performed. Results Among 827 patients, 4 APT strategies were identified: single APT (n = 102), oral dual antiplatelet therapy (dAPT) (Aspirin + Clopidogrel or Ticagrelor; n = 83), Cangrelor (n = 92) and GP IIb/IIIa inhibitors (GPi) (n = 550). Intravenous agents (Cangrelor/GPi) showed a trend towards lower risk of intraprocedural stent occlusion compared to oral dAPT (adjusted odds ratio [aOR] 0.30, [95% CI, 0.09-1.01], P = .053), though this did not reach statistical significance. GP IIb/IIIa inhibitors continued to demonstrate a protective trend at 24 hours (aOR 0.25, [95% CI, 0.06-0.99], P = .047), without a significant increase in sICH. Both intravenous agents were independently associated with higher odds of successful final reperfusion (odds ratio [OR] 4.35, [95% CI, 1.57-12.09], P = .001). No significant differences emerged between GPi and Cangrelor in matched analysis. No significant difference was observed on good functional outcome between APT strategies. Conclusion In the setting of EIS, intravenous APT agents (Cangrelor or GPi) were associated with improved stent patency and higher rates of successful reperfusion, without a significant increase in symptomatic haemorrhage
Development of an isothermal point of care method for detection of human papilloma virus (HPV)
No full textCurrent commercial methods of detection of high-risk human papilloma virus (hrHPV) rely mostly on the polymerase chain reaction (PCR) that use either 14 specific primer pairs or a single consensus primer pair (e.g., GP5+/GP6+). However, PCR requires the use of a thermal cycler (PCR machine) and electricity and therefore is not suitable for a low-cost Point of Care Test (PoCT). Moreover, PCR primers are often not suitable for isothermal amplification since at lower temperature they may anneal non-specifically leading to background amplification. We have developed an isothermal point of care method for the rapid detection of hrHPV that works at a constant temperature (<42°C) using recombinase polymerase amplification (RPA). A novel consensus primer pair was designed able to amplify all 14 hrHPV types. To enable the detection of the amplified double-stranded RPA products, one primer was labelled with a 5′-phosphate, and the other primer was labelled at the 5′-end with 6-carboxyfluorescein (FAM). Then, the double-stranded labelled RPA product was digested with Lambda exonuclease, which preferentially digests 5′-phosphorylated DNA ends whereas the 5′-FAM ends are protected, generating single-stranded 5′-FAM-labelled RPA products. These products can be detected by paper-based lateral flow assays (LFA) using biotinylated detection probes that detect all 14 hrHPV types at the same time (universal consensus detection probe). Lateral flow assay conditions were developed that allow these probes to detect all 14 hrHPV types. Using this novel isothermal rapid hrHPV detection method, amplification of all 14 hrHPV types at constant temperature (currently set at 37°C) within short time (<1h) was achieved.
[Display omitted]
•An isothermal point of care method detecting high-risk human papilloma virus is developed using modified consensus primer.•One primer is labelled at the 5′-end with a phosphate, and the other primer is labelled with 6-carboxyfluorescein (FAM).•The 5′-phosphorylated ends of the amplified double-stranded products are preferentially digested by Lambda exonuclease.•The resulting FAM-labelled single-stranded DNA is detected by lateral flow assays (LFA) using biotinylated detection probes
Ethical Implications of Global Health Care Equivalency
No full textAt the intersection of nanotechnology, nanomedicine, and artificial intelligence (AI), ethical considerations emerge as multifaceted aspects that require a careful examination. The essence of this chapter pertains to the converging vistas of these transformative technological domains, which commences by establishing the necessary context for comprehending the myriad ethical dilemmas engendered by these innovations. Broader ethical dimensions are elucidated, which underscore the significance of ethical leadership and delineate its influence on business and social ethics. The narrative accentuates the profound importance of upholding ethical standards within all facets of the healthcare sector as it traverses circuitous digital frontiers. The author examines the ethical challenges that are likely to arise via the confluence of advanced technologies and further elaborates on the inherent ethical intricacies that will be involved. Contemplating the future, the narrative extends its purview to encompass the plethora of ramifications worldwide. The transformative impacts of these technologies on a global scale are examined, while their potential influences on healthcare paradigms, societal constructs, and the inexorable evolution toward a Global Health Metaverse and Omniverse are envisioned. The chapter concludes with the synthesis of overarching themes, emphasizing the importance of a proactive, harmonized ethical approach toward the concurrent emergence of nanotechnology, nanomedicine, and AI
Injectable Therapy for Androgenetic Alopecia: A Systematic Review
No full textAndrogenetic alopecia (AGA) is the leading cause of patterned hair loss. Current therapies are limited, and injectable therapy has emerged for intradermal delivery of bioactive agents. Despite increasing use, protocols and outcomes remain heterogeneous.
To systematically evaluate the agents, techniques, efficacy, and adverse effects of injectable therapy for AGA.
A systematic review was conducted in July 2025 following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. PubMed, Embase, and Scopus were searched using the terms "mesotherapy" and "AGA." Studies were screened for relevance, with 30 meeting inclusion criteria.
Included studies comprised 7 interventional, 11 observational, and 12 descriptive reports. The most frequently studied agents were multivitamin and peptide formulations, followed by dutasteride, minoxidil, bicalutamide, growth factors, and finasteride. Techniques varied in needle type, depth, and dosing schedules. Reported outcomes ranged from increased hair density and shaft diameter to stabilization of shedding. Adverse events were generally mild but included paradoxical alopecia, scarring, and acute dermatitis.
Injectable therapy may provide cosmetic benefit in AGA, particularly with dutasteride, but current evidence is limited by small sample sizes, variable protocols, and short follow-up. Standardized randomized trials are required before injectable therapy can be recommended as routine therapy
Molecular features of human pathological tau distinguish tauopathy-associated dementias
No full textIn Alzheimer's disease (AD), pathological tau protein shows a progressive accumulation of post-translational modifications (PTMs), reflecting disease severity, progression, and prion-like activity. Although many neurodegenerative diseases with dementia display tau aggregates, the pathological proteoforms of tau protein from each disease type remain unknown. Here, using a quantitative mass spectrometry-based proteomics platform, FLEXITau, deep characterization of pathological tau protein isolated from the brains of 203 human subjects with AD, familial AD (fAD), chronic traumatic encephalopathy (CTE), corticobasal degeneration (CBD), Pick's disease (PiD), progressive supranuclear palsy (PSP), dementia with Lewy bodies (DLB)-a non-tauopathy symptomatic control-and healthy controls (CTR) is performed. Unsupervised data analyses and supervised machine learning identify distinct molecular features of pathological tau for each disease, enabling molecular disease stratification. This study identifies potential disease-specific biomarkers and therapeutic targets for tauopathies and provides critical quantitative information for pharmacokinetic modeling required for therapeutic and disease mechanism studies