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Stimulus-Driven Cerebrospinal Fluid Dynamics Is Impaired in Glaucoma Patients
No full textCerebrospinal fluid (CSF), partly driven by sensory stimulation, is crucial for maintaining homeostasis and clearing metabolic waste. Whether such stimulus-driven CSF flow is disrupted in age-related neurodegenerative diseases of the visual system remains unclear. This study examined the CSF flow during visual stimulation in glaucoma patients and healthy older adults using functional magnetic resonance imaging. In glaucoma, CSF inflow becomes progressively decoupled from the visually evoked blood-oxygenation-level-dependent (BOLD) response. Specifically, the characteristic stimulus-locked CSF patterns, which decrease after stimulus onset and increase after offset, diminish with disease severity. Mediation analysis suggests this flattened CSF pattern is driven by a flatter ascending BOLD slope, leading to a shallower CSF trough and a reduced post-stimulus surge. These results indicate that glaucoma-related functional impairments contribute to downstream alterations in CSF dynamics. Overall, this study provides insight into how glaucoma disrupts visually driven CSF inflow and highlights in vivo biomarkers for monitoring CSF dynamics
Does Dexmedetomidine Affect Opioid Consumption Following Orthognathic Surgery?
No full textBACKGROUND: Despite its purported analgesic effects, controversy exists regarding dexmedetomidine\u27s efficacy as an opioid-sparing anesthetic adjunct.
PURPOSE: The purpose of this study is to measure the association between dexmedetomidine (DEX) administration during orthognathic surgery and postoperative opioid consumption.
STUDY DESIGN, SAMPLE, AND SETTING: A single-blind randomized prospective cohort study was implemented. Patients consenting for orthognathic surgery at Thomas Jefferson University from January 2022 to October 2024 were screened. American Society of Anesthesiologists physical status I to III individuals aged ≥14 years were included. Exclusion criteria were revision surgery, recreational drug use, opioid prescription within 2 years, and chronic pain.
PREDICTOR VARIABLE: The predictor variable was anesthetic adjunct. Subjects were randomized to receive DEX or no DEX (control).
MAIN OUTCOME VARIABLES: The primary outcome variable was 24-hour postoperative opioid consumption, which was calculated as morphine milligram equivalents (MME). Postoperative pain was assessed using a visual analog scale (VAS) at 6 hours and upon patient-controlled analgesia (PCA) discontinuation at 7:00 am the following day (VASPCA). The ratio of PCA that attempts to bolus deliveries was calculated.
COVARIATES: Covariates included age, sex, body mass index (BMI), and operative duration.
ANALYSES: Descriptive statistics were calculated. Shapiro-Wilk test was used to assess sample normality. Relationships between continuous variables and DEX were studied using t test or Wilcoxon rank-sum test; χ
RESULTS: Of 66 enrollees, 50 (75.8%) subjects completed the trial (25 DEX, 25 no DEX). The mean (SD) ages for the no DEX and DEX group cohorts were 35.9 (13.5) and 41.3 (13.6), respectively (P = .2). There were no statistically significant differences in the distribution of covariates between the 2 study groups. Median (interquartile range (IQR)) morphine milligram equivalents consumption was 16.4 (15.4) and 14.8 (12.4) for no DEX and DEX groups, respectively (P = .9). No difference in pain scores was observed at 6 hours (P = .1). Median (interquartile range) VASPCA scores were 5(1) and 4(2) for no DEX and DEX cohorts, respectively (P \u3c .01). Median ratios of PCA that attempts to boluses administered (1.23) were identical between cohorts (P = .9).
CONCLUSIONS AND RELEVANCE: The findings suggest that opioid consumption following orthognathic surgery was not associated with dexmedetomidine administration
The Prevalence of Diabetic Retinopathy in American Indians or Alaska Natives and Non-Indigenous Americans: A Systematic Review and Meta-Analysis.
No full textTOPIC: To estimate the prevalence of diabetic retinopathy (DR) in adult American Indian or Alaska Native (AIAN) and non-AIAN patients with diabetes.
CLINICAL RELEVANCE: Although diabetes mellitus is more prevalent among AIAN patients compared with non-AIAN patients, the evidence is inconsistent regarding whether AIAN patients have a higher prevalence or severity of DR.
METHODS: We searched Ovid MEDLINE, EMBASE, and Web of Science databases from inception through February 23, 2025. We included primary studies evaluating the prevalence of DR in Americans with diabetes. The prevalence of (1) DR, (2) diabetic macular edema (DME), (3) proliferative diabetic retinopathy (PDR), (4) vision-threatening DR (VTDR; including DME, PDR, and severe nonproliferative DR), and (5) PDR complications were estimated. Meta-analyses were performed using Freeman-Tukey double arcsine transformations and random-effects modelling. The Joanna Briggs Institute Appraisal Checklist for Prevalence Studies was used to assess risk of bias. Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) guidelines were used to assess certainty of evidence.
RESULTS: Overall, 53 studies of 10 070 617 individuals were included. In the AIAN and non-AIAN groups, the pooled prevalence of DR was estimated to be 21% (95% confidence interval [CI], 13%-30%; GRADE, low) and 20% (95% CI, 16%-25%; GRADE, low), respectively. The prevalence of PDR was estimated to be 3% (95% CI, 1%-6%; GRADE, low) and 2% (95% CI, 1%-4%; GRADE, low), respectively. The prevalence of DME was estimated to be 3% (95% CI, 2%-4%; GRADE, low) and 3% (95% CI, 2%-4%; GRADE, low), respectively. The prevalence of VTDR was estimated to be 3% (95% CI, 1%-7%; GRADE, low) and 5% (95% CI, 4%-7%; GRADE, low), respectively. High-quality evidence was lacking. Comparative analysis demonstrated that no difference may exist in the rate of DR between AIAN and non-AIAN patients (odds ratio, 0.67; 95% CI, 0.31-1.48; GRADE, low).
DISCUSSION: No appreciable difference seems to exist in the prevalence of DR between AIAN and non-AIAN patients, although evidence is limited by the heterogeneity of studies. The high disease burden highlights that public health strategies are needed equally for AIAN as well as non-AIAN patients.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article
Generative Artificial Intelligence: Clinical Perceptions and Use in Physical Therapy Practice
No full textBackground and Purpose Generative artificial intelligence (GenAI) is an innovative technology that is reshaping healthcare with potentials ranging from improved efficiency to advancing personalized medicine.1 Ensuring the appropriate use of GenAI in teaching and learning has expanded in academia to also ensure graduates can competently use and partner with this technology in their fields.2-4 GenAI needs to be both accepted and adopted for these initiatives to translate into professional practice. Use of GenAI in physical therapy (PT) is being explored5,6and though therapists appear to understand aspects of this technology, current perceptions and actual use of GenAI in practice is unknown. Understanding the current use and perceptions of GenAI in PT practice can facilitate its appropriate integration into the profession. This study explored the clinical use of GenAI in PT practice and compared the perceptions of GenAI between users and non-users.https://jdc.jefferson.edu/ptposters/1003/thumbnail.jp
Severe bilateral retinal degeneration following a twenty-six-year pentosan polysulfate sodium exposure: a case report.
No full textPURPOSE: To describe an advanced case of pentosan polysulfate sodium (PPS)-associated retinopathy with extensive macular and peripheral retinal involvement following prolonged high-dose exposure.
OBSERVATIONS: An 86-year-old male presented with bilateral hand motion visual acuity and a 26-year history of PPS use (400mg daily, ∼3769g cumulative dose) for treatment of interstitial cystitis. Fundus examination revealed widespread retinal degeneration characterized by confluent nummular patches of retinal atrophy in a radial distribution from the optic nerves. Ocular coherence tomography (OCT) demonstrated severe outer retinal disorganization, and fundus autofluorescence (FAF) showed extensive RPE loss and absence of the Robson Holder ring. Genetic testing excluded choroideremia and late-onset retinal dystrophy, identifying only variants of uncertain significance in candidate genes DNAJC17 and SPP2. The patient had a history of excessive coffee consumption, which may have exacerbated his interstitial cystitis and potentially contributed to retinal vascular compromise.
CONCLUSIONS AND IMPORTANCE: This case supports the dose-dependent nature of PPS toxicity and demonstrates that high cumulative doses can lead to widespread retinal degeneration beyond the typical macular involvement. The potential severity of irreversible vision loss highlights the importance of periodic retinal evaluation using multimodal imaging to facilitate early recognition of PPS toxicity in patients on long-term PPS therapy and supports ongoing efforts to establish widely accepted, comprehensive screening guidelines and cumulative dose thresholds for patients on long-term PPS therapy, similar to protocols for other potentially toxic drug-related retinopathies
Flare Guns and Trauma: Patterns, Severity, and Clinical Implications From Case and National Surveillance Data
No full textFlare guns are pyrotechnic devices capable of causing serious injury due to high-temperature combustion and projectile discharge. Though intended for signaling in maritime or wilderness settings, improper use can result in trauma patterns distinct from those seen with typical burns or fireworks. Despite their severity, flare gun injuries remain underreported and poorly characterized. We conducted a scoping review of PubMed, Scopus, and Ovid to identify 12 case reports involving 13 patients, and reviewed US National Electronic Injury Surveillance System records from 2015 to 2024, identifying 18 flare gun-specific injuries for a combined total of 31 injuries. Demographic, injury mechanism, body region, hospitalization, and fatality data were extracted and compared across sources using R. Most case report patients were male with head, neck, or torso injuries; hospitalization occurred in 92 % of cases with two fatalities. National surveillance data showed a broader age range, with 39 % under 18 years. Burns were the most common injury type in both sources; case reports also described vascular injury, airway burns, and organ damage. Fatal injuries were typically linked to moderate-range discharge, while close-range incidents caused severe nonfatal trauma. Flare gun injuries, though rare, span a wide spectrum of severity and disproportionately affect pediatric and adolescent populations. These findings support the need for improved injury surveillance, targeted prevention efforts, and increased clinical awareness of flare guns as a distinct mechanism of burns and trauma
Neck Circumference as a Novel Predictor of Cardiovascular Risk Assessed Using Framingham and PREVENT Equations
No full textPurpose: While body mass index (BMI) and waist circumference (WC) are standard clinical tools for anthropometric cardiovascular risk assessment, they are limited by measurement variability and patient discomfort. Neck circumference (NC) may offer a novel, convenient, and accurate alternative anthropometric measure for assessment of cardiovascular risk.
Methods: Standardized anthropometric measurements (NC, WC, BMI) were obtained by trained medical students from eligible patients (n = 110, 68% female, 75% African American) from primary care and cardiology offices in an IRB-approved cohort study with retrospective chart review. Electronic medical record data extraction via double data entry was used to calculate cardiovascular risk scores: Framingham, PREVENT CVD, PREVENT ASCVD, and PREVENT HF. Pearson correlation assessed unadjusted associations between NC and cardiovascular risk scores. Separate multivariate linear regression models were constructed for each score, adjusting for age, sex, race, and ethnicity.
Results: The African American patient subgroup (n = 82) displayed a positive association of NC with PREVENT Heart Failure Risk (r = 0.22, p = 0.048). Multivariate regression adjusted for age, sex, race, and ethnicity further demonstrated NC as a positive predictor of PREVENT Heart Failure Risk across the entire cohort (β = 0.60, p \u3c 0.01). NC was not predictive of Framingham, PREVENT CVD, or PREVENT ASCVD risk scores, possibly due to sample size limitations. Subject accrual to increase sample size is ongoing.
Conclusion: Preliminary data suggest that NC shows potential as a practical tool for clinical prediction of heart failure and cardiovascular risk, particularly in at-risk African Americans.https://jdc.jefferson.edu/aoa_research_symposium_posters/1018/thumbnail.jp
Oxytocin Dosing During Trial of Labor After Cesarean to Minimize the Risk of Uterine Rupture: A Systematic Review and Meta-Analysis
No full textOBJECTIVE: Oxytocin remains the mainstay for induction and for the management of labor arrest during trial of labor after cesarean (TOLAC). Therefore, the clinical question should be not whether to use oxytocin, but how to optimize its administration. This meta-analysis aimed to assess which oxytocin protocol, in terms of initial dose, amount of increase, timing to next increase, and maximum dose, may minimize the risk of uterine rupture (UR) during TOLAC.
DATA SOURCES: PubMed, Embase and Clinicaltrials.gov were searched up to September 21, 2024.
STUDY ELIGIBILITY CRITERIA: Randomized and nonrandomized studies evaluating the association between induction and/or augmentation with oxytocin and UR during TOLAC versus spontaneous TOLAC were eligible. To be included, studies had to report at least one parameter of the oxytocin protocol used (ie, initial dose, amount of increase, timing to next increase, or maximum dose). The primary outcome was UR.
METHODS: Effect measures were expressed as odds ratios (ORs) with 95% confidence intervals (CIs) and pooled using the Mantel-Haenszel method under a random-effects model. Oxytocin exposure was categorized to perform three separate meta-analyses, ie, any use (for induction and/or augmentation), for induction only, and for augmentation only. In all three comparisons, subgroup analyses assessed differences based on oxytocin initial dose (≤2 vs \u3e2 mU/min), amount of increase (≤2 vs \u3e2 mU/min), timing to next increase (\u3c 30 vs ≥ 30 minutes), and maximum dose (≤20 vs \u3e20 mU/min).
RESULTS: Twenty-one observational studies with 51,511 patients undergoing TOLAC were included. Oxytocin use during TOLAC was consistently associated with a significantly higher risk of UR across all analyses (any use: OR 1.94, 95% CI 1.36-2.77, P=.0003; induction only: OR 2.07, 95% CI, 1.28-3.36, P=.003; augmentation only: OR 2.03, 95% CI 1.22-3.38; P=.007). Among oxytocin protocol parameters, the initial oxytocin dose showed no relationship with UR risk. A significant association was found in some analyses only for increments ≤2 mU/min, though the \u3e2 mU/min subgroup was consistently underpowered. A higher risk of UR was uniformly observed when dose escalations were performed at intervals \u3c 30 minutes. Both moderate (≤20 mU/min) and high (\u3e20 mU/min) maximum doses were significantly associated with increased odds, with a greater risk at higher doses.
CONCLUSIONS: These findings showed an association between oxytocin dosing during TOLAC and an increased risk of UR. Specifically, they suggest that both the timing and cumulative exposure of oxytocin, rather than the initial or incremental dose alone, may critically influence UR risk during TOLAC. Protocols adopting longer escalation intervals (≥30 minutes) and limiting maximum doses (≤20 mU/min) may enhance safety during TOLAC. Reliable evidence, such as that from randomized trials, is required to confirm these results and define the optimal oxytocin regimen in TOLAC management. El resumen está disponible en Español al final del artículo
Safety and Effectiveness of Bolt-Mounted Versus Tunnelled External Ventricular Drains: A Systematic Review, Meta-Analysis and Trial-Sequential Analysis
No full textBACKGROUND: External ventricular drains (EVDs) are fundamental to neurocritical care, yet substantial procedural heterogeneity persists, particularly regarding bolt-mounted versus tunnelled catheter fixation. The relative safety and effectiveness of these approaches remain unclear, with conflicting data from observational studies and a lack of trial-level evidence.
OBJECTIVE: To compare bolt-mounted and tunnelled EVDs across accuracy, reoperation, and key safety outcomes using systematic review, meta-analysis, and trial-sequential analysis.
METHODS: Following PRISMA guidelines, PubMed, Embase, and CENTRAL databases were searched (November 2025) for randomised or observational studies comparing bolt-mounted with tunnelled EVDs in adults. Two reviewers independently screened studies, extracted data, and assessed risk of bias. Primary outcomes were optimal catheter placement (Kakarla Grade I) and reoperation for EVD-related complications. Secondary outcomes included iatrogenic intracranial haemorrhage (ICH), cerebrospinal fluid (CSF) infection, CSF leak, catheter obstruction or malfunction, accidental discontinuation, and drainage duration. Random-effects meta-analyses were conducted using restricted maximum likelihood estimation. Heterogeneity was quantified, and certainty of evidence was assessed using GRADE. Trial-sequential analysis was performed for reoperation to determine whether available data met required information size thresholds.
RESULTS: Ten studies encompassing 2008 patients (800 bolt-mounted, 1208 tunnelled) were included. Bolt-mounted EVDs demonstrated significantly higher optimal catheter accuracy (RR 1.27; 95% CI: 1.06-1.51; P \u3c 0.01; I2 = 29.6 %). Reoperation was numerically lower with bolt-mounted systems (RR 0.51; 95% CI: 0.22-1.36; P = 0.19; I2 = 85 %), although trial-sequential analysis showed the cumulative Z-curve crossed the monitoring boundary without reaching the required information size, indicating insufficient evidence for definitive inference. Bolt-mounted EVDs were associated with lower CSF leak risk (RR 0.13; 95% CI: 0.04-0.47; P \u3c 0.01) and reduced catheter obstruction (RR 0.46; 95% CI: 0.25-0.83; P \u3c 0.05). No significant differences were observed in iatrogenic ICH (RR 1.23; 95% CI: 0.54-2.81; P = 0.62), CSF infection (RR 0.88; 95% CI: 0.71-1.09; P = 0.23), accidental discontinuation (RR 0.41; 95% CI: 0.11-1.59; P = 0.20), or drainage duration (MD 0.56 days; 95% CI = -1.02-2.13; P = 0.49).
CONCLUSIONS: Bolt-mounted EVDs were associated with higher catheter accuracy, reduced CSF leak, and improved mechanical reliability without increased infection or haemorrhage. Although reoperation may be lower with bolt-mounted systems, current evidence remains underpowered for firm conclusions. These findings challenge historical assumptions regarding tunnelled catheters and may inform context-specific device selection in contemporary neurocritical care
Research Support Newsletter (Winter 2026)
No full textSections New Resources & Updates Research Support & Data Management Grants & Funding Opportunities Writing & Publishing Support Design & Presentation Tools Research Integrity Research Workshop