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ICAM-1 Autoantibodies Detected in Healthy Individuals and Cross-react with Functional Epitopes
Full text linkIntracellular adhesion molecule 1 (ICAM-1) is a cell surface glycoprotein that regulates cell-cell interactions, signaling, and immune processes. ICAM-1 expression has been shown to be elevated in many types of infections and inflammatory diseases. Strategies to block ICAM-1 function, including monoclonal anti-ICAM-1 antibodies, have been successful in treating the effects of chronic respiratory, autoimmune, and cardiovascular diseases. Naturally occurring autoantibodies targeting cytokines, endothelial cells, and other host receptors have been identified, and have been found to play a role in immunoregulation in health and disease. In this study, we determined the presence and levels of ICAM-1 autoantibodies across different age groups and disease states. We found that ICAM-1 autoantibody levels increased with age and were lower in individuals with various inflammatory states, suggesting a dynamic role in immune regulation. Using peptide microarrays, we identified high-resolution epitopes targeted by ICAM-1 autoantibodies that overlap with critical functional ICAM-1 binding sites. Finally, we determined that ICAM-1 autoantibodies were enriched for the IgG2 subclass that is critical for the response to bacterial antigens and chronic inflammation. This could indicate that molecular mimicry of bacterial antigens or underlying immune dysregulation could trigger the generation of anti-ICAM-1 antibodies. Understanding the functional implications of ICAM-1 autoantibodies could provide new insights into their contribution to immune homeostasis and their potential impact on inflammatory and autoimmune conditions
Outcomes of Free Flap Bony Reconstruction for Maxillary Defects: A Systematic Review and Meta-Analysis
No full textObjective: To analyze the clinical outcomes associated with free flap bony reconstruction of maxillary defects.
Data sources: A systematic search was performed on PubMed, Scopus, and Google Scholar databases.
Review methods: A single-arm meta-analysis of proportions was performed to calculate the pooled effect size. The inverse variance method was used to combine the effect sizes from individual studies and calculate the 95% confidence interval (CI).
Results: A total of 837 patients undergoing scapula (35.1%), fibula (37.3%), iliac crest (15.4%), and radial forearm (12.2%) reconstruction were included. The pooled flap success rate was 93.0% (95% CI: 90.6-94.9). A low fistula rate (15.9%; 95% CI: 12.8-19.6) and a high speech intelligibility rate (91.2%; 95% CI: 86.9-94.2) were measured. The pooled unrestricted diet rate was 81.2% (95% CI: 69.6-89.0), while the pooled dental implant rate was 23.5% (95% CI: 12.0-40.9). Scapula (13.6%, 95% CI: 5.2-31.2) showed a lower dental implant rate compared to fibula (33.4%, 95% CI: 6.1-79.6) and iliac crest (37.1%, 95% CI: 23.0-53.7) flaps. None of the patients with radial forearm flap received dental implants. No significant differences were found between flaps for the other outcomes.
Conclusions: Free flap bony reconstruction for maxillary defects is a reliable approach achieving excellent speech intelligibility and low fistula rates. Although the rates of unrestricted dietary intake were encouraging, dental implant placement remains a significant area for improvement
Does Color Facilitate Naming Ability in Cognitive Impairment?
No full textAlzheimer’s Disease (AD) is the most common cause of dementia and represents a loss of memory and other cognitive abilities. It is distinguishable from Mild Cognitive Impairment (MCI) in which cognitive impairment is present without impact on daily functioning. Neuropsychological assessment is one of the ways in which dementia and MCI are assessed and diagnosed. One hallmark symptom of AD in earlier stages is impairment in word-finding and naming ability, indicating deficits in semantic memory. The Neuropsychological Assessment Battery Naming Subtest (NAB-N) and the Multilingual Naming Test (MINT) are valid and reliable tests of naming ability used to diagnose dementia and MCI. The inclusion of color into these test stimuli may facilitate object recognition and naming ability, allowing for a more diagnostically accurate assessment in identifying MCI due to AD. The purpose of the dissertation was to test whether adding color to the MINT affected accuracy in discriminating diagnosis between normal cognition (NC) and MCI. Older adults aged 60+ diagnosed with MCI at Ability KC, along with healthy older adults, were recruited. Each subject was randomly assigned to receive the MINT or the newly created color version of the MINT (C-MINT). All participants also completed the NAB-N. The C-MINT was directly compared to the black-and-white MINT and the NAB-N. It was found that the C-MINT did not facilitate naming ability when compared to the MINT in those with diagnosed MCI or in healthy older adults
The Impact of the COVID-19 Pandemic on the Relationships of Older Adults With Intellectual Disability and Subsequent Effects on Quality of Life
No full textIntellectual disability is defined by subaverage intellectual and adaptive functioning, and people with this diagnosis require individual supports to meet their needs and participate in society most effectively. People with intellectual disability are now living longer than at any time in history and their quality of life may depend on the supports they receive. Quality of life is conceptualized through various domains, e.g., interpersonal relations, social inclusion, and emotional well-being. Conditions in one domain have the potential to impact circumstances in other domains. Older adults and people with intellectual disability experienced the greatest negative impact to their quality of life during the COVID-19 pandemic. The current qualitative study sought to determine if the important relationships in the lives of older adults with intellectual disability were impacted by the pandemic, and if so, how changes in these relationships affected other domains of their quality of life during the pandemic. Semi-structured interviews with older adults with intellectual disability determined that their important relationships ameliorated the negative effects of the pandemic. The themes identified in the interviews are Connection, Loss and Distress, Empowerment, Helping, Technology Use, and Faith. The important relationships of older adults with intellectual disability affected several other quality of life domains during the pandemic. Future research is needed to better understand how caregivers were affected by the pandemic, as well as how the important relationships of older adults with intellectual disability who differ from the study sample were affected, and the impact it may have had their quality of life
Idiopathic Atraumatic Renal Hemorrhage: A Case Report
No full textIntroduction: Wunderlich syndrome (WS) is a rare condition characterized by spontaneous, atraumatic renal hemorrhage. It often presents with non-specific symptoms and is typically diagnosed through computed tomography (CT). The most common presentation of WS includes the Lenk triad, which consists of flank pain, a palpable flank mass, and hypovolemic shock. If diagnosis and treatment are delayed, WS can rapidly progress and lead to unfavorable patient outcomes.
Case Report: A 65-year-old male presented to the emergency department with severe sudden-onset left flank pain with subsequent CT angiogram demonstrating an actively bleeding left renal hematoma. The patient was managed conservatively with supportive care. His vitals remained stable, and he did not require any surgical or vascular interventions.
Conclusion: Wunderlich syndrome is a spontaneous renal or perinephric hemorrhage occurring in the absence of trauma; it is rarely included in the differential for patients with flank pain but can become life-threatening when not recognized
PrEP-Related Medical, Structural and Institutional Mistrust among a Socioeconomically Diverse Sample of Black, Latine, Asian, and White Young Sexual Minority Men: Lived Experiences of Intersectional Inequity
No full textMistrust among marginalized populations has been shown to negatively impact health behaviors and outcomes. Young sexual minority men (YSMM) experience many health inequities, including those related to HIV. Understanding how YSMM think about and experience medical, structural, and institutional mistrust is critical to effectively promoting engagement in preventive services like pre-exposure prophylaxis (PrEP). The study recruited 43 YSMM (ages 25-27) from diverse racial, ethnic, and socioeconomic backgrounds in New York City. Semi-structured interviews were conducted from July- November 2018 and focused on sexual health, HIV-related beliefs, PrEP, and experiences with healthcare systems and providers. Three main themes were identified: (1) concerns regarding PrEP as a medication, including its perceived novelty, potential side effects, and the perceived lack of a compelling reason to take preventive medication; (2) ethical and philosophical apprehensions around perceived U.S. government-pharmaceutical collusion, and (3) PrEP and healthcare providers are not necessarily perceived as nefarious; mistrust can coexist with support for PrEP. Although most participants expressed some level of government-pharmaceutical mistrust, such mistrust did not necessarily dissuade them from supporting or even taking PrEP. While most participants did not consider healthcare providers as actors in government-pharmaceutical collusion, clinicians can play an essential role in addressing patients\u27 concerns and building trust. Clinicians should endeavor to make space for open, non-judgmental conversations not only about sexual behavior, but also patients\u27 experiences of discrimination and socioeconomic exclusion. Finally, structural interventions must seek to address societal and institutional inequities to undo harm and earn trust.
Se ha demostrado que la desconfianza entre poblaciones marginadas impacta negativamente en los comportamientos y resultados relacionados con la salud. Los hombres jóvenes pertenecientes a minorías sexuales (HJMS) experimentan numerosas inequidades en salud, incluidas aquellas relacionadas con el VIH. Comprender cómo los HJMS piensan y experimentan la desconfianza médica, estructural e institucional es fundamental para promover de manera efectiva la participación en servicios preventivos como la profilaxis preexposición (PrEP). El estudio reclutó a 43 HJMS (de entre 25 y 27 años) provenientes de diversos contextos raciales, étnicos y socioeconómicos en la ciudad de Nueva York. Se realizaron entrevistas semiestructuradas entre julio y noviembre de 2018, centradas en la salud sexual, creencias relacionadas con el VIH, la PrEP y experiencias con los sistemas de salud y sus proveedores. Se identificaron tres temas principales: (1) preocupaciones en torno a la PrEP como medicamento, incluida su novedad percibida, los posibles efectos secundarios y la falta percibida de una razón convincente para tomar un medicamento preventivo; (2) aprensiones éticas y filosóficas respecto a una supuesta colusión entre el gobierno de los Estados Unidos y la industria farmacéutica; y (3) la PrEP y los proveedores de salud no son necesariamente percibidos como entidades malintencionadas; la desconfianza puede coexistir con el apoyo a la PrEP. Aunque la mayoría de los participantes expresó cierto nivel de desconfianza hacia la relación gobierno-industria farmacéutica, dicha desconfianza no necesariamente los disuadió de apoyar o incluso usar la PrEP. Aunque la mayoría no consideró a los proveedores de salud como actores en la colusión entre el gobierno y la industria farmacéutica, los profesionales clínicos pueden desempeñar un papel esencial en la atención a las inquietudes de los pacientes y en la construcción de confianza. Los clínicos deben procurar generar espacios para conversaciones abiertas y sin juicios, no solo sobre el comportamiento sexual, sino también sobre las experiencias de discriminación y exclusión socioeconómica de los pacientes. Finalmente, las intervenciones estructurales deben orientarse a abordar las inequidades sociales e institucionales con el fin de reparar daños y generar confianza
Epidemiology of Shoulder Dislocations in the United States From 1990 to 2019: A Temporal Study Using the Global Burden of Disease Database
No full textIntroduction
The shoulder joint is a common site for joint dislocation, with many individuals suffering from recurrent dislocations following treatment. The purpose of this study was to evaluate the epidemiology of shoulder dislocations in the United States from 1990 to 2019. Methods
The Global Burden of Disease database was utilized to collect epidemiological data on shoulder dislocations in the United States (U.S.) from 1990 to 2019. These data included age-standardized rates of years lived with disability (YLDs), prevalence rates, and incidence rates per 100,000 people. Using the U.S. Census Bureau definitions, the data were stratified into four regions: the Northeast, Midwest, South, and West. Bartlett’s test was used to assess whether the variance of the dataset was equal. Welch’s ANOVA was performed to assess differences in YLDs, prevalence rates, and incidence rates between regions. Results
From 1990 to 2019, there was an 8.69% decrease in mean YLDs, an 8.69% decrease in prevalence rates, and a 9.14% decrease in mean incidence rates of shoulder dislocations. Women experienced a 0.78% increase in mean YLDs, a 0.77% increase in mean prevalence rates, and a 0.27% increase in mean incidence rates of shoulder dislocation. Men experienced a 15.45% decrease in mean YLDs, a 15.45% decrease in mean prevalence rates, and a 15.82% decrease in mean incidence rate of shoulder dislocations. Regardless of region, men were more likely to experience a higher mean rate of YLDs (1.06 vs. 0.79, p\u3c0.001), higher mean prevalence rates (17.16 vs. 12.70, p\u3c0.001), and higher mean incidence rates (115.25 vs. 84.59, p\u3c0.001) of shoulder dislocations. The West region experienced the highest mean rate of YLDs, the highest mean prevalence rates, and the highest mean incidence rates of shoulder dislocation. The Northeast region experienced the lowest mean rates of YLDs, mean prevalence rates, and mean incidence rates. Men experienced higher mean rates of YLDs, prevalence, and incidence of shoulder dislocations compared to women (p\u3c0.001). Conclusion
From 1990 to 2019, the U.S. witnessed a decline in mean YLDs, incidence, and prevalence rates for shoulder dislocations. This trend varied by gender, with men experiencing notable decreases across these metrics, while women saw slight increases. Overall, men consistently had higher rates of shoulder dislocations compared to women. Geographically, the Western region had the highest rates, whereas the Northeast had the lowest