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Frequency Modulation of Deep Brain Stimulation Targeting the Periaqueductal Gray: Effects on Pain Perception and Autonomic Regulation
Get PDFIntroduction:
The periaqueductal gray (PAG) is a midbrain structure, and effective target for deep brain stimulation (DBS), involved in the modulation of a multitude of sensory and autonomic processes. It has distinct functional columnar organization, with each column playing its own role in alteration of the body’s ability to respond to pain and stressful stimuli.
Background:
Research regarding the effects of DBS on the PAG has shown the four main subregions of the PAG: the dorsomedial PAG (dmPAG), dorsolateral PAG (dlPAG), lateral PAG (lPAG), and ventrolateral PAG(vlPAG), produce various physiologic outputs when stimulated. These outputs are region and frequency dependent.
Materials and Methods:
This review synthesizes findings from 25 research articles gathered across 6 databases on human and animal studies evaluating various effects of DBS targeting the PAG.
Results:
PAG stimulation increased HF HRV and reduced LF/HF ratio13, with LF HRV changes explaining 66.9% of SBP variance (r = 0.818, p = 0.02)5. vlPAG stimulation raised bladder capacity in humans (p = 0.028)11 and increased PEFR by 13.4% 25. In rats, 5–40 Hz vlPAG stimulation reduced allodynia14 and MAP by 19 ± 4 mmHg20.
Conclusions:
DBS targeting the PAG elicits physiologic changes in a subregion and frequency specific manner. vlPAG stimulation promotes parasympathetic activation, analgesia, and bladder and respiratory modulation. These findings support the PAG as a viable target for treating intractable pain and autonomic dysfunction. Further investigation is needed to determine optimal stimulation parameters to enhance therapeutic precision and outcomes
Left Atrial Appendage Occlusion in Heart Failure Patients: A Nationwide Evaluation of Clinical Outcomes
Get PDFBetween 2010-2019 the global risk of atrial fibrillation has risen. Our research sought to explore the database of patients with AF who underwent left atrial appendage occlusion
Laser Atherectomy for Complex CAD in Ischemic Heart Failure: A Systematic Review of Revascularization Outcomes
Get PDFThis review evaluates how laser atherectomy compares to angioplasty and stenting for revascularization in patients with heart failure and complex coronary artery disease (CAD). The review explored whether laser atherectomy could improve procedural success and reduce the risk of restenosis, major cardiovascular events (MACE), and other complications. A search across multiple medical databases yielded six studies directly comparing these treatment methods. Findings showed that procedural success rates were similar between laser atherectomy (ranging from 80% to 95%) and angioplasty/stenting (85% to 98%). Restenosis rates at six and twelve months were also generally equivalent, although laser atherectomy showed potential advantages in treating heavily calcified arteries. The rate of MACE was comparable across both approaches. However, laser atherectomy was associated with a slightly increased risk of complications such as vessel perforation (around 3% vs 1%) and arterial dissection (around 4% vs 2%).
Overall, the evidence suggests that laser atherectomy offers outcomes similar to conventional angioplasty and stenting, with particular promise in patients with calcified or complex lesions—especially those with ischemic heart failure. Since severe calcification is common in this patient population, laser atherectomy may be a valuable tool to improve PCI outcomes. However, the conclusions are limited by the small number of studies and the variability in their design and outcomes, highlighting the need for further research with larger sample sizes and standardized outcomes
Assessing the Safety and Effectiveness of Endovascular Treatment Vs. Surgical Repair of Aortic Aneurysms in Patients with Marfan Syndrome: a Literature Review
Get PDFBackground: This review compares the safety and effectiveness of thoracic endovascular aortic repair (TEVAR) versus open surgical repair in patients with Marfan Syndrome (MFS) and thoracic aortic aneurysms. We assessed differences in mortality, length of hospital stay, renal impairment, and stroke incidence between the two techniques. Currently, open surgical repair is the gold standard treatment.
Hypothesis: As the gold standard treatment, we expect open surgical repair to have more favorable outcomes than TEVAR.
Methods: A systematic literature search was performed using studies from 2000-2024 across PubMed, Scopus, Embase, Cochrane, and Web of Science. Studies were included if they involved adult MFS patients undergoing open or endovascular aortic repair, and excluded if they involved pediatric populations, lacked MFS-specific data, or were case reports. 30-day post-operative outcomes and narrative synthesis of data were performed.
Results: Of 4,160 initial results, 22 studies met the inclusion criteria. TEVAR was associated with reduced in-hospital stay (7–22 days), lower 30-day renal impairment (2.0%), and lower 30-day mortality rate (3.0%) compared to open repair (10–24 days, 9.5% renal impairment, 3.5% mortality rate). TEVAR had a greater 30-day stroke rate (3.5% vs. 1.8%).
Conclusions: Overall, TEVAR and open repair are both potential options for patients with MFS, with TEVAR conferring some early post-operative advantages but with concerns of greater stroke risk. Interpretation of the findings was limited by small sample sizes and variation in outcome definition. Future research should prioritize standardized reporting and long-term follow-up in MFS populations to better inform clinical management strategies
Time-of-Day and Chronotype Influence on Cardiorespiratory and Metabolic Responses to Aerobic Exercise
Get PDFExercise enhances skeletal muscle metabolism and promotes overall health. However, the time-of-day effect of exercise on physiological responses in humans remains less clear. This study investigated how exercise timing and individual chronotype influence cardiorespiratory and metabolic responses during aerobic exercise. Thirty healthy, young (20.9 ± 1.5 years) adults comprising 15 men and 15 women were recruited and classified using the Morningness-Eveningness Questionnaire into morning types (M-types, n = 5), neither types (N-types, n = 20), and evening types (E-types, n = 5). All subjects underwent a V̇o2max test and 2 randomized exercise trials at ∼75% V̇o2max for 30 minutes, 1 in the morning before 9 am and 1 in the afternoon after 3 pm. Oxygen uptake (V̇o2), heart rate (HR), respiratory exchange ratio (RER), and rates of carbohydrate (COX) and fat oxidation (FOX) were determined during the last 15 minutes of each exercise bout. No significant differences in V̇o2 and HR were found between am and pm. However, RER and COX were lower (p \u3c 0.05) in am (0.920 ± 0.012 and 27.83 ± 2.29 mg·kg−1·min−1, respectively) than pm (0.941 ± 0.09 and 30.65 ± 1.66 mg·kg−1·min−1, respectively), while FOX was marginally higher (p = 0.077) in am (4.12 ± 0.63 mg·kg−1·min−1) than pm (3.07 ± 0.49 mg·kg−1·min−1). In addition, HR was higher (p \u3c 0.05) in E-types (188.2 ± 3.9) than in N-types (178.4 ± 2.0) and M-types (167.7 ± 4.0). These results suggest that morning aerobic exercise may be more effective in mobilizing fat as an energy source compared with afternoon exercise. The similar V̇o2 and HR levels between morning and afternoon sessions imply that the time of day may not have a major impact on cardiorespiratory responses during submaximal aerobic exercise. However, exercising HR seems to vary across chronotypes, highlighting the need to consider individual circadian phenotypes when conducting training programs
How Does Exposure to Early-Life Stressors Shape Eating Behaviors in Adulthood?
Get PDFThe objective of this literature review is to explore the relationship between early-life stress and the development of disordered or dysregulated eating in adulthood. A search was conducted across PubMed, CINAHL, Embase, and PsycINFO databases. Results from each study were compared and synthesized. Twelve studies were analyzed including case reports, systematic reviews, cohort studies, and cross-sectional studies. Research indicates that childhood emotional abuse, often more prevalent than other forms of maltreatment, is a significant risk factor for eating pathology, with studies investigating psychological mediators such as anger, anxiety, and dissociation in this relationship. Adverse Childhood Experiences (ACEs) and early life stress appears to be a particularly significant factor in eating psychopathology and increased risk of adulthood obesity through mechanisms such as emotional dysregulation, depression, and disordered eating. Screening for ACEs and childhood trauma may be crucial in identifying individuals at higher risk for developing obesity and eating disorders and treating patients with trauma-informed care. Further research is needed to fully understand the complex causal pathways linking childhood trauma to adult obesity and eating disorders
Side Effect Profiles in Immunotherapy vs Chemotherapy in the Treatment of Pediatric Acute Lymphoblastic Leukemia
Get PDFBackground: Acute lymphoblastic leukemia (ALL) is the most common cancer in children and also one of the most curable, with current cure rates surpassing 90%. Immunotherapy using biologics is an emerging cancer treatment approach that shows significant promise and is generally less toxic than traditional chemotherapy. Due to its lower toxicity compared to chemotherapy, standalone immunotherapy may represent a promising treatment option for pediatric ALL patients.
Hypothesis: This review aims to compare acute side effect profiles and chronic complications in chemotherapy versus immunotherapy treatment modalities for pediatric patients with ALL. Immunotherapy is hypothesized to have a more tolerable side effect profile.
Methods: Online databases were accessed using various search terms. Eleven articles published between 2015-2023 met the inclusion criteria. The inclusion criteria consisted of English-written, primary research and systematic reviews, and focused on chemotherapy and immunotherapy treatments or adverse effects in pediatric ALL patients.
Results: It is demonstrated that blinatumomab use in children and young adults with B-ALL had lower rates of serious adverse events compared to chemotherapy. All adverse effects developed by patients receiving immunotherapy were fully reversible, with no reported deaths related to the adverse effects. Both chemotherapy and immunotherapy have serious side effects; however, chemotherapy-associated effects are typically more severe and chronic.
Conclusion: The use of immunotherapy in treating pediatric ALL has the potential to reduce the number and severity of present and future side effects observed in cancer treatment. Immunotherapy may be a more effective treatment option in patients who show resistance to current treatments
Children Born to Mothers with Inflammatory Bowel Disease: A Review of Pediatric Outcomes
Get PDFBackground: Inflammatory Bowel Disease (IBD), comprising Crohn’s disease and ulcerative colitis, frequently affects women during their reproductive years. While the impact of IBD on pregnancy has been widely studied, less is known about the long-term health outcomes in children born to affected mothers, particularly in the context of in utero exposure to immunosuppressive therapies.
Hypothesis: We hypothesize that children born to mothers with well-managed IBD experience normal growth and development, with minimal risk for immune-related complications, despite potential exposure to biologics and other IBD medications during gestation.
Methods: A literature review was conducted using PubMed and Google Scholar. Search terms included “IBD and Fetal Health,” “Fetal Development in IBD,” “Biologics AND “pregnancy with IBD,” and “IBD and pregnancy.” Inclusion criteria focused on studies evaluating postnatal outcomes such as immune development, infection rates, growth parameters, and risk of IBD in offspring.
Results: Findings from multiple cohort studies, including data from the PIANO registry, suggest that most children demonstrate normal growth and developmental trajectories. Biologic exposure, particularly to anti-TNFα agents, does not appear to significantly increase neonatal infections or immune dysfunction. While there is a modest genetic predisposition for IBD, maternal disease activity or medication use was not directly linked to pediatric disease onset.
Conclusions: Children born to mothers with IBD generally have favorable long-term outcomes. Continued research is essential to further assess immune development, especially following biologic exposure in the third trimester, and to develop evidence-based pediatric follow-up guidelines
A Review of Sutures and the Prospective Applications of Nanofiber Technology in Suture Engineering
Get PDFIntroduction: Suturing is a method to close surgical or traumatic wounds to promote healing. The ideal suture should have high tensile strength that loses strength at the same rate as the healing tissue gains strength, be easy to handle and form secure knots, induce minimal inflammation, and stretch/recoil according to wound contraction. While there are suture materials available for use in various procedures that fulfill most requirements, no one suture possesses every desirable characteristic, and limitations are still prevalent. Nanofiber geometry has a well-known ability to modulate cell morphology, attachment, gene expression, extracellular matrix production, and macrophage polarization in vitro and in vivo when compared to flat/conventional geometries. Therefore, the purpose of this review is to provide an overview of sutures and the current market on sutures in different surgical fields, while highlighting the opportunities for nanofiber technology in suture engineering.
Methods: A comprehensive literature review was performed using key terms on PubMed to examine works regarding the physical and mechanical properties of sutures, the current market on sutures in different surgical specialties, limitations of current sutures, future directions in suture fabrication, polymeric nanofibers, and suitable applications of nanofiber technology in suture engineering. Articles were not excluded based on year of publication or country of origin.
Results: A summary of results is provided in Table 1.
Conclusion: Nanofibers can play an important role in developing new kinds of sutures to replace the traditional threads in terms of properties and functional performances such as drug delivery and wound healing
Analyzing Preventative Skin Care Practices Among Diabetic, Pre-diabetic and Non-diabetic Patients
Get PDFBackground and Hypothesis: Diabetes Mellitus refers to a chronic metabolic syndrome where patients have high blood glucose due to the body’s inability to produce adequate amounts of insulin. This hyperglycemia and other factors make diabetic patients more prone to a number of skin conditions such as dry skin, skin rashes, itchiness and bacterial or fungal infections. There are specific skin practices recommended to reduce the risk of these skin ailments including moisturizing regularly, avoiding hot showers, examining feet regularly for any changes, seeing a physician for major cuts/burns/infections amongst several others. However, there is no available literature that analyzes the awareness of practicing healthy skin care among diabetics. We aim to close this gap in our research. This study aims to analyze the prevalence of healthy skin care practices among diabetic, pre-diabetic and non-diabetic patients. It is hypothesized that diabetic patients are more likely to follow preventive and healthy skin care practices than pre-diabetic and non-diabetic patients.
Methods: This survey-based study was conducted at the Rowan Family Medicine office located in Sewell, NJ. Participants were recruited directly at this primary care center. Inclusion criteria included patients of the Family Medicine office from age 18-89 years old. Exclusion criteria included patients with a personal or family history of skin cancer. A total number of 104 subjects were recruited out of which 63 subjects were included in the study. The subjects were further divided into Type 2 diabetic (n=10), pre-diabetic (n=6) and non-diabetic (n=47). Data on skin care practices was collected through an 8-question survey administered to patients. The response was then analyzed using SPSS software and Excel to assess prevalence and differences across the three groups.
Results: The results indicate that the non-diabetic group had the highest response to “keeping skin clean and dry” (mean = 93% of times/week) compared to Type 2 diabetic group (mean =82.5%) and pre-diabetic group (mean =75%), with a statistically significant difference (p = 0.04). Similarly, avoiding hot baths was most practiced by the Type 2 Diabetic group (mean = 85%) with significant differences across groups (p = 0.01). Other practices, including practicing ABCDE for melanoma, checking feet regularly for cuts, using sun protection, and seeing a dermatologist showed no significant differences across the three groups, with p-values of 0.15, 0.12, 0.63, 0.15, respectively. Although Type 2 Diabetic patients avoid hot baths, other skin care prevention showed no statistical significance highlighting the aspect that more awareness should be brought to practicing preventative skin care practices among patients with diabetes.
Conclusions: The results highlight the need for increased education on skin care practices, especially among diabetic patients. This study underscores the osteopathic principle of preventive care and emphasizes the role of clinicians in promoting skin health awareness among at-risk populations