6501 research outputs found
Sort by
Pathways to therapy resistance: The sheltering effect of the bone marrow microenvironment to multiple myeloma cells
Get PDFMultiple Myeloma (MM) is a malignant expansion of plasma cells in the bone marrow (BM), resulting in a disease characterized by symptoms of end organ damage from light chain secretion, crowding of the BM, and bone lesions. Although the past two decades have been characterized by numerous novel therapies emerging, the disease remains incurable due to intrinsic or acquired drug resistance. A major player in MM\u27s drug resistance arises from its intimate relationship with the BM microenvironment (BMME). Through stress-inducing conditions, soluble messengers, and physical adhesion to BM elements, the BMME activates numerous pathways in the myeloma cell. This not only propagates myeloma progression through survival and growth signals, but also specific mechanisms to circumvent therapeutic actions. In this review, we provide an overview of the BMME, the role of individual components in MM survival, and various therapy-specific resistance mechanisms reported in the literature
A Deep Dive into the Relationship between Sleep Deprivation and Pain Perception: A Cross-Population Analysis
Get PDFBackground: Sleep deprivation and pain perception significantly impact one another through altered sleep parameters such as Total Sleep Time (TST) and Sleep Efficiency (SE). Particularly in neuropathic pain, disturbed sleep exacerbates pain by disrupting neurobiological mediators like opioids and serotonin. Our research examined how sleep loss affects pain in chronic conditions versus healthy individuals. This research underpins our analysis of how interventions, possibly nutritional, could improve sleep quality and modulate pain perception, exploring this relationship across diverse populations and conditions.
Methods: Our study reviewed peer-reviewed articles published since 2010 on sleep deprivation and pain perception. We searched PubMed, focusing on terms related to insomnia and musculoskeletal and neuropathic pain, selecting systematic reviews, meta-analyses, clinical trials, and longitudinal studies to examine the relationship across clinical and healthy populations.
Results: Our research reveals a positive correlation between chronic neck and back spinal pain with insomnia severity. There were similar associations in conditions like fibromyalgia.
Conclusion & Discussion: We found that disrupted sleep, especially decreased deep sleep stages like N3 and REM, correlates with increased pain sensitivity. Our research highlights the crucial role of restorative sleep in modulating pain, as sleep deprivation reduces the effectiveness of natural analgesics and exacerbates inflammatory response. Our research also underscores the importance of managing sleep disturbances to optimize pain control, particularly in athletes who experience reduced sleep quality due to training and stress
A Scoping Review: Ketamine for the Prevention of Perioperative Shivering in Patients Undergoing Spinal Anesthesia
Get PDFIntroduction: Shivering is a frequently encountered perioperative complication in patients undergoing spinal anesthesia. Numerous different pharmacological agents have been employed to mitigate this issue.
Objective: This scoping review aims to evaluate the efficacy of ketamine in mitigating the incidence of shivering.
Methods: Pubmed, Jama, and Cochrane were used as primary databases. Searches were performed using combinations of key terms: Ketamine, Shivering, Spinal Anesthesia, and Hypothermia.
Results:In ketamine versus control, three out of five studies found ketamine to be more effective (p
Conclusion: Ketamine is an effective and safe drug for preventing perioperative shivering. While there is mixed evidence on whether it is better than other treatments, ketamine may have advantages from a hemodynamics standpoint. However, doctors should be cautious when prescribing it to patients who might be prone to delirium due to its association with hallucinations. Overall, ketamine is a safe and effective drug for the prevention of perioperative shivering
Amlodipine-Induced Angioedema: A Case Report and Literature Review
Get PDFAngioedema is a medical condition characterized by rapid and localized swelling in the deeper layers of the skin and mucous membranes. Unlike hives (urticaria), which affect the superficial layers of the skin and appear as raised, itchy welts, angioedema involves swelling beneath the skin\u27s surface and commonly affects areas such as the face, lips, tongue, throat, hands, feet, and genitals. This swelling can be dramatic and may cause discomfort, pain, or difficulty with breathing or swallowing, depending on the location and severity of the swelling. Here we present the case of 73-year-old patient with amlodipine-induced angioedema. This case highlights the importance of considering dietary factors and potential allergic reactions in patients presenting with acute angioedema. Prompt recognition and appropriate management, including airway protection and supportive care, are essential in preventing complications associated with angioedema. Collaboration between specialties, including allergy and immunology, is crucial for optimizing patient care and preventing future episodes
Complex interplay of R&D, advertising and exports in USA manufacturing firms: differential effects of capabilities
No full textThis study aims to explore the dynamic interplay of key resources (i.e. research and development (R&D), advertising and exports) in affecting the performance of USA manufacturing firms. Specifically, the authors examine the dynamic impact of joint resources and predict differential effect scales contingent on firm capabilities.
This study finds that the impact of joint resources and synergistic rents is not uniform but rather distinctive according to the combinatory conditions and that the pattern is further shaped by firm capabilities. Accordingly, besides signifying the contingent aspect of capabilities across a range of resource combinations, the result also shows that managerial sophistication in adaptive resource control is more than a managerial ethos
Developing a fair and interpretable representation of the clock drawing test for mitigating low education and racial bias.
Get PDFThe clock drawing test (CDT) is a neuropsychological assessment tool to screen an individual\u27s cognitive ability. In this study, we developed a Fair and Interpretable Representation of Clock drawing test (FaIRClocks) to evaluate and mitigate classification bias against people with less than 8 years of education, while screening their cognitive function using an array of neuropsychological measures. In this study, we represented clock drawings by a priorly published 10-dimensional deep learning feature set trained on publicly available data from the National Health and Aging Trends Study (NHATS). These embeddings were further fine-tuned with clocks from a preoperative cognitive screening program at the University of Florida to predict three cognitive scores: the Mini-Mental State Examination (MMSE) total score, an attention composite z-score (ATT-C), and a memory composite z-score (MEM-C). ATT-C and MEM-C scores were developed by averaging z-scores based on normative references. The cognitive screening classifiers were initially tested to see their relative performance in patients with low years of education (\u3c = 8 years) versus patients with higher education (\u3e 8 years) and race. Results indicated that the initial unweighted classifiers confounded lower education with cognitive compromise resulting in a 100% type I error rate for this group. Thereby, the samples were re-weighted using multiple fairness metrics to achieve sensitivity/specificity and positive/negative predictive value (PPV/NPV) balance across groups. In summary, we report the FaIRClocks model, with promise to help identify and mitigate bias against people with less than 8 years of education during preoperative cognitive screening
Changes to tropical cyclone trajectories in Southeast Asia under a warming climate
Get PDFThe impacts of tropical cyclones (TCs) on Southeast Asia’s coastlines are acute due to high population densities in low-lying coastal environments. However, the trajectories of TCs are uncertain in a warming climate. Here, we assess \u3e64,000 simulated TCs from the nineteenth century to the end of the twenty-first century for both moderate- and high-emissions scenarios. Results suggest changes to TC trajectories in Southeast Asia, including: (1) poleward shifts in both genesis and peak intensification rates; (2) TC formation and fastest intensification closer to many coastlines; (3) increased likelihoods of TCs moving most slowly over mainland Southeast Asia; and (4) TC tracks persisting longer over land. In the cities of Hai Phong (Vietnam), Yangon (Myanmar), and Bangkok (Thailand), these variations result in future increases in both peak TC intensity and TC duration compared to historical TCs
Case Report: Overdrive Pacing in Refractory Ventricular Tachycardia
Get PDFWe report a case of a 67-year-old male who presented to the emergency department (ED) for palpitations and complaint of his automated implantable cardioverter defibrillator (AICD) firing at home who had multiple episodes of persistent ventricular tachycardia (VT) during his course of stay in the ED. Patients with pacemakers and AICDs can present an additional layer of complexity when treating these conditions. Temporary overdrive pacing (TOP) should be considered as a treatment to correct refractory ventricular tachycardia in patients with implanted pacemakers and AICDs presenting to the ED
Case Report: Varicella Zoster Virus Encephalitis Presenting with Monochorea
Get PDFMeningoencephalitis is a broad range of symptoms as a sequela of inflammation of the CNS system. It is a diagnosis that is often missed, especially in atypical presentations. We describe a case of HSV encephalitis that presented to the ER afebrile with atypical arm movements, most similar to a monochorea, and discuss other cases in the literature of atypical presentations of this disease
Clostridium Perfringens Sepsis from a Hepatic Abscess with Hemolysis and Renal Failure, Requiring Hemodialysis
Get PDFThe prognosis of sepsis caused by Clostridium perfringens is extremely poor, with a mortality rate of 70%-100%. Management includes antibiotic regimens specific to toxin production as well as source control via surgical or interventional mechanisms. We report a case of a 64-year-old male who presented with right upper quadrant (RUQ) abdominal pain and was diagnosed with Clostridium perfringens bacteremia with associated acalculous cholecystitis, hepatic abscess, and acute renal failure requiring hemodialysis. It is felt that early hemodialysis was an associated factor in the patient\u27s survival