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Jaw-Muscle Fiber Architecture and Skull Form Facilitate Relatively Wide Jaw Gapes in Male Cercopithecoid Monkeys
No full textBiology of Healthy Aging: Biological Hallmarks of Stress Resistance Related and Unrelated to Longevity in Humans
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Neurocognitive Outcome in Children With Sickle Cell Disease After Myeloimmunoablative Conditioning and Haploidentical Hematopoietic Stem Cell Transplantation: A Non-Randomized Clinical Trial
No full textBackground: Due to the risk of cerebral vascular injury, children and adolescents with high-risk sickle cell disease (SCD) experience neurocognitive decline over time. Haploidentical stem cell transplantation (HISCT) from human leukocyte antigen-matched sibling donors may slow or stop progression of neurocognitive changes. Objectives: The study is to determine if HISCT can ameliorate SCD-associated neurocognitive changes and prevent neurocognitive progression, determine which specific areas of neurocognitive functioning are particularly vulnerable to SCD, and determine if there are age-related differences in neurocognitive functioning over time. Methods: We performed neurocognitive and neuroimaging in SCD recipients following HISCT. Children and adolescents with high-risk SCD who received parental HISCT utilizing CD34+ enrichment and mononuclear cell (T-cell) addback following myeloimmunoablative conditioning received cognitive evaluations and neuroimaging at three time points: pre-transplant, 1 and 2 years post-transplant. Results: Nineteen participants (13.1 ± 1.2 years [3.3–20.0]) received HISCT. At 2 years post-transplant, neuroimaging and cognitive function were stable. Regarding age-related differences pre-transplantation, older children (≥13 years) had already experienced significant decreases in language functioning (p \u3c 0.023), verbal intelligence quotient (p \u3c 0.05), non-verbal intelligence quotient (p \u3c 0.006), and processing speed (p \u3c 0.05), but normalized post-HISCT in all categories. Conclusion: Thus, HISCT has the potential to ameliorate SCD-associated neurocognitive changes and prevent neurocognitive progression. Further studies are required to determine if neurocognitive performance remains stable beyond 2 years post-HISCT. Clinical trial registration: The study was conducted under an investigator IND (14359) (MSC) and registered at clinicaltrials.gov (NCT01461837)
Racial Differences and Comparative Clinical Outcomes Among Patients With Metabolic Dysfunction-Associated Steatotic Liver Disease Hospitalized for Covid-19: Insights From the National Inpatient Sample Database
No full textBackground: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease in the United States. Literature has shown that patients with advanced chronic liver disease experience higher morbidity and mortality from COVID-19; however, the impact of COVID-19 on those hospitalized with MASLD remains unclear. This study compares the outcomes in MASLD patients with and without COVID-19 using a large nationwide inpatient database.
Methods: National Inpatient Sample (NIS) datasets were used from 2020 to 2021 to identify patients with a diagnosis of MASLD (including MA steatohepatitis, MASH) using ICD-10 codes. Patients under 18 were excluded. Clinical outcomes were compared in hospitalized MASLD patients with or without COVID-19 using multivariable logistic regression, adjusting for confounders.
Results: Of 1,434,504 patients with MASLD, 111,970 patients with MASLD were hospitalized with COVID-19. Outcomes were compared between those without COVID-19 and those with COVID-19. The adjusted odds of mortality were significantly higher in MASLD patients with COVID-19 [aOR: 6.9 (95% CI: 6.53–7.3, p \u3c 0.001)]. Additionally, linear regression analysis showed that the length of stay (LOS) was significantly longer in MASLD patients with COVID-19, with an estimated increase of 4.1 days (95% CI: 3.96–4.25, p \u3c 0.001). Total healthcare charges (THC) were also significantly higher, with an increase of 41,571–$48,087, p \u3c 0.001). The odds of requiring endotracheal intubation (EI) were also significantly higher in MASLD patients with COVID-19aOR: 5.12 (95% CI: 4.83–5.43, p \u3c 0.001)]. Furthermore, these patients had increased odds of developing sepsis [aOR: 2.77 (95% CI: 2.59–2.96, p \u3c 0.001)], septic shock [aOR: 2.99 (95% CI: 2.81–3.19, p \u3c 0.001)], bacterial pneumonia [aOR: 1.63 (95% CI: 1.54–1.73, p\u3c 0.001), hepatic encephalopathy (HE) [aOR: 1.31 (95% CI: 1.19–1.44, p \u3c 0.001)], and acute kidney injury (AKI) [aOR: 1.24 (95% CI: 1.19–1.28, p \u3c 0.001)]. (Table 1 & 2).
Conclusion: This study demonstrates that MASLD patients hospitalized with COVID-19 face significantly worse outcomes than those without COVID-19. These patients have higher odds of mortality, LOS, and THC. Additionally, they are at increased risk of requiring EI and developing severe complications such as sepsis, septic shock, bacterial pneumonia, HE, and AKI. Moreover, our study demonstrates significant racial differences, with higher representation of Hispanics, Asian/Pacific Islanders, and Native Americans in the COVID-19 cohort. Given that these findings are based on pre-vaccine data, it is crucial to consider how vaccination may alter these severe outcomes in the post-vaccine era
Dupilumab-Associated Head and Neck Dermatitis Shows a Pronounced Type 22 Immune Signature Mediated by Oligoclonally Expanded T Cells
No full textDupilumab, a therapeutic antibody blocking the eczematous type 2 immune response in atopic dermatitis (AD), has shown efficacy in many clinical trials and real-world observational studies. In addition to blepharitis and conjunctivitis, the de novo appearance of head/neck dermatitis is now recognized as a distinct side effect, occurring in up to 10% of patients at any time after dupilumab initiation. Histopathological features distinct from conventional AD suggest a drug effect, but the exact underlying mechanisms remain unknown. We thus profiled punch biopsies from dupilumab-associated head and neck dermatitis (DAHND) by using single-cell RNA sequencing and compared data with untreated AD of the same region and of the trunk, as well as healthy control skin. We found that dupilumab treatment was accompanied by normalization of IL-4/IL-13 downstream activity markers such as CCL13, CCL17, CCL18 and CCL26, confirming effective type 2 inhibition within DAHND lesions. By contrast, we found strong increases in type 22-associated markers (IL22, AHR) especially in oligoclonally expanded T cells, accompanied by enhanced keratinocyte activation (S100A7, S100A8, S100A9) and IL-22 receptor upregulation, while expression of the IL22 inhibitor IL22RA2 (IL-22BP) was significantly decreased in Langerhans cells. Taken together, our study demonstrates that dupilumab effectively dampens conventional type 2 inflammation in DAHND lesions, with concomitant hyperactivation of IL22-associated responses
Outstanding User Reported Satisfaction for Light Emitting Diodes Under-Eye Rejuvenation
No full textThe under-eye region is an area of significant cosmetic concern. Photobiomodulation (PBM) has emerged as an effective, safe, inexpensive, and convenient treatment for skin rejuvenation. Herein, we aim to evaluate the safety and efficacy of a LED under-eye device for under-eye rejuvenation, as measured by objective and patient reported outcomes. Eleven participants self-administered treatment using a commercially available LED device emitting red (633 nm) and near infrared (830 nm) light for six weeks. Standardized photographs and questionnaires were administered at baseline and six weeks. Photographic digital analysis indicated an improvement in under-eye wrinkles at six weeks compared to baseline, with a reduction in wrinkle score from 20.05 to 19.72. However, this finding was not statistically significant. Participants self-reported consistent improvements in under-eye wrinkles, texture, dark circles, bags, pigmentation, and erythema. All participants reported a high degree of comfortability, ease of use, and satisfaction with the eye device. The participants noted no moderate or severe adverse events and few reports of transient expected outcomes such as mild erythema. The participants’ self-reported improvements and high user satisfaction, and the device’s favorable safety profile, highlights the benefits of at-home LED devices for under-eye rejuvenation. Future randomized controlled trials with larger sample sizes could further establish the safety and efficacy of at-home LED under-eye treatments
Active Compared With Passive Voiding Trials After Midurethral Sling Surgery: A Systematic Review
No full textOBJECTIVE:To compare active with passive voiding trials on the rate of passing a trial of void and discharge rates with catheter in women who have undergone midurethral sling for treatment of stress urinary incontinence (SUI).DATA SOURCES:MEDLINE, EMBASE, and ClinicalTrials.gov were searched through February 24, 2023.METHODS OF STUDY SELECTION:Our population included women undergoing midurethral sling, with or without anterior or posterior repair, for treatment of SUI. Our two primary outcomes were rate of passing voiding trial and rate of discharge with a catheter. Our secondary outcome was the rate of delayed postoperative urinary retention, when a patient initially passes a trial of void but then subsequently presents in retention.TABULATION, INTEGRATION, AND RESULTS:Abstracts were doubly screened; full-text articles were doubly screened; and accepted articles were doubly extracted. In single-arm studies evaluating either passive or active voiding trial, random-effects meta-analyses of pooled proportions were used to assess outcomes. Of 3,033 abstracts screened, 238 full-text articles were assessed, and 26 met inclusion criteria. Ten studies including 1,370 patients reported active trial of void. Sixteen studies including 3,643 patients reported passive trial of void. We included five randomized controlled trials, five comparative retrospective studies, five prospective single group studies, and 11 retrospective single group studies. Five of the studies included patients with a concomitant anterior or posterior colporrhaphy. On proportional meta-analysis, the active trial of void group was less likely to pass the voiding trial (81.0%, 95% CI, 0.76-0.87% vs 89.0%, 95% CI, 0.84-0.9%3, P=.029) with high heterogeneity (I2=93.0%). Furthermore, there were more discharges with catheter in active trial of void compared with passive trial of void (19.0%, 95% CI, 0.14-0.24% vs 7.0%, 95% CI, 0.05-0.10%, P\u3c.01). The rates of delayed postoperative urinary retention were low and not different between groups (0.6%, 95% CI, 0.00-0.02% vs 0.2%, 95% CI, 0.00-0.01%, P=.366) with low heterogeneity (I2=0%). Sling revisions were statistically lower in the active trial of void group (0.5%, 95% CI, 0.00-0.01% vs 1.5%, 95% CI, 0.01-0.02%, P=.035) with low heterogeneity (I2=10.4%).CONCLUSION:Passive trial of void had higher passing rates and lower discharge with catheter than active trial of void. Rates of most complications were low and similar between both groups, although passive trial of void had higher sling revisions.SYSTEMATIC REVIEW REGISTRATION:PROSPERO, CRD42022341318
The Impact of Artificial Intelligence on Large Vessel Occlusion Stroke Detection and Management: A Systematic Review Meta-Analysis
No full textIntroduction: Stroke remains the second leading cause of death worldwide, with many survivors facing significant disabilities. In acute stroke care, the timeless adage \u27Time is brain\u27 underscores the vital need for quick action. Innovative Artificial Intelligence (AI) technology potentially enables swift detection and management of acute ischemic strokes, revolutionizing acute stroke care towards enhanced automation. Methods: The study is registered with Prospero under CRD42024496716 and adheres to the Problem, Intervention, Comparison, and Outcomes framework (PICO). The analysis used Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched Embase, PubMed, DBLP, Google Scholar, IEEE Xplore, Cochrane database, IEEE, Web of Science, ArXiv, MedRxiv, and Semantic Scholar. The articles included were published between 2019 and 2023. Out of 1528 articles identified, thirty-seven met the inclusion criteria. Results: We compared AI-augmented Large Vessel Occlusion (LVO) detection and non-AI LVO detection in various patient processing times related to emergent endovascular therapy in acute ischemic strokes. Triage Time, Door-to-Intervention Notification Time (INR), and Door-to -Arterial Puncture Time revealed an odds ratio (OR) of 0.39 (95 % CI: 0.29–0.54, p \u3c 0.001), 0.30 (95 % CI: 0.21–0.42, p \u3c 0.001), and 0.50 (95 % CI: 0detection 0.30–0.82, p = 0.007), respectively – all of which had negligible heterogeneity (I^2 = 0). CT-to-Puncture-Time and Door-to-CTA-Time yielded an OR of 0.57 (95 % CI: 0.31–1.04, p = 0.065) and 0.77 (95 % CI: 0.37–1.60, p = 0.489), respectively – both of which had negligible heterogeneity (I^2 = 0). The Last Known Well (LWK) to Time of Arrival resulted in an OR of 1.15 (95 % CI: 0.83–1.59, p = 0.409, I^2 = 0). AI stroke detection sensitivity OR of 0.91 (95 % CI: 0.88–0.95, p \u3c 0.001) should be interpreted with potential heterogeneity in mind (I^2 = 69.3). National Institute of Health score (NIHSS) mean of 16.20 (95 % CI: 14.96–17.45, p = 0.001, I^2 = 0). Patient Transfer-Times between primary and comprehensive stroke centers generated an OR of 0.98 (95 % CI: 0.73–1.32, p = 893, I^2 = 0). Similarly, Door-in-Door-Out Time (DIDO) had an OR of 1.19 (95 % CI: 0.21–6.88, p = 0.848) and low heterogeneity (I^2 = 5.1). The results indicated significant differences across several parameters between the AI augmentation and non-AI groups. Conclusion: Our findings highlight how AI augments healthcare providers\u27 ability to detect and manage strokes swiftly and accurately within acute care settings. As these technologies progress, healthcare organizations mature, and AI becomes more integrated into healthcare systems, longitudinal studies are critical in evaluating its impact on workflow efficiency, cost-effectiveness, and clinical outcomes