Tag: pubmed

Retina. 2024 Dec 16. doi: 10.1097/IAE.0000000000004373. Online ahead of print.

ABSTRACT

PURPOSE: Propose new terminology and evaluate the effectiveness of Therapeutic Refractive Vitrectomy (TRV) for selective removal of vitreous floaters and opacities (VFO) utilizing Standardized Kinetic Anatomical Functional Testing of VFO (SK VFO Test) and new ultra widefield (UWF) OCT imaging techniques.

METHODS: Retrospective analysis. Twenty eyes underwent TRV for symptomatic VFO. Pre-/post-TRV assessments: SK-VFO Test, including straylight measurements (HD Analyzer, Light Disturbance Analyzer, C-Quant) alongside non-contact imaging including a new UWF OCT to evaluate changes in vitreous anatomical and optical properties.

RESULTS: Post-TRV evaluations indicated objective changes in vitreous optical properties and subjective measures. Reduced straylight measurements: HDA 22%, LDA 54.4% (p=0.013), and C-Quant 7.8% (p=0.034). Patient reported outcomes statistically significantly improved (p=0.022). Corrected distance visual acuity (CDVA) changes were marginal. New UWF 26 mm with a 12 mm imaging window OCT facilitated detailed vitreous imaging, confirming status of posterior vitreous detachment (PVD) (100%). Post-TRV UWF and OCT imaging demonstrated restoration of vitreous clarity, confirmed presence of residual cortical vitreous and absence of new PVDs.

CONCLUSION: TRV is a significant contribution for therapeutic refractive surgery as a safe and effective approach to enhancing visual quality, correcting refractive and opaque vitreous anomalies. Improvement in CDVA was minimal representing limited effectiveness as a measure of comprehensive visual function. Improvements in objective straylight measures and imaging are in alignment with subjective symptom improvements post-TRV. This underscores the utility and value of new holistic evaluation methods beyond traditional metrics to assess the impact of TRV on visual function and quality of life.

PMID:39693577 | DOI:10.1097/IAE.0000000000004373

Biochem J. 2024 Dec 18:BCJ20240602. doi: 10.1042/BCJ20240602. Online ahead of print.

ABSTRACT

Advances in solid-state nuclear magnetic resonance (ssNMR) spectroscopy and cryogenic electron microscopy (cryoEM) have revealed the polymorphic nature of the amyloid state of proteins. Given the association of amyloid with protein misfolding disorders, it is important to understand the principles underlying this polymorphism. To address this problem, we combined computational tools to predict the specific regions of the sequence forming the β-spine of amyloid fibrils with the availability of 30, 83 and 24 amyloid structures deposited in the Protein Data Bank (PDB) and Amyloid Atlas (AA) for the amyloid β (Aβ) peptide, α-synuclein (αS), and the 4R isoforms of tau, associated with Alzheimer’s disease, Parkinson’s disease, and various tauopathies, respectively. This approach enabled a statistical analysis of sequences forming β-sheet regions in amyloid polymorphs. We computed for any given sequence residue n the fraction of PDB/AA structures in which that residue adopts a β-sheet conformation (Fβ(n)) to generate an experimental, structure-based profile of Fβ(n) vs n, which represents the β-conformational preference of any residue in the amyloid state. The peaks in the respective Fβ(n) profiles of the three proteins, corresponding to sequence regions adopting more frequently the β-sheet structural core in the various fibrillar structures, align very well with the peaks identified with five predictive algorithms (ZYGGREGATOR, TANGO, PASTA, AGGRESCAN, WALTZ). These results indicate that, despite amyloid polymorphism, sequence regions most often forming the structural core of amyloid have high hydrophobicity, high intrinsic β-sheet propensity and low electrostatic charge across the sequence, as rationalised and predicted by the algorithms.

PMID:39693572 | DOI:10.1042/BCJ20240602

R I Med J (2013). 2025 Jan 2;108(1):39-43.

ABSTRACT

The 2019 Advancing American Kidney Health (AAKH) initiative aims to increase utilization of home dialysis for end-stage kidney disease (ESKD), but its impact on public awareness is unknown. We analyzed Google Trends data from 2013-2021 to compare relative search volumes for “home dialysis”, “peritoneal dialysis”, and “home hemodialysis” in the United States (US) versus globally before versus after the July 2019 AAKH announcement. An interrupted time-series analysis found steady pre-AAKH increases in search interest across terms and locations. An immediate increase after AAKH occurred for all searches, greatest for home dialysis (+5.93 US, +11.2 global), but post-AAKH trends were flat or declining. Differences between US and global trends were not statistically significant. Despite goals to increase home dialysis use, AAKH has not impacted public information-seeking behaviors. Targeted patient education initiatives may be needed to increase awareness of home dialysis options.

PMID:39693534

R I Med J (2013). 2025 Jan 2;108(1):30-34.

ABSTRACT

BACKGROUND/OBJECTIVE: Pediatric sepsis is a significant cause of morbidity and mortality in the United States, and its early recognition is crucial but challenging. This study assessed clinicians’ self-reported preparedness for recognizing and managing pediatric sepsis in the Rhode Island region.

METHODS: A cross-sectional, survey was developed and sent to community emergency medicine clinicians in greater Rhode Island. Results were analyzed using descriptive statistics.

RESULTS: Survey responses were received from 35 participants across 10 Emergency Departments. Ninety-seven percent (97%) felt confident managing adult sepsis with shock, but only 51% felt confident managing pediatric sepsis with shock. Lack of pediatric procedural experience and familiarity with pediatric dosing were barriers to providing care to pediatric patients with sepsis for 74.2% and 62.8% of participants, respectively.

CONCLUSION: Many community ED clinicians lack confidence in managing pediatric sepsis. Structured educational initiatives focused on clinical examination, procedural skills, and medication dosing may enhance confidence in managing these patients.

PMID:39693532

R I Med J (2013). 2025 Jan 2;108(1):23-29.

ABSTRACT

BACKGROUND: With increasing use of diazoxide for hyperinsulinemic hypoglycemia (HH), reporting of serious side effects of diazoxide such as pulmonary hypertension (PHT) increased.

METHODS: Charts of all children diagnosed with HH during the study period and evaluated by Pediatric Endocrinology division of the Hasbro Children’s Hospital were reviewed. We analyzed diazoxide use among infants with HH with focus on infants born small for gestational age (SGA) and preterm infants.

RESULTS: Average timing of diazoxide initiation was later after 6/2017 compared to prior in preterm infants (45 days versus 4 days, p < 0.001) and in SGA infants (28 days versus 13 days, p < 0.001). Prescribing patterns changed further over time, corresponding with development of diazoxide-associated PHT in three infants between 10/2018-5/2020. Delays in diazoxide initiation were observed after 5/2020 compared to prior in full-term, non-SGA infants: 18 days versus12 days (p = 0.01). The proportion of SGA infants who received diazoxide was lower after 5/2020 compared to prior (23% versus 65%, p = 0.03). PHT developed in 12.5% of infants treated with diazoxide in this cohort, 75% of whom were preterm and/or SGA, and 75% were born to mothers with preeclampsia.

CONCLUSIONS: Patterns of diazoxide use changed over time, with delayed use in preterm and/or SGA infants observed after 6/2017, reduced use in SGA infants, and delayed initiation in all infants after 5/2020. PHT was not rare in our cohort, and was more likely in infants born SGA, preterm, or to a mother with preeclampsia.

PMID:39693531

Ophthalmic Epidemiol. 2024 Dec 18:1-10. doi: 10.1080/09286586.2024.2442367. Online ahead of print.

ABSTRACT

PURPOSE: To identify factors that are associated with no-shows and cancellations in a glaucoma clinic.

METHODS: Retrospective observational study of patients seen at a glaucoma clinic over a two-year period (6/2017-5/2019). Demographics and clinic information were recorded from the electronic medical record. A total of 36,810 visits from 7,383 patients were studied. Weather data was collected from the National Centers for Environmental Information. Distance analysis was calculated utilizing Bing Maps application programming interface (API) on Microsoft Excel. Visits were divided into three groups based on appointment status: kept, cancelled, and no-show.

RESULTS: Bivariate analysis found a statistically significant difference in various factors amongst patients based on appointment status. Patients <15 miles from clinic had a higher rate of no-show, but a lower rate of cancellations compared to those farther (p < 0.0001) Using multivariable logistic regression, the following factors were associated with the likelihood of patient cancellation: average snowfall (Odds Ratio = 1.37); presence of storm event (OR = 1.12), new visit (OR = 1.82), follow-up appointments (OR = 1.90), and travel distance > 15 miles (OR = 1.11). The following factors were associated with patient no-show: resident clinic (OR = 1.79), new visit (OR = 2.24), follow-up appointments (OR = 2.18), age (OR = 0.99), average snowfall (OR = 1.27), presence of storm event (OR = 1.41), average windspeed (OR = 0.98), and travel distance > 15 miles (OR = 0.67).

CONCLUSION: Patient age, gender, travel distance, appointment type, and weather were all significantly associated with rates of patient cancellations and no-shows. These risk factors could lead to interventions to improve appointment adherence and patient retention. Weather is an under-analyzed factor in patient follow-up rates that warrants further investigation.

PMID:39693515 | DOI:10.1080/09286586.2024.2442367

Transl Behav Med. 2024 Dec 18:ibae071. doi: 10.1093/tbm/ibae071. Online ahead of print.

ABSTRACT

Healthcare providers (HCPs) face high rates of distress, experienced as burnout, moral distress, compassion fatigue, and grief. HCPs are also experiencing a crisis in meaning whereby distress is associated with disconnection from meaning in work and, in turn, a lack of meaning in work can further perpetuate distress for HCPs. Although scalable systems-level solutions are needed to tackle multidimensional HCP distress, it is also necessary to address HCP suffering at individual, team, and institutional levels. Targeted interventions to alleviate HCP distress are limited. Meaning-centered psychotherapy (MCP), a brief, evidence-based, intervention first developed for persons with advanced cancer, holds promise to mitigate HCP distress. This study adapted MCP for HCPs through feedback from a multidisciplinary sample of clinicians trained in MCP and working in healthcare settings. A survey was distributed electronically between November and December 2023 to HCPs previously trained in MCP assessing quantitative and qualitative feedback on the appropriateness of MCP for HCPs, the relevance of MCP session topics and exercises, and implementation barriers and facilitators. Descriptive statistics on relevant participant ratings were calculated; a matrix analysis approach was used for qualitative data. Forty participants, primarily mental health providers, expressed that MCP principles were highly relevant for HCPs and offered key insights on appropriate intervention modifications, including the need for a primary focus on meaning in professional life, reduced intervention length, and delivery in group format. Feedback informed critical adjustments to promote appropriateness and acceptability of MCP-HCP which is poised for pilot testing to determine its feasibility and preliminary efficacy for HCPs.

PMID:39693501 | DOI:10.1093/tbm/ibae071

Anal Chem. 2024 Dec 18. doi: 10.1021/acs.analchem.4c04418. Online ahead of print.

ABSTRACT

Mixture analysis is crucial in many areas of chemistry, and a wide variety of separation methods are in use. A common method for physical separation is high-performance liquid chromatography (HPLC), but resolution is a problem: chemically similar species coelute. An alternative approach is diffusion-ordered NMR spectroscopy (DOSY), in which the signals of mixture components are separated according to the diffusion coefficient. Again, separation is limited if species diffuse similarly or have overlap in their NMR spectra. Using the two techniques in combination can resolve both NMR spectra and the elution profiles of individual components, even where both techniques fail when used in isolation. Recording diffusion NMR data as a function of HPLC retention time gives a three-dimensional (3D) data set that can be analyzed using multiway statistical methods. PARAFAC analysis of diffusion NMR data measured from HPLC eluate for commercial “monoacetin” (a mixture of glycerol and its mono-, di-, and triacetates) yielded fully resolved and quantitative NMR spectra and elution profiles for all four components, whereas neither HPLC nor diffusion NMR applied independently was able to resolve the components.

PMID:39693498 | DOI:10.1021/acs.analchem.4c04418

AIDS. 2024 Dec 17. doi: 10.1097/QAD.0000000000004093. Online ahead of print.

ABSTRACT

OBJECTIVE: The purpose of this study was to evaluate the efficacy of combination nicotine replacement therapy (c-NRT) for smoking cessation among people with HIV (PWH) in South Africa.

DESIGN: We conducted an open label, individually randomized clinical trial.

METHODS: Using a two-armed approach, PWH who smoke were randomized to receive either 1) intensive anti-smoking behavioral counseling (BC) or 2) intensive anti-smoking BC plus c-NRT (nicotine patches augmented by nicotine gum). Self-reported smoking abstinence was biochemically validated with exhaled breath carbon monoxide (CO) and urine cotinine at six months. Recruitment, provision of trial interventions, and follow-up of participants took place March 2014 through June 2016.

RESULTS: We randomly assigned 280 participants to the BC arm and 281 participants to the BC + c-NRT arm. 438 (78%) participants were male and 123 (22%) were female. For our primary outcome of biochemically verified abstinence at six months, 41 (15%) were quit in the BC + c-NRT arm versus 28 (10%) in the BC arm, resulting in a 5% (95% CI -1%, 10%) absolute difference in relative risk and an adjusted odd ratio of 1.47 (95% CI: 0.86, 2.52) comparing the BC + c-NRT to the BC arm.

CONCLUSIONS: Although our results did not reach statistical significance, we found augmentation of BC with c-NRT to increase smoking abstinence at six months, which is consistent with performance in the general population. PWH in low-resource settings may benefit from the addition of c-NRT to existing tobacco cessation interventions.

PMID:39693492 | DOI:10.1097/QAD.0000000000004093

Reprod Fertil. 2024 Dec 1:RAF-24-0046. doi: 10.1530/RAF-24-0046. Online ahead of print.

ABSTRACT

Chemotherapeutic agents result in the loss of growing follicles, which can manifest as amenorrhoea. Alkylating chemotherapy (AC) is known to be more gonadotoxic than non-alkylating chemotherapy (NAC). Anti-Mullerian Hormone (AMH), an indirect marker of ovarian reserve, and age have been investigated as predictors of ovarian function after chemotherapy, however little is known about the time to return of menses. This study aimed to assess how patient age and baseline serum AMH levels at cancer diagnosis affect the time to return of menses post-chemotherapy. This retrospective cohort study examined oncology patients (n=67) who underwent chemotherapy and were treated through the Reproductive Services Unit of two institutions in Melbourne, Australia. Primary outcomes included correlation between age and baseline AMH with time to return of menses after chemotherapy. Secondary outcomes include the change in AMH levels at 6- and 12-months post-completion of chemotherapy. Pairwise correlation of pre-chemotherapy AMH level and time to return of menses demonstrated statistical significance (Spearman’s coefficient, ρ = -0.40) for patients who underwent AC. This analysis in breast cancer patients who underwent AC displayed a negative correlation, however, was not statistically significant. No association was found between age and time to return of menses for all cancer (NAC or AC) or breast cancer patients who underwent AC. Higher AMH level prior to AC was associated with an earlier return of menses after chemotherapy. Age at the commencement of chemotherapy was not associated with return of menses. Further prospective research is required to assess post-chemotherapy recovery of AMH.

PMID:39693398 | DOI:10.1530/RAF-24-0046