Tag: pubmed

J Neurotrauma. 2023 Oct 5. doi: 10.1089/neu.2023.0377. Online ahead of print.

ABSTRACT

Intracranial pressure (ICP) data from traumatic brain injury (TBI) patients in the intensive care unit (ICU) cannot be interpreted appropriately without accounting for the effect of administered therapy intensity level (TIL) on ICP. A 15-point scale was originally proposed in 1987 to quantify the hourly intensity of ICP-targeted treatment. This scale was subsequently modified &ndash; through expert consensus &ndash; during the development of TBI Common Data Elements to address statistical limitations and improve usability. The latest, 38-point scale (hereafter referred to as TIL) permits integrated scoring for a 24-hour period and has a five-category, condensed version (TIL^(Basic)) based on qualitative assessment. Here, we perform a total- and component-score analysis of TIL and TIL^(Basic) to: (1) validate the scales across the wide variation in contemporary ICP management, (2) compare their performance against that of predecessors, and (3) derive guidelines for proper scale use. From the observational Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study, we extract clinical data from a prospective cohort of ICP-monitored TBI patients (<em>n</em>=873) from 52 ICUs across 19 countries. We calculate daily TIL and TIL^(Basic) scores (TIL₂₄ and TIL^(Basic)₂₄, respectively) from each patient&rsquo;s first week of ICU stay. We also calculate summary TIL and TIL^(Basic) scores by taking the first-week maximum (TIL_max and TIL^(Basic)_max) and first-week median (TIL_median and TIL^(Basic)_median) of TIL₂₄ and TIL^(Basic)₂₄ scores for each patient. We find that, across all measures of construct and criterion validity, the latest TIL scale performs significantly greater than or similarly to all alternative scales (including TIL^(Basic)) and integrates the widest range of modern ICP treatments. TIL_median outperforms both TIL_max and summarised ICP values in detecting refractory intracranial hypertension (RICH) during ICU stay. The RICH detection thresholds which maximise the sum of sensitivity and specificity are TIL_median&ge;7.5 and TIL_max&ge;14. The TIL₂₄ threshold which maximises the sum of sensitivity and specificity in the detection of surgical ICP control is TIL₂₄&ge;9. The median scores of each TIL component therapy over increasing TIL₂₄ reflect a credible staircase approach to treatment intensity escalation, from head positioning to surgical ICP control, as well as considerable variability in the use of cerebrospinal fluid drainage and decompressive craniectomy. Since TIL^(Basic)_max suffers from a strong statistical ceiling effect and only covers 17% (95% CI: 16&ndash;18%) of the information in TIL_max, TIL^(Basic) should not be used instead of TIL for rating maximum treatment intensity. TIL^(Basic)₂₄ and TIL^(Basic)_median can be suitable replacements for TIL₂₄ and TIL_median, respectively (with up to 33% [95% CI: 31&ndash;35%] information coverage) when TIL assessment is infeasible. Accordingly, we derive numerical ranges for categorising TIL₂₄ scores into TIL^(Basic)₂₄ scores. In conclusion, our results validate TIL across a spectrum of ICP management and monitoring approaches. TIL is a more sensitive surrogate for pathophysiology than ICP…

PMID:37795563 | DOI:10.1089/neu.2023.0377

Angew Chem Int Ed Engl. 2023 Oct 5:e202308675. doi: 10.1002/anie.202308675. Online ahead of print.

ABSTRACT

The mechanism for interaction and bonding of single guest molecules with active sites fundamentally determines the sorption and subsequent catalytic processes occurring in host zeolitic frameworks. However, no real-space studies on these significant issues have been reported thus far, since atomically visualizing guest molecules and recognizing single Al T-sites in zeolites remain challenging. Here, we atomically resolved single thiophene probes interacting with acid T-sites in the ZSM-5 framework to study the bonding behaviors between them. The synergy of bifurcated three-centered hydrogen bonds and van der Waals interactions can “freeze” the near-horizontal thiophene and make it stable enough to be imaged. By combining the imaging results with simulations, direct atomic observations enabled us to precisely locate the single Al T-sites in individual straight channels. Then, we statistically found that the thiophene bonding probability of the T11 site is 15 times higher than that of the T6 site. For different acid T-sites, the variation in the interaction synergy changes the inner angle of the host-guest O-H···S hydrogen bond, thereby affecting the stability of the near-horizontal thiophene and leading to considerable bonding inhomogeneities.

PMID:37795545 | DOI:10.1002/anie.202308675

Adv Mater. 2023 Oct 5:e2306631. doi: 10.1002/adma.202306631. Online ahead of print.

ABSTRACT

Monolayers of transition metal dichalcogenides (TMDs) are an ideal 2D platform for studying a wide variety of electronic properties and potential applications due to their chemical diversity. Similarly, single-walled TMD nanotubes (SW-TMDNTs)-seamless cylinders of rolled-up TMD monolayers-are 1D materials that can exhibit tunable electronic properties depending on both their chirality and composition. However, much less has been explored about their geometrical structures and chemical variations due to their instability under ambient conditions. Here, the structural diversity of SW-TMDNTs templated by boron nitride nanotubes (BNNTs) is reported. The outer surfaces and inner cavities of the BNNTs promote and stabilize the coaxial growth of SW-TMDNTs with various diameters, including few-nanometers-wide species. The chiral indices (n,m) of individual SW-MoS₂ NTs are assigned by high-resolution transmission electron microscopy, and statistical analyses reveals a broad chirality distribution ranging from zigzag to armchair configurations. Furthermore, this methodology can be applied to the synthesis of various TMDNTs, such as selenides and alloyed Mo_{1- x} W_x S₂ . Comprehensive microscopic and spectroscopic analyses also suggest the partial formation of Janus MoS_{2(1- x )} Se_{2 x} nanotubes. The BNNT-templated reaction provides a universal platform to characterize the chirality-dependent properties of 1D nanotubes with various electronic structures.

PMID:37795543 | DOI:10.1002/adma.202306631

J Appl Physiol (1985). 2023 Oct 5. doi: 10.1152/japplphysiol.00775.2022. Online ahead of print.

ABSTRACT

Females generally have smaller blood pressure (BP) responses to isolated muscle mechanoreflex and metaboreflex activation compared to males, which may explain sex differences in BP responses to voluntary exercise. The mechanoreflex may be sensitized during exercise, but whether mechanoreflex-metaboreflex interactions differ by sex or variations in sex hormones remains unknown. Thirty-one young healthy subjects (females, n=16) performed unilateral passive cycling (mechanoreflex), active cycling (40% peak Watts), post-exercise circulatory occlusion (PECO; metaboreflex), and passive cycling combined with PECO (combined mechanoreflex and metaboreflex activation). Beat-to-beat BP, heart rate, inactive leg vascular conductance, and active leg muscle oxygenation were measured. Ten females underwent exploratory testing during low- and high-hormone phases of their self-reported menstrual cycle or oral contraceptive use. Systolic BP and heart rate responses did not differ between sexes during active cycling (∆30±9 vs. 29±11mmHg [males vs. females], P=0.9; ∆33±8 vs. 35±6beats/min, P=0.4) or passive cycling with PECO (∆26±11 vs. 21±10mmHg, P=0.3; ∆14±7 vs. 18±15beats/min, P=0.3). Passive cycling with PECO revealed additive, not synergistic, effects for systolic BP (males: ∆23±14 vs. 26±11mmHg, [sum of isolated passive cycling and PECO vs. combined activation]; females: ∆26±11 vs. 21±12mmHg, interaction P=0.05). Results were consistent in subset analyses with sex differences in active cycling BP (P>0.1) and exploratory analyses of hormone phase (P>0.4). Despite a lack of statistical equivalence, no differences in cardiovascular responses were found during combined mechanoreflex-metaboreflex activation between sexes or hormone levels. These results provide preliminary data regarding the involvement of muscle mechanoreflex-metaboreflex interactions in mediating sex differences in voluntary exercise BP responses.

PMID:37795529 | DOI:10.1152/japplphysiol.00775.2022

Br J Haematol. 2023 Oct 5. doi: 10.1111/bjh.19122. Online ahead of print.

ABSTRACT

How important is choice of conditioning regimen in allogeneic haematopoietic stem cell transplantation (HSCT) for sickle cell disease (SCD)? We compared HSCT outcomes by conditioning regimen in paediatric patients with SCD from the EBMT registry. In 2010-2020, 251 patients aged <18 years underwent a first matched sibling donor (MSD) HSCT with conditioning based on busulfan-fludarabine (bu-flu; n = 89) or treosulfan-fludarabine (treo-flu; n = 162). In the bu-flu and treo-flu groups, 51.7% and 99.4% of patients, respectively, received thiotepa. Median follow-up was 2.7 years. Two-year overall survival (OS) was 98.7% (95% confidence interval [CI]: 90.9-99.8) with bu-flu and 99.3% (95% CI: 95.2-99.9) with treo-flu (p = 0.63). Grade III-IV acute graft-versus-host disease (GVHD) at 100 days was 2.4% (95% CI: 0.4-7.5) and 0.6% (0.1%-3.2%) for bu-flu and treo-flu respectively (p = 0.25). The 2-year incidence of extensive chronic GVHD was 1.5% (95% CI: 0.1-7.3) with bu-flu and 8.0% (95% CI: 4.1-13.3) with treo-flu (p = 0.057). These multinational data confirm the excellent curative capacity of MSD HSCT with myeloablative conditioning. Both conditioning regimens yielded excellent OS, low rates of acute and chronic GVHD, and low rates of graft failure.

PMID:37795523 | DOI:10.1111/bjh.19122

S Afr J Physiother. 2023 Sep 18;79(1):1918. doi: 10.4102/sajp.v79i1.1918. eCollection 2023.

ABSTRACT

BACKGROUND: As patients with hemiplegia have a high risk of falling, it is important to develop a fall rehabilitation plan and/or apply personalised treatment when necessary.

OBJECTIVES: We aimed to evaluate the effects of individualised treatment with Computerised Dynamic Posturography (CDP) on balance in patients with and without a history of chronic hemiplegic falls.

METHOD: Forty patients with hemiplegia (time post-stroke: 8-18 months) between 40 and 70 years of age in the Istanbul Yeniyüzyıl University, Gaziosmanpaşa Hospital participated in our study. The patients were divided into two groups: Group 1, falling history (n = 20) and Group 2, no falling history (n = 20). The patients in both groups were included in a traditional rehabilitation programme for 5 weeks, 5 days a week, for 1 h. The group with a history of falls also received individualised CDP treatment for 20 min, 3 days a week, for 5 weeks. Patients were evaluated with a Sensory Organisation Test (SOT) and a Berg Balance Scale (BBS).

RESULTS: In Group 1, a significant improvement was determined in the after-treatment SOT 5 values compared with the before treatment SOT 5 values (p = 0.022). Significant improvement was found in BBS (p = 0.003) and SOT 6 (p = 0.022) values in Group 2. There was no statistically significant difference in improvement between the two groups (p ≥ 0.05).

CONCLUSION: Larger samples and longer duration of individualised CDP therapy studies may be required to improve balance with chronic hemiplegia and a history of falls.

CLINICAL IMPLICATIONS: In addition to traditional therapy, individualised CDP treatment may be beneficial for patients with a history of post-stroke falls.

PMID:37795518 | PMC:PMC10546243 | DOI:10.4102/sajp.v79i1.1918

Front Glob Womens Health. 2023 Sep 18;4:1189706. doi: 10.3389/fgwh.2023.1189706. eCollection 2023.

ABSTRACT

INTRODUCTION: In the last decade, Venezuela has experienced a complex humanitarian crisis that has limited access to healthcare. We set out to describe Venezuelan women’s experiences accessing sexual and reproductive health services, including abortion, which is heavily restricted by law.

METHODS: We fielded an online survey in July of 2020 among Venezuelan women recruited through social media advertisements. We conducted descriptive statistical analyses using Excel and STATA SE Version 16.0.

RESULTS: We received 851 completed survey responses. Almost all respondents experienced significant hardship in the last year, including inflation (99%), worries about personal safety (86%), power outages (76%), and lack of access to clean water (74%) and medications (74%). Two thirds of respondents used contraception in the last two years, and almost half (44%) of respondents had difficulty accessing contraception during that same time period. About one fifth of respondents reported having had an abortion; of these, 63% used abortion pills, and 72% reported difficulties in the process. Half of those who had an abortion did it on their own, while the other half sought help – either from family members or friends (34%), from providers in the private health sector (14%), or from the Internet (12%).

CONCLUSIONS: Venezuelan women who responded to our survey describe a harsh context with limited access to sexual and reproductive health services. However, they report relatively high rates of contraceptive use, and abortion seems to be common despite the restrictive legal setting.

PMID:37795508 | PMC:PMC10545839 | DOI:10.3389/fgwh.2023.1189706

Neurol Clin Pract. 2023 Dec;13(6):1-6. doi: 10.1212/CPJ.0000000000200195. Epub 2023 Oct 2.

ABSTRACT

BACKGROUND AND OBJECTIVES: Psychogenic nonepileptic seizures (PNES) are paroxysmal events that resemble epileptic seizures but have psychological underpinnings. Patients with PNES have high health care utilization. We hypothesize that appropriate care would lead to decreases in utilization. The aim of this study was to measure the impact of a multidisciplinary PNES clinic in reducing health care utilization (HCU) in youth with PNES referred to the clinic.

METHODS: We reviewed the frequency of visits to the emergency department (ED), urgent care (UC), planned and unplanned hospitalizations, neurodiagnostic studies, and total charges associated with these encounters 12 months before and 12 months after initial referral to the clinic. Manual chart review of all patients referred from November 2017 to March 2020 was performed.

RESULTS: Two hundred and twelve unique patients were included in this retrospective study. Patient sex was identified as 71% female, 28% male, and 1% other, with an average age of 14 years at diagnosis. These patients visited the ED a total of 410 times before being seen in the PNES clinic, which decreased to 187 visits after (75% reduction). All measures of HCU decreased in the 12 months after the visit, and statistically significant differences were observed in all measures of HCU except for head MRIs, leading to an estimated potential cost savings of $7,978,447.

DISCUSSION: Patients with PNES were found to have decreased health care utilization in the 12 months after referral to the Nationwide Children’s Hospital multidisciplinary clinic, including significant decreases in emergency services and unnecessary diagnostic testing, in the 12 months after the referral.

PMID:37795502 | PMC:PMC10547481 | DOI:10.1212/CPJ.0000000000200195

Neurol Clin Pract. 2023 Dec;13(6):e200211. doi: 10.1212/CPJ.0000000000200211. Epub 2023 Oct 2.

ABSTRACT

OBJECTIVES: The objective of this study was to complete a scoping review of current literature surrounding health inequities in epilepsy while providing recommendations for future research.

METHODS: During July 2022, we searched MEDLINE and Ovid Embase to find published articles pertaining to epilepsy and health inequities. Initially, authors received training. Authors then screened, and data were extracted in a masked duplicate manner. Studies published within the time frame of 2011-2021 in all countries were deemed appropriate. We screened 5,325 studies for titles and abstracts and then 56 studies for full text. We evaluated the inequities of race/ethnicity, sex or gender, income, occupation status, education level, under-resourced/rural population, and LGBTQ+. To summarize the data and descriptive statistics of our study, we used Stata 17.0 (StataCorp, LLC, College Station, TX).

RESULTS: We obtained a sample size of 45 studies for study inclusion. The most reported health inequities were income (18/45, 40.0%), under-resourced/rural population (15/45, 33.3%), and race/ethnicity (15/45, 33.3%). The least reported health inequity was LGBTQ+ (0/45, 0.0%).

DISCUSSION: The findings of our study suggest that gaps exist in literature concerning epilepsy and inequities. The inequities of income status, under-resourced/rural population, and race/ethnicity were examined the most, while LGBTQ+, occupation status, and sex or gender were examined the least. With the ultimate goal of more equitable and patient-centered care in mind, it is vital that future studies endeavor to fill in these determined gaps.

PMID:37795499 | PMC:PMC10547471 | DOI:10.1212/CPJ.0000000000200211

Front Cardiovasc Med. 2023 Sep 18;10:1254933. doi: 10.3389/fcvm.2023.1254933. eCollection 2023.

ABSTRACT

INTRODUCTION: Hypertension (HT) remains the leading cause of death worldwide. In Brazil it is estimated that 35% of the adult population has HT and that about 20% of these have blood pressure values within the targets recommended for the reduction of cardiovascular risk. There are some data that point to different control rates in patients treated by cardiologists in public and private referral center and this is an important point to be investigated and discussed.

OBJECTIVE: To compare sociodemographic characteristics, body mass index (BMI), antihypertensive (AH) drugs, blood pressure (BP) and control rate in public (PURC) and private (PRRC) referral centers.

METHODOLOGY: A cross-sectional multicenter study that analyzed data from hypertensive patients assisted by the PURC (one in Midwest Region and other in Northeast region) and PRRC (same distribution). Variables analyzed: sex, age, BMI, classes, number of AH used and mean values of systolic and diastolic BP by office measurement and home blood pressure measurement (HBPM). Uncontrolled hypertension (HT) phenotypes and BP control rates were assessed. Descriptive statistics and χ² tests or unpaired t-tests were performed. A significance level of p < 0.05 was considered.

RESULTS: A predominantly female (58.9%) sample of 2.956 patients and a higher prevalence of obesity in PURC (p < 0.001) and overweight in PRRC (p < 0.001). The mean AH used was 2.9 ± 1.5 for PURC and 1.4 ± 0.7 for PRRC (p < 0.001). Mean systolic and diastolic BP values were higher in PURC as were rates of uncontrolled HT of 67.8% and 47.6% (p < 0.001) by office measurement and 60.4% and 35.3% (p < 0.001) by HBPM in PURC and PRRC, respectively.

CONCLUSION: Patients with HT had a higher prevalence of obesity in the PURC and used almost twice as many AH drugs. BP control rates are worse in the PURC, on average 15.3 mmHg and 12.1 mmHg higher than in the PRRC by office measurement.

PMID:37795487 | PMC:PMC10545870 | DOI:10.3389/fcvm.2023.1254933