Acute Recovery Research Articles

Response of Retail Lawn Seed Products during Acute Drought and Recovery

Consumers often have multiple choices when purchasing retail lawn products in stores. In this study, we evaluated the acute drought performance of locally available retail lawn seed products (mixtures or blends) at two mowing heights of 2.5 and 3 inches. We hypothesized that the species present in the products and the height-of-cut differentially influence the drought resistance and recovery of the mixtures and blends. In Fall 2016 and 2017, 28 different products consisting of 25 mixtures and 3 blends of turfgrass seeds were established under a fully automated rainout shelter at the St. Paul campus of the University of Minnesota. The drought treatments lasted for 67 days in 2017, and 52 days in 2018; both the 2017 and 2018 treatments were followed by a recovery period. Data were obtained during acute drought treatments and recovery periods for visual turfgrass quality and green turfgrass cover using digital images of the plots. During the first year, several products displayed higher green stability (or the ability to remain green) at the 3-inch height-of-cut compared with the 2.5-inch height-of-cut. Products with tall fescue (Schedonorus arundinaceus) and fine fescue (Festuca sp.) as dominant species generally performed better during the drought treatments, whereas an increasing presence of perennial ryegrass (Lolium perenne) and kentucky bluegrass (Poa pratensis) decreased the visual drought performance of the products. During the recovery period, an effect of the interaction between mowing height and the date of data collection on the percentage of green cover was observed: the lower mowing height improved the early recovery of green cover after acute drought. These findings suggest that consumers in the upper midwestern United States and areas with a climate similar climate to that of St. Paul, MN, who are challenged with multiple choices of lawn seed products should choose products containing a higher tall fescue content and adjust their mowing heights to optimize recovery.

Comparison Of Acute Covid19 Infected Athletes To Controls Through Electrocardiography

Myocardial complications following COVID19 infection are recorded in athletic populations. PURPOSE: To determine possible acute myocardial issues with post COVID19 infected Division II (DII) collegiate athletes. METHODS: Prior to electrocardiography (ECG) testing, all subjects signed an informed consent approved by the university Institutional Review Board (IRB). Seven (n = 7) athletes from various DII collegiate sports testing positive for COVID19 and their matched counterparts (n = 7) testing negative were administered resting ECG. Positive test subjects followed necessary medical protocols for recovery. Recovery (with quarantine) was testing negative before return to normal activities. ECG recordings were obtained from athletes of the following sports: football, basketball, soccer, and volleyball. These subjects were matched by sport, sex, ethnicity and anthropometry to controls (n = 7). Investigators were blinded to infected vs. control during ECG measures. Measures included: height (cm), weight (kg), BMI (kg*m-2), pulse oximetry (%), heart rate (b*min.-1), PR interval (ms), QRS duration (ms), QTc (ms). Ethnicity was determined from each subject through inquiry of subject identification. Descriptive group means (standard deviations) were established. Main effects ANOVA was run to determine differences in ECG segments between groups and ethnicities. Statistical significance was set a priori at p < 0.05. RESULTS: Means (SD) were the following for infected vs control, respectively: height, 175.4 (8.1) vs. 178.7 (9.9) cm; weight, 81.7 (2.3) vs. 84.4 (15.8) kg; BMI, 26.3 (5.5) vs. 26.3 (3.9) kg*m-2; resting HR, 73.1 (5.8) vs. 63.7 (9.9) b*min.-1; pulse oximetry, 98.4 (0.5) vs. 97.7 (1.1) %; PR interval, 183.6 (32.4) vs. 141.7 (22.7) ms; QRS duration, 86.3 (1.9) vs. 87.3 (10.4) ms; QTc, 393.7 (19.1) vs. 415.7 (33.9) ms. Main effects ANOVA determined differences (p = 0.04) between groups. A post hoc TUKEY HSD determined differences (p = 0.02) between groups with the PR interval. No differences were determined between ethnicities. CONCLUSION: Measures of ECG following acute recovery from COVID19 infection in DII collegiate athletes revealed differences in the PR interval between acutely recovered athletes and controls. This may indicate possible cardiomyopathy with recovered COVID19 athletes.

Preserving Isometric Maximal Strength Using Short-Term Training Cessation

Strength athletes often implement a tapering protocol to peak prior to major competitions. For less important competitions, strength athletes may use short-term training cessation (i.e., ≤7 days) with the aim of preserving performance. However, the optimal duration of short-term training cessation is still unclear and may have a divergent effect on upper versus lower body maximal strength. PURPOSE: The purpose of this study was to compare the effects of 3 days (3D) versus 5 days (5D) of training cessation on isometric maximal strength in strength athletes. METHODS: Nineteen strength athletes (23.8 ± 4.1y; 90.8 ± 20.7 kg; 174.2 ± 7.3 cm) completed a powerlifting specific 4-week training block followed by matched-pairs random assignment to 3D or 5D of training cessation. Isometric squat and bench press peak force (IPF) and allometrically scaled peak force (IPFa) were assessed on force platforms before (T1) and after training (T2), and at 3D or 5D of training cessation (T3). A 2x3 mixed ANOVA with post-hoc comparisons and Hedge’s g effect sizes were used to assess changes in isometric maximal strength. Alpha criterion was set to p < 0.05. RESULTS: A 2x3 mixed ANOVA revealed significant interactions for bench press IPF (p = 0.03) and IPFa (p = 0.04). Post-hoc comparisons revealed significant increases in bench press IPF (p = 0.01,g = 0.45) and IPFa (p = 0.017,g = 0.90) in 3D only following training (T1-T2), whereas bench press IPF (p < 0.001,g = 0.08) and IPFa (p < 0.001,g = 0.16) decreased in 5D only following training cessation (T2-T3). No differences were observed in isometric squat metrics for any time point. CONCLUSIONS: Upper body isometric maximal strength is better preserved with 3D of training cessation whereas lower body isometric maximal strength is preserved similarly with 3D or 5D of training cessation in strength athletes. The expression of maximal strength relative to upper body performance capabilities appears to dissipate more rapidly than the lower body after removing the training stimuli. Therefore, sport scientists and strength and conditioning practitioners who use training cessation to promote acute recovery may consider implementing divergent periods of training cessation for the upper and lower body to best preserve performance for maximal strength.

Cold Water Immersion Offers No Functional or Perceptual Benefit Compared to a Sham Intervention During a Resistance Training Program.

Wilson, LJ, Dimitriou, L, Hills, FA, Gondek, MB, van Wyk, A, Turek, V, Rivkin, T, Villiere, A, Jarvis, P, Miller, S, Turner, A, and Cockburn, E. Cold water immersion offers no functional or perceptual benefit compared to a sham intervention during a resistance training program. J Strength Cond Res 35(10): 2720-2727, 2021-Cold water immersion (CWI) is regularly used by athletes as a postexercise recovery strategy, but relatively little is understood about potential training adaptations associated with habitual use. The aim of this study was to investigate the influence of repeated CWI or a sham intervention on adaptations to a lower body resistance training program. Thirteen men (26 ± 6 years; 83.6 ± 15.7 kg) familiar with resistance training were allocated into a CWI (10 minutes at 10° C) or sham group and completed 2 × 4-week blocks of lower body resistance training. Subjects completed a total of 16 training sessions (2 × session·week-1), with each session immediately followed by their allocated recovery intervention. Measures of perceptual markers, muscle function, and muscle architecture were recorded at baseline, midpoint, and post-training. Data were analyzed using factorial analysis of variances. The training program resulted in significant increases in muscle fibre pennation angle (p = 0.009), isometric peak force (p = 0.018), and 1/4 squat (p < 0.001) with no differences between groups (all p > 0.05). There were no differences in perceptual responses between groups. Despite the popularity of CWI as a postexercise recovery intervention, the findings from the present study demonstrated no functional or perceptual benefit compared with a sham intervention during progressive strength and power training. Furthermore, there was no detrimental impact of CWI on morphological adaptations after 16 exposures. These findings are important for athletes and practitioners wishing to use CWI as an acute recovery strategy after training, without blunting potential training adaptations.

Acute Kidney Injury Incidence, Recovery, and Long-term Kidney Outcomes Among Hospitalized Patients With COVID-19 and Influenza

IntroductionAcute kidney injury (AKI) is a common complication in patients with severe COVID-19. We sought to compare the AKI incidence and outcomes among patients hospitalized with COVID-19 and with influenza.MethodsThis was a retrospective cohort study of patients with COVID-19 hospitalized between March and May 2020 and historical controls hospitalized with influenza A or B between January 2017 and December 2019 within a large health care system. Cox proportional hazards models were used to compare the risk of AKI during hospitalization. Secondary outcomes included AKI recovery, mortality, new-onset chronic kidney disease (CKD), and ≥25% estimated glomerular filtration rate (eGFR) decline.ResultsA total of 2425 patients were included; 1091 (45%) had COVID-19, and 1334 (55%) had influenza. The overall AKI rate was 23% and 13% in patients with COVID-19 and influenza, respectively. Compared with influenza, hospitalized patients with COVID-19 had an increased risk of developing AKI (adjusted hazard ratio [aHR] = 1.58; 95% confidence interval [CI], 1.29–1.94). Patients with AKI were more likely to die in the hospital when infected with COVID-19 versus influenza (aHR = 3.55; 95% CI, 2.11–5.97). Among patients surviving to hospital discharge, the rate of AKI recovery was lower in patients with COVID-19 (aHR = 0.47; 95% CI, 0.36–0.62); however, among patients followed for ≥90 days, new-onset CKD (aHR = 1.24; 95% CI, 0.86–1.78) and ≥25% eGFR decline at the last follow-up (aHR = 1.36, 95% CI, 0.97–1.90) were not significantly different between the cohorts.ConclusionAKI and mortality rates are significantly higher in patients with COVID-19 than influenza; however, kidney recovery among long-term survivors appears to be similar.

Timing of Acute Kidney Injury Recovery a Promising Indicator of Outcomes After Liver Transplantation.

Timing of Acute Kidney Injury Recovery a Promising Indicator of Outcomes After Liver Transplantation.

Impact of Prior Brain Injury on Concussion Recovery in Military Personnel: Evaluation of Timing Between Concussions.

To evaluate the potential impact of timing between the current and the most recent previous concussions on symptom severity among acutely concussed active duty military Service members (SMs). Three military installations. Eighty-four SMs aged 18 to 44 years who sustained a concussion within 72 hours of enrollment. No previous concussion within 1 year preenrollment. Longitudinal study with enrollment within 72 hours of injury, and follow-up at 1 week and 1 month postinjury. Lifetime concussion history (yes/no) and recency of the latest concussion (no history, relatively more recent [1 to <6 years ago], and more remote [6+ years ago]) from the current concussion using the Ohio State University Traumatic Brain Injury Identification Method-Interview Form. Symptom severity (total and by categories: cognitive, affective, somatosensory, vestibular) at all time points using the Neurobehavioral Symptoms Inventory. Concussion history assessed as having any previous concussion was not found significantly related to symptom severity (total or by categories) following a current concussion. However, when timing between concussion was taken into account, time since previous concussion was significantly related to symptomatology, whereby those with relatively more recent previous concussion had greater total symptoms within 72 hours of injury and at 1 week postinjury (though not at 1 month) than those with more remote previous concussion (≤72 hours: difference = 15.4, 95% CI = 1.8 to 29.1; 1 week: difference = 15.2, 95% CI = 1.2 to 29.2) or no history (≤72 hours: difference = 11.6, 95% CI = 0.4 to 22.8; 1 week: difference = 13.9, 95% CI = 2.4 to 25.4). When evaluated by symptom category, this relationship was particularly important on affective and somatosensory symptoms. In recently concussed active duty SMs, the timing between the current and previous concussions may be an important factor in determining prognosis. Clinical assessment of concussion history that accounts for the timing of the most recent event may be necessary to identify patients who may require a more conservative plan of care and more gradual return to activity in the acute recovery stage.

Reintroduction of immunosuppressive medications in pediatric rheumatology patients with histoplasmosis: a case series

BackgroundChildren with rheumatic diseases (cRD) receiving immunosuppressive medications (IM) are at a higher risk for acquiring potentially lethal pathogens, including Histoplasma capsulatum (histoplasmosis), a fungal infection that can lead to prolonged hospitalization, organ damage, and death. Withholding IM during serious infections is recommended yet poses risk of rheumatic disease flares. Conversely, reinitiating IM increases risk for infection recurrence. Tumor necrosis factor alpha inhibitor (TNFai) biologic therapy carries the highest risk for histoplasmosis infection after epidemiological exposure, so other IM are preferred during active histoplasmosis infection. There is limited guidance as to when and how IM can be reinitiated in cRD with histoplasmosis. This case series chronicles resumption of IM, including non-TNFai biologics, disease-modifying anti-rheumatic drugs (DMARDs), and corticosteroids, following histoplasmosis among cRD.Case presentationWe examine clinical characteristics and outcomes of 9 patients with disseminated or pulmonary histoplasmosis and underlying rheumatic disease [juvenile idiopathic arthritis (JIA), childhood-onset systemic lupus erythematosus (cSLE), and mixed connective tissue disease (MCTD)] after reintroduction of IM. All DMARDs and biologics were halted at histoplasmosis diagnosis, except hydroxychloroquine (HCQ), and patients began antifungals. Following IM discontinuation, all patients required systemic or intra-articular steroids during histoplasmosis treatment, with 4/9 showing Cushingoid features. Four patients began new IM regimens [2 abatacept (ABA), 1 HCQ, and 1 methotrexate (MTX)] while still positive for histoplasmosis, with 3/4 (ABA, MTX, HCQ) later clearing their histoplasmosis and 1 (ABA) showing decreasing antigenemia. Collectively, 8/9 patients initiated or continued DMARDs and/or non-TNFai biologic use (5 ABA, 1 tocilizumab, 1 ustekinumab, 3 MTX, 4 HCQ, 1 leflunomide). No fatalities, exacerbations, or recurrences of histoplasmosis occurred during follow-up (median 33 months).ConclusionsIn our cohort of cRD, histoplasmosis course following reintroduction of non-TNFai IM was favorable, but additional studies are needed to evaluate optimal IM management during acute histoplasmosis and recovery. In this case series, non-TNFai biologic, DMARD, and steroid treatments did not appear to cause histoplasmosis recurrence. Adverse events from corticosteroid use were common. Further research is needed to implement guidelines for optimal use of non-TNFai (like ABA), DMARDs, and corticosteroids in cRD following histoplasmosis presentation.

A retrospective cohort study assessing acute kidney injury and renal recovery among septic patients empirically treated with vancomycin piperacillin-tazobactam versus vancomycin cefepime.

Vancomycin plus piperacillin–tazobactam (VPT) is a commonly used antimicrobial regimen for septic patients. VPT is more nephrotoxic than other regimens such as vancomycin plus cefepime (VC) when given over several days. This risk of nephrotoxicity is less clear when VPT is given for initial empiric therapy in sepsis and de-escalated quickly based on evolving clinical information. The objective of this study was to assess nephrotoxicity among septic patients empirically treated with either VPT or VC at initial clinical presentation. We conducted a retrospective study of septic patients who received VPT or VC within 12 h of presentation to the emergency department. The primary outcomes were acute kidney injury (AKI) and renal recovery 72 h after presentation. For the total of 418 patients, 306 received VPT and 112 received VC. Rates of AKI at 72 h were 15.2% for VPT patients and 11.0% for VC patients [p = 0.44]. Among patients with AKI at presentation, 16.3% of VPT patients had AKI at 72 h compared to 8.9% of VC patients [p = 0.19]. Among those without AKI at presentation, 14.2% VPT patients and 16.7% VC patients had AKI at 72 h [p = 0.71]. Renal recovery rates for patients with AKI at presentation were 42.3% for VPT patients versus 40.3% for VC patients [p = 0.78]. In-hospital renal replacement therapy occurred in 6.2% VPT patients and 0.9% VC patients [p = 0.024]. Therefore, initial empiric therapy with VPT in sepsis may not confer increased risk of AKI when de-escalated appropriately.

Higher Protein Intake Does Not Augment Muscle Protein Synthetic Responses During the Early Stages of Resistance Training in Middle-Aged Adults

Abstract Objectives Dietary protein intake augments muscle protein synthesis rates during acute recovery from resistance exercise training (RET) and can help offset age-related loss in muscle mass. Skeletal muscle tissue contains a variety of different protein pools such as myofibrillar (contractile), mitochondrial (substrate oxidation), and collagen (structural support) proteins that have been reported to have different contraction and nutrient sensitivities in controlled laboratory studies. However, no study has investigated the impact of dietary protein intake on the synthesis of these specific muscle proteins fractions during RET in a free-living setting. Therefore, we investigated the effect of dietary protein intake on daily muscle protein synthesis rates (PS) within the myofibrillar (MyoPS), mitochondrial (MitoPS), and collagen (CPS) protein fractions throughout the early phase (0 – 3 wks) of RET in middle-aged adults. Methods Twenty middle-aged adults (47 ± 1 y, BMI 28 ± 1 kg/m2, M = 12, F = 8) were stratified and randomized to consume either moderate (MOD; 1.06 ± 0.22 g/kg/d) or high (HI; 1.55 ± 0.25 g/kg/d) amounts of protein during a dietary counseling-controlled resistance training program. On day 0, participants ingested intermittent boluses of deuterated (2H) water followed by daily maintenance doses throughout the study period. Muscle biopsies were collected prior to and at weeks 1, 2, and 3 of the intervention to assess MyoPS, MitoPS, and CPS by LC/MS. Results MitoPS decreased at 0–3 wks when compared to 0–1 wks (P = 0.010, CI: −0.77 – −0.10%/d) regardless of group (HI: 0.64 ± 0.32%/d and MOD 0.86 ± 0.55%/d; P = 0.827). A similar decline was also observed for CPS (group P = 0.323; time P = 0.007). The MyoPS in the HI condition remained constant (0–1 wk: 0.81 ± 0.42%/d and 0–3 wks: 0.81 ± 0.72%/d, P = 1.0), but MOD decreased over time (0–1 wk: 1.35 ± 0.9%/d and 0–3 wks: 0.77 ± 0.43%/d, P = 0.023). Conclusions Our results demonstrated that additional protein intake above moderate amounts does not meaningfully potentiate the stimulation of longer-term muscle protein synthetic responses within the myofibrillar, mitochondrial, or collagen protein fractions during the early stages of a RET in middle-aged adults. Funding Sources Funded in part by the Beef Checkoff. AFS funded by CAPES Scholarship.

The relation between psychological need satisfaction in acute psychiatric hospital and recovery among emerging adults: A self-determination theory approach.

Mental illness and addiction are prevalent during emerging adulthood and are associated with poorer functioning and quality of life. Research supports early intervention for enhancing recovery, though emerging adults frequently disengage from services, reducing effectiveness of early care. Research on self-determination theory shows healthcare climates that support psychological needs for autonomy, competence, and relatedness foster sustained engagement in treatment and health-promoting behaviors. The present study hypothesized that more need satisfying (and less frustrating) psychiatric hospital experiences would relate to various indicators of recovery among emerging adults. One-hundred four emerging adults from an acute psychiatric inpatient unit completed an adapted questionnaire measuring need satisfaction in the hospital and surveys of treatment attitudes, illness identity, and wellness during the 3rd week of their hospital stay. Six-month postdischarge service utilization data were obtained through electronic health databases. A more need satisfying hospital experience was associated with greater autonomous motivation for treatment, more positive attitudes toward medications and services, more adaptive illness identification, and greater well-being. Greater need frustration was related to less autonomous and more controlled motivation for treatment, less positive attitudes toward medications and services, less adaptive illness identification, and lower well-being. While neither need satisfaction nor frustration related to subsequent visits to the emergency department or rehospitalization, a need frustrating hospital experience related to fewer attended community appointments during the 6 months following discharge. Hospital experiences that satisfy (and do not frustrate) the psychological needs of emerging adults may promote recovery and treatment engagement. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Spotlight on the May 25 Issue

#### Notable in Neurology This Week This issue features an article that investigates the influence of cognitive demands on motor performance during acute stroke recovery; another examines the associations between neighborhood socioeconomic status and 90-day poststroke outcomes. A featured article determines the prevalence and natural history of sporadic inclusion body myositis in a 40-year population-based study. ### Stroke in Pregnancy and Puerperium: Validated Incidence Trends With Risk Factor Analysis in Finland 1987–2016 Pregnancy-associated stroke is associated with considerable maternal morbidity and mortality. In this Finnish population-based, chart-validated cohort study, the incidence of pregnancy-associated stroke doubled from 1987 …

Cardiac safety of dual anti-HER2 blockade with pertuzumab plus trastuzumab (P+T) in the APHINITY trial.

510 Background: Trastuzumab (T) increases the incidence of cardiac events (CEs) in patients (pts) with early breast cancer (BC). Dual blockade with P+T improves BC outcomes and is the standard of care for high-risk HER2-positive BC pts following the phase 3 APHINITY trial that evaluated the addition of P or placebo (Pla) to T and chemotherapy (CT). We analyzed the cardiac safety of P+T in APHINITY. Methods: APHINITY eligibility required a left ventricular ejection fraction (LVEF) ≥55% at study entry. LVEF assessment was performed every 3 months (mos) during treatment, every 6 mos up to month 36, and yearly thereafter. Primary CE was defined as heart failure (HF) class III/IV and a significant decrease in LVEF of at least 10 percentage points from baseline and to &lt;50%, or cardiac death. Secondary CE was defined as a confirmed significant decrease in LVEF or CEs confirmed by the cardiac advisory board. Results: The safety analysis population consists of 4,769 pts. With 74 mos median follow-up (FU), CEs were observed in 159 pts (3.3%): 83 (3.5%) in the P+T and 76 (3.2%) in Pla+T arms, respectively. Most CEs occurred during anti-HER2 therapy: 123/159 (77.4%) and were asymptomatic or mildly symptomatic LVEF decrease (133/159; 83.6%) (Table 1). There were 2 cardiac deaths in each arm (0.1%). More CEs occurred in pts receiving an anthracycline-based CT compared to those receiving non-anthracycline CT (139 vs. 20 CEs, respectively). Acute recovery from a CE based on subsequent LVEF values was observed in 127/155 pts (81.9%). Conclusions: Dual blockade with P+T does not increase the risk of CE compared to Pla+T alone. The use of anthracycline-based CT increases the risk of a CE; hence non-anthracycline CT may be considered particularly in pts with other cardiovascular risk factors. Clinical trial information: NCT01358877. [Table: see text]

Impact of chloride-rich crystalloids on sepsis-associated community-acquired acute kidney injury recovery in critically ill patients.

The use of chloride-rich crystalloids for resuscitation is associated with acute kidney injury (AKI). We aimed to explore the impact of resuscitation with chloride-rich crystalloids compared to balanced crystalloids on kidney function recovery in patients presenting with sepsis-associated community-acquired AKI (SACA-AKI). This is a single-center, historical cohort study of the adult intensive care unit (ICU) patients who presented to the emergency department (ED) with sepsis-associated community-acquired-AKI at the Mayo Clinic, Rochester, MN, from January 2011 to April 2018. We divided the cohort into two groups based on the primary type of crystalloids they received in the ED and the first 48-h of ICU. The first group received primarily normal saline with < 25% balanced solutions, and the second group received at least ≥ 25% balanced crystalloids during the initial volume resuscitation. Among the 732 enrolled patients [mean age: 64 ± 17, males: 461(63%)], 255 (35%) were in the second group and were found to have higher positive fluid balance during the first 48-h of admission compared to the first group [median + 2.3 (IQR: 0.4; 4.5) vs. + 1.1 (IQR: - 0.8; + 2.9) L, p < 0.001]. The second group had a higher rate of kidney function recovery by multivariate logistic regression after adjustments for known recovery risk factors (OR 1.46; 95% CI 1.05-2.04, p = 0.02). The use of balanced crystalloids during the initial resuscitation is associated with higher odds of kidney function recovery in AKI patientswithsepsis-associated community-acquired AKI.

Evaluation of hepatitis E antigen kinetics and its diagnostic utility for prediction of the outcomes of hepatitis E virus genotype 1 infection

ABSTRACT HEV-Ag ELISA assay is a reliable diagnostic test in resource-limited areas. HEV genotype 1 (HEV-1) infections are either self-limited or progress to fulminant hepatic failure (FHF) and death if anti-HEV therapy is delayed. Limited data is available about the diagnostic utility of HEV Ag on HEV-1 infections. Herein we aimed to study the kinetics of HEV Ag during HEV-1 infections at different stages, i.e., acute HEV infection, recovery, and progression to FHF. Also, we evaluated the diagnostic utility of this marker to predict the outcomes of HEV-1 infections. Plasma of acute hepatitis E (AHE) patients were assessed for HEV RNA by RT-qPCR, HEV Ag, and anti-HEV IgM by ELISA. The kinetics of HEV Ag was monitored at different time points; acute phase of infection, recovery, FHF stage, and post-recovery. Our results showed that the level of HEV Ag was elevated in AHE patients with a significantly higher level in FHF patients than recovered patients. We identified a plasma HEV Ag threshold that can differentiate between self-limiting infection and FHF progression with 100% sensitivity and 88.89% specificity. HEV Ag and HEV RNA have similar kinetics during the acute phase and self-limiting infection. In the FHF stage, HEV Ag and anti-HEV IgM have similar patterns of kinetics which could be the cause of liver damage. In conclusion, the HEV Ag assay can be used as a biomarker for predicting the consequences of HEV-1 infections which could be diagnostically useful for taking the appropriate measures to reduce the complications, especially for high-risk groups.

Clinical Use of Surface Electromyography to Track Acute Upper Extremity Muscle Recovery after Stroke: A Descriptive Case Study of a Single Patient.

Arm recovery varies greatly among stroke survivors. Wearable surface electromyography (sEMG) sensors have been used to track recovery in research; however, sEMG is rarely used within acute and subacute clinical settings. The purpose of this case study was to describe the use of wireless sEMG sensors to examine changes in muscle activity during acute and subacute phases of stroke recovery, and understand the participant’s perceptions of sEMG monitoring. Beginning three days post-stroke, one stroke survivor wore five wireless sEMG sensors on his involved arm for three to four hours, every one to three days. Muscle activity was tracked during routine care in the acute setting through discharge from inpatient rehabilitation. Three- and eight-month follow-up sessions were completed in the community. Activity logs were completed each session, and a semi-structured interview occurred at the final session. The longitudinal monitoring of muscle and movement recovery in the clinic and community was feasible using sEMG sensors. The participant and medical team felt monitoring was unobtrusive, interesting, and motivating for recovery, but desired greater in-session feedback to inform rehabilitation. While barriers in equipment and signal quality still exist, capitalizing on wearable sensing technology in the clinic holds promise for enabling personalized stroke recovery.

Prevalence of Venous Thromboembolism Following Acute Spinal Cord Injury in an Urban Inner City Hospital.

Venous thromboembolism (VTE) is known to occur at high rates in patients who suffer spinal cord injury (SCI). Large population studies in the United States have shown a prevalence of approximately 4-5%, with some studies suggesting higher prevalence. While the specific mechanism behind increased VTE incidence in the SCI population is unknown, it is likely tied to immobility and functional decline. Previous studies have also linked social determinants of health to higher VTE prevalence in certain populations. The purpose of this study is to determine the prevalence of VTE after acute SCI in the inner urban city population and to identify factors that place patients at increased VTE risk. Patients who suffered SCI between 2014 and 2019 were identified from one inner city urban hospital. A retrospective chart review was completed to record the development of VTE after SCI. Medical comorbidities, type of thromboprophylaxis used, patient demographics, injury characteristics, and postinjury sequelae were compared between individuals who did and did not develop VTE. A total of 148 patients were included. These patients were from a low socioeconomic demographic when compared with the larger US population. Average household income based on zip code data for included patients was $56 647, $30 315 below the national average. The prevalence of VTE in this patient population was 19.59%. Weight, deep vein thrombosis history, chemoprophylaxis use, mobility impairment postinjury, neurologic level of SCI, malignancy history, and history of smokeless tobacco were associated with VTE (all P < .05). Low molecular weight heparin (LMWH) use was associated with fewer occurrences of VTE (P < .001). Patients from our urban inner city hospital have a higher VTE prevalence after SCI than shown in previous US-based studies. These patients may be at increased risk due to increased numbers of medical comorbidities, social factors, or undiagnosed medical conditions. Thromboprophylaxis with LMWH appears to lower the risk of VTE after SCI. 3. Patients with the previously mentioned risk factors are at increased risk for VTE development during their acute recovery process. These patients should have a much lower screening threshold for VTE evaluation and likely would benefit from more routine screening to prevent complications related to VTE development or progression. Furthermore, these patients should, when medically appropriate, be treated with low molecular weight heparin for VTE prophylaxis as previously recommended by the Consortium for Spinal Cord Medicine.

Obesity is a risk factor for progression to kidney transplant waitlisting after liver transplantation.

Non-alcoholic steatohepatitis has emerged as a leading cause of cirrhosis, and obesity-associated comorbidities, including renal disease, have increased in prevalence. Obesity predisposes the kidney to hyperfiltration injury, potentially impairing acute kidney injury recovery. Identification of patients at risk for renal dysfunction is impeded by poor performance of renal function estimating equations among cirrhotics. To better understand obesity among cirrhotics and renal disease progression, we examined likelihood of kidney transplantation (KT) waitlisting after liver transplant alone (LTA) by obesity class. 68607 LTA recipients were identified in SRTR (2005-2018). Fine and Gray competing risks models were used to analyze likelihood of KT waitlisting. 27.4% of recipients were obese (BMI≥30kg/m2 ) and were 10% more likely to require KT waitlisting (aHR: 1.10, 95%CI: 1.01-1.20). Risk was highest among recipients with Classes II and III obesity (BMI: ≥35kg/m2 ) (aHR: 1.37, 95%CI: 1.17-1.56). Moreover, recipients with Classes II and III obesity were 57% more likely to require KT waitlisting within one year post-LTA (aHR: 1.57, 95%CI: 1.18-2.10) compared to non-obese recipients. These findings suggest obesity was a risk factor for renal recovery failure and/or renal disease progression post-LTA and may confound identification of renal dysfunction and/or prediction of renal recovery among cirrhotics.

Role of S100β Glial Protein as a Serological Marker for Analysis of Acute Ischemic Stroke

Background: Stroke is a major cause of neurological disability, which can be often predicted with serological markers. Glial-derived S100β protein is a potential biomarker for cerebral ischemia and may be helpful in predicting the severity, outcome, and recovery of stroke. Aim: This study aimed to study the role of S100β glial protein as a serological marker in predicting the severity of acute ischemic stroke (AIS), outcome, and functional recovery after 1 month. Methods: A hospital-based prospective case control study included 43 consecutive patients, &gt;18 years old, who were admitted with acute middle cerebral artery (MCA) territory infarcts within 72 h of onset of neurological deficits. Control group comprised of 43 age-matched asymptomatic volunteers. Independent t-test and chi square test were used to compare the means and evaluate the association between protein level and various parameters. P ≤ .05 was statistically significant. Results: S100β protein level in AIS patients was significantly higher compared to controls ( P &lt; .05). Elevated serum S100β protein level was found to be associated with larger infarct volumes, higher National Institute Health Stroke Scale scores, and higher modified Rankin Scale scores at admission ( P &lt; .05). Patients with higher S100β protein levels at admission had poor recovery at 1 month compared to patients having normal S100β protein levels. Conclusion: S100β protein levels at admission after an acute MCA territory infarct may be used as a reliable serological tool in predicting the severity, outcome, and functional recovery in stroke.

The Effects of L-Citrulline on Blood-Lactate Removal Kinetics Following Maximal-Effort Exercise

The accumulation of lactate in muscle and blood during high-intensity exercise is negatively correlated with the duration exercise can be sustained. Removal of lactate is a key component of acute recovery between consecutive bouts of such exercise. Low-intensity exercise enhances recovery by accelerating lactate turnover in metabolically active tissues, largely mediated by blood flow to these tissues. Therefore, the purpose of this research was to clarify if L-citrulline, a nutritional supplement purported to promote vasodilation via enhanced nitric oxide availability, would augment the removal of blood lactate during active recovery (AR). L-citrulline ingestion will augment the rate of blood lactate concentration decrease during AR, reduce the oxygen-cost of submaximal exercise, and increase time-to-exhaustion and peak oxygen uptake (V̇O2peak) during a test of maximal aerobic power. Healthy university students (five males & five females) participated in this double-blind, randomized, placebo-controlled study. Participants exercised on a cycle ergometer at submaximal steady-state intensities followed by progressively increasing intensity to exhaustion, 10 min of AR, and then supramaximal intensity exercise to exhaustion. Oxygen uptake was measured throughout the trial and blood lactate was sampled repeatedly during AR. The protocol elicited very high peak blood lactate concentrations after exercise (11.3 + 1.3 mmol/L). L-citrulline supplementation did not significantly alter blood lactate kinetics during AR, the oxygen cost of exercise, V̇O2peak, or time-to-exhaustion. Despite a strong theoretical basis by which L-citrulline could augment lactate removal from the blood, L-citrulline supplementation showed no effect as an exercise-recovery supplement.