Continuous Therapy Research Articles

Advances in Type 1 Diabetes Mellitus Management in Children.

Recent advancements in the management of type 1 diabetes mellitus (T1DM) have significantly improved outcomes and quality of life for patients, particularly children. Technological innovations, such as continuous glucose monitoring (CGM) systems and insulin pump therapy, including hybrid closed-loop systems, have enhanced glycemic control by providing real-time data and automated insulin delivery. Ultrarapid-acting insulins and adjunctive pharmacotherapies, like sodium-glucose transport protein 2 (SGLT2) inhibitors and glucagon-like peptide 1 (GLP-1) receptor agonists, offer improved postprandial glucose management and reduced insulin requirements. Immunotherapy and beta-cell replacement therapies, including stem cell research and encapsulation devices, aim to preserve or restore endogenous insulin production. Digital health platforms and telemedicine have expanded access to education and support, fostering better self-management. Future directions in precision medicine, artificial intelligence, and microbiome research hold promise for personalized and potentially curative treatments. Collectively, these advances are transforming T1DM management, reducing disease burden, and enhancing the prospects for children with T1DM.

Morel-Lavallee associated lymphedema treated with lymphovenous anastomosis: A case report

Morel-Lavallee Lesions lead to disruption of lymphatic anatomy that require early identification and may necessitate lymphatic reconstruction. We present the case of a 59-year-old male with lower extremity lymphedema resulting after a severe Morel-Lavallee lesion and treated using lymphovenous anastomoses. He was initially managed with multiple aspirations followed by repeat incision and drainage. At 10 months following his injury, he continued to have swelling of his upper thigh and developed a large festoon medially, with lower leg pitting edema. He was diagnosed with lymphedema via lymphoscintigraphy. His superficial lymphatic anatomy was visualized using indocyanine green (ICG) lymphography and showed diffuse dermal backflow across his thigh, with signs of altered lymphatic anatomy distally. We preformed two lymphovenous anastomoses at the level of his mid-thigh to bypass the lymphatic disruption and restore drainage to his lower leg. After rerouting lymphatic flow from the lower extremity, the patient had overall improvement of his symptoms and reduced swelling with continued therapy. At 5 months postoperatively, his volumetric lower extremity measurements showed a decrease by 314 mL and he began walking again in 20-minute intervals. Lymphedema may be an important consideration following severe Morel-Lavallee lesions. Using modern diagnostic and supermicrosurgical techniques, plastic surgeons can help treat this long-term morbidity.

The impact of continuous positive airway pressure therapy on cardiovascular events in patients with obstructive sleep apnoea: an updated systematic review and meta-analysis.

Obstructive sleep apnoea (OSA) is positively associated with cardiovascular diseases, and continuous positive airway pressure (CPAP) is a common treatment for such patients. This study aimed to explore the impact of CPAP on cardiovascular outcomes and prognosis in patients with OSA. A search was conducted in the PubMed, Embase and CENTRAL databases for relevant studies published up to March 2024. Two independent reviewers screened the studies based on inclusion and exclusion criteria, and data were synthesised using RevMan 5.3 software. Heterogeneity was assessed using the Cochran Q test and the I2 statistic. A total of 10 randomised controlled trials and 3 observational studies, comprising 13,832 patients, were included. Compared with standard treatment, the use of CPAP did not significantly reduce the risk of major adverse cardiovascular events (MACE) (risk ratio [RR]: 0.73, 95% confidence interval [CI]: 0.52-1.03; p = 0.07; I2 = 66%), all-cause mortality (RR: 0.92, 95% CI: 0.72-1.16; p = 0.48; I2 = 0%), cardiovascular mortality (RR: 0.63, 95% CI: 0.33-1.19; p = 0.15; I2 = 70%) or non-cardiovascular mortality (RR: 0.81, 95% CI: 0.57-1.15; p = 0.23; I2 = 0%). Similarly, there were no significant differences in the incidence of myocardial infarction, stroke, hospitalisation due to unstable angina or heart failure or atrial fibrillation among those using CPAP. However, when CPAP adherence was ≥ 4h, CPAP significantly reduced the risk of MACE and cardiovascular mortality. Although CPAP's cardiovascular benefits in patients with OSA are not confirmed, it may be that bias risks, CPAP adherence and characteristics of the study population may attenuate the perceived benefits of CPAP. Further research is needed to optimise CPAP therapy.

Pediatric Obstructive Sleep Apnea: An Updated Review

Abstract Pediatric obstructive sleep apnea (OSA) is a prevalent sleep disorder characterized by recurrent upper airway obstruction during sleep, leading to disrupted breathing patterns and intermittent hypoxemia. This review synthesizes current literature on pediatric OSA, covering epidemiology, etiology, clinical presentation, diagnosis, and management. OSA affects 1%–5% of children, with adenotonsillar hypertrophy as a primary cause. The interplay of anatomical and neuromuscular factors contributes to OSA pathophysiology. Clinical manifestations include snoring, witnessed apneas, and daytime sleepiness, although diagnosis can be challenging due to varied symptoms. Diagnostic methods encompass clinical assessment and polysomnography, while management strategies range from adenotonsillectomy to continuous positive airway pressure therapy. Early recognition and intervention are crucial to prevent complications and optimize outcomes in pediatric OSA. Further research is needed to refine diagnostic approaches and enhance treatment efficacy for this significant pediatric health concern.

The latest research progress on the relationship between obstructive sleep apnea–hypopnea syndrome and metabolic syndrome

AbstractObstructive sleep apnea–hypopnea syndrome (OSAHS) is the most common subtype of sleep‐disordered breathing, characterized by symptoms such as snoring, nocturnal sleep disturbances, and excessive daytime sleepiness. OSAHS is defined by recurrent upper airway collapses during sleep, leading to apneas or hypopneas. These episodes result in intermittent nocturnal hypoxia and sleep fragmentation, which provoke sympathetic activation, oxidative stress, and systemic inflammation, ultimately causing chronic damage across multiple bodily systems. OSAHS significantly increases the risk of various cardiovascular and metabolic disorders, including atherosclerosis, hypertension, obesity, insulin resistance, and dyslipidemia. In China, approximately 176 million individuals are estimated to have OSAHS, with about 60 million experiencing moderate to severe forms of the condition. This paper reviews the epidemiological characteristics of OSAHS, the evolution of diagnostic criteria, and the association between OSAHS and metabolic syndrome (MetS), emphasizing the high prevalence of MetS among OSAHS patients. Through cross‐sectional analysis, cohort studies, and interventional studies, the complex interactions between OSAHS and MetS are examined, proposing therapeutic strategies to improve these metabolic anomalies, including continuous positive airway pressure therapy and weight management.

Renal cell carcinoma in a transplanted kidney: a retrospective evaluation

IntroductionKidney transplantation is the optimal treatment modality for patients with end-stage chronic kidney disease. The long-term mortality of kidney recipients is 48–82% lower than that of patients on the waiting list. However, the risk of developing malignancies in these patients is twice as high as in the healthy population. Specifically, the incidence of renal cell carcinoma (RCC) in transplant recipients is 10–30 times higher than in non-transplanted patients. The reason for the increased risk is poorly understood, but is most likely related to continuous immunosuppressive therapy. The problem of kidney graft neoplasia has not been adequately addressed in the medical literature.ObjectiveTo determine the incidence of renal cell carcinoma in transplanted kidneys, enhance the efficacy of its treatment, and study the etiology of RCC development.Materials and methodsA retrospective analysis of RCC incidence in kidney grafts was conducted in 3,270 patients who underwent kidney transplantation between 2013 and 2023. We evaluated the effectiveness of surgical interventions for these complications. Patients with histologically confirmed RCC of the transplanted kidney underwent genetic study to determine the etiology of the neoplasm.ResultsThe incidence of RCC in transplanted kidneys was found to be 0.95% (n = 31), 28 patients underwent laparoscopic resection of the renal transplant tumor, 2 patients were treated with radiofrequency ablation of the tumor. Transplantectomy was performed in 1 patient.ConclusionLaparoscopic resection is an effective and safe method for the treatment of RCC in kidney transplants. Transplanted kidney cancer originates from the donor tissue. The clear cell variant of transplanted kidney cancer is a genetically determined disease.

Analyzing the impact of pulse steroid therapy on relapse rates and disease progression in relapsing-remitting multiple sclerosis: a comprehensive retrospective study

Background and Objective: Relapsing remitting MS (RRMS) is characterized by recurrent relapses with remissions. Over an extended time-frame, high-dose steroid administration has primarily centered on the treatment of acute relapses, rather than relapse prevention. The objective of this retrospective study is to assess the long-term impact of administering three monthly pulse steroid therapy for three days on relapse rates and the Expanded Disability Status Scale (EDSS) scores in patients with RRMS. Methods: This study was conducted at Neurology ward of Chandka Medical College Hospital in Larkana from January 2021 to January 2023. A retrospective analysis of historical patient data, focusing on individuals with RRMS who received three monthly pulse steroid therapy over a specified period. Data was collected through patient records, including details of treatment, relapse history, and EDSS scores. Results: Thirty MS patients including 25 females and five males received one gram methylprednisolone intravenously every three months for three days. The mean age range was 18-50 years. Among them, three experienced no relapses, 11 had one relapse, 13 encountered two relapses, and three had three relapses over next consecutive two years. The severity of relapses varied, with 20 classified as moderate and seven as severe. A reduction in relapse rates and notable improvements in EDSS scores were observed. Conclusion: The initial findings from this retrospective analysis suggest that three monthly pulse steroid therapy is associated with positive outcomes in RRMS patients. These results support the need for further investigation into the potential benefits of continuous steroid therapy in managing RRMS.

Association of continuous subcutaneous insulin therapy and diabetic retinopathy in type 1 diabetes: A national cohort study

AimThis study aimed to investigate the short-and long-term effect on diabetic retinopathy (DR) in individuals with type 1 diabetes treated with continuous subcutaneous insulin injections (CSII) compared to those using multiple daily injections (MDI). MethodsWe conducted a register-based matched cohort study utilizing data from the Danish Registry of Diabetic Retinopathy as well as several other national Danish health registers. Our cohort consisted of all individuals with type 1 diabetes who attended the Danish screening program for DR from 2013 to 2022. We included individuals registered with CSII treatment, and compared them to individuals using MDI, matched by age, sex, and DR level. Cox regression analysis was performed to evaluate the outcomes. ResultsThe study included 674 individuals treated with CSII and 2006 matched MDI users. In our cohort 53.4 % were female and median age was 36 (IQR 27–47). Average follow-up risk-time was 4.8 years. There was no difference in the risk of DR worsening between the CSII group and MDI group (HR 1.05 [95%CI 0.91; 1.22], p = 0.49). However, an increased risk of focal photocoagulation was observed in the CSII group (HR 2.40 [95%CI 1.11; 5.19], p = 0.03). ConclusionsOur findings indicate that CSII treatment does not confer a significant difference in the overall short- and long-term risk of DR worsening or ocular intervention compared to MDI treatment. These results provide insights into the DR outcomes of CSII treatment in individuals with type 1 diabetes.

Continued Intravenous Versus First Week Transition to Oral Antibiotic Therapy in Bloodstream Infections: A Systematic Review and Meta-Analysis.

Bloodstream infections (BSIs) are a major public health concern worldwide, requiring prompt and effective antibiotic therapy. Traditionally, intravenous (IV) antibiotics have been preferred for their rapid action and consistent absorption. However, interest is growing in transitioning to oral (PO) antibiotics when suitable, due to similar pharmacokinetics, improved patient outcomes, and reduced healthcare costs. This meta-analysis aims to evaluate the clinical effectiveness of switching from IV to PO antibiotics for both gram-negative and gram-positive BSIs. Scopus, Embase, and PubMed databases were comprehensively searched until March 2023. The review included randomized controlled trials and cohort studies comparing continued IV therapy with early transition from IV to PO antibiotics within the first week of admission. Inclusion criteria encompassed studies involving adult patients (≥18 years) and reporting specific outcomes such as treatment success, mortality, and hospital readmissions. Meta-analysis of 17 studies comprising 11,245 patients demonstrated higher treatment success rates overall (OR: 1.40, P=0.04), particularly in gram-negative infections (OR: 1.42, P=0.05). However, this effect was not statistically significant in the gram-positive subgroup (OR: 1.41, P=0.036). Oral switch significantly reduced all-cause mortality overall (OR: 0.35, P=0.003), especially in gram-negative infections (OR: 0.22, P=0.008), but not significantly in gram-positive infections (OR: 0.60, P=0.09). Both gram-negative and gram-positive infections benefited from shorter hospital stays (P<0.0001), despite significant heterogeneity. Hospital readmission rates did not significantly differ between IV and oral switch groups (P=0.53). Our meta-analysis suggests potential benefits of early transition from IV to PO antibiotics for BSIs, including improved treatment outcomes and shorter hospital stays without an increased risk of readmission. However, these findings are subject to selection bias, and further standardized randomized trials are essential to validate these results.

The Immediate Effect of Chest Mobilization Technique on Chest Expansion in Patients of COPD

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is characterized by chronic airflow obstruction. Patients with COPD often experience reductions in lung volumes and vital capacity due to chronic respiratory muscle weakness. Additionally, they may exhibit decreased lung distensibility, leading to restrictions in lung volume. The passive recoil of the thoracic cage is influenced by gross muscle weakness, altering the neutral position at which lung and cage recoil pressures are balanced. Mobilizing rib cage joints is a specific therapeutic goal, as it aims to improve reduced rib cage mobility commonly observed in obstructive lung disease. Method: A study was conducted on COPD patients aged over 40 years, specifically including males with VC&lt;80%. Participants with unstable vital parameters, active lung infections, or those requiring continuous oxygen therapy or mechanical ventilation were excluded. The participants were divided into two groups: Group 1 received chest mobilization and breathing exercises, while Group 2 received only breathing exercises. Chest expansion measurements were taken at the 2nd intercostal space, 4th intercostal space, and xiphoid process in both groups before and after the procedures. Result: Result obtained from SPSS20. Mean-age of Group1 was (61.9+6.0) &amp; of Group2 was (62.05+6.1). Comparison between groups found using independent t-tests. There was significant difference of chest-expansion at 2nd IC, 4th IC and xiphoid process between both the groups. Chest-expansion at 2nd IC(M=2.0), 4th IC(M=2.85) and xiphoid process (M=3.43) was increased in group1 than group2 (M=1.58), (M=2.01) &amp; (M=2.49) having significant difference of p&lt;0.05. Conclusion: This study concludes that Chest Wall mobilization has significant effect on Chest-expansion in COPD patients. Hence Chest-Mobilization is definite tool for the improving condition of COPD patients, so it should be included as a part of management in COPD patients with other exercise treatment-programs. Keywords: Chest mobilization, COPD, Chest expansion, Cloth tape measurement

Factors influencing circuit lifetime in paediatric continuous kidney replacement therapies – results from the EurAKId registry

BackgroundContinuous kidney replacement therapy (CKRT) has recently become the preferred kidney replacement modality for children with acute kidney injury (AKI). We hypothesise that CKRT technical parameters and treatment settings in addition to the clinical characteristics of patients may influence the circuit lifetime in children.MethodsThe study involved children included in the EurAKId registry (NCT 02960867), who underwent CKRT treatment. We analysed patient characteristics and CKRT parameters. The primary end point was mean circuit lifetime (MCL). Secondary end points were number of elective circuit changes and occurrence of dialysis-related complications.ResultsThe analysis was composed of 247 children who underwent 37,562 h of CKRT (median 78, IQR 37–165 h per patient). A total of 1357 circuits were utilised (3, IQR 2–6 per patient). MCL was longer in regional citrate anticoagulation (RCA), compared to heparin (HA) and no anticoagulation (NA) (42, IQR 32-58 h; 24, IQR 14-34 h; 18, IQR 12-24 h, respectively, p < 0.001). RCA was associated with longer MCL regardless of the patient’s age or dialyser surface. In multivariate analysis, MCL correlated with dialyser surface area (beta = 0.14, p = 0.016), left internal jugular vein vascular access site (beta = -0.37, p = 0.027), and the use of HA (beta = -0.14, p = 0.038) or NA (beta = -0.37, p < 0.001) vs. RCA. RCA was associated with the highest ratio of elective circuit changes and the lowest incidence of complications.ConclusionAnticoagulation modality, dialyser surface, and vascular access site influence MCL. RCA should be considered when choosing first-line anticoagulation for CKRT in children. Further efforts should focus on developing guidelines and clinical practice recommendations for paediatric CKRT.Graphical abstractA higher resolution version of the Graphical abstract is available as Supplementary information

Psoriatic arthritis, biologic therapy experience, body mass index, and onset age of psoriasis were independent factors of secukinumab discontinuation in patients with psoriasis

ABSTRACT Introduction Despite the availability of several treatments for psoriasis (PsO), factors influencing the persistence of secukinumab (SEC) therapy remain inadequately understood. This study aimed to identify predictors of SEC persistence in PsO. Methods A retrospective analysis was conducted on 109 PsO patients who received SEC treatment at least 1 year. Patients were categorized based on continued or discontinued SEC therapy. Results Among the 109 patients, 64 continued SEC treatment while 45 discontinued. Univariate analysis demonstrated that PsA presence and previous biologic therapy use increased the risk of SEC discontinuation 3.56- and 2.33-fold (p = 0.001, %95 CI: 1.66–7.65 and p = 0.032, %95 CI: 1.08–5.04, respectively). Additionally, the risk of SEC discontinuation is 57% higher in patients with a body mass index (BMI) above 26.5 compared to those with a BMI below 26.5 (p = 0.016, %95 CI: 0.22–0.85). Additionally, patients with PsO onset age below 26.5 years were found to have a 2.93-times higher risk of discontinuing SEC compared to those with PsO onset age above 26.5 years (p = 0.004, %95 CI: 1.40–6.13). Conclusion PsA presence, previous biologic therapy experience, BMI, and PsO onset age were identified as independent predictors of SEC discontinuation. These findings underscore the importance of personalized treatment strategies for PsO patients receiving SEC therapy.

Long-term trajectories of weight loss and health outcomes: protocol of the SCOOP-RNPC nationwide observational study

IntroductionBehavioural weight loss programmes are generally accepted as being beneficial in reducing cardiometabolic risk and improving patient-reported outcomes. However, prospective data from large real-world cohorts are scarce concerning the mid-term...

Continuous Rifampicin Therapy Induced Acute Kidney Injury in a Tuberculous Patient: A Case Report

Background: Tuberculosis (TB) presents with productive cough, hemoptysis, chest pain, fever, weight loss, and night sweats. Anti-tuberculosis treatment (ATT) can affect various organs, including the liver and kidneys. ATT-induced acute kidney injury (AKI) presents with fever, rash, nausea, vomiting, diarrhea, and abdominal pain. It occurs due to type 2 or 3 hypersensitivity and affects individuals who have previously used rifampicin or are currently using it intermittently. Case: An 60-year-old lady was diagnosed with TB and started on ATT. After a few days, she complained of reduced food intake and vomiting, yellow discoloration of the skin, abdominal pain and distention, and limb swelling. She was diagnosed as a case of ATT-induced AKI. She didn't have past exposure to rifampicin and was continuously using it this time. Conclusion: The key learning point from this case is that ATT-induced AKI can develop even when used in a continuous dosing regime and upon first time exposure despite no history of past exposure. This prompts vigilance in monitoring renal function in patients being started on ATT regimen. This is becasuse, ATT-induced AKI poses risk to patient’s life and there is a possibility of developing resistance to anti-tuberculous therapy as a result of discontinuation of treatment. Furthermore, our case suggests that, in addition to immune-mediated mechanisms described in literature for ATT-induced AKI, other pathophysiological mechanisms might also be linked to this pathology and need further research for better understanding and optimization of treatment strategies.

Maintenance therapy for CTCL: importance for prevention of disease progression

There are no established maintenance protocols for cutaneous lymphomas. We aim to determine patient treatments and outcomes during the COVID-19 pandemic in order to uncover the most effective maintenance protocols for cutaneous lymphomas and impact of treatment interruption. Data was collected retrospectively from nine international institutions, including 149 patients. Younger patients had earlier stages of disease and were most frequently treated with skin-directed therapies including topical steroids, mechlorethamine gel, and phototherapy. Treatment interruption varied by treatment type and stage, with patients on topical therapies and earlier stages of disease being least likely to experience interruption. Treatment interruption was significantly associated with progression of disease and worse outcomes, with twice as many patients progressing who had interruption compared to those without interruption. This study may demonstrate the significance of continuous maintenance therapies, even in younger patients with early stages of disease.

Detailed regimens for the prolonged β-lactam infusion therapy

A recent systematic review and meta-analysis of randomized controlled trials (RCTs) evaluated the efficacy and safety of prolonged versus intermittent β-lactam infusion in adult sepsis patients. The findings revealed a significant decrease in all-cause mortality and marked clinical success in the prolonged infusion group. Unfortunately, however, the manuscript lacked data and discussion for the specific regimens of prolonged β-lactam infusion defined in the included 15 RCT studies, which are herein additionally provided. Excluding one RCT, all protocols adopted a continuous infusion for the prolonged treatment. Except for three RCTs, dosages and timings of bolus injection were clearly defined. The total daily antibiotic dose for the continuous therapy was equivalent to those recommended for intermittent therapy. We believe this supplementary data aids clinicians in providing prolonged β-lactam infusions, contributing to enhanced treatment outcomes for patients suffering from severe sepsis or septic shock.

Molecular tumor board: molecularly adjusted therapy upon identification and functional validation of a novel ALK resistance mutation in a case of lung adenocarcinoma.

We report a case of a long-term surviving patient with EML4/ALK translocated non-small cell adenocarcinoma of the lung in UICC8 stage IVA. During recurrence under continuous crizotinib therapy, a hitherto insufficiently characterized missense mutation in the ALK gene (Arg1181His) was identified through targeted sequencing. The aforementioned EML4/ALK translocation could still be detected in this situation. Employing a 3D reconstruction of the ALK tertiary structure, considering its interaction with various ALK inhibitors at the molecular binding site, our analysis indicated the presence of a mutation associated with crizotinib resistance. To validate the biological relevance of this previously unknown mutation, we carried out an in vitro validation approach in cell culture in addition to the molecular diagnostics accompanied by the molecular tumor board. The tumor scenario was mimicked through retroviral transfection. Our comparative in vitro treatment regimen paired with the clinical trajectory of the patient, corroborated our initial clinical and biochemical suspicions. Our approach demonstrates preclinical, in silico, and clinical evidence of a novel crizotinib resistance mutation in ALK as well as sensitivity toward brigatinib and potentially lorlatinib. In future cases, this procedure represents an important contribution to functional diagnostics in the context of molecular tumor boards.

Hot flashes and sleep disruption in a randomized trial in menopausal women

BackgroundHot flashes, common during menopause, affect up to 80% of Western menopausal women and are reported to contribute to sleep disturbances in midlife. Few prospective data are available to confirm the specific role of hot flashes in disrupting sleep in midlife women, however, or confirm whether changes in hot flashes in response to clinical therapies result in improvement in sleep. ObjectiveTo examine the effects of continuous nitroglycerin therapy on sleep quality in peri- and postmenopausal women with frequent hot flashes (pre-specified secondary trial endpoint), and to examine prospective associations between hot flashes and sleep disruption in this population. Study DesignSleep data were analyzed from a randomized, double-blinded, placebo-controlled trial of continuous transdermal nitroglycerin (NTG) therapy to suppress nitric oxide-mediated vasodilation in peri- or postmenopausal women with hot flashes. Participants were randomized to uninterrupted use of transdermal NTG (0.2-0.6 mg/hour) or placebo for 12 weeks. Nocturnal hot flashes awakening participants from sleep were evaluated using 7-day symptom diaries at baseline, 5 weeks, and 12 weeks. Sleep disruption (wake time after sleep onset, WASO) was assessed using validated sleep diaries, and global sleep quality was assessed by the validated Pittsburgh Sleep Quality Index (PSQI: range 0 [best] 21 [worst]) questionnaire. Mixed linear models examined changes in sleep quality and disruption, as well as the strength of associations between nocturnal hot flash frequency and sleep outcomes, over 5 and 12 weeks, adjusting for baseline values, age, race, and ethnicity. ResultsAmong the 141 participants (70 to NTG and 71 to placebo, mean age 54.6 [±3.9] years), the mean baseline hot flash frequency was 10.8 (±3.5) per day, including 2.6 (±1.7) nocturnal hot flashes awakening participants. At baseline, hot flashes were the most commonly reported reason for nocturnal awakening, with 62.6% of participants reporting waking due to hot flashes at least twice nightly. Over 5 and 12 weeks, mean frequency of nocturnal hot flashes causing awakenings decreased in both groups (NTG: -0.9 episodes/night, placebo: -1.0 episodes/night). Sleep disruption as measured by average nightly WASO also decreased (NTG: -10.1 minutes, placebo: -7.3 minutes), and mean PSQI score improved (NTG: -1.3 points, placebo: -1.2 points). No significant between-group differences in change in sleep outcomes were detected from baseline to 5 and 12 weeks, including PSQI sleep quality score as a pre-specified secondary trial endpoint (P ≥ .05 for all). Greater improvement in nocturnal hot flash frequency over 5 and 12 weeks was associated with greater improvement in PSQI sleep quality score (β= -0.30, P=.01) and sleep disruption reflected by WASO (β= -1.88, P=.02) in the combined sample. ConclusionAmong menopausal women in a randomized trial of continuous NTG therapy for hot flashes, hot flashes were the most frequently reported cause of nocturnal awakenings. Compared to placebo, continuous NTG therapy did not result in greater improvements in sleep quality from baseline to 5 and 12 weeks. Based on night-by-night symptom diaries and questionnaires, however, greater improvement in nocturnal hot flash frequency in both groups was associated with greater improvement in sleep quality and disruption.

Impact of specialized renal technologists on optimizing delivery of continuous kidney replacement therapy in critical care areas a retrospective study.

Continuous renal replacement therapy (CKRT) is delivered to some of the most critically ill patients in hospitals. This therapy is expensive and requires coordination of multidisciplinary teams to ensure the prescribed dose is delivered. With increased demands on the critical care nursing staff and increased complexities of patients admitted to critical care units, we evaluated the role of specialized renal technologists in ensuring the prescribed dose is delivered. Therefore, the aim of this study is to investigate the impact of supporting intensive care unit nurses with specialized renal technologists on optimizing efficiency of CKRT sessions in the United Arab Emirates. This is a retrospective study that compared critically ill patients on CKRT overseen by specialized renal technologists versus who are non-covered in the year 2021. A total of 331 sessions on 158 patients were included in the study. The mean filter life was longer in specialized renal technologists-covered patients compared to the non-covered group (66 vs. 59 h, p = 0.019). After adjustment by multiple regression analysis for risk factors (i.e., age, gender, mechanical ventilation, sepsis, mean arterial pressure, vasopressors, and SOFA) that may affect CKRT machines' filter life, presence of a specialized renal technologists resulted in significantly longer filter life (co-efficient 0.129; CI 95% 1.080, 11.970; p-value: 0.019). Our study suggests that specialized renal technologists play a vital role in prolonging CKRT machine's filter life span and optimizing CKRT machine's efficiency. Further research should focus on other potential benefits of having specialized renal technologists performing CKRT sessions, and to confirm the finding of this study. Additionally, a cost-benefit analysis could be conducted to determine the economic impact of having specialized teams performing CKRT.

Emerging Wearable Ultrasound Technology.

This perspective article provides a brief overview on materials, fabrications, beamforming, and applications for wearable ultrasound devices, a rapidly growing field with versatile implications. Recent developments in miniaturization and soft electronics have significantly advanced wearable ultrasound devices. Such devices offer distinctive advantages over traditional ultrasound probes, including prolonged usability and operator independence, and have demonstrated their effectiveness in continuous monitoring, noninvasive therapies, and advanced human-machine interfaces. Wearable ultrasound devices can be classified into three main categories: rigid, flexible, and stretchable, each having distinctive properties and fabrication strategies. Key unique strategies in device design, packaging, and beamforming for each type of wearable ultrasound devices are reviewed. Furthermore, we highlight the latest applications enabled by wearable ultrasound technology in various areas. This article concludes by discussing the outstanding challenges within the field and outlines potential pathways for future advancements.