Course Of Recovery Research Articles

Mild Traumatic Brain Injury in Older Adults: Recovery Course and Insights on Early Predictors of Outcome.

Mild traumatic brain injury (mTBI) is a growing health concern in the context of an aging population. Older adults comprise a distinct population, with an increased vulnerability for mTBI due to comorbid diseases and age-associated frailty compared with the adult population. The aim of this study was to assess the recovery course and determinants of outcome in a large cohort of older patients with mTBI. For this study, 154 patients aged ≥60 years with mTBI admitted to the Emergency Department were investigated in a prospective observational cohort (ReCONNECT study). Demographics and injury characteristics (computed tomography scan, Glasgow Coma Scale) were determined on admission. Early determinants of outcome were assessed at 2 weeks post-injury (e.g., early post-traumatic complaints and emotional distress) with validated questionnaires. Quality of life (QoL) was determined at 3 months with the World Health Organization Quality of Life Scale-Shortened Version. Functional outcome was determined at 3 (early) and 6 months (long term) post-injury with the Glasgow Outcome Scale Extended (GOSE). Logistic regression analyses identified predictors of outcome with dichotomized GOSE scores as dependent variable (incomplete recovery was defined by GOSE ≤ 7 and complete recovery by GOSE 8). Complete recovery was observed in 42% of patients at 3 months post-injury without significant sex differences. More early post-traumatic complaints were present in patients with incomplete recovery, compared with patients with complete recovery (p < 0.001). Scores on overall QoL, general health-related QoL and all subdomains were lower for patients with incomplete recovery compared with patients with complete recovery (p < 0.05). Incomplete recovery at 3 months post-injury was predicted by increased physical frailty and early post-traumatic complaints (Nagelkerke R2 = 0.25). At 6 months post-injury, 53% of patients had complete recovery with higher frequency in males (60%) compared with females (42%) (p = 0.025). None of the investigated variables significantly predicted long-term outcome at 6 months post-injury (Nagelkerke R2 = 0.14), which might be explained by the changing cohort characteristics over time due to age-related morbidity. Our results demonstrate that almost half of older patients with mTBI show complete recovery with complaints and physical frailty as predictors of outcome at 3 months post-injury. Recovery still improves after 3 months and further follow-up is necessary to identify other factors that are associated with long-term outcomes in this specific category of patients with mTBI. The recovery course in older patients with mTBI is dynamic and further research on factors associated with long-term outcomes in this specific patient population is imperative to enhance treatment strategies.

Antibiotic Stewardship Based on Colonization with Multi-Drug-Resistant Bacteria in Liver Transplantation: A Narrative Review

In solid organs post-transplant, bacterial infections can complicate the course of recovery with devastating consequences, such as graft loss and death. We provide an expert review on early post-liver transplant bacterial infections, with a focus on infections with multi-drug-resistant organism (MDRO) etiologies. Best practice recommendations are derived from a combination of available evidence and expert consensus. The main challenge in managing antibiotic therapy arises in patients with severe clinical conditions but negative MDRO screening results, as well as in those with positive MDRO screening results but uncomplicated infections. With the aim of shedding light on these “gray areas”, we propose an algorithm where the patient is stratified as being at low risk or high risk of developing an MDRO infection.

Single-point ultrasound-guided iliohypogastric-ilioinguinal-genitofemoral nerve block for inguinal hernia surgery in older adult patients: a randomized controlled trial.

Ultrasound-guided nerve block can be used for perioperative analgesia and can potentially improve the course of recovery. Although iliohypogastric-ilioinguinal nerve block has been successfully used for inguinal hernia surgery, the poor blocking effect of intraoperative traction reflex remains a major drawback of this technique. The main objective of this study was to investigate the feasibility of single-point ultrasound-guided iliohypogastric-ilioinguinal-genitofemoral nerve (GFN) blockage for open anterior inguinal hernia repair in older adults. A total of 40 older adult patients [categorized as American Society of Anesthesiologists (ASA) I-III, body mass index (BMI) ≤28 kg/m2, age ≥60 years] undergoing open anterior inguinal hernia repair (the Lichtenstein technique) from June 2018 to December 2019 were recruited and randomly separated into an iliohypogastric-ilioinguinal nerve block group (group A; n=20) and an iliohypogastric-ilioinguinal-GFN block group (group B; n=20). The numerical rating scale (NRS) score in the post-anesthesia care unit (PACU) was the primary endpoint. Moreover, the following secondary indicators were recorded: the NRS score at 4 and 12 h after surgery and the duration of the nerve block; the total consumption of anesthetics; the occurrence of perioperative complications; and the mean arterial pressure (MAP), heart rate (HR), and respiration rate (RR), and oxygen saturation (SpO2) at baseline (T0), before skin incision (T1), 1 min after skin incision (T2), after dissection of the hernial sac (T3), at mesh placement (T4), and at the end of surgery (T5). Patients in Group B had lower NRS scores in the PACU (0.9±0.7 vs. 2.1±0.9), at 4 hours post-operation (1.9±1 vs. 2.7±0.7), lower intraoperative traction response scores (0.6±0.8 vs. 1.7±1.2), and fewer postoperative complication scores (0.1±0.3 vs. 0.8±0.9) compared to group A (P<0.05). In addition, the MAP in group A was significantly higher than that in group B (P<0.01) at T2 (89.3±6.7 vs. 83.8±4.9), T3 (92.4±6.9 vs. 86.6±4.8), and T4 (87.8±5.2 vs. 83.1±4.6). The HR in group A was also higher than that in group B (P<0.05) at T2 (73.3±8.4 vs. 68.4±5.4) and T3 (77.0±14.7 vs. 68.7±6.9). Finally, compared to group B, group A showed a higher consumption of sufentanil (5.5±3.9 vs. 2.4±2.8) and lidocaine (3.4±2.3 vs. 1.0±2.0) (P<0.05). Performing an ultrasound-guided iliohypogastric-ilioinguinal-GFN block through a single puncture point is a feasible clinical approach. This strategy provides appropriate intraoperative and postoperative analgesia in older adult patients undergoing open anterior inguinal hernia repair and significantly reduces postoperative complications and thus has the potential to emerge as a novel analgesic option for inguinal hernia surgery. Chinese Clinical Trial Registry identifier: ChiCTR2200066573.

Protection against N. gonorrhoeae induced by OMV-based Meningococcal Vaccines are associated with cross-species directed humoral and cellular immune responses.

Limited protective immunologic responses to natural N. gonorrhoeae infection and a lack of knowledge about mechanisms of protection have hampered development of an effective vaccine. Recent studies in humans and mice have found meningococcal outer membrane vesicle-containing vaccines (OMV) induce cross species immune responses against gonococci and are associated with protection. The exact mechanisms or how humoral and cellular immunity are related to protection, remain unclear. To study this, we immunized mice with two meningococcal OMV-containing vaccines known to accelerate clearance of N. gonorrhoeae , 4CMenB and OMV from an engineered N. meningitidis strain lacking major surface antigens PorA, PorB, and Rmp (MC58 ΔABR). We assessed serologic and cellular immune signatures associated with these immunizations and assessed bacterial clearance in the mice using a vaginal/cervical gonococcal infection model. Mice immunized with 4CMenB or MC58 ΔABR demonstrated shortened courses of recovery of vaginal N. gonorrhoeae compared to control mice immunized with alum alone. Vaccination with 4CMenB or MC58ΔABR OMV elicited serum and vaginal cross-reactive anti-Ng-OMV antibody responses that were augmented after vaginal challenge with N. gonorrhoeae . Further, splenocytes in 4CMenB and MC58 ΔABR immunized mice exhibited elevated cytokine production after restimulation with heterologous N. gonorrhoeae OMV when compared to splenocytes from Alum immunized mice. We further tested for correlations between bacterial burden and the measured anti-gonococcal immune responses within each vaccination group and found different immunologic parameters associated with reduced bacterial burden for each vaccine. Our findings suggest the cross-protection against gonococcal infection induced by different meningococcal OMV vaccines is likely multifactorial and mediated by different humoral and cellular immune responses induced by these two vaccines.

Association between RANTES/CCL5 levels with Plasmodium infections and malaria severity: a systematic review

BackgroundMalaria continues to be a significant global health concern, and developing effective therapeutic strategies requires an understanding of the immune response to the disease. This systematic review synthesized the current body of research on the role of regulated on activation, normal T cell expressed and secreted (RANTES)—in the pathogenesis and disease severity of malaria.MethodsA systematic review protocol was registered with PROSPERO under the registration number CRD42024535822. The systematic review was conducted following PRISMA guidelines to identify studies examining RANTES levels in individuals infected with Plasmodium species. Searches were performed across multiple databases, including ProQuest, Journals@Ovid, Embase, Scopus, PubMed, and MEDLINE. Further searches were performed in Google Scholar. Quality assessment was done using the Joanna Briggs Institute (JBI) critical appraisal tools. Alterations in RANTES levels in patients with malaria were synthesized narratively.ResultsA comprehensive search of major databases identified 22 studies meeting inclusion criteria, predominantly focusing on Plasmodium falciparum and Plasmodium vivax infections. RANTES levels were found to vary significantly across different severities of malaria, with several studies reporting lower levels in severe cases compared to non-malarial controls. However, inconsistencies were observed in the alterations of RANTES levels between severe and non-severe malaria cases.ConclusionTaken together, the finding of this systematic review underscore the complex regulation of RANTES in malaria pathophysiology. Future research should focus on longitudinal assessments to elucidate the dynamic role of RANTES throughout the course of malaria and recovery, to potentially inform the design of novel therapeutic strategies.

Is There a Role for Bronchoscopy in Aspiration Pneumonia?

Aspiration represents the passage of oropharyngeal content to the lower respiratory tract. The interplay between the host and the aspirate proprieties determines the subsequent aspiration syndrome. A low pH, typical of gastric aspirate, favors chemical pneumonitis, whereas an increased bacterial inoculum causes aspiration pneumonia. About a quarter of patients with aspiration pneumonitis will develop a bacterial superinfection during the course of recovery. While antibiotic therapy is indicated for aspiration pneumonia, supportive care remains the cornerstone of treatment in aspiration pneumonitis. However, the overlapping clinical features of these syndromes lead to initiation of antimicrobial therapy in most cases of aspiration. Bronchoscopy can aid in clinical decision-making by direct airway visualization and also by providing access to a series of emerging biomarkers. Invasive microbiological studies increase diagnostic yield and enable a tailored antibiotic treatment. In conjunction with stewardship programs, invasive sampling and novel molecular diagnostics can decrease the amount of inappropriate antibiotic therapy. In the context of foreign body aspiration, bronchoscopy represents both diagnostic and treatment gold standard.

Cognitive recovery of post critical care patients with and without COVID-19: differences and similarities, an observational study

BackgroundCoronavirus disease (COVID-19) patients treated in an intensive care unit (ICU) are at high risk of developing cognitive impairments of a “post-intensive care syndrome” (PICS). We explored whether critically ill COVID-19 and non-COVID-19 survivors differ in their post-ICU recovery course in terms of severity and affected cognitive domains.MethodsAn observational prospective study was conducted in a German post-acute neurological early rehabilitation clinic. Critically ill patients with or without SARS-CoV-2 infection (at least mechanically ventilated for one week) underwent repeated standardized assessments during their subsequent inpatient rehabilitation stay. Cognitive functions (information processing speed, learning, recognition, short-term and working-memory, word fluency, flexibility) assigned to different domains (attention, memory, executive functions) were assessed as primary outcome. Secondary outcomes included mental (depression, anxiety) and physical (Barthel index, modified ranking scale) state.ResultsOut of 92 eligible patients (screened between June 2021 and August 2023), 34 were examined, and 30 were available for analysis (15 per group). Both groups were ventilated for a similar period (COVID-19 vs. Non-COVID-19: median: 48 vs. 53 days). Patients of COVID-19 group spend on average 10 days longer at ICU and developed slightly more complications, but subsequent inpatient rehabilitation was of comparable duration (median: 36.5 vs. 37 days). On the group-level both groups showed similar cognitive dysfunctions with striking impairments (normative T-scores < 41) in information processing speed, word fluency, flexibility, and recognition memory on admission. Significant gains until discharge were only revealed for information processing speed in both groups (main effect visit, mean difference [95%CI] − 7.5 [− 13.1, − 2.0]). Physical and mental state were also similarly affected in both groups on admission, but improved over time, indicating that overall recovery for higher-order cognitive functions is slowest. Interestingly, majority of patients stated correctly being still physically disabled, while a discrepancy was found between subjective and objective evaluation of cognitive health.ConclusionsResults suggest a substantial overlap of cognitive, mental and physical dysfunction in post-acute recovery of ICU survivors independent of SARS-CoV-2 infection which warrants further monitoring to reduce the risk of long-term burden and enable a return to previous functionality.Trial registrationRetrospectively registered at https://drks.de/search/de/trial/DRKS00025523, 21.06.2021.

Narratives on disclosure of sexual violence: Survivors' responses to public testimony to a high-profile case.

Sexual violence is prevalent and associated with an elevated risk for physical health problems and psychological disorders. The social reactions survivors receive in response to disclosures of sexual violence can impact their postassault recovery. Many survivors do not disclose experiences of sexual violence, which can also complicate the course of recovery. The present study aims to further our understanding of survivors' experiences of sexual violence and their decisions to disclose or not disclose. The data set used is also of historical significance as it captures responses to one of the most public disclosures of sexual assault. Qualitative themes were identified from unsolicited, de-identified personal correspondence (n = 91) from a large archive sent to Dr. Christine Blasey Ford after her public testimony in front of the Senate Judiciary Committee describing an alleged sexual assault. Thematic analyses indicated five common negative reactions (i.e., dismissal, disbelief or denial, lack of repercussions for the perpetrator, retaliation, and victim blame) and two positive reactions (i.e., appropriate action and emotional support) in response to sexual violence disclosures. Reasons for nondisclosure included shame and fear of negative social reactions. Findings suggest that the interpersonal act of sexual violence disclosure is a dynamic process that can have lasting effects on survivors and has implications for fostering a sociocultural climate that facilitates posttraumatic growth in the aftermath of sexual violence. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Correlation between Delayed Relief after Microvascular Decompression and Morphology of the Lateral Spread Response in Patients with Hemifacial Spasm-Further Examination with Compound Motor Action Potentials.

Although microvascular decompression (MVD) is a reliable treatment for hemifacial spasm (HFS), postoperative delayed relief is one of its main issues. We previously evaluated the morphology of the lateral spread response (LSR) and reported correlation between delayed relief after MVD and polyphasic morphology of the LSR. This study aimed to investigate the morphology of LSR and the course of recovery of the compound motor action potential (CMAP), to better understand the pathophysiology of delayed healing of HFS. Based on the pattern of the initial LSR morphology on temporal and marginal mandibular branches stimulation, patients were divided into two groups: the monophasic and polyphasic groups. The results of MVD surgery and sequential changes in the CMAP were evaluated 1 week, 1 month, 1 year, and final follow-up after the surgery. Significantly higher rates of persistent postoperative HFS were observed in patients with the polyphasic type of initial LSR at 1 week and 1 month after the surgery (P < 0.05, respectively). In the polyphasic group, the amplitude of the CMAP tended to gradually improve with time, while in the monophasic group, the amplitude of the CMAP decreased on the seventh postoperative day, followed by its gradual improvement. There is a significant correlation between delayed relief after MVD and polyphasic morphology of the initial LSR in patients with HFS. In the polyphasic group, CMAP recovered earlier and showed less reduction in amplitude, suggesting segmental demyelination, with less damage to peripheral nerves.

Plasma Volume Shifts and Acid–Base Balance After a Single Bout of Resistance Training

Abstract Purpose Changes in plasma volume (PV), acid–base status and ventilation have rarely been investigated in relation to resistance training (RT). This study aimed to investigate the effect of a single set of exhaustive leg press exercise on these basic physiological parameters in an integrated manner. Methods Twenty-seven male individuals (27.1 ± 4.1 years, 1.82 ± 0.62 m, 84.4 ± 12.5 kg, BMI: 25.4 ± 3.0 k/gm2) performed a single set leg press exercise during which hemoglobin concentration ([Hb]), hematocrit (Hct), pH, oxygen (pO2) and carbon dioxide partial pressures (pCO2), hydrogen carbonate concentration ([HCO3−]), standard base excess (SBE) and lactate concentration ([La−]) were determined. Total buffer capacity was calculated based on pH, [HCO3−] and pCO2. Results Mean PV decreased by 559 ± 230 mL (13.7%). As a result, arterial oxygen content was significantly increased due to hemoconcentration (P &lt; 0.001). At exhaustion, pH (7.30 ± 0.06), [HCO3−] (18.6 ± 2.0 mmol/L) and SBE (− 6.6 ± 2.4 mmol/L) were all significantly decreased (P &lt; 0.0001). The pCO2 first remained unchanged (39.4 ± 4.3 mm Hg) but demonstrated a significant decrease one-minute post-exercise (34.4 ± 4.2 mmHg), indicating metabolic acidosis with respiratory compensation, which was maintained until t+15. Non-bicarbonate buffering remained constant during recovery while the respiratory component steadily increased until 15-min post-exercise (50.2 mmol/L per pH). Conclusion PV shifts following a single set of leg press exercise improve post-exercise arterial oxygen content. The moderate metabolic acidosis was not compensated during exercise because of restricted breathing but partly compensated during the following 15-min recovery period. The respiratory compensation as part of the bicarbonate buffering made up 50% of total buffer capacity in the course of recovery.

Genetic determinants of antidepressant and antipsychotic drug response.

Today, more than 90% of inpatients hospitalized with Major Depression or Schizophrenia are treated with psychotropic drugs. Since none of the treatment options is causal, response rates are modest and the course of recovery is very heterogeneous. Genetic studies on the etiology and pathogenesis of major psychiatric disorders over the past decades have been largely unsuccessful. Likewise, genetic studies to predict response to psychopharmacological treatment have also not been particularly successful. In this project we have recruited 902 inpatients with ICD-10 diagnoses of schizophrenic ("F2 patients") or depressive disorders ("F3 patients"). The study assessed today's acute inpatient treatment regimens with up to 8 repeated measurements regarding the time course of recovery and adverse side effects. The genotyping included 100 candidate genes with genotypic patterns computed from 549 Single Nucleotide Polymorphisms (SNPs). To predict response to psychopharmacological treatment, we relied on a multidimensional approach to analyzing genetic diversity in combination with multilayer Neural Nets (NNs). Central to this new method were the "gene vectors" that (1) assessed the multidimensional genotypic patterns observed with genes; and (2) evaluated the correlations between genes. By means of these methods, we searched for combinations of multidimensional genotypic patterns that were characteristic of treatment responders while being rare among non-responders. The chosen method of approach provided a powerful technique to detail the complex structures of SNP data that are not detectable by conventional association methods. Molecular-genetic NNs enabled correct classification of 100% "non-responders", along with 94.7% correctly classified "responders" among the F2 patients, and 82.6% correctly classified "responders" among the F3 patients. The F2 and F3 classifiers were not disjoint but showed an overlap of 29.6% and 35.7% between the diagnostic groups, thus indicating that clinical diagnoses may not constitute etiologic entities. Our results suggested that patients may have an unspecific physical-genetic disposition that enables, facilitates, impedes or prevents recovery from major psychiatric disorders by setting various thresholds for exogenous triggers that initiate improvement ("recovery disposition"). Even though this disposition is not causally linked to recovery, it can nonetheless be clinically used in the sense of a "surrogate". Indeed, clinicians are also interested in reliable tools that can "do the job", despite the fact that etiology and pathogenesis of the treated disorders remain unknown.

Navigating the Role of Surgery in Optimizing Patient Outcomes in Traumatic Brain Injuries (TBIs): A Comprehensive Review.

Traumatic brain injuries (TBIs) presentwith symptoms ranging from a mildly altered level of consciousness to irreversible coma and death. The most severe stage of TBIs is diffuse axonal injury and swelling affecting the whole brain. Management strategies are based on the classification of TBIs by severity and type and range from cognitive therapy sessions to complex surgeries. Neuroimaging modalities, predominantly magnetic resonance imaging, and the clinical Glasgow Coma Scale are principal indicators to diagnose and assess a patient's condition and neurological status and decide optimal treatment modality. In this review, we have summarized the indications and patient outcomes based on neurological and functional status, post-surgical complications, and mortality rates for various life-saving interventional procedures including surgery for brain contusions, intracranial hematomas and penetrating injuries, and craniectomy and ventriculostomy for elevated intracranial pressure and hydrocephalus. Cranioplasty performed for aesthetic purposes has also been explored. Overall quality evidence presented advocates surgery as needed for improved patient outcomes resulting in early recovery and decreased mortality, especially with the emergence of minimally invasive techniques. However, there is still an increased risk of certain complications like infections and bleeding and severe disabilities leading to a vegetative state with surgery. Some guidelines have been formed to provide indications for optimal management of TBI patients including surgeries, although their effectiveness in each individual case is debatable. It is imperative to explore certain key areas like the timing of the surgery and the role of intensive patient monitoring pre- and post-procedure in future studies and lay down guidelines also applicable to resource-limited areas. Also, a deeper understanding of physiological and pathological mechanisms of functional outcomes post-surgery will help clinicians predict the patient's course of recovery.

University of Washington Quality of Life subdomain outcomes after treatment of sinonasal malignancy: A prospective, multicenter study.

Sinonasal malignancies (SNMs) adversely impact patients' quality of life (QOL) and are frequently identified at an advanced stage. Because these tumors are rare, there are few studies that examine the specific QOL areas that are impacted. This knowledge would help improve the care of these patients. In this prospective, multi-institutional study, 273 patients with SNMs who underwent definitive treatment with curative intent were evaluated. We used the University of Washington Quality of Life (UWQOL) instrument over 5 years from diagnosis to identify demographic, treatment, and disease-related factors that influence each of the 12 UWQOL subdomains from baseline to 5 -years post-treatment. Multivariate models found endoscopic resection predicted improved pain (vs. nonsurgical treatment CI 2.4, 19.4, p=0.01) and appearance versus open (CI 27.0, 35.0, p<0.001) or combined (CI 10.4, 17.1, p<0.001). Pterygopalatine fossa involvement predicted worse swallow (CI -10.8, -2.4, p=0.01) and pain (CI -17.0, -4.0, p<0.001). Neck dissection predicted worse swallow (CI -14.8, -2.8, p<0.001), taste (CI -31.7, -1.5, p=0.02), and salivary symptoms (CI -28.4, -8.6, p<0.001). Maxillary involvement predicted worse chewing (CI 9.8, 33.2; p<0.001) and speech (CI -21.8, -5.4, p<0.001) relative to other sites. Advanced T stage predicted worse anxiety (CI -13.0, -2.0, p=0.03). Surgical approach, management of cervical disease, tumor extent, and site of involvement impacted variable UWQOL symptom areas. Endoscopic resection predicted better pain, appearance, and chewing compared with open. These results may aid in counseling patients regarding potential QOL expectations in their SNM treatment and recovery course.

Recent odor experience selectively modulates olfactory sensitivity across the glomerular output in the mouse olfactory bulb.

Although animals can reliably locate and recognize odorants embedded in complex environments, the neural circuits for accomplishing these tasks remain incompletely understood. Adaptation is likely to be important as it could allow neurons in a brain area to adjust to the broader sensory environment. Adaptive processes must be flexible enough to allow the brain to make dynamic adjustments, while maintaining sufficient stability so that organisms do not forget important olfactory associations. Processing within the mouse olfactory bulb is likely involved in generating adaptation, although there are conflicting models of how it transforms the glomerular output of the mouse olfactory bulb. Here we performed 2-photon Ca2+ imaging from mitral/tufted glomeruli in awake mice to determine the time course of recovery from adaptation, and whether it acts broadly or selectively across the glomerular population. Individual glomerular responses, as well as the overall population odor representation was similar across imaging sessions. However, odor-concentration pairings presented with interstimulus intervals upwards of 30-s evoked heterogeneous adaptation that was concentration-dependent. We demonstrate that this form of adaptation is unrelated to variations in respiration, and olfactory receptor neuron glomerular measurements indicate that it is unlikely to be inherited from the periphery. Our results indicate that the olfactory bulb output can reliably transmit stable odor representations, but recent odor experiences can selectively shape neural responsiveness for upwards of 30 seconds. We propose that neural circuits that allow for non-uniform adaptation across mitral/tufted glomerular could be important for making dynamic adjustments in complex odor environments.

Slow depolarizing electrical stimuli reveal differential time courses of nociceptor recovery after prolonged topical capsaicin in human skin

AbstractBackgroundWe examined de‐functionalization and temporal functional recovery of C‐nociceptor evoked pain after topical 8% capsaicin applied for 4 consecutive days.MethodsCapsaicin and placebo patches were applied to human forearm skin (n = 14). Cold, warmth and heat pain thresholds, pain NRS to electrical and thermal (48°C, 5 s) stimuli and axon reflex flare were recorded weekly for 49 days. Mechanical and heat sensitive (‘polymodal’) nociceptors were activated by single electrical half‐period sinusoidal pulses (0.5 s, 1 Hz). Mechanical and heat insensitive (‘silent’) nociceptors were activated by 4 Hz sinusoidal stimuli.ResultsCapsaicin abolished heat pain. Sensation to electrical sinusoidal stimulation was reduced but never abolished during the treatment. Pain to electrical 1 Hz ‘polymodal’ nociceptor stimulation took longer to recover than pain ratings to 4 Hz 2.5 s sinusoidal stimulation activating ‘polymodal’ and ‘silent’ nociceptors (35 vs. 21 days). Heat pain was indifferent to placebo from day 21–49. Axon reflex flare was abolished during capsaicin and only recovered to ~50% even after 49 days.ConclusionsCapsaicin abolishes heat transduction at terminal nociceptive endings, whereas small‐diameter axons sensitive to sinusoidal electrical stimulation can still be activated. 1 Hz depolarizing stimuli evoke burst discharges, as demonstrated before, and recover slower after capsaicin than single pulses induced by 4 Hz. The difference in recovery suggests differential time course of functional regeneration for C‐nociceptor sub‐types after capsaicin. All sensations recovered completely within 7 weeks in healthy subjects. Our findings contrast analgesia lasting for months in spontaneous neuropathic pain patients treated with 8% capsaicin.SignificanceSinusoidal electrical stimulation can still activate small diameter axons desensitized to heat after 4 consecutive days of topical 8% capsaicin application and reveals differential temporal functional regeneration of C‐nociceptor sub‐types. Electrical sinusoidal stimulation may detect such axons that no longer respond to heat stimuli in neuropathic skin.

PASS: A scoring system to evaluate persistent kidney injury in critically ill ICU adult patients

Background We evaluated if the course of recovery from sepsis-induced acute kidney injury (AKI) can be predicted using variables collected at admission. Methods A total of 63 patients admitted for sepsis-induced AKI in our Mangalore ICU were evaluated and baseline demographic and clinical/laboratory parameters, including serum creatinine (SCr), base excess (BE), Plethysmographic Variability Index (PVI), Caval Index, R wave variability index (RVI), mean arterial pressure (MAP) and renal resistivity index (RI) using renal doppler and need for inotropes were assessed on admission. Patients were managed as per standard protocol. After six hours of fluid resuscitation, patients were classified as volume responders or non-responders. Re-assessment was done at 24 hours and 72 hours after admission. Primary outcome was persistent AKI after 72 hours. Secondary outcome was initiation of dialysis or death within 15 days of admission. Results A total of 34 subjects recovered from AKI, of whom 32 patients were volume responders and 31 were non-responders. Response to fluid, MAP at admission and six hours, BE at admission, inotrope requirement, and PVI at admission did not correlate with recovery. Multiple logistic regression showed that SCr &lt; 2.36 mg%, RVI &gt; 14.45 and RI &lt; 0.8 on admission correlated with recovery and they were evaluated further to model AKI recovery and develop PASS. PASS score = (SCr points × 5.4) + (RVI points × 4.0) + (RI points × 6.2). One point each was allotted if SCr was &lt; 2.36, RVI was &gt; 14.45 and RI was &lt;0.8, and 0 otherwise. A score &gt; 7.8 predicted recovery with a sensitivity of 79.4%, specificity of 72.4%, PPV 81.8%, NPV 76.7% and AuROC of 0.85. Conclusions The PASS score can be used to identify salvageable cases of sepsis-AKI, guiding fluid resuscitation and aiding early referral from rural to tertiary care centers for better management.

Role and Outcomes of Supported Community Living Programs in Post-Hospital Brain Injury Rehabilitation Programs.

(1) To determine the proportion of participants admitted to supported community living (SCL) programs over the course of 5 years who improve, decline, or maintain functioning and community integration and (2) to examine the associations of time since injury, time in program, and age to their functional trajectory. Data from SCL programs serving individuals with acquired brain injury (ABI). 104 individuals with traumatic brain injury (TBI), stroke, or other ABI. Sex, age, time since injury, Mayo-Portland Adaptability Inventory (4th edition; MPAI-4). Retrospective analyses of MPAI-4 total and MPAI-4 indices using Linear Mixed Models (LMM) of Rasch-derived T-scores from admission to 5 years into service delivery. MPAI-4total, index, and subscale scores for yearly intervals of SCL services from admission to 5years showed a high degree of stability in function (defined using the standard error of measurement (SEM) for the MPAI-4, defined as change≥3T-score points) with all intervals showing at least 89% of patients with improved scores or no change. The rate of change over time did not significantly vary by time since injury, time in the program, or age. The expectations for services in the SCL portion of the care continuum for ABI are unique. Unlike intensive rehabilitation programs which focus on improvement often earlier in the course of recovery, the goal of SCL services is sustained functioning over the long term. Analyses reported here indicate this can be achieved for at least 5years, potentially mitigating the increased risk for rehospitalization and increased care needs in the ABI population. This study highlights a key finding of MPAI-4 stability within these understudied brain injury service lines. Additional exploration of comorbidities and more nuanced delineation of diagnostic information could further clarify factors influencing outcome stability over time.

Distinct trajectories of neuropsychiatric symptoms in the 12 months following traumatic brain injury (TBI): a TRACK-TBI study.

Neuropsychiatric symptoms are common after traumatic brain injury (TBI) and often resolve within 3 months post-injury. However, the degree to which individual patients follow this course is unknown. We characterized trajectories of neuropsychiatric symptoms over 12 months post-TBI. We hypothesized that a substantial proportion of individuals would display trajectories distinct from the group-average course, with some exhibiting less favorable courses. Participants were level 1 trauma center patients with TBI (n = 1943), orthopedic trauma controls (n = 257), and non-injured friend controls (n = 300). Trajectories of six symptom dimensions (Depression, Anxiety, Fear, Sleep, Physical, and Pain) were identified using growth mixture modeling from 2 weeks to 12 months post-injury. Depression, Anxiety, Fear, and Physical symptoms displayed three trajectories: Stable-Low (86.2-88.6%), Worsening (5.6-10.9%), and Improving (2.6-6.4%). Among symptomatic trajectories (Worsening, Improving), lower-severity TBI was associated with higher prevalence of elevated symptoms at 2 weeks that steadily resolved over 12 months compared to all other groups, whereas higher-severity TBI was associated with higher prevalence of symptoms that gradually worsened from 3-12 months. Sleep and Pain displayed more variable recovery courses, and the most common trajectory entailed an average level of problems that remained stable over time (Stable-Average; 46.7-82.6%). Symptomatic Sleep and Pain trajectories (Stable-Average, Improving) were more common in traumatically injured groups. Findings illustrate the nature and rates of distinct neuropsychiatric symptom trajectories and their relationship to traumatic injuries. Providers may use these results as a referent for gauging typical v. atypical recovery in the first 12 months post-injury.

Recovery of Visuospatial Neglect With Standard Treatment: A Systematic Review and Meta-Analysis.

Visuospatial neglect is a common consequence of stroke and is characterized by impaired attention to contralesional space. Currently, the extent and time course of recovery from neglect are not clearly established. This systematic review and meta-analysis aimed to determine the recovery trajectory of poststroke neglect with standard treatment. PsycInfo, Embase, and MEDLINE were searched for articles reporting recovery rates of neglect after stroke. Time since stroke was categorized into early (0-3 months), mid (3-6 months), and late (>6 months) recovery phases. Random-effects models for pooled prevalence were generated for each phase, and potential sources of heterogeneity were explored with metaregressions. Methodological quality of each study was assessed using the Joanna Briggs Institute checklist, with low-quality studies excluded in sensitivity analyses. The search captured 4130 articles including duplicates, and 111 full-text reviews were undertaken. A total of 27 studies reporting data from 839 stroke survivors with neglect were included for review. Meta-analyses indicated a recovery rate of 42% in the early phase, which increased to 53% in the mid-recovery phase. Additional recovery in the late phase was minimal, with an estimated 56% recovery rate. Heterogeneity of studies was high (I2>75%) in all 3 phases of recovery. Estimates were robust to sensitivity analyses. Metaregressions showed significantly greater recovery in studies that included patients with left-hemisphere lesions (β=0.275, P<0.05, I2=84%). Most recovery from neglect occurs in the first 3 months, although additional gains can be expected up to 6 months poststroke. While a large proportion of patients recover from neglect, over 40% show persistent symptoms. Further research is needed on effective rehabilitation interventions, particularly focusing on patients most at risk of chronic visuospatial neglect. URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42023388763.

Effect of Phase Angle on Change in Quadriceps Muscle Strength 1 Year After Total Knee Arthroplasty: The Screening for People Suffering Sarcopenia in Orthopedic Cohort of Kobe Study

BackgroundPhase angle (PhA) has been reported to be associated with quadriceps strength in patients who have knee osteoarthritis and were scheduled for total knee arthroplasty (TKA). The PhA can also be expected to predict the time course of quadriceps muscle strength loss and recovery. We aimed to investigate the relationship between the preoperative PhA and the time course of quadriceps muscle strength change in patients undergoing TKA. MethodsA prospective cohort study was conducted on patients scheduled for primary unilateral TKA. A total of 855 patents were included in the analysis. The PhA and quadriceps muscle strength of the operated knee were measured preoperatively and at 3, 6, and 12 months postoperatively. To analyze the effect of the preoperative PhA on the change in postoperative quadriceps muscle strength, a linear mixed model with the quadriceps muscle strength as a dependent variable with the preoperative PhA, evaluation period (dummy variable), and their product terms as independent variables was conducted after adjusting for preoperative covariates. ResultsA statistically significant negative effect was present for a higher PhA, resulting in a greater decrease in quadriceps muscle strength between preoperative and 3 months postoperative (P = 0.012). In contrast, the effect was not statistically significant between 3 and 6 months postoperatively (P = 0.17). However, a statistically significant positive effect for a higher PhA resulting in a greater increase in quadriceps muscle strength was present between 6 and 12 months postoperatively (P = 0.027). ConclusionsPreoperative PhA is a useful predictor of the quadriceps muscle strength change after TKA. These findings suggest that evaluating the preoperative PhA could aid in the development of targeted rehabilitation programs aimed at optimizing quadriceps muscle function in patients undergoing TKA.