Recovery Of Patients Research Articles

The Role of Neuroinflammation in Shaping Neuroplasticity and Recovery Outcomes Following Traumatic Brain Injury: A Systematic Review.

Neuroplasticity and neuroinflammation are variables seen during recovery from traumatic brain injury (TBI), while biomarkers are useful in monitoring injury and guiding rehabilitation efforts. This systematic review examines how neuroinflammation affects neuroplasticity and recovery following TBI in animal models and humans. Studies were identified from an online search of the PubMed, Web of Science, and Embase databases without any search time range. This review has been registered on Open OSF (n) UDWQM. Recent studies highlight the critical role of biomarkers like serum amyloid A1 (SAA1) and Toll-like receptor 4 (TLR4) in predicting TBI patients' injury severity and recovery outcomes, offering the potential for personalized treatment and improved neurorehabilitation strategies. Additionally, insights from animal studies reveal how neuroinflammation affects recovery, emphasizing targets such as NOD-like receptor family pyrin domain-containing 3 (NLRP3) and microglia for enhancing therapeutic interventions. This review emphasizes the central role of neuroinflammation in TBI, and its adverse impact on neuroplasticity and recovery, and suggests that targeted anti-inflammatory treatments and biomarker-based personalized approaches hold the key to improvement. Such approaches will need further development in future research by integrating neuromodulation and pharmacological interventions, along with biomarker validation, to optimize management in TBI.

Enabling Technologies in the Management of Cervical Spine Trauma.

Narrative review. The objective of this study is to explore and evaluate the role of novel technologies in enhancing the diagnosis, surgical precision, and rehabilitation of cervical spine trauma, and to discuss their potential impact on clinical outcomes. Traumatic cervical spine injuries are challenging to manage due to their complex anatomy, the potential for long-term disability, and severe neurological deficits. Traditional management approaches are being supplemented by emerging technologies that promise to improve patient care and outcomes. A literature review was conducted to identify and analyze advancements in imaging, navigation, robotics, and wearable technologies in the context of cervical spine trauma. The review focuses on the potential of these technologies to improve early detection, surgical accuracy, and postoperative recovery. Technological innovations, including advanced imaging techniques, machine learning for diagnostics, augmented reality, and robotic-assisted surgery, are transforming the management of cervical spine trauma. These tools contribute to more efficient, accurate, and personalized treatment approaches, potentially improving clinical outcomes and reducing patient care burdens. Although these technologies hold great promise, challenges such as implementation costs and the need for specialized training must be addressed. With continued research and interdisciplinary collaboration, these advancements can significantly enhance the management of cervical spine trauma, improving patient recovery and quality of life. Level V.

Factors Influencing the Personal Recovery in Outpatients With Schizophrenia

Objectives: This study aims to quantitatively investigate factors influencing personal recovery in patients with schizophrenia.Methods: This study included 168 outpatients treated for schizophrenia. Patients’ sociodemographic factors (sex, age, education, and marital status), clinical factors (duration of illness, number of hospitalizations, and dose of drug), symptoms, behavior and symptoms, physical and mental health, family attitude, social support, attitude toward drug therapy, insight, self-esteem, hopelessness, and self-stigma were analyzed. The analysis included these 17 factors as explanatory variables for personal recovery to perform regression analysis.Results: Backward elimination was used to select variables, and multiple regression analysis was performed. The five factors (symptoms, self-esteem, insight, physical, and mental health, and social support) accounted for 75.8% of the variance in patients’ perceived willingness for personal recovery.Conclusion: Personal recovery in schizophrenic patients is very important because it means subjective satisfaction and quality of life in society. In this study, social support was the most important variable in predicting personal recovery. These results imply that not only symptoms but also various factors including social support should be emphasized when establishing a recovery strategy for schizophrenic patients.

Unraveling the Impact of Sarcopenia-Induced Lymphopenia on Treatment Response and Prognosis in Patients with Stage III Non-Small Cell Lung Cancer: Insights for Optimizing Chemoradiation and Immune Checkpoint Inhibitor.

Sarcopenia is a poor prognostic factor in non-small cell lung cancer (NSCLC). However, its prognostic significance in patients with NSCLC receiving immune checkpoint inhibitors (ICIs) and its relationship with lymphopenia remain unclear. We aimed to investigate the prognostic role of sarcopenia and its effect on lymphocyte recovery in patients with stage III NSCLC treated with concurrent chemoradiotherapy (CCRT) followed by ICI. We retrospectively evaluated 151 patients with stage III NSCLC who received definitive CCRT followed by maintenance ICI between January 2016 and June 2022. Sarcopenia was evaluated by measuring the skeletal muscle area at the L3 vertebra level using computed tomography scans. Lymphocyte level changes were assessed based on measurements taken before and during CCRT and at 1, 2, 3, 6, and 12 months post-CCRT completion. Even after adjusting for baseline absolute lymphocyte count through propensity score-matching, patients with pre-radiotherapy (RT) sarcopenia (n=86) exhibited poor lymphocyte recovery and a significantly high incidence of grade ≥3 lymphopenia during CCRT. Pre-RT sarcopenia and grade ≥3 lymphopenia during CCRT emerged as prognostic factors for overall survival and progression-free survival, respectively. Concurrent chemotherapy dose adjustments, objective response after CCRT, and discontinuation of maintenance ICI were also analyzed as independent prognostic factors. Our results demonstrated an association between pre-RT sarcopenia and poor survival, concurrent chemotherapy dose adjustments, and impaired lymphocyte recovery after definitive CCRT. Moreover, CCRT-induced lymphopenia not only contributed to poor prognosis but may have also impaired the therapeutic efficacy of subsequent maintenance ICI, ultimately worsening treatment outcomes.

A case report of intrapulmonary mature teratoma with aspergilloma

Introduction: Teratomas are benign germ cell tumors composed of components from the ectoderm, mesoderm, and endoderm. While germ cell tumors account for 10-20% of anterior mediastinal masses, intrapulmonary teratomas (IPTs) are extremely rare. They typically occur in the third decade of life and may present as metastasis from gonadal tumors. This study reports a rare case of a mature IPT in the right middle lobe of the lung, initially misdiagnosed as pulmonary tuberculosis and aspergilloma. Case Presentation: A 17-year-old female presented with a 4-year history of cough with sputum and two episodes of hemoptysis. Despite negative tuberculosis tests, she was treated with anti-tubercular drugs and multiple antibiotics. Imaging revealed a 5.5-cm cavitary mass in the right middle lobe containing an aspergilloma. Surgical resection was performed, and the pathology confirmed a mature teratoma with aspergilloma colonization. The patient recovered well postoperatively and showed no signs of recurrence. Discussion: Teratomas are germ cell tumors rarely found in the lungs, with fewer than 100 cases reported globally. Diagnosis is challenging due to overlapping symptoms with other conditions such as tuberculosis. In this case, the presence of an aspergilloma further complicated the diagnosis. Complete surgical resection led to the patient's recovery. Conclusion: Mature IPTs with aspergilloma are extremely rare, and should be considered in the differential diagnosis of cavitary lung lesions. Early diagnosis and surgical resection are crucial for successful treatment.

Mini-invasive Vs Open posterior Osteosynthesis for posttraumatic thoracolumbar fracture: Retrospective (comparative study)

Introduction :- Patients had mini invasive posterior osteosynthesis at thoracolumbar fracture posttraumatic, have more quick psychological good outcome and also pain score , comparing the patients had traditional open posterior osteosynthesis up to first 3 days post op , most of patient done both the Mini invasive posterior osteosynthesis(MIPOS) and traditional open posterior osteosynthesis (TOPOS) had good outcome but the time frame and pain duration more immediate recovery for MIPOS patients . Methods: - Our study was retrospectively comparative study. Reviews the medical records of the 22 patient was operated in CHU ibn sina university hospital at Rabat, from time frame 2020 – up to 2024 , for 4 years ,files those was admitted at department for clinical and radiological diagnosed ,and operated for short segment posterior osteosynthesis. Results: - the mean age of the 22 patients in our study of MIPOS vs. TOPOS is 38 years, at range of the age (17-63), The female gander was 10 out of 22 patient 45 %, and 12 of them was male 55%, patient had co-morbid was 8/22 =36.36% at different types of co-morbid, Psychiatric 3 patient, Asthmatic, Tuberculosis, Smoker, Hypertension, obstetric , 14 cases had lumbalgia , 5 dorsalgia , and 3 paraplegic , it postop the main result was the MIPOS patient had less hospital stay and pain relived quick compering the TOPOS which its little longer duration of hospital and pain relief take time longer. Conclusion:-the surgical outcome of the patient had mini invasive posterior osteosynthesis posttraumatic thoracolumbar, its quick and fast respond for VAS, reducing Hospital duration, instead of the open procedure little longer, and VAS its delay resolve post op.

Environmental Factors as Contributors to Sleep Disturbance in Critically Ill Patients in Intensive Care Units (ICU): A Descriptive Study

Background: Sleep disturbance is a common problem among critically ill patients in the ICU and can significantly affect their overall experience of care. This study aims to study the experience of sleep disturbance in critically ill patients in the ICU. Methods: This study was conducted in a public hospital in West Sumatra, Indonesia from June to August 2022, using a descriptive approach and focusing on a population of critically ill patients admitted to the ICU. The sample size of 80 participants was determined using power analysis from previous studies, and sampling was done using purposive technique based on inclusion criteria. Results: The results of this study showed that 37.5% of participants reported experiencing sleep disturbances while being treated in the ICU. This demonstrates the prevalence of problems experienced by critically ill patients and highlights the need for targeted interventions to address them. It is imperative for healthcare providers to recognize the impact of sleep disturbances on patient health and recovery and implement strategies to reduce their impact. Conclusion: This study showed a significant prevalence of sleep disturbance among critically ill patients in the ICU. This underscores the importance of proactive measures to address this issue and emphasizes the role of healthcare facilities in providing support and education to individuals affected by sleep disturbance. Further research and appropriate interventions need to be conducted to improve the sleep quality of critically ill patients in the ICU contributing to better overall outcomes and quality of care in the ICU.

Low-dose dobutamine in acute myocardial infarction with intermediate to high risk of cardiogenic shock development (the DOBERMANN-D trial): study protocol for a double-blinded, placebo-controlled, single-center, randomized clinical trial

BackgroundCardiogenic shock (CS) occurs in 5–10% of patients with acute myocardial infarction (AMI), and the condition is associated with a 30-day mortality rate of up to 50%. Most of the AMI patients are in SCAI SHOCK stage B upon hospital arrival, but some of these patients will progression through the stages to overt shock (SCAI C-E). Around one third of patients who develop CS are not in shock at the time of hospital admission. Pro-B-type natriuretic peptide (proband) is a biomarker closely related to CS development. The aim of this study is to investigate the potential for preventing progression of hemodynamic instability by early inotropic support with low-dose dobutamine infusion administrated after revascularization in AMI patients with intermediate to high risk of in-hospital CS development.MethodsThis investigator-initiated, double-blinded, placebo-controlled, randomized, single-center, clinical trial will include 100 AMI patients (≥ 18 years) without CS at hospital admission and at intermediate-high risk of in-hospital CS development (ORBI risk score ≥ 10). Patients will be randomized in a 1:1 ratio to a 24 h intravenous (IV) infusion of dobutamine (5 μg/kg/min) or placebo (NaCl) administrated after acute percutaneous coronary intervention (PCI) (< 24 h from symptom onset). Blood samples are drawn at time points from study inclusion (before infusion, 12, 24, 36, and 48 h).The primary outcome is peak plasma proBNP within 48 h after infusion as a surrogate-measure for the hemodynamic status. Hemodynamic function will be assessed pulse rate, blood pressure, and lactate within 48 h after infusion and by transthoracic echocardiography (TTE) performed after 24–48 h and at follow-up after 3 months. Markers of cardiac injury (troponin T and creatine kinase MB (CK-MB)) will be assessed.DiscussionEarly inotropic support with low-dose dobutamine infusion in patients with AMI, treated with acute PCI, and at intermediate-high risk of in-hospital CS may serve as an intervention promoting hemodynamic stability and facilitating patient recovery. The effect will be assessed using proBNP as a surrogate marker of CS development, hemodynamic measurements, and TTE within the initial 48 h and repeated at a 3-month follow-up.Trial registrationThe Regional Ethics Committee: H-21045751. EudraCT: 2021–002028-19. ClinicalTrials.gov: NCT05350592, Registration date: 2022-03-08. WHO Universal Trial Number: U1111-1277–8523.

Smart noise pollution monitoring system

Increasing pollution poses serious health risks, necessitating urgent control measures for a healthier future for all. Among various pollution types, sound pollution significantly impacts quality of life and well-being, especially in densely populated urban areas. This proposal describes the creation and deployment of an Internet of Things (IoT)-based noise pollution monitoring system intended to track sound levels in certain regions in real time. The core of this system comprises advanced sensors strategically placed to measure sound intensity accurately. These sensors can detect even minor variations in noise levels, providing precise and reliable data. After being gathered, the data is sent to a microcontroller, which effectively processes it. This microcontroller ensures the data is accurately captured and sent over the internet to an online server. Once the data reaches the online server, it becomes accessible for analysis and monitoring by authorities. The system's real-time data capability is crucial for timely intervention. Authorities can continuously monitor noise levels and identify trends or spikes in sound pollution, allowing them to address issues promptly. This feature is particularly beneficial for sensitive areas such as schools, hospitals, and residential zones, areas with heavy traffic, library, Where excessive noise can have severe health effects, including stress, sleep disturbances, and hearing loss. The system includes an alert mechanism that notifies relevant authorities when noise levels exceed predefined thresholds. These alerts enable quick responses to mitigate noise pollution. For instance, in a school, reducing noise levels can enhance the learning atmosphere and improve students' concentration. In hospitals, maintaining a quiet environment is crucial for patient recovery. The integration of IoT technology in this noise pollution monitoring system not only enhances efficiency but also provides a scalable solution adaptable to various urban and rural settings. This scalability ensures the system can be expanded to cover larger areas or multiple locations as needed.

Successful Management of Progressive Multifocal Leukoencephalopathy in an HIV/AIDS Patient: A Therapeutic Case Report

Background: Progressive multifocal leukoencephalopathy (PML), a rare and devastating opportunistic infection caused by JC virus reactivation, typically carries a poor prognosis in immunocompromised individuals, particularly those with HIV. Aim: To report a remarkable case of full recovery in an HIV-positive patient with PML and highlight the significance of prompt recognition, diagnosis, and combination antiretroviral therapy (cART). Case Summary: A 34-year-old HIV-positive male presented with progressive disturbances of consciousness and movement. MRI revealed multifocal white matter lesions, and JC virus DNA was detected in cerebrospinal fluid. Despite initial deterioration, the patient achieved full recovery with cART. Conclusion: This exceptional outcome emphasizes the critical importance of vigilant monitoring, prompt diagnosis, and effective management strategies for PML in HIV patients, highlighting the potential for full recovery with optimal cART.

Vaccination significantly reduced the length of SARS-CoV-2 viral clearance: A story from international healthcare workers.

To investigate the impact of vaccines on sociodemographic characteristics, clinical profiles, and outcomes of SARS-CoV-2 infection among healthcare workers in South China during the period of Omicron variant dominance, a retrospective, analytical cross-sectional study was conducted. The findings revealed that while full vaccination could not prevent Omicron variant infection efficiently (26.51% uninfected vs 14.29% uninfected between vaccinated and unvaccinated participants, p = 0.506), it did substantially reduce the length of viral clearance significantly (p < 0.05), potentially facilitating quicker patient recovery. Unvaccination was found to be an independent risk factor for slow clearance when a linear regression analysis model was used (Coefficient: -3.516; 95% CI: -6.425 to -0.607; p = 0.020). Therefore, all eligible individuals should be fully vaccinated to get prepared for a potential wave of epidemic in the future.

The impact of exogenous ketone body suppletion on energy and pH balance in skeletal muscle during exercise in chronic heart failure patients: a prospective randomized double-blind cross-over study

Abstract Background Heart Failure (HF) is characterized by impediments in exercise capacity. Disruptions in the energy metabolism of skeletal muscle contribute to this condition. Pre-clinical and clinical evidence showed that reductions in carbohydrate and FA metabolism in HF may be partially overcome by a compensatory increase in ketone body oxidation and suggest that suppletion of ketone bodies (KB) may improve energy metabolism in HF. Purpose We tested the effect of exogenous KB suppletion on energy and pH balance during cycling exercise using 31P Magnetic Resonance (MR) Spectroscopy of the exercising quadriceps muscle in patients with HF. Methods In a randomized, double-blind, placebo-controlled cross-over study, 14 stable HF patients with reduced ejection fraction and diminished exercise capacity underwent maximal exercise testing in a MR scanner fitted with a cycling ergometer after KB or placebo treatment. Phosphocreatine (PCr) and inorganic phosphate (Pi) resonance amplitudes and frequencies were measured continuously in the quadriceps muscle during rest, exercise and recovery using in-vivo 31P MR spectroscopy (Figure 1). Results Patients had a median age of 66 [53 – 75] years, were 14% female, had a median LVEF of 37% [27 – 40] and circulating NT-pro BNP levels of 411 [182 – 946] pg/mL. Peak oxygen uptake (VO2) was 18.2 [15.2 – 20.3] ml/kg/min, which is 68% [62 – 78%] of predicted. After treatment, exercise performance in terms of cycling duration and workload were comparable between treatment arms (Figure 2). Quadriceps acidification during exercise was larger after KB suppletion compared to placebo (ΔpH: -0.2 [-0.3 - -0.1] vs -0.1 [-0.3 - -0.1] respectively; p=0.041) while quadriceps energy depletion during exercise was not altered by treatment (ΔPi/PCr 0.77 [0.55 – 2.51] vs 0.66 [0.46 – 0.81] respectively; p=0.087). Post-exercise mitochondrial oxidative function was similar between treatment arms (KB: PCr resynthesis rate 48 sec [25 – 59] versus placebo: 42 sec [36 – 63]; p=0.767). Conclusions Ketone body suppletion increased acidification and did not improve energy balance in skeletal muscle during exercise or mitochondrial function during recovery in patients with chronic HF. These results question the value of ketone bodies as treatment to boost muscular energy metabolism during exercise in HF.31P MRS Spectrum during exercise in HFExercise and energy parameters

Relationship between histological findings of vastus lateralis muscle and function after total hip arthroplasty in patients with hip fracture: a prospective cohort study.

We aimed to examine the histological characteristics of vastus lateralis muscles in patients undergoing total hip arthroplasty (THA) following femoral neck fractures and to explore the correlation between muscle fiber types and postoperative functional recovery. 34 patients undergoing THA for femoral neck fractures were included. A biopsy of the vastus lateralis muscle was performed during surgery, followed by immunohistochemical staining. Subsequently, image analysis was conducted to measure the average area of muscle fiber types and the number of type I and II muscle fibers, and the ratio of the area and the number of type II muscle fibers. Functional recovery was assessed 2 weeks post-surgery using the Short Physical Performance Battery (SPPB). A significant positive correlation was observed between type II muscle fibers and SPPB scores. The ratio of type II muscle fiber area and number strongly correlated with the SPPB scores, indicating a robust static association. The average area of type II fibers showed a strong correlation (r = 0.63, P < 0.001), as did the number of type II fibers (r = 0.53, P = 0.001). Moreover, the ratio of type II muscle fiber area and number significantly correlated with SPPB scores (area: r = 0.77, P < 0.001; number: r = 0.51, P = 0.002), indicating that larger and more numerous type II fibers are associated with better physical performance. The reduction of type II muscle fibers was strongly correlated with a low SPPB postoperative functional recovery in patients who underwent THA following femoral neck fractures.

Right ventricular free wall longitudinal strain as a predictor of myocardial recovery in patients with advanced cardiogenic shock supported with the Impella device

Abstract Background Right ventricular (RV) dysfunction is a known independent factor influencing the outcome of patients in cardiogenic shock (CS). The aim of this monocentric retrospective study was to investigate the impact of left ventricular (LV) unloading on the right heart function and its predictive role regarding weaning following Impella device implantation in patients with profound CS due to LV failure. Methods We performed a retrospective analysis of 41 patients admitted to intensive care unit over a period of 3 years with CS due to LV dysfunction requiring support with Impella. Clinical and echocardiographic data were collected and correlated with weaning success. Finally, a multivariate analysis to identify independent predictors of weaning success was performed. Results After Impella implantation, the following was observed: right ventricular fractional area change (RVFAC) increased from a mean value of 28% to 38% (p=0.01), the tricuspid annular systolic velocity (TASV) increased from 9 cm/s to 10 cm/s (p=0.01), the velocity time integral right ventricular outflow tract (VTI RVOT) increased from 10 to 13 cm3/stroke (p=0.01), the right ventricular free wall longitudinal strain (RVFWLS) increased from -12% to -21% (p&amp;lt; 0.001). However, following LV unloading, a decrease in both RVFAC from 38% to 30% (p 0.01) and in VTI RVOT from 13 to 11 cm3/stroke (p&amp;lt;0.01) was observed. Moreover, there was a significant decrease in RVFWLS from -21% to -14% (p &amp;lt; 0.001). Notably, the percentage of change in RVFWLS between maximum and minimum (Δ%RVFWLSPmax-Pmin) support with Impella during the weaning process was significantly lower in weanable patients (34.5% in weaned vs 86% in non-weaned; p=0.038). Investigating the predicting ability of these parameters, Δ%RVFWLSPmax-Pmin emerged showing an AUC of 0.826 (0.690-0.962) in identifying non-weaned patients with a cut-off value of 38%. According to the multivariate analysis, Δ%RVFWLSPmax-Pmin in non-weaned patients remained the only significant parameter even considering possible confounders. Conclusions LV unloading with Impella in advanced CS patients improved RV function echocardiographic parameters. RVFWLS increased significantly after Impella implantation and its percentage of change between maximum and minimum support was significantly lower in weanable compared to non-weanable patients. Our findings suggest that RVFWLS could be used as a predictor of myocardial recovery allowing to identify weanable patients with adequate accuracy.

Long-term prognostic value of heart rate recovery in patients with left bundle branch block without inducible ischemia and without known coronary artery disease

Abstract Background Heart rate recovery (HRR) has been shown to predict cardiovascular and all-­cause morbidity and mortality. Left bundle branch block (LBBB) is often associated with significant heart disease and is often the result of underlying coronary artery disease (CAD), myocardial injury, strain or hypertrophy. However, there are insufficient data on the prognostic value of HRR in patients with LBBB without inducible ischemia and without known CAD. Aim The aim of this study was to determine the long-term prognostic value of HRR in patients with LBBB without inducible ischemia and without known CAD. Methods This retrospective study included 182 patients (64, 35.2% male gender, average age 63 ± 10 years) with LBBB and without known CAD who were referred to the SECHO test for chest pain. All the patients had negative SECHO test according the Bruce protocol. Risk factors for CAD (diabetes, smoking, hypertension, high cholesterol and positive family history of CAD), functional capacity (Metabolic Equivalents - METs) and heart rate recovery (HRR) were recorded in all patients. HRR was calculated as the difference between heart rate at the peak stress and heart rate in the first minute of rest. Slow HRR was defined as ≤18 beats/min. Median follow up of the patients was 102.5 months (IQR 68-146 months) for the occurrence of MACE (all-cause mortality, non-fatal myocardial infarction (MI), coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI)). Results Overall, 16pts (8.8%) had slow HRR. During the follow-up period 34 out of 182 patients (18.7%) had an adverse event (16 deaths, 10 non-fatal MI, 1 CABG and 7 PCI). Using the Cox regression analysis, univariate predictors of MACE were age (B=0.050, HR 1.051 [95% CI 1.011-1.093], p=0.012), hypertension (B=-1.219, HR 3.385 [95% CI 1.071-10.699], p=0.038), MET (B=-0.183, HR 0.833 [95% CI 0.706-0.982], p=0.030), diabetes (B=0.981, HR 2.667 [95% CI 1.267-5.612], p=0.010) and slow HRR (B=1.171, HR 3.225 [95% CI 1.307-7.959], p=0.011). However, in the multivariate analysis only slow HRR remained the independent predictor of MACE (B=0.974, HR 2.648 [95% CI 0.980-7.151], p=0.048). Using the Kaplan-Meier survival curve we see that the patients with slow HRR had much shorter event-free time compared to the patients with normal HRR (106.9 ± 14.9 months vs 157.9 ± 24 months, Log Rank 7.227, p=0.007) (Figure 1.). Conclusion Slow HRR is an independent long-term predictor of adverse events in patients with left bundle branch block without inducible ischemia and without known coronary artery disease.Kaplan-Meier survival curve for the MACE

Narrative Literature Review: Digital-based Post-Operative Pain Management Innovation

Effective postoperative pain management is a key element in patient recovery after surgery, but often standard protocols do not take advantage of the potential of real-time data and digital technology for more responsive therapy adjustments. The aim of this study was to identify the latest innovations in digital-based postoperative pain management. A literature review examined the use of digital technology in postoperative pain management, focusing on smartphone apps, wearable devices, and real-time data analytics for monitoring patient pain with the keywords "Pain Management AND Digital Postoperative" OR "Digital Health AND Pain Management" AND "Technology" OR "Information Systems". The year of the source of the literature taken is 2019-2024. Database searches use Scopus, Pub Med, Sage Journal, and Google Scholar. The findings of this review suggest that the integration of digital technology in postoperative pain management can improve the personalization of care by allowing for more accurate and responsive therapy adjustments to changes in patients' pain conditions. Data-Based Approaches in the Digital Era are Virtual Reality (VR), PASHA Application (pain assessment, stimulating and healing application), A wireless intelligent PCA (Wi-PCA) AI (Artificial Intelligence), Cell Phone Application, Wearable Devices, Mhealth, NeuroCuple, LINE, Digital Intervention Group, The Panda App and A Digital Application. Wearable apps and devices effectively monitor pain and enable real-time therapy adjustments. Digital-based innovation can be used as an alternative nursing intervention for post-operative pain management.

Impact of microvascular resistance reserve on post-STEMI cardiac remodelling and diastolic function

Abstract Background Coronary microvascular dysfunction (CMD) is a common sequelae of ST-segment elevation myocardial infarction (STEMI), preventing adequate recovery of left ventricular (LV) perfusion. The interferences of con-commitment epicardial stenosis or hyperemic hemodynamic alterations limit traditional physiologic metrics. The microvascular resistance reserve (MRR) was developed to overcome these shortcomings. Purpose We aim to investigate the association between post-STEMI MRR, and the ensuing left ventricle (LV) diastolic dysfunction, and functional remodeling. Methods In this prospective, observational study, we enrolled STEMI patients with multivessel disease who successfully underwent primary percutaneous coronary intervention (PCI). At three months post-PCI, all patients received complete revascularization followed by coronary physiology assessment using the bolus thermodilution method to measure the fractional flow reserve (FFR), coronary flow reserve (CFR), and the index of microcirculatory resistance (IMR). MRR was calculated using the formula: MRR = (CFR/FFR) × (Pa rest/Pa hyper), where Pa rest and Pa hyper represent resting and hyperemic aortic pressure, respectively(1). CMD was defined as an MRR &amp;lt; 3.0 based on Boerhout et al(2). Diastolic dysfunction was defined according to the ASE 2016 guidelines. Functional LV remodelling (FLVR) was categorized according to Chimed et al(3). The relationship between CMD and the stages of FLVR and diastolic dysfunction was scrutinized over a 12-month follow-up period. Results We enrolled 210 patients, of whom 125 (59.5%) were men with a median age of 65 (IQR: 58–76). At the 3-month follow-up, the MRR was 3.46 (IQR 3.00, 3.92), with 56 (26.7%) patients having CMD (MRR&amp;lt;3.0). MRR is significantly correlated with the change of LVEF between primary PCI and 12 months (r=0.48, p&amp;lt;0.001, Fig1A). CMD patients have lower LVEF at 12 months (50.00% vs. 40.00%; p &amp;lt; 0.001) and demonstrated significantly less recovery in LV systolic function (-10.00% vs. 8.00%; p &amp;lt; 0.001, Fig 1B, 1C). CMD patients had a higher prevalence of grade 2 or 3 LV diastolic dysfunction (65.38% vs. 3.95%; p &amp;lt; 0.001, Fig 2A) and a higher incidence of advanced FLVR (Groups 3 and 4) compared to those without CMD (30.77% vs. vs. 10.53%; p &amp;lt; 0.001, Fig 2B). In multivariable logistic regression analysis, MRR was independently associated with LV diastolic dysfunction (0.17, 95%CI 0.08-0.33, p&amp;lt;0.001). Conclusions The novel parameter MRR is significantly related to LVEF recovery in STEMI patients and is an independent predictor for advanced LV diastolic dysfunction and FLVR. CMD patients, as diagnosed with MRR, showed a higher prevalence of advanced FLVR and diastolic dysfunction. These results suggest that MRR is a useful parameter for the identification and management of CMD in STEMI patients.

Application of resistance exercise training combined with CT image evaluation in postoperative functional rehabilitation and fracture risk prediction of elderly femurs

ObjectiveTo evaluate the overall functional recovery of femoral patients, improve recovery ability, and prevent fractures in the elderly. MethodsA group of elderly femoral postoperative participants were selected and randomly divided into resistance exercise training and routine rehabilitation training. Simultaneously, a control group (without a history of fractures) and a fracture group (with a history of fractures) were designed to predict fracture risk. Finally, computerized tomography was used to evaluate the functional rehabilitation status. ResultsThe resistance exercise training group showed significantly better performance in functional rehabilitation and fracture risk prediction than the control group, and the decrease in Barthel index at 12 weeks after surgery in this group was 6.25 (P > 0.001). The age, gender, and volumetric bone density between the control group and the fracture group showed P > 0.001, and the differences were statistically significant. The average age of the control group was significantly higher than that of the fracture group, and the proportion of males in the fracture group was significantly higher than that of the control group. The intramuscular fat content of the iliopsoas muscle in the fracture group was significantly lower than that in the control group, P = 0.004. This indicated that lower intramuscular fat content of the iliopsoas muscle was associated with higher fracture risk, as participants with lower intramuscular fat content of the iliopsoas muscle had less bone protection, resulting in an increased risk of fracture. The difference in body mass index between the two groups was not statistically significant, P = 0.737, indicating that the impact of this parameter on fracture risk was not significant in this study. ConclusionResistance exercise training combined with CT image evaluation is an effective rehabilitation strategy with high clinical application value. This study provides reliable empirical evidence for the application of resistance exercise training and the combination of CT image evaluation, and provides guidance for the optimization of clinical rehabilitation strategies.

Epicardial adipose tissue volume and density are associated with heart failure with improved ejection fraction

Abstract Background Heart failure (HF) with improved ejection fraction (EF, HFimpEF) gains increasing attention as a distinct HF subtype, characterized by left ventricular reverse remodeling and myocardial recovery. Multiple cardiometabolic factors are implicated in this process. Epicardial adipose tissue (EAT), emerging as an endocrine and paracrine organ, contributes to the onset and progression of HF. However, the relation between EAT and the incidence of HFimpEF is still unclear. Methods A total of 203 hospitalized HF patients with reduced EF (HFrEF, EF≤ 40%) who underwent coronary CT angiography (CCTA) during index hospitalization were consecutively enrolled between November 2011 and December 2022. Routine follow-up and repeat echocardiograms were performed. The incidence of HFimpEF was defined as (1) an absolute EF improvement ≥10% and (2) a second EF &amp;gt; 40% (at least 3 months apart). EAT volume and density were semiautomatically quantified on non-enhanced series of CCTA scans. Results During a median follow-up of 8.6 (4.9~13.3) months, 104 (51.2%) patients developed HFimpEF. Compared with HFrEF patients, HFimpEF patients had lower EAT volume (126.03 ± 57.71 cm3 vs 182.74 ± 82.99 cm3 , P&amp;lt; 0.001) and higher EAT density (-74.92 ± 6.84 HU vs -78.76 ± 6.28 HU, P&amp;lt; 0.001) both in ischemic and non-ischemic HF patients. EAT density was inversely correlated with EAT volume (r= -0.33, P&amp;lt; 0.001). Multivariate analysis showed lower EAT volume (OR: 0.881 [95% CI 0.821~0.939]) and higher density (OR: 2.354 [95% CI 1.314~4.415]) were both independently associated with the incidence of HFimpEF, after adjusting for conventional risk factors, pharmacological therapies and baseline anthropometric parameters including body mass index. Subgroup analysis revealed that the association between EAT properties and HFimpEF was not modified by HF etiology. Conclusions This study reveals that lower EAT volume and higher EAT density are associated with development of HFimpEF. Therapies targeted at reducing EAT quantity and improving its quality might provide favorable effects on myocardial recovery in HF patients.

Acute renal failure in patients with infective endocarditis

Abstract Background/Introduction Acute kidney failure (AKF) appears in a high percentage of patients with infective endocarditis (IE), becoming a complication related to the mortality of the disease and delayed recovery of patients. Purpose To investigate the factors that are related to the development of AKF in patients with IE. Methods Study of all cases of IE consecutively diagnosed in an university hospital between 2005 and 2021. A disease extension protocol was carried out using imaging tests and the levels of potentially nephrotoxic antibiotics were monitored. Furthermore, starting in 2010, a multidisciplinary committee (MC) was created to follow patients with EI. Factors potentially related to the development of AKF during hospital admission according to RIFLE criteria were analyzed using a binary logistic regression analysis. Results 305 cases were included, 96.7% of them meeting definitive IE criteria. The median age was 66 (54-74.5) years, 75.4% male. The most frequent microorganism was S. aureus (66; 21.6%), 172 (56.4%) underwent surgery and 107 patients (35.1%) died. 149 cases (45.3%) developed AKF, with no differences before (45.3%) and after the creation of the CM. The variables related in the multivariate analysis to the appearance of AKF were age (OR 1.01; 95% CI: 1.01-1.05; p= 0.006), baseline creatinine (OR= 1.53; 95% CI = 1.22-1.68; p&amp;lt;0.001). ), peripheral embolism (OR=1.86; 95% CI = 1.07-3.22; p= 0.027), the development of heart failure (OR=1.98; 95% CI = 1.12-3.22; p= 0.017) and left ventricular systolic dysfunction (OR= 4.02; 95% CI = 1.09-14.85; p= 0.037). None of the other variables analyzed, including the type of microorganism and the use of nephrotoxic antibiotics, were related to the development of AKF. Conclusions In a hospital center with a protocol for the study and treatment of infective endocarditis, the development of AKF is related to age, baseline creatinine, peripheral embolism, and the development of heart failure.