Severe Impairment Research Articles

Comorbidities, medications, depression, and physical performance measures associated with severe cognitive impairments in community-dwelling adults

Cognitive impairment negatively impacts health, psychological, social, and economic domains. Cognitive impairment commonly affects physical functions in older adults, whereas these are deteriorated. However, the prevalence and associated factors of cognitive impairment among community-dwelling adults in Saudi Arabia have not been investigated yet. This study aimed to examine the prevalence of severe cognitive impairment and its associated factors in community-dwelling older adults in Saudi Arabia. This cross-sectional study involved adults aged ≥50 years. Demographic data and clinical data, including number of medications and body mass index (BMI), were collected. Cognitive impairment and depressive symptoms were measured using Arabic versions of the Montreal Cognitive Assessment (MoCA) and Patient Health Questionnaire-9 (PHQ-9), respectively. The participants were divided into severe cognitive impairment and mild cognitive impairment or normal cognitive function groups based on a score of <20 or ≥20, respectively, using the MoCA. Physical measures included dynamic gait index (DGI) scores, timed up-and-go (TUG), 5 times sit-to-stand (5XSST), functional reach test, and 6-minute walk test. A total of 206 participants (female: n = 96) were included. The prevalence of severe cognitive impairment in the community-dwelling older adults was 12.6%. The number of chronic conditions (odds ratio [OR]: 2.31, p<0.001), number of medications (OR: 1.36, p = 0.003), and depressive symptoms using PHQ-9 (OR: 1.11, p = 0.009) were significantly associated with severe cognitive impairment after adjustment for other covariates, including age, sex, and BMI. Based on the physical function measures, only the scores for DGI (OR: 0.86, p = 0.003), TUG (OR: 1.16, p = 0.035) and 5XSST (OR: 1.25, p <0.001) were significantly associated with severe cognitive impairment. This study revealed a high prevalence of severe cognitive impairment among community-dwelling adults in Saudi Arabia. Its major risk factors include depressive symptoms, number of chronic conditions and medications, and physical measures, including DGI, TUG, and 5XSST.

Risk of significant functional impairment across cancer diagnosis and care continuum

ABSTRACTBackgroundThe authors examined baseline physical functional (PF) impairment among cancer outpatients in the National Cancer Institute Cancer Moonshot study Northwestern University Improving the Management of Symptoms During and Following Cancer Treatment (NU IMPACT). They hypothesized that PF impairment, measured with the Patient Reported Outcome Measurement Information System–Physical Function (PROMIS‐PF) survey, would (1) be common and more prevalent for patients receiving treatment compared with no treatment and (2) differ across tumor types, independent of cancer continuum phase.MethodsAdults who were diagnosed with cancer in NU IMPACT (n = 2273) were sampled, and their PROMIS‐PF scores were compared across tumor types and cancer continuum (curative, noncurative, or no treatment), with scores ≤40 indicating moderate–severe impairment. Multivariable logistic regression models were used to evaluate the relation among patient and cancer factors and PF scores using a 95% confidence interval.ResultsForty percent of the surveyed patients reported moderate–severe PF impairment. Patients with melanoma reported the least impairment, and those with lung cancer were 6.5 times more likely to have moderate–severe impairment (95% confidence interval, 2.393–17.769). The noncurative group was 1.5 times more likely to have moderate–severe impairment (95% confidence interval, 1.045–2.145; mean score, 43; p < .001) than the curative (mean score, 6) and no treatment (mean score, 48) groups. One‐third of those who reported PF impairment also had significant pain and/or fatigue.ConclusionsA sizeable minority experienced PF impairment across tumor types for which pain and/or fatigue co‐occurred, particularly in the noncurative group. The PROMIS‐PF survey effectively identified variations in physical function. Future studies will explore how screening for PF impairment can be used to refer patients for appropriate cancer rehabilitation services.

Predictive utility of self-efficacy in early stroke rehabilitation

ABSTRACT Introduction A biopsychosocial approach entailing person-centered factors provides valuable insight to post-stroke rehabilitation potential. The consideration of an individual’s belief in their capabilities, known as self-efficacy, may prove especially informative in the inpatient rehabilitation setting where motor learning often occurs. Objective To assess the predictive utility of self-efficacy in functional independence status change during inpatient rehabilitation. Methods Individuals with stroke admitted to an inpatient rehabilitation facility (IRF) completed an assessment battery near IRF admission and discharge involving motor assessments, participant-reported self-efficacy (Stroke Self-Efficacy Questionnaire), and functional independence status evaluation (sum of self-care and mobility Quality Indicators (QI) from the IRF-Patient Assessment Instrument). Linear regression was performed to determine the predictive performance of self-efficacy on QI change during IRF stay while accounting for age, time post-stroke, and IRF length of stay. Regression procedures were repeated for separate subgroups based on initial motor impairment level. Results Thirty individuals with stroke (14 females, age = 67.0 ± 9.80 years, 10.4 ± 3.46 days post-stroke) were enrolled. Self-efficacy at IRF admission explained a significant percentage of variance in QI Change for the cohort (R2 = 30.7%, p = .001) and for the moderate to severe motor impairment subgroup (n = 12; R2 = 49.9%, p = .010). After accounting for confounders, self-efficacy remained a significant predictor for the cohort (n = 30) model. Discussion Findings generated from this work support the predictive utility of self-efficacy in early post-stroke motor recovery. The inclusion of self-efficacy in a multi-faceted evaluation framework may therefore optimize rehabilitation outcomes by providing therapists with additional knowledge to better tailor an individual’s care.

Recipient functional status impacts on short and long-term intestinal transplant outcomes in United States adults.

Recipient functional status prior to transplantation has been found to impact post-transplant outcomes in heart, liver and kidney transplants. However, information on how functional status, before and after transplant impacts post-transplant survival outcomes is lacking. To investigate the impact of recipient functional status on short and long term intestinal transplant outcomes in United States adults. We conducted a retrospective cohort study on 1254 adults who underwent first-time intestinal transplantation from 2005 to 2022. The primary outcome was mortality. Using the Karnofsky Performance Status, functional impairment was categorized as severe, moderate and normal. Analyses were conducted using Kaplan-Meier curves and multivariable Cox regression. The median age was 41 years, majority (53.4%) were women. Severe impairment was present in 28.3% of recipients. The median survival time was 906.6 days. The median survival time was 1331 and 560 days for patients with normal and severe functional impairment respectively. Recipients with severe impairment had a 56% higher risk of mortality at one year [Hazard ratio (HR) = 1.56; 95%CI: 1.23-1.98; P < 0.001] and 58% at five years (HR = 1.58; 95%CI: 1.24-2.00; P < 0.001) compared to patients with no functional impairment. Recipients with worse functional status after transplant also had poor survival outcomes. Pre- and post-transplant recipient functional status is an important prognostic indicator for short- and long-term intestinal transplant outcomes.

Exploring psychosocial factors in the functional recovery of children with severe mental disorders: A qualitative content analysis.

Severe mental disorders during childhood and adolescence can be chronic and disturbing, and may result in serious impairments in functioning. Research on the influence of such factors in the functional recovery of children diagnosed with severe mental illnesses is scant. This study aims to enhance understanding of the patterns and descriptions of social factors in the optimal functioning of children with severe mental illnesses. We performed content analysis on 69 medical files of children taking treatment from Child and Adolescent Psychiatry (from 2018 to 2020). We analyzed the medical files using the summative approach by identifying and quantifying certain words and phrases. The Children's Global Assessment Scale (CGAS) and data abstraction form were used to record the functioning profile and quantitative data. Socio-demographic and clinical variables were analyzed using descriptive statistics. A total of three major and ten sub-categories were identified from the data. The most striking categories in psychosocial environments were intrapersonal challenges, adverse living and relationship spaces, and outer structures and systems. Moderate to severe functional impairments were retrospectively observed among children. Children diagnosed with severe mental illnesses and with poor functioning are the most affected group of population and hence, require proper attention.

Associations of Age, Preinjury Morbidity, Injury Severity, and Cognitive Impairment With Mortality and Length of Stay in Trauma Consultation Patients: A Retrospective Study.

Background To the best of our knowledge, we have found no trauma consultation study investigating Injury Severity Score (ISS) ≥16, Glasgow Coma Scale score (GCS), intracranial hemorrhage (ICH), age, preexisting medical conditions (PEMC), and smoking as risk conditions for mortality. Objective We aimed to assess ISS ≥16 and other postinjury and preinjury conditions for associations with death and adverse outcomes (AO). Methodology Consecutive consultations of patients admitted to a trauma center over 18 months were investigated. Data were obtained from the trauma registry and the electronic medical record. AO were death, intensive care unit stay of two days or more, or hospital stay exceeding five days. Results Among 1,031 trauma consultations, 28 patients (2.7%) died and 258 (25.0%) had AO. The proportion of ISS ≥16 was greater with death (53.6% (15/28)) than with survival (20.2% (203/1,003); p<0.0001). Of 218 patients with ISS ≥16, 93.1% (n = 203) survived, whereas 46.4% (13/28) died with an ISS <16. The area under the receiver operating characteristic curve for ISS ≥16 and the death relationship was 0.7 (p<0.001). The proportion of GCS <15 was greater with death (42.9% (12/28)) than with survival (13.1% (131/1,003); p<0.0001). The incidence of ICH was greater with death (57.1% (16/28)) than with survival (32.5% (326/1,003); p=0.0063). The incidence of age ≥70 was greater with death (89.3% (25/28)) than with survival (48.2% (483/1,003); p<0.0001). The proportion of PEMC was greater with death (85.7% (24/28)) than with survival (50.8% (509/1,003); p=0.0002). The proportion of smoking history was similar with death (50.0% (14/28)) and survival (52.5% (527/1,003); p=0.7905). Death had independent associations with age (p=0.0019), GCS (p<0.0001), ISS ≥16 (p=0.0074), and PEMC (p=0.0137). AO had univariate associations with ISS ≥16 (p<0.0001), GCS <15 (p<0.0001), ICH (p=0.0004), and PEMC (p=0.0002). Area under the receiver operating characteristic curve for ISS ≥16 and the AO relationship was 0.6 (p<0.001). AO had independent associations with GCS (p<0.0001), ISS ≥16 (p<0.0001), and PEMC (p=0.0005). Conclusions ISS ≥16 alone is marginally accurate for classifying trauma consultation patients who died or had AO. Other postinjury and preinjury conditions, such as GCS, ICH, age, and PEMC, should also be considered when assessing one's risk of death and AO.

Smartphone Assessment of the Sitting Heel-Rise Test.

The study presents a new approach for assessing plantarflexor muscles' function using a smartphone. The test involves performing repeated heel raises for 60 s while seated. The seated heel-rise test offers a simple method for assessing plantarflexor muscles' function in those with severe balance impairment who are unable to complete tests performed while standing. The study aimed to showcase how gyroscopic data from a smartphone placed on the lower limb can be used to assess the test. Eight participants performed the seated heel-rise test with each limb. Gyroscope and 2D video analysis data (60 Hz) of limb motion were used to determine the number of cycles, the average rise (T-rise), lowering (T-lower), and cycle (T-total) times. The number of cycles detected matched exactly when the gyroscope and kinematic data were compared. There was good time domain agreement between gyroscopic and video data (T-rise = 0.0005 s, T-lower = 0.0013 s, and T-total = 0.0017 s). The 95% CI limits of agreement were small (T-total -0.1118, 0.1127 s, T-lower -0.1152, 0.1179 s, and T-total -0.0763, 0.0797 s). Results indicate that a smartphone placed on the thigh can successfully assess the seated heel-rise test. The seated heel-rise test offers an attractive alternative to test plantarflexor muscles' functionality in those unable to perform tests in standing positions.

Estimating Visual Acuity Without a Visual Acuity Chart.

This study explored whether visual acuity (VA) can be inferred from self-reported ability to recognize everyday objects using a set of yes/no questions. Participants answered 100 yes/no questions designed to assess their ability to recognize familiar objects at typical viewing distances, such as distinguishing between a full moon and a half moon on a clear night. The questions demanded VA ranging from normal to severe vision impairment. Responses were analyzed using item response theory, and the results were compared with participants' VA values. We recruited 385 participants from 4 sites in the United States. Participants had a mean age of 56.7years with VA ranging from -0.3 to 2.0 logarithm of the minimum angle of resolution (logMAR) (mean = 0.58). A strong relationship was observed between participants' estimated vision ability and their VA (r = -0.72). The linear relationship can be used to predict each participant's VA based on their estimated vision ability. The average signed and unsigned prediction errors were 0 and 0.24 logMAR, respectively, with a coefficient of repeatability of 0.59 logMAR between the estimated VA and measured VA. The same linear function was used to determine the VA limit required for each question. For instance, the VA limit for the moon question was 1.0 logMAR. Yes/no questions about everyday visual activities have the potential to estimate an individual's VA. Future refinements may enhance reliability. The survey provides insights into the real-world visual capabilities of people with low vision, making it potentially useful for telehealth applications.

Trends in sex differences in neurodevelopmental outcomes among extremely preterm infants

ObjectiveTo examine whether changes in survival without moderate or severe neurodevelopmental impairment (NDI) at 18–26 months’ corrected age from 1999 to 2018 differed between male and female infants.DesignThis retrospective cohort...

Cognitive phenotyping of GBA1-Parkinson's disease: A study on deep brain stimulation outcomes

BackgroundHeterozygous variants in the glucocerebrosidase (GBA1) gene are the most common genetic risk factor for Parkinson's Disease (PD). GBA1-PD patients exhibit earlier disease onset, severe motor impairment, and heightened cognitive decline. Deep Brain Stimulation (DBS) offers motor improvement for PD patients, but its cognitive effects, particularly in GBA1-PD, are debated. MethodsThis study involved 96 PD patients who underwent subthalamic nucleus DBS at Hospital de la Santa Creu i Sant Pau between 2004 and 2023. Clinical and neuropsychological assessments were conducted pre- and post-surgery, focusing on Mattis Dementia Rating Scale (MDRS) and Frontal Systems Behavior Scale (FrSBe). Patients were categorized into GBA1-PD and non-GBA1-PD groups, with non-GBA1-PD further divided into cognitive fast-progressors and slow-progressors. ResultsGBA1 variants were present in 13.5 % of patients. GBA1-PD patients showed greater cognitive decline over time, particularly in attention, conceptualization, and memory, compared to non-GBA1-PD. Non-GBA1-PD fast-progressors exhibited significant cognitive deterioration in initiation and conceptualization within the first year post-DBS. Motor outcomes improved similarly across all groups, but slow-progressors showed a greater reduction in Levodopa Equivalent Daily Dose (LEDD). ConclusionsGBA1-PD patients experience more rapid cognitive decline, particularly in posterior-cortical and fronto-striatal functions. Additionally, a subset of non-GBA1-PD patients shows significant early cognitive decline post-DBS, especially in executive functions. Baseline MDRS scores do not predict cognitive outcomes, highlighting the need for further research to refine prognostic tools. Despite cognitive challenges, GBA1-PD patients benefit from DBS in terms of motor outcomes, underscoring the importance of individualized assessments for DBS suitability, regardless of genetic status.

Association between widowhood and cognitive function among Chinese older adults with hearing impairment: the moderating effect of social support and participation

BackgroundOlder adults with hearing impairments are vulnerable to cognitive impairment. Although previous reports suggest a correlation between widowhood and cognitive impairment, further investigation is needed to elucidate the effect of widowhood on cognitive function and the moderating effects of social support and participation on widowhood-related cognitive impairment in this vulnerable demographic.MethodsThe study’s data were sourced from the nationally representative Chinese Longitudinal Healthy Longevity Survey (CLHLS) for the years 2011, 2014, and 2018. Multiple linear regression was used to analyze the association between widowhood and cognitive function among older adults. Multivariate logistic regression examined the effect of widowhood on the likelihood of experiencing various levels of cognitive impairment in older adults with hearing impairments. A moderating effect model explored the roles of social support and participation in mitigating widowhood-related cognitive impairment.ResultsThe cognitive function of older adults with hearing impairment was found to be lower than that of those without hearing impairment. Widowhood was significantly negatively correlated with Mini-Mental State Examination (MMSE) scores in older adults, both with (Coef. = -0.898) and without (Coef.: = -0.680) hearing impairments. A stronger association was observed between widowhood and declining cognitive function among older adults with hearing impairment. Specifically, widowhood may be more likely to significantly increase the likelihood of moderate and severe cognitive impairment (RRR = 1.326, 1.538) among older adults with hearing impairments. Social support and social participation significantly moderated the cognitive impairment associated with widowhood among hearing-impaired older adults. These forms of support and engagement are buffers against the risk of widowhood-related cognitive impairment among this demographic.ConclusionsOur findings indicate that widowhood is significantly associated with cognitive impairment in older adults with hearing impairment. Social support and participation help mitigate this risk. Strategies should prioritize early screening, specialized cognitive rehabilitation, comprehensive care, and enhancing social support and participation to maintain cognitive health in this vulnerable population following widowhood.

Neonatal Markers of Prematurity as Predictors of Permanent Childhood Hearing Loss and Neurodevelopmental Impairment in Children Admitted to the Neonatal Intensive Care Unit.

Need for admission to the neonatal intensive care unit (NICU) confers an increased risk of hearing loss in the newborn and of later neurodevelopmental impairment. In this retrospective longitudinal case-controlled study, we assess how the degree of prematurity, measured via gestational age, birth weight, and z-scores, in 138 infants admitted to the NICU are associated with permanent childhood hearing loss (PCHI) and 2-year developmental outcomes. Logistic regression analyses, Kruskal-Wallis analysis of variance, and Chi-squared tests were used. Independent of prematurity, PCHI and NICU admission were predictive of poor developmental outcomes. Twenty-one (47%) children with PCHI had a moderate-to-severe developmental delay, compared to three (7%) matched controls. Days in the NICU but not z-scores predicted PCHI. Z-score was not prognostic of moderate or severe developmental impairment in children with PCHI. The odds ratio of moderate-to-severe neurodevelopmental impairment with PCHI was high, at 12.48 [95% CI = 3.37-46.40]. Children with PCHI were significantly more likely to have cerebral palsy than their matched counterparts (30% vs. 2%). These findings challenge the conventional focus on gestational age and birth weight on neurodevelopmental outcomes for children with PCHI and NICU admission. A more nuanced approach to monitoring and intervention is needed.

Phaeobacter italicus JN-W1: A pathogenic bacterium causing bleaching disease in Porphyra sensu lato (Bangiales, Rhodophyta)

The recent emergence of bleaching disease in the shell-borne conchocelis (SBC) of Porphyra sensu lato has escalated with alarming speed, inflicting severe economic losses on the Porphyra aquaculture industry. Despite the severity of the outbreak, the causative agents of this disease have remained elusive. In this study, we successfully isolated and purified the pathogenic bacterium JN-W1 from SBC affected by bleaching disease. Our infection assays revealed that the bacterium induced the degradation of algal cell organelles and the formation of autophagosomes, ultimately leading to the conversion of dead cells into empty-walled remnants, likely accounting for the bleaching symptoms observed in Porphyra. Additionally, the infection caused severe impairment of the algal photosynthetic apparatus, evidenced by a marked reduction in photosynthetic efficiency as the infection advanced. Through a combination of single-copy orthologous gene analysis and detailed morphological, physiological, and biochemical characterization, strain JN-W1 was definitively classified as Phaeobacter italicus JN-W1. The bacterium demonstrated optimal growth and infection capabilities at 25 °C, pH 7.0, and a salinity of 20. JN-W1's pathogenicity was found to be contact-dependent, mediated by intracellular substances. This study laid a crucial foundation for further exploration of JN-W1's virulence mechanism and the development of effective strategies to prevent and control the outbreaks of Porphyra bleaching disease.

Benchmarking deep learning-based low-dose CT image denoising algorithms.

Long-lasting efforts have been made to reduce radiation dose and thus the potential radiation risk to the patient for computed tomography (CT) acquisitions without severe deterioration of image quality. To this end, various techniques have been employed over the years including iterative reconstruction methods and noise reductionalgorithms. Recently, deep learning-based methods for noise reduction became increasingly popular and a multitude of papers claim ever improving performance both quantitatively and qualitatively. However, the lack of a standardized benchmark setup and inconsistencies in experimental design across studies hinder the verifiability and reproducibility of reportedresults. In this study, we propose a benchmark setup to overcome those flaws and improve reproducibility and verifiability of experimental results in the field. We perform a comprehensive and fair evaluation of several state-of-the-art methods using this standardizedsetup. Our evaluation reveals that most deep learning-based methods show statistically similar performance, and improvements over the past years have been marginal atbest. This study highlights the need for a more rigorous and fair evaluation of novel deep learning-based methods for low-dose CT image denoising. Our benchmark setup is a first and important step towards this direction and can be used by future researchers to evaluate theiralgorithms.

From Science Fiction to Reality: Exploring Brain-Computer Interfaces and their Human Applications

Direct control of mechanical or electrical equipment through mental activity is made possible by brain-computer interfaces (BCIs), often referred to as brain-machine interfaces (BMIs). Using only brain signals, users of BCIs can operate external systems without using neurostimulators, which trigger neural tissues. This allows users to avoid using peripheral neurological and muscle systems. The brain's ability to incorporate and regulate mechanical devices as extensions of its own physiological processes is demonstrated by this capability.When it comes to helping those with severe impairments, BCI systems have a lot of potential uses. For people who suffer from neurological conditions like amyotrophic lateral sclerosis, brainstem stroke, or spinal cord injury who are completely paralyzed or "locked in," they provide a substantial benefit in terms of communication. By directly converting brain intent into executable commands, BCI technology aims to enable communication. This is especially helpful for those who are unable to speak.Neuroprosthetics, which attempt to restore lost motor and sensory functions, have been the main focus of BCI research and development. These systems make use of artificial devices to treat brain-related illnesses, take over for faulty nervous system functions, and compensate for compromised sensory organs. As this science develops, brain-computer interfaces (BCIs) have the potential to improve cognitive capacities and the quality of life for people with severe disabilities.

Current Formulation Strategies to Design Novel Carriers for Targeted Drug Delivery and Management of Infectious Keratitis: A Comprehensive Review on the Present State of the Art

Objective: Infectious keratitis is a pernicious disease that affects the anterior segment of the eye and is one the leading causes of blindness worldwide. This disease may cause severe visual impairment or permanent vision damage if left untreated. Discussion: No doubt there are many conventional drug delivery systems to treat ocular keratitis, yet it is the fifth leading cause of blindness globally. This is the result of the eye's complex anatomy and barrier system, which restricts the total ocular contact time of the conventional formulations resulting in underdosing. The widely used traditional formulations to treat keratitis, like antibiotic eye drops and ointments, are rendered useless due to less ocular contact time and low therapeutic drug levels at the target ocular site. The main requirement of the present time is to develop novel drug delivery-backed stratagems to overcome the shortcomings of conventional formulations, which will reduce the morbidity associated with infectious keratitis and improve clinical outcomes. It is worth mentioning that there are documented incidents of Herpetic keratitis of the cornea followed by COVID-19 infection and vaccination. Conclusion: This paper is a rigorous review of all the novel drug delivery strategies to combat ocular keratitis. These future drug delivery strategies will pave the way for the present time researcher and formulation chemists to develop multi-dimensional novel formulations that are safe, patient-compliant, and surpass the ocular barriers to maintain therapeutic drug levels in ocular tissues.

Efficacy and safety of therapeutic alpha-1-microglobulin RMC-035 in reducing kidney injury after cardiac surgery: a multicentre, randomised, double-blind, parallel group, phase 2a trial

Cardiac surgery invariably triggers acute kidney stress causing adverse renal outcomes. The AKITA study evaluated the efficacy and safety of RMC-035, a novel analogue of alpha-1-microglobulin, for reducing cardiac surgery-associated kidney injury. In this randomised double-blind placebo-controlled phase 2a study, we randomly assigned (1:1) adult hospitalised patients undergoing open-chest cardiac surgery at high risk for acute kidney injury (AKI) at 21 sites in North America and Europe to receive either RMC-035 (1.3 or 0.65mg/kg) or placebo (1:1) for 2 days (5 intravenous infusions), stratified by region and renal function. Eligible patients had at least one pre-defined AKI risk factor. Patients with severe renal impairment (estimated glomerular filtration rate [eGFR] <30mL/min/1.73m2) were excluded. The co-primary efficacy and safety endpoints were AKI (Kidney Disease: Improving Global Outcomes definition) within 72h after surgery and nature, frequency, and severity of treatment-emergent adverse events (TEAEs). Secondary endpoints included eGFR and Major Adverse Kidney Events (MAKE) up to Day 90. Randomised patients who had received at least one dose of study drug were analysed for primary and safety analyses. Participants, investigators and sponsor were masked to treatment allocation. This study is registered at ClinicalTrials.gov (NCT05126303) and EudraCT (2021-004040-19). Patient enrolment was stopped at interim analysis due to futility. Between March 31, 2022 and July 12, 2023, 177 patients (RMC-035: 89, placebo: 88) were randomised and treated. AKI rate for RMC-035 vs placebo was 50.6% (n=45) and 39.8% (n=35) (relative risk [RR]: 1.30, 90% confidence interval [90% CI]: 0.99, 1.71; p=0.12). A short-lived creatinine increase was observed with the higher RMC-035 dose. Treatment with RMC-035 was associated with improved secondary renal outcomes at Day 90: placebo-adjusted eGFR change from baseline 4.3mL/min/1.73m2, 90% CI 0.51-8.12, p=0.06; and MAKE 6.7% (n=6) vs 15.9% (n=14); RR: 0.41, 90% CI: 0.19, 0.88, p=0.05. The most frequently reported TEAEs for RMC-035 were chills (30.3%), nausea (21.3%), anaemia (20.2%); and atrial fibrillation (29.5%), anaemia (20.5%), hypervolemia (14.8%) for placebo. The majority of TEAEs in both treatment groups were mild or moderate in severity. In the RMC-035 group, 26 (29.2%) patients experienced at least one severe or life-threatening TEAE and in the placebo group 16 (18.2%) patients. There were 4 deaths per treatment arm (one treatment-related, in placebo group). In this proof-of-concept study, RMC-035 did not reduce AKI 72h after cardiac surgery. Evaluations may have been confounded by a drug-induced transient creatinine increase in a subgroup of patients. RMC-035 was associated with improved secondary renal outcomes. These results merit further investigation and should be interpreted with caution, as the study was not powered for these outcomes. Guard Therapeutics.

Optimizing the pterional approach in medial sphenoid wing meningioma: a detailed morphometric study on anterior clinoidectomy and its effect on operability score

BackgroundMedial sphenoid wing meningiomas are best treated through pterional craniotomy, as pterional craniotomy provides wide and multidirectional exposure of the anterior and middle cranial fossa. Anterior clinoidectomy can increase the exposure potential. To delineate the role of anterior clinoidectomy (AC) in the standard pterional craniotomy approach through the evaluation of operability score measures (manoeuvrability arc, depth of surgical field, and surgical angle of attack). All patients with inner sphenoidal wing meningioma who underwent microsurgical excision between February 2022 and October 2023 were enrolled in the study. Preoperative and postoperative imaging studies (MR contrast studies and 3D thin-slice CT scans of the brain) were performed to determine the tumour size, extent, and pattern of optic canal involvement by comparing pre- and postoperative operability score parameters.ResultsTwenty-five patients met our inclusion criteria: 2 males (8%) and 23 females (92%). The mean age (SD) was 49.08 ± 6.42 years, with an age range of 39–60 years. The preoperative visual manifestations were as follows: eight patients (32%) had mild visual impairment, five patients (20%) had moderate visual impairment, six patients (24%) had severe visual impairment, and five patients (20%) had blindness. There was a significant positive correlation between the operability score and extent of resection (gross total resection was correlated with a higher operability score) (r = 0.301, n = 25, p = 0.005).ConclusionsA well-planned manoeuvrable arc allows neurosurgeons to perform surgery with precision, ultimately impacting surgical outcomes and the potential for complete tumour removal with minimal patient morbidity.

Experimental Study on Submerged Nozzle Damping Characteristics of Solid Rocket Motor

Acoustic instabilities in solid rocket motors (SRMs) can lead to severe performance deterioration and structural damage. Nozzle damping accounts for the main acoustic dissipation source, and it is highly dependent on geometric parameters and operating conditions. This study experimentally investigated the acoustic damping characteristics of submerged nozzles in SRMs, focusing on the effects of submerged cavity dimensions, nozzle convergent angle, throat-to-port area ratio, and mean pressure variations on the longitudinal instability. The steady-state wave decay method was used to quantify the acoustic damping, and a designed rotary valve system was employed to introduce periodic pressure oscillations in the high-pressure combustion chamber. The results revealed that a larger submerged cavity would reduce the nozzle damping efficiency, with the elimination of the submerged cavity enhancing the nozzle decay coefficient magnitude by 41.9%. Furthermore, increasing the nozzle convergent angle was found to amplify acoustic wave reflection, thereby diminishing damping performance. A linear inverse relationship was observed between the throat-to-port area ratio and the decay coefficient, with a 125% increase in the ratio resulting in a 24.3% reduction in the decay coefficient. Interestingly, despite the formation of complex vortices in the submerged cavity, the mean pressure variation presented negligible effects on acoustic damping characteristics, and its damping performance is similar to a simple nozzle without a cavity. These findings provide valuable experimental data for predicting the stability of a solid rocket motor with a submerged nozzle and offer insights into the optimization of submerged nozzle designs for higher acoustic damping in SRMs.

Autonomous by Extension: Balancing Patient Autonomy and Vulnerability in Surrogate Decision-making.

The experience of serious illness or injury frequently results in increased vulnerability. In cases in which decision-making capacity is compromised, this vulnerability is compounded by threats to a patient's autonomy. This case report presents an opportunity to explore the elaborately entwined relationship between autonomy and vulnerability in patients with severe impairment who are reliant on surrogate decision-makers. Expanded views of autonomy and vulnerability are applied to the case of a young woman with a severe and life-altering spinal cord injury and iatrogenic loss of decisional capacity to illustrate how one can experience enhanced autonomy despite special vulnerability and can be made less vulnerable through surrogate-mediated autonomy. Also revealed is how attitudes and actions of surrogates can potentiate pathogenic vulnerability and disturb the balance between patient autonomy and vulnerability. Through methodical review and robust deliberation, clinical ethics committees can play a stabilizing role in helping distressed care teams reconcile the two.