Severe Impairment Research Articles

Characterization of Cutaneous Radiation Syndrome in a Mouse Model Using [18F]F- Fluorodeoxyglucose Positron Emission Tomography

Abstract Ionizing radiation on the skin has the potential to cause various sequelae affecting quality of life and even leading to death due to multi-system failure. The development of radiation dermatitis is attributed to oxidative damage to the skin’s basal layer and alterations in immune response, leading to inflammation. Past studies have shown that [18F]F-2-fluoro-2-deoxyglucose positron emission tomography-computed tomography ([18F]F-FDG PET/CT) can be used effectively for the detection of inflammatory activity, especially in conditions like hidradenitis suppurativa, psoriasis, and early atherosclerosis. Since currently there are no specific tests for radiation dermatitis, our study aimed to validate whether radiation dermatitis induced in mice can be accurately visualized and measured using [18F]F-FDG PET/CT. We induced cutaneous radiation syndrome in BALB/c mice with different radiation absorbed doses and monitored symptom development through photography, PET imaging, and histopathology, marking the first attempt at non-invasively quantifying radiation dermatitis effects at the molecular level using PET imaging. Our results showed that there were progressive changes in the dorsal skin of irradiated mice, with notable differences between those exposed to varying doses of radiation. Erythema, epilation, and desquamation were more pronounced in mice exposed to lower doses (25 Gy and 35 Gy) than at 45 Gy; however, by the third week, severe skin deterioration, including ulceration and dermal atrophy, was evident in mice irradiated with 35 Gy and 45 Gy. PET/CT imaging revealed increased [18F]F-FDG uptake in the irradiated dorsal skin area of all mice compared to controls, with more pronounced avidity for the lesion in the 25 Gy and 35 Gy than the 45 Gy. Comparison of tissue-normalized SUVMax values showed that both the 25 Gy and 35 Gy mice exhibited fourfold [18F]F-FDG uptake in the dorsal skin compared to controls, while a twofold uptake was seen at 45 Gy, thus indicating substantial metabolic changes in the dorsal skin induced by radiation exposure. Histopathological analyses correlated with the above findings, demonstrating generalized hypertrophy and epidermal thickening in all irradiated mice compared to controls, with thicker epidermis observed with higher radiation doses and increased destruction of microvasculature. In conclusion, PET/CT emerges as a successful tool for imaging cutaneous radiation syndrome, with the observed dermal changes in irradiated mice closely aligning with metabolic alterations of the affected area.

Cognitive behavioral therapy for complex regional pain syndrome

Complex regional pain syndrome (CRPS) is often associated with severe mental impairments. Initial pain-related fears in particular appear to be negative predictors for long-term therapy results. Procedures for cognitive behavioral therapy are an important component of treatment. The psychotherapy of CRPS consists of various elements that are implemented in the different phases of treatment. In the beginning the focus is on targeted psychoeducation. In the following activation phase body awareness exercises are accompanied by occupational and physiotherapeutic treatment in order to improve the perception of individual maximum loads. Behavioral analyses are used to uncover dysfunctional coping patterns, such as afear avoidance coping strategy. In this case the use of graded activity treatment approach is indicated, in which the activity level is gradually increased. In the transfer phase psychotherapy supports affected patients in (re)designing their professional and private environments.

Deciphering the Role of Adrenergic Receptors in Alzheimer’s Disease: Paving the Way for Innovative Therapies

Neurodegenerative diseases are currently among the most devastating diseases with no effective disease-modifying drugs in the market, with Alzheimer’s disease (AD) being the most prevalent. AD is a complex multifactorial neurodegenerative disorder characterized by progressive and severe cognitive impairment and memory loss. It is the most common cause of progressive memory loss (dementia) in the elderly, and to date, there is no effective treatment to cure or slow disease progression substantially. The role of adrenergic receptors in the pathogenesis of Alzheimer’s disease and other tauopathies is poorly understood or investigated. Recently, some studies indicated a potential benefit of drugs acting on the adrenergic receptors for AD and dementias, although due to the heterogeneity of the drug classes used, the results on the whole remain inconclusive. The scope of this review article is to comprehensively review the literature on the possible role of adrenergic receptors in neurodegenerative diseases, stemming from the use of agonists and antagonists including antihypertensive and asthma drugs acting on the adrenergic receptors, but also from animal models and in vitro models where these receptors have been studied. Ultimately, we hope to obtain a better understanding of the role of these receptors, identify the gaps in knowledge, and explore the possibility of repurposing such drugs for AD, given their long history of use and safety.

Refining the clinical and therapeutic spectrum of granulomatous myositis from a large cohort of patients.

Granulomatous myositis (GM) is a rare entity whose precise clinical features and therapeutic outcomes have not yet been well defined. Given the limited evidence, data from a large cohort of patients is needed to aid in the recognition and management of this condition. We retrospectively analyzed our institutional databases to identify patients who had myositis and non-caseating granuloma on muscle biopsy (GM). We collected data on clinical and diagnostic features, management, and outcomes of these cases and compared them with inclusion body myositis (IBM) controls. 22 GM patients were identified and subdivided into 3 main groups:13 patients with GM and sarcoidosis (6 of whom subsequently developed suspected or confirmed IBM), 7 patients with idiopathic isolated GM (2 of whom subsequently developed confirmed IBM), 2 patients with GM and Crohn's disease. Patients with GM and sarcoidosis without IBM, as well as patients with isolated GM, exhibited variable clinical presentation ranging from myalgia to mostly symmetrical proximo-distal weakness, with most showing complete or at least partial response to therapies. Patients with GM associated with Crohn's disease had only mild clinical impairment and good therapeutic outcomes. Conversely, patients with GM and IBM presented more severe asymmetric proximo-distal muscle weakness, increased occurrence of dysphagia and poor treatment response, similar to IBM controls. A frequent association of GM with IBM and/or sarcoidosis was demonstrated in our cohort. When associated with IBM, GM led to treatment refractoriness and more severe clinical impairment, unlike the other GM groups which showed satisfactory outcomes in most cases.

Validation of Spatial Orientation Screening questionnaire for use in memory clinic patients

Background Spatial orientation is required for independent mobility in society. Deficits in spatial orientation can be an early symptom of Alzheimer's disease and other dementias, and there is a need for brief assessment tools to identify impairments. Objective The aim of this study was to evaluate the construct and known-group validity of our newly developed Spatial Orientation Screening (SOS) questionnaire. Methods We included 132 patients with subjective cognitive decline (n = 16), mild cognitive impairment (n = 32), or all-cause dementia (n = 84) from a memory clinic and a reference group of cognitively unimpaired older adults (n = 108). The patients and their next-of-kin answered the self- and proxy-rated versions of the 4-item SOS (0–8 points) and the 10-item Questionnaire of Everyday Navigational Ability (QuENA, 0–30 points). The patients also performed the Floor Maze Test (FMT) for performance-based spatial abilities. Results Mean ages (SD) of the patient and reference groups were 68.6 (±7.6) years and 73.7 (±6.7) years, respectively. Construct validity between self-rated versions of the SOS and QuENA was satisfactory with rs = 0.66, between the proxy-rated versions rs = 0.61, and between the proxy-reported SOS and FMT rs = 0.49 (all p < 0.001). Known-group validity was also acceptable, with significantly higher median (IQR) SOS self-reported scores in patients 1.0 (2.0) compared to the reference group 0.2 (0.5) points, (p < 0.001). Informants reported more severe impairments compared to the patients’ self-reports on both SOS and QuENA (both p < 0.001). Conclusions The SOS had satisfactory validity for use as a screening instrument for assessment of spatial orientation in memory clinic patients.

Restoration of Memory Potential by Piper betel Leaves Extract in High-Fat Diet (HFD)-Induced Dementia in Mice

The present study has been designed to evaluate the effect of ethanolic extract of leaves of Piper betel in high fat diet (HFD) induced dementia and memory restoration effect in Albino mice by various parameters like Morris water maze (MWM) test, Elevated Plus Maze etc. and Estimation of serum total cholesterol using commercially available kit. Dementia is a syndrome in which the deterioration of cognitive functions occurs. The results of this study indicate that the administration of a high-fat diet to the Swiss mice produces a severe deterioration of spatial memory as determined by the Morris water maze (MWM) test, Elevated Plus Maze, T Maze delayed alteration task performed. Administration of ethanolic extract of Piper betel (250 and 500 mg/kg, p.o.) for 14 days significantly attenuated high-fat diet-induced memory deficits. Moringa Oleifera treatment to HFD induced mice improves cognition by virtue of its results support that the protective effect obtained with Piper betel may be through the activation of pregnane x receptors. ethanolic extract of Piper betel treatment to HFD induced mice improves cognition by virtue of its results, supports that the protective effect obtained with Piper betel may be through the activation of pregnane x receptors. Keywords: Dementia, Piper betel, high fat diet, Morris water maze, Elevated plus Maze, T Maze and Piracetam.

Prevalence of and risk factors analysis for post-intensive care syndrome among survivors of critical care during 3-month longitudinal follow-up.

Patients discharged from the intensive care unit (ICU) can experience post-intensive care syndrome (PICS), which is comprised of cognitive, physical and psychological impairments. The objective of this study was to identify the prevalence of and risk factors associated with all three domains of PICS at the first and third month after ICU discharge. A prospective descriptive-analytic study was conducted in two ICUs of a Chinese university hospital. We used the Healthy Aging Brain Care Monitor Self-Report Chinese version, a scale from 1 to 57, with 57 indicating the worst outcome, to comprehensively assess PICS at the first and third month follow-ups after patients left the ICU. We performed an analysis of stepwise multiple linear regression to explore the relationship between risk factors and PICS. We enrolled 654 and 584 participants at the first- and third-month follow-ups, respectively. More than 60% of patients experienced different degrees of PICS, with the most severe impairment being in the physical domain. We classified risk factors associated with PICS, categorized as patient-related, disease-related, and ICU-related factors. Among these risk factors, only being the main income provider for the family, the diagnosis of digestive system disease, trauma and the number of invasive catheters at ICU discharge significantly predicted PICS at both follow-ups. ICU-related risk factors should be given greater attention, given their potential for modification. The prevalence and severity of PICS were high in this population after their ICU stay. ICU nurses and medical staff members should collaborate to pay more attention to the comprehensive risk factors and implement targeted preventive measures. ICU staff must have a holistic view of PICS and a comprehensive understanding of its risk factors to proactively evaluate patients at high risk of PICS upon admission to the hospital.

The Missing Link in Antiamyloid Therapy.

Alzheimer's disease (AD) impacts millions of elderly adults worldwide causing cognitive decline and severe deterioration of activities of daily life. The popular causal hypotheses for several decades include beta-amyloid (Aβ) deposition and tau hyperphosphorylation. AD research and more than 34% of clinical trials in AD are based on these two hypotheses. A phase-III clinical trial of lecanemab in early AD and mild cognitive impaired (MCI) patients reported a delay in cognitive decline of 27% over an 18-month treatment schedule. This multicenter trial found high specificity of lecanemab toward toxic protofibrils and subsequent clearance of beta-amyloid. There were, however, adverse events, which included cerebral edema and intracerebral hemorrhages in 23.1% of patients compared to 9.3% for those who received a placebo. Suboptimal clinical outcomes, brain volume loss, and adverse events in lecanemab treatment prompted a search for an alternative etiopathogenic explanation. Our research and others have focused on the oxidative stress (OS) hypothesis in AD. Autopsy studies have found significant depletion of the master antioxidant glutathione (GSH) in the hippocampal region, and is believed to be an early event in AD progression. Hippocampal GSH depletion is positively correlated with memory impairment. We have confirmed non-invasively with magnetic resonance spectroscopy (MRS) the depletion of GSH in patients with MCI and AD. We therefore propose a combinational therapy involving oral supplementation of gamma-glutamylcysteine (GGC), an early precursor of glutathione, to replenish brain GSH in addition to lecanemab, potentially to maximize desirable outcomes from combined therapeutic approach.

Mechanisms through which exercise reduces symptom severity and/or functional impairment in posttraumatic stress disorder (PTSD): Protocol for a living systematic review of human and non-human studies

Background Exercise can play an important role in reducing symptom severity and improving functional impairment in patients with posttraumatic stress disorder (PTSD). However, the precise mechanisms underpinning the effect of exercise in PTSD management are not fully understood. This living systematic review aims to synthesize and triangulate the evidence from non-human and human studies to gain insight into the biopsychosocial mechanisms through which exercise reduces symptom severity and functional impairment. Methods Independent searches will be conducted in electronic databases to identify eligible studies. Two reviewers will independently conduct the study selection, data extraction, and risk of bias assessment. We will extract outcome data and variables that can act as effect modifiers or as mediators of the effect of exercise. For the non-human studies, outcome data will include the non-human equivalents of PTSD symptom clusters. For human studies, the primary outcome will be PTSD symptom severity. The secondary outcomes will be avoidance symptom severity, reexperiencing symptom severity, hyperarousal symptom severity, negative cognitions and mood severity, functional impairment, loss of PTSD diagnosis, and dropout rates. To explain the biopsychosocial mechanisms through which exercise affects the outcome of interest, we will extract effects that relate to the impact of exercise on potential mediating variables and the effect of the later outcomes. Comparison of within-study direct and indirect effects obtained from mediation analysis, when reported, will provide insight into the importance of the examined mediator. If appropriate, we will synthesize study results using meta-analyses. We will examine potential effect modifiers of the total exercise effect to understand better the impact of exercise on PTSD symptoms and function impairment (when possible). The evidence about the potential mediators of the association between exercise and PTSD-related outcomes will be considered in a consensus meeting when sufficient evidence is available. Protocol registration PROSPERO-ID: 453615

Biochemical characteristics, genetic variants and treatment outcomes of 55 Chinese cases with neonatal intrahepatic cholestasis caused by citrin deficiency

BackgroundThe diagnostic criteria of neonatal intrahepatic cholestasis caused by citrin deficiency (NICCD) have not been established due to non-specific clinical manifestations, and our understanding on the treatment outcome is still limited. We aim to investigate the biochemical characteristics, genetic variants, and treatment outcome of NICCD patients.MethodsWe compared the nutritional status and biochemical characteristics of 55 NICCD infants and 27 idiopathic neonatal cholestasis (INC) infants. SLC25A13 gene variant analysis was performed for definitive diagnosis of NICCD. NICCD infants received 12 months of lactose-free and/or medium-chain triglyceride-enriched (LF/MCT) formula treatment. The treatment efficacy was evaluated by comparing the outcome of NICCD with the 24 healthy infants that were selected as normal controls. All NICCD patients were followed up until death or at least 1 year of age.ResultsCompared to INC group, significant increase was found in levels of total bilirubin, indirect bilirubin, total bile acid, gamma-glutamyl transpeptidase, alkaline phosphatase, prothrombin time, thrombin time, international normalized ratio, alpha-fetoprotein (AFP), Vitamin D, and Vitamin E of NICCD group, while alanine aminotransferase, albumin, fibrinogen, glucose, and Vitamin A levels showed significant decrease in the NICCD group (P < 0.05). There were 7 novel variants among 19 SLC25A13 variant types. No significant differences were found between NICCD patients treated for 12 months and normal controls. In long term follow-up, 2 cases developed FTTDCD, 8 cases had special dietary habits, and 1 case died from cirrhosis.ConclusionsNICCD showed more severe impairments in liver, coagulation, and metabolic function than INC. Significantly increased AFP levels could provide reference for the differential diagnosis of NICCD. The newly discovered variants may be meaningful for the individualized treatment of NICCD patients. LF/MCT formula was recommended for NICCD patients.

Non-Viral Delivery Systems to Transport Nucleic Acids for Inherited Retinal Disorders

Inherited retinal disorders (IRDs) represent a group of challenging genetic conditions that often lead to severe visual impairment or blindness. The complexity of these disorders, arising from their diverse genetic causes and the unique structural and functional aspects of retinal cells, has made developing effective treatments particularly challenging. Recent advancements in gene therapy, especially non-viral nucleic acid delivery systems like liposomes, solid lipid nanoparticles, dendrimers, and polymersomes, offer promising solutions. These systems provide advantages over viral vectors, including reduced immunogenicity and enhanced targeting capabilities. This review delves into introduction of common IRDs such as Leber congenital amaurosis, retinitis pigmentosa, Usher syndrome, macular dystrophies, and choroideremia and critically assesses current treatments including neuroprotective agents, cellular therapy, and gene therapy along with their limitations. The focus is on the emerging role of non-viral delivery systems, which promise to address the current limitations of specificity, untoward effects, and immunogenicity in existing gene therapies. Additionally, this review covers recent clinical trial developments in gene therapy for retinal disorders.

Associations Between Peak Expiratory Flow and Community Mobility Loss Among Older Adults in the United States.

Community mobility is a vital patient-centered outcome for older adults living in the community. These deficits in mobility are linked to social isolation, increased hospitalizations, and higher mortality rates. Impaired pulmonary function may be a modifiable risk factor for mobility decline, with existing inequities in lung health potentially contributing disproportionately to mobility loss among Black older adults. A cohort of 4742 community-dwelling older adults (weighted n = 29,180,893) with self-reported ability to walk 3 or more blocks in their community was drawn from the National Health and Aging Trends Study (NHATS). Pulmonary function was measured by PEF in NHATS. Community mobility loss was defined as self-reported inability to walk ≥ 3 blocks in the 1-year follow-up assessment. Hierarchical multivariable logistic regression was used and adjusted for demographics, comorbidities, pain, and assistive device use. Overall, 73.7% of the sample had normal PEF, 18.6% had moderate impairment, and 7.7% had severe impairment. Those with severe impairment were more likely to be male and identify as Black. In unadjusted analyses, 8.8% of older adults with normal PEF experienced mobility loss, compared with 12.7% of those with moderate impairment, and 19.7% with severe impairment. Odds of mobility loss were 111% higher for those with severe PEF impairment as compared to those with normal PEF (OR = 2.1, 95% CI 1.2-3.7) in fully adjusted models, with weaker relationships being observed for those with moderately impaired PEF (OR = 1.2, 95% CI 0.8-1.8). Nearly 8%, or an estimated 1 million community-ambulating U.S. older adults, had severe impairments in peak expiratory flow in 2015; these older adults have a substantially higher risk of losing the ability to ambulate community distances over the subsequent year.

RSVP Keyboard with Inquiry Preview: mixed performance and user experience with an adaptive, multimodal typing interface combining EEG and switch input.

The RSVP Keyboard is a non-implantable, event-related potential-based brain-computer interface (BCI) system designed to support communication access for people with severe speech and physical impairments. Here we introduce Inquiry Preview, a new RSVP Keyboard interface incorporating switch input for users with some voluntary motor function, and describe its effects on typing performance and other outcomes. Four individuals with disabilities participated in the collaborative design of possible switch input applications for the RSVP Keyboard, leading to the development of Inquiry Preview and a method of fusing switch input with language model and electroencephalography (EEG) evidence for typing. Twenty-four participants without disabilities and one potential end user with incomplete locked-in syndrome took part in two experiments investigating the effects of Inquiry Preview and two modes of switch input on typing accuracy and speed during a copy-spelling task. For participants without disabilities, Inquiry Preview and switch input tended to worsen typing performance compared to the standard RSVP Keyboard condition, with more consistent effects across participants for speed than for accuracy. However, there was considerable variability, with some participants demonstrating improved typing performance and better user experience with Inquiry Preview and switch input. Typing performance for the potential end user was comparable to that of participants without disabilities. He typed most quickly and accurately with Inquiry Preview and switch input and gave favorable user experience ratings to those conditions, but preferred standard RSVP Keyboard. Inquiry Preview is a novel multimodal interface for the RSVP Keyboard BCI, incorporating switch input as an additional control signal. Typing performance and user experience and preference varied widely across participants, reinforcing the need for flexible, customizable BCI systems that can adapt to individual users. gov Identifier: NCT04468919.

A creatine efflux transporter in oligodendrocytes.

Creatine is essential for ATP regeneration in energy-demanding cells. Creatine deficiency results in severe neurodevelopmental impairments. In the brain, creatine is synthesized locally by oligodendrocytes to supply neighboring neurons. Neuronal uptake is mediated by SLC6A8. However, it is still unknown how creatine is released from the producing cells. Here, we investigated the function of the transporter SLC22A15, which exhibits strikingly high amino acid sequence conservation. The release of substrates from 293 cells via heterologously expressed human and rat SLC22A15 was analyzed by mass spectrometry. A number of zwitterions were identified as substrates, with similar efflux transport efficiencies. However, in absolute numbers, the efflux of creatine far outweighed all other substrates. In contrast to the permanent creatine efflux mediated by SLC16A12 and SLC16A9, SLC22A15 was, by default, completely inactive, thereby preventing continuous creatine loss from producing cells. External substrates such as guanidinoacetic acid, GABA, or MPP+ trigger creatine release through a one-to-one exchange. Human and mouse mRNA profiles indicate that SLC22A15 expression is highest in oligodendrocytes and bone marrow. Single-cell RNA sequencing data substantiate the hypothesis that SLC22A15 depends on high intracellular creatine concentrations: high SLC22A15 counts, as in oligodendrocytes and macrophages, correlate with high counts of the creatine synthesis enzymes AGAT and GAMT in both humans and mice, whereas in proximal tubular cells and hepatocytes, AGAT counts are high, but SLC22A15 is absent. Our findings establish SLC22A15 as the pivotal transporter for controlled creatine release from oligodendrocytes, filling a critical gap in understanding creatine metabolism in the brain.

Outcomes of Extremely Preterm Infants Exposed to Prolonged Prelabor Rupture of Membranes before 24 Weeks of Gestation.

Preterm prelabor rupture of membranes (PPROM) before or around the limit of fetal viability is associated with serious maternal and neonatal complications including chorioamnionitis, extremely preterm birth, and pulmonary hypoplasia. To describe contemporary outcomes of extremely preterm infants born after prolonged periviable PPROM, and to identify perinatal factors associated with survival and survival without severe neurodevelopmental impairment (NDI). Among actively treated infants born alive at <27 weeks' gestational age (GA) in centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network from 2012 to 2018, the outcomes of survival and survival without severe NDI at 22-26 months' corrected age were compared between infants exposed to prolonged (≥120 hours) periviable (<24 weeks' GA) PPROM and unexposed infants born after rupture of membranes ≤18 hours before delivery or at delivery, adjusting for birth GA, sex, multiple gestation, antenatal steroids, small for gestational age (SGA), insurance, and center. Regression models were used to identify perinatal factors associated with survival and survival without severe NDI among the infants exposed to prolonged periviable PPROM. The analysis included 609 infants exposed to prolonged periviable PPROM and 4,489 unexposed infants. In the prolonged periviable PPROM group, 444/608 (73%) infants survived and 298/533 (56%) infants survived without severe NDI. Odds of survival (OR, 0.84; 95% CI, 0.68-1.05) and survival without severe NDI (OR, 0.91; 95% CI, 0.75-1.12) were not significantly different between prolonged periviable PPROM and unexposed groups. Variables associated with higher odds of survival without severe NDI were later GA at birth (OR, 1.37; 95% CI, 1.13-1.67), later GA at PPROM (OR 1.44; 95% CI, 1.26-1.63), and female sex (OR, 1.57; 95% CI, 1.06-2.34), while SGA infants had lower odds of survival without severe NDI (OR, 0.14; 95% CI, 0.04-0.51). Odds of survival and survival without severe NDI among infants exposed to prolonged periviable PPROM were not significantly different from unexposed infants, but decreased with earlier GA at birth and PPROM.

Lung ultrasound for assessing disease progression in UIP and NSIP: a comparative study with HRCT and PFT/DLCO

BackgroundThis study aims to compare Lung Ultrasound (LUS) findings with High-Resolution Computerized Tomography (HRCT) and Pulmonary Function Tests (PFTs) to detect the severity of lung involvement in patients with Usual Interstitial Pneumonia (UIP) and Non-Specific Interstitial Pneumonia (NSIP).MethodsA cross-sectional study was conducted on 35 UIP and 30 NSIP patients at a referral hospital. All patients underwent LUS, HRCT, and PFT. LUS findings such as B-lines, pleural fragmentation, and pleural thickening were compared with HRCT-based lung involvement and PFT parameters.ResultsIn UIP patients, B-lines > 18 and pleural fragmentation significantly differentiated between < 50% and > 50% HRCT involvement. A logistic regression model showed that B-lines > 18 (OR = 39, p = 0.04) and pleural fragmentation (OR = 22, p = 0.037) independently predicted > 50% HRCT involvement. ROC analysis of the model revealed 84.2% sensitivity and 84.5% specificity. Furthermore, the crude number of B-lines (OR = 1.2, p = 0.038) and > 50% HRCT involvement (OR = 9.5, p = 0.045) independently predicted severe DLCO impairment, with a sensitivity of 94.7% and specificity of 84.5%. Linear regression showed that each additional B-line was associated with a 0.4% decrease in DLCO (Beta = -0.377, p = 0.043), independent of patient diagnosis. In NSIP patients, no significant correlation was observed between LUS findings and > 50% HRCT involvement (p > 0.05), though B-line numbers and pleural thickening increased in cases with severe DLCO impairment (p < 0.05).ConclusionsLUS shows promise as a sensitive, radiation-free alternative to HRCT in monitoring the severity of UIP. It is particularly valuable in predicting the extent of lung involvement and severe DLCO impairment in UIP patients but has limited application in NSIP.

Incidence and risk factors of postoperative delirium in elderly surgical patients 2023

Postoperative delirium has the potential to impact individuals of all age groups, with a significant emphasis on the elderly population. Its presence leads to an increase in surgical morbidity and mortality rates, as well as a notable prolongation of hospital stays. However, there is a lack of research regarding the prevalence, risk factors, and implications of postoperative delirium in developing nations like Ethiopia, which affects both patients and healthcare institutions. An observational study was conducted at hospitals in the South Gondar Zone to diagnose postoperative delirium in the Post-Anesthesia Care Unit (PACU) using the Nursing Delirium Screening Scale. Both bivariable and multivariable logistic regression techniques were employed to analyze the association between independent factors and postoperative delirium. The strength of the association was indicated by the odds ratio with a 95% confidence interval (CI). Any p-values below 0.05 were considered statistically significant. The incidence of postoperative delirium was determined to be 41%. In the multivariate logistic regression analysis, several factors were identified as significantly associated with postoperative delirium. These factors include an age of 75 or older (AOR, 11.24; 95% CI, 4.74–26.65), ASA-PS IV (AOR, 3.25; 95% CI, 1.81–5.85), severe functional impairment of activities of daily living (AOR, 3.29; 95% CI, 1.06–10.20), premedication with benzodiazepine (AOR, 4.61; 95% CI, 2.48–8.57), intraoperative estimated blood loss exceeding 1000 ml (AOR, 2.74; 95% CI, 1.50–4.98), and intraoperative ketamine use (AOR, 3.84; 95% CI, 2.21–6.68). Additionally, postoperative delirium was found to significantly prolong the duration of stay in the post-anesthesia care unit (PACU) and the length of hospital stay (p-value < 0.05). Patients aged 75 or older, ASA-PS IV, experiencing severe functional impairment of ADL, patients premedicated with benzodiazepine, patients with intraoperative estimated blood loss exceeding 1000 ml, and intraoperative ketamine use were identified as risk factors for post-operative delirium.

We All Need at Least One Friend Who Understands What We Do Not Say: A Scoping Review of Friendship and Augmentative and Alternative Communication.

The purpose of this scoping review was to understand what is known about the friendships of individuals who use augmentative and alternative communication (AAC) devices. Because communication is important to friendship, severe communication impairment may impact the establishment or maintenance of friendships in unique and important ways. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for scoping reviews and Covidence software using an established set of operationally defined inclusion criteria supported the identification of the 46 papers included in this review. Included papers presented original data on the friendships of individuals with disabilities (acquired and developmental) who could benefit from AAC across the lifespan. Data were extracted to identify features of the body of literature and to identify themes that could inform future research and clinical practice. Themes identified from the included studies related to how friendship is defined, supports for friendship formation and maintenance, help and care in friendships, positive outcomes, barriers, the impact of AAC, and recommendations for moving clinical practice and research forward. Friendships are chosen relationships that stem from congruences in perspectives between two individuals. People who use AAC, like the broader population, are likely to seek out and maintain friendships with people who are similar to them: people who share personality traits, past experiences (including experiencing disability), interests, and activities. Creative solutions are needed to increase the independence of disabled children and adults to meet and engage with new people with a variety of lived experiences. https://doi.org/10.23641/asha.28119857.

Development of a predictive model for loss of functional and cognitive abilities in long-term care home residents: a protocol

IntroductionLong-term care (LTC) residents require extensive assistance with daily activities due to physical and cognitive impairments. Medical treatment for LTC residents, when not aligned with residents’ wishes, can cause discomfort...

Effect of comorbid allergic diseases on attention-deficit hyperactivity disorder symptoms and sleep: A cross-sectional study.

Recent studies have shown a close relationship between attention-deficit hyperactivity disorder (ADHD) and allergic diseases in children. Regrettably, few studies have investigated the effect of comorbid allergies on ADHD symptoms and sleep, in particular, it is unclear whether comorbid allergic conditions further exacerbate sleep problems in children with ADHD. To investigate the effect of comorbid allergic on symptoms and sleep in children with ADHD. This was a cross-sectional study, 222 ADHD children (aged 6-14 years) were enrolled in, of whom 93 had allergic diseases and 129 without allergic diseases. Collected all ADHD symptom severity and functional impairment scales, including: Swanson, Nolan and Pelham (SNAP) scale, Integrated Visual and Auditory Continuous Performance Test (IVA-CPT), Conners Parents Symptom questionnaire (PSQ) and Weiss Functional Impairment Rating Scale-Parent Form (WFIRS-P). Every guardian of children diagnosed with ADHD is required to complete the Children's Sleep Habits Questionnaire (CSHQ). Compared to ADHD children without allergic diseases, we observed significantly higher hyperactivity and impulsivity scores on the SNAP-IV, higher hyperactivity index and impulsivity index on the PSQ, and higher risky activities on the WFIRS-P in ADHD children with comorbid allergic diseases (all p < 0.05). CSHQ total score and sleep disordered breathing were particularly prominent in ADHD children with comorbid allergic diseases (all p < 0.05), and changes in CSHQ correlate with ADHD symptoms and functional impairment. Further analyses revealed that ADHD symptoms and sleep did not worsen with increasing number of comorbid allergic diseases (all p > 0.05). The primary influence on ADHD symptoms and sleep was the type of allergic diseases, where food allergies predominantly influence ADHD symptoms, including attention deficit disorder and hyperactivity disorder (all p < 0.05); allergic rhinitis notably impacts parasomnias, sleep disordered breathing (all p < 0.05); and allergic asthma significantly affects sleep anxiety, daytime sleepiness, and sleep disordered breathing in children with ADHD (all p < 0.05). The presence of comorbid allergic diseases affects both the hyperactivity and impulsivity symptoms of ADHD and sleep disordered breathing, predominantly influenced by the type of the allergic diseases.