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RationaleFollowing acute respiratory distress syndrome (ARDS), joblessness is common but poorly understood.ObjectivesTo evaluate the timing of return to work after ARDS, and associated risk factors, lost earnings, and changes in healthcare coverage Methods: Over 12-month longitudinal follow-up, ARDS survivors from 43 U.S. ARDSNet hospitals provided employment and healthcare coverage data via structured telephone interviews. Factors associated with the timing of return to work were assessed using Fine and Gray regression analysis. Lost earnings were estimated using Bureau of Labor Statistics data.Measurements and main resultsOf 922 consenting survivors, 386 (42%) were employed before ARDS (56% male; mean ± SD age, 45 ± 13 yr), with seven dying by 12-month follow-up. Of 379 previously employed 12-month survivors, 166 (44%) were jobless at 12-month follow-up. Accounting for competing risks of death and retirement, half of enrolled and previously employed survivors returned to work by 13 weeks after hospital discharge, with 68% ever returning by 12 months. Delays in return to work were associated with longer hospitalization and older age among nonwhite survivors. Over 12-month follow-up, 274 (71%) survivors accrued lost earnings, averaging $26,949 ± $22,447 (60% of pre-ARDS annual earnings). Jobless survivors experienced a 14% (95% confidence interval, 5-22%; P = 0.002) absolute decrease in private health insurance (from 44% pre-ARDS) and a 16% (95% confidence interval, 7-24%; P

Background Bone age assessment is a critical tool in pediatric orthopedic surgery, guiding treatment decisions for growth-related disorders and surgical interventions. Traditional methods, such as the Greulich-Pyle and Tanner-Whitehouse techniques, rely on manual interpretation of hand and wrist radiographs, making them time-intensive and susceptible to inter-operator variability. Artificial intelligence (AI) has emerged as a promising tool to enhance accuracy, efficiency, and standardization in skeletal maturity assessment. Methods This study evaluates the application of AI in pediatric bone age prediction using the Radiological Society of North America (RSNA) 2017 Pediatric Bone Age Challenge dataset. A deep learning model based on the ResNet-50 architecture (Microsoft Research, Redmond, Washington, USA) was developed and trained on 12,611 hand and wrist radiographs, validated on 1,425 images, and tested on 200 images. Model performance was assessed using root mean square error (RMSE), mean absolute error (MAE), and coefficient of determination (R²). Results The AI model achieved an RMSE of 11.07 months, an MAE of 8.54 months, and an R² of 0.929, indicating strong alignment with radiologist-determined bone ages. The Pearson correlation coefficient (0.963) and Spearman's rank correlation (0.955) confirmed the model's predictive robustness. Compared to traditional methods, which have reported variability with errors ranging from 6 to 18 months, the AI model demonstrated a reduction in inter-operator variability and improved reliability. Conclusion The implementation of AI in bone age assessment offers a more standardized, rapid, and precise alternative to conventional methods. By improving the accuracy and efficiency of skeletal maturity evaluations, AI has significant implications for pediatric orthopedic surgery, optimizing treatment timing and expanding access to high-quality bone age assessments. Further validation studies are needed to ensure clinical applicability across diverse patient populations., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2025, Zadoo et al.)

Aims: Investigate the effects of breakfast timing on postprandial glycaemia in adults with type 2 diabetes (T2D), and the impact of a 20-min walk after breakfast., Methods: Eleven adults with T2D (57 ± 7 y; HbA1c 7.4 ± 1%) participated in a six-week randomised crossover controlled trial comprising three 4-day conditions: Early (0700 h), Mid (0930 h) and Delayed (1200 h). After each condition, a second 4-day intervention of 20-min walk after each condition was undertaken. Standardised breakfast was provided. Interstitial glucose and physical activity were measured. Incremental area under the curve (iAUC) 2-h post-breakfast, 24-h iAUC, and fasting glucose were analysed with linear mixed-effects models. Cohen's d of the 2-h iAUC post-breakfast 20-min walk was calculated., Results: Mid and Delayed had lower 2-h post-breakfast iAUC (p < 0.002, -57 mmol/L×2h; p < 0.02, -41 mmol/L×2h) compared to Early. There were no differences in fasting (0600 h) glucose or 24-h iAUC. There was a small effect of the 20-min walk on lowering 2-h post-breakfast iAUC for Early (d = 0.35) and Delayed (d = 0.37), with no effect in Mid., Conclusion: In people with T2D, delaying breakfast from 0700 h to mid-morning or midday reduced postprandial glycaemia. Additional post-meal walking for 20 min had a small effect in lowering postprandial glycaemia when breakfast was at 0700 h or midday, but provided no additional benefit when breakfast was at mid-morning., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Research Trust of DiabetesIndia (DiabetesIndia) and National Diabetes Obesity and Cholesterol Foundation (N-DOC). Published by Elsevier Ltd. All rights reserved.)

Objective: Large language models such as ChatGPT have demonstrated significant potential in question-answering within ophthalmology, but there is a paucity of literature evaluating its ability to generate clinical assessments and discussions. The objectives of this study were to (1) assess the accuracy of assessment and plans generated by ChatGPT and (2) evaluate ophthalmologists' abilities to distinguish between responses generated by clinicians versus ChatGPT., Design: Cross-sectional mixed-methods study., Subjects: Sixteen ophthalmologists from a single academic center, of which 10 were board-eligible and 6 were board-certified, were recruited to participate in this study., Methods: Prompt engineering was used to ensure ChatGPT output discussions in the style of the ophthalmologist author of the Medical College of Wisconsin Ophthalmic Case Studies. Cases where ChatGPT accurately identified the primary diagnoses were included and then paired. Masked human-generated and ChatGPT-generated discussions were sent to participating ophthalmologists to identify the author of the discussions. Response confidence was assessed using a 5-point Likert scale score, and subjective feedback was manually reviewed., Main Outcome Measures: Accuracy of ophthalmologist identification of discussion author, as well as subjective perceptions of human-generated versus ChatGPT-generated discussions., Results: Overall, ChatGPT correctly identified the primary diagnosis in 15 of 17 (88.2%) cases. Two cases were excluded from the paired comparison due to hallucinations or fabrications of nonuser-provided data. Ophthalmologists correctly identified the author in 77.9% ± 26.6% of the 13 included cases, with a mean Likert scale confidence rating of 3.6 ± 1.0. No significant differences in performance or confidence were found between board-certified and board-eligible ophthalmologists. Subjectively, ophthalmologists found that discussions written by ChatGPT tended to have more generic responses, irrelevant information, hallucinated more frequently, and had distinct syntactic patterns (all P < 0.01)., Conclusions: Large language models have the potential to synthesize clinical data and generate ophthalmic discussions. While these findings have exciting implications for artificial intelligence-assisted health care delivery, more rigorous real-world evaluation of these models is necessary before clinical deployment., Financial Disclosures: The author(s) have no proprietary or commercial interest in any materials discussed in this article., (© 2024 by the American Academy of Ophthalmology.)

Polycystic ovary syndrome (PCOS) is a common endocrine disorder that disrupts reproductive function and hormonal balance. It primarily affects reproductive-aged women and leads to physical, metabolic, and emotional challenges affecting the quality of life. In this study, we develop a machine learning-based model to accurately identify PCOS pelvic ultrasound images from normal pelvic ultrasound images. By leveraging 1,932 pelvic ultrasound images from the Kaggle online platform (Google LLC, Mountain View, CA), we were able to create a model that accurately detected multiple small follicles in the ovaries and an increase in ovarian volume for PCOS pelvic ultrasound images from normal pelvic ultrasound images. Our developed model demonstrated a promising performance, achieving a precision value of 82.6% and a recall value of 100%, including a sensitivity and specificity of 100% each. The value of the overall accuracy proved to be 100% and the F1 score was calculated to be 0.905. As the results garnered from our study are promising, further validation studies are necessary to generalize the model's capabilities and incorporate other diagnostic factors of PCOS such as physical exams and lab values., Competing Interests: Human subjects: All authors have confirmed that this study did not involve human participants or tissue. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Kermanshahchi et al.)

This study investigates the interaction between titanium oxide nanoparticles (TiO 2 NPs) and the heterocyclic fluorophore 6-fluoro,4-hydroxy,2-methylquinoline (6-FHMQ), aiming to understand fluorescence quenching mechanisms and thermodynamic characteristics. Spectroscopic techniques including spectrofluorometry (FL) and spectrophotometry (UV-Vis) were used, with a lifetime decay (τ) of 0.18 ns for 6-FHMQ measured using time correlated single photon counting (TCSPC). The interaction between 6-FHMQ and TiO 2 NPs revealed a mix of static and dynamic fluorescence quenching mechanisms, with increasing quenching constants (Ksv) and a higher bimolecular quenching rate constant (Kq). The dynamic nature was highlighted by a temperature-dependent increase in binding sites from 1 to ~ 2. Spontaneous complexation was affirmed by negative change in free energy (ΔG), with negative change in enthalpy (ΔH) and a positive change in entropy (ΔS) values indicating favorable electrostatic and ionic interactions. The impact of varying TiO 2 NP concentrations on 6-FHMQ absorption was analyzed using the Benesi-Hildbrand equation, with a quantum yield of 0.61 determined. By forster resonance energy transfer (FRET) theory, the proximity between 6-FHMQ and TiO 2 NPs was found to be less than 70 Å. Ground and excited state dipole moments of 6-FHMQ in different solvents were calculated to demonstrate solvent sensing ability and charge transfer properties. Ultimately, this study serves as a testament to the power of scientific innovation in the realms of drug delivery and tissue engineering., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Gene therapies have the potential to treat disease by delivering therapeutic genetic cargo to disease-associated cells. One limitation to their widespread use is the lack of short regulatory sequences, or promoters, that differentially induce the expression of delivered genetic cargo in target cells, minimizing side effects in other cell types. Such cell-type-specific promoters are difficult to discover using existing methods, requiring either manual curation or access to large datasets of promoter-driven expression from both targeted and untargeted cells. Model-based optimization (MBO) has emerged as an effective method to design biological sequences in an automated manner, and has recently been used in promoter design methods. However, these methods have only been tested using large training datasets that are expensive to collect, and focus on designing promoters for markedly different cell types, overlooking the complexities associated with designing promoters for closely related cell types that share similar regulatory features. Therefore, we introduce a comprehensive framework for utilizing MBO to design promoters in a data-efficient manner, with an emphasis on discovering promoters for similar cell types. We use conservative objective models (COMs) for MBO and highlight practical considerations such as best practices for improving sequence diversity, getting estimates of model uncertainty, and choosing the optimal set of sequences for experimental validation. Using three relatively similar blood cancer cell lines (Jurkat, K562, and THP1), we show that our approach discovers many novel cell-type-specific promoters after experimentally validating the designed sequences. For K562 cells, in particular, we discover a promoter that has 75.85% higher cell-type-specificity than the best promoter from the initial dataset used to train our models.

The ability to deliver genetic cargo to human cells is enabling rapid progress in molecular medicine, but designing this cargo for precise expression in specific cell types is a major challenge. Expression is driven by regulatory DNA sequences within short synthetic promoters, but relatively few of these promoters are cell-type-specific. The ability to design cell-type-specific promoters using model-based optimization would be impactful for research and therapeutic applications. However, models of expression from short synthetic promoters (promoter-driven expression) are lacking for most cell types due to insufficient training data in those cell types. Although there are many large datasets of both endogenous expression and promoter-driven expression in other cell types, which provide information that could be used for transfer learning, transfer strategies remain largely unexplored for predicting promoter-driven expression. Here, we propose a variety of pretraining tasks, transfer strategies, and model architectures for modelling promoter-driven expression. To thoroughly evaluate various methods, we propose two benchmarks that reflect data-constrained and large dataset settings. In the data-constrained setting, we find that pretraining followed by transfer learning is highly effective, improving performance by 24-27%. In the large dataset setting, transfer learning leads to more modest gains, improving performance by up to 2%. We also propose the best architecture to model promoter-driven expression when training from scratch. The methods we identify are broadly applicable for modelling promoter-driven expression in understudied cell types, and our findings will guide the choice of models that are best suited to designing promoters for gene delivery applications using model-based optimization. Our code and data are available at https://github.com/anikethjr/promoter&#95;models.

Antiarrhythmic drugs play a pivotal role in managing and preventing arrhythmias. Amiodarone, classified as a class III antiarrhythmic, has been used prophylactically to effectively prevent atrial fibrillation postoperatively in cardiac surgeries. However, there is a lack of consensus on the use of amiodarone and other antiarrhythmic drugs as prophylaxis to reduce the occurrence of all types of postoperative arrhythmias in cardiac and non-cardiac surgeries. A comprehensive PubMed query yielded 614 relevant papers, of which 52 clinical trials were analyzed. The data collection included the class of antiarrhythmics, timing or method of drug administration, surgery type, type of arrhythmia and its incidence, and hospitalization length. Statistical analyses focused on prophylactic antiarrhythmics and their respective reductions in postoperative arrhythmias and hospitalization length. Prophylactic amiodarone alone compared to placebo demonstrated a significant reduction in postoperative arrhythmia incidence in cardiac and non-cardiac surgeries (24.01%, p<0.0001), and it was the only treatment group to significantly reduce hospitalization length versus placebo (p = 0.0441). Prophylactic use of class 4 antiarrhythmics versus placebo also demonstrated a significant reduction in postoperative arrhythmia incidence (28.01%, p<0.0001), and while there was no significant statistical reduction compared to amiodarone (4%, p=0.9941), a lack of abundant data provides a case for further research on the prophylactic use of class 4 antiarrhythmics for this indication. Amiodarone prophylaxis remains a prime cornerstone of therapy in reducing postoperative arrhythmia incidence and hospitalization length. Emerging data suggests a need for a broader exploration of alternative antiarrhythmic agents and combination therapies, particularly class 4 antiarrhythmics, in both cardiac and non-cardiac surgeries. This meta-analysis depicts the effectiveness of amiodarone, among other antiarrhythmics, in postoperative arrhythmia incidence and hospitalization length reduction in cardiac and non-cardiac surgeries., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Yarlagadda et al.)

This investigation explores the potential efficacy of machine learning algorithms (MLAs), particularly convolutional neural networks (CNNs), in distinguishing between benign and malignant breast cancer tissue through the analysis of 1000 breast cancer images gathered from Kaggle.com, a domain of publicly accessible data. The dataset was meticulously partitioned into training, validation, and testing sets to facilitate model development and evaluation. Our results reveal promising outcomes, with the developed model achieving notable precision (92%), recall (92%), accuracy (92%), sensitivity (89%), specificity (96%), an F1 score of 0.92, and an area under the curve (AUC) of 0.944. These metrics underscore the model's ability to accurately identify malignant breast cancer images. Because of limitations such as sample size and potential variations in image quality, further research, data collection, and integration of theoretical models in a real-world clinical setting are needed to expand the reliability and generalizability of these MLAs. Nonetheless, this study serves to highlight the potential use of artificial intelligence models as supporting tools for physicians to utilize in breast cancer detection., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Lam et al.)

This review provides an in-depth analysis of the effect of length of stay (LOS), comorbidities, and procedural complications on the cost-effectiveness of transcatheter aortic valve replacement (TAVR) in comparison to surgical aortic valve replacement (SAVR). We found that the average LOS was shorter for patients undergoing TAVR, contributing to lower average costs associated with the procedure, although the LOS varied between patients due to the severity of illness and comorbidities present. TAVR has also been found to improve the quality of life for patients receiving aortic valve replacement compared to SAVR. Although TAVR has a lower rate of most post-operative complications caused by SAVR, such as bleeding and cardiac complications, TAVR shows an increased rate of permanent pacemaker (PPM) implantation due to mechanical trauma on the heart's conduction system. In addition, our findings suggest that the cost-effectiveness of each procedure varies based on the types of valve, the patient history of other medical conditions, and the procedural methods. Our findings show that TAVR is preferred over SAVR in terms of cost-effectiveness across a variety of patients with other coexisting medical conditions, including cancer, advanced kidney disease, cirrhosis, diabetes mellitus, and bundle branch block. TAVR also appears to be superior to SAVR with fewer post-operative complications. However, TAVR appears to have a higher rate of PPM implantation rates as compared to SAVR. The comorbidities of the valve recipient must be considered when deciding whether to use TAVR or SAVR as cost-effectiveness varies with the patient background., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Kermanshahchi et al.)

Background: Historically, norepinephrine has been administered through a central venous catheter (CVC) because of concerns about the risk of ischemic tissue injury if extravasation from a peripheral IV catheter (PIVC) occurs. Recently, several reports have suggested that peripheral administration of norepinephrine may be safe., Research Question: Can a protocol for peripheral norepinephrine administration safely reduce the number of days a CVC is in use and frequency of CVC placement?, Study Design and Methods: This was a prospective observational cohort study conducted in the medical ICU at a quaternary care academic medical center. A protocol for peripheral norepinephrine administration was developed and implemented in the medical ICU at the study site. The protocol was recommended for use in patients who met prespecified criteria, but was used at the treating clinician's discretion. All adult patients admitted to the medical ICU receiving norepinephrine through a PIVC from February 2019 through June 2021 were included., Results: The primary outcome was the number of days of CVC use that were avoided per patient, and the secondary safety outcomes included the incidence of extravasation events. Six hundred thirty-five patients received peripherally administered norepinephrine. The median number of CVC days avoided per patient was 1 (interquartile range, 0-2 days per patient). Of the 603 patients who received norepinephrine peripherally as the first norepinephrine exposure, 311 patients (51.6%) never required CVC insertion. Extravasation of norepinephrine occurred in 35 patients (75.8 events/1,000 d of PIVC infusion [95% CI, 52.8-105.4 events/1,000 d of PIVC infusion]). Most extravasations caused no or minimal tissue injury. No patient required surgical intervention., Interpretation: This study suggests that implementing a protocol for peripheral administration of norepinephrine safely can avoid 1 CVC day in the average patient, with 51.6% of patients not requiring CVC insertion. No patient experienced significant ischemic tissue injury with the protocol used. These data support performance of a randomized, prospective, multicenter study to characterize the net benefits of peripheral norepinephrine administration compared with norepinephrine administration through a CVC., Competing Interests: Financial/Nonfinancial Disclosures None declared., (Copyright © 2023 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Osteosarcoma (OS) is a debilitating cancer of the bone that commonly afflicts the young and old. This may be de novo or associated with tumorigenic syndromes. However, many molecular mechanisms are still being uncovered and may offer greater avenues for screening and therapy. Cadherins, including E-cadherin and N-cadherin/vimentin, are involved in epithelial-to-mesenchymal transmission (EMT), which is key for tumor invasion. A study reviewing the relationship between OS and cadherins might elucidate a potential target for therapy and screening. A robust literature review was conducted by searching PubMed with the keywords "osteosarcoma", "cadherin", "e-cadherin" and "n-cadherin". Of a preliminary 266 papers, 25 were included in the final review. Review articles and those without primary data were excluded. Loss of E-cadherin is noted in metastatic cell lines of osteosarcoma. Overexpression of E-cadherin or knockout of N-cadherin/vimentin results in loss of metastatic potential. There are several methods of gene knockout, including CRISPR-Cas9 gene editing, viral vector insertion with micro RNA complementary to long noncoding RNA within gene segments, or proteomic editing. Screening for EMT and genetic treatment of EMT is a possible avenue for the treatment of refractory osteosarcoma. Several studies were conducted ex vivo. Further testing involving in vitro therapy is necessary to validate these methods. Limitations of this study involve a lack of in vivo trials to validate methods., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Issagholian et al.)

Cervical spine fractures represent a significant healthcare challenge, necessitating accurate detection for appropriate management and improved patient outcomes. This study aims to develop a machine learning-based model utilizing a computed tomography (CT) image dataset to detect and classify cervical spine fractures. Leveraging a large dataset of 4,050 CT images obtained from the Radiological Society of North America (RSNA) Cervical Spine Fracture dataset, we evaluate the potential of machine learning and deep learning algorithms in achieving accurate and reliable cervical spine fracture detection. The model demonstrates outstanding performance, achieving an average precision of 1 and 100% precision, recall, sensitivity, specificity, and accuracy values. These exceptional results highlight the potential of machine learning algorithms to enhance clinical decision-making and facilitate prompt treatment initiation for cervical spine fractures. However, further research and validation efforts are warranted to assess the model's generalizability across diverse populations and real-world clinical settings, ultimately contributing to improved patient outcomes in cervical spine fracture cases., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Riazi Esfahani et al.)

The cost of transcatheter aortic valve replacement (TAVR) has been studied in the context of high-risk or specific comorbidity populations; this paper provides a comprehensive overview of broader patient populations' outcomes and costs with TAVR in comparison to surgical aortic valve replacement (SAVR). In the past, SAVR had been the more cost-effective option than TAVR, but in recent years, TAVR has been becoming more cost-effective.Though the cost of TAVR can vary due to several factors the major focus of this review will focus on the surgical technique, medicare reimbursements, insertion point, and varying risk populations. In conclusion, the price of TAVR is declining as more cost-efficient valves arrive on the market. Climbing healthcare costs play a significant role in clinical decisions when deciding on which procedures are most cost-effective for the patient and healthcare system. The declining price of TAVR could lead to the preference of TAVR over SAVR for both low-risk and high-risk aortic stenosis patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Kermanshahchi et al.)

This study explores the application of machine learning and deep learning algorithms to facilitate the accurate diagnosis of melanoma, a type of malignant skin cancer, and benign nevi. Leveraging a dataset of 793 dermatological images from the Kaggle online platform (Google LLC, Mountain View, California, United States), we developed a model that can accurately differentiate between these lesions based on their distinctive features. The dataset was divided into training (80%), validation (10%), and testing (10%) sets to optimize model performance and ensure its generalizability. Our findings demonstrate the potential of machine learning algorithms in enhancing the efficiency and accuracy of melanoma and nevi detection, with the developed model exhibiting robust performance metrics. Nonetheless, limitations exist due to the potential lack of comprehensive representation of melanoma and nevi cases in the dataset, and variations in image quality and acquisition methods, which may influence the model's performance in real-world clinical settings. Therefore, further research, validation studies, and integration into clinical practice are necessary to ensure the reliability and generalizability of these models. This study underscores the promise of artificial intelligence in advancing dermatologic diagnostics, aiming to improve patient outcomes by supporting early detection and treatment initiation for melanoma., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Riazi Esfahani et al.)

Background Age-related macular degeneration (AMD), diabetic retinopathy (DR), drusen, choroidal neovascularization (CNV), and diabetic macular edema (DME) are significant causes of visual impairment globally. Optical coherence tomography (OCT) imaging has emerged as a valuable diagnostic tool for these ocular conditions. However, subjective interpretation and inter-observer variability highlight the need for standardized diagnostic approaches. Methods This study aimed to develop a robust deep learning model using artificial intelligence (AI) techniques for the automated detection of drusen, CNV, and DME in OCT images. A diverse dataset of 1,528 OCT images from Kaggle.com was used for model training. The performance metrics, including precision, recall, sensitivity, specificity, F1 score, and overall accuracy, were assessed to evaluate the model's effectiveness. Results The developed model achieved high precision (0.99), recall (0.962), sensitivity (0.985), specificity (0.987), F1 score (0.971), and overall accuracy (0.987) in classifying diseased and healthy OCT images. These results demonstrate the efficacy and efficiency of the model in distinguishing between retinal pathologies. Conclusion The study concludes that the developed deep learning model using AI techniques is highly effective in the automated detection of drusen, CNV, and DME in OCT images. Further validation studies and research efforts are necessary to evaluate the generalizability and integration of the model into clinical practice. Collaboration between clinicians, policymakers, and researchers is essential for advancing diagnostic tools and management strategies for AMD and DR. Integrating this technology into clinical workflows can positively impact patient care, particularly in settings with limited access to ophthalmologists. Future research should focus on collecting independent datasets, addressing potential biases, and assessing real-world effectiveness. Overall, the use of machine learning algorithms in conjunction with OCT imaging holds great potential for improving the detection and management of drusen, CNV, and DME, leading to enhanced patient outcomes and vision preservation., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Riazi Esfahani et al.)

Background Degenerative spinal conditions (DSCs) involve a diverse set of pathologies that significantly impact health and quality of life, affecting many individuals at least once during their lifetime. Treatment approaches are varied and complex, reflecting the intricacy of spinal anatomy and kinetics. Diagnosis and management pose challenges, with the accurate detection of lesions further complicated by age-related degeneration and surgical implants. Technological advancements, particularly in artificial intelligence (AI) and deep learning, have demonstrated the potential to enhance detection of spinal lesions. Despite challenges in dataset creation and integration into clinical settings, further research holds promise for improved patient outcomes. Methods This study aimed to develop a DSC detection and classification model using a Kaggle dataset of 967 spinal X-ray images at the Department of Neurosurgery of Arrowhead Regional Medical Center, Colton, California, USA. Our entire workflow, including data preprocessing, training, validation, and testing, was performed by utilizing an online-cloud based AI platform. The model's performance was evaluated based on its ability to accurately classify certain DSCs (osteophytes, spinal implants, and foraminal stenosis) and distinguish these from normal X-rays. Evaluation metrics, including accuracy, precision, recall, and confusion matrix, were calculated.  Results The model achieved an average precision of 0.88, with precision and recall values of 87% and 83.3%, respectively, indicating its high accuracy in classifying DSCs and distinguishing these from normal cases. Sensitivity and specificity values were calculated as 94.12% and 96.68%, respectively. The overall accuracy of the model was calculated to be 89%.  Conclusion These findings indicate the utility of deep learning algorithms in enhancing early DSC detection and screening. Our platform is a cost-effective tool that demonstrates robust performance given a heterogeneous dataset. However, additional validation studies are required to evaluate the model's generalizability across different populations and optimize its seamless integration into various types of clinical practice., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Ghauri et al.)

Background Tuberculosis (TB) is an infectious disease caused by the bacterium Mycobacterium tuberculosis . It primarily affects the lungs but can also affect other organs, such as the kidneys, bones, and brain. TB is transmitted through the air when an infected individual coughs, sneezes, or speaks, releasing tiny droplets containing the bacteria. Despite significant efforts to combat TB, challenges such as drug resistance, co-infection with human immunodeficiency virus (HIV), and limited resources in high-burden settings continue to pose obstacles to its eradication. TB remains a significant global health challenge, necessitating accurate and timely detection for effective management.  Methods This study aimed to develop a TB detection model using chest X-ray images obtained from Kaggle.com, utilizing Google's Collaboration Platform. Over 1196 chest X-ray images, comprising both TB-positive and normal cases, were employed for model development. The model was trained to recognize patterns within the TB chest X-rays to efficiently recognize TB within patients in order to be treated in time. Results The model achieved an average precision of 0.934, with precision and recall values of 94.1% each, indicating its high accuracy in classifying TB-positive and normal cases. Sensitivity and specificity values were calculated as 96.85% and 91.49%, respectively. The F1 score was also calculated to be 0.941. The overall accuracy of the model was found to be 94%.  Conclusion These results highlight the potential of machine learning algorithms for TB detection using chest X-ray images. Further validation studies and research efforts are needed to assess the model's generalizability and integration into clinical practice, ultimately facilitating early detection and improved management of TB., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Goswami et al.)

Age-related macular degeneration (AMD) is a disease that worsens the central vision of numerous individuals across the globe. Ensuring that patients are diagnosed accurately and that their symptoms are carefully monitored is essential to ensure that adequate care is delivered. To accomplish this objective, retinal imaging technology is necessary to assess the pathophysiology that is required to give an accurate diagnosis of AMD. The purpose of this review is to assess the ability of various retinal imaging technologies such as optical coherence tomography (OCT), color fundus retinal photography, fluorescein angiography, and fundus photography. The statistical methods that were conducted yielded results that suggested that using OCT in conjunction with other imaging technologies results in a higher detection of symptoms among patients that have AMD. Further investigation should be conducted to ascertain the validity of the conclusions that were stated within the review., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Riazi Esfahani et al.)

Nonalcoholic fatty liver disease (NAFLD) encompasses a spectrum of disease from simple steatosis to nonalcoholic steatohepatitis, with inflammatory cytokines and adipokines identified as drivers of disease progression. Poor dietary patterns are known to promote an inflammatory milieu, although the effects of specific diets remain largely unknown. This review aimed to gather and summarize new and existing evidence on the effect of dietary intervention on inflammatory markers in patients with NAFLD. The electronic databases MEDLINE, EMBASE, CINAHL, and Cochrane were searched for clinical trials which investigated outcomes of inflammatory cytokines and adipokines. Eligible studies included adults >18 y with NAFLD, which compared a dietary intervention with an alternative diet or control (no intervention) group or were accompanied by supplementation or other lifestyle interventions. Outcomes for inflammatory markers were grouped and pooled for meta-analysis where heterogeneity was allowed. Methodological quality and risk of bias were assessed using the Academy of Nutrition and Dietetics Criteria. Overall, 44 studies with a total of 2579 participants were included. Meta-analyses indicated intervention with an isocaloric diet plus supplement was more effective in reducing C-reactive protein (CRP) [standard mean difference (SMD): 0.44; 95% CI: 0.20, 0.68; P = 0.0003] and tumor necrosis factor-alpha (TNF-α) (SMD: 0.74; 95% CI: 0.02, 1.46; P = 0.03) than an isocaloric diet alone. No significant weighting was shown between a hypocaloric diet with or without supplementation for CRP (SMD: 0.30; 95% CI: -0.84, 1.44; P = 0.60) and TNF-α (SMD: 0.01; 95% CI: -0.43, 0.45; P = 0.97). In conclusion, hypocaloric and energy-restricted diets alone or with supplementation, and isocaloric diets with supplementation were shown to be most effective in improving the inflammatory profile of patients with NAFLD. To better determine the effectiveness of dietary intervention alone on a NAFLD population, further investigations of longer durations, with larger sample sizes are required., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Hip replacement procedures, professionally known as hip arthroplasty, are one of the most common orthopedic procedures. Due to the variation in this procedure, the use and types of anesthetics differ. One such commonly used anesthetic is lidocaine. Since there are currently no standardized or general procedures for the application of lidocaine for perioperative hip arthroplasty procedures, this review aims to delve into this topic. A literature review surrounding the key terms "hip replacement" and "lidocaine" was performed on PubMed. After reviewing 24 randomized control trials, statistical analyses between groups that had no lidocaine versus groups that did were performed. The results showed that there was no statistical significance between various age groups and the use of lidocaine. One percent (1%) and 2% injected into the lumbar region were the most commonly reported doses of lidocaine, with 2% often being the first test dose. Other conclusions were that lidocaine was used for general anesthesia for individuals that underwent hip arthroplasty due to an underlying condition (cauda equina syndrome, ankylosing spondylitis, etc.). Lidocaine was also used for postoperative pain relief, which is a potential concern from its addictive qualities. This investigation outlines the current stance and usage of lidocaine in perioperative hip arthroplasty while noting its limitations., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Lu et al.)

Osteosarcomas are a type of bone cancer that typically affect young adults, often in the bones of the arms and legs. To treat osteosarcoma, doctors typically use a combination of chemotherapy, radiotherapy, and surgery, with External Beam Radiation Therapy (EBRT) being the most commonly used form of radiotherapy. EBRT involves directing high-energy photons, X-rays, gamma rays, protons, and electrons at the tumor to induce cancer cell death. Additionally, healthcare providers use imaging techniques to monitor treatment success. This literature review aims to explore the relationship between osteosarcomas and EBRT, investigate the impact of the delayed diagnosis on survival rates, and examine the effectiveness of innovative uses of EBRT for treating osteosarcomas in unusual locations using comprehensive diagnostic techniques. To achieve these objectives, the review examines case studies and literary analyses and categorizes them based on the delay between symptom onset and diagnosis. The null hypothesis is that the presence or absence of a delay in diagnosis does not significantly impact outcomes for the "Delay" category. A lack of delay results in a more favorable outcome in the "Lack of Delay" category. However, the data and statistical results suggest that additional follow-up care in patients with rare or commonly recurring cancers could benefit outcomes. It is important to note that due to the rarity of osteosarcoma with EBRT, the small sample size in the studies warrants further investigation. Interestingly, many patients presented with head and neck tumors despite the most common location of osteosarcoma being in the long bones., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Landau et al.)

Introduction Pancreatic cancer resections comprise a class of complex surgical operations with a high postoperative morbidity rate. Due to the complicated nature of pancreatic resection, individuals who undergo this procedure are advised to visit a high-volume medical center that performs such pancreatic surgeries frequently. However, this specialized treatment option may not be available for uninsured patients or patients with other socioeconomic limitations that may restrict their access to these facilities. To gain a better understanding of the impact of healthcare disparities on surgical outcomes, we aimed to explore if there were significant differences in mortality rate post-pancreatic resection between high- and low-volume hospitals within San Bernardino, Riverside, Los Angeles, and Orange Counties. Methods We utilized the California Health and Human Services Agency (CHHS) California Hospital Inpatient Mortality Rates and Quality Ratings public dataset to compare risk-adjusted mortality rates (RA-MR) of pancreatic cancer resections procedures. We focused on procedures performed in hospitals within San Bernardino, Riverside, Los Angeles, and Orange County from 2012 to 2015. To assess post-resection outcomes in relation to hospital volume, we utilized an independent T-test (significance level was set equal to 0.05) to determine if there is a statistically significant difference in RA-MR after pancreatic resection between high- and low-volume hospitals. Results During the 2012-2015 study period, 57 hospitals across San Bernardino, Riverside, Orange, and Los Angeles Counties were identified to perform a total of 6,204 pancreatic resection procedures. The low-volume hospital group (N=2,539) was associated with a higher RA-MR of M=4.45 (SD=11.86). By comparison, the high-volume hospital group (N=3,665) was associated with a lower RA-MR of M=1.72 (SD=2.61). Conclusion Pancreatic resection surgeries performed at low-volume hospitals resulted in a significantly higher RA-MR compared to procedures done at high-volume hospitals in California., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Ghauri et al.)

As diabetes mellitus becomes increasingly prevalent globally, so does diabetic nephropathy, a complication leading to one of the world's leading causes of end-stage renal disease (ESRD). Current research has linked an increase in the urine albumin-to-creatinine ratio (UACR), a marker for kidney damage, to a greater risk of adverse renal outcomes and ESRD in patients with diabetes. Of the diabetes medications studied and implemented in clinical settings, glucagon-like peptide-1 receptor agonist (GLP1-RA) drugs have been shown to not only help control HbA1c in diabetes but have also demonstrated numerous cardiovascular, hepatic, and renal benefits. The objective of our study was to assess the efficacy of GLP1-RA drugs in reducing UACR in patients with type 2 diabetes mellitus (T2 DM) to determine if GLP1-RAs could be used to provide renoprotection in diabetic nephropathy in addition to their glucose-lowering effects. Upon a comprehensive review of the literature, we conducted a statistical analysis to determine the efficacy of GLP1-RA monotherapy and combination therapy in reducing UACR in comparison to placebo and insulin glargine. Of the studies analyzed, GLP1-RAs exhibited a statistically significant effect in reducing UACR in comparison to a placebo but not in comparison to insulin glargine. GLP1-RA combination therapy (GLP1-RA used with either insulin glargine, metformin, or dapagliflozin) did not exhibit statistically significant UACR reductions in comparison with insulin glargine. However, GLP1-RA combination therapy showed a trend suggestive of being more effective than insulin glargine in reducing UACR, but due to the limited literature studying this treatment method, further studies in a more focused group of patients with diabetic nephropathy may produce stronger and more definitive results. GLP1-RA monotherapy or combination therapy has been determined to be an effective method for reducing UACR and decreasing the incidence of adverse renal outcomes associated with diabetic kidney disease. GLP1-RA therapy could serve as an alternative treatment in diabetic nephropathy to insulin glargine, which carries a higher risk of hypoglycemia and unintentional weight gain while potentially being less cost-effective., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Yarlagadda et al.)

Parkinson's disease (PD) is a prevalent neurodegenerative disorder that occurs in old age due to a decrease in dopamine, which causes nerve cell destruction. This disease is difficult to diagnose since its symptoms are similar to those of the aging process. Those with PD have impaired motor control and function, dyskinesia, and tremors. To treat PD, drugs that enhance the amount of dopamine given to the brain are administered to alleviate symptoms. This inquiry examines the prescription of rotigotine to achieve this objective. The primary objective of this review is to examine the usage of rotigotine in both the late and early stages of PD. The statistical model utilized in the review found that there was not a significant difference in the dosage of rotigotine prescribed to late and early-stage PD patients, however, there were some confounding variables that may have skewed this result; therefore, further research is necessary to validate or nullify this hypothesis., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Rajendran et al.)

Squamous cell carcinoma (SCC) is a form of skin cancer that can be treated using a procedure known as Mohs surgery. Mohs surgery is a safe and effective procedure for eliminating SCC. This surgery requires the usage of an analgesic known as lidocaine. Additional anesthetics were also reported to be necessary for this procedure to be conducted in a manner that significantly minimizes patient harm. According to the review, it was found that SCC was treated with lidocaine as a topical analgesic outside of Mohs surgery. This review analyzes the usage of lidocaine in the treatment of SCC. It was also discovered that lidocaine, as an agent, has the potential to slow the progression of SCC, but more research is needed to see if this is truly the case. On average, it was reported that the concentration of lidocaine used in the in vivo studies was significantly higher than that in the in vitro investigations. Further exploration may be needed to verify the conclusions that were based on the analysis of the papers within the review., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Maalouf et al.)

Gliomas are the most common primary tumors of the nervous system, accounting for approximately 81% of brain tumors. The primary treatment for these primary brain tumors, especially those of high grade, is surgical resection with subsequent therapy such as targeted radiotherapy, chemotherapy, or supportive care. In an effort to devise nuanced ways to treat gliomas, studies have examined various chemical agents to expand therapeutic avenues for gliomas. In this study, we investigate the applications of ethylenediaminetetraacetic acid (EDTA) in the investigation and treatment of gliomas. Searches were conducted on PubMed to find studies about the use of EDTA in the treatment of glioma. We identified 36 studies that had the information needed for analysis. We collected information on the dosage of EDTA, the agent that EDTA was complexed with, the route of administration, the outcome of the EDTA usage, and the type of glioma cells that were involved. In addition, a one-way analysis of variance was performed to identify any relationships between the effect of cell type, study purpose, and year published on dosage. We identified 36 articles that met our inclusion criteria. In-vitro studies utilized EDTA in various complexes to evaluate cellular viability, including proliferation and toxicity, intracellular enzyme kinetics, and intercellular interactions such as chelation and cellular aggregation. In-vivo studies predominantly utilized the versatile nature of EDTA as a tracer for imaging studies involved in diagnostics and identifying recurrent tumor growth and localization in human patients. Our statistical analysis failed to identify any significant relationships between cell type, study purpose, and publication year on EDTA dosage. We identified a variety of uses for EDTA in the investigation hopefully providing physicians with information regarding the context and applications of EDTA to assist in exploring new treatment options for glioma patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Ghauri et al.)

When laser in situ keratomileusis (LASIK) surgery is employed for myopia, hyperopia, and astigmatism, the process requires the usage of anesthetics to ensure that there is minimal patient harm and negative consequences once the procedure is complete. Statistical analysis was conducted as part of this review to evaluate the application of and distinctions between the different analgesics used for LASIK surgery by compiling and filtering information from multiple research studies. Topically administered oxybuprocaine and proparacaine were found to be the most commonly used anesthetics for LASIK, according to the data included in the review. It was also determined that there were no significant differences in terms of patient outcomes and drug concentrations when proparacaine was substituted for oxybuprocaine. This is particularly intriguing given their different chemical compositions. Temporary dry eyes were the most commonly reported adverse effect of LASIK when the anesthetic was employed. Perhaps cocaine derivatives produce similar anesthetic and post-surgical effects, but further investigations are needed to verify this hypothesis., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Riazi Esfahani et al.)

The ability of clopidogrel (Plavix) to work in tandem with aspirin in a dual therapy strategy to boost the anti-platelet therapeutic impact and diminish platelet aggregation induced by platelet receptor inhibition is one of its many key advantages. The researchers discovered that the average reduction in risk of adverse cardiovascular events related to Plavix much outweighed any potential systemic effects. The analysis also revealed that, even though treatment results for diabetic patients with coronary microvascular disease (CMD) are poorer, the dosage and administration of clopidogrel for dual therapy are not modified to address this issue. Although it has been established that the current standard of care for microvascular disease decreases damage, more study is necessary to ensure that this standard is enhanced. It may become more usual in the future to include patient groups in trials who do not have diabetes as a criterion. Patients with diabetes often have higher low-density lipoprotein (LDL) cholesterol levels than the general population, therefore, it is possible that the research findings are flawed. To confirm or reject this assumption, further research is necessary., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Iskandar et al.)

Infantile malignant osteopetrosis is a debilitating disease that requires total bone marrow irradiation and transplant procedures for patients to survive. The major complication of this procedure is graft vs host disease (GVHD), followed by infections and end organ toxicity. Therefore, current research efforts into treatment mainly aim to reduce GVHD while limiting infections and organ toxicity. Different regimens of alkylating agents have been used to try to reduce GVHD. The most common regimen is cyclophosphamide (Cy) with busulfan (Bu), followed by Cy with Bu and thiotepa (Thio). This meta-analysis aimed to evaluate the efficacy of different treatments by comparing mortality and morbidity causes and rates across groups. The mean one-year survival rate for the Cy, Bu, Thio regimen studies in the human leukocyte antigen (HLA) unmatched group (45.01%) was statistically lower than the one-year survival rate for the studies using just a Cy, Bu regimen (70.8%) in the HLA unmatched studies (p<0.00142). The one-year survival in the studies which had HLA-matched donors was 80.56%, which is statistically higher (p<0.001) than the one-year survival in the HLA-unmatched studies (53.96%), indicating a benefit of finding HLA-matched donors. It seems that price and availability could be a factor in the widespread use of Cy., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Wagh et al.)

Purpose: To describe the use of a medical intensive care unit (MICU) delirium order set pilot and its associated impact on utilization of nonpharmacologic and pharmacologic interventions, pharmacologic continuation at transitions of care, and resolution of ICU delirium., Methods: This was a retrospective cohort analysis of MICU patients who received delirium management using an order set pilot compared to standard care. Patients 18 years of age or older admitted to the MICU between May 2019 and January 2020 who received an antipsychotic or valproic acid for the treatment of delirium were included., Results: Pharmacologic treatment continuation past ICU discharge occurred in 30% of patients in the pilot cohort (n = 50) compared to 54% of patients receiving standard care (n = 50; P = 0.027). On treatment days 1 through 7, utilization of deliriogenic medications was significantly lower in the pilot cohort (78% vs 96%, P = 0.007). No differences were observed between the groups in delirium resolution, delirium recurrence, hospital and ICU length of stay, or mortality., Conclusion: A MICU order set prioritizing nonpharmacologic management and limiting the duration of pharmacologic agents for delirium may aid providers in the management of ICU delirium and reduce exposure to pharmacologic interventions., (© American Society of Health-System Pharmacists 2022. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: To determine the association of catecholamine dose, lactate concentration, and timing from shock onset at vasopressin initiation with in-hospital mortality., Design: Retrospective, observational study using segmented and multivariable logistic regression to evaluate the associations of catecholamine dose, lactate concentration, and timing from shock onset at vasopressin initiation with in-hospital mortality., Setting: Multiple hospitals within the Cleveland Clinic Health System., Patients: Adult patients who met criteria for septic shock based on the U.S. Centers for Disease Control and Prevention Adult Sepsis Event definition., Interventions: All patients received continuous infusion vasopressin as an adjunct to catecholamine vasopressors., Measurements and Main Results: In total, 1,610 patients were included with a mean Acute Physiology and Chronic Health Evaluation III 109.0 ± 35.1 and Sequential Organ Failure Assessment 14.0 ± 3.5; 41% of patients survived the hospital admission. At the time of vasopressin initiation, patients had median (interquartile range) lactate concentration 3.9 mmol/L (2.3-7.2 mmol/L), norepinephrine-equivalent dose 25 µg/min (18-40 µg/min), and 5.3 hours (2.1-12.2 hr) elapsed since shock onset. The odds of in-hospital mortality increased 20.7% for every 10 µg/min increase in norepinephrine-equivalent dose up to 60 µg/min at the time of vasopressin initiation (adjusted odds ratio, 1.21 [95% CI, 1.09-1.34]), but no association was detected when the norepinephrine-equivalent dose exceeded 60 µg/min (adjusted odds ratio, 0.96 [95% CI, 0.84-1.10]). There was a significant interaction between timing of vasopressin initiation and lactate concentration (p = 0.02) for the association with in-hospital mortality. A linear association between increasing in-hospital mortality was detected for increasing lactate concentration at the time of vasopressin initiation, but no association was detected for time elapsed from shock onset., Conclusions: Higher norepinephrine-equivalent dose at vasopressin initiation and higher lactate concentration at vasopressin initiation were each associated higher in-hospital mortality in patients with septic shock who received vasopressin., Competing Interests: Dr. Bauer reports that he is a consultant for Wolters Kluwer, and he received funding from Wolters Kluwer. The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2022 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)

Background: The direct comparison of twice daily (BID) and thrice daily (TID) dosing of subcutaneous low dose unfractionated heparin (LDUH) for venous thromboembolism (VTE) prophylaxis in a mixed inpatient population is not well-studied., Objective: This study evaluated the effectiveness and safety of BID compared to TID dosing of LDUH for prevention of VTE., Methods: Retrospective, single-center analysis of patients who received LDUH for VTE prophylaxis between July and September 2015. Outcomes were identified by ICD-9 codes. A matched cohort was created using propensity scores and multivariate analysis was conducted to identify independent risk factors for VTE. The primary outcome was incidence of symptomatic VTE., Results: In the full cohort, VTE occurred in 0.71% of patients who received LDUH BID compared to 0.77% of patients who received LDUH TID ( p = 0.85). There was no difference in major ( p = 0.85) and minor ( p = 0.52) bleeding between the BID and TID groups. For the matched cohort, VTE occurred in 1.4% of BID patients and 2.1% of TID patients ( p = 0.32). Major bleed occurred in 0.36% of BID patients and 0.52% of TID patients ( p = 0.7), while a minor bleed was seen in 3.4% of BID patients and 2.1% of TID patients ( p = 0.13). Personal history of VTE ( p = 0.002) and weight ( p = 0.035) were independently associated with increased risk of VTE., Conclusion: This study did not demonstrate a difference in effectiveness or safety between BID and TID dosing of LDUH for VTE prevention.

Although it is not a very common condition, people who have suffered from neuro-damage or neuro-diseases are at risk for developing a condition known as Alien hand syndrome (AHS). Individuals who have this condition are unable to control the movement of their hands for certain brief intervals of time. In order to improve upon the treatment of individuals with AHS, it is important that signs and symptoms of the disease are identified as soon as possible. The purpose of this investigation is to catalog the data regarding the pre-existing conditions and the method of diagnosis for AHS. Within the review, it was revealed that stroke was the most common pre-existing condition for the disease. Therefore, physicians who have stroke patients within their care should carefully monitor their condition in case they do develop AHS. Additionally, it was found that using an MRI machine was the most common method of diagnosing a patient with AHS. This was most likely because MRI scans provide the most information about a patient's brain functionality which can be used to deduce if an individual has AHS., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Pradhan et al.)

A cataract is the primary cause of preventable blindness and is characterized by a congenital, developmental, or acquired opacity of the human lens. Cataracts are predominantly treated through surgical procedures utilizing a combination of anesthetic agents such as proparacaine to reduce patient discomfort. Proparacaine is used to inhibit voltage-gated sodium channels on neuronal membranes to prevent signal propagation and pain signaling in the patient. Current clinical standards call for the utilization of 0.5% proparacaine when used for local anesthesia in cataract surgeries. In this review, the authors extracted the reported application site and concentrations of proparacaine in conjunction with various combination agents to accurately describe its usage in cataract surgery. It was found that most surgeons adhered to the standard concentrations of proparacaine and generally used tropicamide, an eye dilator, as a combination agent in cataract surgery. Additionally, surgeons preferred anesthetic application to the retrobulbar block. The authors find that although surgeons are following standard protocol, adjustments for lowering the standard dose of proparacaine could prove beneficial in preventing proparacaine toxicity. Furthermore, the authors find that more research can be conducted in the future examining other combination agents for use with proparacaine to improve patient outcomes., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Dang et al.)

Objectives: Vasopressin is reported to retain vasoconstrictive activity in the setting of acidemia, but preclinical models are inconsistent and studies have not evaluated the clinical effectiveness of vasopressin based on arterial pH. This study sought to determine the association between arterial pH and blood pressure after vasopressin initiation in septic shock., Design: This retrospective, multicenter, observational cohort study evaluated the association of arterial pH at the time of vasopressin initiation with hemodynamic response to vasopressin and change in catecholamine dose after vasopressin initiation. Hemodynamic response was defined as a catecholamine dose decrease with mean arterial pressure greater than or equal to 65 mm Hg at 6 hours after vasopressin initiation., Setting: Patients from eight hospitals in a health system were evaluated., Patients: Patients with septic shock initiated on vasopressin as a catecholamine adjunct between January 2012 and November 2017 were screened for inclusion., Interventions: None., Measurements and Main Results: A total of 1,350 patients were included. At the time of vasopressin initiation patients were severely ill with arterial pH 7.28 ± 0.13, Sequential Organ Failure Assessment 14.1 ± 3.5, lactate 5.6 ± 4.6 mmol/L, and norepinephrine-equivalent catecholamine dose 32.3 ± 25.4 µg/min. After adjusting for lactate and Sequential Organ Failure Assessment with multivariable logistic regression, lower arterial pH was independently associated with lower odds of hemodynamic response to vasopressin (for each 0.1 unit arterial pH was below 7.40, response odds ratio 0.79; 95% CI, 0.72-0.87). For each 0.1 unit the pH was below 7.40 at vasopressin initiation, the norepinephrine-equivalent catecholamine dose increased by 1.5 µg/min (95% CI, 0.5-2.5 µg/min) at 1 hour, and increased by 2.5 µg/min (95% CI, 1.4-3.5 µg/min) at 6 hours after vasopressin initiation., Conclusions: Compared with higher arterial pH, patients with septic shock and low arterial pH had lower odds of vasopressin response and higher catecholamine doses after vasopressin initiation. Similar to other vasopressors, the clinical effectiveness of vasopressin appears to be impaired in the setting of acidemia., Competing Interests: Dr. Bauer reports receiving consultancy fees from Wolters Kluwer and is supported by a grant from the Cleveland Clinic Department of Pharmacy. Dr. Vachharajani is supported by a grant from the National Institutes of Health (grant number R01AA028763). The remaining authors have disclosed that they do not have any conflicts of interest., (Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.)

Background: Knee osteoarthritis has an inflammatory component that is linked to pain and joint pathology, yet common non-surgical and non-pharmacological interventions (e.g., exercise, calorie restricting diets) do not typically target inflammation. We aimed to evaluate the feasibility of a telehealth delivered anti-inflammatory diet intervention for knee osteoarthritis., Methods: This 9-week single-arm feasibility study recruited participants aged 40-85 years with symptomatic knee osteoarthritis (inclusion criteria: average pain ≥4/10 or maximal pain ≥5/10 during past week). All participants received a telehealth-delivered anti-inflammatory dietary education intervention involving 1:1 consultations at baseline, 3- and 6-week follow-up. The diet emphasised nutrient-dense wholefoods and minimally processed anti-inflammatory foods and discouraged processed foods considered to be pro-inflammatory. The primary outcome of feasibility was assessed via: i) eligibility, recruitment and retention rates; ii) self-reported dietary adherence; iii) adverse events; and iv) treatment satisfaction. Post-intervention interviews evaluated the acceptability of the dietary intervention delivered via telehealth. Secondary outcomes included changes in self-reported body mass, Knee injury and Osteoarthritis Outcome Score (KOOS), health-related quality of life (EuroQoL-5D), analgesic use and global rating of change. Worthwhile effects were determined by the minimal detectable change (MDC) for all five KOOS-subscales (pain, symptoms, activities of daily living, sport/recreation, quality of life) being contained within the 95% confidence interval., Results: Forty-eight of seventy-three (66%) individuals screened were eligible and 28 enrolled over 2 months (82% female, mean age 66 ± 8 years, body mass index 30.7 ± 4.8 kg.m -2 ). Six participants withdrew prior to final follow-up (21% drop-out). Of those with final follow-up data, attendance at scheduled telehealth consultations was 99%. Self-reported adherence to diet during the 9-week intervention period: everyday = 27%, most of time = 68% and some of time = 5%. Two minor adverse events were reported. Change scores contained the MDC within the 95% confidence interval for all five KOOS subscales. Suggestions to improve study design and limit drop-out included an initial face-to-face consultation and more comprehensive habitual dietary intake data collection., Conclusion: This study supports the feasibility of a full-scale randomised controlled trial to determine the efficacy of a primarily telehealth-delivered anti-inflammatory dietary education intervention in adults with symptomatic knee osteoarthritis., Trial Registration: ACTRN12620000229976 prospectively on 25/2/2020., (© 2022. The Author(s).)

COVID-19 patients admitted to the ICU have high incidence of AKI requiring prolonged renal replacement therapy and often necessitate the placement of a tunneled dialysis catheter (TDC). We describe our experience with two cases of COVID-19 patients who underwent successful bedside placement of TDC under ultrasound guidance using anatomical landmarks without fluoroscopy guidance. Tunneled dialysis catheter placement under direct fluoroscopy remains the standard of care; but in well selected patients, placement of tunneled dialysis catheter at the bedside using anatomic landmarks without fluoroscopy can be safely and successfully performed without compromising the quality of care and avoid transfer of COVID-19 infected patients outside the ICU.

Background: Arginine vasopressin (AVP) is suggested as an adjunct to norepinephrine in patients with septic shock. Guidelines recommend an AVP dosage up to 0.03 units/min, but 0.04 units/min is commonly used in practice based on initial studies. This study was designed to compare the incidence of hemodynamic response between initial fixed-dosage AVP 0.03 units/min and AVP 0.04 units/min., Methods: This retrospective, multi-hospital health system, cohort study included adult patients with septic shock receiving AVP as an adjunct to catecholamine vasopressors. Patients were excluded if they received an initial dosage other than 0.03 units/min or 0.04 units/min, or AVP was titrated within the first 6 hours of therapy. The primary outcome was hemodynamic response, defined as a mean arterial pressure ≥65 mm Hg and a decrease in catecholamine dosage at 6 hours after AVP initiation. Inverse probability of treatment weighting (IPTW) based on the propensity score for initial AVP dosage receipt was utilized to estimate adjusted exposure effects., Results: Of the 1536 patients included in the observed data, there was a nearly even split between initial AVP dosage of 0.03 units/min (n = 842 [54.8%]) and 0.04 units/min (n = 694 [45.2%]). Observed patients receiving AVP 0.03 units/min were more frequently treated at the main campus academic medical center (96.3% vs. 52.2%, p < 0.01) and in a medical intensive care unit (87.4% vs. 39.8%, p < 0.01). The IPTW analysis included 1379 patients with achievement of baseline covariate balance. There was no evidence for a difference between groups in the incidence of hemodynamic response (0.03 units/min 50.0% vs. 0.04 units/min 53.1%, adjusted relative risk 1.06 [95% CI 0.94, 1.20])., Conclusions: Initial AVP dosing varied by hospital and unit type. Although commonly used, an initial AVP dosage of 0.04 units/min was not associated with a higher incidence of early hemodynamic response to AVP in patients with septic shock.

Alzheimer's disease (AD) has been very difficult to prevent and cure using the medicine available today. However, there has been some hope with using a ketogenic diet (KD) to reduce the cognitive and quality of life decline experienced by patients with AD. In this review, the authors discuss the research done on the effect of a KD on AD to provide some potential avenues for future research and to determine a KD that can be best adopted by patients. The authors also go over the effects of KD's and low-carbohydrate diets (LCDs) on the cognitive function of healthy patients and on patients without AD to determine the similar and dissimilar effects of the diets. The authors found that the KD was able to improve the cognitive abilities and quality of life of patients ranging from mild to severe AD. Several types of memory were improved as a result of the diets. Further research needs to be conducted to determine the cause behind these improvements. However, the several studies that were done were mostly in agreement that once ketosis was reached, cognitive improvements were observed in patients ranging from mild to severe AD or mild to moderate cognitive impairment. Through the use of a KD, potential mechanisms can be found to reduce the cognitive decline of patients with AD, and potentially even prevent the damaging effects of cognitive decline from AD altogether., Competing Interests: Conflict of interest: The authors declare no conflict of interest in this paper., (© 2022 the Author(s), licensee AIMS Press.)

Exercise is a critical factor that impacts arterial stiffness. In this narrative review, we noted multiple findings that could not be reconciled with one another. Some studies indicated that arterial stiffness increases after a regimen of resistance training. However, such studies were limited by a lack of specification of the resistance training protocols, as well as varying results reported from different areas of the body, undermining the internal validity of the studies. Another factor explored in this review was how the order of performing exercises can affect arterial stiffness. Low-intensity resistance training before high-intensity resistance training resulted in increased arterial stiffness, whereas vice versa showed no change in arterial stiffness. Other studies indicated that resistance exercise results in reduced arterial stiffness. Intensity is a variable in studies that produces inconsistent results of arterial stiffness, with some studies suggesting high-intensity resistance training increases arterial stiffness and low-intensity resistance training decreases arterial stiffness, while other studies pointing to a significant decrease in arterial stiffness, regardless of the intensity of resistance training. Demographic factors such as gender, age, and diet play an important role in explaining these differences. In terms of future implications, there is potential clinical significance as increased arterial stiffness serves as a prognostic marker in diagnosing coronary heart disease., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Tabaie et al.)