Ortizrichard9531
tient.A faculty position can be a balancing act. Many new faculty, particularly minorities, struggle due to a lack of mentorship. Writing accountability groups (WAGs) offer new faculty an opportunity to glean advice from mentors and improve their writing skills and enhance their career development in science, technology, engineering, and mathematics (STEM).
High-density (HD) spinal cord stimulation (SCS) delivers higher charge per time by increasing frequency and/or pulse duration, thus increasing stimulation energy. Previously, through phantom studies and computational modeling, we demonstrated that stimulation energy drives spinal tissue heating during kHz SCS. In this study, we predicted temperature increases in the spinal cord by HD SCS, the first step in considering the potential impact of heating on clinical outcomes.
We adapted a high-resolution computer-aided design-derived spinal cord model, both with and without a lead encapsulation layer, and applied bioheat transfer finite element method multiphysics to predict temperature increases during SCS. We simulated HD SCS using a commercial SCS lead (eight contacts) with clinically relevant intensities (voltage-controlled 0.5-7 V
) and electrode configuration (proximal bipolar, distal bipolar, guarded tripolar [+-+], and guarded quadripolar [+--+]). Results were compared with the conventional and 10-kHz a possible mechanism of action of SCS, bioheat models of HD SCS serve as tools for programming optimization.
As a direct consequence of the higher charge, HD SCS increases tissue heating; voltage-controlled stimulation introduces special dependencies on electrode configuration and lead encapsulation (reflected in impedance). If validated with an in vivo measurement as a possible mechanism of action of SCS, bioheat models of HD SCS serve as tools for programming optimization.
Patients who suffer from long-term, neuropathic pain that proves refractory to conventional medical management are high consumers of health care resources and experience poorer physical and mental health than people with other forms of pain. Pharmacologic treatments have adverse effects; nonpharmacologic interventions have limitations. Spinal cord stimulation (SCS) is an effective treatment for neuropathic pain, although 30% to 40% of patients fail to achieve acceptable levels of pain relief. There are currently no objective methods to predict the success of SCS to treat neuropathic pain, and therefore, it is important to understand which patient factors may be predictive of a lack of response to SCS, to inform future patient treatment options. This study proposes a protocol for a systematic review and meta-analysis of published studies to examine these predictive factors.
Several bibliographic databases will be searched to identify relevant studies published since 2012 that provide data on patient characguide the use of neuromodulation in patient subgroups and the design and reporting of future clinical studies in this field.
Electroacupuncture (EA) is a traditional Chinese therapeutic technique that has a beneficial effect on neuropathic pain; however, the specific mechanism remains unclear. In this study, we investigated whether EA inhibits spinal Ca/calmodulin-dependent protein kinase II (CaMKIIα) phosphorylation through Sirtuin 3 (SIRT3) protein, thus relieving neuropathic pain.
We used wild-type and SIRT3 knockout (SIRT3
) mice and used chronic constriction injury (CCI) as a pain model. We performed Western blotting, immunostaining, von Frey, and Hargreaves tests to gather biochemical and behavioral data. Downregulation and overexpression and spinal SIRT3 protein were achieved by intraspinal injection of SIRT3 small interfering RNA and intraspinal injection of lentivirus-SIRT3. To test the hypothesis that CaMKIIα signaling was involved in the analgesic effects of EA, we expressed CaMKIIα-specific designer receptors exclusively activated by designer drugs (DREADDs) in the spinal dorsal horn (SDH) of mice.
These results showed that the mechanical and thermal hyperalgesia induced by CCI was related to the decreased spinal SIRT3 expression in the SDH of mice. A significant reduction of mechanical and thermal thresholds was found in the SIRT3
mice. SIRT3 overexpression or EA treatment alleviated CCI-induced neuropathic pain and prevented the spinal CaMKIIα phosphorylation. Most importantly, EA increased the expression of spinal SIRT3 protein in the SDH. Downregulation of spinal SIRT3 or CaMKIIα Gq-DREADD activation inhibited the regulatory effect of EA on neuropathic pain.
Our results showed that CaMKIIα phosphorylation was inhibited by spinal SIRT3 in neuropathic pain and that EA attenuated CCI-induced neuropathic pain mainly by upregulating spinal SIRT3 expression in the SDH of mice.
Our results showed that CaMKIIα phosphorylation was inhibited by spinal SIRT3 in neuropathic pain and that EA attenuated CCI-induced neuropathic pain mainly by upregulating spinal SIRT3 expression in the SDH of mice.
Immune checkpoint blocker (ICB) associated myocarditis (ICB-myocarditis) may present similarly and/or overlap with other cardiac pathology including acute coronary syndrome presenting a challenge for prompt clinical diagnosis.
An international registry was used to retrospectively identify cases of ICB-myocarditis. Presence of coronary artery disease (CAD) was defined as coronary artery stenosis >70% in patients undergoing coronary angiogram.
Among 261 patients with clinically suspected ICB-myocarditis who underwent a coronary angiography, CAD was present in 59/261 patients (22.6%). Coronary revascularization was performed during the index hospitalisation in 19/59 (32.2%) patients. Patients undergoing coronary revascularization less frequently received steroids administration within 24h of admission compared to the other groups (p=0.029). Myocarditis-related 90-day mortality was 9/17 (52.7%) in the revascularised cohort, compared to 5/31 (16.1%) in those not revascularized and 25/156 (16.0%) in those zation is performed. This is potentially mediated through delayed diagnosis and treatment or more severe presentation of ICB-myocarditis.
To review the evidence supporting the modification of behavioral habits and substance use management during cancer treatment and how to implement them as part of a multimodal optimization intervention.
A literature review of the association between cancer and behavioral habits, their impact on oncological treatment outcomes, and substance use management guidelines.
There is an association between harmful habits, such as smoking and alcohol consumption, and cancer. The continuation of poor behavioral habits throughout oncological treatments is associated with poor oncological outcomes and increased complications. Prehabilitation could be an ideal setting to screen, assess, and modify these harmful habits. Prehabilitation programs should be equipped with professionals and resources to help patients achieve harmful habit cessation.
This review puts into manifest the importance of a multidisciplinary approach to substance use management. It can serve as a framework to develop a harmful habit cessation intervention in the context of multimodal prehabilitation to improve surgical and oncological outcomes in the cancer population.
This review puts into manifest the importance of a multidisciplinary approach to substance use management. It can serve as a framework to develop a harmful habit cessation intervention in the context of multimodal prehabilitation to improve surgical and oncological outcomes in the cancer population.The purpose of this study was to examine patient portal enrollment and the usage with a specific focus on the utilization of on-line radiology reports by patients. Oracle SQL (Austin, TX, USA) queries were used to extract portal enrollment data over a 13-month period from March 1, 2017 through March 31, 2018 from the hospital system's EMR. Patient enrollment was collected as was patient information including basic demographics and utilization patterns. For enrolled patients, interaction within the portal with the "Radiology" work tab (RADTAB) was used as a surrogate for review of radiology results. As a comparator, interaction within the portal with the "Laboratory" work tab (LABTAB) was used as a surrogate for review of laboratory results. Statistical analysis on the data was performed using Chi-squared, Student's t-test, Logistic regression and multivariate analysis where appropriate. The population for analysis included 424,422 patients. Overall, 138,783 patients (32.7%) were enrolled in the portal. Patients enrolled in the portal were older (P less then 0.0001), female (P less then 0.0001) and Caucasian (P less then 0.0001). Patients enrolled in the portal had higher levels of educational attainment (p less then 0.0001), higher annual household income (P less then 0.0001), and more outpatient clinic visits (P less then 0.0001). The proportion of enrolled patients that interacted with the LABTAB (47.2%) was significantly higher than those that interacted with the RADTAB (27.1%) (P less then 0.0001; Table 2). Patients that utilize the portal are more likely to utilize the Laboratory tab than the Radiology tab, and demographic differences do not account for this difference in usage. Further investigation is needed to better understand the reasons for the differing usage trends of Laboratory and Radiology tabs.The incidence of burnout among radiologists has been increasing exponentially, largely attributed to increased work volumes, expectations for more rapid turn-around times and decreasing interpersonal interactions. While personal wellness activities have been described in the literature, there is little information on the role of cognitive behavioral therapy strategies to mitigate burnout. This manuscript will describe the value of naming automatic negative emotions which can lead to burnout and will provide an overview of strategies that can be used to combat them, using cognitive behavioral therapy techniques.This study aimed to investigate the prevalence of hepatic steatosis in racially diverse adults presenting to the emergency department at a tertiary healthcare system in the United States using attenuation values on unenhanced computed tomography (CT) as the reference standard. The utility of known risk factors for predicting the presence of hepatic steatosis was assessed. Additionally, reporting of hepatic steatosis in original radiology reports was evaluated. B02 RNA Synthesis inhibitor For 381 consecutive adults (193 women and 188 men; mean age 55.2 ± 17.2 years), hepatic (left medial, left lateral, right anterior, and right posterior) and splenic (upper, middle, and lower) CT attenuation values (Hounsfield units) were obtained by drawing a 1 cm2 region of interest on unenhanced chest CT obtained in the emergency department for any indication. Multiple attenuation criteria for steatosis, including liver thresholds and liver and spleen attenuation comparison, were applied. Relevant clinical risk factors were recorded and compared againwere more specific (specificity = 62.2%-93.9%) but highly insensitive (sensitivity = 7.5%-40.3%). 63% (12/19) radiology reports mentioned the presence of moderate-to-severe hepatic steatosis but only 11.1% (15/135) of them mentioned the presence of mild hepatic steatosis. Unenhanced chest CT can be used to assess hepatic steatosis for individuals presenting to the emergency department and provide a non-invasive means for opportunistic screening.
