Effects of withdrawal and re-application of spinal cord stimulation to restore cough.

Context: Paralysis of the expiratory muscles in cervical and high thoracic spinal cord injury (SCI) results in an impaired ability to clear airway secretions effectively and increases the risk of atelectasis and respiratory tract infections (RTI). Spinal cord stimulation (SCS) applied via the Cough Stimulation System (CSS) has been shown to restore an effective cough mechanism in subjects with SCI. In this study, we evaluated the specific impact of use of the CSS by one study participant with SCI, subsequent discontinuation of usage, and then re-institution of this modality.

A stakeholder-involved adaptation of pathways and resources for engagement and participation (PREP) material with young adults with complex disability in Australia: an implementation feasibility study.

Purpose: Pathways and Resources for Engagement and Participation (PREP) is an intervention to optimise individuals' participation by building problem-solving capacity and addressing environmental barriers. We investigated the feasibility of implementing PREP with young adults (18-30 years) with complex disability in Australia.

Materials And Methods: Explanatory sequential mixed methods study in three stages.

Hypertrophic Cardiomyopathy.

Purpose Of Review: Hypertrophic cardiomyopathy (HCM) is a common inherited cardiac condition with potential for severe complications including sudden cardiac death. Early diagnosis allows appropriate risk stratification and prompt intervention to minimise the potential for adverse outcomes. The implications of poorly coordinated screening are significant, either missing relatives at high-risk or burdening low-risk individuals with a diagnosis associated with reduced life expectancy.

APOBEC3 activity promotes the survival and evolution of drug-tolerant persister cells during acquired resistance to EGFR inhibitors in lung cancer.

APOBEC mutagenesis is one of the most common endogenous sources of mutations in human cancer and is a major source of genetic intratumor heterogeneity. High levels of APOBEC mutagenesis are associated with poor prognosis and aggressive disease across diverse cancers, but the mechanistic and functional impacts of APOBEC mutagenesis on tumor evolution and therapy resistance remain relatively unexplored. To address this, we investigated the contribution of APOBEC mutagenesis to acquired therapy resistance in a model of EGFR-mutant non-small cell lung cancer.

Impact of the cough stimulation system on the care burden and life quality of caregivers of tetraplegics.

Objectives: To determine caregiver burden and quality of life of primary family caregivers of participants with cervical SCI before and after use of the cough stimulation system (CSS).

Design: Prospective assessment at four timepoints via questionnaire responses.

Setting: Out-patient hospital, United States.

Sequencing of medical therapy in heart failure with a reduced ejection fraction.

The management of heart failure with a reduced ejection fraction is a true success story of modern medicine. Evidence from randomised clinical trials provides the basis for an extensive catalogue of disease-modifying drug treatments that improve both symptoms and survival. These treatments have undergone rigorous scrutiny by licensing and guideline development bodies to make them eligible for clinical use.

Effects of restoration of cough via spinal cord stimulation on subject quality of life.

Objectives: To determine participant quality of life before and after use of the cough stimulation system (Cough System).

Design: Prospective assessment of life quality at 4 timepoints via questionnaire responses.

Setting: Out-patient hospital, United States.

Phrenic-to-intercostal reflex activity in response to high frequency spinal cord stimulation (HF-SCS).

Objective: HF-SCS is a novel technique of inspiratory muscle activation which results in coincident activation of the diaphragm and inspiratory intercostal muscles via spinal cord pathways and has the potential to provide respiratory support in ventilator dependent persons with spinal cord injury. The purpose of the present study was to examine the phrenic-to-intercostal reflex during HF-SCS.

Methods: In 5 anesthetized and C2 spinalized dogs, electrical stimulation was applied via a stimulating electrode located on the ventral surface of the upper thoracic spinal cord at the T2 level.

In Vivo Modeling of Tumor Heterogeneity for Immuno-Oncology Studies: Failures, Improvements, and Hopes.

Murine tumor modeling is fundamental for the preclinical development of anti-cancer therapies. Use of immunocompetent mouse models is becoming increasingly relevant as we gain more knowledge of how cancer cells interact with the immune system in the tumor microenvironment and how we can harness the immune system to fight tumors. However, there are few intrinsically immunogenic preclinical tumor models, and the vast majority either do not respond to therapy or do not faithfully predict the responses of the therapy when applied in the clinic.

Ventricular Arrhythmias and Sudden Death in Nonischemic Dilated Cardiomyopathy: Matter of Sex or Scar?

Background: To evaluate the association between sex and ventricular arrhythmias (VA) or sudden death (SD) in nonischemic dilated cardiomyopathy, including analysis of potential confounders.

Methods And Results: Retrospective cohort study of consecutive patients with DCM referred for cardiac magnetic resonance at 2 tertiary hospitals. The primary combined end point encompassed sustained VA, appropriate implantable cardioverter defibrillator therapies, resuscitated cardiac arrest, and SD.

Use of a Knowledge-Based Governance Approach to Plan a Post-COVID-19 Predoctoral Dental.

COVID-19 abruptly changed dental education, forcing educators out of their comfort zones and into using new technologies and teaching approaches. At the University of Washington School of Dentistry, a task force evaluated the curricular changes that resulted from COVID and made recommendations for the future predoctoral dental curriculum. This manuscript reports the process employed, the findings of the task force, and how these findings will impact the curriculum.

APOBEC Mutagenesis Inhibits Breast Cancer Growth through Induction of T cell-Mediated Antitumor Immune Responses.

The APOBEC family of cytidine deaminases is one of the most common endogenous sources of mutations in human cancer. Genomic studies of tumors have found that APOBEC mutational signatures are enriched in the HER2 subtype of breast cancer and are associated with immunotherapy response in diverse cancer types. However, the direct consequences of APOBEC mutagenesis on the tumor immune microenvironment have not been thoroughly investigated.

To block, or not to block … is it still the question? Effectiveness of alpha- and beta-blockade in phaeochromocytoma surgery: an institutional analysis.

Introduction: Phaeochromocytomas/paraganglioma (PPGL) surgery was historically associated with significant risks of perioperative complications. The decreased mortality (<3.0%) had been attributed in part to optimal preoperative alpha-blockade.

Synacthen Stimulation Test Following Unilateral Adrenalectomy Needs to Be Interpreted With Caution.

Background: Cortisol levels in response to stress are highly variable. Baseline and stimulated cortisol levels are commonly used to determine adrenal function following unilateral adrenalectomy. We report the results of synacthen stimulation testing following unilateral adrenalectomy in a tertiary referral center.

Model-Based Optimization of Spinal Cord Stimulation for Inspiratory Muscle Activation.

Objective: High-frequency spinal cord stimulation (HF-SCS) is a potential method to provide natural and effective inspiratory muscle pacing in patients with ventilator-dependent spinal cord injuries. Experimental data have demonstrated that HF-SCS elicits physiological activation of the diaphragm and inspiratory intercostal muscles via spinal cord pathways. However, the activation thresholds, extent of activation, and optimal electrode configurations (i.

Comparison of wire and disc electrodes to electrically activate the inspiratory muscles in dogs.

Objective: To compare the effectiveness of wire versus disc electrodes to activate the inspiratory muscles via high frequency spinal cord stimulation.

Design: Animal study.

Setting: Research laboratory.

Initial assessment and management of respiratory infections in persons with spinal cord injuries and disorders in the COVID-19 era.

As the COVID-19 pandemic unfolds, emergency department (ED) personnel will face a higher caseload, including those with special medical needs such as persons living with spinal cord injuries and disorders (SCI/D). Individuals with SCI/D who develop COVID-19 are at higher risk for rapid decompensation and development of acute respiratory failure during respiratory infections due to the combination of chronic respiratory muscle paralysis and autonomic dysregulation causing neurogenic restrictive/obstructive lung disease and chronic immune dysfunction. Often, acute respiratory infections will lead to significant mucus production in individuals with SCI/D, and aggressive secretion management is an important component of successful medical treatment.

Effects of Lower Thoracic Spinal Cord Stimulation on Bowel Management in Individuals With Spinal Cord Injury.

Objective: To systematically determine whether use of the spinal cord stimulation (SCS) system to restore cough may improve bowel management (BM) in individuals with spinal cord injury (SCI).

Design: Experimental studies (clinical trial).

Setting: Inpatient hospital setting for electrode insertion; outpatient setting for measurement of respiratory pressures; home setting for application of SCS.

The changing face of reoperative parathyroidectomy: a single-centre comparison of 147 parathyroid reoperations.

Introduction: Reoperative parathyroidectomy for persistent and recurrent primary hyperparathyroidism is dependent on radiology. This study aimed to compare outcomes in reoperative parathyroidectomy at a single centre using a combination of traditional and newer imaging studies.

Materials And Methods: Retrospective case note review of all reoperative parathyroidectomies for persistent and recurrent primary hyperparathyroidism over five years (June 2014 to June 2019; group A).

Intraprofessional education with dental hygienists: The post training impact on dentists.

Purpose/objectives: Generally, dental and dental hygiene (DH) students are educated separately. When these students are educated together, studies show improvements in teamwork and understanding of their distinct roles. This longitudinal study was conducted to see if intraprofessional education (IntraPE) between dental and DH students can impact dentists in practice.