Sleep Stewardship.

Sleep stewardship is a systematic effort to ensure relaxed and restorative sleep, by optimizing pre-sleep, intra-sleep and post-sleep environment and ambience, in a rational manner. It includes not only sleep hygiene and prevention of sleeping pill abuse, but also macro- and meso-level interventions to improve sleep quality. The person living with sleep disorder, their family, members of society, health care professionals, and policy makers: all have a role to play in sleep stewardship.

Regional adipose distribution and metabolically unhealthy phenotype in Chinese adults: evidence from China National Health Survey.

Background: The mechanisms distinguishing metabolically healthy from unhealthy phenotypes within the same BMI categories remain unclear. This study aimed to investigate the associations between regional fat distribution and metabolically unhealthy phenotypes in Chinese adults across different BMI categories.

Methods: This cross-sectional study involving 11833 Chinese adults aged 20 years and older.

Preventing unrestricted and unmonitored AI experimentation in healthcare through transparency and accountability.

The integration of large language models (LLMs) into electronic health records offers potential benefits but raises significant ethical, legal, and operational concerns, including unconsented data use, lack of governance, and AI-related malpractice accountability. Sycophancy, feedback loop bias, and data reuse risk amplifying errors without proper oversight. To safeguard patients, especially the vulnerable, clinicians must advocate for patient-centered education, ethical practices, and robust oversight to prevent harm.

Associations of fat, bone, and muscle indices with disease severity in patients with obstructive sleep apnea hypopnea syndrome.

Purpose: To investigate the relationship between obstructive sleep apnea hypopnea syndrome (OSAHS) severity and fat, bone, and muscle indices.

Methods: This study included 102 patients with OSAHS and retrospectively reviewed their physical examination data. All patients underwent polysomnography, body composition analysis, dual-energy X-ray absorptiometry, computed tomography (CT) and blood test.

A Mobile Health Intervention to Support Collaborative Decision-Making in Mental Health Care: Development and Usability.

Background: Shared decision-making between clinicians and service users is crucial in mental health care. One significant barrier to achieving this goal is the lack of user-centered services. Integrating digital tools into mental health services holds promise for addressing some of these challenges.

A Triple Threat: A Case Report Detailing Surgical Management for Hypertrophic Cardiomyopathy, Flail Mitral Valve and Severe Pulmonary Hypertension.

Unlabelled: The combination of hypertrophic cardiomyopathy with outflow tract obstruction, severe pre-capillary and post-capillary pulmonary hypertension, and severe primary mitral regurgitation is rare and presents distinct management challenges.

Background And Clinical Significance: Pulmonary hypertension is an independent predictor of all-cause mortality in patients with hypertrophic cardiomyopathy managed medically and often precludes patients from undergoing cardiopulmonary bypass due to increased surgical morbidity and mortality. In studies specifically evaluating surgical myectomy, however, survival is favorable in patients with moderate-to-severe pulmonary hypertension.

Feasibility of In-Hospital Administration of a Tool to Predict Persistent Post-ICU Functional Impairment Among Older ICU Survivors: A Pilot Study.

Background: A recent international consensus conference called for the development of risk prediction models to identify ICU survivors at increased risk of each of the post-ICU syndrome domains. We previously developed and validated a risk prediction tool for functional impairment after ICU admission among older adults.

Research Question: In this pilot study, we assessed the feasibility of administering the risk prediction tool in the hospital to older adults who had just survived critical illness.

Hygrometry behavior during high-flow nasal oxygen therapy and non-invasive mechanical ventilation: A narrative review of bench to clinical studies.

Recently, there has been growing interest in knowing the best hygrometry level during high-flow nasal oxygen and non-invasive ventilation (NIV) and its potential influence on the outcome. Various studies have shown that breathing cold and dry air results in excessive water loss by nasal mucosa, reduced mucociliary clearance, increased airway resistance, reduced epithelial cell function, increased inflammation, sloughing of tracheal epithelium, and submucosal inflammation. With the Coronavirus Disease 2019 pandemic, using high-flow nasal oxygen with a heated humidifier has become an emerging form of non-invasive support among clinicians.

Mentoring Fellows into Career Educators through a Multispecialty Clinician-Educator Course.

Background: Subspecialty fellows are a unique group of trainees for whom there currently exist few opportunities to pursue formal training as clinician-educators, as singular fellowship programs often face significant obstacles to implementing such coursework.

Objective: To develop, implement, and assess a clinician-educator course for fellows from multiple subspecialty fellowships at a single large academic medical center.

Methods: Our course, entitled Fellow as Clinician-Educator, was initiated across numerous fellowship programs from August 2021 to April 2023 at University of California San Diego Health.

Moving toward Interprofessional Teaching in the Intensive Care Unit: A Mixed Methods Study.

Background: There is an evolving focus on interprofessional education (IPE) to promote teamwork and collaboration in health professions education. Studies in medical students have shown that exposure to IPE leads to perceived improvements in interprofessional communication, effective work in healthcare teams, and understanding of professional limitations. Most research focuses on IPE in undergraduate medical education; less is known about how this functions in graduate medical education.

Accuracy of Echocardiographic Cardiac Output Assessment by Critical Care Fellows.

Background: Advanced critical care echocardiography comprises a specific set of qualitative and quantitative point-of-care echocardiography skills, including a reliable, noninvasive method to measure cardiac output. This technique requires echocardiographic measurement of left ventricular outflow tract (LVOT) diameter and LVOT velocity time integral (VTI). Although there is a demand among critical care fellows to learn these advanced techniques, there are no data describing the acquisition of mastery in these skills.

Neural Variability and Cognitive Control in Individuals With Opioid Use Disorder.

Importance: Opioid use disorder (OUD) impacts millions of people worldwide. Prior studies investigating its underpinning neural mechanisms have not often considered how brain signals evolve over time, so it remains unclear whether brain dynamics are altered in OUD and have subsequent behavioral implications.

Objective: To characterize brain dynamic alterations and their association with cognitive control in individuals with OUD.

Development and Validation of a Clinical, CT, Genomic Classifier and BAL Scoring System for Diagnosing IPF.

The utility of incorporating a usual interstitial pneumonia (UIP) genomic classifier (GC) and bronchoalveolar lavage (BAL) cell count analysis alongside traditional clinical-imaging assessment in aiding in the multidisciplinary diagnosis of IPF in patients with a non-definite HRCT UIP pattern is uncertain.We reviewed consecutive adult patients presenting with fibrotic interstitial lung disease (fILD) and non-definite HRCT UIP pattern who underwent BAL and GC. The initial fILD diagnoses were re-evaluated after bronchoscopy and a final multidisciplinary consensus diagnosis was provided.

Toward a Computable Phenotype for Determining Eligibility of Lung Cancer Screening Using Electronic Health Records.

Purpose: Lung cancer screening (LCS) has the potential to reduce mortality and detect lung cancer at its early stages, but the high false-positive rate associated with low-dose computed tomography (LDCT) for LCS acts as a barrier to its widespread adoption. This study aims to develop computable phenotype (CP) algorithms on the basis of electronic health records (EHRs) to identify individual's eligibility for LCS, thereby enhancing LCS utilization in real-world settings.

Materials And Methods: The study cohort included 5,778 individuals who underwent LDCT for LCS from 2012 to 2022, as recorded in the University of Florida Health Integrated Data Repository.

Endothelial cell (EC)-specific CTGF/CCN2 Expression Increases EC Reprogramming and Atherosclerosis.

Arterial endothelial cells (ECs) reside in a complex biomechanical environment. ECs sense and respond to wall shear stress. Low and oscillatory wall shear stress is characteristic of disturbed flow and commonly found at arterial bifurcations and around atherosclerotic plaques.

Nonpharmacological interventions to promote sleep in the adult critical patients unit: A scoping review.

Background: Sleep and circadian rhythms are markedly altered in intensive care unit (ICU) patients. Numerous factors related to the patient and the ICU environment affect the ability to initiate and maintain sleep. Therefore, nonpharmacological interventions could play an essential role in improving sleep and circadian rhythm.

Polysomnographic features of hypoglossal nerve stimulation efficacy: Looking deeper than the apnea-hypopnea index.

Objectives: Hypoglossal nerve stimulation (HGNS) is a promising surgical option for patients with obstructive sleep apnea (OSA) who are intolerant of continuous positive airway pressure therapy (CPAP). Efficacy studies for HGNS stimulation largely focus on the apnea-hypopnea index and/or oxygen desaturation index. This study's objective was to show the physiological effects of HGNS stimulation on upper airway patency, airflow, and treatment effect during polysomnography (PSG) testing.

Pulmonary artery choriocarcinoma mimicking pulmonary thromboembolism: a case report.

Background: Primary choriocarcinoma of the pulmonary artery is an exceedingly rare malignant neoplasm, which is often misdiagnosed due to its nonspecific clinical presentation. While this condition is characterized by the presence of trophoblastic cells, typically associated with gestational trophoblastic diseases, we encountered a case occurring in an extragenital location. The rarity of such tumors makes it challenging for clinicians to consider them in differential diagnosis, especially when the initial symptoms mimic more common conditions such as pulmonary thromboembolism (PTE).

Hand dominance shift during sleep in sexsomnia: a clue to pathophysiology?

Study Objectives: To elucidate whether awake handedness in sexsomnia is retained during sleep to uncover potential clues about the underlying neurophysiologic mechanisms.

Methods: Participants' and observers' self-reported handedness during sexsomnia events.

Results: Case 1: A 22 y/o right-handed female with an eight-year history of nocturnal sleep-related masturbatory behavior (SMB) involving the left hand (LH) exclusively.

Obstructive sleep apnea and polysomnographic predictors of neuropsychological performance two years after injury in a prospective cohort of adults with traumatic brain injury.

Obstructive sleep apnea (OSA) has been associated with structural and functional brain changes and cognitive impairment in sleep clinic samples. Persons with traumatic brain injury (TBI) are at increased risk of OSA compared to community samples, and many experience chronic cognitive disability. However, the impact of OSA on cognitive outcome after TBI is unknown.

Single-cell analysis reveals ESX-1-mediated accumulation of permissive macrophages in infected mouse lungs.

(MTB) ESX-1, a type VII secretion system, is a key virulence determinant contributing to MTB's survival within lung mononuclear phagocytes (MNPs), but its effect on MNP recruitment and differentiation remains unknown. Here, using multiple single-cell RNA sequencing techniques, we studied the role of ESX-1 in MNP heterogeneity and response in mice and murine bone marrow-derived macrophages (BMDM). We found that ESX-1 is required for MTB to recruit diverse MNP subsets with high MTB burden.

Longitudinal qualitative assessment of meaningful symptoms and relevance of WATCH-PD digital measures for people with early Parkinson's.

Background: Longitudinal qualitative data on what matters to people with Parkinson's disease are lacking and needed to guide patient-centered clinical care and development of outcome measures.

Objective: To evaluate change over time in symptoms, impacts, and relevance of digital measures to monitor disease progression in early Parkinson's.

Methods: In-depth, online symptom mapping interviews were conducted with 33 people with early Parkinson's at baseline and 1 year later to evaluate (A) symptoms, (B) impacts, and (C) relevance of digital measures to monitor personally relevant symptoms.

A Structured, Anatomy-Based Chest CT Interpretation Curriculum for Pulmonary Fellows Covering the Main Patterns of Parenchymal Lung Disease.

Introduction: Chest computed tomography (CT) interpretation is a key competency for pulmonary fellows, with many resources intended for radiologists but very few for this specific group. We endeavored to create a curriculum to teach chest CT interpretation to first-year pulmonary fellows.

Methods: We assembled a team of two pulmonologists, one radiologist, and a fellow with computer drafting software experience.

Therapeutic doses of efzofitimod demonstrate efficacy in pulmonary sarcoidosis.

Background: In a phase 1b/2a clinical trial of efzofitimod in patients with corticosteroid-requiring pulmonary sarcoidosis, treatment resulted in dose-dependent improvement in key end-points. We undertook a analysis pooling dose arms that achieved therapeutic concentrations of efzofitimod (Therapeutic group) those that did not (Subtherapeutic group).

Methods: Peripheral blood mononuclear cells incubated with tuberculin-coated beads were exposed to varying concentrations of efzofitimod in an assay to determine concentrations that inhibited granuloma formation.

The impact of highly effective modulator therapy on sinusitis and dysosmia in young children with cystic fibrosis: a prospective study protocol.

Background: Chronic rhinosinusitis (CRS) and olfactory dysfunction (OD) are prevalent disease complications in people with cystic fibrosis. These understudied comorbidities significantly impact quality of life. The impact of highly effective modulator therapy (HEMT) in young children with cystic fibrosis (YCwCF) on these disease complications is unknown.