ALSUntangled #77: Psilocybin.

ALSUntangled reviews alternate and off-label treatments prompted by patient interest. Here, we review psilocybin, a chemical derived from mushrooms and belonging in the category of drugs known as psychedelics. Psilocybin has plausible mechanisms for slowing ALS progression because of its ability to cross the blood brain barrier and effect neurogenesis and inflammation.

Implementation of trauma and disaster mental health awareness training in Puerto Rico.

Climate change is disproportionately impacting youth mental health around the world. Using a Community-Based Participatory approach, three universities (one in South Carolina and two in Puerto Rico) partnered after the devastation of Hurricane Maria in 2017. We offered culturally and linguistically tailored trauma and disaster-informed mental health awareness training (e.

Bedside mental health risk screening of traumatic injury patients is enhanced by measurement of injury mechanism and social support.

Background: The American College of Surgeons now requires mental health screening and follow up for hospitalized patients in trauma centers. National estimates indicate that 20-40 % of these patients will develop posttraumatic stress disorder (PTSD) and/or depression within one year post-injury. Research has identified brief bedside screens that predict PTSD and depression post-discharge, such as the Injured Trauma Survivor Screen and Peritraumatic Distress Inventory.

Qualitative and quantitative relationships between comorbid seizures and dementia among hospitalized stroke patients.

This study examines the relationship between comorbid seizures and dementia among stroke patients using the 2017 Nationwide Inpatient Sample (NIS), the largest publicly available inpatient healthcare database in the United States. We analyzed data from 128,341 stroke patients, including those with ischemic and hemorrhagic strokes, to determine the prevalence of seizures and dementia, and the association between these conditions. Our findings reveal that 7.

Ranking of Health Problems and Prioritization of Cancer Education Topics by African American Communities in South Carolina.

Despite landmark breakthroughs in cancer research, African American adults (AA) bear the highest cancer burden compared to other racial groups in the United States (US). AA adults have twice the likelihood of dying from prostate and uterine cancers compared to White adults, suggesting that there are fundamental issues yet to be addressed when developing and implementing cancer-preventative programs for AA communities. Community-based participatory research (CBPR) empowers community members to identify and prioritize their health problems and preferred strategies to tackle these issues.

Multiple DNA repair pathways prevent acetaldehyde-induced mutagenesis in yeast.

Acetaldehyde is the primary metabolite of alcohol and is present in many environmental sources including tobacco smoke. Acetaldehyde is genotoxic, whereby it can form DNA adducts and lead to mutagenesis. Individuals with defects in acetaldehyde clearance pathways have increased susceptibility to alcohol-associated cancers.

Vagus nerve stimulation in treatment-resistant depression: A one-year, randomized, sham-controlled trial.

Background: Few treatments are available for individuals with marked treatment-resistant depression (TRD).

Objective: Evaluate the safety and effectiveness of FDA-approved adjunctive vagus nerve stimulation (VNS) in patients with marked TRD.

Methods: This 12-month, multicenter, double-blind, sham-controlled trial included 493 adults with marked treatment-resistant major depression who were randomized to active or no-stimulation sham VNS for 12 months.

Adaptive Platform Trials in Stroke.

Clinical trials of treatments for stroke have generally utilized 2-arm, randomized designs to evaluate a single intervention against a control. Running separate clinical trials, with each addressing a single therapeutic question, is resource intensive and slows evidence generation, especially in a field with rapidly expanding treatment options and evolving practices. Platform trials-randomized clinical trials designed to evaluate multiple interventions that may enter and exit the ongoing platform based on a master protocol-accelerate the investigation of multiple therapeutic options within a single infrastructure.

Neurophysiological Effects of Latent Trigger Point Dry Needling on Spinal Reflexes.

Deep dry needling (DDN) is a method to treat muscle trigger points (TrPs) often found in persons with neuromuscular pain and spasticity. Currently, its neurophysiological actions are not well established. Thus, to understand how DDN affects spinal cord physiology, we investigated the effects of TrP DDN on spinal reflexes.

Transcription as a double-edged sword in genome maintenance.

Genome maintenance is essential for the integrity of the genetic blueprint, of which only a small fraction is transcribed in higher eukaryotes. DNA lesions occurring in the transcribed genome trigger transcription pausing and transcription-coupled DNA repair. There are two major transcription-coupled DNA repair pathways.

Burnout in Practicing Neurologists: A Systematic Review and Meta-Analysis.

Purpose Of Review: Burnout is a context-dependent, global issue among physicians in the medical field who often face job-related stressors, high workloads, and limited or lack of social support or autonomy. Within medicine, neurology is a specialty with high levels of burnout and low levels of work-life satisfaction. We, therefore, conducted this study to evaluate burnout rates among neurologists globally and identify the tools used to evaluate it.

Cirrhosis associated with increased complications and healthcare utilization following total shoulder arthroplasty.

Introduction: Cirrhosis is a known risk factor for morbidity and mortality following surgical procedures and has been associated with increased complications, hospital length of stay (LOS), and cost of admission following total joint arthroplasty. However, a paucity of literature exists evaluating the effect of cirrhosis on postoperative outcomes following total shoulder arthroplasty (TSA). The purpose of this study is to evaluate the short-term outcomes following elective primary TSA in patients with cirrhosis compared to matched controls.

Effects of vagus nerve stimulation on daily function and quality of life in markedly treatment-resistant major depression: Findings from a one-year, randomized, sham-controlled trial.

Background: Depression treatments aim to minimize symptom burden and optimize quality of life (QoL) and psychosocial function.

Objective: Compare the effects of adjunctive versus sham vagus nerve stimulation (VNS) on QoL and function in markedly treatment-resistant depression (TRD).

Methods: In this multicenter, double-blind, sham-controlled trial, 493 adults with TRD and ≥4 adequate but unsuccessful antidepressant treatment trials (current episode) were randomized to active (n = 249) or sham (n = 244) VNS (plus treatment as usual) over a 12-month observation period.

Deriving human intestinal organoids with functional tissue-resident macrophages all from pluripotent stem cells.

Background & Aims: Organs of the gastrointestinal tract contain tissue-resident immune cells that function during tissue development, homeostasis, and disease. However, most published human organoid model systems lack resident immune cells, thus limiting their potential as disease avatars. For example, human intestinal organoids (HIOs) derived from pluripotent stem cells contain epithelial and various mesenchymal cell types but lack immune cells.

Pneumonia Vaccines: Indications for Use and Current Safety Data in Pregnancy.

Streptococcus pneumoniae is a leading cause of pneumonia, meningitis, and invasive pneumococcal disease among adults in the United States, with higher rates of disease occurring among individuals with chronic medical and immunocompromising conditions. Pregnant individuals, especially those with co-morbid conditions, are also at increased risk of infection due to S. pneumoniae due to physiologic and immunologic changes in pregnancy.

Effectiveness of ceftazidime-avibactam versus ceftolozane-tazobactam for multidrug-resistant Pseudomonas aeruginosa infections in the USA (CACTUS): a multicentre, retrospective, observational study.

Background: Ceftolozane-tazobactam and ceftazidime-avibactam are preferred treatment options for multidrug-resistant Pseudomonas aeruginosa infections; however, real-world comparative effectiveness studies are scarce. Pharmacokinetic and pharmacodynamic differences between the agents might affect clinical response rates. We aimed to compare the effectiveness of ceftolozane-tazobactam and ceftazidime-avibactam for treatment of invasive multidrug-resistant P aeruginosa infections.

Antithrombotic therapy for secondary Stroke prevention in patients with symptomatic large artery atherosclerosis and atrial fibrillation (FIB-CAS study) A single-center experience.

Introduction: Atrial fibrillation (AF) and large artery atherosclerotic diseases are major causes of ischemic stroke and their coexistence increases the risk of stroke and mortality. Research on antithrombotic strategies for AF patients with symptomatic large artery atherosclerosis is limited. This study aims to report a single center's experience regarding the antithrombotic regimens prescribed for this population and the association with stroke recurrence and hemorrhagic events.

The Pediatric Influence of Cooling Duration on Efficacy in Cardiac Arrest Patients (P-ICECAP): Statistical Methods Planned in the Bayesian, Adaptive, Duration Finding Trial.

Objectives: To determine the optimal cooling duration for children after out-of-hospital cardiac arrest (OHCA) using an adaptive Bayesian trial design.

Design: The Pediatric Influence of Cooling duration on Efficacy in Cardiac Arrest Patients (P-ICECAP) trial is a randomized, response-adaptive duration/dose-finding clinical trial with blinded outcome assessment. Participants are randomized to one of several cooling durations (0, 12, 18, 24, 36, 48, 60, 72, 84, or 96 hr).

Immediate Postintervention Outcomes from a Randomized Trial that Sought to Enhance Access to Live Donor Kidney Transplant for Black and African Americans.

Introduction: Eliminating racial inequities in access to kidney transplantation requires multilevel interventions that target both patients and health systems.

Research Question: The aim of this study was to determine whether adding culturally sensitive, web-based patient education to a transplant center-level intervention was associated with increased knowledge, motivation to pursue living donor kidney transplant, and confidence in the behavioral skills to discuss living donation among Black/African American patients with end-stage kidney disease.

Design: A total of 411 transplant candidates were randomized to intervention (N = 222) or control groups (N = 189) and completed measures at baseline and immediate follow-up during the transplant evaluation visit.