Delirium Management Quality Improvement Project to Improve Awareness and Screening in a Medical ICU.

Although delirium is common during critical illness, standard-of-care detection and prevention practices in real-world intensive care unit (ICU) settings remain inconsistent, often due to a lack of provider education. Despite availability for over 20 years of validated delirium screening tools such as the Confusion Assessment Method in the ICU (CAM-ICU), feasible and rigorous educational efforts continue to be needed to address persistent delirium standard-of-care practice gaps. Spanning an 8-month quality improvement project period, our single-ICU interdisciplinary effort involved delivery of CAM-ICU pocket cards to bedside nurses, and lectures by experienced champions that included a live delirium detection demonstration using the CAM-ICU, and a comprehensive discussion of evidence-based delirium prevention strategies (e.

Mycological Profile and Associated Factors Among Patients with Dermatophytosis in Astana, Kazakhstan.

Dermatophytosis, also known as Tinea infection, remains a significant interdisciplinary concern worldwide. This dermatophyte infection may be more serious in individuals with underlying somatic diseases, immunodeficiencies, endocrine disorders, or chronic illnesses. This study analyzed 313 patients with suspected dermatophytosis.

Osteopenia Metabolomic Biomarkers for Early Warning of Osteoporosis.

: This study aimed to capture the early metabolic changes before osteoporosis occurs and identify metabolomic biomarkers at the osteopenia stage for the early prevention of osteoporosis. : Metabolomic data were generated from normal, osteopenia, and osteoporosis groups with 320 participants recruited from the Nicheng community in Shanghai. We conducted individual edge network analysis (iENA) combined with a random forest to detect metabolomic biomarkers for the early warning of osteoporosis.

A Randomized, Placebo-Controlled, Single-Center, Crossover Study to Evaluate the Effects of Pre-Meal Whey Protein Microgel on Post-Prandial Glucometabolic and Amino Acid Response in People with Type 2 Diabetes and Overweight or Obesity.

: Whey protein (WP) consumption prior to a meal curbs appetite and reduces postprandial glucose (PPG) through stimulating endogenous GLP-1 secretion and insulin. : We assessed the metabolic effects of a concentrated WP, using a new micelle-technology (WPM), in people with type 2 diabetes (T2D) and overweight or obesity (NCT04639726). In a randomized-crossover design, participants performed two 240 min lunch meal (622 kcal) tests 7 ± 4 days apart.

The Validation of a Novel, Sex-Specific LDL-Cholesterol Equation and the Friedewald, Sampson-NIH, and Extended-Martin-Hopkins Equations Against Direct Measurement in Korean Adults.

: The currently established equations for calculating low-density lipoprotein cholesterol (LDLc) do not reflect the sex-specific differences in lipid metabolism. We aimed to develop a sex-specific LDLc equation (SSLE) and validate it with three established equations (Friedewald, Sampson-NIH, and ext-Martin-Hopkins) against direct LDLc measurement in Korean adults. This study included 23,757 subjects (51% male; median age, 51 years) from the 2009-2022 Korean National Health and Nutrition Examination Survey.

Current Trends and Perspectives of Pressure Wire-Based Coronary Artery Bypass Grafting.

Fractional flow reserve (FFR) has been well validated as a modality for evaluating myocardial ischemia, demonstrating the superiority of FFR-guided percutaneous coronary intervention (PCI) over conventional angiography-guided PCI. As a result, the strategy for coronary artery bypass grafting (CABG) is shifting toward FFR guidance. However, the advantage of FFR-guided CABG over angiography-guided CABG remains unclear.

General procrastination associated with the evening preference in healthy people but not with circadian rhythm sleep-wake disorders with phase delay.

Procrastination behavior has been reportedly associated with the evening preference. This study aimed to evaluate its difference between patients with circadian rhythm sleep-wake disorders with phase delay (CRSWDswPD) and healthy controls in terms of evening preference and comorbid psychiatric disorders. Thirty patients with CRSWDswPD and 29 healthy participants were included.

The impact of virtual reality on patient experience during wide-awake surgery: a randomized controlled trial.

This study aimed to establish whether virtual reality can reduce patient anxiety and improve surgical satisfaction during wide-awake local anaesthetic no tourniquet hand procedures. Previously validated questionnaires were used to assess subjective anxiety and patient satisfaction. Objective anxiety was determined using patient blood pressure and heart rate measured four times during the procedure.

High FGF18 expression levels predict poor prognosis in endometrial carcinoma patients and promote tumor growth and metastasis.

Objective: To investigate if fibroblast growth factor 18 (FGF18) expression plays an important role in endometrial carcinoma (EC).

Methods: The clinicopathological associations and prognostic value of FGF18 expression were retrospectively analyzed in 190 patients with EC. FGF18 expression was stably knocked down in EC cell lines.

-Rearranged Enteric Tumors: Updates on Clinicopathologic and Molecular Genetics Features.

Recent advances in molecular genetics, particularly in identifying and characterizing genetic abnormalities within mesenchymal neoplasms, have led to a more comprehensive and evolving classification system. Modern technological developments in cytogenetics and next-generation sequencing have enabled the analysis of small clinical samples, expanded our understanding of tumor biology, and improved the diagnostic, prognostic, and predictive precision by identifying targeted genetic alterations, confirming the presence of fusion transcripts, and/or revealing the overexpression of specific genes and their targets. In this review, we focus specifically on the -rearranged enteric tumor, a recent clinicopathological entity that has emerged within the expanding classification of mesenchymal tumors.

The Gene Product STIL Is Essential for Dendritic Spine Formation.

Dendritic spine formation/maintenance is highly dependent on actin cytoskeletal dynamics, which is regulated by small GTPases Rac1 and Cdc42 through their downstream p21-activated kinase/LIM-kinase-I/cofilin pathway. ARHGEF7, also known as ß-PIX, is a guanine nucleotide exchange factor for Rac1 and Cdc42, thereby activating Rac1/Cdc42 and the downstream pathway, leading to the upregulation of spine formation/maintenance. We found that STIL, one of the primary microcephaly gene products, is associated with ARHGEF7 in dendritic spines and that knockdown of resulted in a significant reduction in dendritic spines in neurons both in vitro and in vivo.

Enhanced Interleukin 6 Trans-Signaling Modulates Disease Process in Amyotrophic Lateral Sclerosis Mouse Models.

Charcot first described ALS in 1869, but the specific mechanisms that mediate the disease pathology are still not clear. Intense research efforts have provided insight into unique neuroanatomical regions, specific neuronal populations and genetic associations for ALS and other neurodegenerative diseases; however, the experimental results also suggest a convergence of these events to common toxic pathways. We propose that common toxic pathways can be therapeutically targeted, and this intervention will be effective in slowing progression and improving patient quality of life.

Optimizing Neurobehavioral Assessment for Patients with Disorders of Consciousness: Proposal of a Comprehensive Pre-Assessment Checklist for Clinicians.

Background: Clinicians are challenged by the ambiguity and uncertainty in assessing level of consciousness in individuals with disorder of consciousness (DoC). There are numerous challenges to valid and reliable neurobehavioral assessment and classification of DoC due to multiple environmental and patient-related biases including behavioral fluctuation and confounding or co-occurring medical conditions. Addressing these biases could impact accuracy of assessment and is an important aspect of the DoC assessment process.

The Stress and Adversity Inventory for Adults (Adult STRAIN) in Korean: Initial Validation and Associations with Psychiatric Disorders.

Background/objectives: Stressors occurring across the life course are considered to have a cumulative impact on health, but there is no instrument for assessing lifetime stressor exposure in Korea. Therefore, we validated the Stress and Adversity Inventory (Adult STRAIN) in Korean.

Methods: We translated the Adult STRAIN into Korean and examined its concurrent, predictive, and comparative predictive validity in 218 Korean adults (79 men, 139 women; = 29.

Management of Anterior Choroidal Artery Aneurysms: A Retrospective Cohort Study.

Anterior choroidal artery (AChoA) aneurysms pose a challenge for both endovascular and clipping procedures. The eloquent territory supplied by the parent vessel has limited collateralization and its compromise can lead to significant morbidity. This study aims to analyze the clinical outcomes and procedure-related complications of clipping and endovascular treatment of AChoA aneurysms to aid physician decision making.

Analyzing Gait Dynamics and Recovery Trajectory in Lower Extremity Fractures Using Linear Mixed Models and Gait Analysis Variables.

In a prospective study, we examined the recovery trajectory of patients with lower extremity fractures to better understand the healing process in the absence of complications. Using a chest-mounted inertial measurement unit (IMU) device for gait analysis and collecting patient-reported outcome measures, we focused on 12 key gait variables, including Mean Leg Lift Acceleration, Stance Time, and Body Orientation. We employed a linear mixed model (LMM) to analyze these variables over time, incorporating both fixed and random effects to account for individual differences and the time since injury.

Deep Temporal Clustering of Pathological Gait Patterns in Post-Stroke Patients Using Joint Angle Trajectories: A Cross-Sectional Study.

Rehabilitation of gait function in post-stroke hemiplegic patients is critical for improving mobility and quality of life, requiring a comprehensive understanding of individual gait patterns. Previous studies on gait analysis using unsupervised clustering often involve manual feature extraction, which introduces limitations such as low accuracy, low consistency, and potential bias due to human intervention. This cross-sectional study aimed to identify and cluster gait patterns using an end-to-end deep learning approach that autonomously extracts features from joint angle trajectories for a gait cycle, minimizing human intervention.

SMARCA4/BRG1 deficiency induces a targetable dependence on oxidative phosphorylation in clear cell renal cell carcinoma.

The tumor suppressor gene SMARCA4, a critical component of the SWI/SNF chromatin remodeling complex, is frequently inactivated in various cancers, including clear cell renal cell carcinoma (ccRCC). Despite its significance, the role of SMARCA4 in ccRCC development and its potential therapeutic vulnerabilities have not been fully explored. Our research found that SMARCA4 deficiency was associated with poor prognosis and was observed in a subset of high-grade ccRCCs.

Development and Validation of a Predictive Model Based on Serum Silent Information Regulator 6 Levels in Chinese Older Adult Patients: Cross-Sectional Descriptive Study.

Background: Serum levels of silent information regulator 6 (SIRT6), a key biomarker of aging, were identified as a predictor of coronary artery disease (CAD), but whether SIRT6 can distinguish severity of coronary artery lesions in older adult patients is unknown.

Objectives: This study developed a nomogram to demonstrate the functionality of SIRT6 in assessing severity of coronary artery atherosclerosis.

Methods: Patients aged 60 years and older with angina pectoris were screened for this single-center clinical study between October 1, 2022, and March 31, 2023.