MR perfusion characteristics of pseudoprogression in brain tumors treated with immunotherapy - a comparative study with chemo-radiation induced pseudoprogression and radiation necrosis.

Purpose: Pseudoprogression is an atypical imaging pattern of response to immunotherapy in patients with brain tumors. MR perfusion studies in this field are limited. The purpose of our study is to compare the perfusion features between pseudoprogression lesions in malignant gliomas and brain metastases treated with immunotherapy (iPsP) and the pseudoprogression after chemo-radiation therapy and radiation necrosis after radiation treatment (ChR-PsP & RN).

The probability of detecting host-specific microbial source tracking markers in surface waters was strongly associated with method and season.

Fecal contamination of surface waters presents significant human health and environmental risks. While many methods for understanding fecal contamination cannot differentiate between human and animal sources, microbial source tracking (MST) marker methods are used to identify fecal sources. To understand how to best employ MST marker data for managing fecal contamination risks, the present study compiled previously collected MST marker data ( = 12,878 samples) from across North America; each sample in the data set had been tested for fecal contamination from one or more of five sources (avian, canine, human, ruminant, swine).

The Financial Impact of an Employee Wellness Program Focused on Cardiovascular Disease Risk Reduction.

Background: Evidence for the effectiveness and cost-savings of workplace wellness programs (WWPs) is varied, likely due to the variability in program design, as not all WWPs meet the five-point criteria of a "comprehensive WWP" set by the U.S. Centers for Disease Control and Prevention.

HIV-1 Tat Protein and Cigarette Smoke Mediated ADAM17 Upregulation Can Lead to Impaired Mucociliary Clearance.

Human immunodeficiency virus type-1 (HIV-1) associated comorbidities account for the majority of poor health outcomes in people living with HIV (PLWH) in the era of antiretroviral therapy. Lung-related comorbidities such as chronic obstructive pulmonary disease (COPD) and bacterial pneumonia are primarily responsible for increased morbidity and mortality in PLWH, even when compensated for smoking. Smokers and COPD patients demonstrate cilia shortening, attenuated ciliary beat frequency (CBF), dysfunctional ciliated cells along with goblet cell hyperplasia, and mucus hypersecretion.

The Clinical Utility of Assessing Orthostatic Intolerance in Adolescents with Sport-Related Concussion, a Retrospective Study.

Background/objective: Assessing Orthostatic Intolerance (OI, symptoms upon standing from supine) is recommended in athletes with sport-related concussions (SRCs), as this is caused by impairments in the cardiovascular autonomic nervous system (cANS). Early Exercise Intolerance (Early EI, symptoms on light physical exertion) is also due to impairments in the cANS but is difficult to incorporate into outpatient clinical practice (cost of personnel, time, equipment). The purpose of this study was to determine if we could use OI to screen for Early EI, as well as understand differences between adolescents who do and do not report OI.

Portable Medical Orders and Inpatient Cost at End of Life in Acute Myeloid Leukemia and Myelodysplastic Syndromes.

Purpose: We previously demonstrated that early completion of portable medical orders, known as Medical Orders for Life-Sustaining Treatment (MOLST), was associated with lower-intensity care at the end of life (EOL) for patients with acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS). The purpose of this study was to investigate the impact of a MOLST form completed before hospitalization on the cost of inpatient care during the last 30 days of life for patients with AML and MDS.

Methods: We conducted a retrospective study of 271 adult patients with a diagnosis of AML or MDS who died between January 1, 2014, and December 31, 2019, and received care for their hematologic malignancy at the University of Rochester Medical Center (URMC).

Is a Consensus Case Definition for Viral Associated Lower Respiratory Tract Disease (LRTD) in Clinical Trials Possible?

Lower respiratory tract illness or disease (LRTI/LRTD) represents a significant source of morbidity and mortality following viral respiratory illnesses, yet a consensus definition for this outcome is lacking. Recent studies of novel vaccines against respiratory syncytial virus (RSV) for older adults used LRTI/LRTD as the primary outcome to assess vaccine efficacy. However, the different vaccine trials have used highly variable criteria to define this outcome, leading to difficulty in comparison of vaccine efficacy results between trials.

Obliged to fight? Patient moral processes in the face of poor prognosis cancer.

Objective: Theoretical work suggests that moral psychological processes-those pertaining to the interests or welfare of others-are a key driver of overtreatment at the end of life. We examined patient moral processes and their associations with distress and treatment decision-making.

Method: During structured interviews with 116 patients with advanced cancer and a poor prognosis, Likert scale items were used to operationalize (a) moral emotions: feeling shame and guilt about cancer getting worse, (b) moral motives for cancer treatment: perceiving an obligation to family for continuing potentially nonbeneficial treatments, and (c) moral performance: putting up the appearance of feeling better than how one is really feeling (5-point response scale, ).

Biological sex, microglial signaling pathways, and radiation exposure shape cortical proteomic profiles and behavior in mice.

Patients receiving cranial radiation therapy experience tissue damage and cognitive deficits that severely decrease their quality of life. Experiments in rodent models show that these adverse neurological effects are in part due to functional changes in microglia, the resident immune cells of the central nervous system. Increasing evidence suggests that experimental manipulation of microglial signaling can regulate radiation-induced changes in the brain and behavior.

Enhancing metabolic and inflammatory status in insulin-resistant rats: Acute intervention with cocoa flavanols and submaximal aerobic exercise activates intracellular signaling pathways for glucose metabolism.

Introduction: Type 2 diabetes, characterized by hyperglycemia, is closely linked to obesity and low-grade inflammation. Acute cocoa flavanols (CF) intake has demonstrated benefits in vasoreactivity, cognitive functions, and antioxidant enzyme activity. However, the physiological mechanisms of CF concerning glucose uptake, inflammatory mediators, and their interplay with aerobic exercise remain unclear in populations with metabolic diseases.

Associations between mindfulness and symptom severity among adults living with chronic obstructive pulmonary disease (COPD).

Background: Mindfulness-based interventions (MBI) benefit adults with chronic obstructive pulmonary disease (COPD) by helping them manage their symptoms and improve their quality of life. Little is known about their baseline mindfulness knowledge and practice and how these may relate to symptom management.

Objectives: To 1) compare symptom severity scores of depression, anxiety, dyspnea, fatigue, and insomnia between those who know and practice mindfulness and those who do not, and 2) construct phenotype profile characteristics of COPD patients based on their levels of mindfulness.

TRPS1 is a useful marker in differentiating metastatic breast carcinoma from pancreatic adenocarcinoma in fine-needle aspiration specimens.

Objectives: Distinction of metastatic breast carcinoma (BC) to the pancreas from primary pancreatic adenocarcinoma (PAC) is essential but challenging. Breast carcinoma shares similar morphology and exhibits an overlapping immunohistochemistry (IHC) profile with PAC. We investigated the utility of recently reported trichorhinophalangeal syndrome type 1 (TRPS1) IHC in differentiating metastatic BC from PAC in fine-needle aspiration (FNA) specimens.

High barriers to treatment are associated with stereotactic radiation instead of surgery for patients with operable stage I non-small cell lung cancer†.

Objectives: Although surgery is considered the standard of care for early-stage lung cancer, there has been increased use of stereotactic radiotherapy for operable patients in recent years. Given that this modality may be perceived as a more practical treatment, we hypothesized that it might be more often delivered to patients who experience barriers to care.

Methods: The National Cancer Database (2018-2020) was queried for patients with clinical stage IA non-small cell lung cancer treated with surgery or stereotactic radiotherapy (48-60 Gy, 3-5 fractions), excluding patients with contraindications to surgery.

A Prehospital Quality Improvement Framework to Reduce Mortality and Other Harms Associated with Opioid Use Disorder.

Objectives: In response to the escalating overdose crisis there is an urgent need for innovative strategies to reduce overdose death. Emergency Medical Services (EMS) is uniquely poised to reduce mortality and other harms associated with opioid use through prevention, harm reduction, and treatment, yet there is a paucity of nationally recognized best practices or quality measures to guide prehospital quality improvement (QI) efforts related to opioid use disorder (OUD).

Methods: A multidisciplinary team of subject matter experts in addiction medicine, EMS, public health, and QI was convened to develop recommendations for a model QI framework for prehospital OUD prevention, harm reduction, and treatment based on the Model for Improvement framework.

A comprehensive neuroimaging review of the primary and metastatic brain tumors treated with immunotherapy: current status, and the application of advanced imaging approaches and artificial intelligence.

Cancer immunotherapy has emerged as a novel clinical therapeutic option for a variety of solid tumors over the past decades. The application of immunotherapy in primary and metastatic brain tumors continues to grow despite limitations due to the physiological characteristics of the immune system within the central nervous system (CNS) and distinct pathological barriers of malignant brain tumors. The post-immunotherapy treatment imaging is more complex.

Deaf culture awareness among physicians and advanced practice providers in the emergency department: A multicenter study.

Background And Objective: In areas with a large Deaf/hard-of-hearing (DHH) population, emergency medicine (EM) providers may benefit from cultural awareness training as this has been shown to foster delivery of more equitable care in other minority populations. Rochester, New York, has been touted to be the home to the largest per-capita DHH population in the United States. Given the large local DHH community and DHH professionals working in Rochester, University of Rochester (UR) providers likely have higher exposure to DHH people than most other EM providers in the United States.

SHIP-1 Differentially Regulates IgE-Induced IL-10 and Antiviral Responses in Human Monocytes.

IgE-mediated stimulation of monocytes regulates multiple cellular functions including cellular maturation, cytokine release, antiviral responses, and T-cell differentiation. Expression of the high-affinity IgE receptor, FcεRI, is closely linked to serum IgE levels and atopic disease. The signaling molecules regulating FcεRI effector functions have been well studied in mast cells and basophils; however, less is known about the signaling and regulatory mechanisms in monocytes.

Treatment of Hypothyroidism by Age and Sex in the United States: A NHANES and Optum Claims Data Analysis.

Objective: Recent data using NHANES and Optum Claims data (OCD) showed an increase in primary hypothyroidism (HT) prevalence in the United States following the 2002 NHANES III report. Using these data, we characterized treatment patterns of overt HT (OHT) in the United States.

Methods: Data on adults with OHT were collected from NHANES (2009-2012) and OCD (2012-2019).

A Review of Autoimmune Thyroid Diseases and Their Complex Interplay with Female Fertility.

Hashimoto thyroiditis and Graves' disease are autoimmune thyroid disorders that are common in women of reproductive age and have a complex relationship with female fertility and health of the maternal-fetal dyad. Both hyperthyroidism and hypothyroidism, whether subclinical or overt in severity, directly or indirectly affect nearly every level of the hypothalamic-pituitary-ovary axis, uterine and ovarian function, as well as fetal development from implantation through delivery. Autoimmunity itself also appears to negatively impact both spontaneous and assisted fertility, as well as miscarriage risk, although the mechanism remains unclear, and the presence and magnitude of risk is variable in published literature.