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Mashup Score: 8Of Minds and Embryos: Left-Right Asymmetry and the Serotonergic Controls of Pre-Neural Morphogenesis - 4 month(s) ago
Abstract. Serotonin is a clinically important neurotransmitter regulating diverse aspects of cognitive function, sleep, mood, and appetite. Increasingly, it is becoming appreciated that serotonin signaling among non-neuronal cells is a novel patterning mechanism existing throughout diverse phyla. Here, we review the evidence implicating serotonergic signaling in embryonic morphogenesis, including gastrulation, craniofacial and bone patterning, and the generation of left-right asymmetry. We propose two models suggesting movement of neurotransmitter molecules as a novel mechanism for how bioelectrical events may couple to downstream signaling cascades and gene activation networks. The discovery of serotonin-dependent patterning events occurring long before the development of the nervous system opens exciting new avenues for future research in evolutionary, developmental, and clinical biology.
Source: karger.comCategories: General Medicine News, Future of MedicineTweet
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Mashup Score: 9Association between Time with Open Ductus Arteriosus and Outcomes in Congenital Diaphragmatic Hernia - 4 month(s) ago
Abstract. Introduction: While a patent ductus arteriosus (PDA) helps offload the right ventricle in the acute congenital diaphragmatic hernia (CDH)-associated pulmonary hypertension, its role on long-term outcomes in CDH has not been investigated. Our objective was to examine associations of the PDA with long-term clinical outcomes in CDH. Methods: A single-center retrospective descriptive study of 122 CDH patients dichotomized by duration with PDA, as ≤14 versus >14 postnatal days (PND) and ≤30 versus >30 PND. Fisher’s exact test, Wilcoxon rank-sum test, and multiple linear and logistic regression analyses were used for analyses. Results: In unadjusted and adjusted for CDH severity comparisons, patients with PDA >14 PND and >30 PND had a higher risk of death, longer length of stay, mechanical ventilation duration, and need for tracheostomy, diuretics, and PH medications at discharge. Conclusion: A PDA beyond the newborn period is associated with adverse outcomes in infants with CDH.
Source: karger.comCategories: General Medicine News, General HCPsTweet
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Mashup Score: 6Association between Time with Open Ductus Arteriosus and Outcomes in Congenital Diaphragmatic Hernia - 4 month(s) ago
Abstract. Introduction: While a patent ductus arteriosus (PDA) helps offload the right ventricle in the acute congenital diaphragmatic hernia (CDH)-associated pulmonary hypertension, its role on long-term outcomes in CDH has not been investigated. Our objective was to examine associations of the PDA with long-term clinical outcomes in CDH. Methods: A single-center retrospective descriptive study of 122 CDH patients dichotomized by duration with PDA, as ≤14 versus >14 postnatal days (PND) and ≤30 versus >30 PND. Fisher’s exact test, Wilcoxon rank-sum test, and multiple linear and logistic regression analyses were used for analyses. Results: In unadjusted and adjusted for CDH severity comparisons, patients with PDA >14 PND and >30 PND had a higher risk of death, longer length of stay, mechanical ventilation duration, and need for tracheostomy, diuretics, and PH medications at discharge. Conclusion: A PDA beyond the newborn period is associated with adverse outcomes in infants with CDH.
Source: karger.comCategories: General Medicine News, General HCPsTweet
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Mashup Score: 7Predictive accuracy of clinicians estimates of death and recovery after acute intracerebral hemorrhage: pre-specified analysis in INTERACT3 study - 5 month(s) ago
Abstract. Introduction: Accurately predicting a patient’s prognosis is an important component of decision-making in intracerebral hemorrhage (ICH). We aimed to determine clinicians’ ability to predict survival, functional recovery, and return to premorbid activities in patients with ICH. Methods: Pre-specified secondary analysis of the third INTEnsive care bundle with blood pressure Reduction in Acute Cerebral hemorrhage Trial (INTERACT3), an international, multicenter, stepped-wedge cluster randomized controlled trial. Clinician perspectives on prognosis were collected at hospital admission and Day 7 (or before discharge). Prognosis questions were the likelihood of (i) survival at 48 hours and 6 months, (ii) favorable functional outcome (recovery walking and self-care) and (iii) return to usual activities at 6 months. Clinician predictions were compared with actual outcomes. Results: Most clinician participants were from neurosurgery (75%) with a median of 8 working years (IQR 5-14) o
Source: karger.comCategories: General Medicine News, NephrologyTweet
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Mashup Score: 6Acute Kidney Injury in Cardiorenal Syndrome Type 1 Patients: A Systematic Review and Meta-Analysis - 5 month(s) ago
Abstract. Background: We evaluated the epidemiology and outcome of acute kidney injury (AKI) in patients with cardiorenal syndrome type 1 (CRS-1) and its subgroups: acute heart failure (AHF), acute coronary syndrome (ACS) and after cardiac surgery (CS). Summary: We performed a systematic review and meta-analysis. CRS-1 was defined by AKI (based on RIFLE, AKIN and KDIGO), worsening renal failure (WRF) and renal replacement therapy (RRT). We investigated the three most common clinical causes of CRS-1: AHF, ACS and CS. Out of 332 potential papers, 64 were eligible – with AKI used in 41 studies, WRF in 25 and RRT in 20. The occurrence rate of CRS-1, defined by AKI, WRF and RRT, was 25.4, 22.4 and 2.6%, respectively. AHF patients had a higher occurrence rate of CRS-1 compared to ACS and CS patients (AKI: 47.4 vs. 14.9 vs. 22.1%), but RRT was evenly distributed among the types of acute cardiac disease. AKI was associated with an increased mortality rate (risk ratio = 5.14, 95% CI 3.81-6.94;
Source: karger.comCategories: General Medicine News, NephrologyTweet
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Mashup Score: 39
Hypertrophic cardiomyopathy (HCM) is one of the most common inherited cardiovascular diseases, with a prevalence between 1:200 and 1:500, affecting more than 20 million people worldwide [1]. Although the majority (∼75%) of HCM patients have normal life expectancy without limiting symptoms, the natural history of the disease includes ominous events such as atrial fibrillation and stroke, infective endocarditis, heart failure (HF) to the worst scenario represented by sudden cardiac death (SCD). HF can develop over time mainly through three different phenotypes: left ventricular (LV) obstruction (obstructive HCM), non-obstructive HCM with a normal or preserved ejection fraction (LVEF), “end-stage” HCM or hypokinetic-dilated evolution (ES-HCM) [1].The major determinants of the most ominous outcomes, namely, all-cause death, SCD, hospitalization for HF, and HF progression, have been largely researched and studied over time and only partially identified and characterized. To date, the role o
Source: karger.comCategories: General Medicine News, CardiologistsTweet
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Mashup Score: 27
Abstract. Introduction. Chronic kidney disease (CKD) drives onerous human and healthcare costs, underscoring an urgent need to avert disease progression. Secondary hyperparathyroidism (SHPT) develops as CKD advances, and persistently elevated parathyroid hormone (PTH) may be nephrotoxic and associated with earlier dialysis onset. This study examines, for the first time, the hypothesis that sustained reduction of elevated intact PTH (iPTH) with extended-release calcifediol (ERC) reduces the nephrotoxic impact of SHPT and forestalls renal decline. Methods. Changes in estimated glomerular filtration rate (eGFR) were analyzed post-hoc in 126 adults with SHPT, stage 3-4 CKD and low serum 25-hydroxyvitamin D (25D) treated for one year with ERC in pivotal trials. ERC was administered at 30 μg/day increasing, as needed, to 60 μg/day to achieve ≥30% reductions in iPTH. Calcium, phosphorus, 25D, 1,25-dihydroxyvitamin D (1,25D), iPTH, eGFR, fibroblast growth factor 23 (FGF23), bone turnover marke
Source: karger.comCategories: General Medicine News, Partners & KOLsTweet
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Mashup Score: 30A randomized trial on Hemodynamic Optimization of cerebral Perfusion after successful Endovascular therapy in patients with acute ischemic stroke (HOPE) - 6 month(s) ago
Abstract. Introduction: In patients with acute ischemic stroke (AIS) secondary to intracranial large vessel occlusion (LVO), optimal blood pressure (BP) management following endovascular treatment (EVT) has not yet been established. The randomized trial on Hemodynamic Optimization of cerebral Perfusion after successful Endovascular therapy in patients with acute ischemic stroke (HOPE) (clinicaltrials.gov id: NCT04892511), aims to demonstrate whether hemodynamic optimization using different systolic BP targets following EVT according to the degree of final recanalization, is more effective than currently recommended BP management in improving functional outcomes of patients with AIS. Methods: HOPE is an investigator-initiated multicentre clinical trial with randomized allocation, open label treatment, and blinded endpoint evaluation (PROBE). Patients with an anterior circulation AIS within 24h of symptom onset, treated with EVT, and showing successful recanalization (mTICI ≥2b) at the e
Source: karger.comCategories: General Medicine News, NephrologyTweet
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Mashup Score: 41
Abstract. Background: Generative artificial intelligence (AI) is rapidly transforming various aspects of healthcare, including critical care nephrology. Large language models (LLMs), a key technology in generative AI, show promise in enhancing patient care, streamlining workflows, and advancing research in this field. Summary: This review analyzes the current applications and future prospects of generative AI in critical care nephrology. Recent studies demonstrate the capabilities of LLMs in diagnostic accuracy, clinical reasoning, and continuous renal replacement therapy (CRRT) alarm troubleshooting. As we enter an era of multiagent models and automation, the integration of generative AI into critical care nephrology holds promise for improving patient care, optimizing clinical processes, and accelerating research. However, careful consideration of ethical implications and continued refinement of these technologies are essential for their responsible implementation in clinical practic
Source: karger.comCategories: General Medicine News, NephrologyTweet
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Mashup Score: 14Intestinal ultrasonography diagnostic performance and feasibility in IBD during pregnancy: a systematic review and narrative synthesis. - 7 month(s) ago
Abstract. Introduction: Inflammatory bowel diseases (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC) are associated to poor maternal and foetal outcomes during pregnancy, requiring a strict monitoring of the disease activity, preferably with non-invasive modalities. There are numerous data confirming intestinal ultrasonography (IUS) accuracy and efficacy for the detection of IBD disease activity and complications, but data in pregnant IBD patients are scarce. We aimed to evaluate the diagnostic performance and feasibility of IUS to monitor IBD activity throughout pregnancy. Methods: A systematic literature review has been performed identifying studies the use of ultrasound modality in pregnant inflammatory bowel disease women from date of inception until April 2024 using MEDLINE, Cochrane library, EMBASE and ISI Web of Science databases, with keywords including 1) ultrasound/ultrasonography2) pregnancy, and 3) IBD (CD and UC). Additional relevant studies were identifie
Source: karger.comCategories: General Medicine News, GastroenterologyTweet
RT @drmichaellevin: @niko_kukushkin And, serotonin functions long before brains or neurons appear - https://t.co/UG4AO5I6ma how much of th…