MemorialCare Health System

Analyzing gene expression data from three separate clinical trials, we find that the antiretroviral drug tenofovir, which belongs to the class of nucleotide analogue reverse transcriptase inhibitors, induces the type I/III interferon system of innate immunity in the mucosa. This effect occurs in the absence of HIV infection and manifests itself over various treatment durations and after both oral and topical drug delivery. Tenofovir and other related medications are important components of long-term antiretroviral treatment taken by people living with HIV. Therefore, this unexpected immunological effect might need to be considered as a potential contributor to comorbidities in people living with HIV, as well as an immunopharmacological co-factor when testing novel HIV cure interventions. This study is registered with ClinicalTrials.gov as NCT01768962, NCT01687218, and NCT01232803.

Introduction: Chronic low-grade systemic inflammation constitutes a central biological feature of aging and a key factor in the development of multiple chronic diseases [1,2]. The soluble urokinase Plasminogen Activator Receptor (suPAR) has emerged as a robust biomarker of chronic systemic inflammation and biological vulnerability [3-5]. Nutritional strategies aimed at modulating intracellular redox balance may influence upstream inflammatory pathways involved in the regulation of suPAR [6-9]. Objective: To explore whether supplementation with a cysteine-rich whey protein isolate, a glutathione precursor, is associated with changes in circulating suPAR concentrations and health-related quality of life in adults. Methods: An exploratory, open-label, single-arm, longitudinal pre-post intervention proof-of-concept study. Twelve adult participants received oral supplementation with a cysteine-rich whey protein isolate (Immunocal®) for three months. Circulating suPAR concentrations and health-related quality of life, assessed using the SF-36 questionnaire, were measured at baseline and at the end of the intervention. Results: After three months of supplementation, mean suPAR levels decreased from 3.19 to 1.87 ng/mL (mean Δ = 1.31; p < 0.0001). Mean total SF-36 scores increased from 71.77 to 87.39 (mean Δ = 15.61; p < 0.0001). The intervention was well tolerated and no serious adverse events were reported. Conclusion: Supplementation with glutathione precursors using Immunocal® for a three-month period was associated with a significant reduction in circulating suPAR concentrations, a consolidated biomarker of chronic systemic inflammation and immune activation, as well as with concomitant improvements in health-related quality of life in adults.

Upper blepharoplasty is the most common cosmetic procedure in East Asia. A natural Asian double eyelid features specific crease characteristics. AI advancements, such as UNet and PointRend, enhance medical image segmentation, aiding in post-blepharoplasty evaluation. This study applies deep neural networks to analyze facial images, providing morphological parameters to assist surgeons in assessing outcomes and planning revisions. This study included 102 eyes from 51 patients seeking for revisional blepharoplasty and 100 eyes from 50 volunteers with inborn double eyelid. Standardized images and videos were collected. The deep learning-based image analysis automatically evaluated four eyelid morphological parameters, including pre-tarsal show, corneal visibility ratio, dynamic value, and crease depth. Analysis was done on the agreement between the automated measures and the manual measurements. The parameters of the patients' and volunteers' eyelids were compared. FACE-Q surveys were used to measure patient-reported esthetic outcomes. The intraclass correlation coefficients between manual measures and automated measurements of pre-tarsal show, corneal visibility ratio, and dynamic value were 0.973, 0.975, and 0.965. At the long-term follow-up, the pre-tarsal show and crease depth decreased significantly, whereas the corneal visibility ratio and dynamic value increased significantly. FACE-Q scores demonstrated a high level of patient satisfaction for facial appearance (87.6) and were negatively correlated with pre-tarsal show (r = - 0.814, p = 0.000). The deep neural network technique automatically measured the eyelid morphology with excellent precision and reproducibility, enabling an objective evaluation of the surgical outcomes for blepharoplasty. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

BackgroundRespiratory syncytial virus (RSV) vaccines were approved in 2023 and recommended for adults over the age of 75 and adults aged 60 – 74 at high risk of severe RSV infection. In this study, we investigated nationwide RSV vaccine administration and the efficacy of RSV vaccines in adults aged over 60.Figure 1.Monthly RSV vaccinations and testing volumes in adults 60 - 74 years of age and in adults 75+ from September 2022 to December 2024. Gray bars and the left y-axis indicate RSV testing volumes. Orange bars and right y-axis indicate RSV vaccination volumes.Figure 2.RSV testing volumes normalized to all respiratory panel testing volumes in December of 2022 – 2024 in adults 60 – 74 years of age and in adults 75+MethodsWe conducted an observational analysis of two nationwide, deidentified crossover datasets of 107,035 RSV vaccination events from September 2023 to December 2024 and 6,660 RSV diagnostic testing from September 2022 to December 2024 in adults over the age of 60 who were administered seasonal vaccinations. Time-to-event analysis was conducted for 110 adults over age 60 with RSV diagnostic testing performed at Labcorp within one year of vaccination.Figure 3.Monthly RSV positivity rates and vaccination volumes in adults 60 – 74 years of age and in adults 75+ from September 2022 to December 2024. Line plot indicates RSV positivity rates. Orange bars and right y-axis indicate RSV vaccination volumes. Shapes indicate the number of diagnostic tests performed per month.Figure 4.RSV diagnostic testing results within one year of RSV vaccination in 57 adults o60 – 74 years of age and in 53 adults 75+. Bars are colored by when each patient received the RSV vaccine.ResultsPeak uptake of RSV vaccines occurred in November 2023 in the 2023 – 2024 RSV vaccination season and in October 2024 in the 2024 – 2025 RSV vaccination season in adults aged 60 – 74. For adults 75+, peak vaccine uptake occurred in November 2023 and October 2024 (Fig 1). Peak RSV testing in adults aged 60 – 74 occurred in December. Peak RSV testing in adults 75+ occurred in December 2022 and in January and December 2024. Peak uptake of RSV vaccines occurred 1 – 2 months prior to the peak RSV testing months. Testing volumes in peak testing month of December decreased by 43.8% in adults aged 60 – 74 and by 42.5% in adults 75+ 2024 from 2023 (Fig 2). Peak RSV positivity rates in 2023 – 2024 RSV vaccination season occurred in December in adults aged 60 – 74 (9.3%) and adults aged 75+ (7.4%; Fig 3). Vaccine uptake peaked 1 – 2 months prior to peak RSV positive months. There were no breakthrough RSV infections in 57 adults aged 60 – 74 or in 53 adults aged 75+ with RSV diagnostic testing within one year of vaccination (Fig 4).ConclusionOur data demonstrate a potential correlation between the introduction of RSV vaccines and a reduction in RSV diagnostic testing in older adults. Furthermore, our data suggests that RSV vaccination is highly protective for RSV infection with zero breakthrough infections in a limited dataset. Further longitudinal study is warranted.DisclosuresKathryn Lang, MD, PhD, VaxCare: Advisor/Consultant David Alfego, PhD, Labcorp: Employee|Labcorp: Employee|Labcorp: Stocks/Bonds (Public Company) Min Kyung Lee, PhD, Labcorp: Employee|Labcorp: Stocks/Bonds (Public Company) Laura Gillim, PhD, Labcorp: Stocks/Bonds (Public Company) Charles M. Walworth, MD, Labcorp: Employee|Labcorp: Stocks/Bonds (Public Company)|Labcorp: Stocks/Bonds (Public Company) Suzanne Dale, PhD, Labcorp: Stocks/Bonds (Public Company) Colm Smart, MBA, VaXcare: Stocks/Bonds (Private Company) Ruth Carrico, PhD, DNP, APRN, VaxCare: Advisor/Consultant Payman Ghasemi, PhD, VaxCare: Grant/Research Support

Background: Percutaneous dilatational tracheostomy (PDT) is a widely used procedure in intensive care units (ICUs) for patients requiring prolonged airway support. Traditionally, PDT is performed by two physicians—an intensivist or surgeon, and a second physician providing bronchoscopy guidance. However, many community hospitals face a shortage of intensivists and limited resources, prompting the need to evaluate the safety and feasibility of a bedside PDT team model that utilizes available hospital staff in such settings. Aim and Objectives: This study aims to demonstrate that PDTs can be safely performed in a community hospital with limited resources by a team led by an intensivist and supported by a hospitalist or internal medicine resident. The objective is to assess procedural safety, team composition, and resource utilization, encouraging similar institutions to establish PDT teams without the need for multiple subspecialists. The study does not address optimal timing of tracheostomy or compare PDT with surgical tracheostomy. Methods: We conducted a single-center retrospective case series analyzing all PDTs performed between 2017 and June 2020 in a community hospital. The study included 42 patients who underwent 43 PDT procedures. The bedside PDT team consisted of an intensivist, a hospitalist or internal medicine resident, a respiratory therapist, and a nurse. A standardized 15-point procedural safety checklist was used, and patient selection was guided by clinical examination and neck ultrasound to identify contraindications. All team members received targeted training in airway management and crew resource management (CRM) tactics to enhance safety and communication. Results: Out of 43 PDTs performed, no procedural deaths occurred, and major complications were infrequent. Seven deaths within seven days post-procedure were unrelated to PDT. The mean patient age was 65.6 years, and 31% had a BMI ≥30 kg/m2. The average procedure time was 18 minutes. Complications included two cases of accidental decannulation, one significant hemorrhage requiring surgical intervention, and one case of cellulitis, all of which were managed appropriately. No cases resulted in permanent loss of airway, paratracheal cannulation, tracheal perforation, or pneumothorax. Team protocols and staff education were adapted following adverse events, such as mandatory suture placement for tube security and enhanced anticoagulation management. Conclusion: The establishment of a bedside PDT team in a community hospital is both safe and feasible, even with limited resources and staffing. Effective training, standardized protocols, and CRM strategies contribute to procedural safety and positive patient outcomes. These findings support the adoption of similar PDT teams in resource-limited settings, potentially improving access to tracheostomy care without reliance on multiple subspecialists. Limitations: It is important to note that the findings from this study should not be generalized to all community hospitals, especially those that do not have PDT team members with sufficient or appropriate training. The safety and feasibility outcomes observed in this case series are directly tied to the presence of a multidisciplinary team whose members had received targeted education in airway management, neck ultrasound, and crew resource management tactics. Therefore, hospitals lacking similarly trained staff may not achieve comparable results, and the implementation of bedside PDT should be approached with caution in such settings.

Pelvic inflammatory disease (PID) remains a major cause of tubal factor infertility. Although in vitro fertilization (IVF) has largely replaced reconstructive surgery, selected patients with mild tubal damage may still achieve natural conception after surgical repair. This case highlights a spontaneous conception following bilateral fimbrioplasty in a patient with mild post-PID distal tubal occlusion. A 33-year-old, gravida 4 para 2, woman presented with three years of secondary infertility. Hysterosalpingogram (HSG) showed mild bilateral hydrosalpinx and distal tubal occlusion, with normal ovarian reserve and hormonal evaluation. The patient underwent robotic fimbrioplasty on July 23, 2025. Operative findings included Fitz-Hugh-Curtis changes, bilateral filmy adhesions, and grade-I distal occlusion. Bilateral adhesiolysis and fimbrioplasty were performed with restoration of tubal patency on chromotubation. The postoperative course was uncomplicated. Ten weeks after surgery, the patient conceived spontaneously with a normal intrauterine pregnancy. Tubal reconstructive surgery remains a valuable fertility-preserving option for selected patients who decline or lack access to IVF. Success depends on careful patient selection, minimal tubal damage, and meticulous microsurgical technique. Tubal reconstruction can offer selected women an affordable, fertility-preserving option, especially in low-resource settings where IVF is inaccessible.

Criminal thinking refers to cognitive distortions that justify antisocial and unlawful conduct and is increasingly recognized as a clinically relevant barrier to rehabilitation, relapse prevention, and reintegration. Parental bonding is a foundational developmental influence on emotional security and self-regulation, whereas peer environments shape identity formation, behavioral norms, and cognitive justification processes particularly among vulnerable individuals. Self-Determination Theory (SDT) proposes that chronic frustration of autonomy, relatedness, and competence needs can heighten susceptibility to maladaptive external influence and deviant social reinforcement, which may contribute to criminogenic cognition.This study examined associations between parental bonding and criminal thinking among drug rehabilitation patients in Pakistan and evaluated whether peer influence can be positioned as a theoretically defensible mediating mechanism within an SDT framework. Using the available dataset, empirical analyses focused on parental bonding and criminal thinking, while dark tetrad traits were modeled as criminogenic personality correlates.A cross-sectional correlational design was employed. Participants (N = 123) were recruited from rehabilitation centers in Lahore, Pakistan. Measures included the Parental Bonding Instrument (PBI), the Texas Christian University Criminal Thinking Scales (TCU-CTS), and the Short Dark Tetrad (SD4). Data were analyzed using descriptive statistics, reliability analysis, bivariate correlations, hierarchical regression, and regression-based mediation modeling.Criminal thinking was positively associated with dark tetrad traits and demonstrated meaningful patterns across psychosocial indicators. Parenting dimensions did not yield a statistically significant indirect pathway through dark tetrad traits. However, results supported SDT-consistent interpretations that social-contextual mechanisms particularly peer influence may act as reinforcement pathways shaping criminogenic cognition in addiction-linked rehabilitation populations.The findings confirm that criminogenic personality traits are strongly linked to criminal thinking among Pakistani rehabilitation patients. Although peer influence could not be tested as a statistical mediator within the available dataset, SDT provides a coherent explanatory model suggesting that need frustration within family relationships increases vulnerability to deviant peer norms, reinforcing criminal thinking styles. Rehabilitation programs should combine cognitive restructuring, family-based relational repair, and peer-context interventions to reduce criminogenic cognition and relapse vulnerability.