Mercy Health

SummaryThis study evaluated lumbar spine bone mineral density and trabecular bone score in ISS astronauts using DXA under 3 different countermeasure regimes. ARED + bisphosphonate maintained BMD, while both ARED and ARED + bisphosphonate preserved TBS. TBS supplements DXA assessments of spaceflight effects on bone health.PurposeTo assess the utility of lumbar spine (LS) bone mineral density (BMD) and trabecular bone score (TBS) from scans using dual x-ray absorptiometry (DXA) performed in astronauts before and after spaceflights aboard the International Space Station (ISS). The influence of mission duration and of inflight countermeasures on changes described by BMD and TBS was also evaluated from longitudinal DXA tests performed postflight.MethodsPreflight and postflight DXA scans, from which BMD and TBS were acquired, were performed from 51 crewmembers: 41 men (mean age ± SD, 48 ± 5, range 37–56 years) and 10 women (mean age ± SD, 44 ± 3 years, range 41–50 years) who flew on missions of ~ 6 months duration. Participants were categorized into three groups: Pre-ARED (advanced resistive exercise device) (n = 24), ARED (n = 20), and ARED + bisphosphonate (alendronate 70 mg/week) (n = 7). Longitudinal DXA scans were obtained from 311 individual astronauts (266 men, 45 women; age range, 41–80 years) from November 1999 to February 2014 to assess trends following spaceflights, categorized as short-duration (less than 1 bone remodeling cycle [BRC]) and long-duration (> 1 BRC).ResultsOnly the ARED + bisphosphonate group was not different from preflight BMD (+ 2.8%, p = 0.1). Regarding TBS, both the ARED and ARED + bisphosphonate countermeasure groups were not different from preflight (+ 0.2%, p = 0.7; −1.5%, p = 0.3). Longitudinal trends of TBS and BMD from short-duration missions revealed declining trends in men. In terms of long-duration missions, there tended to be declining trends in spine BMD and TBS when plotted as a function of age.ConclusionDXA can detect how various in-flight countermeasures and the length of mission affect the lumbar spine that is enhanced with the addition of TBS.

Introduction Among patients with emergent large vessel occlusion due to intracranial stenosis (ICAS‐LVO), the effect of reperfusion status following thrombectomy remains unknown. In this secondary analysis of the RESCUE‐ICAS registry, we evaluated the impact of baseline reperfusion status on outcomes of mechanical thrombectomy with and without bailout stenting. Methods We conducted a secondary analysis of the RESCUE‐ICAS registry which included patients who underwent thrombectomy with or without bailout stenting for acute ICAS‐LVO. Patients were classified into four groups based on baseline reperfusion status and stenting use. Successful recanalization was defined as modified Thrombolysis in Cerebral Infarction (mTICI) ≥2B. The primary outcome was 90‐day functional independence (mRS 0‐2). Associations were analyzed using multivariable logistic regression with inverse probability of treatment weighting (IPTW). Results A total of 413 patients were analyzed across four groups: MT alone with failed recanalization (n=55), MT alone with successful recanalization (n=184), MT with stent after failed pre‐stent recanalization (n=108), and MT with stent after successful pre‐stent recanalization (n=66). Baseline characteristics were similar, except for age (p=0.004) and hyperlipidemia (p=0.003). On multivariable analysis, there was no difference in 90‐day outcome between patients with MT + bailout stenting with and without successful pre‐stent reperfusion. However, MT + bailout stenting with successful pre‐stenting reperfusion was associated with better 90‐day outcome compared to MT alone with successful reperfusion. Conclusion Adjunct stenting was associated with improved 90‐day functional outcomes in ICAS‐LVO patients even in patients with successful pre‐stenting reperfusion. These findings support early consideration of stenting in ICAS‐LVO to reduce re‐occlusion risk and improve long‐term outcomes. image

Introduction The influence of collateral circulation on outcomes in intracranial atherosclerotic stenosis‐related large vessel occlusion (ICAS‐LVO) treated with mechanical thrombectomy (MT) with or without rescue stenting is not well defined. We aimed to determine whether collateral status modifies the effect of stenting on angiographic and clinical outcomes. Methods We analyzed patients with ICAS‐LVO in the RESCUE‐ICAS registry who underwent MT alone or with rescue stenting in the anterior circulation. Collaterals were graded as good or bad based on ASITN/SIR score. Outcomes included functional independence (mRS 0‐2 at 90 days), mortality, successful recanalization, sICH, and 24‐hour DWI infarct volume. Regression models evaluated stenting and collateral status interaction, adjusted using inverse probability weighting for age, sex, race, diabetes, hypertension, atrial fibrillation, hyperlipidemia, prior stroke, smoking, pre‐stroke mRS, admission NIHSS, IV tPA, and baseline ASPECTS, with weights trimmed at ≤4. Results A total of 324 patients were included (MT alone, n=182; stent+MT, n=142). Median age was 67 years, 57% were male, and vascular comorbidities were frequent. Good collaterals were present in 27% of cases. Interaction analysis between stenting and collateral status showed no significant effect modification for functional independence (adjusted OR 0.78, 95% CI 0.33‐1.82, p =0.560), mortality (adjusted OR 1.56, 95% CI 0.52‐4.68, p =0.425), sICH (adjusted OR 0.22, 95% CI 0.04‐1.42, p =0.112), or infarct volume (β = ‐10.1 mL, 95% CI ‐32.9 to 12.7, p =0.656). A borderline interaction was observed for successful recanalization, with stenting in the setting of good collaterals associated with higher odds of reperfusion (adjusted OR 5.34, 95% CI 0.90‐31.7, p =0.065). Conclusions In patients with anterior circulation ICAS‐LVO, collateral status did not significantly modify the benefit of rescue stenting. These findings suggest that good collaterals alone do not obviate the need for stenting, and highlight the need for prospective studies to define optimal medical management strategies in this population. image image

Figure 1 Age-adjusted NSCLC mortality rates in the United States (1999-2023).Annual age-adjusted mortality rates (AAMR) per 100,000 for non-small cell lung cancer (NSCLC) in U.S. adults aged !45 years

Abstract Introduction Managing atherosclerotic large vessel occlusion is procedurally challenging. Prior literature pertaining to technical considerations remain heterogenous and further research is necessary to highlight important differences. As such, first-line thrombectomy technique remains an active area of debate with respect to rate of recanalization, need for rescue stenting, and hemorrhagic complications. Methods This is a pre-planned analysis of the prospective RESCUE-ICAS registry which included atherosclerotic large vessel occlusions treated with mechanical thrombectomy from 25 sites. Patients were excluded if they had missing data on first-line technique or primary outcomes. Patients were dichotomized into two cohorts based on whether their first-line thrombectomy technique was with aspiration alone or a stentriever (SR). Primary procedural outcome was first-pass effect while primary safety outcome was mortality at 90 days. Propensity score matching and inverse probability weighted analysis were performed with respect to primary and secondary outcomes. Results 419 were patients included in this analysis with 266 and 153 patients in the aspiration and stentriever cohorts, respectively. The cohort’s mean age was 68 (SD ±13) years, and the majority of patients were white (59%) and male (62%). There were no significant baseline demographic differences between cohorts; however, ICA occlusions were more common in the stentriever cohort (52% vs 31%), while MCA occlusions were more frequent in the aspiration cohort (35% vs 15%). In the un-adjusted model, first pass effect was higher in stentriever versus aspiration (35.3% vs 23.7%, p = 0.01) with equivalent mortality rates (31% vs 26%, p = 0.31). Distal embolization rates were higher in the aspiration cohort (9.8% vs 3.9%, p = 0.03), yet aspiration was associated with lower composited procedural complications (6% vs 11%, p = 0.01). Propensity score matching and weighted analysis demonstrated that differences in primary clinical efficacy and safety outcomes were insignificant between cohorts. Conclusion In patients with atherosclerotic large vessel occlusions, first line stentriever utilization was associated with higher first-pass effect rates, lower rates of distal embolization and shorter procedural length compared to aspiration. However, no clinical outcome difference was appreciated between the two groups and aspiration was associated with lower complication rates.

Purpose Online awareness, or the ability to detect errors and monitor performance during activities, is a component of functional cognition essential for safety and independence within everyday activities. There is a lack of assessment methods that target online awareness for individuals with neurological conditions. This study aimed to make recommendations for a clinically useful method for assessing online awareness in rehabilitation. Materials and methods The methods included a conceptual analysis to define online awareness and identify existing assessment approaches; three rounds of Delphi surveys involving an international expert panel to develop an online awareness assessment; and pilot testing of the assessment with consumers. Results The conceptual analysis generated an online awareness definition framework that included four key elements: appraisal, anticipation/prediction, monitoring, and self-evaluation. This framework guided survey questions posed to the expert panel. The Delphi process supported development of the ‘Online Awareness Behaviours Scale’, an assessment that can be used in clinical practice and research. Consumer feedback indicated high levels of usability and acceptability of the assessment. Conclusions The Online Awareness Behaviours Scale is a new, clinically acceptable tool for rehabilitation clinicians that assesses online awareness of individuals with neurological conditions.

Herpesviruses have evolved numerous immune evasion tactics, persisting within their hosts through self-perpetuating strategies. One such tactic involves acquiring functional copies of host genes encoding cytokines such as IL-6 (HHV-8), IL-10 (HHV-4, HHV-5), and IL-17 (SaHV-2). These viral mimics, or virokines, can bind to cellular receptors, modulating the natural cytokine signaling to manipulate the immune response in favor of the virus or stimulate target cell growth to enhance virus replication. In the course of full-length cDNA sequencing of infectious laryngotracheitis virus (ILTV) transcripts, a previously unknown highly spliced gene was discovered in the viral genome predicted to encode a 147 amino acid protein with similarity to vertebrate interleukin-4. The three-intron gene structure was precisely conserved with chicken and other vertebrate IL-4 homologs, and the amino acid sequence displayed structural conservation with vertebrate homologs at the primary, secondary, and tertiary levels based on computational modeling. The viral IL-4 gene was subsequently identified in all sequenced ILTV genomes. The mature transcript was highly expressed both in vitro and in vivo, and protein expression in infected cells was confirmed using LC-MS/MS. Phylogenetic analyses, along with the conserved gene structure, suggested direct capture from a Galliformes host. Functionally, an LPS-stimulation assay showed that the expressed viral IL-4 homolog stimulated nitric oxide production in a macrophage cell line at comparable levels to recombinant chicken IL-4. A recombinant virus lacking vIL-4 exhibited slightly higher titers in cell culture compared to the parental strain. In vivo bird studies demonstrated reduced pathogenicity of the vIL-4 knockout compared to wildtype. These results represent the first report of a previously unknown virokine encoded in the ILTV genome expressing a functional IL-4 homolog and virulence factor.