Northside Hospital

Nausea and vomiting, whether acute or chronic, often result from disturbances in the central, autonomic, and enteric nervous systems. Both space motion sickness and gastrointestinal motility disorders share overlapping mechanisms involving autonomic dysfunction, abnormal gastric myoelectric activity, and delayed gastric emptying. Conventional medical and surgical treatments often provide incomplete relief or cause undesirable side effects, which has encouraged investigation into nonpharmacologic approaches. This study evaluates the therapeutic potential of Autogenic Feedback Training Exercise, a behavioral intervention developed by the National Aeronautics and Space Administration, as an adjunctive treatment for patients with gastrointestinal motility disorders and related autonomic dysfunction. Findings from clinical and experimental research involving astronauts, pilots, and individuals with gastrointestinal motility disorders were reviewed. The training combines cognitive imagery and biofeedback techniques to help subjects voluntarily regulate physiological responses such as heart rate, blood pressure, and skin conductance. Sessions typically last thirty minutes and include alternating relaxation and arousal exercises over several weeks. Autogenic Feedback Training Exercise increased motion sickness tolerance and reduced sympathetic activation while improving physiological stability. In individuals with gastrointestinal motility disorders, it enhanced gastric emptying, improved electro gastrographic activity, and lessened symptom severity, particularly in those with mild to moderate delay in gastric emptying. When combined with gastric electrical stimulation, outcomes further improved through enhanced autonomic and enteric regulation. Autogenic Feedback Training Exercise offers a promising, noninvasive approach for restoring autonomic balance and improving gastrointestinal function. Remote delivery through telemedicine may expand access for patients with chronic illness.

High cervical spinal cord injuries (SCIs) can lead to diaphragmatic paralysis, necessitating long-term mechanical ventilation. Diaphragmatic pacemakers (DPs) offer an alternative by stimulating the phrenic nerve to restore diaphragmatic function, thereby improving quality of life and reducing ventilator dependence. However, anesthetic management for DP placement presents unique challenges due to the need to preserve diaphragmatic activity and manage autonomic instability. This case reports a 35-year-old male with complete C4 SCI resulting in quadriplegia and respiratory failure requiring mechanical ventilation. After multiple interventions, including spinal fusion and tracheostomy, he underwent DP placement to reduce ventilator dependency. The patient was successfully transitioned to DP postoperatively and discharged from the hospital on room air via a tracheostomy collar. DP is a valuable intervention for high cervical SCI patients but requires anesthetic strategies that preserve diaphragmatic function and manage common complications such as pneumothorax, autonomic dysreflexia, and ventilator challenges with abdominal insufflation. Avoiding muscle relaxants, continuous diaphragmatic monitoring, and proactive hemodynamic management are essential. The literature highlights rare but serious device-related complications, emphasizing the importance of vigilant intraoperative monitoring and interdisciplinary planning. As DP becomes more accessible, particularly in community hospitals, anesthesiologists must be prepared to navigate its perioperative challenges. This case underscores the importance of tailored anesthetic approaches to support safe and effective DP implantation.

The eastern paralysis tick of Australia, Ixodes holocyclus, is by far the most important ectoparasite of dogs and cats in eastern Australia. In spite of the development of tick-antisera and the availability of highly effective tick-preventative medications, thousands of dogs and cats present to veterinary clinics and hospitals with signs of tick paralysis each year; about 10% of these dogs and 8% of these cats may die from tick paralysis or are euthanized due to severe signs of tick envenomation. One of the mainstays of optimising patient outcome of dogs and cats with signs of tick paralysis is the prompt removal of the tick. In the present paper, we studied 10,913 attachment-sitesof I. holocyclus arising from 10,311 veterinary consultations of dogs and cats in eastern Australia. This is, to our knowledge, the largest study of attachment-site preference of I. holocyclus on dogs and cats. We found that whereas I. holocyclus is most often found on the head of dogs, on cats, these ticks are most often found on their necks. In addition, we report attachment-site preferences of adult and immature (larval and nymphal) I. holocyclus. We also highlight some unusual and inconspicuous attachment-sitesof I. holocyclus, which may be informative to veterinarians and pet owners alike.

Bulk RNA sequencing, while cost-effective compared to high resolution spatial transcriptomics, averages gene expression across heterogeneous cell populations and thus lacks spatial context. To address this limitation, we introduce a structured, human guided, multi stage computational AI agent SPI WSI, that iteratively generates, evaluates, and refines biologically informative natural language prompts, thereby localizing bulk derived pathway activity within histopathology slides. Our pipeline uses in context prompting in large language models (LLMs) to adapt dynamically to the task of prompt generation. Candidate prompts are first produced by the LLM and then subjected to a secondary pathologist critiquing by the same LLM that cross references PubMed to ensure both biological plausibility and specificity. Each approved prompt against their image tile is scored using the vision language foundation model (CONCH). We benchmarked different LLMs, Gemini 2.0, Gemini 2.5, Claude 3.7 and Claude 4.0, and found that Claude 4.0 achieves the highest cosine similarity (~0.7) between image and prompt embeddings. Pathologist-driven scoring and manual segmentation confirm that our method accurately identifies clusters of spatial pathological morphologies. In addition, we have validated the method against ground truth spatial transcriptomic spots using in-house and public datasets. Overall, the trend emphasized by ground-truth spatial RNA sequencing prompts is closely aligned with those from bulk prompt. This pathologist in the-loop workflow enables large-scale, reproducible tissue profiling and grounds AI-driven spatial annotations.

The efficacy, safety, pharmacokinetics, and pharmacodynamics of liposomal bupivacaine combined with bupivacaine hydrochloride administered via adductor canal block for total knee arthroplasty were evaluated. This randomized, double-blind, active-controlled, multicenter trial (NCT05139030) enrolled adults undergoing primary unilateral total knee arthroplasty. Participants were randomized 1:1 to receive an adductor canal block administered as a single dose of liposomal bupivacaine 133 mg admixed with bupivacaine hydrochloride 50 mg (liposomal bupivacaine group) or bupivacaine hydrochloride 50 mg admixed with saline (bupivacaine group). The study enrolled 167 participants (liposomal bupivacaine group, n = 85; bupivacaine group, n = 82). The primary endpoint was the area under the curve of numerical rating scale pain intensity scores from 0 to 96 hours postsurgery. From zero to 96 hours after surgery, the least squares mean (LSM) (SE) of the area under the curve of the numerical rating scale pain intensity score was lower in the liposomal bupivacaine group (568.9 [20.07]) versus the bupivacaine group (634.7 [20.04]) (LSM difference versus bupivacaine, ‒65.8 [95% CI (confidence interval), ‒118.7 to ‒12.9]; P = 0.0074). In the liposomal bupivacaine group, total opioid consumption was lower from 0 to 96 hours versus the bupivacaine group (LSM [95% CI], 101.8 [89.1 to 116.3] versus 132.8 [116.3 to 151.7] morphine milligram equivalents; LSM ratio relative to bupivacaine [95% CI], 0.77 [0.64 to 0.92]; P = 0.0018). The median time to first opioid consumption after surgery was longer for the liposomal bupivacaine group (median [interquartile range], liposomal bupivacaine, 4.2 hours [2.7 to 6.1]; bupivacaine, 3.6 hours [2.5 to 4.8]; P = 0.0127). Treatment-related adverse event incidence was similar between groups (liposomal bupivacaine: 3.5%; bupivacaine: 2.5%). Liposomal bupivacaine administered via adductor canal block for total knee arthroplasty was associated with concurrent reductions in pain and opioid consumption compared with bupivacaine during the first 96 hours after surgery.