University of Toledo Medical Center

Introduction: Pulmonary rehabilitation after critical illness for acute respiratory failure has a positive impact on patients’ lives by improving their functional outcomes and independence. However, evidence to identify participation in pulmonary rehabilitation (PR) is limited. The purpose of this study is to identify the relationship between patient characteristics and clinical course with participation in PR and functional outcomes. Methods: This prospective study enrolled patients who survived critical illness at the University of Kentucky. Social determinants of health data (SDOH) data were collected using a validated screener 3 months after hospital discharge. Patient demographics, clinical course information and functional outcomes during PR were extracted from the electronic health record (EHR). Grouped t-tests, chi-square and correlations were completed for statistical analysis. Results: Of 42 patients enrolled in the study, 26 attended PR after ICU discharge with an equal number of male and female patients with an average age of 56.8 ± 9.0 years and BMI of 26.7 ± 5.4 kg/m2. Patients with greater severity of illness upon hospital admission determined by the Sequential Organ Failure Assessment (SOFA) (r= -0.353, p=0.028) were less likely to attend PR after discharge. Additionally, those that reported being a caregiver prior to ICU admission had better functional outcomes measured by the 5 times sit to stand (t= 9, p= 0.046), gait speed (t= 66.5, p= 0.005), Short Physical Performance Battery (t= 60, p= 0.042), Timed Up and Go (t= 7.5, p= 0.010), and distance ambulated in the 6 minute walk test (t= 69, p= 0.002), compared to those that were not a caregiver. Of the patients who reported unmet social needs, a trend was observed where all (n=12) the patients who reported 1-2 unmet needs attended PR whereas 33% (n=1) of the patients who reported 5-6 unmet needs attended. A similar clinically relevant trend was reflected with only 33% (n=2) of patients who reported food insecurity attending PR. Conclusions: Barriers to participating in pulmonary rehabilitation after discharge are related to patients’ societal roles and their health prior to an ICU stay as well as their clinical course during the hospital. Addressing barriers to attending pulmonary rehabilitation may improve patient recovery.

Introduction: Patients who survive critical illness often have functional impairments impacting their ability to engage in physical activity (PA). Previous studies have shown that in the first week after hospital discharge, survivors of critical illness achieved an average of 1300 steps per day. The factors related to lower PA engagement may be impacted by patient’s social determinants of health (SDOH). The purpose of this study is to identify patient characteristics and SDOH that influence PA during early recovery. Methods: This prospective study enrolled patients who survived critical illness at the University of Kentucky Medical Intensive Care Unit (MICU). Patients were provided with activity trackers (Garmin VivoFit 4) to wear daily upon enrollment near hospital discharge (baseline). Steps per day were collected at baseline, 3- and 6-months after discharge. SDOH were examined with a validated questionnaire and self-reported activity was assessed with the International Physical Activity Questionnaire (IPAQ)) at the 6-month time point. Grouped t-tests, chi-square, repeated measures ANOVAs, and Spearman correlations were conducted for statistical analyses. Results: Eighty-two patients were included in the study of which 53% were male with a median age of 60 (IQR 50-66) and a median BMI of 27.7 (IQR 22.9- 31.6). The average steps per day at baseline, 3 and 6 months were 3,963 (CI 1,736-9,049), 5,425 (CI 2,403-12,245) and 6,536 (CI 2,916-14,649) respectively. Baseline daily steps were significantly different from the 3-month t= 2.97, p= 0.004) and 6-month (t= 3.72, p< 0.001) time points after discharge. Based on the reported living situation, patients engaged in different quantities and levels of exertion during walking each week. (H= 6.17, p= 0.046) Patients with a higher BMI (r= -0.29, p=0.041) and a greater number of comorbidities (r= -0.33, p=0.019) were associated with less engagement in vigorous activity per the self-reported IPAQ. Conclusions: Patients surviving critical illness engaged in less than the American Heart Association recommended amount of daily activity (7,000 steps per day) for cardiovascular health up to 6 months after discharge. Recognizing that patients’ preexisting health status and SDOH related to their PA engagement is crucial to improve patient recovery after critical illness.

Adverse childhood experience (ACE) has been associated with impairments of the hypothalamic-pituitary-adrenal (HPA) axis including reduced hair cortisol concentrations (HCC) and hypothalamus volumes in adults from previous trauma studies, but how both impairments contribute to post-traumatic stress symptoms (PTSS) after new trauma remains unclear. It is possible that a combination of reduced pre-trauma baseline levels of cortisol and early post-trauma hypothalamic dysregulation contributes to inadequate stress reactions to acute trauma. To test this hypothesis, 73 adult trauma survivors completed a hair sample collection immediately after trauma for pre-trauma HCC measures. The PTSD Checklist (PCL), Childhood Trauma Questionnaire (CTQ), and an MRI scan for hypothalamic and subunit volume measures were obtained within 2 weeks post-trauma. PTSS was further assessed using PCL 3 months later. The results indicate that interactions of pre-trauma HCC and early post-trauma volumes of the hypothalamus or its posterior subunits significantly affect PTSS severity at 2 weeks post-trauma (bilateral t = 2.502 ~ 3.920, p = 0.016 ~ 0.001) and re-experiencing symptom severity at 3 months post-trauma (left side only, t = 2.196 ~ 2.529, p = 0.017 ~ 0.037). CTQ scores interact with pre-trauma HCC and with both HCC and left hypothalamus volume to significantly affect re-experiencing symptom severity at 3 months post-trauma (p = 0.017 ~ 0.031). These findings suggest that combinations of pre- and early post-trauma conditions of the HPA axis affect acute PTSS and moderate an association between ACE and re-experiencing symptoms in subsequent months after trauma.

Background: The optimal management of patients with acute ischemic stroke presenting with low National Institutes of Health Stroke Scale (NIHSS) scores and confirmed vessel occlusion remains uncertain. While intravenous thrombolysis (IVT) is standard in many cases, its benefit in this specific subgroup compared to antithrombotic therapy alone is debated. Objective: To evaluate the efficacy and safety of IV thrombolysis versus antithrombotic agents in patients with acute ischemic stroke, low NIHSS scores, and confirmed vessel occlusion. Methods: Literature search on PubMed, EMBASE, and Cochrane databases from inception up to 1 July 2025 was conducted. Five studies which reported clinical outcome, mortality, and symptomatic ICH were included in qualitative synthesis and meta-analysis. Results: Across the included studies, IV thrombolysis did not significantly improve the likelihood of achieving a good functional outcome compared to antithrombotics (OR 0.98; 95% CI 0.73–1.32; P = 0.89). Mortality rates were also similar between groups (OR 1.2; 95% CI 0.18–7.87; P = 0.85). There was a nonsignificant trend toward increased risk of SICH in the IVT group (OR 2.47; 95% CI 0.79–7.74; P = 0.12). Conclusion: In patients with acute ischemic stroke, low NIHSS, and confirmed vessel occlusion, treatment with IV thrombolysis was not associated with improved functional outcomes or reduced mortality compared to antithrombotic therapy, and carried a nonsignificant increase in the risk of SICH. These findings highlight the need for randomized controlled trials to guide optimal treatment strategies in this patient subgroup.

The mammalian spermatozoon neck is a unique structure that functions during spermatid differentiation and spermatozoa swimming, and its contents are critical for post-fertilization embryogenesis. Mutations in proteins localizing to the neck connecting piece (the modified pericentriolar material) result in acephalic spermatozoa. In contrast, mutations in proteins localizing to the centriole often produce abnormal tail morphology. Acephalic spermatozoa can be categorized based on the exact location of the neck breakpoint. Here, we classify 24 proteins known to cause acephaly in human and mice spermatozoa into five different acephalic types, depending on where the breakpoint occurs. We also discuss other proteins found in the spermatozoonneck, which may result in spermatozoa acephaly. The relationship between the exact location of the neck's break and intracytoplasmic sperm injection (ICSI) outcomes is explored in the context of the spermatozoon centrosome's role. We conclude that to understand this relationship, future research should investigate DNA, phospholipase C zeta, and centriole functionality, in addition to the location of the acephalic breakpoint in the patient's sperm.

Intensive research for 50years did not find a way to predict the faith of organ transplants after successful transplantation. Current immunosuppressive regiments reduce kidney transplant acute rejection episodes to 6-11% for the first year, but 49% of them develop chronic allograft nephropathy in 5years. Similarly, heart transplants have 8% acute rejection episodes in the first year and 50% develop cardiac vasculopathy in 5years. Multiple cytokines regulate acute cellular T-cell-mediated rejection (TCMR) and acute antibody-mediated rejection (AMR), and both mechanisms contribute to chronic allograft rejection. In addition to common γ chain (cγ) cytokines [interleukin-2 (IL-2), IL-4, IL-7, IL-9, IL-15, and IL-21], other cytokines [IL-1, IL-6, IL-10, interferon-α, (IFN)α, INFβ, INFγ, tumor necrosis factor α, TNFα; tumor growth factor β, TGFβ] are all extensively involved in the regulation of acute and chronic allograft rejections. Interestingly, the same cytokines also regulate functions of normal cells and tissues. To induce transplant tolerance, it is necessary to maintain physiological cytokine levels as well as boost the function of T regulatory T (Treg) cells producing IL-10, IL-35, and TGFβ. This chapter emphasizes the necessity of maintaining a balance by cytokines to divert them from the inflammation path producing chronic rejection to normal function support combined with Treg-dominated transplantation tolerance.

Translation: The University of Toledo Journal of Medical Sciences is the online journal launched by the University of Toledo. Manuscripts will be considered on the understanding that they report original work and are not under consideration for publication by any other journal. The journal publishes original articles reporting experimental results of basic or clinical research, case reports, and reviews. The journal uses a single blind peer review system and each manuscript, based on the results presented in its original submission, will be evaluated by two student reviewers and one faculty reviewer. This process will provide an opportunity for medical students, graduate students, residents, fellows and faculty to publish research observation in a timely manner.

Objective: The objective of this paper is to assess the quality of life and fatigue among adult patients diagnosed with inflammatory bowel disease (IBD) compared to healthy controls. Methods: We conducted searches in Medline and Embase from January 2015 to April 2025. We included publications that examined adult patients with IBD without comorbidities, compared them to healthy controls, and assessed quality of life and fatigue. Two reviewers independently conducted study selection, data extraction, and quality assessment. We described results narratively due to high heterogeneity. Results: Ten studies with a pool of 10,661 participants were selected. Three studies showed significantly worsened mental and physical components for quality of life in IBD patients compared to healthy controls. Additionally, three studies reported that fatigue was more prevalent among patients with IBD than in healthy controls. Conclusions: Our review suggests that quality of life is significantly reduced, and fatigue is more prevalent in IBD patients compared to healthy controls. Further long-term follow-up studies are needed to provide a more comprehensive understanding of the global impact of IBD, particularly in non-Western populations.