Time Course of Mechanical Ventilation Driving Pressure Levels in Pediatric Acute Respiratory Distress Syndrome: Outcomes in a Prospective, Multicenter Cohort Study From Colombia, 2018-2022.

OBJECTIVES: High driving pressure (DP, ratio of tidal volume (Vt) over respiratory system compliance) is a risk for poor outcomes in patients with pediatric acute respiratory distress syndrome (PARDS). We therefore assessed the time course in level of DP (i.e., 24, 48, and 72 hr) after starting mechanical ventilation (MV), and its association with 28-day mortality. DESIGN: Multicenter, prospective study conducted between February 2018 and December 2022. SETTING: Twelve tertiary care PICUs in Colombia. PATIENTS: One hundred eighty-four intubated children with moderate to severe PARDS. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The median (interquartile range [IQR]) age of the PARDS cohort was 11 (IQR 3-24) months. A total of 129 of 184 patients (70.2%) had a pulmonary etiology leading to PARDS, and 31 of 184 patients (16.8%) died. In the first 24 hours after admission, the plateau pressure in the nonsurvivor group, compared with the survivor group, differed (28.24 [IQR 24.14-32.11] vs. 23.18 [IQR 20.72-27.13] cm H2O, p < 0.01). Of note, children with a Vt less than 8 mL/kg of ideal body weight had lower adjusted odds ratio (aOR [95% CI]) of 28-day mortality (aOR 0.69, [95% CI, 0.55-0.87]; p = 0.02). However, we failed to identify an association between DP level and the oxygenation index (aOR 0.58; 95% CI, 0.21-1.58) at each of time point. In a diagnostic exploratory analysis, we found that DP greater than 15 cm H2O at 72 hours was an explanatory variable for mortality, with area under the receiver operating characteristic curve of 0.83 (95% CI, 0.74-0.89); there was also increased hazard for death with hazard ratio 2.5 (95% CI, 1.07-5.92). DP greater than 15 cm H2O at 72 hours was also associated with longer duration of MV (10 [IQR 7-14] vs. 7 [IQR 5-10] d; p = 0.02). CONCLUSIONS: In children with moderate to severe PARDS, a DP greater than 15 cm H2O at 72 hours after the initiation of MV is associated with greater odds of 28-day mortality and a longer duration of MV. DP should be considered a variable worth monitoring during protective ventilation for PARDS.

An unusual case of endotipsitis: persistent infection and migration to the right atrium of a transjugular intrahepatic portosystemic shunt (TIPS).

Endotipsitis is an underdiagnosed entity mainly because it requires a high initial level of suspicion. It should be considered in the differential diagnosis of persistent bacteremia in the cirrhotic patient with TIPS. Most cases are treated conservatively with a long-term antibiotherapy, due to the impossibility of surgical removal of the TIPS, except in a liver transplant or autopsy. The patient we present had endotipsitis that manifested as persistent bacteremia with thrombosis of the TIPS. Initially, conservative management with intravenous antibiotherapy was performed; however, due to mechanical complications caused by migration of the original endoprosthesis, it was decided to perform surgery.

Sleep Health Among Adults in Outpatient Opioid Use Disorder Treatment: A Systematic Review.

The current systematic review synthesized available original research on objective and self-reported sleep health dimensions among adults aged 18 to 50 years in outpatient treatment for opioid use disorder (OUD). A comprehensive search was conducted using multiple electronic databases followed by screening 2,738 records published in English from the inception of each database to September 14, 2021. Quality was assessed with the Mixed Methods Appraisal Tool (version 2001). Fifty nine studies-50 descriptive (21 longitudinal, 18 cross-sectional, and 11 case control), seven interventional (five non-randomized), and two mixed/multi method designs-were included, comprising 18,195 adults with mean ages ranging from 23 to 49 years (mean age = 37.5 [SD = 5.9] years; 54.4% female) with OUD and 604 comparison participants without OUD. Studies were predominantly observational with various designs with self-report and objective measures with participants at various points in treatment. More work is needed to understand the multidimensional depth of sleep health in adults with OUD. Optimizing sleep health in adults with OUD may improve their addiction trajectory and should be a priority in practice and research. [Journal of Psychosocial Nursing and Mental Health Services, 62(1), 19-26.].

Optimizing biodegradable plastics: Molecular dynamics insights into starch plasticization with glycerol and oleic acid.

Petroleum-based plastics dominate everyday life, necessitating the exploration of natural polymers as alternatives. Starch, abundant and biodegradable, is a promising raw material. However, understanding the molecular mechanisms underlying starch plasticization has proven challenging. To address this, we employ molecular dynamics simulations, focusing on amylose as a model. Our comprehensive evaluation revealed that chain size affects solubility, temperature influenced diffusivity and elastic properties, and oleic acid expressed potential as an alternative plasticizer. Furthermore, blending glycerol or oleic acid with water suggested the enhancement amylose's elasticity. These findings contribute to the design of sustainable and improved biodegradable plastics.

Substance Use, Sleep Duration, and Health Among Adults in Ohio.

Introduction: Substance use affects approximately 46.3 million people aged 12 years or older (16.5% of the US population) and is associated with poor sleep health overall. Methods: We conducted a cross-sectional secondary analysis of data from the 2020 Behavioral Risk Factor Surveillance System survey in Ohio. The sample comprised 14,676 adults. We examined associations between the use of 2 types of substances (marijuana and nonprescribed prescription pain medication) and short sleep duration (<6 hours per night) and overall health (mental, physical, and general). We used linear and logistic regression modeling while adjusting for individual-level (age, sex, race and ethnicity, education, income, and body mass index) and area-level (socioeconomic deprivation) covariates. Results: Of survey respondents who answered questions, 9.2% (1,140 of 12,362) reported using marijuana, and 1.4% (111 of 8,203) used nonprescribed prescription pain medication. Respondents who used marijuana used it an average 17.3 days per month. In adjusted logistic regression models, the odds of reporting short sleep duration were 2.4 times greater among respondents who used nonprescribed prescription pain medication (vs those who did not). The odds of reporting short sleep duration, poor mental health, poor physical health, and poor general health were 1.5, 1.3, 2.1, and 1.9 times greater, respectively, among respondents who reported marijuana use (vs those who did not). In the linear regression models (adjusted), more days of marijuana use were associated with longer sleep duration, worse mental health, and worse general health. Conclusion: Understanding the connection between substance use and health outcomes is needed to improve trajectories of substance use and recovery. Sleep duration is often underassessed among people who use substances. Expanding diagnostics and treatment options for those who use substances may result in lower levels of substance use and improved overall health.

Barriers, perceived benefits and preferences to exercise in adults with an opioid use disorder in the U.S.

Introduction: Over 10 million Americans misuse opioids and more than 5 million have been diagnosed with an opioid use disorder (OUD). In 2021, over 100,000 Americans died of a drug overdose and more than 75% of these deaths involved an opioid. Exercise has been shown to increase abstinence and decrease anxiety and depression in people with a substance use disorder. However, only a few small trials have focused on persons with OUD who often experience additional challenges including chronic pain, mental health disorders and cardio-metabolic abnormalities. Methods: We aimed to describe the barriers, perceived benefits and preferences to exercise in adults with OUD in residential treatment in the U.S. as part of a larger study. We conducted 33 individually administered, semi-structured interviews and transcribed audiotapes verbatim, conducted coding and thematic analysis using NVivo v12 software (QSR International Inc.). Results: Our sample had nearly equal representation of males and females and, was predominantly Caucasian (88%) with a mean of age of 34.5 (s.d. 7.5) years old. Participants stated that exercise helps to reduce drug cravings, anxiety, depression and pain and improve mood, physical health and build "normalcy". Barriers included lack of time, access to resources, fear of poor health and triggering pain. Participants preferred moderate intensity exercise 3 times/week and 30-60 min sessions. Conclusions: Our findings indicate that adults with OUD believe exercise is a valuable tool to use in their recovery but they encounter several barriers. Many barriers, however, could be overcome with structured programs offered by residential treatment centers.

Cognitive Behavioral Sleep Self-Management Intervention for Young Adults With Type 1 Diabetes (NCT04975230).

The purpose of this study was to explore perceptions of the first dose of a cognitive behavioral sleep self-management intervention (CB-sleep) among young adults aged 18 to 25 years with type 1 diabetes (T1D). We used a qualitative descriptive approach to conduct in-depth semi-structured focused interviews with a purposive sample of 16 young adults with T1D, transitioning from adolescence to early adulthood. Interviews were audio-recorded, transcribed verbatim, and analyzed using qualitative content analysis. Participants described their sleep knowledge (previous, new, and additional), sleep health goals, along with barriers and facilitators of the CB-sleep intervention. Based on these results, we suggest CB-sleep is a useful modality with the potential to support sleep self-management in young adults with T1D during this complex life transition. Furthermore, CB-sleep could be incorporated into an existing diabetes self-management education and support program after pilot testing and determining efficacy to improve sleep and glycemic health.

Life expectancy after surgical aortic valve replacement for low-gradient aortic stenosis with preserved ejection fraction.

INTRODUCTION AND OBJECTIVES: Surgical aortic valve replacement (SAVR) can modify the natural history of severe aortic stenosis (SAS). However, compared with the general population, these patients have a loss of life expectancy. The life expectancy of patients who undergo SAVR due to low-gradient SAS with preserved left ventricular ejection fraction (LVEF) is unknown. METHODS: We included all patients between 50 and 65 years who underwent isolated SAVR in 27 Spanish centers during an 18-year period. We analyzed observed and expected survival at 18 years in patients with low-gradient SAS with preserved LVEF and all other types of SAS. We used propensity score matching to compare the life expectancy of patients with low-gradient SAS with preserved LVEF vs those with high-gradient SAS with preserved LVEF. RESULTS: We analyzed 5084 patients, of whom 413 had low-gradient SAS with preserved LVEF. For these patients, observed survival at 10, 15 and 18 years was 86.6% (95%CI, 85.3-87.8), 75% (95%CI, 72.7-77.2), and 63.5% (95%CI, 58.8-67.8). Expected survival at 10, 15 and 18 years was 90.2%, 82.1%, and 75.7%. In the matched sample, survival of patients with low-gradient SAS with preserved LVEF was similar to that of patients with high-gradient with preserved LVEF, log-rank test, P=.95; HR=1 (95%CI, 0.7-1.4; P=.95). CONCLUSIONS: There is a loss of life expectancy in patients with all types of SAS undergoing SAVR. This loss is higher in patients with left ventricular dysfunction and lower in patients with low-gradient or high-gradient aortic stenosis with preserved LVEF. The benefit of surgery is similar between these last 2 groups.

Coronary pseudoaneurysm after Bentall-Bono intervention: A novel treatment to a rare surgery complication.

We present a rare case of a coronary pseudoaneurysm after a Bentall-Bono procedure. During a routine follow-up computed tomography scan, a pseudoaneurysm located between the aorta and the proximal portion of the right coronary artery was diagnosed. Contrast extravasation was observed with partial thrombosis of the pseudoaneurysm. Coronary angiography and intravascular ultrasound were performed showing the point of contrast extravasation dependent of the right coronary artery in its proximal portion. An angioplasty procedure was performed sealing the pseudoaneurysm with the implantation of a covered stent. After an uneventful postoperative follow-up, the patient was discharged home. Learning objective: The development of a coronary artery pseudoaneurysm (CAP) after complex cardiac surgeries, like Bentall-Bono procedure, could be a life-threatening condition. The possible derived complications of CAP are rupture, compression of surrounding structures, or coronary ischemia.Although surgical approach to a CAP may have an extremely high surgical risk, most of the cases require a complex surgical repair. We describe a novel possible treatment option by angioplasty and sealing of the CAP with the implantation of a covered stent.

Glucose and unstructured physical activity coupling during sleep and wake in young adults with type 1 diabetes.

Glucose variations have a bidirectional relationship with the sleep/wake and circadian systems in type 1 diabetes (T1D); however, the mechanisms remain unclear. The aim of this study was to describe the coupling between glucose and unstructured physical activity over 168 h in young adults with T1D. We hypothesized that there would be differences in sleep and wake characteristics and circadian variations. Glucose was measured with a continuous glucose monitoring device every 5 min and activity with a non-dominant wrist-worn actigraph in 30-s epochs over 6-14 days. There was substantial glucose and unstructured physical activity coupling during sleep and wake, along with circadian variation based on the wavelet coherence analysis. The extent to which glucose fluctuations result in disrupted sleep over longer than one week should be examined considering the harmful effects on achieving glycemic targets. Further studies are needed to delineate the respective roles of glucose production and utilization and the potential for improved meal and insulin timing to optimize glucose and sleep in this population reliant on exogenous insulin.

Life expectancy after aortic valve replacement in young patients.

INTRODUCTION AND OBJECTIVES: In young patients with severe aortic stenosis, it is unknown whether their life expectancy restored after aortic valve replacement (AVR) is unknown. METHODS: We analyzed all patients aged between 50 and 65 years who underwent isolated AVR in 27 Spanish centers during an 18-year period. We compared observed and expected survival at 15 years of follow-up. We repeated all analyses for patients without complications in the postoperative period. RESULTS: A total of 5084 patients were analyzed. For the overall sample, observed survival at 10 and 15 years was 85.3% (95%CI, 84.1%-86.4%) and 73.7% (95%CI, 71.6%-75.6%), respectively. Expected survival was 90.1% and 82.1%. Cumulative relative survival for 1, 5, 10 and 15 years of follow-up was 97.4% (95%CI, 96.9%-97.9%), 96.5% (95%CI, 95.7%-97.3%), 94.7% (95%CI, 93.3%-95.9%), and 89.8% (95%CI, 87.3%-92.1%). For patients without complications, cumulative relative survival for 1, 5, 10 and 15 years was 100.3% (95%CI, 99.8%-100.5%), 98.9% (95%CI 97.6% -99.9%), 97.3% (95%CI, 94.9%-99.4%), and 91.9% (95%CI, 86.5%-96.8%). CONCLUSIONS: Life expectancy in young patients who have severe aortic stenosis and undergo AVR is lower than that of the general population. Life expectancy of individuals without complications during the postoperative period is also reduced. Therefore, baseline characteristics are likely the main factors that explain the reduction in life expectancy.

Social Service Workers' Use of Social Media to Obtain Client Information: Current Practices and Perspectives on a Potential Informatics Platform.

To gain insight into current use of social-media platforms in human services delivery, we systematically surveyed 172 social-service workers from six agencies in a Midwest US city to gather data about social-media usage among social-service providers, potential challenges and benefits of using social media, and whether a social-media-based informatics platform could be valuable. Quantitative analyses showed that approximately half of participants have used social media to collect client-related information; nearly one-quarter indicated "often" or "nearly daily" use. Adjusting for the effects of worker characteristics, social-media use was associated with the type of agency involved and with increased tenure in social services. Adjusted results also showed that participants' comfort with using the potential application was greater in those agencies substantially involved with investigative/legal work. However, trust in the information collected by the potential application was a stronger, independent predictor of comfort using the tool. Qualitative analyses identified numerous challenges and ethical concerns, and positive and negative aspects of a social-media-based informatics platform. If the platform is to be created, work must be done carefully, fully considering ethical issues rightly raised by social service workers, existing agency policies, and professional standards. Future research should investigate ways to negotiate these complex challenges.

Two giant sinus of Valsalva pseudoaneurysms as a casual finding.

BACKGROUND: Pseudoaneurysms of the sinus of Valsalva are infrequent cardiac pathologies that usually involve a single sinus. MATERIAL AND METHODS: We present a case of a 63-year-old male who was diagnosed with ascending aortic aneurysm during a routine echocardiogram. CONCLUSION: We report here a patient with giant pseudoaneurysms of two sinuses of Valsalva who successfully underwent a sinus of Valsalva reconstruction.

Differences in life expectancy between men and women after aortic valve replacement.

OBJECTIVES: Some researchers have observed an increased number of deaths during the follow-up of young patients who undergo aortic valve replacement due to severe aortic stenosis, suggesting that this procedure does not restore their life expectancy. Our goal was to confirm these findings and explore sex-based differences. METHODS: All patients between 50 and 65 years of age who underwent isolated aortic valve replacement in 27 Spanish centres during an 18-year period were included. We compared observed and expected survival at 15 years of follow-up and estimated the cumulative incidence of death from a competing risks point of view. We stratified by sex and analysed if being a woman was an independent risk factor for death. RESULTS: For men, the observed survival at 10 and 15 years of follow-up was 85% [95% confidence interval (CI) 83.6%-86.4%] and 72.3% (95% CI 69.7%-74.7%), respectively whereas the expected survival was 88.1% and 78.8%. For women, the observed survival at 10 and 15 years was 85% (95% CI 82.8%-86.9%) and 73% (95% CI 69.1%-76.4%), whereas the expected survival was 94.6% and 89.4%. At 15 years of follow-up, the cumulative incidence of death due to the disease in men and women was 8.2% and 16.7%, respectively. In addition, being a woman was an independent risk factor for death (hazard ratio = 1.23 (95% CI 1.02-1.48; P = 0.03). CONCLUSIONS: After the aortic valve replacement, men and women do not have their life expectancy restored, but this loss is much higher in women than in men. In addition, being a woman is a risk factor for long-term death. Reasons for these findings are unknown and must be investigated.

Takotsubo syndrome after mitral valve surgery: a case report.

BACKGROUND: Takotsubo syndrome is a frequent entity; however, it has never been described after a mitral valve surgery. CASE SUMMARY: We present the case of a 79-year-old woman, with background of atrial fibrillation and a left atrial appendage closure device, who was admitted for elective mitral valve replacement, because of asymptomatic severe primary mitral regurgitation. Biologic mitral valve was implanted without incidences, but in the postoperative, she developed cardiogenic shock. Electrocardiogram (ECG) showed inverted T waves in precordial leads and an echocardiography showed severe left ventricular (LV) dysfunction with mid to distal diffuse hypokinesis, and better contractility in basal segments. Troponin levels were mildly elevated. With the suspicion of a postoperative acute coronary syndrome, a coronary angiography was performed and showed no significant coronary lesions. The haemodynamic situation was compromised for the next 48 h, in which vasoactive support and intra-aortic balloon counterpulsation were implemented. After 48 h, the haemodynamic situation suddenly improved. The ECG was normalized, and a control echocardiogram showed partial recovery of the LV function with resolution of regional wall motion abnormalities. The patient could be discharged at 1 week. The clinical picture was interpreted as a stress cardiomyopathy after mitral valve surgery. DISCUSSION: Takotsubo syndrome is a threatening condition; complications in acute phase could lead to a fatal outcome. Mitral valve surgery has to be considered as a trigger for this entity, after excluding coronary involvement, specially of left circumflex artery.

The burden of carcinogenic air toxics among Asian Americans in four US metro areas.

This study investigated disparities in residential exposure to carcinogenic air pollutants among Asian Americans, including Asian ancestry subgroups, in four US metro areas with high proportions of Asians, i.e., Honolulu, Los Angeles, San Francisco Bay Area, and Seattle. Generalized estimating equations adjusting for socioeconomic status, population density and clustering show that a greater proportion of Asian Americans in census tracts was associated with significantly greater health risk in all four metro areas. Intracategorical disparities were uncovered for Asian ancestry. A greater proportion Korean was positively associated with risk in four metro areas; greater proportion Chinese and Filipino were positively associated with risk in three of the four metro areas. While Asian Americans are infrequently examined in environmental justice research, these results demonstrate that Asian Americans experience substantial distributional environmental injustices in these four metro areas and that ancestry is an important dimension of intracategorical complexity.

Recurrent haemorrhagic pericardial effusion due to idiopathic pericarditis: a case report.

BACKGROUND: Haemorrhagic pericardial effusion (PE) has been described in pericarditis due to infection, neoplasm, collagen vascular disease, uraemia, pericardial inflammation after acute myocardial infarction, trauma, irradiation, and idiopathic pericarditis. Patients with large haemorrhagic PE develop recurrence or constrictive pericarditis (CP) frequently as complication without being treated intensively. CASE SUMMARY: A 22-year-old female patient with a previous episode of pericarditis with severe PE was admitted for acute pericarditis. Three days before, she was evaluated at the emergency department and presented normal laboratory workup and no significant findings in the transthoracic echocardiogram (TTE). A new TTE showed severe PE and laboratory work-up showed low haemoglobin levels. Fifteen days later, due to slow evolution, a left anterior mini-thoracotomy pericardial window procedure was performed finding minimal haemorrhagic PE with clots. We performed a complete work-up for a cause without significant findings and treated intensely to prevent recurrence or CP. DISCUSSION: This is a case of recurrent haemorrhagic PE due to idiopathic pericarditis. Physicians should perform an intensive workup in order to find the cause because of its clinical implications and possible treatments. An intensive treatment must be initiated as soon as possible to prevent recurrence or CP.