-
Critical Care (London, England) Jul 2023Sepsis-associated acute kidney injury (SA-AKI) is associated with high morbidity, with no current therapies available beyond continuous renal replacement therapy (CRRT).... (Observational Study)
Observational Study
Prognostic and predictive value of endothelial dysfunction biomarkers in sepsis-associated acute kidney injury: risk-stratified analysis from a prospective observational cohort of pediatric septic shock.
BACKGROUND
Sepsis-associated acute kidney injury (SA-AKI) is associated with high morbidity, with no current therapies available beyond continuous renal replacement therapy (CRRT). Systemic inflammation and endothelial dysfunction are key drivers of SA-AKI. We sought to measure differences between endothelial dysfunction markers among children with and without SA-AKI, test whether this association varied across inflammatory biomarker-based risk strata, and develop prediction models to identify those at highest risk of SA-AKI.
METHODS
Secondary analyses of prospective observational cohort of pediatric septic shock. Primary outcome of interest was the presence of ≥ Stage II KDIGO SA-AKI on day 3 based on serum creatinine (D3 SA-AKI SCr). Biomarkers including those prospectively validated to predict pediatric sepsis mortality (PERSEVERE-II) were measured in Day 1 (D1) serum. Multivariable regression was used to test the independent association between endothelial markers and D3 SA-AKI SCr. We conducted risk-stratified analyses and developed prediction models using Classification and Regression Tree (CART), to estimate risk of D3 SA-AKI among prespecified subgroups based on PERSEVERE-II risk.
RESULTS
A total of 414 patients were included in the derivation cohort. Patients with D3 SA-AKI SCr had worse clinical outcomes including 28-day mortality and need for CRRT. Serum soluble thrombomodulin (sTM), Angiopoietin-2 (Angpt-2), and Tie-2 were independently associated with D3 SA-AKI SCr. Further, Tie-2 and Angpt-2/Tie-2 ratios were influenced by the interaction between D3 SA-AKI SCr and risk strata. Logistic regression demonstrated models predictive of D3 SA-AKI risk performed optimally among patients with high- or intermediate-PERSEVERE-II risk strata. A 6 terminal node CART model restricted to this subgroup of patients had an area under the receiver operating characteristic curve (AUROC) 0.90 and 0.77 upon tenfold cross-validation in the derivation cohort to distinguish those with and without D3 SA-AKI SCr and high specificity. The newly derived model performed modestly in a unique set of patients (n = 224), 84 of whom were deemed high- or intermediate-PERSEVERE-II risk, to distinguish those patients with high versus low risk of D3 SA-AKI SCr.
CONCLUSIONS
Endothelial dysfunction biomarkers are independently associated with risk of severe SA-AKI. Pending validation, incorporation of endothelial biomarkers may facilitate prognostic and predictive enrichment for selection of therapeutics in future clinical trials among critically ill children.
Topics: Humans; Child; Shock, Septic; Prognosis; Sepsis; Biomarkers; Acute Kidney Injury
PubMed: 37400882
DOI: 10.1186/s13054-023-04554-y -
JMIR Formative Research Dec 2021The impact of qualitative olfactory disorders is underestimated. Parosmia, the distorted perception of familiar odors, and phantosmia, the experience of odors in the...
BACKGROUND
The impact of qualitative olfactory disorders is underestimated. Parosmia, the distorted perception of familiar odors, and phantosmia, the experience of odors in the absence of a stimulus, can arise following postinfectious anosmia, and the incidences of both have increased substantially since the outbreak of COVID-19.
OBJECTIVE
The aims of this study are to explore the symptoms and sequalae of postinfectious olfactory dysfunction syndrome using unstructured and unsolicited threads from social media, and to articulate the perspectives and concerns of patients affected by these debilitating olfactory disorders.
METHODS
A thematic analysis and content analysis of posts in the AbScent Parosmia and Phantosmia Support group on Facebook was conducted between June and December 2020.
RESULTS
In this paper, we identify a novel symptom, olfactory perseveration, which is a triggered, identifiable, and usually unpleasant olfactory percept that persists in the absence of an ongoing stimulus. We also observe fluctuations in the intensity and duration of symptoms of parosmia, phantosmia, and olfactory perseveration. In addition, we identify a group of the most common items (coffee, meat, onion, and toothpaste) that trigger distortions; however, people have difficulty describing these distortions, using words associated with disgust and revulsion. The emotional aspect of living with qualitative olfactory dysfunction was evident and highlighted the detrimental impact on mental health.
CONCLUSIONS
Qualitative and unsolicited data acquired from social media has provided useful insights into the patient experience of parosmia and phantosmia, which can inform rehabilitation strategies and ongoing research into understanding the molecular triggers associated with parosmic distortions and research into patient benefit.
PubMed: 34904953
DOI: 10.2196/29086 -
Ethnicity & Health Nov 2019Black Americans (BAs) are at an elevated risk for morbidity and mortality in comparison to White Americans (WAs). Racial stressors are a common occurrence in American... (Randomized Controlled Trial)
Randomized Controlled Trial
Black Americans (BAs) are at an elevated risk for morbidity and mortality in comparison to White Americans (WAs). Racial stressors are a common occurrence in American culture and is theorized to contribute to these disparities. When race-focused, stereotype threat (ST) is considered to be a factor that is detrimental to health in BAs; however few studies have directly investigated the impact of a ST manipulation on physiological function. Furthermore, it is proposed that racial stressors such as ST may have prolonged effects when more likely to perseverate (e.g. rumination) over the stressor and thus, those with greater trait perseveration may be more affected by ST. We sought to explore the impact of ST and trait perseveration on changes in vagus nerve activity - an indication of adaptive psychological and physiological well-being - as indexed by vagally mediated heart rate variability (vmHRV). Forty-three (24 females, mean age of 20, standard deviation of 3 years) apparently healthy BA individuals were randomly assigned to one of three experimental conditions in which they received either implicit (subtle), explicit (blatant), or no ST priming (control condition), prior to completing a cognitive task. Resting vmHRV was assessed both at baseline (pre-task) and recovery (post-task). BAs in the explicit ST condition exhibited the greatest decrease in vmHRV in comparison to the control group from pre- to post-task. BAs with moderate to high levels of trait perseveration showed the greatest decrease in vmHRV from pre- to post-task in comparison to those with lower levels of trait perseveration and BAs in the control group. These data suggest that racial ST, especially when explicit and coupled with trait perseveration, can decrease vagal activity, as indexed by decreased vmHRV, which when experienced frequently can have significant consequences for health and longevity in BAs.
Topics: Adolescent; Black or African American; Autonomic Nervous System; Electrocardiography; Female; Health Status Disparities; Heart Rate; Humans; Male; Stereotyping; Stress, Psychological; Vagus Nerve; Young Adult
PubMed: 28922935
DOI: 10.1080/13557858.2017.1378803 -
Revista de NeurologiaThe executive function is a collection of cognitive abilities that allow the anticipation and establishment of goals, the formation of plans and programs, the beginning... (Review)
Review
INTRODUCTION
The executive function is a collection of cognitive abilities that allow the anticipation and establishment of goals, the formation of plans and programs, the beginning of activities and mental operations, the auto regulation of tasks, and the ability to carry on them efficiently. Both psychopathy and disexecutive syndrome have been considered as prototypes of frontal lobe damage, although they have been related very recently.
DEVELOPMENT
Psychopathy construct is not clear defined in the international classifications of mental disorders. They have focused only in the antisocial disorder of personality. A clear conceptual delimitation of psychopathy is necessary. The typical behaviours of psychopaths could be related with structural and functional brain alterations showed by the neuroimaging techniques and neuropsychological tests. These deficits are the neurological support of the inability of psychopaths to the integration of reasoning process with emotions, and specifically, of the presence of symptoms as impulsivity, inattention, context dependency, pathological perseverations and metacognitive alteration.
CONCLUSION
The relevant conclusion of this study is the close relationship between reasoning and emotion. Executive function could be the explaining nexus of this connection.
Topics: Antisocial Personality Disorder; Cognition Disorders; Diagnostic Imaging; Electroencephalography; Emotions; Humans; Neuropsychological Tests; Prefrontal Cortex; Syndrome
PubMed: 15054723
DOI: No ID Found -
Materials (Basel, Switzerland) Jun 2023Due to its resistance to natural degradation and decomposition, plastic debris perseveres in the environment for centuries. As a lucrative material for packing... (Review)
Review
Due to its resistance to natural degradation and decomposition, plastic debris perseveres in the environment for centuries. As a lucrative material for packing industries and consumer products, plastics have become one of the major components of municipal solid waste today. The recycling of plastics is becoming difficult due to a lack of resource recovery facilities and a lack of efficient technologies to separate plastics from mixed solid waste streams. This has made oceans the hotspot for the dispersion and accumulation of plastic residues beyond landfills. This article reviews the sources, geographical occurrence, characteristics and recyclability of different types of plastic waste. This article presents a comprehensive summary of promising thermochemical technologies, such as pyrolysis, liquefaction and gasification, for the conversion of single-use plastic wastes to clean fuels. The operating principles, drivers and barriers for plastic-to-fuel technologies via pyrolysis (non-catalytic, catalytic, microwave and plasma), as well as liquefaction and gasification, are thoroughly discussed. Thermochemical co-processing of plastics with other organic waste biomass to produce high-quality fuel and energy products is also elaborated upon. Through this state-of-the-art review, it is suggested that, by investing in the research and development of thermochemical recycling technologies, one of the most pragmatic issues today, i.e., plastics waste management, can be sustainably addressed with a greater worldwide impact.
PubMed: 37444877
DOI: 10.3390/ma16134563 -
Cortex; a Journal Devoted To the Study... Mar 1986We developed a battery of tests to evaluate the relationship of perseveration to aphasia, and tested 44 subjects (18 with aphasia, 13 with right hemispheric lesions, 13...
We developed a battery of tests to evaluate the relationship of perseveration to aphasia, and tested 44 subjects (18 with aphasia, 13 with right hemispheric lesions, 13 normal controls). Several major findings emerged: left hemispheric, posteriorly located, aphasia producing lesions also produced abundant perseverations, both verbal and non-verbal, which were primarily recurrent in type; right hemispheric lesions produced few perseverations, and these were primarily of the continuous type; more than half of the verbal recurrent perseverations of aphasia on a naming task were semantic in nature. We conclude that recurrent perseveration has a special, perhaps integral, link to language disorders of aphasia, particularly fluent aphasia associated with posterior lesions.
Topics: Anomia; Aphasia; Aphasia, Broca; Aphasia, Wernicke; Brain Damage, Chronic; Dominance, Cerebral; Humans; Middle Aged; Neuropsychological Tests; Psychomotor Performance; Stereotyped Behavior; Verbal Behavior
PubMed: 2423294
DOI: 10.1016/s0010-9452(86)80035-1 -
International Journal of Nursing... Apr 2017The purpose of this study was to describe the structure of meaning in the experience of surviving stroke for adults living in Appalachia.
OBJECTIVE
The purpose of this study was to describe the structure of meaning in the experience of surviving stroke for adults living in Appalachia.
METHODS
This qualitative phenomenological study includes a sample of 6 adult survivors of ischemic stroke who were discharged from either a community or university hospital to home in the Appalachian region. Data was collected through semi-structured interviews, transcribed, and analyzed thematically by two investigators. The explicated themes were verified by the survivors as representative of their experience.
RESULTS
Five main themes emerged: 1) Frustration with new physical and functional impairment, 2) Negative emotions including anger, guilt, loneliness, and depression 3) Need for accessible support, 4) Longing for home during recovery and, 5) Stepping forward after stroke which included sub-themes of perseverance, acceptance, and retraining. Anger was described as contributing to delayed recover and emotional lability was described as a source of anger. The familiarity of home was viewed as key to reestablishing control over one's life. Survivors described how they developed perseverance to move forward and emphasized that willingness to participate in retraining led to adapting to impairments. Acceptance was described as letting go of prior expectations of self and others so one could live in the present.
PubMed: 31406728
DOI: 10.1016/j.ijnss.2017.02.005 -
Borderline Personality Disorder and... 2018The UPPS-P Model of Impulsive Personality, a prominent model of impulsive personality derived from the Five Factor Model of Personality, is a multi-dimensional model of... (Review)
Review
The UPPS-P Model of Impulsive Personality, a prominent model of impulsive personality derived from the Five Factor Model of Personality, is a multi-dimensional model of impulsive personality that consists of negative urgency, lack of premeditation, lack of perseveration, sensation seeking, and positive urgency. The UPPS-P model has highlighted the importance of separating multidimensional traits due to the specificity of these traits corresponding to different risk behaviors. The goal of the current review paper is to make recommendations on how to apply the UPPS-P Model of Impulsive Personality, to diagnosis of and treatment for psychopathology. However, despite impulsivity being one of the most frequently used criteria for a number of clinical disorders, our review of the Diagnostic and Statistical Manual for Mental Disorders-5 found that the UPPS-P traits are not well represented in the diagnostic criteria, which we propose limits inferences about etiology and treatment targets. Additionally, research has largely focused on the importance of these traits for risk models; our review of the literature applying the UPPS-P traits to treatment processes and outcomes concluded that this area is not yet well studied. Here, we propose the specific application of the UPPS-P model to improve diagnosis and increase treatment effectiveness.
PubMed: 29619225
DOI: 10.1186/s40479-018-0084-x -
Annals of Indian Academy of Neurology 2021Progressive supranuclear palsy (PSP) is a large-scale network disease resulting in variable signs and symptoms including gait impairment and higher order cognitive...
CONTEXT
Progressive supranuclear palsy (PSP) is a large-scale network disease resulting in variable signs and symptoms including gait impairment and higher order cognitive dysfunction. Despite few studies showing the association of falls and cognitive dysfunction, the existing literature is yet to establish the exact relationship of discrete characteristics of gait with cognitive function in PSP.
AIMS
In this cross-sectional study, we aimed to characterize and explore the relationship of these two apparently distinct physiological phenomena in patients with PSP and across its different variants.
METHODS AND MATERIAL
Quantitative assessment of two-dimensional gait parameters was measured using an electronic walkway (GAITRite®). Dementia Rating Scale-2 was used to assess global as well as higher order cognitive functions.
STATISTICAL ANALYSIS USED
A regression model was used to interpret results.
RESULTS
We observed that the variability domain of gait was significantly impaired in PSP patients with severe cognitive impairment compared to that of intact cognition. Moreover, initiation/perseveration (I/P), a higher order cognitive process, and one of its specific components, i.e., complex verbal task (β = 2.39, < 0.001), significantly predict gait velocity in PSP [ (1, 40) = 16.102, < 0.001].
CONCLUSIONS
Our findings indicate that the severity of cognitive functions affects gait variability, which might lead to frequent falls as observed in PSP. Furthermore, semantic fluency task of I/P function may act as a predictor of gait velocity. We suspect that higher order cognitive dysfunction through the damage of frontal lobe structure including dorsolateral prefrontal cortex or related network may influence gait in PSP.
PubMed: 35359519
DOI: 10.4103/aian.AIAN_71_21 -
Journal of Huntington's Disease 2019Neuropsychiatric symptoms are highly prevalent in Huntington's disease (HD). However, little is known of the prevalence and course of obsessive-compulsive behaviors...
BACKGROUND
Neuropsychiatric symptoms are highly prevalent in Huntington's disease (HD). However, little is known of the prevalence and course of obsessive-compulsive behaviors (OCBs) and perseverative behaviors (PBs) during the progression of the disease.
OBJECTIVE
This review provides a summary of the literature on OCBs and PBs in HD gene expansion carriers (HDGECs).
METHODS
Pubmed database was searched for articles on OCBs and PBs in HD up to 2017. We used search terms, all synonyms for HD, and various terms for OCBs and PBs.
RESULTS
We found 5 case series and 11 original articles that describe a prevalence range of 5 to 52% for OCBs and up to 75% for PBs depending on disease stage and measurement scale used. Premanifest HDGECs report more OCBs compared to controls, and manifest HDGECs report a higher rate of OCBs compared to premanifest HDGECs. OCBs and PBs are associated with a longer disease duration and disease severity in manifest HDGECs, but decrease in the most advanced stages. When HDGECs come closer to estimated motor onset, the companion ratings on OCBs appear to be higher than the self-ratings of HDGECs.
CONCLUSIONS
Both OCBs and PBs are characteristic neuropsychiatric features of HD. Perseveration is probably best distinguished from OCBs as it occurs without the individual's full awareness or insight into their presence (and the behavior may not be distressing). Although these behaviors are seldom distinguished, we conclude that differentiating OCBs from PBs in HD is beneficial for the management and treatment of these symptoms in HDGECs.
Topics: Adult; Aged; Behavior; Cognition Disorders; Disease Progression; Female; Heterozygote; Humans; Huntington Disease; Male; Middle Aged; Obsessive-Compulsive Disorder; Prevalence
PubMed: 30714966
DOI: 10.3233/JHD-180335