Citations

Heart failure (HF) is a complex clinical syndrome that represents one of the leading causes of morbidity and mortality in developed nations. It is well established that every HF-related hospital admission leads to worsened quality of life for the patient and their caregiver and also imposes a significant financial burden on society. Therefore, reducing hospital admissions for this population has emerged as a critical tactic over the past decades. Initial attempts at remote monitoring focused on self-reported vital signs and symptoms, yet these proved ineffective. Meanwhile, subsequent technological advancements have enabled the development of miniature sensors capable of detecting and monitoring a wide range of physiologically relevant parameters; some of these advancements have been integrated into implantable devices, such as pacemakers and defibrillators. However, noninvasive monitoring has recently emerged as an alternative option for patients with HF, offering early congestion detection without requiring an invasive procedure. This review aims to summarize implanted and noninvasive devices, their characteristics, monitored parameters, and potential limitations and challenges around their integration into routine clinical practices.

Abstract Background Patients with inflammatory bowel disease (IBD) often experience symptoms refractory to available treatments, prompting the use of alternative therapies like cannabis. Previous studies have shown cannabis users require higher levels of sedation for procedures. The anti-inflammatory effects of cannabis have been studied with mixed conclusions. We aimed to investigate if patients with IBD who reported cannabis use required more resources for endoscopic procedures and were more likely to have endoscopic inflammation. Methods This is a retrospective case–control study of adult patients with IBD between November 2018 and November 2022 at a tertiary academic medical center undergoing endoscopic evaluation of acute complaints related to IBD. Cases were matched for age, sex, and body mass index. Results There were 124 patients with IBD with 62 patients reporting cannabis use and 62 patients without reported cannabis use. There was a significant difference in endoscopy duration (P < .001) and endoscopic inflammation (P = .044) between groups. There was no significant difference in recovery room length of stay (P = .15), IBD treatment during time of endoscopy (P = .84), stricture (P = .53), propofol dose administered when adjusted for procedure duration (P = .082), or endoscopic duration between cannabis users with and without endoscopic inflammation (P = .194). Conclusions IBD cannabis users had longer endoscopic durations and were more likely to exhibit inflammation on endoscopic evaluation compared to cannabis non-users. Our study underscores the importance of medication reconciliation for more accurate resource allocation. Additionally, federal expansion of cannabis research is needed for randomized control trials to fulfill the presently unmet need for data on patient outcomes.

This study introduces Logarithmic Positional Partition Interval Encoding (LPPIE), a novel lossless compression methodology employing iterative logarithmic transformations to drastically reduce data size. While conventional dictionary-based algorithms rely on repeated sequences, LPPIE translates numeric data sequences into highly compact logarithmic representations. This achieves significant reduction in data size, especially on large integer datasets. Experimental comparisons with established compression methods—such as ZIP, Brotli, and Zstandard—demonstrate LPPIE’s exceptional effectiveness, attaining compression ratios nearly 13 times superior to established methods. However, these substantial storage savings come with elevated computational overhead due to LPPIE’s complex numerical operations. The method’s robustness across diverse datasets and minimal scalability limitations underscore its potential for specialized archival scenarios where data fidelity is paramount and processing latency is tolerable. Future enhancements, such as GPU-accelerated computations and hybrid entropy encoding integration, are proposed to further optimize performance and broaden LPPIE’s applicability. Overall, LPPIE offers a compelling alternative in lossless data compression, substantially redefining efficiency boundaries in high-volume numeric data storage.

Hepatocellular carcinoma (HCC) remains a leading cause of cancer-related mortality worldwide, with early detection playing a crucial role in improving survival rates. Artificial intelligence (AI), particularly in medical image analysis, has emerged as a potential tool for HCC diagnosis and surveillance. Recent advancements in deep learning-driven medical imaging have demonstrated significant potential in enhancing early HCC detection, particularly in ultrasound (US)-based surveillance. This review provides a comprehensive analysis of the current landscape, challenges, and future directions of AI in HCC surveillance, with a specific focus on the application in US imaging. Additionally, it explores AI’s transformative potential in clinical practice and its implications for improving patient outcomes. We examine various AI models developed for HCC diagnosis, highlighting their strengths and limitations, with a particular emphasis on deep learning approaches. Among these, convolutional neural networks have shown notable success in detecting and characterising different focal liver lesions on B-mode US often outperforming conventional radiological assessments. Despite these advancements, several challenges hinder AI integration into clinical practice, including data heterogeneity, a lack of standardisation, concerns regarding model interpretability, regulatory constraints, and barriers to real-world clinical adoption. Addressing these issues necessitates the development of large, diverse, and high-quality data sets to enhance the robustness and generalisability of AI models. Emerging trends in AI for HCC surveillance, such as multimodal integration, explainable AI, and real-time diagnostics, offer promising advancements. These innovations have the potential to significantly improve the accuracy, efficiency, and clinical applicability of AI-driven HCC surveillance, ultimately contributing to enhanced patient outcomes.

PURPOSE Oncology pharmacists (OPs) play a crucial role in cancer care, treatment, survivorship, and multidisciplinary teams (MDTs). OPs have specialized training in designing, administering, monitoring, and modifying oncology chemotherapy; managing adverse events; and evaluating clinical trials and investigational drugs. Yet, the state of OP has remained largely unknown in the clinical oncology workforce of the West African region. Therefore, this study aimed to understand who reconstitutes chemotherapy and to explain the OP educational and practice needs, challenges, and solutions in Nigeria. MATERIALS AND METHODS Using a concurrent embedded mixed method design, 35 OPs completed a questionnaire, and 12 others responded to a semistructured interview. The data were then subjected to inductive thematic and descriptive analyses. RESULTS The findings showed that 54% of the OPs were responsible for chemotherapy reconstitution, and only 60% of the oncology centers had a biosafety cabinet. 91% of OPs were practicing; however, only 54% were trained in OP, and none of the OPs were board-certified. Most of the OPs spent time weekly on reconstitution, administrative duties, teaching, and training; only 3% spent on oncology clinical trials and conferences and 8% on noninterventional research. We identified four themes: (1) Some OPs are not reconstituting chemotherapy: A Call for MDT, (2) For OP, No Training is Enough, (3) Board Certification will give OPs Recognition, and (4) Introduction of OP Course in Universities. CONCLUSION To improve patient treatment outcomes, training on chemotherapy reconstitution should be prioritized, integration of OPs into MDTs, and the safe handling of chemotherapy in centers should be mandated in the region. The West African Postgraduate College of Pharmacists should be supported in expanding its curriculum and introducing OP fellowships.

Background Vaccinations for COVID-19 have played a pivotal role in controlling the global pandemic, with most adverse events being mild and transient. However, rare post-vaccination autoimmune responses have been reported. The understanding of long-term rheumatologic sequelae, particularly autoimmune polyarthritis following COVID-19 vaccination, remains limited. Case Presentation We report the case of a 41-year-old previously healthy man who developed progressive polyarthritis and systemic symptoms following the Johnson & Johnson COVID-19 vaccine. The initial symptoms of joint swelling and arthralgia appeared within a week of the first vaccine dose, subsiding temporarily with medication. After receiving a booster dose, the patient experienced worsening polyarthritis affecting multiple joints including knees, elbows, wrists, shoulders, and neck, along with low-grade fever, fatigue, and functional decline. Despite outpatient anti-inflammatory therapy, symptoms persisted and worsened over the next six months, prompting hospitalization. Workup revealed elevated inflammatory markers (ESR 77 mm/hr, CRP 193.2 mg/L), synovial fluid consistent with inflammatory arthritis, and infectious serologies. Imaging showed joint effusions and calcified pulmonary granulomas. He was diagnosed with vaccine-induced reactive arthritis. Treatment with intravenous corticosteroids led to partial symptom relief, and he was discharged on oral steroids and initiated on methotrexate for long-term management. Conclusion Clinicians should maintain a high index of suspicion for autoimmune phenomena such as reactive polyarthritis following COVID-19 vaccination, especially in patients with new-onset joint symptoms. Early recognition and referral to rheumatology may improve outcomes. Further studies are needed to clarify the pathophysiology, risk factors, and long-term prognosis of such vaccine-associated autoimmune conditions.

Abstract Introduction: Hyperexcitability, particularly of DRG neurons, is a key driver of persistent pain states including neuropathic pain. Contactin-associated protein-like 2 (CASPR2) is transmembrane protein known to interact and regulate the function of Kv1 channels, important determinants of neuronal excitability. Patients with autoantibodies (-Abs) against CASPR2 commonly have neuropathic pain, and these patient-Abs enhance the excitability of DRG neurons secondary to Kv1 channel disruption, leading to pain-related hypersensitivity. This is also observed after genetic ablation of CASPR2. Conversely, increasing CASPR2 levels in DRG neurons reduces excitability. Objectives: The aim of this study was to assess whether overexpressing CASPR2 could be a potential approach to treat pain. Methods: We generated a Cre-dependent mouse line to express human CASPR2 (R26 LSL:hCNTNAP2(+/+) (CASPR2 OE )) and crossed this with either Hoxb8 Cre or Nav1.8 Cre mice for CASPR2 overexpression in either all DRG neurons or to target nociceptors more selectively. Results: In both lines, CASPR2 was significantly overexpressed in DRG neurons, including at the cell membrane. In comparison to control littermates, overexpression of CASPR2 did not affect acute pain–related behaviour to mechanical or thermal stimulation or nerve injury–induced pain-related hypersensitivity. However, in both overexpression mouse lines, there were significantly reduced nocifensive responses to capsaicin. Although CASPR2 overexpression increased the contribution of α-dendrotoxin–sensitive Kv1 channels to the slowly inactivating outward current I KD , it did not affect total I KD. Conclusion: CASPR2 overexpression in DRG neurons can affect nociception, reducing pain-related behaviours to the noxious stimulant capsaicin, yet is insufficient to reduce mechanical pain–related hypersensitivity caused by nerve injury.

Abstract Aims To assess the performance of an artificial intelligence-enabled electrocardiogram (AI-ECG) algorithm in identifying patients with moderate to severe aortic stenosis (AS) in an Asian cohort from a tertiary care centre. Methods and results We identified a randomly selected patients ≥60 years old who underwent echocardiography and ECG within in 31 days between 2012 and 2021 at the Samsung Medical Center in Korea. Patients with previous cardiac surgery, prosthetic valves, or pacemakers were excluded. The AI-ECG model, originally developed and validated by Mayo Clinic in the USA, was applied without fine-tuning. Performance metrics, including the area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy, were calculated to compare AI-ECG predictions with TTE-confirmed AS status. Among 5425 patients, 1095 had moderate to severe AS, and 4330 age- and sex-matched patients without AS were included as controls. The AI-ECG model achieved an AUC of 0.85 (95% CI: 0.84–0.87) in detecting moderate to severe AS. Sensitivity, specificity, PPV, NPV, and accuracy were 0.83, 0.65, 0.37, 0.94, and 68.29%, respectively. The model's performance was consistent across various age and sex subgroups, with sensitivity increasing in older patients. Conclusion The AI-ECG model developed in the USA demonstrated comparable performance in detecting moderate to severe AS in an Asian cohort compared with its original validation population. These findings highlight the potential utility of AI-ECG as a non-invasive screening tool for AS across diverse patient populations.

Obstructive sleep apnea (OSA), a sleep disorder that is associated with exposure to repeated bouts of hypoxia overnight. Evidence suggests that the oxyhemoglobin dissociation curve (ODC) may be shifted rightward with OSA. Nitric oxide (NO) functions as an allosteric regulator of hemoglobin oxygen-binding properties, possibly shifting the ODC curve leftward. Nitrate/nitrite supplementation increases NO bioavailability and attenuates the physiological responses to hypoxia which may be due to changes in the ODC. Therefore, we explored the hypothesis that dietary nitrate supplementation improves oxygen re-saturation following inspiratory hypoxia in subjects with OSA. Fourteen subjects with untreated mild-moderate OSA (53 ± 10yr, 8M/6F; Apnea-hypopnea Index, 17.8 ± 8.1 events) completed two separate study visits. Each visit consisted of two hypoxic bouts separated by ~2 hours and the consumption of one of two beetroot juice beverages (Placebo [BR P ] containing 5-10 mg nitrate, no detectable nitrite, or Active [BR A ] containing 500mg nitrate and 40mg nitrite). For each hypoxia bout, subjects’ pulse oxygen saturation (%SpO 2 ) was titrated to ≤80% over 3-5min by blending a 10% FiO2 gas cylinder with room air. Once ≤80% SpO 2 was achieved, subjects inhaled normoxic room air (~21% FiO2) and oxygen saturation was monitored until SpO 2 returned to baseline (recovery). During recovery, SpO 2 was averaged into 5 sec bins from the end of hypoxia (nadir) up to +15 SpO 2 % above nadir. The ‘hypoxic load’ during recovery was calculated as ( i =1 ∑ n ∣Value i −nadir+15∣) and reflects a total sum of each 5 sec bin ( n ). BR A increased plasma nitrite (248 ± 155 to 738 ± 427nM, P < 0.05), whereas there was no change following BR P (266 ± 153 to 277 ± 164nM, P = 0.87). The level of desaturation (SpO 2 nadir) at the end of hypoxia did not differ within or between trials (BR A : Pre 78 ± 2 vs. 78 ± 3; BR P : Pre 78 ± 2 vs. 78 ± 2, condition x time interaction P = 0.21). Hypoxia load increased following BR P (162.7 ± 36.6 vs. 231.8 ± 65.7, P < 0.001), but was unchanged following BR A (174.3 ± 54.2 vs. 191.2 ± 52, P = 0.32). In summary, our study suggests that acute nitrate supplementation may cause a leftward shift in the ODC in patients with untreated OSA. This is supported by a reduced hypoxic load following a repeat bout of inspiratory hypoxia. These findings may have implications for the health of patients with OSA. Foundation for the National Institutes of Health, K12 AR084222 (Joshua Bock) This abstract was presented at the American Physiology Summit 2025 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.