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People with lower limb loss often experience psychological concerns related to falling. A concern for falling (CFF) includes four subdomains: fear of falling, self-efficacy, consequences of falling, and perceptions of falls. Limited research exists on how these subdomains are influenced by clinical factors and falls history. This cross-sectional online survey evaluated: (1) associations among CFF outcome measures; (2) relationships between falls history and outcome measures; and (3) clinical and demographic factors related with outcome measures. Inclusion criteria: ≥18 years old, unilateral transtibial amputation and ambulating with a prosthesis. Eight measures assessed CFF: visual analog scale fear of falling, Modified Survey of Activities and Fear of Falling in the Elderly (mSAFFE), Activities-specific Balance Confidence (ABC), Falls Efficacy Scale International (FES-I), Prosthetic Limb Users Survey - Mobility (PLUS-M), Locomotor Capabilities Index, Consequences of Falling Scale, and Perceived Ability to Manage Falls. Pearson bivariate correlation analysis assessed associations among outcome measures. T tests evaluated the association of falls status on outcome scores. Multiple linear regression modelled the clinical and demographic factors related to each measure. Sixty-eight adults (mean 61.8 ± 12.0) participated. Moderate statistically significant (P < 0.001) correlations were found across most outcome measures, with the strongest between PLUS-M and mSAFFE (r = -0.841), and ABC and FES-I (r = -0.821). Faller status was not associated with any measure (P > 0.05). Quality of life was associated with fear of falling, activity avoidance, self-efficacy, and certainty to managing falls (R2 ranged from 0.27 to 0.47). CFF should be evaluated independently of falls history., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Patients with prior COVID-19 infections often develop chronic post-COVID symptoms, such as fatigue and dyspnea. Some patients have residual pulmonary disorders with abnormal pulmonary function tests and/or chest radiographs to explain their dyspnea. However, other patients appear to have dyspnea that is out of proportion to any measurable change in lung function. Some of these patients have abnormal cardiopulmonary exercise testing with definite cardiac or respiratory limits. However, others have normal cardiopulmonary exercise testing based on VO 2 measurement but pronounced dyspnea during this testing. These patients often have abnormal respiratory patterns, referred to as dysfunctional breathing, with irregular and variable respiratory rates and/or tidal volumes. Consequently, their control of breathing is impaired, and this may represent residual effects from prior COVID-19 infection involving the central nervous system. Alternatively, patients may have acquired "a memory" of respiratory symptoms during their infection which persists post-infection. These patients should participate in pulmonary rehabilitation and breathing retraining., Competing Interests: Declaration of competing interest The authors have no conflict of interest related to this manuscript., (Copyright © 2024 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.)

This case report and review describes a 31-year-old man with a history of chronic pancreatitis who presented to the hospital with shortness of breath and left-sided chest pain. Three days prior, he underwent mid-splenic artery embolization due to hematemesis attributed to a splenic artery pseudoaneurysm associated with a peripancreatic pseudocyst. Upon this presentation, the patient reported increasing shortness of breath, left-sided pleuritic chest pain, and epigastric and left upper quadrant abdominal pain. Imaging revealed left pleural effusion, splenic infarcts, and adjacent fluid collections. Thoracentesis confirmed an exudative effusion. The pleural effusion was attributed to recent splenic artery embolization, and the patient was discharged on appropriate medications in stable condition on the sixth day of hospitalization. This case underscores the importance of considering embolization-related complications in the differential diagnosis of pleural effusions following such procedures. The etiology, diagnosis, and management of splenic artery aneurysms are discussed in this review., (Copyright © 2024 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.)

Patients undergoing cardiac surgery often receive vasopressor and inotropic medications during the surgical procedure and during intensive care unit (ICU) management following surgery. Patients with cardiogenic shock, septic shock, and other clinical disorders associated with shock also receive vasopressor medications during their ICU care. The level of support and the duration of support are likely associated with outcomes, including mortality and new organ dysfunction, such as acute kidney injury. The vasopressor-inotropic score provides a simple method to determine the level of support during the care of these patients; this score includes the infusion rates of norepinephrine, epinephrine, dopamine, dobutamine, and other inotropic medications. It has been studied in patients undergoing cardiac surgery, coronary artery bypass grafting, cardiac transplantation, left ventricular assist device implantation, septic shock, and traumatic brain injury. Higher scores are associated with poor outcomes and complications during ICU care. The studies analyzed in this review demonstrate the utility of the vasopressor-inotropic score in a variety of clinical disorders associated with shock. Electronic medical record systems should develop algorithms to calculate this score and provide continuous up-to-date measurements. This could help clinicians identify patients at risk for mortality and important complications, such as acute kidney injury., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Dyspnea is an important non-motor symptom in Parkinson's disease (PD) that impacts quality of life. The mechanisms underlying dyspnea have been difficult to determine due to challenges separating central respiratory control abnormalities from peripheral respiratory muscle dysfunction and chest wall rigidity., Methods: A comprehensive literature review was conducted, searching the PubMed database for observational studies on respiratory dysfunction and dyspnea in PD. Inclusion criteria were studies with PD patients without other neurological disorders. Case studies were excluded. Data on study size, disease duration, control groups, and respiratory defects were extracted., Results: The search yielded 23 unique publications on pulmonary function in PD. Key findings were: 1) restrictive defects are common, with prevalence up to 85 % in some studies; 2) effects of levodopa on pulmonary function are variable across studies; 3) there is limited research on the role of central respiratory centers in dyspnea pathophysiology in PD. Proposed mechanisms include direct involvement of brainstem respiratory structures, loss of dopamine input to these regions, and astrocyte dysfunction affecting respiratory rhythm generation., Conclusion: This review outlines potential mechanisms underlying dyspnea in PD, including central respiratory dysfunction, peripheral muscle/chest wall abnormalities, impaired respiratory sensation, and medication effects. More research is needed investigating specific brainstem regions involved, chemoreceptor pathology, correlations between respiratory load and perceived dyspnea, and medication effects on pulmonary function., Competing Interests: Declaration of competing interest Suyash Jain, Shruti Patel, and Kenneth Nugent have nothing to declare related to this particular project., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Resveratrol as well as natural products biosynthetically derived from it, have been shown to have protective effects against oxidative stress. However, these compounds possess poor druglike properties. At sub-nanomolar concentrations, a novel compound (RVM-6) inspired by a resveratrol natural product prolongs synaptic viability in neuromuscular junctions in D. melanogaster exposed to acute oxidative stress., Competing Interests: The authors declare that there are no conflicts of interest present., (Copyright: © 2024 by the authors.)

Purpose: To evaluate the relative diagnostic yield of clinical germline genomic tests in a diverse pediatric cancer population., Patients and Methods: The KidsCanSeq study enrolled pediatric cancer patients across six sites in Texas. Germline analysis included both exome sequencing and a therapy-focused pediatric cancer gene panel. The results were categorized by participants demographics, the presence of pathogenic or likely pathogenic (P/LP) variants, and variants of uncertain significance (VUS) in cancer predisposition genes (CPGs). Pediatric actionable CPGs were defined as those with cancer surveillance recommendations during childhood., Results: Cancer P/LP variants were reported by at least one platform in 103 of 578 (17.8%) participants of which 76 were dominant cancer genes (13.1%) with no significant differences by self-described race or Hispanic ethnicity. However, the proportion of participants with VUS was greater in Asian and African American participants ( P = .0029). Diagnostic yield was 16.6% for exome versus 8.5% for panel ( P < .0001) with 42 participants with concordant germline results. Exome-only results included P/LP variants in 30 different CPGs in 54 participants, whereas panel-only results included seven participants with a copy number or structural P/LP variants in CPGs. There was no significant difference in diagnostic yield limited to pediatric actionable CPGs ( P = .6171)., Conclusion: Approximately 18% of a diverse pediatric cancer population had germline diagnostic findings with 50% of P/LP variants reported by only one platform because of CPGs not on the targeted panel and copy number variants (CNVs)/rearrangements not reported by exome. Although diagnostic yields were similar in this diverse population, increases in VUS results were observed in Asian and African American populations. Given the clinical significance of CNVs/rearrangements in this cohort, detection is critical to optimize germline analysis of pediatric cancer populations.

Background: The combination of vancomycin and piperacillin-tazobactam (VPT) has been associated with acute kidney injury (AKI) in hospitalized patients when compared to similar combinations. Additional studies examining this nephrotoxic risk in critically ill patients have not consistently demonstrated the aforementioned association. Furthermore, patients with baseline renal dysfunction have been excluded from almost all of these studies, creating a need to examine the risk in this patient population. Methods: This was a retrospective cohort analysis of critically ill adults with baseline chronic kidney disease (CKD) who received vancomycin plus an anti-pseudomonal beta-lactam at Emory University Hospital. The primary outcome was incidence of AKI. Secondary outcomes included stage of AKI, time to development of AKI, time to return to baseline renal function, new requirement for renal replacement therapy, intensive care unit and hospital length of stay, and in-hospital mortality. Results: A total of 109 patients were included. There was no difference observed in the primary outcome between the VPT (50%) and comparator (58%) group ( P  = .4), stage 2 or 3 AKI (15.9% vs 6%; P  = .98), time to AKI development (1.7 vs 2 days; P  = .5), time to return to baseline renal function (4 vs 3 days; P  = .2), new requirement for RRT (4.5% vs 1.5%; P  = .3), ICU length of stay (7.3 vs 7.4 days; P  = .9), hospital length of stay (19.3 vs 20.1 days; P  = .87), or in-hospital mortality (15.9% vs 10.8%; P  = .4). A significant difference was observed in the duration of antibiotic exposure (3.32 vs 2.62 days; P  = .045 days). Conclusion: VPT was not associated with an increased risk of AKI or adverse renal outcomes. Our findings suggest that the use of this antibiotic combination should not be avoided in this patient population. More robust prospective studies are warranted to confirm these findings., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Hepatitis C virus is an important global cause of hepatitis and subsequently cirrhosis and hepatocellular carcinoma. These infections may also cause extrahepatic manifestations, including insulin resistance and type 2 diabetes mellitus. These two complications can potentially reduce sustained virologic responses (SVR) in some drug regimens for this infection. Metformin has important biochemical effects that can limit viral replication in cellular cultures and can improve the response to antiviral drug therapy based on ribavirin and interferon. Clinical studies comparing treatment regimens with interferon, ribavirin, metformin with these regimens without metformin have demonstrated that metformin increases viral clearance, establishes higher rates of SVRs, and increases insulin sensitivity. Metformin also reduces the frequency of hepatocellular carcinoma in patients who have had SVRs. Larger treatment trials are needed to determine metformin's short-term and long-term treatment effects in patients with diabetes using newer antiviral drugs. In particular, if metformin reduces the frequency of cirrhosis and hepatocellular carcinoma, this would significantly reduce the morbidity and mortality associated with this infection., Competing Interests: Conflict of Interest The author has no financial or other conflicts of interest to disclose., (Copyright © 2024 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.)