Latest News Releases 8 April

Plain radiographs (X-ray), computed tomography (CT) scans and magnetic resonance imaging (MRI) are commonly used in the evaluation of lower back pain. While MRI use has increased most over the past decades (more than 300% from 1994-2005), its use in low back pain (LBP) management can be associated with added costs and increased surgical interventions.

A new study from researchers at Boston University Chobanian & Avedisian School of Medicine has found that in cases of low back pain without worrisome signs, use of an X-ray is often sufficient to diagnose the problem.

Background: The details regarding the pathogenesis of hypoxemia in the presence of acute type-A aortic dissection (ATAAD) remains to be fully elucidated. In this study, we investigated the dynamic changes in systemic inflammatory response, gut injury, hypoxemia, and succinate levels in patients with ATAAD and their impact on perioperative hypoxemia.

Methods: We conducted a single-center, observational, case-control study that enrolled 18 patients with ATAAD who underwent emergency total arch repair (TAR) combined with frozen elephant trunk (FET) procedure under hypothermic lower-body circulatory arrest and antegrade cerebral perfusion. White blood cell (WBC) count, interleukin (IL)6, IL8, tumor necrosis factor α (TNFα), diamine oxidase (DAO), intestinal fatty-acid-binding protein (iFABP), peptidoglycan (PGN), and succinate were assessed preoperatively and 12, 24, and 48 hours after operation. The PaO₂/FiO₂ ratios were evaluated preoperatively and 4, 8, and 12 hours after operation. These variables were compared between different time points. Correlation analyses and multivariate linear regression were performed to evaluate the variables’ impact on 12-hour postoperative hypoxemia.

Results: Compared to controls, patients with ATAAD had a significantly higher preoperative WBC count [(12.18±4.50)×10⁹/L vs. (3.73±1.05)×10⁹/L; P<0.001], IL6 (129.31±12.86 vs. 114.22±14.11 pg/mL; P=0.002), IL8 (147.57±16.03 vs. 127.56±20.23 pg/mL; P=0.002), TNFα (59.29±6.90 vs. 40.51±7.53 pg/mL; P<0.001), DAO activity (17.94±1.54 vs. 13.32±1.82 U/L; P<0.001), and succinate (235.92±48.09 vs. 106.95±27.63 µM; P<0.001) but a lower PaO₂/FiO₂. In patients with ATAAD, postoperative levels of IL6, IL8, TNFα, DAO, iFABP, and PGN were significantly elevated compared to preoperative levels, while the PaO₂/FiO₂ ratio decreased significantly from the preoperative levels. Succinate levels peaked prior to the operation and remained elevated at both the 12- and 24-hour postoperative time points. PGN, iFABP, succinate, and lowest rectal temperature during cardiopulmonary bypass were the risk factors for hypoxemia at 12 hours’ postoperation.

Conclusions: Systemic inflammatory response, gut injury, and hypoxemia had already occurred preoperatively in patients with ATAAD and exacerbated postoperatively following TAR combined with FET procedure under hypothermic lower-body circulatory arrest and antegrade cerebral perfusion. Succinate may play a pivotal role in the development of hypoxemia in patients with ATAAD.

Keywords: Type A aortic dissection; systemic inflammatory response; hypoxemia; gut injury; succinate

Background and Objective: Airway clearance is essential for maintaining patency in critically ill patients and relies on the mucociliary escalator, expiratory flow, and cough strength. A weak cough significantly increases the risk of therapy failure in patients receiving noninvasive ventilation (NIV) or high-flow nasal cannula (HFNC). This review aims to summarize current practices for assessing and exercising cough strength in critically ill patients.

Methods: A comprehensive literature search was conducted in PubMed, Embase, and ScienceDirect using specific keywords related to cough assessment and exercises. A total of 281 articles on cough assessment and 1,407 on cough exercises were identified, with 26 and 73 studies included in the review, respectively.

Key Content and Findings: By collecting literature related to cough efficacy, this narrative review describes methods for assessing cough ability and strategies for improving it. The assessment methods for cough ability include quantitative, semi-quantitative, and qualitative evaluations, each targeting different populations and having its own advantages and disadvantages. For patients whose cough ability has diminished, it is essential to implement cough training. Cough exercises focus on increasing inhaled volume, enhancing expiratory flow, and utilizing oscillation techniques to improve cough effectiveness. Choosing the appropriate training method for the patients can lead to significantly better outcomes.

Conclusions: Weak cough in critically ill patients correlates with increased risks of extubation failure and prolonged hospitalization. Employing appropriate assessment methods and individualized cough exercises is critical for improving patient outcomes in the intensive care unit (ICU) setting. Further research is needed to optimize training methods and enhance patient cooperation.

New Curtin University research into the overlooked environmental impact of pet dogs has found far-reaching negative effects on wildlife, ecosystems and climate.

(WASHINGTON— April 9, 2025) — A marker linked to inflammation, C-reactive protein, may increase significantly during the follicular phase of the menstrual cycle in female patients with sickle cell disease (SCD), according to emerging research published today in Blood Vessels, Thrombosis & Hemostasis.  This observation provides insight into the pattern of painful vaso-occlusive events (VOEs), which are driven by inflammation, in female patients with the disorder.