Salivary Gland Botulinum Toxin a Injections for Treating Sialorrhea Among Critically Ill Patients With Neurological Disorders.

Sialorrhea is associated with various neurological conditions. Among critically ill patients with acute neurological injuries (ANI), sialorrhea leads to several adverse consequences, including extubation failure, inability to initiate non-invasive ventilation, aspiration pneumonia and prolonged hospitalization. Botulinum toxin (BoTN) injections can reduce salivary production.

Traumatic brain injury and disorders of consciousness.

Trauma is one of the most common causes of disorders of consciousness (DOC) worldwide. Traumatic brain injury (TBI) leads to heterogeneous, multifocal injury via focal brain damage and diffuse axonal injury, causing an acquired network disorder. Recovery occurs through reemergence of dynamic cortical and subcortical networks.

Novel Post-Neurointensive Care Recovery Clinic: Design, Utilization, and Clinician Perspectives.

Background And Objectives: Despite increasing interest in post-intensive care unit (ICU) clinical care and management, there have been limited descriptions focused on the post-neurologic (neuro)-ICU population. Here, we describe the design of a post-neuro-ICU Neurorecovery Clinic (NRC) and present data collected regarding the clinic's population, referrals, visits, and clinician satisfaction.

Methods: This is a single-institution experience with a NRC designed to provide an infrastructure for post-ICU care to patients recovering from acute neurologic disorders or systemic conditions with neurologic sequelae.

Prognostication in Prolonged and Chronic Disorders of Consciousness.

Patients with prolonged disorders of consciousness (DOCs) longer than 28 days may continue to make significant gains and achieve functional recovery. Occasionally, this recovery trajectory may extend past 3 (for nontraumatic etiologies) and 12 months (for traumatic etiologies) into the chronic period. Prognosis is influenced by several factors including state of DOC, etiology, and demographics.

Safe Use of Cenobamate in Super Refractory Status Epilepticus: A Case Series.

Cenobamate is an effective new adjunctive antiseizure medication (ASM) for treatment resistant focal epilepsy. It has broad spectrum anticonvulsant activity and may be a useful medication for super refractory status epilepticus (SRSE), but has not yet been studied in generalized seizures or an inpatient setting. Here we describe 2 SRSE cases where cenobamate was added safely to other treatments.

Surgical Management in Herpes Simplex Encephalitis: Illustrative Case Report and Systematic Review of the Literature.

Background: Herpes simplex virus (HSV) is a common cause of viral encephalitis and can result in refractory seizures. Although HSV encephalitis (HSVE) is treated primarily with acyclovir, surgery can play a role in medically intractable cases.

Objective: To systematically review cases describing surgery for the treatment of severe HSVE.

Early withdrawal of life sustaining therapy in extracorporeal cardiopulmonary resuscitation (ECPR): Results from the Extracorporeal Life Support Organization registry.

Aims: Although extracorporeal cardiopulmonary resuscitation (ECPR) improves survival outcomes in refractory cardiac arrest, morbidity and mortality remain significantly high. Information on causes of death in ECPR is limited; however, some evidence suggests withdrawal of life sustaining therapy (WLST) is a major factor in ECPR-associated mortality. We sought to describe the patients experiencing WLST after ECPR.

Population Characteristics and Markers for Withdrawal of Life-Sustaining Therapy in Patients on Extracorporeal Membrane Oxygenation.

Objective: As survival with extracorporeal membrane oxygenation (ECMO) therapy improves, it is important to study patients who do not survive secondary to withdrawal of life-sustaining therapy (WLST). The purpose of the present study was to determine the population and clinical characteristics of those who experienced short latency to WLST.

Design: Retrospective cohort study.

High-dose hydroxocobalamin achieves biochemical correction and improvement of neuropsychiatric deficits in adults with late onset cobalamin C deficiency.

Cobalamin C () deficiency is the most common inborn error of intracellular cobalamin metabolism caused by pathogenic variant(s) in and manifests with methylmalonic acidemia, hyperhomocysteinemia, and hypomethioninemia with a variable age of presentation. Individuals with late-onset may be asymptomatic until manifesting neuropsychiatric symptoms, thromboembolic events, and renal disease. Although hydroxocobalamin provides a foundation for therapy, optimal dose regimen for adult patients has not been systematically evaluated.

Sodium bicarbonate cotransporter NBCe2 gene variants increase sodium and bicarbonate transport in human renal proximal tubule cells.

Rationale: Salt sensitivity of blood pressure affects >30% of the hypertensive and >15% of the normotensive population. Variants of the electrogenic sodium bicarbonate cotransporter NBCe2 gene, SLC4A5, are associated with increased blood pressure in several ethnic groups. SLC4A5 variants are also highly associated with salt sensitivity, independent of hypertension.

The sodium-bicarbonate cotransporter NBCe2 (slc4a5) expressed in human renal proximal tubules shows increased apical expression under high-salt conditions.

The electrogenic sodium bicarbonate cotransporter (NBCe2) is encoded by SLC4A5, variants of which have been associated with salt sensitivity of blood pressure, which affects 25% of the adult population. NBCe2 is thought to mediate sodium bicarbonate cotransport primarily in the renal collecting duct, but NBCe2 mRNA is also found in the rodent renal proximal tubule (RPT). The protein expression or function of NBCe2 has not been demonstrated in the human RPT.

Exosomal transfer from human renal proximal tubule cells to distal tubule and collecting duct cells.

Objectives: Exosomes are 50-90nm extracellular membrane particles that may mediate trans-cellular communication between cells and tissues. We have reported that human urinary exosomes contain miRNA that are biomarkers for salt sensitivity and inverse salt sensitivity of blood pressure. This study examines exosomal transfer between cultured human renal proximal tubule cells (RPTCs) and from RPTCs to human distal tubule and collecting duct cells.

Urinary exosome miRNome analysis and its applications to salt sensitivity of blood pressure.

Objectives: To investigate microRNAs (miRNAs) in urinary exosomes and their association with an individual's blood pressure response to dietary salt intake.

Design And Methods: Human urinary exosomal miRNome was examined by microarray.

Results: Of 1898 probes tested, 194 miRNAs were found in all subjects tested.

A novel role for c-Myc in G protein-coupled receptor kinase 4 (GRK4) transcriptional regulation in human kidney proximal tubule cells.

The G protein-coupled receptor kinase 4 (GRK4) negatively regulates the dopaminergic system by desensitizing the dopamine-1-receptor. The expressional control of GRK4 has not been reported, but here we show that the transcription factor c-Myc binds to the promoter of GRK4 and positively regulates GRK4 protein expression in human renal proximal tubule cells (RPTCs). Addition of phorbol esters to RPTCs not only increased c-Myc binding to the GRK4 promoter but also increased both phospho-c-Myc and GRK4 expression.