Carilion Clinic, formerly known as Carilion Health System, is a Roanoke, Virginia-based non-profit integrated health care organization that provides care for nearly one million Virginians and West Virginians. Carilion owns and operates seven hospitals in the western part of Virginia as well as Radford University Carilion and a joint venture medical school and research institute with Virginia Tech. The system consists of hospitals, primary and specialty physician practices, pharmacies, health clubs and other complementary services. Carilion has more than 13,200 employees with 737 physicians covering more than 70 specialties at 225 practice sites, making it the largest employer in the Roanoke Valley. Clinical expertise include cancer, cardiology, heart surgery and vascular care, gastroenterology, neurology, neurosurgery, orthopaedics, primary and preventive care, pediatrics, trauma, and women's health..
There is a need to understand the predictors of prostatic urethral lift (PUL) durability to help physicians counsel patients and optimize outcomes. A simple logistic regression analysis was performed on a pooled dataset of 331 subjects across 5 PUL controlled studies with up to 5 years follow up. Predictors of “surgical durability” (no surgical treatment for return of symptoms) and “total durability” (no surgical or medical treatment for return of symptoms) were assessed at 1- and 5-year post-procedure. Placing ≤4 implants regardless of baseline prostate volume was associated with increased surgical retreatment within the first year. Through one year, more implants were protective of retreatment; for every incremental implant placed, surgical retreatment odds decreased an additional 41.2
Biofilm-associated infections continue to present a formidable clinical challenge, as surface-adhered microbial communities exhibit remarkable tolerance toward conventional antibiotics. Polymeric materials have emerged as a versatile platform for combating biofilms, offering chemical tunability and enabling diverse antimicrobial strategies. This feature review article highlights recent advances in polymeric materials designed to prevent biofilm-associated infections by resisting bacterial adhesion (passive inhibition) or exerting bactericidal effects (active inhibition). These approaches include antifouling surfaces, polymer-nanoparticle composites, and bioinspired materials. Particular attention is given to how polymer structure and functionality (e.g., hydrophobicity, charge, and network architecture) govern bacterial adhesion and viability at interfaces. Emerging glycomaterials are also discussed, where glycan motifs are integrated with nanoparticles or cationic domains to enhance biofilm penetration and antimicrobial efficacy. Collectively, these studies underscore the potential of polymeric materials to modulate microbe-surface interactions, thereby guiding the design of next-generation antibiofilm materials.
Objective The purpose of this investigation was to identify the mortality rate at three months and one year for patients 65 years old or older with a nonoperatively managed pelvic ring fracture. Materials and methods A retrospective comparative cohort study was performed at a single level 1 trauma tertiary referral center. From 2014 to 2019, we reviewed all patients older than 65 years who underwent nonoperative treatment for a pelvic ring fracture (Current Procedural Terminology codes 27193 or 27197). Demographics, including age, sex, body mass index (BMI), and Charlson Comorbidity Index (CCI), were recorded. Mortality status and death dates were determined from our institutional electronic health record and cross-referenced with the TriNetX database (Cambridge, MA, USA). The primary outcome was the standardized mortality ratio (SMR) for one-year mortality, calculated by comparing observed deaths in the study population with expected deaths in the age- and sex-matched general population. Secondary outcomes included three-month and one-year mortality rates, as well as demographic variables associated with mortality. Results A total of 307 patients met the inclusion criteria. There were 41 (13.4%) that died within three months and 77 (25.1%) that died within 1 year. Compared to the general population, pelvic ring fracture patients demonstrated an SMR of 3.12 (95% confidence interval: 2.46, 3.85) for one-year mortality. Compared with patients alive at three months post-injury, deceased patients did not differ significantly in age (80.9 ± 8.6 vs. 81.0 ± 9.7 years; p = 0.964), BMI (24.3 ± 5.2 vs. 25.9 ± 5.9; p = 0.062), or sex (p = 0.507). Alive patients had a lower mean CCI compared to deceased patients (5.4 ± 2.1 vs. 6.8 ± 2.8; p < 0.001). At one year, deceased patients did not demonstrate statistically significant age differences (80.5 ± 8.5 vs. 82.4 ± 9.5 years; p = 0.103), BMI (24.5 ± 5.3 vs. 24.5 ± 5.5; p = 0.922), or sex (p = 0.835), and alive patients had a lower mean CCI (5.2 ± 2.0 vs. 6.6 ± 2.6; p < 0.001). Conclusions Geriatric patients who undergo nonoperative treatment of pelvic ring fractures have a threefold higher one-year mortality compared to their age- and sex-matched peers who do not have pelvic ring fractures. There is an association between mortality and higher comorbidity burden, and clinicians should counsel patients on the elevated risk of post-injury mortality based on comorbidity status. This has implications for counseling patients and their families, as such an approach may inform surgical decision-making and ensure that treatment plans are tailored to the patient's overall health and prognosis.
Objective We aimed to create a double humanised lupus mouse model with a human immune system and faecal microbiota from patients with SLE.Methods We established the Double humanised SLE (DhuSLE) mouse by engrafting NSG immunodeficient mice with human CD34+ haematopoietic stem and progenitor cells (NSG-hu mice) and performing faecal microbiota transplantation from patients with SLE (SLE-FMT).Results While FMT in general transiently suppressed the development of human T cells in NSG-hu mice, SLE-FMT but not FMT from non-SLE donors promoted superficial skin lesions. Importantly, the combination of SLE-FMT and pristane in NSG-hu, now called the DhuSLE-P mouse, induced proteinuria although this clinical sign observed in mice did not reflect that of the microbiota donors. DhuSLE-P mice exhibited a higher level of human IgM in the circulation than NSG-hu mice, which was positively correlated with the frequency of plasma cells in the spleen. In the splenic sections of DhuSLE-P mice, nuclear BCL6 was minimally detected but CD138 expression was evident, suggesting that most plasma cells generated were not class switched and produced IgM. Some human IgG was detected in the kidney of DhuSLE-P mice with a trend towards increased total IgG in the serum. Analysis of the faecal microbiota revealed that the gut microbiota compositions were different between DhuSLE-P mice and NSG-hu mice due to SLE-FMT but not the injection of pristane.Conclusion Together, these results introduced the first humanised lupus mouse model combining the human immune system and gut microbiota from patients with SLE. However, limitations exist and the model may benefit from methods that promote antibody class switching. On further development, the DhuSLE model can be useful for elucidating mechanisms and/or evaluating SLE treatments.
Abstract A 97 year old caucasian woman presented to the pulmonary clinic with a 3 year history of progressively worsening productive cough, intermittently producing dark or “black” sputum. She also endorsed night sweats, but denied fever, weight loss, dyspnea or hemoptysis. She has no history of smoking, COPD, asthma, alcohol use or immunosuppression. She had a history of COVID pneumonia in 2022. Her chronic cough had previously been attributed to recurrent bronchitis and treated symptomatically without improvement. High resolution chest CT revealed chronic bronchiectasis, upper and lower lobe pleural thickening and scarring. Due to persistent symptoms despite conservative therapy, induced sputum sampling was performed. Acid-fast bacilli smears were repeatedly negative. HIV testing and fungal studies were negative. However, three separate induced sputum cultures consistently isolated Nocardia cyriacigeorgica, establishing a diagnosis of chronic pulmonary nocardiosis. The patient was initiated on trimethroprom-sulfamethoxazole (TMP-SMX) with careful dosing titration in consideration of advanced age and renal function. She continues therapy with plans for a prolonged antimicrobial course to prevent relapse. Discussion Nocardia Cyriacigeorgica is an increasingly recognized pulmonary pathogen and has been reported in immunocompromised and immunocompetent older adults. The clinical course is often indolent, with nonspecific respiratory symptoms that may be misattributed to chronic airway disease or old age illness. Radiographic findings frequently mimic post-infectious bronchiectasis, chronic aspiration especially in older adults and post-infectious scarring. Diagnosis is commonly delayed as nocardia requires prolonged culture incubation and may not be detected if specimens are not specifically requested to be held for longer than routine testing. Additionally, negative AFB smears do not exclude nocardiosis, as the organism is weakly acid-fast. This case highlights the critical role of repeated and induced sputum sampling when spontaneous sputum production is limited. Induced sputum is important in evaluating patients who have bronchiectasis with chronic cough. Early recognition is essential because directed and prolonged therapy is effective and prevents relapse. References: 1. Brown-Elliott BA, Conville PS, Wallace RJ Jr. Clinical and Laboratory Features of Nocardia Species. Clin Microbiol Rev. 2006;19(2):259-282.2. McTaggart LR, Richardson SE, Witkowska M, et al. Nocardia cyriacigeorgica: An Emerging Pathogen. J Clin Microbiol. 2015;53(2):627-635.3. Rivera A, Hager DN, Debiane LG. Nocardia infections in older adults. Drugs Aging. 2021;38:927-938.4. Wilson JW. Nocardiosis: Updates and Clinical Overview. Mayo Clin Proc. 2012;87(4):403-407.5. Griffith DE, Girard WM, Wallace RJ Jr. Pulmonary nocardiosis in patients with bronchiectasis. Clin Infect Dis. 1999;28(2):373-378. This abstract is funded by: none
