The Western Pennsylvania Hospital, commonly referred to as "West Penn Hospital", is located at 4800 Friendship Avenue in the Bloomfield neighborhood of Pittsburgh, Pennsylvania. The 317-bed hospital is part of the Allegheny Health Network. It serves as a Clinical Campus of Temple University School of Medicine, offering medical education, including a large number of residency and fellowship programs. It is also the primary clinical setting of the West Penn Hospital School of Nursing.
Mild traumatic brain injury (mTBI) is the most common type of traumatic brain injury (TBI), with 2.5 million cases reported annually in the United States. mTBI involves diverse signs, symptoms, and functional impairments that typically resolve within 1 month, but may persist. Female sex is one of the most consistent predictors associated with an increased risk of mTBI and worse outcomes, including greater symptom severity and prolonged recovery. Emerging evidence also suggests that females are at greater risk of menstrual cycle dysfunction following mTBI, which could have downstream consequences on reproductive and related women's health outcomes. Researchers have speculated that the underlying mechanism for these detrimental effects is the injury's impact on the hypothalamic-pituitary-ovarian (HPO) axis; however, it is necessary to further clarify the extent of these disruptions, identify consistent patterns across studies, and determine potential implications for reproductive health and hormonal regulation following mTBI. The goal of this narrative review is to understand the effects of mTBI on the HPO axis, identify gaps in the research and clinical practice, and provide recommendations to address these issues in females with mTBI. We summarize: (1) sex differences observed following mTBI, including physiological variables that contribute to these differences, particularly the menstrual and ovulatory cycles in females; (2) pituitary gland functions and hormonal regulations; (3) pituitary and hormonal dysfunction after mTBI; and (4) implications of hormone dysregulation on mTBI recovery. Our review concludes by highlighting methodological gaps, research needs, strategy recommendations, and treatment referrals for patients with HPO axis dysfunction after mTBI.
Trauma-informed care continues to follow the 4R principles (realize the widespread nature of trauma, recognize what unresolved trauma looks like, respond by changing practices and protocols, and resist retraumatization) but has expanded to include 6 core guiding principles that include safety, trust, peer support, mutuality, empowerment, and the understanding of an individual's cultural context. Additionally, it is now recommended that trauma-informed practices be offered as universal precautions to all individuals, regardless of trauma history, focusing on trauma prevention. Obstetric anesthesia providers play an important role in minimizing and eliminating preventable trauma and mitigating psychological harm.
Background/Objectives: Metabolomics has emerged as a tool to gain insight into the body’s biological responses to therapeutic interventions. Bariatric surgery remains the most effective treatment for severe obesity and associated comorbidities, leading to significant weight and metabolic improvements. Using a multi-platform, multi-compartment metabolomics approach, this study systematically characterizes longitudinal changes in fecal and serum metabolomes of 45 patients following sleeve gastrectomy (SG). Participants were stratified by weight loss outcomes to identify metabolic signatures associated with differential responses, which may serve as predictors of weight loss and provide mechanistic insights in developing targeted therapeutic strategies. Methods: Metabolomic and lipidomic responses to SG were analyzed using multivariable linear mixed-effects models based on data collected pre-operatively and at 3 and 12 months post-operatively. Results: The percentage total weight loss for the highest versus lowest weight loss tertiles (T3 vs. T1) at twelve months was 35.81 + 5.4% and 19.49 + 2.62%, p < 0.001, respectively. Substantial alterations in fecal metabolites and lipid species were observed among T3 after twelve months, including aspartate, tyrosine, carnitine, glycine, PC.ae.C36.4, PC.aa.C38.0, PC.ae.C44.4, PC.ae.C40.2, and PC.aa.C40:5. Specifically, changes in serum lipid species including SM.OH.C22:1, PC.ae.C32:1, PC.aa.C34:4, PC.aa.C36:6, PC.ae.C34:3, PC.ae.C34:1, and PC.ae.C32:2, support serum lipidomics as a minimally invasive marker of gut remodeling and adaptation following SG. Sex-stratified analysis revealed unique fecal and serum metabolic changes, highlighting the significance of personalized metabolic monitoring and obesity treatment. Conclusions: Our findings identify metabolic alterations associated with response variability following SG and highlight the potential utility of machine learning to predict weight-loss trajectories and inform personalized interventions.
BACKGROUND:Renal colic is a common emergency department (ED) presentation, and imaging practices vary despite increasing use of renal point-of-care ultrasound (rPOCUS). OBJECTIVES:To evaluate the association between rPOCUS findings and Computed tomography (CT) utilization, ED length of stay (LOS), and downstream urologic interventions in patients with suspected renal colic. METHODS:We conducted a retrospective cohort study of adults undergoing rPOCUS for suspected renal colic from January 2020 through January 2022. Standardized chart abstraction with double review of a subset captured prespecified clinical and imaging variables. Comparative analyses and regression models assessed predictors of CT utilization, stone detection, urologic intervention timing, and ED LOS. RESULTS:Among 188 patients, 89 (47%) had hydronephrosis on rPOCUS. CT was obtained in 108 (57%) and was notably more common in patients with hydronephrosis on rPOCUS (72% vs. 44%; adjusted OR: 2.63, 95% CI: 1.29-5.46). Hydronephrosis predicted ureteral stone presence on CT (74% vs. 30%; OR: 6.71) and urologic intervention within 24 hours (26% vs. 6%; OR: 5.40). Clinically significant alternative diagnoses were uncommon (1.6%) and occurred only in patients without hydronephrosis. Mean LOS did not differ by hydronephrosis status (269 vs. 273 minutes; p = 0.81), but LOS was longer when CT was performed (p < 0.01). In multivariable analysis, CT utilization and abdominal tenderness were associated with longer LOS, whereas hydronephrosis was not. CONCLUSIONS:Hydronephrosis on rPOCUS was associated with stone disease and early urologic intervention but not shorter ED LOS. CT utilization was higher in patients with hydronephrosis and remained the primary factor associated with prolonged ED throughput. These findings reflect contemporary imaging patterns and suggest that the operational benefits of rPOCUS may be limited when CT is obtained irrespective of ultrasound findings.
