Risultati per: Incontinenza urinaria da stress o mista

Objective
This scoping review aims to identify the COVID-19-related stressors and the corresponding coping strategies among emergency physicians during and following the pandemic.

Introduction
In the midst of an unprecedented COVID-19 crisis, healthcare professionals confront a diverse set of difficulties. Emergency physicians are under immense pressure. They must provide frontline care and make quick decisions in a high-pressure environment. This can lead to a variety of physical and psychological stressors, including extended working hours, increased workload, personal risk of infection and the emotional toll of caring for infected patients. It is critical that they be informed of the numerous stressors they face, as well as the various coping methods accessible to them, in order to deal with these pressures.

Inclusion criteria
This paper will summarise the findings of primary or secondary investigations on emergency physicians’ stressors and coping strategies during and following the COVID-19 epidemic. All journals and grey literature in English and Mandarin published after January 2020 are eligible.

Methods
The Joanna Briggs Institute (JBI) method will be used to conduct the scoping review. A thorough literature search will be performed on OVID Medline, Scopus and Web of Science to find eligible studies, using the keywords related to emergency physicians, stress and coping strategies. Two reviewers will independently revise all of the full-text articles, extract data and evaluate the study quality. A narrative overview of the findings from included studies will be given.

Ethics and dissemination
This review will involve secondary analysis of published literature, and therefore ethics approval is not required. The Preferred Reporting Items for Systematic reviews and Meta-Analyses checklist will be used to guide translation of findings. Results will be disseminated through peer-reviewed journals and presented in conferences via abstract and presentation.

This cohort study evaluates whether wrist-wearable devices can provide useful biomarkers for recovery after traumatic stress exposure.

Although small patient subsets benefit from current targeted strategies or immunotherapy, gemcitabine remains the first-line drug for pancreatic cancer (PC) treatment. However, gemcitabine resistance is widespread and compromises long-term survival. Here, we identified ubiquitin-conjugating enzyme E2T (UBE2T) as a potential therapeutic target to combat gemcitabine resistance in PC.

Analisi di Fem coordinata da University College Cork

Analisi di Fem coordinata da University College Cork

Introduction
Previous studies indicate that computerised trainings implementing cognitive bias modification (CBM) for interpretation bias might be promising treatments for trauma-related cognitive distortions and symptoms. However, results are mixed, which might be related to the implemented task (sentence completion task), setting, or training duration. Within the present study, we aim to evaluate the efficacy and safety of an app-based intervention for interpretation bias using standardised imagery audio scripts, which is designed as a standalone treatment.

Methods and analysis
The study is a randomised controlled trial, implementing two parallel arms. 130 patients diagnosed with post-traumatic stress disorder (PTSD) will be allocated to either the intervention group or the waiting-list control group receiving treatment as usual. The intervention consists of 3 weeks of an app-based CBM training for interpretation bias using mental imagery, with three training sessions (20 min) per week. Two months after the last training session, 1 week of booster CBM treatment will be implemented, consisting of three additional training sessions. Outcome assessments will be conducted pretraining, 1 week post-training, 2 months post-training, as well as 1 week after the booster session (approximately 2.5 months after initial training termination). The primary outcome is interpretation bias. Secondary outcomes include PTSD-related cognitive distortions and symptom severity, as well as negative affectivity. Outcome assessment will be conducted by intention-to-treat analysis, as well as per-protocol analysis using linear mixed models.

Ethics and dissemination
The study was approved by the Ethics Committee of the State Chamber of Physicians in Baden-Wuerttemberg, Germany (number of approval: F-2022-080). Scientific findings will be published in peer-reviewed journals informing future clinical studies, which focus on the reduction of PTSD-related symptoms using CBM.

Trial registration number
German Clinical Trials Register (DRKS00030285; https://drks.de/search/de/trial/DRKS00030285).

Introduction
Emergency service workers are routinely exposed to stress and trauma, and there is a need to address mental health symptoms early to prevent chronic impairment and/or psychiatric disorder. Digital health innovations mean that face-to-face psychosocial interventions can now be delivered remotely, which is particularly appealing to populations who have strong preferences for digital delivery, such as emergency service workers. This two phase study aims to first adapt the Skills fOr Life Adjustment and Resilience (SOLAR) programme into a smartphone application (‘app’), and then evaluate the effectiveness of this new app.
Methods and analyses
First, focus groups and codesign activities with mental health professionals and emergency service workers will be conducted to develop and test the prototype smartphone version of SOLAR (ie, SOLAR-m). Second, a multicentre randomised controlled trial will investigate the effectiveness of the new app, compared with an active control app, in reducing symptoms of anxiety and depression (primary outcome), as well as other indicators of mental health and work performance. Firefighters from one of the largest urban fire and rescue services in Australia who are currently experiencing distress will be invited to participate. After screening and baseline assessment, 240 will be randomised to receive either SOLAR-m or the control app for 5 weeks, with measurements pre, post and 3-month follow-up. Analyses will be conducted within an intention-to-treat framework using mixed modelling.

Ethics and dissemination
The current trial has received ethics approval from the University of Melbourne Human Research Ethics Committee (2021-20632-18826-5). Study results will be disseminated through peer-reviewed journals and conferences, with a focus on how to expand the new app to other trauma-affected populations if proven effective.

Trial registration number
ANZCTRN12621001141831.

Objective
This study intended to assess the impact of COVID-19 pandemic on anxiety and stress among healthcare professionals in Ethiopia.

Design
This study applied a design of systematic review and meta-analysis of observational studies.

Data sources

Eligibility criteria and outcomes
Observational studies examining anxiety and stress among healthcare professionals in Ethiopia following COVID-19 pandemic were considered. The primary outcomes were the prevalence of anxiety and stress and the secondary outcomes were factors associated to the prevalence of anxiety and stress.

Data extraction and synthesis
Two authors extracted the data and performed quality assessment independently. The Newcastle-Ottawa Scale was used to evaluate the quality of eligible studies. Random-effect model with the inverse variance method was used to estimate the pooled effect size of the outcome variables with its 95% CI. Publication bias was checked by DOI plot and Luis Furuya Kanamori index. Stata V.14.0 (StataCorp) software was used for statistical analysis.

Results
Thirteen studies were included. From eight studies the pooled prevalence of anxiety was 46% (95% CI 0.30% to 0.61%, 2=0.0497, I2=99.07%, p

This technology could improve exercise testing and ambulatory monitoring.

Stroke, Volume 54, Issue Suppl_1, Page AWMP6-AWMP6, February 1, 2023. Introduction:Hyperglycemia has consistently been associated with worse outcome following an acute ischemic stroke (AIS). Recent studies have shown that a stress glucose ratio (SGR) may be a better predictor of critical illness than absolute hyperglycemia. An elevated initial stress glucose ratio (iSGR) was significantly associated with malignant cerebral edema and ICH after thrombectomy. We sought to identify genetic loci related to iSGR in a cohort of the GENISIS (Genetics of Early Neurological InStability after Ischemic Stroke) study.Methods:GENISIS is a multi-site international study that enrolled AIS patients within 6 hours of symptom onset. A sub-cohort with available initial glucose and HbA1c levels was selected. For all patients, Hg38 imputed genotypes were available. iSGR was calculated by dividing initial glucose by the estimated average glucose concentration (= 28.7 * A1c – 46.7) and normalized by log transformation for the GWAS. Association was adjusted by age, sex, baseline NIHSS, principal components and genotyping rounds. Samples were analyzed by country of origin and ethnicity using Plink2 and then meta-analyzed by ethnicity using METAL.Results:Three separate populations were identified (African-Americans n=299; European-Americans n=622; and Spanish n=625). Median age was 71 (IQR 60-80) with 46% female. Baseline NIHSS was 11 (IQR 5-16). A suggestive loci (chr13:rs9560146, p=9.88×10-8) was identified in the meta-analysis. Gene-based analyses suggested that the loci in chromosome 13 is driven byKLF5(p=0.002). In addition, rs9560146 is also associated withKLF5gene expression in brain (eQTL p=3.30×10-3; frontal cortex: Braineac).Conclusions:We demonstrated that a variant inKLF5may be associated with iSGR in a cohort of AIS patients.KLF5is induced under hypoxia conditions and interacts with HIF-1a to mediate glucose homeostasis. Recently, a pre-clinical study demonstrated that a micro RNA (miR-10b-3p) had neuroprotective effects against ischemia/reperfusion injury by targeting KLF5. Thus, investigating the genetic architecture of stress hyperglycemia may be informative and reveal variants, genes or pathways involved in ischemic brain injury. We plan to recruit a cohort for replication and sample size expansion.

Stroke, Volume 54, Issue Suppl_1, Page A104-A104, February 1, 2023. Introduction:Cytochrome b5 reductase 3 (Cyb5R3) is a heme iron reductase that reverses oxidized soluble guanylate cyclase (sGC) heme iron (Fe3+Fe2+) to preserve nitric oxide signaling. Under oxidative stress, such as occurs with sickle cell disease (SCD) and ischemic stroke, Cyb5R3 redox signaling provides resilience against tissue damage. A loss-of-function (roughly 50%) Cyb5R3 missense variant (T117S) occurs with high frequency (0.23 minor allele) in persons of African ancestry, who also suffer a greater burden of sickle cell anemia and ischemic stroke than other races. We hypothesized that Cyb5R3 regulates the erythropoietin response to ischemic stroke in a mouse model of SCD.Methods:Age-matched male SCD mice with wild-type Cyb5R3 (SSWT) or T117S Cyb5R3 (SST117S) underwent middle cerebral artery occlusion (55 min) and reperfusion (48 hr). Blood was sampled at baseline and 48h reperfusion for hematology measurements. Brains were stained with 2,3,5-triphenyltetrazolium chloride to quantify infarct volume. Erythropoietin (EPO), heme oxygenase 1 (HMOX1) and sGC were assayed by Western blot.Results:We found brain infarct volume to be greater in SST117Svs SSWT(63 vs 27 cm3, respectively; P=0.003). Red cells, hematocrit and hemoglobin decreased in SST117Spost-stroke, which was opposite to SSWT(red cells: -13% vs 13%, P=0.01; hematocrit: -20% vs 0%, P=0.03; hemoglobin: -18% vs 3%, P=0.02, respectively). In the absence of stroke (age-matched controls), SSWThad elevated HMOX1 protein compared to SST117S, which normalized in post-stroke SSWTbut was unchanged in post-stroke SST117S. Kidney and plasma EPO levels significantly increased in SSWTpost-stroke, but not in SST117S. In vitro studies using HEK293 cells showed EPO and HMOX1 decrease with Cyb5R3 knockdown by siRNA.Conclusion:Our findings suggest a modifying role for Cyb5R3 in brain-kidney crosstalk during ischemic stroke, wherein loss of T117S Cyb5R3 activity negatively impacts renal and plasma EPO levels and resilience against infarct of ischemic brain tissue. The Cyb5R3 axis on which the brain-kidney-blood response to stroke in SCD turns represents a novel target for precision medicine approaches to managing stroke risk and pathology in SCD carriers of the T117S variant.

Stroke, Volume 54, Issue Suppl_1, Page ATMP13-ATMP13, February 1, 2023. Background:Intra-saccular hemodynamics play a key role in the pathobiological remodeling of the intracranial aneurysm (IA) wall. Evaluating the relationship between hemodynamic forces at the aneurysm wall and wall presentation can help us understand the complex processes of dysregulated vascular remodeling that occurs during IA natural history.Hypothesis:We hypothesized that greater hemodynamic insult, i.e., high wall shear stress (WSS) and high wall shear stress divergence (WSSD), results in endothelial damage and loss of internal elastic lamina, which presents as thin, translucent regions on interoperative imaging.Methods:From digital subtraction angiography images of 15 patients with IAs, aneurysm and surrounding vessels were segmented. Computational fluid dynamics (CFD) simulations were performed using generic boundary conditions for all the patients. Aneurysm walls were identified from 2D intraoperative images of IAs taken during clipping, and wall regions were classified as thick regions (white), normal (purple-crimson), and thin/translucent (red), using a semi-supervised machine learning algorithm. 2D wall classifications were mapped onto the 3D geometries for statistical analysis of differences between average hemodynamic properties across wall regions.Results:On an average, more than 30% of IA sac was visible on the 2D intra-operative image. Of then=15 IAs,n=8,n=5 andn=2 showed pre-dominantly thick, thin, and normal wall types respectively. Average WSS and WSSD were significantly higher at thin regions of IAs as compared to both normal and thick regions. Thin wall regions also tended to co-locate with significantly lower RRT as compared to the thick and normal regions.Conclusion:Thin wall regions observed on intra-operative images of IAs are associated with greater hemodynamic insult (higher WSS and WSSD) and higher flow velocity (lower RRT).

Stroke, Volume 54, Issue Suppl_1, Page AWP13-AWP13, February 1, 2023. Objective:This study aimed to evaluate the correlation between the stress hyperglycemia and clinical outcomes after large vessel occlusion stroke (LVO) at 90 days.Methods:The RESCUE BT trial was a multicenter, randomized, double-blind, placebo-controlled clinical trial, consisting of 948 patients from 55 centers in China. In this subgroup study, 542 consecutive stroke patients with glucose or glycated hemoglobin values were included. Stress hyperglycemia was evaluated both as a tri-categorical variable (≤1.07 vs 1.08-1.29 vs ≥1.30) and a continuous variable. The primary outcome was favorable functional outcome (modified Rankin Scale [mRS] ≤ 2) at 90 days. The secondary outcome contained excellent functional outcome (modified Rankin Scale [mRS] ≤ 1) and safety outcomes such as 90-day mortality and intracranial hemorrhage.Results:542 patients were included. Compared to patients with the lowest tertiles of stress hyperglycemia, calculated as glucose/GA ratio, the highest tertiles of stress hyperglycemia was obviously associated with a higher rate of poor functional outcome at 90-day (modified Rankin Scale [mRS] score 3-6) after adjusted for potential covariates (adjusted hazard ratio, 0.44; 95% confidence interval, 0.28-0.69, P < 0.001). This result was also consistent in the excellent clinical outcome of 90-day mRS score 2-6 (adjusted hazard ratio, 0.48; 95% confidence interval, 0.29-0.79, P =0.004).Conclusion:In patients with acute ischemic stroke, lower stress hyperglycemia, as measured by glucose/GA ratio, was more likely to have favorable outcome at 90-day.Trial registrationChinese Clinical Trial Registry Identifier: ChiCTR-IOR-17014167, December 27, 2017.

Stroke, Volume 54, Issue Suppl_1, Page ATMP119-ATMP119, February 1, 2023. Background:Pregnancy is associated with an increased risk of stroke largely driven by the comorbidity of preeclampsia (PE), a hypertensive disorder that complicates 4-8% of all pregnancies. Although stroke treatment has improved in recent years, pregnant women have been excluded from stroke clinical trials and thus little is known about treatment and stroke outcome in this population. We investigated stroke outcome (infarct and hemorrhagic transformation, HT) in normal pregnancy (Preg; n=13) and in a model of preeclampsia (PE; n=6) induced by feeding pregnant Sprague Dawley rats a high cholesterol diet on gestational days 7-21. Nonpregnant (NP; n=7) rats were a control for pregnancy.Methods:Middle cerebral artery occlusion (MCAO) was used to induce focal ischemia for 3 hours with 1 hour of reperfusion. Perfusion deficit in the core MCA and collateral territories were measured using multi-site laser Doppler. Infarction and oxidative stress were determined by cresyl violet and 3-nitrotyrosine staining of fixed brain tissue, respectively. Endothelial oxidative stress and hemostatic factors were measured by ELISA for 8-isoprostane and thrombin.Results:Perfusion deficit in core MCA was similar between groups; however, collateral flow was significantly impaired in ePE vs. NP and LP: -51±8% vs. -21±15% and -25±13% (p

Stroke, Volume 54, Issue Suppl_1, Page AWP50-AWP50, February 1, 2023. Introduction:Stress hyperglycemia is an essential survival response. However, it is associated with poor prognosis after ischemic stroke, and its contribution to collateral failure is not well defined. We investigated whether stress hyperglycemia would be associated with early neurological deterioration (END) in acute large vessel occlusion (LVO) patients who present with mild neurological deficit.Methods:From a multicenter stroke registry, ischemic stroke patients with acute anterior circulation LVO and mild symptoms (NIHSS

Stroke, Volume 54, Issue Suppl_1, Page AWP61-AWP61, February 1, 2023. Introduction:After an ischemic stroke or transient ischemic attack (TIA), patients may have post-event anxiety and re-experience transient neurological symptoms. However, some stroke patients develop persistent and disabling symptoms of post-traumatic stress disorder (PTSD). Data on post-stroke post-traumatic stress disorder (PS-PTSD) is sparse.Methods:We conducted a single-center observational pilot study of 20 adult patients diagnosed with stroke or TIA in the previous 31 days to 1 year. Patients completed the PTSD Check List-5 (PCL-5), Patient Health Questionnaire-9 (PHQ-9), stroke specific Quality of Life Scale-12 (SS-QOL-12), modified Rankin Scale of disability, and the National Institutes of Health Stroke Scale. The PCL-5 is a 20 item self-report score assessing symptoms of re-experiencing (Criterion B), avoidance (Criterion C), negative alterations in cognition or mood (Criterion D), and hyperarousal (Criterion E). Subjects were classified as having PS-PTSD with PCL-5 score ≥33 or endorsement of moderate symptoms in at least one B item, one C item, two D items, and two E items.Results:Twenty patients completed the PCL-5 and 19 completed the follow up scales. Seven patients (35%) were found to have PS-PTSD. Higher PCL-5 scores were significantly correlated with lower SS-QOL12 scores indicating worsened quality of life (r= -0.709, P=.001) and higher PHQ9 scores representing more depressive symptoms (r= 0.727, P