Carotid Body Tumors
Because CBTs may become malignant and metastasize, it is important for NPs to be knowledgeable about presenting symptoms and appropriate diagnostic studies to be able to refer patients to vascular surgeons early to prevent complications.
KEY FINDINGS: This case series showed that patients with CBTs should be assessed with a combination of history and physical exams along with imaging studies to confirm the diagnosis. Because CBTs may become malignant and metastasize, it is important for NPs to be knowledgeable about presenting symptoms and appropriate diagnostic studies to be able to refer patients to vascular surgeons early to prevent complications.
BACKGROUND: Carotid body tumors (CBTs) are uncommon neuroendocrine tumors located near the carotid bifurcation within the carotid body. CBTs are slow-growing; affected individuals may remain asymptomatic for years and are often diagnosed incidentally following imaging studies. When present, symptoms are nonspecific. Because incidence is low, retrospective review of CBT case series is an ideal study design for investigating common symptomology, identifying successful diagnostic tools, and evaluating treatment outcomes.
DETAILS: This article describes a case series of 11 patients treated for CBTs at an academic medical center in the Southeastern US. A retrospective chart review of 11 patients who had been discharged from the hospital following treatment for CBTs between 2017 and 2021 was conducted. Descriptive statistics were used to delineate the case series. There were four males (36%) and seven females (64%) included in the retrospective case series. The age range was 34 to 79 with a mean of 56.73 (standard deviation 16.038). Three patients were found to have a neck mass on physical exam. Additional symptoms included vocal cord paralysis, facial paralysis, ischemic stroke, Bell palsy, dysphonia, and dizziness. Two patients had familial CBTs. Ten patients underwent surgical excision.
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Source: Ratliff, C. R. and Strider, D. V. (2023). Carotid Body Tumors: A Retrospective Case Series Of 11 Patients. The Nurse Practitioner. 2023; 48(2): 35-40. Published: February, 2023. DOI: 10.1097/01.NPR.0000000000000004.
Effects of Emergency Nurses' Life-Sustaining Treatment Withdrawal Knowledge, Role Perception, and Job Stress on Providing End-of-Life Care
Despite the challenging environment of the emergency department, nurses who recognize their important role in the process of life-sustaining treatment withdrawal are more likely to provide high-quality EOL care. The perception of nurses' roles is especially influential on psychological care performance, and alternative approaches may be necessary for spiritual care.
KEY FINDINGS: Despite the challenging environment of the emergency department, nurses who recognize their important role in the process of life-sustaining treatment withdrawal are more likely to provide high-quality EOL care. The perception of nurses' roles is especially influential on psychological care performance, and alternative approaches may be necessary for spiritual care.
BACKGROUND: This study aimed to identify predictors of end-of-life (EOL) care provided by emergency nurses in South Korea.
DETAILS: A cross-sectional survey was conducted using a structured questionnaire. Data were collected using Google Forms between June 21 and 30, 2022. A total of 154 emergency nurses from 10 tertiary hospitals in a metropolitan area were recruited using convenience sampling, and 139 completed surveys were analyzed. Multiple linear regression was employed to examine the effects of nurses' knowledge of life-sustaining treatment withdrawal (knowledge), their perceptions of their role in the withdrawal process (role perception), and job stress on EOL care. The mean scores for knowledge, role perception, job stress, and EOL care were 13.09±1.75 (max 6), 4.18±0.44 (max 5), 3.55±0.32 (max 4), and 2.48±0.40 (max 4), respectively. Among the EOL care subdomains, psychological domain scores were the highest. Multiple linear regression analysis indicated that nurses' role perception significantly predicted EOL care performance, particularly in the psychological (F=3.924, P=0.001) and spiritual (F=2.171, P=0.020) domains.
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Copyright © Journal of Hospice and Palliative Care. All rights reserved.
Source: Park, H. J., Hong, E. A., Min, S. H., et al. (2024). Effects of Emergency Nurses' Life-Sustaining Treatment Withdrawal Knowledge, Role Perception, and Job Stress on Providing End-of-Life Care. J Hosp Palliat Care. 2025; 28(3): 89-98. Published: September 1, 2025. DOI: 10.14475/jhpc.2025.28.3.89.
Risdiplam in Presymptomatic Spinal Muscular Atrophy
Infants up to 6 weeks of age with genetically diagnosed SMA who were treated with risdiplam before the development of clinical signs or symptoms appeared to have better functional and survival outcomes at 12 and 24 months than untreated infants in natural history studies. Larger, controlled studies with longer follow-up are needed to further understand the relative efficacy and safety of presymptomatic treatment of SMA with risdiplam.
KEY FINDINGS: Infants up to 6 weeks of age with genetically diagnosed SMA who were treated with risdiplam before the development of clinical signs or symptoms appeared to have better functional and survival outcomes at 12 and 24 months than untreated infants in natural history studies. Larger, controlled studies with longer follow-up are needed to further understand the relative efficacy and safety of presymptomatic treatment of SMA with risdiplam.
BACKGROUND: Risdiplam, an oral pre–messenger RNA splicing modifier, is an efficacious treatment for persons with symptomatic spinal muscular atrophy (SMA). The safety and efficacy of risdiplam in presymptomatic disease are unclear.
DETAILS: Authors conducted an open-label study of daily oral risdiplam (with the dose adjusted to 0.2 mg per kilogram of body weight) in infants 1 day (birth) to 42 days of age with genetically diagnosed SMA but without strongly suggestive clinical signs or symptoms. The primary outcome, assessed in infants with two SMN2 copies and a baseline ulnar compound muscle action potential (CMAP) amplitude of at least 1.5 mV, was the ability to sit without support at month 12. Natural history studies have shown that the majority of infants with two SMN2 copies who are untreated would have a severe SMA phenotype (type 1), would never sit independently, would receive permanent ventilation and feeding support, or would die by 13 months of age. Secondary outcomes that were assessed over a period of 24 months included survival, ventilatory support, motor milestones, the development of clinically manifested SMA, feeding, and growth. A total of 26 infants with two, three, or four or more copies of SMN2 were enrolled. After 12 months of treatment, 21 infants (81%) could sit unsupported for 30 seconds, 14 (54%) could stand alone, and 11 (42%) could walk alone. A total of 4 of 5 infants (80%; 95% confidence interval, 28 to 100) with two SMN2 copies and a baseline ulnar CMAP amplitude of at least 1.5 mV were able to sit without support for at least 5 seconds. Three infants were withdrawn from the study by a parent or caregiver after the month 12 visit. Of 23 infants who completed 24 months of treatment, all were alive without the use of permanent ventilation or feeding support. Over a period of 24 months, nine treatment-related adverse events were reported in 7 infants; none of these events were serious.
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Copyright © Massachusetts Medical Society. All rights reserved.
Source: Finkel, R. S., Servais, L., Vlodavets, D., et al. (2024). Risdiplam in Presymptomatic Spinal Muscular Atrophy. N Engl J Med. 2025; 393(7): 671-682. Published: August 13, 2025. DOI: 10.1056/NEJMoa2410120.
Experience of Carbon Monoxide Poisoning Treated With Hyperbaric Oxygen Therapy and Steroid Pulse Therapy
This case suggests that the combination of steroid pulse therapy (SPT) and hyperbaric oxygen therapy (HBOT) may be effective for treating severe CO poisoning. The combined therapy not only improved acute neurological recovery but also appeared to prevent the development of delayed neurological sequelae (DNS).
KEY FINDINGS: This case suggests that the combination of steroid pulse therapy (SPT) and hyperbaric oxygen therapy (HBOT) may be effective for treating severe CO poisoning. The combined therapy not only improved acute neurological recovery but also appeared to prevent the development of delayed neurological sequelae (DNS). This is a single case report, and further research is needed to validate these findings.
BACKGROUND: Carbon monoxide (CO) poisoning is a significant concern in emergency medicine, often leading to delayed neurological sequelae (DNS) such as memory impairment, disorientation, apraxia, agnosia, gait disturbances, and Parkinson-like symptoms. While hyperbaric oxygen therapy (HBOT) is a recognized treatment for preventing DNS, there is no established treatment for the acute neurological symptoms of severe CO poisoning. This case report explores a combined therapeutic approach.
DETAILS: This is a case report about a 50-year-old man who was admitted to the hospital with severe CO poisoning, presenting with a Glasgow Coma Scale score of 3. His carboxyhemoglobin level was 51.2%. The patient was treated in the intensive care unit with a combination of hyperbaric oxygen therapy (HBOT) and steroid pulse therapy (SPT). The patient's level of consciousness improved significantly within three days of starting the combined therapy. He was discharged from the hospital after 14 days and had no complications, including DNS, during a follow-up period of 49 days.
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Copyright © BioMed Central Ltd unless otherwise stated. All rights reserved.
Source: Kano, S., Miyake, T., Asano, H.,s et al. (2025). Experience of Carbon Monoxide Poisoning Treated With Hyperbaric Oxygen Therapy and Steroid Pulse Therapy: A Case Report. International Journal of Emergency Medicine. 2025; Published: August 18, 2025. DOI: 10.1186/s12245-025-00966-5.
A New Hope for Recurrent Respiratory Papillomatosis: FDA Approves Papzimeos
FDA approved Papzimeos (zopapogene imadenovec-drba), a first-of-its-kind non-replicating adenoviral vector-based immunotherapy for the treatment of adult patients with recurrent respiratory papillomatosis (RRP).
KEY FINDINGS:
BACKGROUND: Recurrent Respiratory Papillomatosis (RRP) is a rare and chronic condition caused by human papillomavirus (HPV) types 6 and 11. The disease leads to the formation of benign tumors in the respiratory tract, most often in the larynx, which can cause significant symptoms like voice changes and difficulty breathing. Historically, the primary treatment for RRP has been repeated surgical removal of the tumors, as there have been no approved medical therapies to address the underlying cause.
DETAILS: The U.S. Food and Drug Administration (FDA) has approved Papzimeos (zopapogene imadenovec-drba), a groundbreaking immunotherapy, for the treatment of adult patients with RRP. This therapy is a non-replicating adenoviral vector that works by stimulating a targeted immune response against the HPV-infected cells. It is administered via a subcutaneous injection and represents the first non-surgical therapeutic option for this rare disease, offering a new approach beyond traditional surgical management.
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The approval of Papzimeos was based on data from a single-arm, open-label trial. The study demonstrated that 51.4% of patients who received the treatment achieved a complete response, defined as not needing any further surgical intervention for 12 months following the treatment. The clinical benefits were shown to be durable for most patients over a two-year period and correlated with the development of specific T-cells targeting HPV 6 and 11. The therapy had a favorable safety profile with no serious treatment-related adverse events.
Key information:
- First-of-its-kind Approval: Papzimeos is the first approved medical therapy for RRP.
- Novel Mechanism: It is an immunotherapy that targets the root cause of the disease, HPV-infected cells.
- Approval Pathway: The product received Orphan Drug and Breakthrough Therapy designations and was approved under Priority Review, reflecting the significant unmet medical need for RRP patients.
Source: FDA Approves First Immunotherapy for Recurrent Respiratory Papillomatosis. FDA. 2025; Published: August 14, 2025.
Metabolomic Profiling of Plasma Reveals Differential Disease Severity Markers in Avian Influenza A(H7N9) Infection Patients
The characteristics of plasma metabolome in H7N9 patients were first revealed. It was discovered that lipid-like molecules were downregulated in death group. Metabolites of the tryptophan metabolic pathway were elevated in death group. The metabolite-based machine-learning achieved an AUC of 0.929 on the test set.
KEY FINDINGS: Authors first revealed the plasma metabolomic characteristics of H7N9 patients and found that a machine-learning model based on plasma metabolites could predict the risk of death for H7N9 in the early stage of admission.
BACKGROUND: Avian influenza such as H7N9 is currently a major global public health risk, and at present, there is a lack of relevant diagnostic and treatment markers.
DETAILS: Authors collected plasma samples from 104 confirmed H7N9 patients, 31 of whom died. Plasma metabolites were detected by UHPLC-HRMS, and a survival prediction model based on metabolites was constructed by machine-learning models. A total of 1536 metabolites were identified in the plasma samples of H7N9 patients, of which 64 metabolites were up-regulated and 35 metabolites were down-regulated in the death group. The enrichment analysis of tryptophan metabolism, porphyrin metabolism, and riboflavin metabolism were significantly up-regulated in the death group. We found that most lipids and lipid–like molecules were down-regulated in the death group, and organoheterocyclic compounds were significantly up-regulated in the death group. A machine-learning model was constructed for predicting mortality based on porphobilinogen, 5-hydroxyindole-3-acetic acid, L-kynurenine, Biliverdin, and D-dimer. The AUC on the test set was 0.929.
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Copyright © The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. All rights reserved.
Source: Wang, Y., Ni, J., Huanga, M., et al. Metabolomic Profiling of Plasma Reveals Differential Disease Severity Markers in Avian Influenza A(H7N9) Infection Patients. International Journal of Infectious Diseases. 2025; 158: 107957. Published: September, 2025. DOI: 10.1016/j.ijid.2025.107957.
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