Severe traumatic brain injury is a leading cause of death and disability worldwide, resulting in a significant individual and socioeconomic burden. We present two cases of severe traumatic brain injury with surprisingly encouraging outcomes. We attribute this to the additional combined administration of citicoline and cerebrolysin.
Congenital hyporhinia or partial arrhinia is a very rare congenital abnormality of nasal embryogenesis with unknown etiology. It is commonly associated with other craniofacial anomalies which are thought to be caused by an absent or rudimentary nose. A case of congenital hyporhinia with associated other anomalies is presented and discussed.
71-year-old male with epidural spinal lipomatosis and spondylolisthesis. Conservative treatment failed, and a spinal fusion and laminectomy were performed. Postoperatively, the patient reported a reduction in pain; however, the pain recurred soon after surgery. After losing 53 pounds with medical management, the patient reported a complete absence of pain.
Spontaneous extradural hematoma in Sickle cell disease is rare neurological complication with few cases reported in the English literature. We report a case of a 16-year old male diagnosed with Sickle Cell Beta Thalassemia who demonstrated right sided acute parietal extradural hematoma with mass effect.
Tuberculous meningitis is possibly complicated with multiple cerebral infarctions and basal meningitis, and the mortality and neurological prognosis is reportedly poor. This case suggested that clinicians should consider tuberculous meningitis as a differential diagnosis of patients with disturbed consciousness in an aging country Japan.
Pediatric immune thrombocytopenia (ITP) is an acquired disorder associated with autoimmune destruction and impairment of platelet production in children. Some children exhibit poor or transient response to ITP-directed treatments and are referred to as having refractory ITP (rITP). There is currently no consensus on the definition of rITP, nor evidence-based treatment guidelines for patients with rITP. After a survey of pediatric ITP experts demonstrated lack of consensus on pediatric rITP, we pursued a systematic review to examine the reported clinical phenotypes and treatment outcomes in pediatric rITP. The search identified 253 relevant manuscripts; following review, 11 studies proposed a definition for pediatric rITP with no consensus amongst them. Most definitions included sub-optimal response to medical management, while some outlined specific platelet thresholds to define this sub-optimal response. Common attributes identified in this study should be used to propose a comprehensive definition, which will facilitate outcome comparisons of future rITP studies.
Introduction: It is rarely seen that neonates with congenital lung mass presenting with respiratory distress require emergency intervention. No consensus has been achieved concerning the best policy facing such condition. This study aims to evaluate the efficacy and safety of our strategies in managing neonates with congenital lung mass presenting with respiratory distress. Methods: We retrospectively reviewed the data of five congenital lung mass (CLM) neonates presenting with respiratory distress from April 2020 to April 2022 for whom different strategies were adopted and favorable outcomes were obtained. The relevant data was reviewed and analyzed. Results: All the patients were prenatally diagnosed with CLM, and among them, four neonates with cystic lung masses accepted percutaneous thoracic catheter drainage prior to surgery. The first neonate with macrocystic lung mass experienced prompt open lobectomy due to failure of drainage. The other three patients obtained good drainage of the large air-filled cyst, thus gaining the opportunity for elective thoracoscopic surgery in median 48 d. The fifth patient directly underwent emergency surgery due to the solid nature of the lung lesion. Conclusions: For neonates with cystic lung masses presenting with respiratory distress due to mediastinal compression, percutaneous thoracic catheter drainage and subsequent elective thoracoscopic surgery were superior to emergency thoracotomy in terms of safety and parenchyma-sparing surgery based on the study and literature. For those with solid lung lesions whose CVR value is no less than 1.6, either EXIT surgery or emergency thoracotomy is a reliable strategy depending on the medical resources available.
In this paper we consider the Catalan triangle numbers ( B n , k ) n ≥ 1 , 1 ≤ k ≤ n and ( A n , k ) n ≥ 1 , 1 ≤ k ≤ n + 1 to define powers of Catalan generating function C( T) where T is a linear and bounded operator on a Banach space X. When the operator 4 T is of power-bounded operator, the Catalan generating function is given by the Taylor series C ( T ) : = ∑ n = 0 ∞ C n T n , where c = ( C n ) n ≥ 0 is the Catalan sequence. Note that the operator C( T) is a solution of the quadratic equation T Y 2 − Y + I = 0 . We obtain new formulae which involves Catalan triangle numbers ( B n , k ) n ≥ 1 , 1 ≤ k ≤ n and ( A n , k ) n ≥ 1 , 1 ≤ k ≤ n + 1 . As element in the Banach algebra ℓ 1 ( N 0 , 1 4 n ) , we describe the spectrum of c ∗ j for j≥1, and the expression of c −∗ j in terms of Catalan polynomials. In the last section, we give some particular examples to illustrate our results and some ideas to continue this research in the future.
A 22-year-old immunocompetent female with a history of small pericardial effusion while infant presented with fever and hemodynamic collapse four days after facial trauma. She was found to have cardiac tamponade secondary to infected chylopericardium from bacterial translocation. We report this very unusual case and review of the literature on chylopericardium infections.
Introduction: Aspirin and clopidogrel are the most commonly used antiplatelet agents, either alone or as dual therapy, in patients undergoing CABG surgery to reduce organ ischaemia and mortality. The systematic review aims to explore the resistance to the antiplatelet agents, how to assess it, and the effect of resistance on the outcomes in CABG surgery. Materials & methods: A systematic search is carried out on MEDLINE via Ovid, PubMed, Embase, the Cochrane Library Database and Google Scholar until November 2021 to look for studies evaluating the antiplatelet resistance in patients undergoing both on-pump and off-pump CABG surgery. Only high-quality studies were included after the risk of bias assessment. Results: A total of 17 studies, of which 3 randomised controlled trials and 14 observational studies were included after inclusion criteria is applied. The incidence of aspirin resistance ranges from 11-51.5%, whereas, clopidogrel resistance is 22%. A wide variety of different assessment methods for antiplatelets are reported. Antiplatelet resistance is a predictor of vein graft occlusion, with up to 13 fold increase in occlusion rate. There is no overall effect of aspirin resistance on mortality, stroke or myocardial infarction, however, clopidogrel resistance leads to higher mortality, MI and target vessel revascularisations. The effect of cardiopulmonary bypass on antiplatelet resistance is not clear. Conclusion: There is no uniform definition of antiplatelet resistance. Assessment methods differ greatly and their results are not interchangeable. Antiplatelet resistance is associated with a higher rate of graft occlusion in CABG patients. Aspirin resistance does not influence overall adverse outcomes, however, clopidogrel resistance leads to worse outcomes.
In this paper, we study two inverse problems for the nonlinear Boussinesq system for incompressible viscoelastic non-isothermal Kelvin-Voigt fluids. The studying inverse problems consist of determining an intensities of density of external forces and heat source under given integral overdetermination conditions. Two types of boundary conditions for the velocity v are considered: sticking and sliding conditions on boundary. In both cases of these boundary conditions, the local and global in time existence and uniqueness of weak and strong solutions are established under suitable assumptions on the data. The large time behavior of weak solutions is also studied.
Although fractional and classical order cubic quintic nonlinear Schrödinger (NS) equation and cubic nonlinear Schrödinger equation are used simultaneously in nonlinear optics disciplines, the fractional-order NS equations are nowadays extensively used due to their higher coherence. The space-time fractional cubic quintic and nonlinear cubic Schrödinger equations integrating beta derivative are significant in modeling to nonlinear optics, photonics, plasmas, condensed matter physics, and other domains. The fractional wave transformation is exploited to translate the space-time fractional equations and the optical soliton solutions in the form of exponential, trigonometric, and hyperbolic functions with free parameters have been established in this article by putting to use the improved Bernoulli sub-equation function (IBSEF) approach. The shape of the solutions includes kink, periodic, bell-shaped soliton, breathing soliton, bright soliton, and singular kink type soliton. The physical features of the solitons have been revealed by depicting 3D, 2D, contour, and density graphs of some of the solutions. The results demonstrate that the IBSEF approach is simple, straightforward, effective and that it can be applied to a wide range of nonlinear fractional-order models in optics and communication engineering to achieve soliton solutions.
Background and Purpose: Chronic pain is a devastating problem affecting 1 in 5 individuals around the globe, with neuropathic pain the most debilitating and poorly treated type of chronic pain. Advances in transcriptomics and data mining have contributed to cataloging diverse cellular pathways and transcriptomic alterations in response to peripheral nerve injury but have focused on phenomenology and classifying transcriptomic responses. Experimental approach: Here, with the goal of identifying new types of pain-relieving agents, we compared transcriptional reprogramming changes in the dorsal spinal cord after peripheral nerve injury cross-sex and cross-species and imputed commonalities, as well as differences in cellular pathways and gene regulation. Key Results: We identified 93 transcripts in the dorsal horn that were increased by peripheral nerve injury in male and female mice and rats. Following gene ontology and transcription factor analyses, we constructed a pain interactome for the proteins encoded by the differentially expressed genes, discovering new, conserved signaling nodes. We interrogated the interactome with the Drug-Gene database to predict FDA-approved medications that may modulate key nodes within the network. The top hit from the analysis was fostamatinib, the molecular target of which is the non-receptor tyrosine kinase Syk, which our analysis had identified as a key node in the interactome. Conclusions & Implications : We found that intrathecally administrating the active metabolite of fostamatinib, R406, significantly reversed pain hypersensitivity in both sexes. Thus, we have identified and shown the efficacy of an agent that could not have been previously predicted to have analgesic properties.
SARS-CoV-2-Triggered Hemophagocytic Lymphohistiocytosis with Complications of Posterior Reversible Encephalopathy SyndromeRoss M. Perry, M.D. a* | Scott D. Casey, M.D., M.S. b | Alex Q. Lee, M.D.a | Sylvia P. Bowditch, M.D.c | Mary A. Rasmussen, M.D.c | Viyeka Sethi, M.D. d| Arun R. Panigrahi, M.D. eaUniversity of California, Davis, School of Medicine, Sacramento, California, USA; bDepartment of Emergency Medicine, University of California, Davis, Sacramento, California, U.S.A.; cDepartment of Pediatrics, University of California, Davis, Sacramento, California, U.S.A;dDepartment of Pediatric Critical Care Medicine, University of California, Davis, Sacramento, California, U.S.A;eDepartment of Pediatric Hematology & Oncology, University of California, Davis, Sacramento, California, U.S.A*Correspondence to:Ross Perry, M.D., 14 Rock Lane, Berkeley, CA, 94708, Phone: (707) 331-4626, Fax: (510) 752-1571, E-mail: email@example.comMain Text Word Count: 850Tables: 1; Figures: 1Short Title: SARS-CoV-2-Triggered HLH Complicated by PRESKeywords: SARS-CoV-2, HLH, PRES, MIS-C, corticosteroids, anakinra
Despite the increasing accessibility of high-throughput sequencing, obtaining high-quality genomic data on non-model organisms without proximate well-assembled and annotated genomes remains challenging. Here we describe a workflow that takes advantage of distant genomic resources and ingroup transcriptomes to select and jointly enrich long open reading frames (ORFs) and ultraconserved elements (UCEs) from genomic samples for integrative studies of microevolutionary and macroevolutionary dynamics. This workflow is applied to samples of the African unionid bivalve tribe Coelaturini (Parreysiinae) at basin and continent-wide scales. Our results indicate that ORFs are efficiently captured without prior identification of intron-exon boundaries. The enrichment of UCEs was less successful, but nevertheless produced substantial datasets. Exploratory continent-wide phylogenetic analyses with ORF supercontigs (>515,000 parsimony informative sites) resulted in a fully resolved phylogeny, the backbone of which was also retrieved with UCEs (>11,000 informative sites). Variant calling on ORFs and UCEs of Coelaturini from the Malawi Basin produced ~2,000 SNPs per population pair. Estimates of nucleotide diversity and population differentiation were similar for ORFs and UCEs. They were low compared to previous estimates in mollusks, but comparable to those in recently diversifying Malawi cichlids and other taxa at an early stage of speciation. Skimming off-target sequence data from the same enriched libraries of Coelaturini from the Malawi Basin, we reconstructed the maternally-inherited mitogenome, which displays the gene order inferred for the most recent common ancestor of Unionidae. Overall, our workflow and results provide exciting perspectives for integrative genomic studies of microevolutionary and macroevolutionary dynamics in non-model organisms.
Ivabradine is an established treatment for chronic heart failure with reduced ejection fraction (HFrEF) but not for acute heart failure. β-blocker up-titration is often not possible because of its negative inotropic effect (NIE). Ivabradine has no NIE; therefore, it may be preferred over β-blockers in patients with acute decompensated HFrEF.
This paper proposes a unified creep rupture life prediction method based on continuous damage mechanics under multiaxial stress state. Instead of the traditional method, this method can calculate the skeletal point location for different size of notches in a uniform way. We also conducted creep tests on Ni-based superalloy round bar specimens with different notch parameters, which verified the accuracy of the method. Meanwhile, we carried out creep rupture mechanism analysis for different notch sizes by combining finite element simulation with experiment, which analyzed the stress, damage, and explained the void growth based on triaxial stress.
Abstract Objective To explore the value of serum aquaporin 8 (AQP8) expression in evaluating the degree of hydrolabyrinth and predicting prognosis in patients with Meniere’s disease. Methods 105 patients with Meniere’s disease in our hospital were included in the Meniere’s disease group.Another 102 healthy subjects in our hospital were included as the control group. The multivariate Logistic regression was used to analyze the influencing factors of poor prognosis in patients with Meniere’s disease. Results The expression of serum AQP8 mRNA in the Meniere’s disease group was greatly higher than that in the control group (P<0.05). Serum AQP8 mRNA expression in severe hydrops group was greatly higher than that in mild hydrops group and no endolymphatic hydrops group, and serum AQP8 mRNA expression in mild hydrops group was greatly higher than that in no endolymphatic hydrops group (P<0.05). The course of disease, the proportion of severe hydrops and the expression of serum AQP8 mRNA in the poor prognosis group were greatly higher than those in the good prognosis group (P<0.05). The area under the curve (AUC) of serum AQP8 mRNA for predicting poor prognosis in Meniere’s disease patients was 0.812 (95%CI: 0.702-0.922), with a sensitivity of 81.0% and a specificity of 70.2%. AQP8 mRNA was an independent risk factor for poor prognosis in patients with Meniere’s disease (P<0.05). Conclusion AQP8 mRNA is associated with the degree of hydrolabyrinth in patients with Meniere’s disease, and has a high performance in predicting prognosis.