Elevated Peak Research Articles

Piezo1 regulates expression of BK and TRPV4 channels in mouse cortical collecting duct (CCD)

Within the CCD, an acute increase in tubular fluid flow rate (TFFR) leads to an immediate high amplitude increase in [Ca 2+ ] i , due to release of IP3-sensitive internal Ca 2+ stores coupled to extracellular Ca 2+ entry at the basolateral membrane in both principal (PC) and intercalated (IC) cells therein (Liu et al., 2003, 2005, 2007). This is followed by a decay in [Ca 2+ ] i to a sustained plateau elevation due, at least in part, to luminal Ca 2+ entry through TRPV4 (Berrout et al., 2012). This flow-induced increase in [Ca 2+ ] i is necessary for BK channel-mediated flow induced K + secretion (FIKS) in the microperfused mammalian CCD. We generated a mouse with IC-specific targeted deletion of the mechanosensitive Ca 2+ permeable channel, Piezo1, which is expressed on the basolateral membranes of PCs and ICs in the mouse CCD (Dalghi et al., 2019). Microperfused CCDs isolated from these IC-PIEZO1-KO mice fed a high K (HK, 5% K + ) diet and subject to an increase in TFFR did not exhibit either a peak or plateau elevation in [Ca 2+ ] i in response to flow, and FIKS was eliminated. The absence of FIKS and the plateau elevation in [Ca 2+ ] during sustained flow in the CCDs of KO mice led us to examine whether BK and TRPV4 channel expression was impacted by deletion of PIEZO1.Indirect immunofluorescence (IF) staining was performed to examine expression and localization of the BK and TRPV4 channels in PCs and ICs of IC-PIEZO1-KO mice. Whole cell and apical + subapical fluorescence intensities in cryosections were analyzed using LAS X software from a total of 3 male and 3 female control mice and 3 male and 3 female IC-PIEZO1-KO mice fed HK diet x 10d.IF analysis showed reduced whole cell BKα expression in ICs of both male (p≤0.05) and female (p≤0.01) IC-PIEZO1-KO mice. We also saw reduced BKα expression in PCs from female but not male KOs. In addition, ICs in female but not male KO mice had reduced whole cell TRPV4 expression vs. controls (p≤0.01). Also, whole cell expression of TRPV4 in PCs from female KO mice was reduced vs. female controls (p≤0.01). The ratio of apical-to-whole cell expression of BKα was similar in PCs and ICs of KO and control mice. Male, but not female, KO mice had modestly reduced apical TRPV4 expression in PCs vs. controls (p≤0.01). Piezo1 plays a role in the regulation of BK and TRPV4 channel expression in CCDs. In addition, sex differences exist in whole cell expression of these channels in response to IC-selective deletion of PIEZO1. R01 DK038470 (TK, LMS); R01 DK129285 (TK, LMS); P30 DK079307 (TK) This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Nieuwerkerk - Emperor of China (NEC) Seamounts (Banda Sea): A multibeam seafloor imagery analysis

A new multibeam dataset of Nieuwerkerk and Emperor of China (NEC) seamounts was acquired during the Jalacitra 2-2022 ”Banda” Expedition in the Banda Sea region. This study discusses a morphometric analysis of the seamounts based on a high-resolution bathymetry digital elevation model (DEM) and describes the morphometric features, namely: slope, profile curvature, and aspect. Morphological results indicate that the Nieuwerkerk seamount has an area of 2,416 km2 with a maximum peak elevation of approximately 3,460 m above the seabed and 357 m below the water surface. In the southwest of the Nieuwerkerk seamount, two new seamounts were discovered, which are still unnamed and seem morphologically connected to the Nieuwerkerk seamount. Each of the seamounts covers an area of 148 km2 and 220 km2, respectively, with a maximum peak elevation of approximately 2,338 m and 2,053 m above the seabed. Additionally, both seamounts have an elevation of 1,878 m and 2,017 m below the sea surface. Meanwhile, the Emperor of China seamount is located southwest of the three formerly mentioned seamounts, with the maximum peak seats at 2,165 m below the sea surface. Seamount C is located in the west of the surveyed area and it covers an area of 95.6 km2 with an elevation of 1,834 m above the seabed. The results of regression analysis indicate that all of the features could be used for the morphological classification.

A Rare Case of Rhombencephalitis after Covid-19 infection: A Case Report (P6-10.002)

<h3>Objective:</h3> COVID-19 has been associated with multiple neurological presentations. We present a unique case of rhombencephalitis secondary to COVID-19. <h3>Background:</h3> Rhombencephalitis, interchangeably used term brainstem-encephalitis is the inflammation of brainstem and cerebellum. Infectious, autoimmune, and paraneoplastic are common etiological categories. Listeria is the most common infectious cause. In this era of pandemic, COVID-19 has been reported as a cause of rhombencephalitis in 5 cases. <h3>Design/Methods:</h3> Case-report <h3>Results:</h3> A 62-year-old female with past medical history of recent COVID-19 infection, diabetes, B-12 deficiency, and breast cancer presented with nausea, blurry vision, and dysarthria. CT head and CTA head/neck were normal. MRI brain without contrast showed abnormal signal in the midbrain and pons. She was initially treated as suspected Wernicke’s with minimal improvement. Repeat MRI brain with contrast one week later showed progression of hyperintensity within the brainstem. She developed worsening encephalopathy, bilateral ptosis with ophthalmoplegia, dis-conjugate gaze, diminished left-sided sensation, and scanning dysarthria. She was treated with high dose steroids with minimal response. She continued to test positive for COVID-19 despite infection one month prior. Repeat MRI brain 2 weeks later showed continued progression of signal abnormality in brainstem and right cerebellum. MRI Spectroscopy showed reduced N-acetyl aspartate peak with elevated choline and creatinine peaks, inconsistent with malignancy. MRI of the spinal axis was normal. Lumbar puncture showed elevated protein and myelin basic protein. CSF NMO/AQ4-IgG, paraneoplastic, and autoimmune panel were negative. Given progression of symptoms, she underwent plasmapheresis with notable improvement overtime. She was eventually discharged to a rehab. <h3>Conclusions:</h3> Our case adds a post-infectious neurological-sequalae of the COVID-19 to the literature. One should be vigilant for such rare manifestation. In cases of possible COVID-19 related rhombencephalitis, early initiation of immunosuppressive treatment should be considered while excluding other infectious mimics to minimize the devastating complications. <b>Disclosure:</b> Dr. Zahra has nothing to disclose. Dr. Huang has nothing to disclose. Dr. Choudhary has nothing to disclose.

A Rare Familial Case of MELAS in a 66-Year-Old Female and Her 33-Year-Old Son (P12-5.005)

<h3>Objective:</h3> Mitochondrial encephalopathy, lactic acidosis, and stroke like episodes (MELAS) is a mitochondrial disorder presenting most commonly between 2 to 40 years of age, with 75% of cases before age 20. Rare cases have been reported past age 60. We report on a case of a family presenting with late onset MELAS in the same year. <h3>Background:</h3> A 66-year-old female with a past medical history of sensorineural hearing loss, type 2 diabetes, hypertension and hyperlipidemia presented with word finding difficulty and right sided neglect. MRI demonstrated a DWI lesion in the left temporal lobe consistent with infarct. Vessel imaging, echocardiogram, and cardiac monitor were unremarkable, and she was discharged on clopidogrel. She returned 11 days later with worsening aphasia and MRI revealed extension of her stroke into the left occipital lobe and right cerebellum. It was then discovered her previously healthy 33-year-old son had been diagnosed with MELAS three months prior. The son had presented with subtle speech difficulties and was found to have a right temporal DWI and T2 hyperintense lesion on MRI. CSF and serum studies were unremarkable for infectious and autoimmune causes. He was discharged following improvement of symptoms but returned the following day after having generalized seizure. MRI revealed expansion of the lesion into the right parietal lobe. MR Spectroscopy showed an elevated lactate peak leading to a presumptive diagnosis of MELAS. He was started on L-Arginine and CoQ10. In both cases, genetic testing revealed a pathogenic MT-TL1 m.3243A&gt;G variant consistent with MELAS (9.7% heteroplasmy in mother and 31% heteroplasmy in son). <h3>Design/Methods:</h3> NA <h3>Results:</h3> NA <h3>Conclusions:</h3> This case demonstrates low heteroplasmy can lead to a later presentation of MELAS requiring MELAS to be on the differential even in people older than 60. <b>Disclosure:</b> Dr. Iordanova has nothing to disclose. Dr. Wong has nothing to disclose. Dr. Cheng has nothing to disclose.

A new metric for characterizing limb loading dynamics in post anterior cruciate ligament reconstruction individuals

BackgroundUnresolved neuromuscular deficits often persist in post-anterior cruciate ligament reconstruction (ACLR) individuals manifesting as altered impact and active peak force production during running that can contribute to detrimental limb loading. Elevated impact and active peaks are common in pathological populations indicating a stiffer limb loading strategy. Although impact and active peaks are sensitive to changes in limb loading, to our knowledge, there are no established, standardized measures or cutoff criteria to differentiate between healthy and pathological limb loading. However, prior studies have demonstrated that the ratio between traditional biomechanical measures can be used to successfully establish quantifiable and graphical ranges to delineate between healthy and pathological movement. Research questionTherefore, this study sought to exploit the impact-to-active peak ratio to generate a new, standardized metric to quantify and characterize limb loading dynamics in healthy controls and post-ACLR individuals during running. MethodsTwenty-eight post-ACLR individuals and 18 healthy controls performed a running protocol. Impact peak and active peak data were extracted from their strides as they ran at a self-selected speed. A linear regression model was fit to the healthy control data and the models 95 % prediction intervals were used to define a boundary region of healthy limb loading dynamics. ResultsThe post-ACLR individuals produced a higher impact-to-active peak ratio than the healthy controls indicating that they adopted a stiffer limb loading strategy. The boundary regions derived from the impact and active peak model successfully classified the healthy controls and post-ACLR individual’s limb loading dynamics with an accuracy, sensitivity, and specificity of 89 %, 100 %, and 75 %, respectively. SignificanceThe ability to effectively evaluate limb loading dynamics using impact and active peaks can provide clinicians with a new, non-invasive metric to quantify and characterize healthy and pathological movement in a clinical setting.

Effect of currents on nonlinear waves in shallow water

Effect of various forms of currents on regular nonlinear waves in shallow water is investigated by use of a computational fluid dynamics approach. A range of wave conditions with different wave heights and wave periods are considered. Effect of three types of currents on these waves is investigated, namely (i) uniform current over the water depth, (ii) shear current from the seafloor to the still-water level, and (iii) a custom current profile that changes over the water depth. The current profiles are considered in both following and opposing directions of the incoming wave, forming in total 18 wave–current configurations. The Navier–Stokes equations for a laminar flow are solved computationally in two dimensions. A numerical wave–current maker is created to generate combined nonlinear waves and currents in shallow water. The effect of the currents on the change of the wave field, including quantitative change of the surface elevation, wave height, wavelength, horizontal particle velocity, and the velocity and pressure fields is presented and discussed. It is found that presence of the current can alter the wave field significantly, and the current profile and direction play a significant role in the change of the wave field. A following current in shallow water increases the peak of surface elevation, horizontal particle velocity and pressure, along with an increase in wavelength and wave height, while an opposing current reduces these. The change of wave height with current direction appears to be opposite to that observed in deep water in the literature. It is also concluded that a linear superposition of the undisturbed wave and current velocities can describe the horizontal particle velocity of the wave–current field for following currents (particularly under the wave trough) reasonably well, but larger differences are observed for opposing currents.

ROB ANALYSIS ON THE COAST OF SEMARANG CITY (CENTRAL JAVA, INDONESIA) ON MAY 23, 2022 BASED ON TIDAL DATA AND INUNDATION DISTRIBUTION

The coast of Semarang City every year always faces flood and tidal problems. Flooding is generally caused by the ongoing rainy season, while tidal flows are caused by rising Java sea levels before the interseason change. This study aims to find the relationship between the tidal incident on May 23, 2022 on the coast of Semarang City with the tidal pattern at the Port of Semarang, and find out the distribution of tidal flows based on the height of inundation in the coastal area of Semarang City. The material used is daily tide data on May 23, 2022, monthly tide data April-May 2022. Data on the distribution of high inundation was obtained based on field surveys and interviews. The results showed that the peak of java sea level elevation occurred on May 23, 2022 with an altitude at the tide staff of 210 cm. Rob occurs almost evenly along the north coast of Semarang City with different heights. The largest tidal height occurred in the Semarang Port Area, which reached a puddle height of 100 cm. There are supposes that the amount of inundation at the site is related to the land subsidence at the site that continues to occur.

Transplant renal artery stenosis: utilization of machine learning to identify ancillary sonographic and doppler parameters to predict stenosis in patients with graft dysfunction

To determine if ancillary sonographic and Doppler parameters can be used to predict transplant renal artery stenosis in patients with renal graft dysfunction. IRB-approved, HIPAA-compliant retrospective study included 80 renal transplant patients who had renal US followed by renal angiogram between January 2018 and December 2019. A consensus read of two radiologists recorded these parameters: peak systolic velocity, persistence of elevated velocity, grayscale narrowing, parvus tardus, delayed systolic upstroke, angle of the systolic peak (SP angle), and aliasing. Univariate analysis using t-test or chi-square was performed to determine differences between patients with and without stenosis. P values under 0.05 were deemed statistically significant. We used machine learning algorithms to determine parameters that could better predict the presence of stenosis. The algorithms included logistic regression, random forest, imbalanced random forest, boosting, and CART. All 80 cases were split between training and testing using stratified sampling using a 75:25 split. We found a statistically significant difference in grayscale narrowing (p=0.0010), delayed systolic upstroke (p=0.0002), SP angle (p=0.0005), and aliasing (p =0.0024) between the two groups. No significant difference was found for an elevated peak systolic velocity (p =0.1684). The imbalanced random forest (IRF) model was selected for improved accuracy, sensitivity, and specificity. Specificity, sensitivity, AUC, and normalized Brier score for the IRF model using all parameters were 73%, 81%, 0.82, and 69 in the training set, and 78%, 58%, 0.78, and 80 in the testing set. VIMP assessment showed that the combination of variables that resulted in the most significant change of the training set performance was that of grayscale narrowing and SP angle. Elevated peak systolic velocity did not discriminate between patients with and without TRAS. Adding ancillary parameters into the machine learning algorithm improved specificity and sensitivity similarly in the training and testing sets. The algorithm identified the combination of lumen narrowing coupled with the angle of the systolic peak as better predictor of TRAS. This model may improve the accuracy of ultrasound for transplant renal artery stenosis.

Differential Pulse Voltammetric Analysis of Hydrazine in Water Samples by Using Screen-Printed Graphite Electrode Modified with Nitrogen-Doped Hollow Carbon Spheres

The present study introduces a facile and efficient voltammetric hydrazine sensor via the modification of screen-printed graphite electrode (SPGE) with nitrogen-doped hollow carbon spheres (N-HCSs). This work is the first report of the new method of electroanalytical determination of hydrazine through N-HCSs modified SPGE. The N-HCSs fabricated through the templating approach (hard template) were characterized by Fourier transform infrared (FT-IR) spectroscopy, field emission-scanning electron microscopy (FE-SEM), and energy-dispersive X-ray spectroscopy (EDS). Cyclic voltammetry (CV), chronoamperometry (CA), and differential pulse voltammetry (DPV) were employed for electrochemical determinations. The produced N-HCSs/SPGE had an appreciable electrocatalytic capacity for the hydrazine oxidation, with the least oxidation overpotential and elevated voltammetric peak currents. The peak current of hydrazine oxidation on N-HCSs/SPGE possessed a distinct linear association with its levels (0.02–380.0 μM) under the optimized experimental circumstances, with the limit of detection (LOD) as narrow as 0.007 μM. Good stability and acceptable reproducibility were also attained on the N-HCSs/SPGE. In addition, the developed technique exhibited good selectivity toward the detection of hydrazine in the presence of some interfering species. The practical applicability of proposed sensor was successful by sensing hydrazine in water samples.

A complex genomic architecture underlies reproductive isolation in a North American oriole hybrid zone

Natural hybrid zones provide powerful opportunities for identifying the mechanisms that facilitate and inhibit speciation. Documenting the extent of genomic admixture allows us to discern the architecture of reproductive isolation through the identification of isolating barriers. This approach is particularly powerful for characterizing the accumulation of isolating barriers in systems exhibiting varying levels of genomic divergence. Here, we use a hybrid zone between two species—the Baltimore (Icterus galbula) and Bullock’s (I. bullockii) orioles—to investigate this architecture of reproductive isolation. We combine whole genome re-sequencing with data from an additional 313 individuals amplityped at ancestry-informative markers to characterize fine-scale patterns of admixture, and to quantify links between genes and the plumage traits. On a genome-wide scale, we document several putative barriers to reproduction, including elevated peaks of divergence above a generally high genomic baseline, a large putative inversion on the Z chromosome, and complex interactions between melanogenesis-pathway candidate genes. Concordant and coincident clines for these different genomic regions further suggest the coupling of pre- and post-mating barriers. Our findings of complex and coupled interactions between pre- and post-mating barriers suggest a relatively rapid accumulation of barriers between these species, and they demonstrate the complexities of the speciation process.

Interdependence of glycemic and lipid modulation in cured chronic hepatitis C patients by direct-acting antiviral agents.

Chronic hepatitis C virus (HCV) infection causes various liver diseases and metabolic disorders. With direct-acting antiviral agents (DAAs), which effectively eradicate pan-genotypic HCV, hepatic and concomitant metabolic restorations are achieved. The study aims to evaluate the posttherapeutic benefits of lipid and glycemic homeostasis. Nighty-five chronic hepatitis C patients who achieved sustained virological response (SVR) by using DAAs were enrolled to collect plasma samples and fractionated lipoproteins at baseline, SVR, and during the post-SVR follow-ups for 6 months (pS6m) and 1 year (pS1yr). The lipid and glycemic parameters were analyzed to establish muturally modulatory relationships. Plasma cholesterol (Chol) and glucose were elevated at SVR from baseline, whereas plasma Chol remained increased until pS1yr; however, glucose returned to the basal level. The post-SVR responses included a peak elevation of glycated hemoglobin at pS6m, a sustained elevation of triglyceride (Tg), and sustained declines in insulin, homeostasis model assessment (HOMA)-insulin resistance, and HOMA-beta levels until pS1yr. The changes in plasma Chol and high-density-lipoprotein Chol showed positive correlations, as did the plasma Tg with low-density-lipoprotein Tg and very-low-density-lipoprotein Tg per particle load. Very-low-density-lipoprotein was found to be loaded with increased Tg and Chol and underwent efficient Tg catabolism in the form of conversion into low-density-lipoprotein. Additionally, the posttherapeutic dynamics exhibited correlations of high-density-lipoprotein Chol with plasma glucose and HOMA-beta. Irrespective of the baseline metabolic status, the posttherapeutic interdependent modulation of blood glycemic and lipid metabolic parameters were revealed in chronic hepatitis C patients following clearance of HCV viremia by DAA treatment.

Factors affecting dialysis duration in children with Shiga toxin-producing Escherichia coli-associated hemolytic uremic syndrome.

Predicting disease severity can be informative for management of HUS. Dialysis requirement, volume depletion, elevated white blood cell counts, very young age, and use of antimotility agents are known factors associated with severe HUS. A retrospective cohort analysis was performed to identify factors associated with dialysis duration using electronic medical record and chart review of 76 children ≤ 18years of age at presentation with STEC-HUS identified through billing data from July 2008 to April 2020 at James Whitcomb Riley Hospital for Children, Indiana University, Indiana. Novel findings associated with prolongeddialysis duration were age ≥ 6years old at presentation (p = 0.041) and lack of drop in platelets below 60,000/mm3 anytime during the illness (p = 0.015). In addition, children with NSAID exposure trended longer on dialysis: 15days with vs. 10days without (p = 0.117). Known risk factors for severe disease including elevated peak white blood cell (WBC) count and higher hematocrit at presentation were also associated with longer dialysis duration: children with peak WBC > 20,000/mm3 were on dialysis for 15 vs. 9.5days (p = 0.002) and in children on dialysis ≥ 14days hematocrit at presentation was 29.6% vs. 24.2% (p = 0.03). Children requiring dialysis for 20days or longer were more likely to be on anti-hypertensive medications (p = 0.025) and have chronic kidney disease at 12-month follow up (p = 0.044). Age ≥ 6, elevated WBC count > 20,000/mm3, higher hematocrit at presentation, lack of drop in platelets to < 60,000/mm3, and possibly NSAID exposure during illness are associated with longer dialysis duration in STEC-HUS. A higher resolution version of the Graphical abstract is available as Supplementary information.

MR Perfusion Imaging as a Problem- Solving Tool for Differentiating High-grade Glioma and Tumefactive Demyelination: A Report of Two Cases

Clinically, it is nearly impossible to differentiate between high-grade glioma, specifically Glioblastoma Multiforme (GBM), and Tumefactive Demyelination (TMD). Radiologically, distinguishing between GBM and TMD is challenging since they show similar findings on Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). To avoid invasive procedures that may increase patient morbidity, the use of MR perfusion imaging is highlighted in these case reports. We present two cases of young adult females with neurological deficits. The first case involves an 18-year-old female who presented with a dull, intermittent, holocephalic headache for eight months, along with heaviness and recent onset of pain in the right upper limb. MR spectroscopy revealed an increased choline/creatinine ratio at the margins of the lesion, measuring approximately 2.4, with a decrease in N-Acetylaspartate (NAA) and NAA/Creatinine. Based on these findings, the possibility of either high-grade glioma or TMD was considered. Further evaluation using perfusion imaging showed a substantial increase in the mean relative Cerebral Blood Volume (rCBV) within the lesion, suggesting a higher likelihood of high-grade glioma rather than TMD. Biopsy confirmed the diagnosis as high-grade glioma (GBM), revealing marked mitotic changes with nuclear pleomorphism and multinucleated cells. The second case involves a 22-year- old female who presented with left upper limb and lower limb weakness for 10 days. MR spectroscopy showed reduced NAA values and an elevated choline peak with small lactate at a few places. A choline/creatine ratio of 1.9 was obtained. On perfusion imaging, the observed mean rCBV values were substantially low (rCBV measuring approximately 1.07). Consequently, a final radiological diagnosis of TMD was considered. A biopsy confirmed the presence of inflammatory demyelination.

The quality of acid soils treated with seaweed (Kappapychus alvarezii) sap enriched biochar from Southeast Sulawesi, Indonesia

Biochar enriched with fertilizers has the potential to improve the quality of acid soils. In the agricultural sector, it was reported that the sap of &lt;em&gt;Kappapychus&lt;/em&gt;&lt;em&gt; alvarezii&lt;/em&gt; (K-sap) is often used as a biofertilizer. Therefore, this study aimed to (i) examine the character of biochar enriched with the K-sap and (ii) analyze the soil quality after incubation. This study was carried out using two treatment factors arranged in a randomized block design, namely the biochar dose at 0%, 2.5%, 5.0%, and 7.5% in weight and K-sap at concentrations of 0%, 5%, 10%, and 15%. Ten kilograms of acid soil were incubated with K-sap enriched biochar for up to 2 weeks in each experimental pot. The results showed that the absorption band increased with the K-sap concentration for the functional group associated with the OH-stretching of the biochar enriched with K-sap was stronger and wider than the unenriched. The peak elevation pattern detected by X-ray diffraction for all biochars was similar. The dosage of 7.5% biochar enriched with 5%-10% K-sap concentrations increased pH, EC, organic C, total N, C:N ratio, available P, and exchangeable K, Ca, Mg, and Si than those without treatment. Furthermore, ammonium and total spores of arbuscular mycorrhizal fungi decreased, flagellates increased with and without the biochar, while the nitrate, total bacteria, and fungi of all treatments were similar. Based on these results, it was concluded that biochar enriched with K-sap could improve the quality of acid soil.

지연성 근통증 유발 후 Ibuprofen 투여가 최대근력 및 근 손상 지표에 미치는 영향

This study aimed to investigate the effects of Ibuprofen supplement on delayed onset muscle soreness(DOMS) by analyzing the maximum muscle strength and indicators of muscle damꠓ age. Eighteen men with majors in physical education were assigned to the Ibuprofen group and placebo group in a double-blinded design, and repeated measurements were conducted. DOMS was induced with an isokinetic exercise. Following Ibuprofen administration, the changes in the knee extension peak torque, flexion peak torque, creatine kinase (CK), and lactate dehydrogenase (LDH) concentrations were analyzed. The administration of Ibuprofen inhibits the reduction of the extension peak torque and elevation of CK concentrations. Therefore, Ibuprofen might be administered as a supplement to maintain the muscle strength and prevent muscle damage.

Prognosis Prediction Using Magnetic Resonance Spectroscopy and Oligoclonal Bands in Central Nervous System Methotrexate-associated Lymphoproliferative Disorder.

Central nervous system methotrexate-associated lymphoproliferative disorder (CNS-MTX-LPD) is rare, but its spontaneous regression has been observed in some patients after withdrawal of agents. We herein report three cases of primary CNS-MTX-LPD that received oral MTX for rheumatoid arthritis. Epstein-Barr virus and oligoclonal bands (OCBs) were positive, while proton magnetic resonance spectroscopy (1H-MRS) showed an elevated lipid peak and slightly elevated choline/N-acetylaspartate ratio in common. After MTX withdrawal, brain lesions showed spontaneous regression in all cases. Our patient's 1H-MRS findings and OCBs may reflect a non-monoclonal lymphoproliferative histology as benign-type lesions in CNS-MTX-LPD.

HME filters: a boon or bane?

Heat and moisture exchange filters (HMEFs) have been a controversial yet widely used adjunct to breathing circuit. Here we discuss a case scenario where clogging of HMEF with moisture presented as elevated peak airway pressures. Apart from stressing the importance of monitoring airway pressure, we discuss about the judicious use of HMEFs, problems associated with their use and measures to overcome the same. Being a ubiquitous adjunct, a thorough knowledge of its functioning and constant vigilance during its use is of paramount importance

Sonographic Assessment of Acute Versus Chronic Cholecystitis: An Ultrasound Probability Stratification Model.

What sonographic variables are most predictive for acute cholecystitis? What variables differentiate acute and chronic cholecystitis? The surgical pathology database was reviewed to identify adult patients who underwent cholecystectomy for cholecystitis and had a preceding ultrasound of the right upper quadrant within 7 days. A total of 236 patients were included in the study. A comprehensive imaging review was performed to assess for gallstones, gallbladder wall thickening, gallbladder distension, pericholecystic fluid, gallstone mobility, the sonographic Murphy's sign, mural hyperemia, and the common hepatic artery peak systolic velocity. Of 236 patients with a cholecystectomy, 119 had acute cholecystitis and 117 had chronic cholecystitis on surgical pathology. Statistical models were created for prediction. The simple model consists of three sonographic variables and has a sensitivity of 60% and specificity of 83% in predicting acute versus chronic cholecystitis. The most predictive variables for acute cholecystitis were elevated common hepatic artery peak systolic velocity, gallbladder distension, and gallbladder mural abnormalities. If a patient had all three of these findings on their preoperative ultrasound, the patient had a 96% chance of having acute cholecystitis. Two of these variables gave a 73-93% chance of having acute cholecystitis. One of the three variables gave a 40-76% chance of having acute cholecystitis. If the patient had 0 of 3 of the predictor variables, there was a 29% chance of having acute cholecystitis. Gallbladder distension, gallbladder mural abnormalities, and elevated common hepatic artery peak systolic velocity are the most important sonographic variables in predicting acute versus chronic cholecystitis.

Risk factors, clinical features, and outcomes of premature acute myocardial infarction.

To investigate the risk factors, clinical features, and prognostic factors of patients with premature acute myocardial infarction (AMI). A retrospective cohort study of patients with AMI included in data from the West China Hospital of Sichuan University from 2011 to 2019 was divided into premature AMI (aged < 55 years in men and < 65 years in women) and non-premature AMI. Patients' demographics, laboratory tests, Electrocardiography (ECG), cardiac ultrasound, and coronary angiography reports were collected. All-cause death after incident premature MI was enumerated as the primary endpoint. Among all 8,942 AMI cases, 2,513 were premature AMI (79.8% men). Compared to the non-premature AMI group, risk factors such as smoking, dyslipidemia, overweight, obesity, and a family history of coronary heart disease (CHD) were more prevalent in the premature AMI group. The cumulative survival rate of patients in the premature AMI group was significantly better than the non-premature AMI group during a mean follow-up of 4.6 years (HR = 0.27, 95% CI 0.22-0.32, p < 0.001). Low left ventricular ejection fraction (LVEF) (Adjusted HR 3.00, 95% CI 1.85-4.88, P < 0.001), peak N-terminal pro-B-type natriuretic peptide (NT-proBNP) level (Adjusted HR 1.34, 95% CI 1.18-1.52, P < 0.001) and the occurrence of in-hospital major adverse cardiovascular and cerebrovascular events (MACCEs) (Adjusted HR 2.36, 95% CI 1.45-3.85, P = 0.001) were predictors of poor prognosis in premature AMI patients. AMI in young patients is associated with unhealthy lifestyles such as smoking, dyslipidemia, and obesity. Low LVEF, elevated NT-proBNP peak level, and the occurrence of in-hospital MACCEs were predictors of poor prognosis in premature AMI patients.

Asymmetrically coupled Co Single-atom and Co nanoparticle in Double-shelled Carbon-based nanoreactor for enhanced reversible oxygen catalysis

Simultaneous construction of size-asymmetric metal single atoms and nanoparticle active sites in advanced and robust carrier materials is particularly important yet challenging for efficient reversible oxygen catalysis. Herein, a facile “chemical etching/in-Situ capture” synthesis strategy was developed to fabricate a unique double-shelled carbon-based nanobox integrated with size-asymmetric Co single-atom (CoSA) and metallic Co nanoparticle (CoNP) moiety. As expected, this well-managed catalyst product yielded remarkable bifunctional electrocatalytic performances in alkaline electrolytes, with a decent half-wave potential of 0.886 V for oxygen reduction reaction (ORR) and a small overpotential of 341 mV at 10 mA/cm2 for oxygen evolution reaction (OER). Besides, this nanobox catalyst served as a cost-effective and efficient oxygen electrode in the assembled rechargeable ZABs, exceeding the mixed electrocatalyst of expensive Pt/C-RuO2, in terms of the elevated peak power density of 239 mW/cm2, the promoted specific capacity of 770 mAh/gZn, as well as the appreciable charge–discharge cycle stability. Theoretical calculations revealed that the strong interaction between the delicate CoSA site and CoNP phase, could effectively optimize the adsorption and desorption energy barriers of reaction intermediates on the designed catalyst surface, thus achieving synergistic enhancement of electrocatalytic activity towards ORR and OER. This finding affords a feasible and effective strategy to achieve highly active and durable bifunctional catalysts for both fundamental research and practical rechargeable ZABs applications.