Small Case Research Articles

Utility of SHOX2 and RASSF1A gene methylation detection on the residual cytology material from endobronchial ultrasound-guided transbronchial needle aspiration.

This study aims to assess the effectiveness of Short Stature Homeobox 2 (SHOX2) and RAS Association Domain Family 1 Isoform A (RASSF1A) gene methylation detection in residual liquid-based cytology (LBC) materials from Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA) and investigate the diagnostic accuracy of a comprehensive diagnostic approach. Between June 2022 and May 2023, a total of 110 cases that underwent EBUS-TBNA were enrolled in the study. SHOX2 and RASSF1A genes methylation detection using the residual cytological material, LBC, and cell block (CB) were conducted for each EBUS-TBNA case. The sensitivity and specificity of cytology, CB histopathology, SHOX2, and RASSF1A methylation in diagnosing EBUS-TBNA samples were determined based on follow-up data. Among the 72 cases confirmed as pulmonary carcinomas, the methylation test yielded positive results in 24 adenocarcinoma cases, 10 squamous cell carcinoma cases, and 14 small cell carcinoma cases. The sensitivity of the comprehensive diagnosis (combining LBC, CB, and methylation detection) in distinguishing metastatic pulmonary epithelial malignancies in mediastinal and hilar lymph nodes or masses from benign lesions was higher (97.22%, 70/72) than that of morphological diagnosis alone (LBC and CB) (88.89%, 64/72; P < 0.05). SHOX2 and RASSF1A methylation detection demonstrates a high sensitivity and negative predictive value in the identification of pulmonary epithelial malignancies and holds promise as a valuable ancillary approach to enhance morphological diagnosis of EBUS-TBNA.

Outcome of emergency neurosurgery in patients with refractory and super-refractory status epilepticus: a systematic review and individual participant data meta-analysis.

Refractory (RSE) and super-refractory status epilepticus (SRSE) are serious neurological conditions requiring aggressive management. Beyond anesthetic agents, there is a lack of evidence guiding management in these patients. This systematic review and individual participant data meta-analysis (IPDMA) seeks to evaluate and compare the currently available surgical techniques for the acute treatment of RSE and SRSE. A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Individual Participant Data (PRISMA-IPD). Only patients who underwent surgery while in RSE and SRSE were included. Descriptive statistics were used to compare various subgroups. Multivariable logistic regression models were constructed to identify predictors of status epilepticus (SE) cessation, long-term overall seizure freedom, and favorable functional outcome (i.e., modified Rankin score of 0-2) at last follow-up. A total of 87 studies including 161 participants were included. Resective surgery tended to achieve better SE cessation rate (93.9%) compared to non-resective techniques (83.9%), but this did not reach significance (p = 0.071). Resective techniques were also more likely to achieve seizure freedom (69.1% vs. 34.4%, p = <0.0001). Older age at SE (OR = 1.384[1.046-1.832], p = 0.023) was associated with increased likelihood of SE cessation, while longer duration of SE (OR = 0.603[0.362-1.003], p = 0.051) and new-onset seizures (OR = 0.244[0.069-0.860], p = 0.028) were associated with lower likelihood of SE cessation, but this did not reach significance for SE duration. Only shorter duration of SE prior to surgery (OR = 1.675[1.168-2.404], p = 0.0060) and immediate termination of SE (OR = 3.736 [1.323-10.548], p = 0.014) were independently associated with long-term seizure status. Rates of favorable functional outcomes (mRS of 0-2) were comparable between resective (44.4%) and non-resective (44.1%) techniques, and no independent predictors of outcome were identified. Our findings suggest that emergency neurosurgery may be a safe and effective alternative in patients with RSE/SRSE and may be considered earlier during the disease course. However, the current literature is limited exclusively to small case series and case reports with high risk of publication bias. Larger clinical trials assessing long-term seizure and functional outcomes are warranted to establish robust management guidelines.

Effect of manifold size on PEMFC performance with metal foam flow field

Metal foam flow fields are considered as an alternative to conventional channel/rib flow field in polymer electrolyte membrane fuel cell (PEMFC) because of the advantages of three-dimensional pore structure. In this study, the effect of metal foam flow field with different manifold size on PEMFC performance was investigated, with a 25 cm2 unit cell. Polarization curve and electrochemical impedance spectroscopy results were analyzed to investigate the effects of gas stoichiometry and relative humidity on performance. The mass transfer loss was decreased with reduced manifold size. However, mass transfer loss was increased due to difficulty of water discharge in small manifold case. The metal foam flow field offer advantages in water discharge and mass transfer loss. At 100% relative humidity, performance was improved with increased air stoichiometry for different manifold size. At 25% relative humidity, performance was a little improved with increased air stoichiometry for small manifold case. Regardless of relative humidity, fuel cell performance with metal foam flow field was most improved in case of smallest manifold size based on air stoichiometry due to the high pressure drop.

Ventricular arrhythmia events in patients with implantable cardioverter-defibrillator before and after the treatment with sodium-glucose co-transporter 2 inhibitors

Abstract Background The role of sodium-glucose co-transporter 2 inhibitors (SGLT2i) in the treatment of chronic heart failure is expanding. However, the timing of implantable cardioverter-defibrillator (ICD) implantation for primary prevention in relation to the use of SGLT2i remains unclear. A small case series has described appropriate shocks from ICD in two patients following the initiation of SGLT2i, but a comprehensive analysis is lacking in the literature. Methods This study aimed to investigate the rate of ventricular arrhythmic burden and appropriate anti-tachycardia therapy from ICD before and after the initiation of SGLT2i therapy. We conducted a retrospective single-center analysis, comparing ventricular events from home monitoring reports three months before and three months after SGLT2i therapy initiation. Results Seventeen patients were enrolled in the study. At baseline, clinical characteristics were as follows: 13 (76%) were male, 9 (53%) had ischemic, 2 (12%) had valvular, and 6 (35%) had idiopathic cardiomyopathy. The mean end-diastolic volume (EDV) was 203 ± 90 ml, and the mean left ventricular ejection fraction was 0.36 ± 0.09. All patients were treated with beta-blockers, 14 (82%) with sacubitril-valsartan, 13 (76%) with aldosterone antagonists, 16 (94%) with furosemide, and 5 (29%) with amiodarone. SGLT2i started with dapagliflozin for 13 patients (76%), empagliflozin for 3 patients (18%), and canagliflozin for 1 patient (6%). Ten patients (59%) had single-chamber or dual-chamber ICDs, and 7 had implantable cardiac resynchronization therapy (CRT) defibrillators. In the three months before SGLT2i treatment, 4/17 patients had non-sustained ventricular tachycardia (NSVT), compared to 8/17 (23% vs. 47%, p-value 0.23) patients with NSVT after treatment. Seven patients (41%) experienced an increase in the rate of NSVT events, with one patient having 28 NSVT events after treatment versus none before treatment. No patients had anti-tachycardia therapy in the three months before treatment, while in the three months after SGLT2i treatment, 1 patient had ventricular tachycardia treated with anti-tachycardia pacing (110 days after the beginning of the treatment), and 2 patients had ventricular tachycardia treated with appropriate shocks (2 and 25 days after the initiation of SGLT2i treatment). Conclusion This small retrospective analysis revealed an increase in ventricular arrhythmic events in the three months following the initiation of SGLT2i. These findings highlight the need for a more extensive analysis to establish a stronger statistical correlation.

#2435 Calciphylaxis: patient demographics, risk factors and outcomes in a single regional centre in New Zealand

Abstract Background and Aims Calciphylaxis, a condition associated with microvascular calcification and subsequent formation of non-healing tender skin lesions, has previously been estimated to affect only approximately 1% of patients with ESRD each year. However, clinicians practicing in a regional renal unit in the North Island of New Zealand have noted an increase in the frequency of clinical diagnoses of this condition over recent years. The aim of this review was to analyze patient demographics and risk factors and attempt to identify any correlation with subsequent outcomes. Method A cross sectional retrospective review of dialysis patients from Palmerston North Hospital's Renal Unit who were found to have diagnoses of calciphylaxis, was performed. The following factors were assessed: gender, ethnicity, smoking status, diabetes, obesity, hypertension, dialysis modality, prescription of phosphate binders, vitamin D analogues, and sodium thiosulphate (STS). We included patients with both histologically proven calciphylaxis and clinical diagnosis only. Levels of serum PTH, calcium and phosphate at the time of diagnosis were reviewed, though only PTH levels were included in the final analysis. Results A total of nineteen patients were identified having calciphylaxis as a diagnosis in the period studied. Findings were limited due to the small patient cohort size, but of those identified and reviewed some commonalities were found. Included were 9 NZ European people and 8 NZ Māori people. There were 8 females. One patient was a current smoker at time of diagnosis and five were documented as ex-smokers. Fourteen patients (74%) had type 2 diabetes mellitus and hypertension. Twelve patients (63%) were obese. Eighteen patients (95%) had hyperparathyroidism. Warfarin use was seen in 10 of the patients studied (52%) and twelve (63%) had used phosphate binders. Nine patients (47%) were diagnosed in the period between 2011 and 2021, with the remaining ten (53%) diagnoses occurring in 2022 or 2023. The majority (90%) were treated with STS, however 84% died. Dialysis modality at time of diagnosis and throughout disease span was also reviewed. Eight patients (42%) used only haemodialysis (HD), six patients (32%) used both modalities and five patients (26%) used only peritoneal dialysis. The majority (63%) of patients were on haemodialysis at time of diagnosis. Conclusion Calciphylaxis appears to be increasing dramatically in the single center studied in this review. Positive correlations were identified between high levels of PTH, obesity, hypertension, type 2 diabetes, and use of warfarin. Unfortunately, due to small case numbers, and poor historical documentation, further conclusions could not be drawn easily. A further RCT would be required to investigate the efficacy of STS as a treatment for calciphylaxis.

#1443 Bone and mineral metabolism in patients with nephropathic cystinosis as a function of age and eGFR

Abstract Background and Aims Cystinosis-associated metabolic bone disease (CMBD) is a major challenge in the treatment of patients with infantile nephropathic cystinosis (NC). Study data are limited due to small case numbers, lack of adults or patients on renal replacement therapy and/or inadequate assessment of bone health. Method We investigated markers for CMBD in all age groups (1-44 years; 61% children) and CKD stages 1-5D/T in the largest NC cohort to date with 103 German and Austrian NC patients. Skeletal comorbidity and concentrations of fibroblast growth factor 23 (FGF23), the osteoblast marker bone-specific alkaline phosphatase (BAP), the bone remodeling inhibitor sclerostin, the osteoclast marker tartrate-resistant acid phosphatase 5b (TRAP5b), the soluble receptor activator of nuclear factor kappa B ligand (sRANKL), osteoprotegerin (OPG) and the sRANKL/OPG ratio as surrogates for the regulation of osteoclastogenesis by osteoblasts were determined by ELISA, converted into age- and sex-specific z-scores and compared as a function of eGFR. Multivariable regression analyses were used to identify specific influencing factors associated with biochemical and clinical findings in pre-transplant NC patients. Results Skeletal complications occurred in two-thirds of patients, with the risk being five times higher in adults than in children. Pediatric and adult NC patients with CKD stages 1-4 showed hypophosphatemia and hypocalcemia associated with suppressed FGF23 and PTH levels and elevated BAP concentrations. This was associated with age, eGFR and treatment with phosphate and active vitamin D, suggesting more vigorous treatment of Fanconi syndrome in pre-transplant patients. As indicated by the increased TRAP5b and decreased sRANKL/OPG ratio, osteoclast activity was increased despite counterregulation by osteoblasts, which in conjunction with increased sclerostin activity may have contributed to the progressive bone loss and skeletal comorbidity in our patient cohort. Conclusion Bone health in NC progressively deteriorates with age, largely due to persistent rickets/osteomalacia associated with inadequate treatment of Fanconi syndrome and increased osteoclast activity despite osteoblast counterregulation via OPG/RANKL. Our data suggest that a primary osteoclast defect in NC promotes increased bone resorption, limiting maximal bone mass and leading to progressive bone loss and increased skeletal comorbidity.

#2078 Study of spectrum of renal dysfunction in cancer patients on ICPI as mono or combination with conventional chemo in north India

Abstract Background and Aims Although use of ICPI's have revolutionized the treatment of cancer patient with significantly improving the longevity of these patients but it also is associated with various adverse reactions known as iRAE's related to its use, which in due course is being revealed gradually. Kidney related iRAE's are important and also limitation to therapy, which could be a detrimental factor for these patients availing the beneficial effects of these revolutionary medications. Previous literature on these therapeutics had the limitations of being retrospective, small case series and case reports and evaluating only one or two parameters of kidney dysfunction, also the criteria used for evaluations had the limitation of standardization. With this we aimed to study the spectrum of renal dysfunction in cancer patients, receiving ICPI with or without conventional chemotherapy using standard criteria. Method Study involved patients with malignancy who had received at least 1 dose of ICPI as mono or combination with conventional chemotherapy. The primary end-point was 6 month assess the clinical spectrum &amp; outcome of renal dysfunction, and the secondary end-points were the patient-level risk factors for renal dysfunction, the impact of renal dysfunction on clinical outcomes. Results Conducted through October 2021-2022, enrolled N = 156 (66 male &amp; 90 females) &amp; followed up for 6 months. 109 (69.9%) subjects developed KDIGO–AKI—Stage I (51.4%) &amp; Stage II (35.8%) &amp; non required RRT. The median duration for onset of AKI was 131 days. Proteinuria was observed in n = 143 (91.67%). n = 116 (74.3%) developed new-onset proteinuria. n = 40 (25.6%) were proteinuric at the start of the study &amp; 27/40 (67.5%) were observed to have &amp;gt;50% increase in proteinuria, qualifying for proteinuria with therapy. 92/143 proteinuric subjects (64.3%) developed &amp;gt;1 g/day proteinuria. On subcategorizing proteinuria it was observed that 82/92 (57.3%) had 1–3 g/day proteinuria and ≥3.0 g/day proteinuria was observed in 10/92 (7.0%). Definitive ICPI–AKI could be attributed to only 2 subjects, as they underwent kidney biopsy for their kidney dysfunction and significant proteinuria. Secondary amyloid deposits in the glomeruli and mesangium was found in 1 subject &amp; the other subject showed acute tubulointerstitial deposits with granular cast. Proteinuria and kidney dysfunction resolved with stoppage of the ICPI and steroids administration, which was consistent with the limited literature available for the management of ICPI related amyloidosis &amp; iRAE. n = 88 had partial recovery of kidney dysfunction following an AKI event &amp; complete recovery was seen in n = 3 (2.7%). &amp;gt;50% recovery in eGFR was observed in n = 41 (37.6%). Electrolyte abnormality commonly observed were hyponatremia, hypokalemia &amp; hypomagnesemia &amp; was seen in distributed almost equally, followed by hypocalcemia. Hypernatremia, hyperkalemia, hypermagnesemia &amp; hypercalcemia were less commonly reported. Lastly mortality was also observed in n = 16 (10.2%), but could not be directly attributed to ICPI use, kidney dysfunction, malignancy type, comorbid conditions &amp; other concomitants medication use. Conclusion To conclude this present prospective cohort study is a comprehensive assessment of the spectrum of renal dysfunction in cancer patients, among recipients of ICPI with or without conventional chemotherapy using standard criteria to the best of our knowledge, which has been the limitation of previous literature. We have shown a vast spectrum of kidney dysfunction possibly attributed to the ICPI's in malignancy patients. Viewed in respect to better QoL with ICPI therapy in malignancy patients, kidney related iRAE's could limit the patients from their beneficial effects. A possible persistent immune injury might have led to partial recovery of kidney dysfunction in majority. An unusual finding of secondary amyloid deposits with pembrolizumab, which possible might have occurred due to persistence of high levels of inflammatory markers due to these drugs. Thus underscoring the need for a close follow-up and recommend kidney biopsy to better &amp; definitively identify the glomerular pathology &amp; treatment accordingly.

Ceftazidime Poloxamer Gel: Expanding the Therapeutic Armamentarium for Ciprofloxacin-Resistant Pseudomonas Mastoid Cavity Otorrhea.

To present and evaluate the treatment of ciprofloxacin-resistant Pseudomonas mastoid cavity otorrhea with a ceftazidime thermosensitive poloxamer gel. A retrospective clinical capsule report. Three patients diagnosed with ciprofloxacin-resistant Pseudomonas otorrhea in the setting of a previous canal-wall-down mastoidectomy between March 2019 and June 2023 visiting our tertiary care institution were retrospectively reviewed. Application of a 2% ceftazidime thermosensitive poloxamer gel to mastoid cavity. No evidence of disease during microscopic inspection of the ear within a month of initial treatment or bacterial eradication on subsequent culture. Two patients had complete resolution of symptoms and achieved a safe and dry ear after topical application of the hydrogel. The second patient had pseudomonal eradication on culture, but persistent otorrhea due to other multidrug-resistant bacteria and an anatomically unfavorable mastoid cavity, which ultimately resolved after revision surgery. This small case series suggests that topical treatment of mastoid cavity otorrhea with a 2% ceftazidime poloxomer gel is a potential therapeutic avenue in patients with ciprofloxacin-resistant Pseudomonas .

Misdiagnosis and Clinical Insights into Acral Amelanotic Melanoma-A Systematic Review.

Acral amelanotic melanomas (AAMs), a rare subset of melanomas located on acral sites such as the palms, soles, and subungual areas, are diagnostically challenging due to their lack of typical pigmentation and often benign clinical appearance. Misdiagnosis is common, leading to delays in treatment and potentially worse outcomes. This systematic review aims to synthesise evidence on cases of AAM initially misdiagnosed as other conditions, to better understand their clinical and epidemiological characteristics, diagnostic pitfalls, and management strategies. A comprehensive search of the MEDLINE/PubMed, EMBASE, and SCOPUS databases was conducted up to March 2024. Case reports and small case series of AAMs initially misdiagnosed as other conditions were included. Data on patient demographics, clinical presentation, and diagnostic methods were collected and analyzed. Of the 152 records identified, 26 cases from 23 articles met the inclusion criteria. A demographic analysis revealed that the gender distribution appears to be perfectly balanced, with an age range of 38 to 91 years. Misdiagnoses included non-healing ulcers or traumatic lesions (37.5%), benign proliferative lesions (29.2%) and infectious lesions (20.8%). The foot was the most affected site (53.8%). Notably, a histological evaluation was performed in 50% of cases involving the upper extremities, in contrast to only 7.1% of cases involving the foot and 0% of cases of the heel. This discrepancy suggests a reluctance to perform biopsies in the lower extremities, which may contribute to a higher misdiagnosis rate in these areas. The underutilization of biopsy in the diagnosis of lower extremity lesions contributes significantly to the misdiagnosis and delay in treatment of AAMs. Especially when the clinical assessment and dermoscopy are inconclusive, biopsies of suspicious lesions are essential. Immunohistochemistry and markers such as PRAME are critical in differentiating melanoma from other malignancies such as clear cell sarcoma. This review highlights the need for increased vigilance and a proactive diagnostic approach to increase early detection rates and improve prognostic outcomes.

“So if you’re going fossil hunting, that’s where you should look”

Abstract Whether directed at adults or children, popularization can be viewed as a process of “translating” and “recontextualizing” expert discourse for a lay audience. In fact, knowledge dissemination for children appears to entail an additional form of “translation,” given their limited background knowledge. This “re-translation” often occurs on dedicated websites based on “edutainment.” While most museum websites function as promotional tools or as agents of knowledge dissemination, a small number of them are targeted at children and offer texts that insert museum objects in a broader context. By means of a small case study, this paper explores how knowledge is popularized and presented in two science museum websites: the Natural History Museum (NHM) in London and OLogy, the science website for children of the American Museum of Natural History (AMNH) in New York. From a corpus-linguistic and discourse-analysis perspective, our interest lies in how popularization takes shape in these two websites, the former intended for different age groups and the latter explicitly addressing children. Quantitative and qualitative results show similarities and dissimilarities, thus accounting for different types of popularization as forms of translation. The analysis aims to grant insights to translators and interpreters engaged in museum adaptations and translation of contexts.

Pectoralis Major Tendon Reconstruction With Achilles Tendon Allografts Utilizing Combined Pulvertaft Weave and Onlay Techniques.

Surgical treatment of chronic pectoralis major tears presents a technical challenge, as injury chronicity may preclude the ability to perform a direct repair. Many techniques have been described to repair an acute pectoralis tendon rupture, including utilization of unicortical buttons within the humeral footprint. In the chronic setting when direct repair is not possible, reconstruction with allograft tissue can restore strength, improve cosmesis, and yield high functional outcomes; however, literature is limited to small case series. We describe a combined Pulvertaft Weave and onlay technique with dual Achilles tendon allograft in the management of an active duty infantryman with a chronic pectoralis major injury.

Immunohistochemistry as an adjunct for challenging histological patterns of borderline Brenner tumors: An illustrative study of 4 cases

Borderline Brenner tumors (BBT) have a range of morphology that shows considerable overlap with that of malignant Brenner tumors (MBT). In particular, two histological patterns of BBT can be particularly challenging: 1) BBT with intraepithelial carcinoma (BBT-IEC) and 2) BBT with a small nested pattern (BBT-SNP). BBT-IEC is characterized by a tumor with the low-power non-infiltrative silhouette of a conventional BBT, but with increased cytological atypia and mitotic activity similar to that of MBT. Conversely, BBT-SNP is characterized by a complex proliferation of small tumor nests that closely resemble the infiltrative growth pattern of MBT, but without the obligate cytologic atypia and mitotic activity of MBT.We suggest that the combination of p16, p53 and Ki-67 may be helpful in distinguishing these 2 patterns of BBT from both conventional BBT and from MBT. While both conventional BBT and BBT-IEC show a null pattern of p16 expression, our case of BBT-IEC showed aberrant p53 overexpression, albeit with a maturation pattern similar to that described for TP53 mutant mucinous ovarian carcinoma and differentiated vulvar intraepithelial neoplasia (dVIN). Similarly, while BBT-SNP shows an infiltrative-like growth pattern similar to that of MBT, our case also showed a wild-type pattern of p53 expression and a Ki-67 proliferative index similar to areas with conventional BBT histology. In conclusion, in our small case series, we show that the use of immunohistochemistry for p53 and Ki-67 may help to distinguish challenging patterns of BBT from MBT. Further studies are needed to validate this finding in a larger case cohort.

Pattern Recognition of EFL University Students’ Online Behaviors through Data Science: Any Investment on English Language Components or Skills?

Artificial intelligence (AI) has played a crucial role in many fields of study, and its merits and demerits have been investigated by related scholars. However, it seems a somewhat gray area when implementing AI in teaching and learning. This could be mainly because AI developers know little about learning varied sciences and they also lack pedagogical knowledge for implementing AI in teaching (Luckin &amp; Cukurova, 2019). Therefore, the current research aimed at gathering data regarding the online behaviors of 21 Iranian EFL university students through installing an application on their mobile phones for a period of eight days. Afterwards, the collected data were analyzed through Data Science methods and varied patterns of behavior were recognized. The results exhibited that messaging and social media applications are two great parts of the students’ life. Also, there existed some common patterns regarding the applications students owned and the amount of time they spent on them. As a small case in point, the results of the study cannot be generalized; however, the outcomes highlight the proof that in an EFL context, serious steps need to be adopted by course designers and stakeholders in order to cultivate a greater and purposeful use of online learning applications, websites etc. among EFL university students so as to enhance the teaching-learning process. This gains prominence because any AI-mediated learning approach is believed to enhance students’ second/foreign language motivation as well as self-regulation in learning. AI is actually promising a revolution in the realm of language education.

Successful launch of robot-assisted mitral valve repair in Japan under universal health coverage

ObjectivesWe compared the clinical outcomes of mitral valve repair for mitral regurgitation via the robot-assisted approach and small right thoracotomy approach 3 years after the reimbursement of the robot-assisted approach in Japan. MethodsPatients who underwent isolated mitral valve repair by minimally invasive approach between 2018 and 2020 from the Japan Cardiovascular Surgery Database were included. Patients in the robot-assisted approach group were matched to the small right thoracotomy approach group based on propensity scores estimated from patient and surgical characteristics. Perioperative outcomes were compared among all cases as well as in subgroups categorized on the basis of the yearly number of robot-assisted approach cases and small right thoracotomy approach cases (≥10 or <10) at the hospital. ResultsWe identified 2443 patients who had undergone isolated mitral valve repair at 250 institutions in the database, and analysis of propensity-matched 577 patient-pairs demonstrated that operation time, cardiopulmonary bypass time, and aortic crossclamp time were significantly shorter with the robot-assisted approach. Although the intensive care unit stay was longer in the robot-assisted approach, the time to discharge was significantly shorter in the robot-assisted approach. There was no meaningful difference in the in-hospital mortality. The incidences of postoperative stroke, renal failure, and prolonged ventilation, and the number of patients who converted to mitral valve replacement were similarly low. Procedural time, blood transfusions, explorative procedures for bleeding, postoperative stroke, and prolonged ventilation occurred at a lower rate in the high-volume institutions. ConclusionsThe study found that the robot-assisted approach is just as effective as the small right thoracotomy approach. The introduction of robot-assisted mitral valve repair in Japan has been successful.

Snapping Biceps Femoris Repair: A Rare Cause of Lateral Knee Pain

Background: Snapping biceps femoris syndrome (SFS) represents a rare clinical entity in which the biceps femoris subluxates over the fibular head in deep flexion. Two primary pathophysiologies have been described including a prominent or abnormal fibular head morphology. Others have implicated an anomalous biceps femoris insertion. The diagnosis is made clinically, with operative and nonoperative intervention strategies available for treatment. Indications: SFS often results in audible snapping and associated pain at the lateral fibular head. When recalcitrant to nonoperative management, surgical intervention can lead to resolution of symptoms. We present the case of a college-aged male who has bilateral symptoms, worse on the right, which have resulted in significant activity modification and daily discomfort recalcitrant to anti-inflammatory medication and physical therapy. Technique Description: The patient was placed supine on the operating room table with an ipsilateral bump under the hip to assist in exposure of the lateral aspect of the knee. Examination under anesthesia (EUA) confirmed the snapping biceps femoris. A lateral approach to the knee and a common peroneal neurolysis was performed. The biceps femoris insertional anatomy was examined for anomalous tendon insertion or insertional tearing. The prominent fibular head was exposed and resected, with careful attention not to disrupt the lateral collateral ligament or popliteofibular ligament insertion sites. The biceps femoris was then repaired to the prepared bony bed of the fibula with one double-loaded suture anchor. Repeat EUA confirmed complete resolution of snapping even with maximal internal rotation of the tibia; this was carefully examined again with the tourniquet deflated to ensure its compressive effect was not partially responsible for the resolution. Results: Published data pertaining to SFS is limited to case reports and small case series. With appropriate indications, surgical intervention yields promising results with a high percentage of patients returning to prior level of activity or prior participation level in sport. Discussion/Conclusion: SFS can be diagnosed with a careful clinical assessment. When recalcitrant to nonoperative management, it is effectively treated with surgical intervention to restore normal fibular anatomy, and prevent recurrent instability and persistent pain. The presented technique allows for appropriate management of these rare injuries. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Propofol enhancement of slow wave sleep to target the nexus of geriatric depression and cognitive dysfunction: protocol for a phase I open label trial

IntroductionLate-life treatment-resistant depression (LL-TRD) is common and increases risk for accelerated ageing and cognitive decline. Impaired sleep is common in LL-TRD and is a risk factor for cognitive decline. Slow...

Assessment of triglyceride clearance of haemoperfusion from three cases of hypertriglyceridaemia-induced acute pancreatitis: a case series.

Rapid reduction of plasma triglycerides (TG) is believed to improve the outcome of pancreatitis in the context of hypertriglyceridaemia (HTG)-induced acute pancreatitis (HTG-AP). Previous studies have suggested that haemoperfusion (HP) with the Jafron cartridge series could be effective for reducing TG concentrations in patients with HTG-AP. However, the clearance capacity (CC) for TG removal has not been reported. This case series reports on data from three patients with HTG-AP who underwent HP with HA230 or HA330 cartridges. Blood samples were collected from both before and after the cartridge circuit every 30 min and the CC was calculated. Twelve pairs of blood samples were collected for each type of HP cartridge. The mean ± SD CC of the HA230 cartridge for TG removal in this case series was 0.009781 ± 1.117235 ml/min (95% confidence interval [CI], -0.7000762, 0.7196384 ml). The mean ± SD CC of the HA330 cartridge for TG removal in this case series was 0.344914 ± 1.412183 ml/min (95% CI, -0.5523448, 1.2421721 ml). Based on the findings of this small case series, special caution is advised when considering the use of the HA230 and HA330 cartridges for reducing blood TG concentration pending further conclusive evidence from larger studies.

The Optimized Parameters of Red Blood Cell Exchange by Apheresis in Transfusion-Dependent Thalassemia, a Small Case Series

The Optimized Parameters of Red Blood Cell Exchange by Apheresis in Transfusion-Dependent Thalassemia, a Small Case Series

Investigating Tailless UAV Flight Dynamics through Modeling, Simulation, and Flight Testing

Tailless Unmanned Aerial Vehicles (UAVs) offer several advantages over their conventional counterparts, including enhanced maneuverability, higher durability, and better stealth. However, they are challenging in their stability and control due to the absence of stabilizing and control surfaces that typically exist in conventional empennage. A crucial process for analyzing the tailless UAVs’ stability/performance characteristics and determining/validating their flight control parameters is done via the modeling and simulation of flight dynamics. This paper presents a comprehensive and systematic procedure for investigating the flight dynamics of a tailless UAV, including modeling, simulation, analytical verification, and flight testing, while also explaining the interconnections among these elements. It also addresses the common challenge of limited accessibility of UAV essential data through using diverse analytical, empirical, and experimental methods. First, a rapid and effective first-principles modeling approach is introduced to simulate the nonlinear six-degree-of-freedom flight dynamics of a small tailless UAV case study. The modeling process follows a modular framework where well-defined experiments and commercial of-the-shelf software, tools, and sensors are employed to build the necessary sub-models, including geometric, mass–inertia, aerodynamic, propulsion, and actuator models. Then, all sub-models are integrated into a simulation environment to allow the prediction of the UAV dynamic response obtained from the given control inputs. The developed flight dynamic model is subjected to a thorough verification process to ensure its integrity and proper functionality by comparing the simulated trim and natural flight modes with the calculated analytical results. Finally, a set of specific flight tests are performed to validate the developed simulation model and verify relevant performance characteristics for the case-study UAV. The results show that the proposed approach provides a systematic and straightforward method for examining the flight dynamics of small tailless UAVs with reasonable accuracy.

Sequencing of Anti-CD19 Therapies in the Management of Diffuse Large B-Cell Lymphoma.

Several second- and third-line immunotherapeutic options for patients with relapsed or refractory diffuse large B-cell lymphoma ineligible for autologous stem cell transplant are directed against the B-cell antigen cluster of differentiation 19 (CD19). The anti-CD19 monoclonal antibody tafasitamab, paired with the immunomodulator lenalidomide, mediates antibody-dependent cellular toxicity and phagocytosis; the antibody-drug conjugate loncastuximab tesirine delivers the DNA cross-linking agent tesirine via CD19 binding and internalization; and CD19-directed chimeric antigen receptor T-cell therapy (CAR-T) products are engineered from autologous T cells. Although CD19 expression is assessed at diagnosis, clinically relevant thresholds of CD19 expression-which may not be detectable using current routine methodologies-have not been defined and may vary between CD19-directed treatment modalities. Determining optimal treatment sequencing strategies for CD19-directed therapy is hampered by the exclusion of patients who have received prior CD19-directed therapies from major clinical trials. Antigen escape, which is attributed to mechanisms including epitope loss and defective cell surface trafficking of CD19, is an important cause of CAR-T failure. Limited data suggest that CD19 expression may be maintained after non-CAR-T CD19-directed therapy, and retrospective analyses indicate that some patients with disease relapse after CAR-T may benefit from subsequent CD19-directed therapy. To date, clinical evidence on the effect of anti-CD19 therapy prior to CAR-T has been limited to small case series. Prospective studies and detailed analyses are needed to understand how pretreatment and posttreatment CD19 expression correlates with clinical responses to subsequent CD19-directed therapy to fully maximize treatment strategies.