Unclear Cause Research Articles

Chronic Spontaneous Urticaria—New Predictor on the Horizon?

Chronic urticaria is one of the most common diseases in allergology and dermatology practice with unclear causes of occurrence. Background: Some studies emphasize the correlation between inflammation in chronic urticaria and disturbed intestinal microbiota. It raises the question about the role of some intestine-related substances in the pathogenesis of urticaria as well as their potential role as disease predictors. Calprotectin is an acute-phase protein with a well-established diagnostic position in the field of gastroenterology. There are some data on the relationship between this parameter and gut microbiota. The major aim of this preliminary study is to investigate whether calprotectin can be potentially taken into account as a disease course predictor in urticaria. Methods: We included in our study 54 chronic spontaneous urticaria (CSU) patients (of whom 26 manifested the symptoms of recurrent angioedema) and 29 patients allergic to Hymenoptera venom for the reference group (in these patients, before venom immunotherapy induction, full diagnostics is performed including intestinal problems). Disease activity in the CSU patients was assessed using the Urticaria Activity Score (UAS) and the disease control in this group was assessed with the Urticaria Control Test (UCT). Moreover, we analyzed fecal and serum calprotectin concentrations. Results: Positive correlation was found only between the values of serum calprotectin concentration and the control level of CSU symptoms with the lack of other relations. Conclusions: Our results do not supply unequivocal evidence for calprotectin as a potential marker of CSU course, though this concept, in the light of growing evidence for microbiota’s role in urticaria, requires further research.

Therapeutic efficacy of a probiotic preparation on idiopathic halitosis: a retrospective observational study.

Idiopathic halitosis is an unusual condition of unclear causes, which has never been thoroughly investigated. We aimed to explore the role of small intestinal bacterial overgrowth (SIBO) in the pathogenesis of idiopathic halitosis, and to evaluate the therapeutic efficacy of a probiotic preparation on this condition. This retrospective observational study included 162 idiopathic halitosis patients and 198 healthy controls (HCs). Halitosis was diagnosed using the organoleptic test (OLT), and idiopathic halitosis was diagnosed by excluding known causes. SIBO was identified through the hydrogen/methane lactulose breath test (LBT), and accordingly, patients were identified as SIBO-positive or SIBO-negative. Idiopathic halitosis patients were treated with the probiotic preparation Bifidobacterium triple viable capsule for two months, followed by re-evaluation of halitosis and SIBO. This study found that all cases of idiopathic halitosis were extra-oral. The SIBO positivity rate in idiopathic halitosis patients was significantly higher than that in HCs (74.69% [121/162] vs. 3.03% [6/198], P < 0.001), with an odds ratio (OR) of 94.44 (95% CI: 39.99-211.35). After treatment, 80.17% (97/121) of the SIBO-positive patients became SIBO-negative. Moreover, 87.60% (106/121) of the SIBO-positive patients experienced improved halitosis, a rate significantly higher than that observed in SIBO-negative patients (2.75%, 3/41) (P < 0.001). In addition, 98.97% (96/97) of the post-treatment SIBO-negative patients experienced improved halitosis, a rate significantly higher than that of post-treatment sustained SIBO-positive patients (41.67%, 10/24) (P < 0.001). Our findings suggest that idiopathic halitosis is an extra-oral condition which mostly originates from the small intestine. SIBO is one of its underlying causes. The probiotic preparation can effectively improve idiopathic halitosis, probably through its impact on SIBO.

Lipedematous scalp and lipedematous alopecia: a narrative review.

Lipedematous scalp (LS) and lipedematous alopecia (LA) are uncommon conditions with an unclear cause. Over the past century, about 115 cases have been documented in the literature. It is unknown if these disorders are indeed so uncommon or if cases that accept the illness as a structural alteration or are asymptomatic make the disease appear more uncommon than it is. Despite the fact that the majority of cases are seen in young and middle-aged people, the cases involving congenital, elderly, and children have also been reported. In the reported cases, female gender was observed to be dominant. The most significant clinical characteristics include felty swelling of the scalp in both disorders, diffusely or locally enlarged subcutaneous tissue with a swampy, spongy feel, and varied degrees of alopecia in LA. There is still much to learn about the pathogenetic mechanisms and therapeutic approaches for LA and LS. In this article, I review the general clinical characteristics, supposed pathogenetic mechanisms, histopathologic characteristics, diagnostic procedures, and management strategies for LS and LA.

Elevated serum IL-17 A and CCL20 levels as potential biomarkers in major psychotic disorders: a case-control study

BackgroundMajor psychotic disorders (MPD), including schizophrenia (SCZ) and schizoaffective disorder (SAD), are severe neuropsychiatric conditions with unclear causes. Understanding their pathophysiology is essential for better diagnosis, treatment, and prognosis. Recent research highlights the role of inflammation and the immune system, particularly the Interleukin 17 (IL-17) family, in these disorders. Elevated IL-17 levels have been found in MPD, and human IL-17 A antibodies are available. Changes in chemokine levels, such as CCL20, are also noted in SCZ. This study investigates the relationship between serum levels of IL-17 A and CCL20 in MPD patients and their clinical characteristics.MethodWe conducted a case-control study at the Ibn Sina Psychiatric Hospital (Mashhad, Iran) in 2023. The study involved 101 participants, of which 71 were MPD patients and 30 were healthy controls (HC). The Positive and Negative Symptom Scale (PANSS) was utilized to assess the symptoms of MPD patients. Serum levels of CCL20 and IL-17 A were measured using Enzyme-Linked Immunosorbent Assay (ELISA) kits. We also gathered data on lipid profiles and Fasting Blood Glucose (FBS).ResultsThe mean age of patients was 41.04 ± 9.93 years. The median serum levels of CCL20 and IL-17 A were significantly elevated in MPD patients compared to HC (5.8 (4.1–15.3) pg/mL and 4.2 (3–5) pg/mL, respectively; p < 0.001). Furthermore, CCL20 and IL-17 A levels showed a positive correlation with the severity of MPD. MPD patients also had significantly higher FBS, cholesterol, and Low-Density Lipoprotein (LDL) levels, and lower High-Density Lipoprotein (HDL) levels compared to HC. No significant relationship was found between PANSS components and blood levels of IL17 and CCL20.ConclusionThe current study revealed that the serum levels of IL-17 A and CCL20 in schizophrenia patients are higher than those in the control group. Metabolic factors such as FBS, cholesterol, HDL, and LDL also showed significant differences between MPD and HC. In conclusion, the findings suggest that these two inflammatory factors could serve as potential therapeutic targets and prognostic biomarkers for schizophrenia.

A novel diode laser intervention in the management of external invasive cervical resorption

Abstract “Invasive cervical resorption (ICR)” is a rare category of “external root resorption.” It is a progressive and destructive condition with an unclear cause. Managing external “ICR” presents a significant challenge, even to the most seasoned dental professionals. The removal of excessively vascularized granulation tissue is viewed as a pivotal step. This case report highlights the use of a diode laser to excise granulation tissue, by achieving optimal tissue ablation, promoting better healing, and subsequently restoring the severely damaged crown of the external ICR tooth with an intracanal fiber post.

Profiling of MicroRNAs for the Identification of Unique and Common MicroRNAs in Preeclamptic Patients of South India Using Next-Generation Sequencing.

Preeclampsia (PE) is a serious pregnancy complication with an unclear cause. Recent studies suggest that microRNAs (miRNAs), particularly miR-1, may play a role in controlling the genes associated with this condition. This study aimed to compare the expression of miRNAs in the blood and placental tissues of women with PE to those with normal pregnancies. We conducted small RNA sequencing on blood and placental samples from three groups: (a) early-onset preeclampsia (EOPE), (b) late-onset preeclampsia (LOPE), and (c) normal pregnancies. Bioinformatics tools were used to compare the miRNA profiles across these groups. A total of 744 miRNAs were detected in placental samples, while 913 miRNAs were found in blood samples. We further analyzed the target genes using protein-protein interaction (PPI) maps to understand how these miRNAs may influence gene functions. Our analysis revealed significant differences in miRNA expression between the EOPE, LOPE, and control groups. Eight miRNAs were consistently detected in both blood and placental samples across all groups, while other miRNAs were either specific to PE or certain tissue types. The 492 target genes identified formed dense interaction networks, with several key genes occupying central roles. These findings suggest that altered miRNA expression and the resulting disruption of gene networks may contribute to the development of PE. The distinct differences between EOPE and LOPE indicate that these two subtypes may be driven by different underlying mechanisms. This paves the way for future research to explore new treatments targeting these miRNAs and their associated genes.

Ogilvie syndrome with caecal perforation following cesarean section: a rare case report from Jordan

Introduction: Ogilvie syndrome is a rare condition characterized by acute colonic dilation. In 1948, H. Ogilvie first described it in medical literature. Its incidence is estimated at 100 cases per 100 000 per year in the US. Both abdominal distention and pain are considered major symptoms. Presentation of case: A 32-year-old woman, 36+1 weeks pregnant, experienced labour pain and was admitted to the hospital. Upon examination, she was in labour, but the foetus was in a breech position, necessitating a caesarean section. After 36 h later, she returned to the emergency department with severe, 1-day-old diffuse abdominal pain, accompanied by moderate bilious vomiting and significant abdominal distension. Abdominal CT with contrast revealed pneumoperitoneum, abdominal wall emphysema, and pneumatosis intestinalis involving the caecum and ascending colon, suggesting bowel necrosis. Emergency laparotomy revealed a caecal perforation, which was closed surgically without resection. Clinical discussion: Ogilvie syndrome is more common in males but can occur in females for several reasons, including pregnancy, caesarean section, pelvic surgeries, and trauma. Several factors contribute to the occurrence of this syndrome, such as pelvic fractures and cardiac events. Surgery may be required if there is suspicion of bowel perforation or ischaemia. Conclusion: OS is a rare condition in women, often seen after childbirth or pelvic surgery, with an unclear cause but believed to be related to autonomic nervous system imbalance. Patients with abdominal pain and distension, without evidence of obstruction, should be evaluated for pseudo-obstruction using abdominal pelvic CT, and treatment may involve conservative measures, medication, and colonoscopic decompression.

Immune signature of gene expression pattern shared by autism spectrum disorder and Huntington's disease

Autism spectrum disorder (ASD) and Huntington's disease (HD) are complex neurological conditions with unclear causes and limited treatments, affecting individuals, families, and society. Despite ASD and HD representing two opposing stages of neuronal development and degeneration, they share similar clinical-pathological features in motor function. In this study, we leveraged transcriptomic data from the prefrontal cortex available in public databases to identify shared transcriptional characteristics of ASD and HD. Differential expression analysis revealed that the majority of differentially expressed genes (DEGs) were up-regulated in ASD carriers, whereas most DEGs were down-regulated in HD carriers. Among the DEGs shared between both diseases, three out of seven protein-coding genes were related to the immune system. Furthermore, we identified two enriched pathways shared between ASD and HD DEGs. The gene interaction network analysis unveiled four hub genes shared by both diseases, all of which are associated with immune functions. The findings suggest a shared gene expression pattern in the prefrontal cortex of people with ASD and HD, closely linked to the immune system. These findings will contribute to exploring the biological mechanisms underlying the shared phenotypes of these two diseases from an immunological perspective.

EP267 - Patient with Pneumomediastinum and Pneumoperitoneum – Importance of Human Factors

Abstract Clinical assessment 70-year-old lady presents with one-day history of dyspnoea, chest and abdominal pain. She was recently discharged following a three-week hospital admission with fall related traumatic rib fractures and hospital acquired pneumonia. Her abdomen was soft and non-tender. CT scan with oral and IV contrast demonstrates pneumomediastinum and pneumoperitoneum with connection at diaphragmatic crura. Management Patient was managed conservatively however two days after admission her CRP climbed to 150 and clinical suspicion remained high. Repeat CT scan over the weekend demonstrated increase in the pneumoperitoneum and decrease in the pneumomediastinum with a collection around sigmoid colon. Trainee raised concern to consultant and a laparotomy was done. Operative findings showed perforated sigmoid colon with faeculent peritonitis of unclear cause. Hartmann’s procedure was done and patient continued post recovery in ITU. Discussion This case demonstrates the complex varying presentations of our elderly co-morbid population. The presence of air in thoracic and abdominal cavities with unknown cause weeks after the fall was suspicious. Hence, the team communicated well from top-down and likewise from weekday to weekend. Low threshold for escalation and high index of suspicion enabled a re-scan which proved to be life-saving for this patient. Identifying complicated cases where errors can occur is a critical first step. Clear communication among staff, accurate documentation and addressing the patient concerns enabled the surgical team to navigate the complex disease process and ensure safe patient care.

The Role of hCG and Histamine in Emesis Gravidarum and Use of a Chewing Gum Containing Vitamin C as a Treatment Option: A Double-Blinded, Randomized, Controlled Trial.

Background: Nausea and vomiting in pregnancy (NVP), or emesis gravidarum, is a frequent complication of early gestation with unclear causes, suspected to involve genetic, hormonal, and gastrointestinal factors. Our study investigated the association of human chorionic gonadotropin (hCG), histamine, diamine oxidase (DAO), thyroxine and pyridoxine and the severity of NVP symptoms and assessed the efficacy of a vitamin C-containing chewing gum as a potential NVP treatment. Methods: In this prospective, double-blinded, randomized, controlled trial, 111 participants were assigned to receive vitamin C-containing chewing gum, placebo gum, or no treatment at two follow-ups during early pregnancy. Maternal serum levels of hCG, histamine, DAO, thyroxine, and pyridoxine were measured and correlated with NVP severity using the Pregnancy-Unique Quantification of Emesis and Nausea (PUQE-24) score. Results: Elevated maternal hCG levels were significantly associated with an increased PUQE-24 score (p < 0.001), while histamine levels showed no significant correlation (p = 0.68). Maternal DAO levels negatively correlated with NVP symptoms (p < 0.001) and elevated thyroxine (p < 0.001) and pyridoxine levels (p < 0.001) were associated with increased PUQE-24 scores. The vitamin C-containing chewing gum did not demonstrate efficacy in alleviating NVP symptoms compared to placebo gum or no treatment during the first (p = 0.62) and second follow-up visits (p = 0.87). Conclusions: Our study underscores the complexity of factors contributing to NVP, highlighting the significant roles of hCG and DAO, while histamine levels appear unrelated. Maternal thyroxine and pyridoxine levels also significantly correlate with NVP symptoms. Vitamin C-containing chewing gum was not effective as a treatment for NVP. Further large-scale studies are needed to better understand these interactions and develop targeted treatments in the future.

New insights into the mechanisms and therapeutic strategies of chondrocyte autophagy in osteoarthritis.

Osteoarthritis (OA) is a chronic joint disease with an unclear cause characterized by secondary osteophytes and degenerative changes in the articular cartilage. More than 250 million people are expected to be affected by it by 2050, putting a tremendous socioeconomic strain on the entire world. OA cannot currently be treated with any effective medications that change the illness. Over time, chondrocytes undergo gradual metabolic, structural, and functional changes as a result of aging or abuse. The degenerative progression of osteoarthritis is significantly influenced by the imbalance of chondrocyte homeostasis. By continuously recycling and rebuilding macromolecules or organelles, autophagy functions as a crucial regulatory system to maintain homeostasis during an individual's growth and development. This review uses chondrocytes as its starting point and establishes a strong connection between autophagy and osteoarthritis in order to thoroughly examine the mechanisms behind chondrocyte autophagy in osteoarthritis. Biomarkers of chondrocyte autophagy will be identified, and prospective targeted medications and novel treatment approaches for slowing or preventing the course of OA will be developed based on chondrocyte senescence, autophagy, and apoptosis in OA. KEY MESSAGES: Currently, OA has not been treated with any drugs that can effectively cure it. We hope that by exploring specific targets in the course of osteoarthritis, we can promote the progress of treatment strategies. The degenerative progression of osteoarthritis is significantly influenced by the imbalance of chondrocyte balance. Through the continuous recovery and reconstruction of macromolecules or organelles, autophagy is an important regulatory system for maintaining homeostasis during individual growth and development. In this paper, the close relationship between autophagy and osteoarthritis was established with chondrocytes as the starting point, in order to further explore the mechanism of chondrocyte autophagy in osteoarthritis. The development process of osteoarthritis was studied from the perspective of chondrocytes, and the change of autophagy level had a significant impact on osteoarthritis. Chondrocyte autophagy is mainly determined by intracellular mitochondrial autophagy, so we are committed to finding relevant molecules. Through PI3K/AKT- and MAPK-related pathways, the biomarkers of chondrocyte autophagy were identified, and chondrocyte senescence, autophagy, and apoptosis based on osteoarthritis provided a constructive idea for the development of prospective targeted drugs and new therapies to slow down or prevent the progression of osteoarthritis.

Expression Patterns of MOTS-c in Adrenal Tumors: Results from a Preliminary Study.

Adrenal tumors, such as adrenocortical carcinoma (ACC), adrenocortical adenoma (ACA), and pheochromocytoma (PCC) are complex diseases with unclear causes and treatments. Mitochondria and mitochondrial-derived peptides (MDPs) are crucial for cancer cell survival. The primary aim of this study was to analyze samples from different adrenal diseases, adrenocortical carcinoma, adrenocortical adenoma, and pheochromocytoma, and compare them with normal adrenal tissue to determine whether the expression levels of the mitochondrial open reading frame of the 12S rRNA type-c (MOTS-c) gene and protein vary between different types of adrenal tumors compared to healthy controls using qPCR, ELISA, and IHC methods. Results showed decreased MOTS-c mRNA expression in all adrenal tumors compared to controls, while serum MOTS-c protein levels increased in ACA and PCC but not in ACC. The local distribution of MOTS-c protein in adrenal tissue was reduced in all tumors. Notably, MOTS-c protein expression declined with ACC progression (stages III and IV) but was unrelated to patient age or sex. Tumor size and testosterone levels positively correlated with MOTS-c mRNA but negatively with serum MOTS-c protein. Additionally, serum MOTS-c protein correlated positively with glucose, total cholesterol, HDL, LDL, and SHGB levels. These findings suggest disrupted expression of MOTS-c in the spectrum of adrenal diseases, which might be caused by mechanisms involving increased mitochondrial dysfunction and structural changes in the tissue associated with disease progression. This study provides a detailed examination of MOTS-c mRNA and protein in adrenal tumors, indicating the potential role of MDPs in tumor biology and progression.

Cardiovascular Risk Profile in Ménière’s Disease and Posterior Circulation Infarction: A Comparative Study

Ménière’s disease (MD) has an unclear cause. The microvascular dysregulation of the inner ear has been increasingly pointed out as a potential contributor. This study investigates the prevalence of cardiovascular risk factors (CVRFs) in MD patients compared to those with posterior circulation cerebral infarction (POCI). CVRFs like hypertension, diabetes, dyslipidemia, obesity, coronary heart disease, and smoking were assessed in both MD and POCI patients. Brain MRI identified POCI etiology as “small vessel occlusion” (SVO) or “other etiology” (OE). This study included 64 MD and 84 POCI patients. Compared to MD, POCI OE showed a higher prevalence of CVRFs across various age groups, including hypertension, diabetes, dyslipidemia, and smoking. Notably, the odds of having POCI OE were significantly higher for individuals with hypertension and smoking. On the other hand, POCI SVO showed a similar prevalence of CVRFs compared to MD. This study revealed no significant differences in CVRF prevalence between MD and smaller vessel POCI. However, a clear distinction emerged when comparing MD to POCI with the involvement of larger blood vessels. Further research is needed to confirm these findings and explore potential shared risk factors between POCI (SVO) and MD.

Failure Mechanisms and Strategies Toward Flexible Zinc‐Air Batteries

AbstractFlexible zinc‐air batteries (FZABs) have emerged as a promising alternative to lithium‐ion batteries in flexible electronic devices due to the advantages of excellent mechanical properties, high energy density, and notable safety. However, the unclear causes of performance degradation and failure mechanisms of FZABs significantly impede their commercialization. Therefore, extensive research is needed to fully reveal the factors and mechanisms responsible for the performance decline of FZABs. In this review, the failure mechanisms of FZABs' key components, including the Zn anode, solid electrolyte, catalyst air cathode, and electrolyte/electrode interface are analyzed and discussed. To promote further research and development of FZABs, a series of challenges and corresponding strategies are summarized and analyzed. Finally, the future development of FZABs is envisioned. This paper aims to comprehensively elucidate the failure mechanisms of FZABs, guide the development of high‐performance FZABs, and thus promote their commercialization.

The Renin-Angiotensin-Aldosterone System Regulates Sarcoidosis Granulomatous Inflammation.

Rationale: Sarcoidosis is a granulomatous disorder of unclear cause notable for abnormal elevation of blood and tissue ACE1 (angiotensin converting enzyme 1) levels and activity. ACE1 regulates the renin-angiotensin-aldosterone system (RAAS), the terminal product of which is aldosterone, which selectively engages mineralocorticoid receptors to promote inflammation. Objectives: We sought to determine whether the RAAS promotes sarcoidosis granuloma formation and related inflammatory responses. Methods: Using an established ex vivo model, we first determined whether aldosterone was produced by sarcoidosis granulomas and verified the presence of CYP11B2, the enzyme required for its production. We then evaluated the effects of selective inhibitors of ACE1 (captopril), angiotensin type 1 receptor (losartan), and mineralocorticoid receptors (spironolactone, eplerenone) on granuloma formation, reflected by computer image analysis-generated granuloma area, and selected cytokines incriminated in sarcoidosis pathogenesis. Measurements and Main Results: Aldosterone was spontaneously produced by sarcoidosis peripheral blood mononuclear cells, and both intra- and extracellular levels steadily increased during granuloma formation. In parallel, peripheral blood mononuclear cells were shown to express more CYP11B2 during granuloma formation. Significant inhibition of sarcoidosis granulomas and related cytokines (TNFα, IL-1β, IFNγ, IL-10) was observed in response to pretreatments with captopril, losartan, spironolactone, or eplerenone, comparable to that of prednisone. Conclusions: The RAAS is intact in sarcoidosis granulomas and contributes significantly to early granuloma formation and to related inflammatory mediator responses, with important implications for clinical management.

MANAGEMENT OF SIDHMA KUSTA: A CASE STUDY.

Psoriasis is an immune mediated disease with an unclear cause that is characterised by inflammation caused by Dysfunction of the immune system. Psoriatic plaque shows epidermic hyperplasia. Erythrodermic psoriasis is an acute condition in which almost all body surface is inflamed. This study is to show better management through ayurvedic treatment. In this case, a 35-year-old male patient diagnosed with erythrodermic psoriasis all over body predominantly on hands which is accompanied by erythema, dry, thin scaly lesions and itching. The condi-tion managed by Snehana(oleation), Pitta rechana(purgation), internal medicines, external application with Taila which is given according to avasthanusara(stage wise). Observation and results: The outcome is positive, significant in terms of reduction of erythema, itching, scales, dryness and healing of lesions produced noticeable improvement. Ayurvedic principles provide great im-provement in signs and symptoms and increase the quality of life in the treatment of psoriasis.

Association of spontaneous coronary artery dissection with bradycardia - a novel observational study

Abstract Introduction Spontaneous coronary artery dissection (SCAD) is a common cause of Myocardial infarction (MI) in women less than 50 years of age (1). SCAD has a high recurrent rate, and beta blockers are the only drug shown to reduce the recurrence of SCAD. However, in our clinical practice, we could not use beta-blockers in some of our patients due to sinus bradycardia of unclear cause. Therefore, we planned to study if SCAD could cause Bradycardia. Purpose To determine if Bradycardia is associated with SCAD. Methodology Utilising the National Inpatient Sample (NIS) from 2016 to 2020, we performed a multivariable logistic regression analysis to determine if SCAD was independently associated with Bradycardia (ICD-10 code R0.01) among adults. SCAD was defined as coronary artery dissection (ICD-10 code I25.42) after excluding patients who had PCI. Results A- A total of 2,561,434 (95% CI 2,526,646-2,596,222) weighted hospitalisations with Bradycardia and 18,049 (95% CI 17,288-18,811) with SCAD was included. Bradycardia was present in 5.2% (95% CI 4.6-6) of patients with SCAD and 1.7% (95% 1.7-1.7) in patients without SCAD. After adjusting for relevant causes of Bradycardia, SCAD was highly associated with Bradycardia (OR 3.04, 95% CI 2.61-3.55). Among all the risk factors studied, SCAD showed the 2nd highest strength of association (Table 1). Discussion We report the first described association of SCAD with Bradycardia in literature. Although the prevalence of Bradycardia with SCAD in our study is only 5.2%, Bradycardia is frequently not coded, and we suspect the true frequency of Bradycardia in SCAD is much higher. The exact mechanism for this association is unclear. Although the frequency of beta-blocker use is not available in our study, several other conditions, such as ischemic heart disease and cardiomyopathy, which involve more frequent beta-blocker use, did not show a degree of association as strong as SCAD with bradycardia. Therefore, we hypothesize Bradycardia could be from SCAD itself, and the current ongoing BA-SCAD (Beta-blockers and Antiplatelet agents in patients with Spontaneous Coronary Artery Dissection) trial could shed light on this association (2).

Nodular/Keloidal Scleroderma with No Systemic Involvement-A Case Report and a Review of the Literature.

Nodular or keloidal scleroderma is a rare condition with unclear cause and sporadic mentions in the medical literature. It was first recognized in the 19th century, yet its classification is still debated due to the limited number of reported cases. This rare variant of scleroderma is associated with either progressive systemic sclerosis or localized morphea. Clinically, it presents with asymptomatic nodules or plaques, resembling spontaneous keloid formation, often found on the trunk and proximal extremities. Recent literature reviews show a predominance of women with a mean age of 44 years. Diagnosis relies on clinical and histopathological findings, which usually show overlapping features of both scleroderma and true keloids, secondarily to an excessive fibrosing reaction attributed to collagen formation. We present an unusual case of a 70-year-old female patient who displayed the coexistence of two distinct subtypes of morphea (nodular/keloidal and linear), and exclusive skin involvement, which contrasts with the typical presentation of nodular/keloidal scleroderma, often associated with organ-specific disease. However, recent publications have diverged from previous ones regarding systemic sclerosis, with no systemic involvement reported between 2018 and 2024, which we evaluated in our descriptive literature review. With less than 50 cases reported in total, our case underlines the importance of recognizing this rare disease, ensuring appropriate evaluation, treatment, and follow-up.

Ten-year mortality after treating obstructive coronary atherosclerosis with contemporary stents in patients with or without concomitant peripheral arterial disease

Background and aimsPrevious studies in percutaneous coronary intervention (PCI) patients showed a higher 3-year adverse event risk, including all-cause mortality, in those with concomitant peripheral arterial disease (PADs). Ten-year data of mortality and causes of death are scarce. This analysis assessed PCI patients, treated with contemporary drug-eluting stents, the impact of concomitant PADs on very long-term mortality, and causes of death. MethodsWe assessed PCI all-comers from our center who participated in the TWENTE and DUTCH PEERS trials (clinicaltrials.gov:NCT01066650, NCT01331707), comparing patients with versus without PADs. Life status was checked in the Dutch Personal Records Database; causes of death were obtained from medical records. ResultsOf 2705 study patients, 668 (24.7%) died during follow-up: 88/212 (41.5%) patients with PADs and 580/2493 (23.1%) without PADs. In PADs patients, the 10-year rate of all-cause mortality was about twice as high as in patients without PADs (41.5% vs.23.1%, HR: 2.05, 95%-CI: 1.64–2.57, p<0.001). For both groups, the rates of patients dying from various causes of death were: cardiac (14.1% vs.6.8%), vascular (2.8% vs. 1.1%), non-cardiovascular (17.4% vs. 9.8%), and unclear causes (7.1% vs. 5.3%), without a statistically significant between-group difference. When multivariate analysis was adjusted for between-group differences in cardiovascular risk profile, PADs remained predictor of all-cause mortality (adjusted HR: 1.38, 95%-CI: 1.08–1.75, p=0.01). ConclusionsThe 10-year all-cause mortality rate in PCI patients with concomitant PADs was almost twice as high as in those without PADs. Age and other traditional cardiovascular risk factors were higher in patients with PADs, but after correction for these confounders PADs still accounted for almost 40% increase in mortality.

Unveiling the Microscopic Origin of Irreversible Capacity Loss of Hard Carbon for Sodium‐Ion Batteries

AbstractThe primary bottleneck hindering the application of hard carbon in sodium‐ion batteries (SIBs) anodes lies in its inadequate initial Coulombic efficiency (ICE). Unclear causes of capacity loss at the microscopic level restrict the improvement of hard carbon anodes. Here, two pivotal stages that influence the structure and composition of hard carbon, namely synthesis, and storage are evaluated; subsequently identifying crucial determinants contributing to irreversible capacity loss. The results suggest that undergrown carbon layers allowing the intrusion of solvent molecules into the interior of the hard carbon is a key factor during the synthesis stage, while the gradual formation of oxygen‐containing functional groups on the surface of the hard carbon is another factor leading to irreversible loss of capacity during storage stage. This research microscopically clarifies the irreversible capacity loss mechanism on hard carbon and provides guidelines for designing and applying high ICE hard carbon for SIBs.